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Hirota Y, Shin JH, Sasaki N, Kunisawa S, Fushimi K, Imanaka Y. Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia. PLoS One 2023; 18:e0282272. [PMID: 36827320 PMCID: PMC9955922 DOI: 10.1371/journal.pone.0282272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Discharge planning enhances the safe and timely transfer of inpatients between facilities. Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. We aimed to develop and validate prediction models for the discharge destination of elderly patients with aspiration pneumonia. METHODS Using a nationwide inpatient database, we identified aspiration pneumonia cases for patients aged ≥65 years who had been admitted to hospital from their home or from a nursing home between April 2020 and March 2021. We divided the cases into derivation and validation cohorts according to the location of the admitting hospital. We developed two prediction models by dividing the cases based on the patient's place of residence prior to admission, one model to predict the home discharge of cases admitted from home and the other to predict the home or to a nursing home discharge of cases admitted from a nursing home. The models were internally validated with bootstrapping and internal-externally validated using a validation cohort. Nomograms that could be used easily in clinical practice were also created. RESULTS The derivation cohort included 19,746 cases admitted from home and 14,359 cases admitted from a nursing home. Of the former, 10,760 (54.5%) cases were discharged home; from the latter, 7,071 (49.2%) were discharged to either home or a nursing home. The validation cohort included 6,262 cases admitted from home and 6,352 cases admitted from a nursing home. In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively. CONCLUSIONS We developed and validated new prediction models for the discharge of elderly patients with aspiration pneumonia either to home or to a nursing home. Our models and nomograms could facilitate the early implementation of discharge planning.
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Affiliation(s)
- Yoshito Hirota
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jung-ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
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2
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Kawamura K, Murayama K, Takamura J, Minegishi S. Effect of a weekly functional independence measure scale on the recovery of patient with acute stroke: A retrospective study. Medicine (Baltimore) 2022; 101:e28974. [PMID: 35356904 PMCID: PMC10684118 DOI: 10.1097/md.0000000000028974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Excessive assistance may decrease stroke patients' physical activity and make them more dependent on assistance. We have structured a system that provides an ADL (activities of daily living) educational program that focuses on stroke patients' toileting in our daily clinical practice. Here, we investigated the effect of a functional independence measure (FIM) scale on the recovery of patients with acute stroke.We retrospectively collected the data of 407 stroke patients from the medical record system of our emergency hospital in Tsukuba, Japan. The enrolled stroke patients (n = 373) were divided into FIM and control groups. Both groups received the standard treatment, but for the FIM group, ward and rehabilitation staff calculated the toilet FIM score for patients 1 ×/wk. The FIM scale measures the amount of assistance a patient needs to perform activities of daily living and is often used in rehabilitation settings. The rehabilitation staff then instructed the ward staff about better assistance methods based on each patient's physical function and executive dysfunction. We evaluated the usefulness of the FIM scale was based on the patients' FIM scores at discharge and improvements in their scores.The recoveries of the total, motor, and cognitive FIM scores recovery at discharge were significantly greater in the FIM group compared with the control group (68.0 vs 45.0, P = .004; 41.0 vs 24.0, P = .005; and 24.0 vs 20.0, P = .007, respectively). The use of the FIM scale contributes to the patients' recovery of physical function and cognitive function.The FIM scale can contribute to stroke patients' recovery of activities of daily living.
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Affiliation(s)
- Kenta Kawamura
- Correspondence: Kenta Kawamura, Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan (e-mail: ).
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3
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Van Ancum JM, Tuttle CSL, Koopman R, Pijnappels M, Meskers CGM, Paul SK, Lim WK, Reijnierse EM, Lynch GS, Maier AB. Albumin and C-reactive protein relate to functional and body composition parameters in patients admitted to geriatric rehabilitation after acute hospitalization: findings from the RESORT cohort. Eur Geriatr Med 2022; 13:623-632. [PMID: 35235196 PMCID: PMC9151554 DOI: 10.1007/s41999-022-00625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Albumin and C-reactive protein (CRP) are non-specific markers of inflammation, which could affect muscle tissue during acute hospitalization. We investigated the association between albumin and CRP during acute hospitalization with functional and body composition parameters in patients admitted to geriatric rehabilitation. METHODS The REStORing Health of Acutely Unwell AdulTs (RESORT) cohort includes geriatric rehabilitation patients assessed for change in activities of daily living (ADL, using the Katz index) during acute hospitalization, and subsequently for Katz ADL, gait speed (GS), handgrip strength (HGS) and skeletal muscle mass index (SMI) at geriatric rehabilitation admission. Albumin and CRP average (median), variation (interquartile range), and maximum or minimum were collected from serum samples, and were examined for their association with functional and body composition parameters using multivariable linear regression analysis adjusted for age, sex and length of acute hospital stay. RESULTS 1769 Inpatients were included for analyses (mean age 82.6 years ± 8.1, 56% female). Median length of acute hospitalization was 7 [IQR 4, 13] days and median number of albumin and CRP measurements was 5 [IQR 3, 12] times. ADL declined in 89% of patients (median - 3 points, IQR - 4, - 2). Lower average albumin, higher albumin variation and lower minimum albumin were associated with larger declines in ADL and with lower ADL, GS, HGS and SMI at geriatric rehabilitation admission. Higher average and maximum CRP were associated with lower GS. CONCLUSION Inflammation, especially lower albumin concentrations, during acute hospitalization is associated with lower physical function at geriatric rehabilitation admission.
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Affiliation(s)
- Jeanine M Van Ancum
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Camilla S L Tuttle
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Centre for Medical Research Building, 300 Grattan Street, Parkville, VIC, 3010, Australia
| | - René Koopman
- Centre for Muscle Research, Department of Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Centre for Medical Research Building, 300 Grattan Street, Parkville, VIC, 3010, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Centre for Medical Research Building, 300 Grattan Street, Parkville, VIC, 3010, Australia.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Gordon S Lynch
- Centre for Muscle Research, Department of Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Centre for Medical Research Building, 300 Grattan Street, Parkville, VIC, 3010, Australia. .,Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Centre for Healthy Longevity @AgeSingapore, National University Health System, Singapore, Singapore.
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4
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Hosoda T, Hamada S. Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study. BMC Geriatr 2021; 21:638. [PMID: 34772350 PMCID: PMC8586826 DOI: 10.1186/s12877-021-02597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02597-w.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 210-0013, Japan.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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5
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Helsel BC, Kemper KA, Williams JE, Truong K, Van Puymbroeck M. Multidimensional risk score to stratify community-dwelling older adults by future fall risk using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) framework. Inj Prev 2021; 27:461-466. [PMID: 33443031 PMCID: PMC9940266 DOI: 10.1136/injuryprev-2020-044014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Stopping Elderly Accidents, Deaths and Injuries (STEADI) screening algorithm aligns with current fall prevention guidelines and is easy to administer within clinical practice. However, the stratification into low, moderate and high risk categories limits the meaningful interpretation of the fall-related risk factors. METHODS Baseline measures from a modified STEADI were used to predict self-reported falls over 4 years in 3170 respondents who participated in the 2011-2015 National Health and Aging Trends Study. A point method was then applied to find coefficient-based integers and 4-year fall risk estimates from the predictive model. Sensitivity and specificity estimates from the point method and the combined moderate and high fall risk STEADI categories were compared. RESULTS There were 886 (27.95%) and 387 (12.21%) respondents who were classified as moderate and high risk, respectively, when applying the stratification method. Falls in the past year (OR: 2.16; 95% CI: 1.61 to 2.89), multiple falls (OR: 2.94; 95% CI: 1.89 to 4.55) and a fear of falling (OR: 1.77; 95% CI: 1.45 to 2.16) were among the significant predictors of 4-year falls in older adults. The point method revealed integers that ranged from 0 (risk: 27.21%) to 44 (risk: 99.71%) and a score of 10 points had comparable discriminatory capacity to the combined moderate and high STEADI categories. CONCLUSION Coefficient-based integers and their risk estimates can provide an alternative interpretation of a predictive model that may be useful in determining fall risk within a clinical setting, tracking changes longitudinally and defining the effectiveness of an intervention.
