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Heinzmann J, Rossen ML, Efthimiou O, Baumgartner C, Wertli MM, Rodondi N, Aubert CE, Liechti FD. Risk Factors for Falls Among Hospitalized Medical Patients - A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01077-3. [PMID: 38972474 DOI: 10.1016/j.apmr.2024.06.015] [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: 10/06/2023] [Revised: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To identify and quantify risk factors for in-hospital falls in medical patients. DATA SOURCES Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) were systematically screened until April 11, 2023, to identify relevant articles. STUDY SELECTION All titles and abstracts of the retrieved articles were independently screened by 2 researchers who also read the full texts of the remaining articles. Quantitative studies that assessed risk factors for falls among adult patients acutely hospitalized were included in the review. Publications that did not capture internal medicine patients or focused on other specific populations were excluded. DATA EXTRACTION Information on study characteristics and potential risk factors were systematically extracted. Risk of bias was assessed using the Quality in Prognosis Studies tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology guidelines were followed for reporting. DATA SYNTHESIS The main outcome was any in-hospital falls. Using a random-effects meta-analysis model, association measures for each risk factor reported in 5 or more studies were pooled. Separate analyses according to effect measure and studies adjusted for sex and age at least were performed. Of 5067 records retrieved, 119 original publications from 25 countries were included. In conclusion, 23 potential risk factors were meta-analyzed. Strong evidence with large effect sizes was found for a history of falls (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.63-3.96; I2, 91%), antidepressants (pooled OR, 2.25; 95% CI, 1.92-2.65; I2, 0%), benzodiazepines (OR, 1.97; 95% CI, 1.68-2.31; I2, 0%), hypnotics-sedatives (OR, 1.90; 95% CI, 1.53-2.36; I2, 46%), and antipsychotics (OR, 1.61; 95% CI, 1.33-1.95; I2, 0%). Furthermore, evidence of associations with male sex (OR, 1.22, 95% CI, 0.99-1.50; I2, 65%) and age (OR, 1.17, 95% CI, 1.02-1.35; I2, 72%) were found, but effect sizes were small. CONCLUSIONS The comprehensive list of risk factors, which specifies the strength of evidence and effect sizes, could assist in the prioritization of preventive measures and interventions.
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Affiliation(s)
- Jeannelle Heinzmann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Michael L Rossen
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern
| | - Orestis Efthimiou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Maria M Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern
| | - Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern.
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Urinary and double incontinence in older women with hip fracture - risk of death and predictors of incident symptoms among survivors in a 1-year prospective cohort study. Arch Gerontol Geriatr 2023; 107:104901. [PMID: 36521394 DOI: 10.1016/j.archger.2022.104901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the association of urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) with one-year mortality among older female hip fracture patients and to identify predictors of incident UI and DI. DESIGN A prospective cohort study SETTING AND SUBJECTS: 1,468 female patients aged ≥ 65 treated for their first hip fracture during the period 2007-2019 METHODS: Continence status was elicited at baseline and one-year post-fracture. Age- and multivariable-adjusted Cox proportional hazards and multinomial logistic regression models were used to determine the associations of incontinence with one-year mortality and to examine the associations of baseline predictors with incident UI and DI respectively. RESULTS Of the women with no incontinence, UI and DI, 78 (13%), 159 (23%) and 60 (34%), died during follow-up. UI (HR 1.72, 95% CI 1.31-2.26) and DI (HR 2.61, 95% CI 1.86-3.66) were associated with mortality after adjusting for age. These associations lost their predictive power in multivariable analysis while age over 90, living in an institution, impaired mobility, poor nutrition, polypharmacy, and late removal of urinary catheter remained associated with mortality. Of continent women, 128 (21%) developed UI and 23 (4%) DI during follow-up. In multivariable analysis, impaired mobility was associated with incident UI (OR 2.56, 95% CI 1.48-4.44) and DI (OR 4.82, 95% CI 1.70-13.7), as well as living in an institution (OR 3.44, 95% CI 1.56-7.61 and OR 3.90, 95% CI 1.17-13.0). CONCLUSIONS AND IMPLICATIONS Underlying vulnerability likely explains differences in mortality between continence groups and development of incident UI and DI.
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Northcott A, Boddington P, Featherstone K. Pad cultures: An ethnography of continence care and its consequences for people living with dementia during a hospital admission. DEMENTIA 2022; 21:2191-2209. [PMID: 35861583 PMCID: PMC9483683 DOI: 10.1177/14713012221116490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little research examining how continence care is organised and delivered to people living with dementia across an acute hospital admission, despite the prevalence of this patient population and their vulnerability within these settings. OBJECTIVE To explore how continence care is delivered to people living with dementia during an acute hospital admission. DESIGN Ethnographic. SETTING(S) Acute medical units and wards within three hospitals across England and Wales. PARTICIPANTS People living with dementia and ward staff (registered nurses and care assistants) on participating wards. METHODS Ethnographic fieldwork collected over a period of 12 months (180 days of non-participant observation) focussing on the organisation and delivery of continence care to people living with dementia. Observations were supported with in situ ethnographic interviews (n = 562) with patients, visitors and staff within the six observed wards. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory. RESULTS The findings comprised of five overall themes: (1) visibility of continence; (2) rationales of continence care; (3) containment and contagion; (4) consequences of continence care and (5) supporting continence. CONCLUSIONS We introduce the term 'pad cultures' to refer to the established routine use of continence pads in the care of a wider group of people living with dementia (regardless of continence status and independence), with the rationale to provide safeguards, ensure containment and prevent 'accidents' or incontinent episodes. There was an expectation within acute wards that people living with dementia not only wear continence pads but that they also use them.
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Affiliation(s)
- Andy Northcott
- Geller Institute of Ageing and Memory, University of West London, Ealing, London, UK
| | - Paula Boddington
- Geller Institute of Ageing and Memory, University of West London, Ealing, London, UK
| | - Katie Featherstone
- Geller Institute of Ageing and Memory, University of West London, Ealing, London, UK
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Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women. Aging Clin Exp Res 2022; 34:1407-1418. [PMID: 34984652 PMCID: PMC9151507 DOI: 10.1007/s40520-021-02046-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Incontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls. AIMS We aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture. METHODS A prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability. RESULTS At baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16-2.84) and constipation (OR 1.48, 95% CI 1.02-2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31-4.14), impaired mobility (OR 2.08, 95% CI 1.05-4.15), and poor nutrition (OR 2.31, 95% CI 1.11-4.79) associated with DI. CONCLUSIONS This study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.
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Amjad H, Samus QM, Huang J, Gundavarpu S, Bynum JPW, Wolff J, Roth DL. Acute care utilization risk among older adults living undiagnosed or unaware of dementia. J Am Geriatr Soc 2022; 70:470-480. [PMID: 34773706 PMCID: PMC8821204 DOI: 10.1111/jgs.17550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dementia is associated with increased risk of hospitalization and emergency department (ED) visits. Many persons with dementia are undiagnosed or unaware of their diagnosis, however. Our objective was to determine whether undiagnosed dementia or unawareness affects risk of hospitalization or ED visits. METHODS Retrospective longitudinal cohort study of 3537 community-living adults age ≥65 enrolled in the 2011-2017 National Health and Aging Trends Study with linked fee-for-service Medicare claims. Using self or proxy reported diagnosis, proxy dementia screening questionnaire, cognitive testing, and Medicare claims diagnosis, participants were classified as having (1) no dementia or dementia, for which they were classified as (2) undiagnosed, (3) diagnosed but unaware, or (4) diagnosed and aware. Proportional hazards models evaluated all-cause and potentially preventable hospitalization and ED visit risk by time-varying dementia status, adjusting for older adult characteristics. RESULTS Most participants (n = 2879) had no dementia at baseline. Among participants with dementia at baseline (n = 658), 187 were undiagnosed, 300 diagnosed but unaware, and 171 diagnosed and aware. In multivariable adjusted proportional hazards models, persons with undiagnosed dementia had lower risk of hospitalization and ED visits compared to persons diagnosed and aware (all-cause hospitalization aHR 0.59 [0.44, 0.79] and ED visit aHR 0.63 [0.47, 0.85]) and similar risks of these outcomes compared to persons without dementia. Individuals diagnosed but unaware had greater risk compared to those without dementia: aHR 1.37 (1.18, 1.59) for all-cause hospitalization and 1.48 (1.28, 1.71) for ED visits; they experienced risk comparable to individuals diagnosed and aware. CONCLUSION Older adults with undiagnosed dementia are not at increased risk of acute care utilization after accounting for differences in other characteristics. Individuals unaware of diagnosed dementia demonstrate risk similar to individuals aware of the diagnosis. Increasing diagnosis alone may not affect acute care utilization. The role of awareness warrants further investigation.
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Affiliation(s)
- Halima Amjad
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD,Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Quincy M. Samus
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | | | - Julie PW Bynum
- University of Michigan Medical School, Division of Geriatric & Palliative Medicine, Ann Arbor, MI
| | - Jennifer Wolff
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - David L. Roth
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD,Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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Yuan L, Zhang X, Guo N, Li Z, Lv D, Wang H, Jin J, Wen X, Zhao S, Xu T, Jiao J, Wu X. Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study. BMC Geriatr 2021; 21:595. [PMID: 34696723 PMCID: PMC8543818 DOI: 10.1186/s12877-021-02556-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients. METHODS This study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes. RESULTS The study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65-75 years, and 26.27% were aged 75-85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076-1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037-1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was - 0.013 (95% CI: - 0.024-- 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65-74 years. CONCLUSIONS We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800017682 , registered 09 August 2018.
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Affiliation(s)
- Li Yuan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China
| | - Xiaoming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Na Guo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhen Li
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China.
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China.
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Mendoza T, Lee CH, Huang CH, Sun TL. Random Forest for Automatic Feature Importance Estimation and Selection for Explainable Postural Stability of a Multi-Factor Clinical Test. SENSORS (BASEL, SWITZERLAND) 2021; 21:5930. [PMID: 34502821 PMCID: PMC8434667 DOI: 10.3390/s21175930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/28/2023]
Abstract
Falling is a common incident that affects the health of elder adults worldwide. Postural instability is one of the major contributors to this problem. In this study, we propose a supplementary method for measuring postural stability that reduces doctor intervention. We used simple clinical tests, including the timed-up and go test (TUG), short form berg balance scale (SFBBS), and short portable mental status questionnaire (SPMSQ) to measure different factors related to postural stability that have been found to increase the risk of falling. We attached an inertial sensor to the lower back of a group of elderly subjects while they performed the TUG test, providing us with a tri-axial acceleration signal, which we used to extract a set of features, including multi-scale entropy (MSE), permutation entropy (PE), and statistical features. Using the score for each clinical test, we classified our participants into fallers or non-fallers in order to (1) compare the features calculated from the inertial sensor data, and (2) compare the screening capabilities of the multifactor clinical test against each individual test. We use random forest to select features and classify subjects across all scenarios. The results show that the combination of MSE and statistic features overall provide the best classification results. Meanwhile, PE is not an important feature in any scenario in our study. In addition, a t-test shows that the multifactor test of TUG and BBS is a better classifier of subjects in this study.
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Affiliation(s)
- Tomas Mendoza
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
| | - Chia-Hsuan Lee
- Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Da’an District, Taipei 106, Taiwan;
| | - Chien-Hua Huang
- Department of Eldercare, Central Taiwan University of Science and Technology, Taipei 106, Taiwan;
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
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Menezes KVRS, Auger C, Barbosa JFS, Gomes CS, Menezes WRS, Guerra RO. Trajectories and Predictors of Functional Capacity Decline in Older Adults From a Brazilian Northeastern Hospital. J Geriatr Phys Ther 2021; 44:82-87. [PMID: 31855883 DOI: 10.1519/jpt.0000000000000255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Older adults face increased risk of loss of functional capacity both before and during hospitalization, so identifying older adults at risk for loss in functional capacity during hospitalization would help researchers and clinicians make informed decisions. This study aims to evaluate functional changes from preadmission (baseline) until discharge of hospitalized older adults and identify predictors of loss in functional capacity. METHODS This is a prospective cohort study conducted at a tertiary care hospital in Natal, Brazil, and enrolled all consecutive patients aged 60 years and older between January 1, 2014, and April 30, 2015. Independent variables included personal characteristics, instrumental activities of daily living (IADL) (evaluated by the Lawton and Brody scale), cognition (evaluated by the Leganés cognitive test), depression (assessed by the Geriatric Depression Scale-15), and in-hospital mobility (evaluated by the Short Physical Performance Battery). The dependent variable functional capacity was assessed by the Katz scale. These instruments were applied at 2 different times: upon admission (within first 24 hours) and at discharge (12-24 hours before). Functional trajectories were defined as the course of functioning from preadmission until discharge using functional capacity data. A multivariate analysis with generalized estimating equation estimated the longitudinal changes in functional capacity. RESULTS AND DISCUSSION The final sample consisted of 1191 older adults and 53.9% were less than 70 years of age. Regarding changes in functional capacity, 52.5% of the older adults presented worse functional capacity at discharge than at baseline. Being dependent for IADL instrumental daily living activities, the presence of depressive symptoms, low levels of cognition, and in-hospital mobility were risk factors for greater loss in functional capacity during a hospitalization event. CONCLUSION Hospitalization events may be catastrophic for functional capacity in older adults in Brazil. Functional, cognitive, and emotional status and in-hospital mobility must be carefully assessed at hospital admission and monitored during hospitalization. Effective strategies for preventing loss in functional capacity in older people must improve in the Brazilian hospital system.