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Affiliation(s)
- Brian C Helsel
- Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Karen A Kemper
- Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Joel E Williams
- Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Khoa Truong
- Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Marieke Van Puymbroeck
- Parks, Recreation and Tourism Management, Clemson University, Clemson, South Carolina, USA
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Lee JH, Kwon HY, Kwon KS, Park SH, Suh YJ, Kim JS, Kim H, Shin YW. Percutaneous endoscopic gastrostomy feeding effects in patients with neurogenic dysphagia and recurrent pneumonia. Ther Adv Respir Dis 2021; 15:1753466621992735. [PMID: 33764224 PMCID: PMC8010805 DOI: 10.1177/1753466621992735] [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] [Indexed: 01/15/2023] Open
Abstract
Background: Percutaneous endoscopic gastrostomy (PEG) feeding provides enteral nutrition to patients with neurological dysphagia. However, the conditions in which PEG should be applied to prevent pneumonia remain unclear. We aimed to evaluate the effect of PEG for patients with neurological dysphagia in preventing pneumonia. Methods: We undertook a retrospective data review of 232 patients with neurological dysphagia who had undergone PEG from January 2008 to December 2018 at Inha University Hospital, in Incheon, Korea. We excluded patients who had not been followed up 6 months pre- and post-PEG feeding. In total, our study comprised 42 patients. We compared pneumonia episodes and incidence pre- and post-PEG. Results: During the median post-PEG follow-up period, the 6-month pneumonia incidence among patients who had undergone PEG had decreased [median 0.3 (interquartile range (IQR) 0.0–0.7) versus 0.1 (IQR 0.1–0.3) episodes, p = 0.04]. In a multiple mixed model, PEG did not decrease the incidence of pneumonia (p = 0.76). However, the association between PEG and the incidence of pneumonia differed significantly depending on the presence or absence of recurrent pneumonia (p < 0.001). Conclusions: PEG could effectively reduce the incidence of pneumonia in patients with neurogenic dysphagia, especially in those who had experienced recurrent pneumonia. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Jung Hwan Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.,Department of Hospital Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Hea Yoon Kwon
- Division of Infectious Disease, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Kye Sook Kwon
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea
| | - Soo-Hyun Park
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, South Korea
| | - Jung-Soo Kim
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Hyungkil Kim
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Yong Woon Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
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7
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Conca A, Koch D, Regez K, Kutz A, Bächli C, Haubitz S, Schuetz P, Mueller B, Spirig R, Petry H. Self-Care Index and Post-Acute Care Discharge Score to Predict Discharge Destination of Adult Medical Inpatients: Protocol for a Multicenter Validation Study. JMIR Res Protoc 2021; 10:e21447. [PMID: 33263553 PMCID: PMC7843199 DOI: 10.2196/21447] [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: 06/16/2020] [Revised: 09/14/2020] [Accepted: 12/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Delays in patient discharge can not only lead to deterioration, especially among geriatric patients, but also incorporate unnecessary resources at the hospital level. Many of these delays and their negative impact may be preventable by early focused screening to identify patients at risk for transfer to a post-acute care facility. Early interprofessional discharge planning is crucial in order to fit the appropriate individual discharge destination. While prediction of discharge to a post-acute care facility using post-acute care discharge score, the self-care index, and a combination of both has been shown in a single-center pilot study, an external validation is still missing. OBJECTIVE This paper outlines the study protocol and methodology currently being used to replicate the previous pilot findings and determine whether the post-acute care discharge score, the self-care index, or the combination of both can reliably identify patients requiring transfer to post-acute care facilities. METHODS This study will use prospective data involving all phases of the quasi-experimental study "In-HospiTOOL" conducted at 7 Swiss hospitals in urban and rural areas. During an 18-month period, consecutive adult medical patients admitted to the hospitals through the emergency department will be included. We aim to include 6000 patients based on sample size calculation. These data will enable a prospective external validation of the prediction instruments. RESULTS We expect to gain more insight into the predictive capability of the above-mentioned prediction instruments. This approach will allow us to get important information about the generalizability of the three different models. The study was approved by the institutional review board on November 21, 2016, and funded in May 2020. Expected results are planned to be published in spring 2021. CONCLUSIONS This study will provide evidence on prognostic properties, comparative performance, reliability of scoring, and suitability of the instruments for the screening purpose in order to be able to recommend application in clinical practice. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21447.
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Affiliation(s)
- Antoinette Conca
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Daniel Koch
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Katharina Regez
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Bächli
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Rebecca Spirig
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Heidi Petry
- Centre of Clinical Nursing Research and Development, University Hospital Zurich, Zurich, Switzerland
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Kwong YD, Mehta KM, Miaskowski C, Zhuo H, Yee K, Jauregui A, Ke S, Deiss T, Abbott J, Kangelaris KN, Sinha P, Hendrickson C, Gomez A, Leligdowicz A, Matthay MA, Calfee CS, Liu KD. Using best subset regression to identify clinical characteristics and biomarkers associated with sepsis-associated acute kidney injury. Am J Physiol Renal Physiol 2020; 319:F979-F987. [PMID: 33044866 PMCID: PMC7792692 DOI: 10.1152/ajprenal.00281.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022] Open
Abstract
Sepsis-associated acute kidney injury (AKI) is a complex clinical disorder associated with inflammation, endothelial dysfunction, and dysregulated coagulation. With standard regression methods, collinearity among biomarkers may lead to the exclusion of important biological pathways in a single final model. Best subset regression is an analytic technique that identifies statistically equivalent models, allowing for more robust evaluation of correlated variables. Our objective was to identify common clinical characteristics and biomarkers associated with sepsis-associated AKI. We enrolled 453 septic adults within 24 h of intensive care unit admission. Using best subset regression, we evaluated for associations using a range of models consisting of 1-38 predictors (composed of clinical risk factors and plasma and urine biomarkers) with AKI as the outcome [defined as a serum creatinine (SCr) increase of ≥0.3 mg/dL within 48 h or ≥1.5× baseline SCr within 7 days]. Two hundred ninety-seven patients had AKI. Five-variable models were found to be of optimal complexity, as the best subset of five- and six-variable models were statistically equivalent. Within the subset of five-variable models, 46 permutations of predictors were noted to be statistically equivalent. The most common predictors in this subset included diabetes, baseline SCr, angiopoetin-2, IL-8, soluble tumor necrosis factor receptor-1, and urine neutrophil gelatinase-associated lipocalin. The models had a c-statistic of ∼0.70 (95% confidence interval: 0.65-0.75). In conclusion, using best subset regression, we identified common clinical characteristics and biomarkers associated with sepsis-associated AKI. These variables may be especially relevant in the pathogenesis of sepsis-associated AKI.
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Affiliation(s)
- Y Diana Kwong
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California
| | - Hanjing Zhuo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Kimberly Yee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Alejandra Jauregui
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Serena Ke
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Thomas Deiss
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Jason Abbott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
| | - Pratik Sinha
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Carolyn Hendrickson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Antonio Gomez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Aleksandra Leligdowicz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Matthay
- Cardiovascular Research Institute, Department of Medicine and Department of Anesthesia, University of California, San Francisco, California
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
- Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, California
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9
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Poss J, McGrail K, McGregor MJ, Ronald LA. Long-Term Care Facility Ownership and Acute Hospital Service Use in British Columbia, Canada: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1490-1496. [PMID: 32646822 DOI: 10.1016/j.jamda.2020.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/26/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Previous studies report higher hospitalization rates in for-profit compared with nonprofit long-term care facilities (LTCFs), but have not included staffing data, a major potential confounder. Our objective was to examine the effect of ownership on hospital admission rates, after adjusting for facility staffing levels and other facility and resident characteristics, in a large Canadian province (British Columbia). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Our cohort included individuals resident in a publicly funded LTCF in British Columbia at any time between April 1, 2012 and March 31, 2016. MEASURES Health administrative data were extracted from multiple databases, including continuing care, hospital discharge, and Minimum Data Set (MDS 2.0) assessment records. Cox extended hazards regression was used to estimate hospitalization risk associated with facility- and resident-level factors. RESULTS The cohort included 49,799 residents in 304 LTCF facilities (116 publicly owned and operated, 99 for-profit, and 89 nonprofit) over the study period. Hospitalization risk was higher for residents in for-profit (adjusted hazard ratio [adjHR] 1.34; 95% confidence interval [CI] 1.29-1.38) and nonprofit (adjHR 1.37; 95% CI 1.32-1.41) facilities compared with publicly owned and operated facilities, after adjustment for staffing, facility size, urban location, resident demographics, and case mix. Within subtypes, risk was highest in single-site facilities: for-profit (adjHR 1.42; 95% CI 1.36-1.48) and nonprofit (adjHR 1.38, 95% CI 1.33-1.44). CONCLUSIONS AND IMPLICATIONS This is the first Canadian study using linked health data from hospital discharge records, MDS 2.0, facility staffing, and ownership records to examine the adjusted effect of facility ownership characteristics on hospital use of LTCF residents. We found significantly lower adjHRs for hospital admission in publicly owned facilities compared with both for-profit and nonprofit facilities. Our finding that publicly owned facilities have lower hospital admission rates compared with for-profit and nonprofit facilities can help inform decision-makers faced with the challenge of optimizing care models in both nursing homes and hospitals as they build capacity to care for aging populations.
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Affiliation(s)
- Jeffrey Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret J McGregor
- Community Geriatrics, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Ronald
- Community Geriatrics, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study. BMC Geriatr 2020; 20:112. [PMID: 32197581 PMCID: PMC7082946 DOI: 10.1186/s12877-020-01510-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to one in three of older patients who are hospitalised develop functional decline, which is associated with sustained disability, institutionalisation and death. This study developed and validated a clinical prediction model that identifies patients who are at risk for functional decline during hospitalisation. The predictive value of the model was compared against three models that were developed for patients admitted to a general medical ward. METHODS A prospective cohort study was performed on two cardiac care units between September 2016 and June 2017. Patients aged 75 years or older were recruited on admission if they were admitted for non-surgical treatment of an acute cardiovascular disease. Hospitalisation-associated functional decline was defined as any decrease on the Katz Index of Activities of Daily Living between hospital admission and discharge. Predictors were selected based on a review of the literature and a prediction score chart was developed based on a multivariate logistic regression model. RESULTS A total of 189 patients were recruited and 33% developed functional decline during hospitalisation. A score chart was developed with five predictors that were measured on hospital admission: mobility impairment = 9 points, cognitive impairment = 7 points, loss of appetite = 6 points, depressive symptoms = 5 points, use of physical restraints or having an indwelling urinary catheter = 5 points. The score chart of the developed model demonstrated good calibration and discriminated adequately (C-index = 0.75, 95% CI (0.68-0.83) and better between patients with and without functional decline (chi2 = 12.8, p = 0.005) than the three previously developed models (range of C-index = 0.65-0.68). CONCLUSION Functional decline is a prevalent complication and can be adequately predicted on hospital admission. A score chart can be used in clinical practice to identify patients who could benefit from preventive interventions. Independent external validation is needed.
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Li X, Zheng T, Guan Y, Li H, Zhu K, Shen L, Yin Z. ADL recovery trajectory after discharge and its predictors among baseline-independent older inpatients. BMC Geriatr 2020; 20:86. [PMID: 32131744 PMCID: PMC7057590 DOI: 10.1186/s12877-020-1481-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Among the previous studies about the ADL recovery and its predictors, the researches and resources used to study and protect the baseline-independent older patients from being permanently ADL-dependent was few. We aimed to describe the level of activities of daily living (ADL) at discharge and ADL change within 6 months after discharge in older patients who were ADL-independent before admission but became dependent because of acute illness, and to identify the predictors of early rehabilitation,so as to provide the basis to early intervention. Methods Stratified cluster sampling was used to recruit 520 hospitalised older patients who were ADL-independent from departments of internal medicine at two tertiary hospitals from August 2017 to May 2018. Demographics, clinical data, and ADL status at 1, 3, and 6 months after discharge were collected. Data were analysed using descriptive statistics, Student’s t-test, Pearson’s chi-square test,Spearman’s correlation analysis, binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis. Results There were 403 out of 520 patients completing the 6-month follow-up, and 229 (56.8%) regained independence at 6 months after discharge. There was an overall increasing trend in ADL with time. The recovery rate was the highest within the first month after discharge, gradually declined after 1 month, and changed less obviously from 3 to 6 months after discharge (p < 0.001). ADL score at discharge (OR = 1.034, p < 0.001), age (OR = 0.269, p = 0.001), post-discharge residence (OR = 0.390, p < 0.05), and cognition status at discharge (OR = 1.685, p < 0.05) were predictors of ADL recovery. The area under the curve of the four predictors combined was 0.763 (p < 0.001). Conclusion Studying ADL recovery rate and its predicting indicators of the baseline independent inpatients at different time points provide a theoretical reference for the formulation of nursing plans and allocation of care resources.
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Affiliation(s)
- Xiuyue Li
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China
| | - Tingting Zheng
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China
| | - Yaqi Guan
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China
| | - Hui Li
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China
| | - Kexin Zhu
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China
| | - Lu Shen
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China
| | - Zhiqin Yin
- Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China.
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Kobewka DM, Mulpuru S, Chassé M, Thavorn K, Lavallée LT, English SW, Neilipovitz B, Neilipovitz J, Forster AJ, McIsaac DI. Predicting the need for supportive services after discharged from hospital: a systematic review. BMC Health Serv Res 2020; 20:161. [PMID: 32131817 PMCID: PMC7057581 DOI: 10.1186/s12913-020-4972-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some patients admitted to acute care hospital require supportive services after discharge. The objective of our review was to identify models and variables that predict the need for supportive services after discharge from acute care hospital. METHODS We performed a systematic review searching the MEDLINE, CINAHL, EMBASE, and COCHRANE databases from inception to May 1st 2017. We selected studies that derived and validated a prediction model for the need for supportive services after hospital discharge for patients admitted non-electively to a medical ward. We extracted cohort characteristics, model characteristics and variables screened and included in final predictive models. Risk of bias was assessed using the Quality in Prognostic Studies tool. RESULTS Our search identified 3362 unique references. Full text review identified 6 models. Models had good discrimination in derivation (c-statistics > 0.75) and validation (c-statistics > 0.70) cohorts. There was high quality evidence that age, impaired physical function, disabilities in performing activities of daily living, absence of an informal care giver and frailty predict the need for supportive services after discharge. Stroke was the only unique diagnosis with at least moderate evidence of an independent effect on the outcome. No models were externally validated, and all were at moderate or higher risk of bias. CONCLUSIONS Deficits in physical function and activities of daily living, age, absence of an informal care giver and frailty have the strongest evidence as determinants of the need for support services after hospital discharge. TRIAL REGISTRATION This review was registered with PROSPERO #CRD42016037144.
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Affiliation(s)
- Daniel M Kobewka
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, ON K1Y 4E9, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Sunita Mulpuru
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Montreal, Quebec, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Neilipovitz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jonathan Neilipovitz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, ON K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Performance Measurement, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Departments of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Lopes ACP, Coltro PH, Lopes VJ, Fiori SMP, Knapik JS, Boumer TC. Muscle weakness assessment in older intensive care unit patients. GERIATRICS, GERONTOLOGY AND AGING 2020. [DOI: 10.5327/z2447-212320202000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: After long periods of hospitalization, older adults may develop muscle weakness that can affect their functional independence after discharge. OBJECTIVE: To assess muscle weakness in older patients admitted to an ICU. METHOD: This cross-sectional, descriptive study with a quantitative approach assessed functional independence with the Katz Index and post-ICU muscle strength with a handgrip strength (HS) test and the Medical Research Council (MRC) sum-score. The sample consisted of 60 patients with an average age of 76 (60–99) years, 36 (60%) of whom were female. RESULTS: Post-ICU, 86.7% of the patients were functionally dependent. Female patients had significantly lower HS than males: 7 (0–24) vs. 17 (1–37) (p < 0.001). Female patients who received mechanical ventilation (MV) or sedation had significantly lower HS and MRC scores than those who did not (p < 0.001): HS MV 1 (0–13) vs. 11 (0–24) p < 0.001; MRC MV 35 (14–48) vs. 43 (27–57) p < 0.001; HS sedation 0 (0–12) vs. 9 (0–24) p < 0.001; MRC sedation 34 (14–36) vs. 42 (22–57) p < 0.001, respectively. Finally, there was an inversely proportional correlation between HS, MRC scores, and ICU length of stay, Spearman’s rho = -0.267 (p = 0.0039) and Spearman’s rho = -0.347 (p = 0.007), respectively. CONCLUSION: Older women who received mechanical ventilation and sedation have lower muscle strength than those who did not. As the ICU length of stay increases, muscle strength decreases.