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Affiliation(s)
- Karla V R S Menezes
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Université de Montréal, Montreal, Quebec, Canada, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM) du CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, Québec, Canada
| | - Juliana F S Barbosa
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Cristiano S Gomes
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Weslley R S Menezes
- Department of Physiotherapy, Potiguar University, Natal, Rio Grande do Norte, Brazil
| | - Ricardo O Guerra
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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In-hospital complications in an acute care geriatric unit. ACTA ACUST UNITED AC 2021; 41:293-301. [PMID: 34214270 PMCID: PMC8382119 DOI: 10.7705/biomedica.5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 11/21/2022]
Abstract
Introduction: In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care.
Objective: To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia.
Materials and methods: We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson’s linear regression model to identify associated variables.
Results: The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications.
Conclusion: In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.
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Amjad H, Borson S. Invigorating primary care for older adults living with dementia. J Am Geriatr Soc 2021; 69:1186-1189. [PMID: 33890295 DOI: 10.1111/jgs.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Park HJ, Lee NG, Kang TW. Fall-related cognition, motor function, functional ability, and depression measures in older adults with dementia. NeuroRehabilitation 2021; 47:487-494. [PMID: 33164957 DOI: 10.3233/nre-203249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As the severity of dementia progresses over time, cognition and motor functions such as muscle strength, balance, and gait are disturbed, and they eventually increase the risk of fall in patients with dementia. OBJECTIVE To determine the relationship between the fall risk and cognition, motor function, functional ability, and depression in older adults with dementia. METHODS Seventy-four older adults diagnosed with dementia were recruited. Clinical measurements included the Fall Risk Scale by Huh (FSH), Korean version of the Mini-Mental State Examination (MMSE-K), hand grip strength (HGS), Tinetti Performance Oriented Mobility Assessment (POMA), 10-m walk test (10-MWT), Korean version of the Modified Barthel Index (MBI-K), and the Geriatric Depression Scale (GDS). RESUTLS The MMSE-K was significantly correlated with the FSH, HGS, and the MBI-K, and FSH was significantly correlated with all of the other outcome measures. In particular, the MMSE-K, HGS, POMA, and the MBI-K were negatively correlated with fall history among the FHS sub-items. Additionally, the MMSE sub-item, attention/concentration was associated with the FSH, HGS, POMA, and the MBI-K. CONCLUSIONS These findings suggest that falling is significantly related to impaired cognition, reduced muscle strength, impaired balance, gait, and activities of daily living abilities, and depression in older adults with dementia.
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Affiliation(s)
- Hyun-Ju Park
- Department of physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Republic of Korea
| | - Nam-Gi Lee
- Rehabilitation Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju, Republic of Korea
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Measurement Properties of the CAPACITY Instrument to Assess Perceived Communication With the Health Care Team Among Care Partners of Patients With Cognitive Impairment. Med Care 2020; 58:842-849. [PMID: 32826749 DOI: 10.1097/mlr.0000000000001363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The CAregiver Perceptions About CommunIcaTion with Clinical Team members (CAPACITY) instrument measures how care partners perceive themselves to be supported by the patient's health care team and their experiences communicating with the team. OBJECTIVES The objective of this study was to assess the measurement properties (ie, structural validity of the construct and internal consistency) of the CAPACITY instrument in care partners of patients with cognitive impairment, and to examine whether care partner health literacy and patient cognitive impairment are associated with a higher or lower CAPACITY score. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS A total of 1746 dyads of community-dwelling care partners and older adults in the United States with cognitive impairment who obtained an amyloid positron emission tomography scan. MEASURES The CAPACITY instrument comprises 12 items that can be combined as a total score or examined as subdomain scores about communication with the team and care partner capacity-assessment by the team. The 2 covariates of primary interest in the regression model are health literacy and level of cognitive impairment of the patient (Modified Telephone Interview Cognitive Status). RESULTS Confirmatory factor analysis showed the CAPACITY items fit the expected 2-factor structure (communication and capacity). Higher cognitive functioning of patients and higher health literacy among care partners was associated with lower communication domain scores, lower capacity domain scores, and lower overall CAPACITY scores. CONCLUSIONS The strong psychometric validity of the CAPACITY measure indicates it could have utility in other family caregivers or care partner studies assessing the quality of interactions with clinical teams. Knowing that CAPACITY differs by care partner health literacy and patient impairment level may help health care teams employ tailored strategies to achieve high-quality care partner interactions.
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Ruangritchankul S, Peel NM, Hanjani LS, Gray LC. Drug related problems in older adults living with dementia. PLoS One 2020; 15:e0236830. [PMID: 32735592 PMCID: PMC7394402 DOI: 10.1371/journal.pone.0236830] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M. Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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14
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Anderson TS, Marcantonio ER, McCarthy EP, Herzig SJ. National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia. J Am Geriatr Soc 2020; 68:2240-2248. [PMID: 32700399 DOI: 10.1111/jgs.16636] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Dementia is associated with higher healthcare expenditures, in large part due to increased hospitalization rates relative to patients without dementia. Data on contemporary trends in the incidence and outcomes of potentially preventable hospitalizations of patients with dementia are lacking. DESIGN Retrospective cohort study using the National Inpatient Sample from 2012 to 2016. SETTING U.S. acute care hospitals. PARTICIPANTS A total of 1,843,632 unique hospitalizations of older adults (aged ≥65 years) with diagnosed dementia. MEASUREMENTS Annual trends in the incidence of hospitalizations for all causes and for potentially preventable conditions including acute ambulatory care sensitive conditions (ACSCs), chronic ACSCs, and injuries. In-hospital outcomes including mortality, discharge disposition, and hospital costs. RESULTS The survey weighted sample represented an estimated 9.27 million hospitalizations for patients with diagnosed dementia (mean [standard deviation] age = 82.6 [6.7] years; 61.4% female). In total, 3.72 million hospitalizations were for potentially preventable conditions (40.1%), 2.07 million for acute ACSCs, .76 million for chronic ACSCs, and .89 million for injuries. Between 2012 and 2016, the incidence of all-cause hospitalizations declined from 1.87 million to 1.85 million per year (P = .04) while the incidence of potentially preventable hospitalizations increased from .75 million to .87 million per year (P < .001), driven by an increased number of hospitalizations of community-dwelling older adults. Among patients with dementia hospitalized for potentially preventable conditions, inpatient mortality declined from 6.4% to 6.1% (P < .001), inflation-adjusted median costs increased from $7,319 to $7,543 (P < .001), and total annual costs increased from $7.4 to $9.3 billion. Although 86.0% of hospitalized patients were admitted from the community, only 32.7% were discharged to the community. CONCLUSION The number of potentially preventable hospitalizations of older adults with dementia is increasing, driven by hospitalizations of community-dwelling older adults. Improved strategies for early detection and goal-directed treatment of potentially preventable conditions in patients with dementia are urgently needed. J Am Geriatr Soc 68:2240-2248, 2020.