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Fanaroff AC, Cyr D, Neely ML, Bakal J, White HD, Fox KAA, Armstrong PW, Lopes RD, Ohman EM, Roe MT. Days Alive and Out of Hospital: Exploring a Patient-Centered, Pragmatic Outcome in a Clinical Trial of Patients With Acute Coronary Syndromes. Circ Cardiovasc Qual Outcomes 2019; 11:e004755. [PMID: 30562068 DOI: 10.1161/circoutcomes.118.004755] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiovascular clinical trials have traditionally incorporated separate time-to-first-event analyses for their primary efficacy and safety comparisons, but this framework has a number of limitations, including limited patient-centeredness and a traditional requirement for central adjudication. Days alive and out of the hospital (DAOH) has the potential to provide additional insight. Methods and Results TRILOGY ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) was a randomized, multinational clinical trial that compared the effect of prasugrel versus clopidogrel in patients stabilized after non-ST segment elevation acute coronary syndrome treated without revascularization; the trial had a neutral result. DAOH was calculated for each patient using site-submitted adverse event reporting data. We described patterns of DAOH overall, and among younger adults (<75 years old), older adults (≥75 years old), and frail/prefrail patients over 12 months follow-up and used Poisson regression to compare DAOH for patients randomized to prasugrel versus clopidogrel. Of 9249 patients in the overall trial population, 500 (5.4%) died, and 2504 (27.1%) were hospitalized 4150 times over 12 months' follow-up; the mean±SD DAOH was 317±86. The distribution of DAOH over 12 months was left-skewed, with median DAOH 363 days. Among younger adults, older adults, and frail/prefrail patients, mean DAOH were 323, 293, and 304 days, respectively. There were no differences in DAOH by treatment arm in the overall population (rate ratio, 1.00; 95% CI, 0.99-1.01) or any subgroup. Conclusions These results support the feasibility of determining DAOH, a patient-centered outcome that can potentially overcome many of the disadvantages of the traditional time-to-composite-event framework in the clinical trial setting. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00699998.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology (A.C.F., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., D.C., M.L.N., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC
| | - Derek Cyr
- Duke Clinical Research Institute (A.C.F., D.C., M.L.N., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC
| | - Megan L Neely
- Duke Clinical Research Institute (A.C.F., D.C., M.L.N., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC
| | - Jeffery Bakal
- Division of Cardiology, University of Alberta and the Canadian VIGOUR Centre, Edmonton (J.B., P.W.A.)
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, New Zealand (H.D.W.)
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.)
| | - Paul W Armstrong
- Division of Cardiology, University of Alberta and the Canadian VIGOUR Centre, Edmonton (J.B., P.W.A.)
| | - Renato D Lopes
- Division of Cardiology (A.C.F., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., D.C., M.L.N., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC
| | - E Magnus Ohman
- Division of Cardiology (A.C.F., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., D.C., M.L.N., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC
| | - Matthew T Roe
- Division of Cardiology (A.C.F., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., D.C., M.L.N., R.D.L., E.M.O., M.T.R.), Duke University, Durham, NC
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15
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Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge. BMC Geriatr 2019; 19:261. [PMID: 31604425 PMCID: PMC6787981 DOI: 10.1186/s12877-019-1294-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/26/2019] [Indexed: 01/28/2023] Open
Abstract
Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients who aged over 65 years and admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation (GEE) was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. The study demonstrated that all the geriatric patients with functional decline presented gradual improvements of physical function up to 180 days after discharge. Whether depression exists did not substantially affect functional recovery after discharge, whilst either dementia or delirium could impede elder people functional status. The recovery of functional improvement in delirium or dementia was relatively irreversible when comparing with depression. Once delirium or dementia was diagnosed, poorer functional restore was expected. In brief, intensive work and strategies on modifying delirium or dementia should be put more effort as early as possible. Conclusions Old hospitalized patients with depression can recover well after adequate intervention. We emphasize that early detection of dementia and delirium is imperative in subsequent functional outcome, even if at or before admission. Comprehensive plan must be implemented timely.
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Chua JM, Lim W, Bee YM, Goh S, Edmund Chan Tick C, Andrew Tan Xia H, Wee Z, Xin X, Ang LC, Heng WM, Teh MM. Factors associated with prolonged length of stay in patients admitted with severe hypoglycaemia to a tertiary care hospital. Endocrinol Diabetes Metab 2019; 2:e00062. [PMID: 31294080 PMCID: PMC6613227 DOI: 10.1002/edm2.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/15/2019] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
Severe hypoglycaemia carries considerable morbidity and potential mortality. We aim to elucidate the factors which were associated with a prolonged length of stay (LOS) among patients with diabetes who were admitted to the hospital with severe hypoglycaemia. Three hundred and four patients were included in the analysis, with a mean age of 70.6 ± 11.3 years, mean glycated haemoglobin of 6.9 ± 1.3% and median LOS of 3 days. Patients with a LOS >3 days had significantly higher Charlson Comorbidity Index (CCI) (4.9 ± 2.1 vs 4.1 ± 2.1, P < 0.01), a lower glomerular filtration rate (GFR) (34.6 ± 31.4 mL/min vs 44.8 ± 28.9 mL/min, P = 0.01) and a higher proportion of these patients suffered from recurrent hypoglycaemia during the admission (38.9% vs 27.7%, P = 0.04). In addition, they had higher white cell counts (11.1 ± 4.8 × 109/L vs 9.3 ± 3.2 × 109/L) and lower albumin concentrations (32.9 ± 6.6 g/L vs 36.8 ± 4.9 g/L). Bivariate analysis showed that the same factors were associated with prolonged LOS. Identification of risk factors associated with prolonged LOS provides the opportunity for intervention to reduce the LOS and improve the outcomes for these patients.
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Affiliation(s)
- Jia Min Chua
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Weiying Lim
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Yong Mong Bee
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Su‐Yen Goh
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | | | | | - Zongwen Wee
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Xiaohui Xin
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Li Chang Ang
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Wee May Heng
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
| | - Ming Ming Teh
- Department of EndocrinologySingapore General HospitalSingapore CitySingapore
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Palmer RM. The Acute Care for Elders Unit Model of Care. Geriatrics (Basel) 2018; 3:E59. [PMID: 31011096 PMCID: PMC6319242 DOI: 10.3390/geriatrics3030059] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 11/16/2022] Open
Abstract
Older patients are at risk for loss of self-care abilities during the course of an acute medical illness that results in hospitalization. The Acute Care for Elders (ACE) Unit is a continuous quality improvement model of care designed to prevent the patient's loss of independence from admission to discharge in the performance of activities of daily living (hospital-associated disability). The ACE unit intervention includes principles of a prepared environment that encourages safe patient self-care, a set of clinical guidelines for bedside care by nurses and other health professionals to prevent patient disability and restore self-care lost by the acute illness, and planning for transitions of care and medical care. By applying a structured process, an interdisciplinary team completes a geriatric assessment, follows clinical guidelines, and initiates plans for care transitions in concert with the patient and family. Three randomized clinical trials and systematic reviews of ACE or related interventions demonstrate reduced functional disability among patients, reduced risk of nursing home admission, and lower costs of hospitalization. ACE principles could improve elderly care in any acute setting. The aim of this commentary is to describe the ACE model and the basis of its effectiveness.
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Affiliation(s)
- Robert M Palmer
- Internal Medicine, Eastern Virginia Medical School 825 Fairfax Avenue, Suite 201 Norfolk, VA 23507, USA.
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18
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Ní Chróinín D, Basic D, Conforti D, Shanley C. Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study. Eur Geriatr Med 2018; 9:321-327. [PMID: 34654235 DOI: 10.1007/s41999-018-0041-7] [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: 12/18/2017] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital outcomes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital outcomes. MATERIALS AND METHODS Consecutive patients admitted under geriatric medicine over 5 years were prospectively included. Pre-hospital decline was defined as decrease in Modified Barthel Index (MBI) between pre-morbid status (1 month prior) and admission. The primary outcome was in-hospital functional decline (decline in MBI and/or new assistance/aid to mobilise). Secondary outcomes included length-of-stay (LOS; highest quartile), in-hospital falls and death. RESULTS Amongst 1458 patients (mean age 82.0; 60.91% female), 76.89% (1121/1458) experienced pre-hospital MBI decline. On univariate logistic regression, pre-hospital MBI decline was associated with in-hospital functional decline (OR 15.83, p < 0.001). Adjusting for age, nursing home residence, pre-morbid MBI, in-hospital referral source, dementia, adverse drug reaction and number of active diagnoses, pre-hospital decline was independently associated with in-hospital functional decline (OR 15.22, CI 10.89-21.26, p < 0.001). On univariate analysis, those with pre-hospital decline had more in-hospital falls (OR 2. 91, p = 0.02). Adjusting for age, sex, dementia, number of active diagnoses, and ambulation, no strong association was observed between pre-hospital decline and in-hospital falls (OR 1.86, p = 0.08). Prolonged LOS ≥ 20 days was more common amongst patients with pre-hospital decline on univariate (OR 1.95, p < 0.001) but not adjusted analyses (p = 0.14). No association was observed with in-hospital death. CONCLUSION Pre-hospital functional decline was associated with poorer in-hospital functional outcomes. Exploration of early interventions to optimise function in such patients is needed.
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Affiliation(s)
- Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia. .,UNSW South Western Sydney Clinical School, UNSW, Liverpool, Australia.
| | - David Basic
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia.
| | - David Conforti
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia
| | - Chris Shanley
- Centre for Applied Nursing Research, Western Sydney University, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Australia
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Basic D, Ní Chróinín D, Conforti D, Shanley C. Predictors on admission of functional decline among older patients hospitalised for acute care: A prospective observational study. Australas J Ageing 2017; 36:E57-E63. [PMID: 28856791 DOI: 10.1111/ajag.12458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to investigate the incidence of, and factors associated with, in-hospital functional decline among older acute hospital patients. METHODS We conducted a prospective observational study of consecutive patients admitted under geriatric medicine over 5 years. The primary outcome measure was functional decline between admission and discharge, representing deterioration in any of the following: Modified Barthel Index (MBI), independence in Timed Up and Go test or walking, and/or need for walking aid. RESULTS Overall, 56% (950/1693) patients (mean age 81.9 years) exhibited in-hospital functional decline. Premorbid MBI (odds ratio (OR) 1.05 per unit increase, P < 0.001), adverse drug reaction (OR 1.50, P = 0.001) and in-hospital consultation as the referral source (OR 1.57, P = 0.001) were independently associated with functional decline, adjusting for age, dementia and nursing home residence. CONCLUSION These factors may aid identification of vulnerable patients who might particularly benefit from targeted multidisciplinary intervention. Further studies validating this, and exploring the impact of focussed management, are needed.
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Affiliation(s)
- David Basic
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - David Conforti
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Chris Shanley
- Centre for Applied Nursing Research, Western Sydney University; and Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
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Condorhuamán-Alvarado PY, Menéndez-Colino R, Mauleón-Ladrero C, Díez-Sebastián J, Alarcón T, González-Montalvo JI. [Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness]. Rev Esp Geriatr Gerontol 2017; 52:253-256. [PMID: 28587716 DOI: 10.1016/j.regg.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. MATERIAL AND METHOD A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI-dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. RESULTS The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. CONCLUSIONS The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness.
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Affiliation(s)
| | - Rocío Menéndez-Colino
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, España; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, España; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
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Hamano J, Tokuda Y, Kawagoe S, Shinjo T, Shirayama H, Ozawa T, Shishido H, Otomo S, Nagayama J, Baba M, Tei Y, Hiramoto S, Suga A, Hisanaga T, Ishihara T, Iwashita T, Kaneishi K, Kuriyama T, Maeda T, Morita T. Adding items that assess changes in activities of daily living does not improve the predictive accuracy of the Palliative Prognostic Index. Palliat Med 2017; 31:258-266. [PMID: 27412258 DOI: 10.1177/0269216316650788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Changes in activities of daily living in cancer patients may predict their survival. The Palliative Prognostic Index is a useful tool to evaluate cancer patients, and adding an item about activities of daily living changes might improve its predictive value. AIM To clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index. DESIGN Multicenter prospective cohort study. SETTING A total of 58 palliative care services in Japan. PARTICIPANTS Patients aged >20 years diagnosed with locally extensive or metastatic cancer (including hematological neoplasms) who had been admitted to palliative care units, were receiving care by hospital-based palliative care teams, or were receiving home-based palliative care. Palliative care physicians recorded clinical variables at the first assessment and followed up patients 6 months later. RESULTS A total of 2425 subjects were recruited and 2343 of these had analyzable data. The C-statistic of the original Palliative Prognostic Index was 0.801, and those of modified Palliative Prognostic Indices ranged from 0.793 to 0.805 at 3 weeks. For 6-week survival predictions, the C-statistic of the original Palliative Prognostic Index was 0.802, and those of modified Palliative Prognostic Indices ranged from 0.791 to 0.799. The weighted kappa of the original Palliative Prognostic Index was 0.510, and those of modified Palliative Prognostic Indices ranged from 0.484 to 0.508. CONCLUSION Adding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.
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Affiliation(s)
- Jun Hamano
- 1 Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | | | | | | | | | | | - Sen Otomo
- 8 Shonan International Village Clinic, Hayama-machi, Japan
| | | | - Mika Baba
- 10 Department of Palliative Care, Saito Yukoukai Hospital, Osaka, Japan
| | - Yo Tei
- 11 Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shuji Hiramoto
- 12 Department of Oncology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Akihiko Suga
- 13 Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | | | - Tatsuhiko Ishihara
- 15 Palliative Care Department, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Keisuke Kaneishi
- 17 Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Toshiyuki Kuriyama
- 18 Department of Palliative Medicine, Wakayama Medical University Hospital Oncology Center, Wakayama, Japan
| | - Takashi Maeda
- 19 Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Tatsuya Morita
- 20 Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Wu LW, Chen WL, Peng TC, Chiang ST, Yang HF, Sun YS, Chan JYH, Kao TW. All-cause mortality risk in elderly individuals with disabilities: a retrospective observational study. BMJ Open 2016; 6:e011164. [PMID: 27625055 PMCID: PMC5030612 DOI: 10.1136/bmjopen-2016-011164] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Disability is considered an important issue that affects the elderly population. This study aimed to explore the relationship between disability and all-cause mortality in US elderly individuals. DESIGN Retrospective and longitudinal designs. SETTING Data from the National Health and Nutrition Examination Survey (NHANES 1999-2002) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. PARTICIPANTS A total of 1834 participants in the age range 60-84 years from NHANES 1999-2002. MAIN OUTCOME MEASURES We acquired five major domains of disability (activities of daily living (ADL), general physical activities (GPA), instrumental ADL (IADL), lower extremity mobility (LEM) and leisure and social activities (LSA)) through self-reporting. We applied an extended-model approach with Cox (proportional hazards) regression analysis to investigate the relationship between different features of disability and all-cause mortality risk in the study population. RESULTS During a mean follow-up of 5.7 years, 77 deaths occurred. An increased risk of all-cause mortality was identified in elderly individuals with disability after adjustment for potential confounders (HR 2.23; 95% CI 1.29 to 3.85; p=0.004). Participants with more than one domain of disability were associated with a higher risk of mortality (ptrend=0.047). Adjusted HRs and 95% CIs for each domain of disability were 2.53 (1.49 to 4.31), 1.99 (0.93 to 4.29), 1.74 (0.72 to 4.16), 1.57 (0.76 to 3.27) and 1.52 (0.93 to 2.48) for LEM, LSA, ADL, IADL and GPA, respectively. CONCLUSIONS The results of this study support an increased association between disability and all-cause mortality in the elderly in the USA. Disability in LEM may be a good predictor of high risk of all-cause mortality in elderly subjects.
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Affiliation(s)
- Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - Sheng-Ta Chiang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - Hui-Fang Yang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - Yu-Shan Sun
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - James Yi-Hsin Chan
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
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Fimognari FL, Pierantozzi A, De Alfieri W, Salani B, Zuccaro SM, Arone A, Palleschi G, Palleschi L. The Severity of Acute Illness and Functional Trajectories in Hospitalized Older Medical Patients. J Gerontol A Biol Sci Med Sci 2016; 72:102-108. [DOI: 10.1093/gerona/glw096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/10/2016] [Indexed: 01/11/2023] Open
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Pierluissi E. Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital. J Gen Intern Med 2016; 31:461. [PMID: 26941041 PMCID: PMC4835369 DOI: 10.1007/s11606-016-3619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Edgar Pierluissi
- Division of Hospital Medicine and Geriatrics, University of California, San Francisco, San Francisco, CA, USA. .,San Francisco General Hospital, 1001 Potrero Avenue, Room 5H17, San Francisco, CA, 94110, USA.
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25
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Chodos AH, Kushel MB, Greysen SR, Guzman D, Kessell ER, Sarkar U, Goldman LE, Critchfield JM, Pierluissi E. Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital. J Gen Intern Med 2015; 30:1765-72. [PMID: 25986139 PMCID: PMC4636578 DOI: 10.1007/s11606-015-3395-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals. OBJECTIVES To describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital. DESIGN Secondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders. SETTING Medicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital. PARTICIPANTS A total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group. MEASUREMENTS The outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function. RESULTS Many participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15). CONCLUSIONS In adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55.