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Affiliation(s)
- Timothy S Anderson
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ellen P McCarthy
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Shoshana J Herzig
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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15
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Tien SC, Chan HY, Hsu CC. The factors associated with inappropriate prescription patterns of benzodiazepines and related drugs among patients with dementia. Psychogeriatrics 2020; 20:447-457. [PMID: 32032470 DOI: 10.1111/psyg.12527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND It has been emphasised that benzodiazepines and related drugs (BZDRs) should be used cautiously in people with dementia. The aim of this study was to identify factors associated with inappropriate prescription patterns of BZDRs including polypharmacy, long-term treatment and high doses among patients with dementia taking BZDRs. METHODS This was a retrospective chart review study of patients with dementia who were treated at the study hospital. The date that the patient was issued a catastrophic illness certificate from the National Health Insurance Administration was used as the index date. Medical records of the 2-year period after the index date were reviewed. RESULTS A total of 308 patients with dementia were included in this study. Among them, 151 (49.0%) received at least one prescription of BZDRs. After adjusting for covariates, psychiatric comorbidities (adjusted odds ratio (aOR) = 4.74, 95% CI = 1.75-12.81), history of past suicidal behaviour (aOR = 4.25, 95% CI = 1.40-12.88) and long-term treatment with BZDRs (aOR = 3.38, 95% CI = 1.11-10.27) were associated with polypharmacy of BZDRs. Age (aOR = 1.05, 95% CI = 1.0-1.11) and polypharmacy (aOR = 3.57, 95% CI = 1.23-10.32) were associated with long-term treatment. Living with family (aOR = 3.33, 95% CI = 1.32-9.79) and fewer psychiatric admissions to the study hospital (aOR = 0.56, 95% CI = 0.36-0.86) were associated with treatment with high doses of BZDRs. CONCLUSIONS Treatment with BZDRs is prevalent in patients with dementia. Inappropriate prescription patterns of BZDRs are not uncommon in these patients and may be interlinked.
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Affiliation(s)
- Shin-Chiao Tien
- Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan
| | - Hung-Yu Chan
- Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Chi Hsu
- Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan
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16
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201, USA.
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17
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Voss S, Brandling J, Pollard K, Taylor H, Black S, Buswell M, Cheston R, Cullum S, Foster T, Kirby K, Prothero L, Purdy S, Solway C, Benger J. A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project. BMC Emerg Med 2020; 20:6. [PMID: 31996145 PMCID: PMC6988190 DOI: 10.1186/s12873-020-0306-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process. However, to our knowledge no research has specifically examined the process of decision-making by paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with dementia who did not require immediate clinical treatment. Methods This qualitative study used a combination of observation, interview and document analysis to investigate the factors influencing the decision-making process during EMS calls to older people with dementia. A researcher worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically. Findings Four main themes emerged from the data concerning the way that paramedics make conveyance decisions when called to people with dementia: 1) Physical condition; the key factor influencing paramedics’ decision-making was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. 3) Patient circumstances; this included the patient’s medical history and the support available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from colleagues or information from the patient’s General Practitioner, to inform their decision-making. Conclusion The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for EMS calls to people with dementia.
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Affiliation(s)
- Sarah Voss
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
| | - Janet Brandling
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Katherine Pollard
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Black
- Research and Audit Department, South Western Ambulance Service NHS Foundation Trust, Taunton, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Richard Cheston
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Sarah Cullum
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Theresa Foster
- Research Support Services, East of England Ambulance Service NHS Trust, Bury St. Edmunds, UK
| | - Kim Kirby
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.,Research and Audit Department, South Western Ambulance Service NHS Foundation Trust, Taunton, UK
| | - Larissa Prothero
- Research Support Services, East of England Ambulance Service NHS Trust, Bury St. Edmunds, UK
| | - Sarah Purdy
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Solway
- Research Network, Alzheimer's Society, London, UK
| | - Jonathan Benger
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
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18
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Chan HY, Tien SC, Chen JJ. A retrospective study of chart review for the use of benzodiazepines and related drugs among patients with dementia. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_20_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Seppala LJ, Wermelink AMAT, de Vries M, Ploegmakers KJ, van de Glind EMM, Daams JG, van der Velde N. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc 2019; 19:371.e11-371.e17. [PMID: 29402652 DOI: 10.1016/j.jamda.2017.12.098] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Falls are a major public health problem in older adults. Earlier studies showed that psychotropic medication use increases the risk of falls. The aim of this study is to update the current knowledge by providing a comprehensive systematic review and meta-analysis on psychotropic medication use and falls in older adults. METHODS AND DESIGN This study is a systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated psychotropics (antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses were performed using generic inverse variance method pooling unadjusted and adjusted odds ratio (OR) estimates separately. RESULTS In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses using adjusted data showed the following pooled ORs: antipsychotics 1.54 [95% confidence interval (CI) 1.28-1.85], antidepressants 1.57 (95% Cl 1.43-1.74), tricyclic antidepressants 1.41 (95% CI 1.07-1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85-2.20), benzodiazepines 1.42 (95%, CI 1.22-1.65), long-acting benzodiazepines 1.81 (95%, CI 1.05-3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04-1.56) Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and healthcare setting. CONCLUSIONS Antipsychotics, antidepressants, and benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Prescription bias could not be accounted for. Future studies need to address pharmacologic subgroups as fall risk may differ depending on specific medication properties. Precise and uniform classification of target medication (Anatomical Therapeutic Chemical Classification) is essential for valid comparisons between studies.
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Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anne M A T Wermelink
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Max de Vries
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kimberley J Ploegmakers
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Esther M M van de Glind
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
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20
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Cieślik B, Chamela-Bilińska D, Ostrowska B, Szczepańska-Gieracha J. Postural instability in cognitively impaired elderly during forward and backward body leans. J Phys Ther Sci 2019; 31:573-577. [PMID: 31417224 PMCID: PMC6642884 DOI: 10.1589/jpts.31.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/22/2019] [Indexed: 01/09/2023] Open
Abstract
[Purpose] The aim of this study was to determine whether there are differences in
postural stability control while leaning forward and backward between healthy elderly
participants and elderly participants with cognitive impairment. [Participants and
Methods] Postural stability was analyzed in 36 participants. According to the Mini-Mental
State Examination results, participants were divided into the cognitive impairment group
and the control group. A force plate was used to register the center of pressure in the
sagittal and frontal plane, during two trials of maximum forward and backward body
leaning. [Results] Significant differences were shown in both forward and backward leaning
between the control and cognitive impairment groups. [Conclusion] The control of stability
in the sagittal plane during maximum forward and backward lean of the body in cognitively
impaired patients is similar to the results obtained by their healthy peers. However,
individuals with cognitive impairment demonstrated larger lateral oscillations, which may
be the reason for postural instability in this group, leading to an increased occurrence
of falls.
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Affiliation(s)
- Błażej Cieślik
- Faculty of Pedagogy, Jan Długosz University: Armii Krajowej 13/15, 42-200 Częstochowa, Poland
| | | | - Bożena Ostrowska
- Faculty of Physiotherapy, The University School of Physical Education, Poland
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21
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Bott NT, Sheckter CC, Yang D, Peters S, Brady B, Plowman S, Borson S, Leff B, Kaplan RM, Platchek T, Milstein A. Systems Delivery Innovation for Alzheimer Disease. Am J Geriatr Psychiatry 2019; 27:149-161. [PMID: 30477913 PMCID: PMC6331256 DOI: 10.1016/j.jagp.2018.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The authors describe a comprehensive care model for Alzheimer disease (AD) that improves value within 1-3 years after implementation by leveraging targeted outpatient chronic care management, cognitively protective acute care, and timely caregiver support. METHODS Using current best evidence, expert opinion, and macroeconomic modeling, the authors designed a comprehensive care model for AD that improves the quality of care while reducing total per capita healthcare spending by more than 15%. Cost savings were measured as reduced spending by payers. Cost estimates were derived from medical literature and national databases, including both public and private U.S. payers. All estimates reflect the value in 2015 dollars using a consumer price index inflation calculator. Outcome estimates were determined at year 2, accounting for implementation and steady-state intervention costs. RESULTS After accounting for implementation and recurring operating costs of approximately $9.5 billion, estimated net cost savings of between $13 and $41 billion can be accomplished concurrently with improvements in quality and experience of coordinated chronic care ($0.01-$6.8 billion), cognitively protective acute care ($8.7-$26.6 billion), timely caregiver support ($4.3-$7.5 billion), and caregiver efficiency ($4.1-$7.2 billion). CONCLUSION A high-value care model for AD may improve the experience of patients with AD while significantly lowering costs.
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Affiliation(s)
- Nicholas T Bott
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA.
| | - Clifford C Sheckter
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Daniel Yang
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Stephanie Peters
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Brian Brady
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Scooter Plowman
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Soo Borson
- the Department of Psychiatry and Behavioral Sciences (SB), University of Washington, Seattle; the Department of Neurology (SB), University of Minnesota, Minneapolis
| | - Bruce Leff
- Center for Transformative Geriatric Research (BL), Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore
| | - Robert M Kaplan
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Terry Platchek
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Arnold Milstein
- Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA
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22
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Liang Y, Rausch C, Laflamme L, Möller J. Prevalence, trend and contributing factors of geriatric syndromes among older Swedes: results from the Stockholm County Council Public Health Surveys. BMC Geriatr 2018; 18:322. [PMID: 30594139 PMCID: PMC6311019 DOI: 10.1186/s12877-018-1018-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022] Open
Abstract
Background Evidence is scarce on the trend in prevalence of geriatric syndromes (GS). This study assesses how GS prevalence changes over time in Swedish older community-dwellers by socio-demography, and attempts to highlight factors that may contribute to explain the trend. Methods Data from Stockholm County Council Public Health Surveys in 2006, 2010 and 2014 were used. Old adults, aged 65–84 years, with measurements on GS items were identified. Thus, a total of 17,560 participants were selected in 2006 (n = 6295), 2010 (n = 6733) and 2014 (n = 4532). Data on socio-demographics, lifestyles and health status were collected through questionnaires. GS was defined as having at least one of the following: insomnia, urinary incontinence, severe hearing/vision problem, functional decline, fall and depressive disorder. Logistic regression was performed to assess the prevalence trend as well as the change in the associations of sociodemographic factors, health behaviors and chronic disease with GS. Results From 2006 to 2014, the prevalence of GS remained stable (Ptrend = 0.54). However, among old adults born outside Nordic countries, it increased significantly from 73.0% in 2006, 78.0% in 2010 to 83.0% in 2014 (Ptrend < 0.001). Furthermore, the association with GS became stronger for born outside Nordic counties (Ptrend < 0.001) and weaker for sedentary lifestyles (Ptrend = 0.004), whereas the association did not change for other sociodemographic factors, health behaviors and chronic disease (all Ptrend > 0.05). Conclusions At population level, GS prevalence remained stable at a high level among Swedish old community-dwellers. There are noteworthy differences in GS trend between population groups, in particular to the detriment of older adults born outside Nordic countries. Electronic supplementary material The online version of this article (10.1186/s12877-018-1018-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska, 17177, Stockholm, Sweden.
| | - Christian Rausch
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska, 17177, Stockholm, Sweden.,University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, University of Groningen, Groningen, The Netherlands
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska, 17177, Stockholm, Sweden
| | - Jette Möller
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska, 17177, Stockholm, Sweden
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Osborne S, Harrison G, O'Malia A, Barnett AG, Carter HE, Graves N. Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay. BMJ Open 2018; 8:e023127. [PMID: 30580267 PMCID: PMC6307584 DOI: 10.1136/bmjopen-2018-023127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Long-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources. OBJECTIVE To determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers' willingness to pay for bed days released. DESIGN A prospective, matched cohort study with historical controls. SETTING A large, tertiary teaching and referral hospital in metropolitan Southeast Queensland, Australia. METHODS Length of hospital stay for a cohort of patients seen under the specialist social worker-led model of care was compared with a matched control group of patients admitted to the hospital prior to the introduction of the new model of care using a multistate model with the social worker model of care as an intermediate event. Costs associated with the model of care were calculated and an estimate of the 'cost per bed day' was produced. RESULTS The model of care reduced mean length of stay by 33 days. This translated to 9999 bed days released over 12 months. The cost to achieve this was estimated to be $A229 000 over 12 months. The cost per bed day released was $23, which is below estimates of hospital decision makers' willingness to pay for a bed day to be released for an alternate use. CONCLUSIONS The specialist social worker-led model of care was associated with a reduced length of stay at a relatively low cost. This is likely to represent a cost-effective use of hospital resources. The limitations of our historic control cohort selection mean that results should be interpreted with caution. Further research is needed to confirm these findings.