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Affiliation(s)
- Anna H Chodos
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA. .,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Margot B Kushel
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - S Ryan Greysen
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - Eric R Kessell
- Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - L Elizabeth Goldman
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - Jeffrey M Critchfield
- Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Edgar Pierluissi
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.,Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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Abdelhafiz AH, Sinclair AJ. Low HbA1c and Increased Mortality Risk-is Frailty a Confounding Factor? Aging Dis 2015; 6:262-70. [PMID: 26236548 DOI: 10.14336/ad.2014.1022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus is increasingly becoming an older person disease due to the increased survival and aging of the population. Previous studies which showed benefits of tight glycemic control and a linear relationship between HbA1c and mortality have largely included younger patients newly diagnosed with diabetes and with less comorbidities. Recent studies, which included older population with diabetes, have shown a U-shaped relationship of increased mortality associated with low HbA1c. The mechanism of such relationship is unclear. There was no direct causal link between low HbA1c and mortality. It appears that malnutrition, inflammation and functional decline are characteristics shared by the populations that showed increased mortality and low HbA1c. In these studies functional status, disability or frailty was not routinely measured. Therefore, although adjustment for comorbidities was made there may be a residual confounding by unmeasured factors such as frailty. Thus, frailty or decline in functional reserve may be the main confounding factor explaining the relationship between increased mortality risk and low HbA1c.
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Affiliation(s)
- Ahmed H Abdelhafiz
- Consultant Physician and Honorary Senior Clinical Lecturer, Department of Elderly Medicine, Rotherham General Hospital, Rotherham, S60 2UD, UK
| | - Alan J Sinclair
- Dean and Professor of Medicine, Institute of Diabetes for Older People (IDOP), Bedfordshire &, Hertfordshire Postgraduate Medical School, University of Luton, Puteridge Bury Campus, Bedfordshire, LU2 8LE, UK
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Abstract
OBJECTIVE To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. DATA SOURCES We searched PubMed, CINAHL, Web of Science and Google Scholar for studies reporting disability outcomes (i.e., activities of daily living, instrumental activities of daily living, and mobility activities) and/or cognitive outcomes among patients treated in an ICU who were 65 years or older. We also reviewed the bibliographies of relevant citations to identify additional citations. STUDY SELECTION We identified 19 studies evaluating disability outcomes in critically ill patients who were 65 years and older. DATA EXTRACTION Descriptive epidemiologic data on disability after critical illness. DATA SYNTHESIS Newly acquired disability in activities of daily living, instrumental activities of daily living, and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less severe cognitive impairment were also highly prevalent. Factors related to the acute critical illness, ICU practices, such as heavy sedation, physical restraints, and immobility, as well as aging physiology, and coexisting geriatric conditions can combine to result in these poor outcomes. CONCLUSIONS Older adults who survive critical illness have physical and cognitive declines resulting in disability at greater rates than hospitalized, noncritically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs.
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Sourdet S, Lafont C, Rolland Y, Nourhashemi F, Andrieu S, Vellas B. Preventable Iatrogenic Disability in Elderly Patients During Hospitalization. J Am Med Dir Assoc 2015; 16:674-81. [PMID: 25922117 DOI: 10.1016/j.jamda.2015.03.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or "iatrogenic disability." METHODS A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. RESULTS Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%-15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%-90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). CONCLUSIONS The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.
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Affiliation(s)
| | | | - Yves Rolland
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
| | - Fati Nourhashemi
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
| | - Sandrine Andrieu
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
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Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in older people - a less well recognized risk factor for frailty. Aging Dis 2015; 6:156-67. [PMID: 25821643 DOI: 10.14336/ad.2014.0330] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/30/2014] [Indexed: 12/16/2022] Open
Abstract
Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients' general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences including under nutrition. Therefore, attention should be paid to the management of under nutrition in the general elderly population by improving energy intake and maintaining muscle mass. Increasing physical activity and having a more conservative approach to glycemic targets in frail older people with diabetes may be worthwhile.
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Affiliation(s)
- Ahmed H Abdelhafiz
- 1Department of Elderly Medicine, Rotherham General Hospital, England, Moorgate Road, Rotherham, UK
| | - Leocadio Rodríguez-Mañas
- 2Hospital Universitario de Getafe, Department of Geriatrics and School of Health Sciences, Universidad Europea de Madrid, Spain
| | - John E Morley
- 3Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, USA
| | - Alan J Sinclair
- 4Institute of Diabetes for Older People (IDOP), University of Bedfordshire, Luton LU2 8LE, UK
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30
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Brown RT, Pierluissi E, Guzman D, Kessell ER, Goldman LE, Sarkar U, Schneidermann M, Critchfield JM, Kushel MB. Functional disability in late-middle-aged and older adults admitted to a safety-net hospital. J Am Geriatr Soc 2014; 62:2056-63. [PMID: 25367281 DOI: 10.1111/jgs.13103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age. DESIGN Cross-sectional analysis. SETTING Safety-net hospital in San Francisco, California. PARTICIPANTS English-, Spanish-, and Chinese-speaking community-dwelling individuals aged 55 and older admitted to a safety-net hospital with anticipated return to the community (N = 699). MEASUREMENTS At hospital admission, participants reported their need for help performing five activities of daily living (ADLs) and seven instrumental activities of daily living (IADLs) 2 weeks before admission. ADL disability was defined as needing help performing one or more ADLs and IADL disability as needing help performing two or more IADLs. Participant characteristics were assessed, including sociodemographic characteristics, health status, health-related behaviors, and health-seeking behaviors. RESULTS Overall, 28.3% of participants reported that they had an ADL disability 2 weeks before admission, and 40.4% reported an IADL disability. The prevalence of preadmission ADL disability was 28.9% of those aged 55 to 59, 20.7% of those aged 60 to 69, and 41.2% of those aged 70 and older (P < .001). The prevalence of IADL disability had a similar distribution. The characteristics associated with functional disability differed according to age; in participants aged 55 to 59, African Americans had a higher odds of ADL and IADL disability, whereas in participants aged 60 to 69 and aged 70 and older, inadequate health literacy was associated with functional disability. CONCLUSION Preadmission functional disability is common in individuals aged 55 and older admitted to a safety-net hospital. Late-middle-aged individuals admitted to safety-net hospitals may benefit from models of acute care currently used for older adults that prevent adverse outcomes associated with functional disability.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatrics, University of California at San Francisco, San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California
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Osuna-Pozo CM, Ortiz-Alonso J, Vidán M, Ferreira G, Serra-Rexach JA. [Review of functional impairment associated with acute illness in the elderly]. Rev Esp Geriatr Gerontol 2014; 49:77-89. [PMID: 24529877 DOI: 10.1016/j.regg.2013.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 06/03/2023]
Abstract
Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.
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Affiliation(s)
| | - Javier Ortiz-Alonso
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Maite Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Guillermo Ferreira
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Kosai K, Izumikawa K, Imamura Y, Tanaka H, Tsukamoto M, Kurihara S, Takazono T, Morinaga Y, Nakamura S, Miyazaki T, Yanagihara K, Tashiro T, Kohno S. Importance of functional assessment in the management of community-acquired and healthcare-associated pneumonia. Intern Med 2014; 53:1613-20. [PMID: 25088872 DOI: 10.2169/internalmedicine.53.2499] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE In Japan, the number of elderly people who have difficulties performing the activities of daily living (ADLs) is increasing. The objective of this study was to assess the relationship between ADL and the clinical characteristics of pneumonia. METHODS We conducted a retrospective study of 219 adult patients hospitalized due to pneumonia [151 patients with community-acquired pneumonia (CAP) and 68 patients with healthcare-associated pneumonia (HCAP)]. CAP, HCAP, and all the patients were stratified into two groups using a modified version of the Katz index of five ADLs as follows: independent in all ADLs or dependent in one to three ADLs (CAP-A, HCAP-A, and All-A groups) and dependent in four or five ADLs (CAP-B, HCAP-B, and All-B groups). Disease severity, microbiological findings, and mortality were compared between the groups. RESULTS As the ability to perform ADLs declined, A-DROP scores (the CAP severity measurement index) increased significantly in CAP (CAP-A: 1.1±1.1, CAP-B: 2.6±1.1), HCAP (HCAP-A: 2.0±1.0, HCAP-B: 2.8±1.0), and all patients (All-A: 1.3±1.1, All-B: 2.8±1.0). Thirty-day mortality was higher in the CAP-B (23.1%) and All-B (19.2%) groups than in the CAP-A (0.7%) and All-A (1.8%) groups, respectively. A multivariate Cox proportional hazards analysis showed an ADL score ≥ four to be a significant predictor of 30-day mortality in CAP patients [hazard ratio (HR), 19.057; 95% confidence interval (CI), 1.930-188.130] and in all patients (HR, 8.180; 95% CI, 1.998-33.494). CONCLUSION A functional assessment using a modified version of the Katz index is useful for the management of CAP and HCAP patients.