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Affiliation(s)
- Sonya Osborne
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Gai Harrison
- Department of Social Work, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Angela O'Malia
- Department of Social Work, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Adrian Gerard Barnett
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Holden TR, Keller S, Kim A, Gehring M, Schmitz E, Hermann C, Gilmore-Bykovskyi A, Kind AJ. Procedural Framework to Facilitate Hospital-Based Informed Consent for Dementia Research. J Am Geriatr Soc 2018; 66:2243-2248. [PMID: 30246863 PMCID: PMC6289792 DOI: 10.1111/jgs.15525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Improving quality and delivery of care for people with Alzheimer disease and related dementias (ADRD) requires a comprehensive research agenda that encompasses the entire care continuum. Logistical and ethical challenges of informed consent for research participation of persons with ADRD include determination of capacity to consent, surrogate consent when capacity to consent is compromised, timely identification of the legally authorized representative (LAR) providing surrogate consent, and balancing residual autonomy with surrogate consent. Short stays; limited access to patients, caregivers, and LARs; and fluctuating influences of acute illness on capacity determination compound these challenges in the acute care setting. To address these challenges, we worked with the University of Wisconsin Health Sciences Institutional Review Board to develop a procedural framework for obtaining informed consent from hospitalized individuals with ADRD and their caregivers to participate in a minimal risk care intervention. The framework is specially designed for minimal risk situations in which rapid enrollment is a necessity and uses rapid identification of surrogates to consent for patients who lack legal capacity to make medical decisions, indicated by an activated healthcare power of attorney, and individualized formal assent procedures for patients who lack capacity to consent. These methods were proven effective in facilitating hospital-based recruitment in an ongoing randomized controlled trial and provide a basis for increasing access to acute care clinical research for persons with ADRD. Bolstering research participation through more easily used consent procedures during acute illness is critical to fostering improvements in the delivery of high-quality care to persons with ADRD. J Am Geriatr Soc 66:2243-2248, 2018.
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Affiliation(s)
- Timothy R. Holden
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Sarah Keller
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Alice Kim
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael Gehring
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Emily Schmitz
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carol Hermann
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Andrea Gilmore-Bykovskyi
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
- University of Wisconsin School of Nursing, Madison, WI
| | - Amy J.H. Kind
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI
- United States Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, Madison, WI
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25
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Mudge AM, McRae P, Hubbard RE, Peel NM, Lim WK, Barnett AG, Inouye SK. Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care. J Am Geriatr Soc 2018; 67:352-356. [PMID: 30423197 DOI: 10.1111/jgs.15662] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To propose a new multicomponent measure of hospital-associated complications of older people (HAC-OP) and evaluate its validity in a large hospital sample. DESIGN Observational study using baseline (pre-intervention) data from the Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital cluster randomized controlled trial. SETTING Acute medical and surgical wards in 4 hospitals in Queensland, Australia. PARTICIPANTS Individuals aged 65 and older (mean age 76, 48% female) with a hospital stay of 72 hours or longer (N=434). MEASUREMENTS We developed a multicomponent measure including 5 well-recognized hospital-associated complications of older people: hospital-associated delirium, functional decline, incontinence, falls, and pressure injuries. To evaluate construct validity, we examined associations with common risk factors (aged ≥75, functional impairment, cognitive impairment, history of falls). To evaluate predictive validity, we examined the association between length of stay, facility discharge, and 6-month mortality and any HAC-OP and total number of HAC-OP. RESULTS Overall, 192 (44%) participants had 1 or more HAC-OP during their admission. Any HAC-OP was strongly associated with the proposed shared risk factors, and there was a strong and graded association between HAC-OP and length of stay (9.1±7.4 days for any HAC-OP vs 6.8 ±4.1 days with none, p < .001), facility discharge (59/192 (31%) vs 27/242 (11%), p < .001) and 6-month mortality (26/192 (14%) vs 17/242 (7%), p = .02). CONCLUSION This study provides evidence of construct and predictive validity of the proposed measure of HAC-OP as a potential outcome measure for research investigating and improving hospital care of older people. J Am Geriatr Soc 67:352-356, 2019.
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Affiliation(s)
- Alison M Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australian
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australian
| | - Wen Kwang Lim
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sharon K Inouye
- Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, Massachusetts
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Boltz M, Kuzmik A, Resnick B, Trotta R, Mogle J, BeLue R, Leslie D, Galvin JE. Reducing disability via a family centered intervention for acutely ill persons with Alzheimer's disease and related dementias: protocol of a cluster-randomized controlled trial (Fam-FFC study). Trials 2018; 19:496. [PMID: 30223870 PMCID: PMC6142366 DOI: 10.1186/s13063-018-2875-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/23/2018] [Indexed: 01/03/2023] Open
Abstract
Background Hospitalized older persons with Alzheimer’s disease and related dementias are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, lack of family involvement and limited staff knowledge of dementia care. We have developed a theory-based intervention, Family centered Function-focused Care, that incorporates an educational empowerment model for family caregivers (FCGs) provided within a social-ecological framework to promote specialized care to patients with dementia during hospitalization and the 60-day post-acute period. Primary aims are to test the efficacy of the intervention in improving physical and cognitive recovery in hospitalized persons living with Alzheimer’s disease and related dementias (ADRD) and improving FCG preparedness and experiences. Method We will implement Family centered Function-focused Care in a cluster-randomized trial of 438 patient/FCG dyads in six hospital units randomized within three hospitals. We hypothesize that patients who receive the intervention will demonstrate better physical function, less delirium occurrence and severity, neuropsychiatric symptoms, and depression compared to those in the control condition (Education-only). We also hypothesize that FCGs enrolled in Family centered Function-focused Care will experience increased preparedness for caregiving, and less strain, burden, and desire to institutionalize, as compared to FCGs the control group. We will also examine the costs and relative cost savings associated with the intervention and will evaluate the cultural appropriateness of Family centered Function-focused Care for families from diverse backgrounds. Discussion Our theory-based intervention makes use of real-world applicable approaches in a novel and innovative way to change the paradigm of how we currently look at acute care and post-acute transitions in persons with ADRD. Trial registration ClinicalTrials.gov, ID: NCT03046121. Registered on 8 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2875-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Boltz
- The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA, 16802, USA.
| | - Ashley Kuzmik
- The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Rebecca Trotta
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Mogle
- The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA, 16802, USA
| | | | - Douglas Leslie
- The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA, 16802, USA
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Holden TR, Shah MN, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Outcomes of Patients With Syncope and Suspected Dementia. Acad Emerg Med 2018; 25:880-890. [PMID: 29575587 PMCID: PMC6156993 DOI: 10.1111/acem.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
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Affiliation(s)
- Timothy R. Holden
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI,Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tommy A. Gibson
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - David H. Adler
- Department of Emergency Medicine, University of Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L. Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A. Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel K. Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Kirk A. Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN
| | - Scott T. Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
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28
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Fogg C, Griffiths P, Meredith P, Bridges J. Hospital outcomes of older people with cognitive impairment: An integrative review. Int J Geriatr Psychiatry 2018; 33:1177-1197. [PMID: 29947150 PMCID: PMC6099229 DOI: 10.1002/gps.4919] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. METHODS Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. RESULTS One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all-cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. CONCLUSIONS Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
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Affiliation(s)
- Carole Fogg
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- School of Health Sciences and Social Work, Faculty of ScienceUniversity of PortsmouthPortsmouthUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter Griffiths
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Paul Meredith
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
| | - Jackie Bridges
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
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29
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Naef R, Ernst J, Bürgi C, Petry H. Quality of acute care for persons with cognitive impairment and their families: A scoping review. Int J Nurs Stud 2018; 85:80-89. [PMID: 29859348 DOI: 10.1016/j.ijnurstu.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND An increasing number of older persons with cognitive impairment use inpatient services for co-occurring acute illness. Research has demonstrated that persons with cognitive impairment face more adverse health outcomes during hospitalization than their age counterparts without cognitive impairment. As hospitals tend to be ill equipped to meet the complex care needs of this population, various initiatives underscore the need to better utilize existing evidence to improve quality of care. OBJECTIVES To map the extent of knowledge about quality of acute care in inpatient settings, and to synthesize knowledge on strategies to improve quality care for persons with cognitive impairment and their families. DESIGN A scoping review using Arksey and O'Malley's methodological framework. DATA SOURCES CINAHL and Medline were searched and reference lists of pertinent articles screened to identify publications regarding acute care for persons with cognitive impairment. REVIEW METHODS Two reviewers independently screened and identified publications based on eligibility criteria. Publications were included if they targeted acute care issues relating to persons with cognitive impairment 65 years or older, their family members, or health professionals caring for them, and were published after 2000 in English or German. Publications were read and data were extracted using a predefined template. Thematic analysis was conducted by two reviewers. RESULTS Of the 1445 identified publications, 66 were included. Quality of acute inpatient services pertained to structural (such as staff capacity and knowledge) and process dimensions (such as forming a caring relationship, assessing and intervening). Strategies identified to improve care quality included interventions at the point of care, such as specific tools and specialist roles to improve patient outcomes, as well as educational and training interventions to enable staff to care for this patient group. CONCLUSIONS There is a discrepancy between clearly defined best practice for persons with cognitive impairment utilising inpatient services, and the quality of care actually experienced by patients, family members, and staff. Research reveals a sobering picture of inadequate care and manifold challenges encountered by this patient group, family members and staff alike. Promising strategies to improve care quality target health professionals' knowledge and capacity to work with this group and include specific tools and models of care, such as specialist roles and units. Organisation-wide efforts to ensure quality care for this patient group are needed, as is further research to determine which implementation and intervention strategies achieve the most beneficial outcomes for all involved.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Bürgi
- Division of Abdomen-Metabolism, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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30
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Parke B, Boltz M, Hunter KF, Chambers T, Wolf-Ostermann K, Adi MN, Feldman F, Gutman G. A Scoping Literature Review of Dementia-Friendly Hospital Design. THE GERONTOLOGIST 2018; 57:e62-e74. [PMID: 27831481 DOI: 10.1093/geront/gnw128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/31/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia. Design and Methods Exploratory iterative design utilizing scoping literature review methodology. Results A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function. Implications Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | | | - Thane Chambers
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | | | - Mohamad Nadim Adi
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Surrey, British Columbia, Canada.,Seniors Fall and Injury Prevention, Primary Care, Chronic Disease Management and Specialized Seniors, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Gloria Gutman
- Gerontology Department and Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink AMAT, van der Velde N. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others. J Am Med Dir Assoc 2018; 19:372.e1-372.e8. [PMID: 29402646 DOI: 10.1016/j.jamda.2017.12.099] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications. METHODS AND DESIGN A systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately. RESULTS In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association). CONCLUSION Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.