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Lakhan P, Jones M, Wilson A, Gray LC. The Higher Care At Discharge Index (HCDI): Identifying older patients at risk of requiring a higher level of care at discharge. Arch Gerontol Geriatr 2013; 57:184-91. [DOI: 10.1016/j.archger.2013.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/25/2022]
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García-Peña C, García-Fabela LC, Gutiérrez-Robledo LM, García-González JJ, Arango-Lopera VE, Pérez-Zepeda MU. Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study. PLoS One 2013; 8:e69849. [PMID: 23936113 PMCID: PMC3723742 DOI: 10.1371/journal.pone.0069849] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/12/2013] [Indexed: 01/09/2023] Open
Abstract
Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79–0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.
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Affiliation(s)
- Carmen García-Peña
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Area de Envejecimiento. Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, Distrito Federal, México
| | - Luis C. García-Fabela
- Departamento de Geriatría, Instituto de Seguridad Social del Estado de México y Municipios, Estado de México, México
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Borenstein J, Aronow HU, Bolton LB, Choi J, Bresee C, Braunstein GD. Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study. BMC Geriatr 2013; 13:72. [PMID: 23834816 PMCID: PMC3710470 DOI: 10.1186/1471-2318-13-72] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 06/25/2013] [Indexed: 01/01/2023] Open
Abstract
Background There is a persistently high incidence of adverse events during hospitalization among Medicare beneficiaries. Attributes of vulnerability are prevalent, readily apparent, and therefore potentially useful for recognizing those at greatest risk for hospital adverse events who may benefit most from preventive measures. We sought to identify patient characteristics associated with adverse events that are present early in a hospital stay. Methods An interprofessional panel selected characteristics thought to confer risk of hospital adverse events and measurable within the setting of acute illness. A convenience sample of 214 Medicare beneficiaries admitted to a large, academic medical center were included in a quality improvement project to develop risk assessment protocols. The data were subsequently analyzed as a prospective cohort study to test the association of risk factors, assessed within 24 hours of hospital admission, with falls, hospital-acquired pressure ulcers (HAPU) and infections (HAI), adverse drug reactions (ADE) and 30-day readmissions. Results Mean age = 75(±13.4) years. Risk factors with highest prevalence included >4 active comorbidities (73.8%), polypharmacy (51.7%), and anemia (48.1%). One or more adverse hospital outcomes occurred in 46 patients (21.5%); 56 patients (26.2%) were readmitted within 30 days. Cluster analysis described three adverse outcomes: 30-day readmission, and two groups of in-hospital outcomes. Distinct regression models were identified: Weight loss (OR = 3.83; 95% CI = 1.46, 10.08) and potentially inappropriate medications (OR = 3.05; 95% CI = 1.19, 7.83) were associated with falls, HAPU, procedural complications, or transfer to intensive care; cognitive impairment (OR = 2.32; 95% CI = 1.24, 4.37), anemia (OR = 1.87; 95% CI = 1.00, 3.51) and weight loss (OR = 2.89; 95% CI = 1.38, 6.07) were associated with HAI, ADE, or length of stay >7 days; hyponatremia (OR = 3.49; 95% CI = 1.30, 9.35), prior hospitalization within 30 days (OR = 2.66; 95% CI = 1.31, 5.43) and functional impairment (OR = 2.05; 95% CI = 1.02, 4.13) were associated with 30-day readmission. Conclusions Patient characteristics recognizable within 24 hours of admission can be used to identify increased risk for adverse events and 30-day readmission.
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Affiliation(s)
- Jeff Borenstein
- Applied Health Services Research, Cedars-Sinai Health System, Los Angeles, CA 90048, USA.
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Yoo JW, Seol H, Kim SJ, Yang JM, Ryu WS, Min TD, Choi JB, Kwon M, Kim S. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness. Geriatr Gerontol Int 2013; 14:71-7. [DOI: 10.1111/ggi.12056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine and Institute of Gerontology; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Haesun Seol
- Federally Qualified Health Center; VNA Health Center; Bensenville Illinois USA
| | - Sun Jung Kim
- School of Public Health; Yonsei University; Seoul Korea
| | - Janet Miyoung Yang
- Department of Internal Medicine; Saint Joseph Mercy Hospital; Ann Arbor Michigan USA
| | - Woo Sang Ryu
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Too Dae Min
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Jong Bum Choi
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Minkyung Kwon
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Sulgi Kim
- Department of Epidemiology; School of Public Health; University of Washington; Seattle Washington USA
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Barnes DE, Mehta KM, Boscardin WJ, Fortinsky RH, Palmer RM, Kirby KA, Landefeld CS. Prediction of recovery, dependence or death in elders who become disabled during hospitalization. J Gen Intern Med 2013; 28:261-8. [PMID: 23054919 PMCID: PMC3614138 DOI: 10.1007/s11606-012-2226-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Many older adults become dependent in one or more activities of daily living (ADLs: dressing, bathing, transferring, eating, toileting) when hospitalized, and their prognosis after discharge is unclear. OBJECTIVE To develop a prognostic index to estimate one-year probabilities of recovery, dependence or death in older hospitalized patients who are discharged with incident ADL dependence. DESIGN Retrospective cohort study. PARTICIPANTS 449 adults aged ≥ 70 years hospitalized for acute illness and discharged with incident ADL dependence. MAIN MEASURES Potential predictors included demographics (age, sex, race, education, marital status), functional measures (ADL dependencies, instrumental activities of daily living [IADL] dependencies, walking ability), chronic conditions (e.g., congestive heart failure, dementia, cancer), reason for admission (e.g., neurologic, cardiovascular), and laboratory values (creatinine, albumin, hematocrit). Multinomial logistic regression was used to develop a prognostic index for estimating the probabilities of recovery, disability or death over 1 year. Discrimination of the index was assessed for each outcome based on the c statistic. KEY RESULTS During the year following hospitalization, 36 % of patients recovered, 27 % remained dependent and 37 % died. Key predictors of recovery, dependence or death were age, sex, number of IADL dependencies 2 weeks prior to admission, number of ADL dependencies at discharge, dementia, cancer, number of other chronic conditions, reason for admission, and creatinine levels. The final prognostic index had good to excellent discrimination for all three outcomes based on the c statistic (recovery: 0.81, dependence: 0.72, death: 0.78). CONCLUSIONS This index accurately estimated the probabilities of recovery, dependence or death in adults aged 70 years or older who were discharged with incident disability following hospitalization. This tool may be useful in clinical settings to guide care discussions and inform decision-making related to post-hospitalization care.
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Fisher SR, Kuo YF, Sharma G, Raji MA, Kumar A, Goodwin JS, Ostir GV, Ottenbacher KJ. Mobility after hospital discharge as a marker for 30-day readmission. J Gerontol A Biol Sci Med Sci 2012; 68:805-10. [PMID: 23254776 DOI: 10.1093/gerona/gls252] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about older patient's mobility soon after discharge home from an acute hospitalization. We examined daily postdischarge mobility levels as marker of overall health and response to in-hospital treatment in older medicine patients. METHODS One hundred and eleven ambulatory men and women aged 65 years and older hospitalized with an acute medical illness and discharged to home were studied. Patients received an ankle-worn accelerometer during hospitalization and wore it continually for up to 1 week after discharge. Total number of steps taken per day was assessed. The primary outcome was all-cause 30-day readmission. RESULTS Thirteen (11.7%) participants were readmitted within 30 days of discharge. There was a significant association between mean daily steps taken postdischarge and 30-day readmission (odds ratio = 0.85, 95% confidence interval = 0.72-0.99, and p = .04; odds ratio and confidence intervals were calculated for 500-step intervals). Though not statistically significant in the fully adjusted model (odds ratio = 0.83, 95% confidence interval = 0.71-1.02, and p = .08), mean daily steps was the strongest predictor among known readmission risk factors. The least active participants postdischarge were significantly more likely to be older (p = .02), be not married (p = .02), use a cane or walker prior to admission (p < .01), have longer lengths of hospital stay (p = .02), and be readmitted (p = .05). CONCLUSIONS Mobility level soon after discharge home shows promise as a simple physical biomarker of overall health and risk of 30-day readmission in older patients.
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Affiliation(s)
- Steve R Fisher
- Department of Physical Therapy, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0460, USA.
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Lakhan P, Jones M, Wilson A, Gray LC. The decline in Activities of Daily Living at Discharge (DADLD) index: stratifying patients at lower and higher risk. J Nutr Health Aging 2012; 16:919-24. [PMID: 23208033 DOI: 10.1007/s12603-012-0092-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery. OBJECTIVE To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge. DESIGN Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD± 7.1) and a validation cohort (n=153; mean age 81.5 years; SD± 6.1). PATIENTS AND SETTING General medical patients aged ≥ 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia. MEASUREMENT AND MAIN RESULTS The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1). CONCLUSIONS The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.
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Affiliation(s)
- P Lakhan
- The University of Queensland, Brisbane, Australia
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Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012; 60:E1-E25. [PMID: 22994865 DOI: 10.1111/j.1532-5415.2012.04188.x] [Citation(s) in RCA: 452] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Affiliation(s)
| | - Lorenzo Palleschi
- Division of Geriatrics; Azienda Ospedaliera S. Giovanni-Addolorata; Rome; Italy
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Baztán Cortés JJ, Vidán Astiz MT, López-Dóriga P, Cruz-Jentoft AJ, Petidier Torregrosa R, Gil Gregorio P, Serra Rexach JA. [Which patients benefit the most from hospital geriatric care in the opinion of the geriatricians?]. Rev Esp Geriatr Gerontol 2012; 47:205-209. [PMID: 22537916 DOI: 10.1016/j.regg.2012.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/23/2012] [Accepted: 02/28/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the most appropriate criteria considered by geriatricians to select patients who might benefit the most from geriatric hospital care. MATERIAL AND METHODS We carried out a survey that consisted of various socio-demographic, clinical, functional and mental criteria included in the definition of the geriatric and frail elderly patient. The survey was sent to all specialists in geriatrics in the different hospitals of the Madrid Health Service. They were asked to answer to each criterion indicating whether they considered it as high priority, priority, low priority or no priority. The responses were clustered by type of hospital: acute hospitals with or without a post-graduate geriatric program for medical residents, and medium and long stay hospitals. RESULTS A total of 83 questionnaires were completed (70% of the study population): 42 teaching hospitals a post-graduate geriatric program (74% of possible), 20 of those with an emergency department but without a post-graduate geriatric program (56% of possible), and 21 medium and long stay hospitals (84% of potential). All proposed criteria were considered individually as priority or high-priority by more than 50% of respondents. An age 85 years and over, admission for hip fracture, the presence of severe cognitive or functional impairment, frailty, and unexplained deterioration of health status, were considered individually as criteria for selecting high-priority target population by more than 85% of respondents. CONCLUSIONS Certain criteria, such as advanced age, or the presence of geriatrics-specific conditions, such as hip fracture or severe functional or cognitive impairment, are identified by geriatricians as useful to select patients to receive geriatric specialist hospital care.
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Affiliation(s)
- Juan J Baztán Cortés
- Comité Técnico para la elaboración del Plan Estratégico de Geriátrica de la Comunidad de Madrid.
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Depalma G, Xu H, Covinsky KE, Craig BA, Stallard E, Thomas J, Sands LP. Hospital readmission among older adults who return home with unmet need for ADL disability. THE GERONTOLOGIST 2012; 53:454-61. [PMID: 22859438 DOI: 10.1093/geront/gns103] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study determined whether returning to the community from a recent hospitalization with unmet activities of daily living (ADL) need was associated with probability of readmission. METHODS A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the interview and reported ADL disability at the time of the interview were considered for analysis. Medicare claims linked to the NLTCS provided information about hospital episodes, so those enrolled in Health Maintenance Organizations or Veterans Affairs Medical Centers were not included (n = 62), resulting in a total sample size of 522. ADL disability was defined as needing human help or equipment to complete the task. Unmet ADL need was defined as receiving inadequate or no help for one or more ADL disabilities. Disability that began within 90 days of the interview was considered new disability. RESULTS After adjusting for demographic, health, and functioning characteristics, unmet ADL need was associated with increased risk for hospital readmission (HR: 1.37, 95% CI: 1.03-1.82). Risk of readmission was greater for those with unmet need for new disabilities than those with unmet need for disabilities that were present before the index hospitalization (HR: 1.66, 95% CI: 1.01-2.73). IMPLICATIONS Many older patients are discharged from the hospital with ADL disability. Those who report unmet need for new ADL disabilities after they return home from the hospital are particularly vulnerable to readmission. Patients' functional needs after discharge should be carefully evaluated and addressed.
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Affiliation(s)
- Glen Depalma
- Department of Statistics, Purdue University, West Lafayette, Indiana 47907-2069, USA
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Abdelhafiz A, Bailey C, Sinclair A. Hypoglycaemia in hospitalized non-diabetic older people. Review. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aging Phenotypes of Common Marmosets (Callithrix jacchus). J Aging Res 2012; 2012:567143. [PMID: 22506113 PMCID: PMC3312272 DOI: 10.1155/2012/567143] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/15/2011] [Accepted: 11/07/2011] [Indexed: 11/19/2022] Open
Abstract
Characterizing the phenotypic changes associated with aging in a short-lived primate is necessary in order to develop better translational models for human health, aging, and disease research. A population of conventionally housed marmoset monkeys was assessed to determine if phenotypes of body composition, hematology, and morphometrical measures were associated with age or risk of death. We found that the cause of mortality in older marmosets was more likely to be due to cardiac and chronic kidney disease than in younger marmosets. Older marmosets have decreased fat mass, morphometric measures, and serum albumin. Older marmosets are more likely to show a modified posture while at rest and this modified posture was significantly associated with an increased risk of imminent death. These assessments provide an initial definition of aged health in marmosets and a base for future translational aging research with this species.
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Baztán JJ, Cáceres LA, Llanque JL, Gavidia JJ, Ruipérez I. Predictors of functional recovery in older hospitalized adults. J Am Geriatr Soc 2012; 60:187-9. [PMID: 22239317 DOI: 10.1111/j.1532-5415.2011.03716.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brown SH, Flint K, Storey A, Abdelhafiz AH. Routinely assessed biochemical markers tested on admission as predictors of adverse outcomes in hospitalized elderly patients. Hosp Pract (1995) 2012; 40:193-201. [PMID: 22406895 DOI: 10.3810/hp.2012.02.960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To explore whether routinely assessed biochemical markers tested on admission will predict 3 predefined adverse outcomes for hospitalized elderly patients: discharge to a long-term care facility, in-hospital mortality, and prolonged hospital length of stay (> 14 days). METHODS A prospective observational study of elderly patients (aged ≥ 75 years) admitted to an acute-care geriatric ward over a 6-month period. Patients were assessed on admission and baseline characteristics were collected. Activities of daily living were assessed by the Barthel Index and cognitive function by the abbreviated mental test. Results from biochemical markers tested on admission were downloaded from the pathology laboratory database using patient details. Patients were followed-up with until discharge or in-hospital mortality. RESULTS A total of 392 patients formed the study population. Mean (standard deviation) age was 83.2 (± 5.5) years and 283 (72%) patients were men. Thirty-eight (10%) patients were discharged to a long-term care facility, 134 (34%) had a prolonged hospital length of stay, and 33 (8%) died in the hospital. Results from testing 5 biochemical markers independently predicted in-hospital mortality: hypoalbuminemia (adjusted odds ratio [OR], 2.5; 95% CI, 0.9-6.7; P = 0.04), low total cholesterol level (adjusted OR, 2.9; 95% CI, 1.3-6.3; P = 0.01), hyperglycemia (adjusted OR, 2.9; 95% CI, 1.2-7.4; P = 0.02), high C-reactive protein level (adjusted OR, 4.2; 95% CI, 1.3-13.4; P = 0.01), and renal impairment (adjusted OR, 3.8; 95% CI, 1.7-8.7; P = 0.002). High C-reactive protein level independently predicted prolonged hospital length of stay (OR, 1.7; 95% CI, 1.1-2.9; P = 0.03). Hypoalbuminemia predicted discharge to a long-term care facility independent of confounding factors except for physical dysfunction (OR, 2.4; 95% CI, 1.1-5.1; P = 0.03). Significance was reduced after adjustment for Barthel Index score (OR, 1.9; 95% CI, 0.9-4.1; P = 0.08). CONCLUSION Testing of routinely assessed biochemical markers on admission predicted adverse hospital outcomes for elderly patients. Their inclusion in a standardized prediction tool may help to create interventions to improve such outcomes.
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Affiliation(s)
- Siobhan H Brown
- Department of Elderly Medicine, Rotherham General Hospital, Rotherham, UK.
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