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Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Esther M M van de Glind
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Joost G Daams
- Medical library, Academic Medical Center, Amsterdam, the Netherlands
| | - Kimberley J Ploegmakers
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Max de Vries
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anne M A T Wermelink
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
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Burgstaller M, Mayer H, Schiess C, Saxer S. Experiences and needs of relatives of people with dementia in acute hospitals—A meta‐synthesis of qualitative studies. J Clin Nurs 2018. [DOI: 10.1111/jocn.13934] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melanie Burgstaller
- Department of Nursing Science University of Vienna Vienna Austria
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
| | - Hanna Mayer
- Department of Nursing Science University of Vienna Vienna Austria
| | - Cornel Schiess
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
| | - Susi Saxer
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
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Demir N, Yuruyen M, Atay K, Yavuzer H, Hatemi I, Doventas A, Erdincler DS, Dobrucalı A. Prevalence of fecal incontinence and associated risk factors in elderly outpatients: a cross-sectional study. Aging Clin Exp Res 2017; 29:1165-1171. [PMID: 28120284 DOI: 10.1007/s40520-017-0723-x] [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] [Received: 10/24/2016] [Accepted: 01/04/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data on the prevalence of fecal incontinence in elderly patients admitted to outpatient clinics in Turkey are scarce. AIMS The aim of this study was to assess the prevalence of fecal incontinence and the associated risk factors in the elderly outpatients. METHODS Patients 60 years and older admitted to a geriatrics outpatient clinic between October 2013 and March 2014 were included. Demographic characteristics, anthropometric measurements, marital status, educational status, parity (for females), fecal incontinence (FI), urinary incontinence (UI), constipation, comorbid conditions, and medications were recorded. FI assessment was based on the Fecal Incontinence Severity Index (FISI). RESULTS A total of 364 patients (64.8% female, n = 236) with a mean age of 73.2 ± 8.1 years were enrolled in the study. The prevalence of FI was 9.9% (10.2% female, 9.4% male). UI was 42.6%. Co-occurrence of FI and UI was 7.4%. According to the FISI, the most frequent type of defecation was liquid stool (61.1%). While the predictive factors for FI were polypharmacy (standardized coefficient, [r] = 0.203, 95% confidence interval [CI] = 0.009-0.040, p = 0.002), UI (r = 0.134, 95% CI = 0.006-0.156, p = 0.035), and being married (r = 0.200, 95% CI = -0.088 to -0.020, p = 0.002) in females, those were UI (r = 0.306, 95% CI = 0.093-0.309, p < 0.001) and polypharmacy (r = 0.251, 95% CI = 0.009-0.043, p = 0.003) in males. CONCLUSIONS In both genders, urinary incontinence and polypharmacy seem to be the most important risk factors for fecal incontinence. Fecal incontinence should be questioned in detail and evaluated using FISI in elderly outpatients.
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Hartley P, Gibbins N, Saunders A, Alexander K, Conroy E, Dixon R, Lang J, Luckett J, Luddington T, Romero-Ortuno R. The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis. Age Ageing 2017; 46:559-567. [PMID: 28119313 DOI: 10.1093/ageing/afx007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/05/2017] [Indexed: 11/12/2022] Open
Abstract
Background in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association. Method we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. Population: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission. Setting: acute hospital (excluding critical care and subacute or intermediate care). Outcome of interest: change in a measure of physical function or disability between pre-admission or admission, and discharge or post-discharge. This review was registered on PROSPERO (CRD42016035978). Results the search returned 5,988 unique articles, of which 34 met inclusion criteria. All studies were observational, with 30 prospective and 4 retrospective from 14 countries, recruiting from general medicine (n = 11), geriatric medicine (n = 11) and mixed (n = 12) wards. Twenty-six studies (54,637 participants) were suitable for the quantitative synthesis. The meta-analysis suggested that cognitive impairment was associated with functional decline in hospitalised older adults (risk ratio (RR): 1.64; 95% confidence interval (CI): 1.45-1.86; P < 0.01). Results were similar in subanalyses focusing on diagnosis of dementia (RR: 1.36; 95% CI: 1.05-1.76; P = 0.02; n= 2,248) or delirium (RR: 1.55; 95% CI: 1.31-1.83; P < 0.01; n= 1,677). Conclusion cognitive impairments seem associated with functional decline in hospitalised older people. Causality cannot be inferred, and limitations include low quality of studies and possible confounding.
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Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Nathalie Gibbins
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Amanda Saunders
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Kerry Alexander
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Eimear Conroy
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Rebecca Dixon
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Joseph Lang
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Jasmine Luckett
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Tim Luddington
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Roman Romero-Ortuno
- Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Box 135, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
- Department of Public Health and Primary Care, University of Cambridge, Clinical Gerontology Unit, Box 251, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Jackson TA, Gladman JRF, Harwood RH, MacLullich AMJ, Sampson EL, Sheehan B, Davis DHJ. Challenges and opportunities in understanding dementia and delirium in the acute hospital. PLoS Med 2017; 14:e1002247. [PMID: 28291818 PMCID: PMC5349650 DOI: 10.1371/journal.pmed.1002247] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In an Essay, Andrew Jackson and colleagues discuss challenges in the diagnosis and management of older people with dementia and delirium in acute hospitals.
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Affiliation(s)
- Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- * E-mail:
| | - John R. F. Gladman
- Division of Rehabilitation and Ageing, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Rowan H. Harwood
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
| | - Bart Sheehan
- Psychological Medicine, Rehabilitation and Cardiac Division, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniel H. J. Davis
- MRC Unit for Lifelong Health & Ageing, University College London, London, United Kingdom
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Romero-Ortuno R, Forsyth DR, Wilson KJ, Cameron E, Wallis S, Biram R, Keevil V. The Association of Geriatric Syndromes with Hospital Outcomes. J Hosp Med 2017; 12:83-89. [PMID: 28182802 DOI: 10.12788/jhm.2685] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital. OBJECTIVE To study the association of frailty (≥6 points in the Clinical Frailty Scale [CFS]), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery). DESIGN Retrospective observational study. SETTING Large university hospital in England. PATIENTS We analyzed 8202 first nonelective inpatient episodes of people aged 75 years and older between October 2014 and October 2015. MEASUREMENTS The outcomes studied were prolonged length of stay (LOS ≥10 days), inpatient mortality, delayed discharge, institutionalization, and 30-day readmission. Statistical analyses were based on multivariate regression models. RESULTS Independently of controlling variables, prolonged LOS was predicted by CFS ≥6: odds ratio (OR) =1.55; 95% confidence interval [CI], 1.36-1.77; P ⟨ 0.001; HoD: OR = 2.16; 95% CI, 1.79-2.61; P ⟨ 0.001; and ACS: OR = 3.31; 95% CI, 2.64-4.15; P ⟨ 0.001. Inpatient mortality was predicted by CFS ≥6: OR = 2.29; 95% CI, 1.79-2.94; P ⟨ 0.001. Delayed discharge was predicted by CFS ≥6: OR = 1.46; 95% CI, 1.27-1.67; P ⟨ 0.001; HoD: OR = 2.17; 95% CI, 1.80-2.62; P ⟨ 0.001; and ACS: OR = 2.29; 95% CI: 1.83-2.85; P ⟨ 0.001. Institutionalization was predicted by CFS ≥6: OR = 2.56; 95% CI, 2.09-3.14; P ⟨ 0.001; HoD: OR = 2.51; 95% CI, 2.00-3.14; P ⟨ 0.001; and ACS: OR 1.93; 95% CI, 1.46-2.56; P ⟨ 0.001. Readmission was predicted by ACS: OR = 1.36; 95% CI, 1.09-1.71; P = 0.006. CONCLUSIONS Routine screening for frailty, HoD, and ACS in hospitals may aid the development of acute care pathways for older adults. Journal of Hospital Medicine 2017;12:83-89.
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Affiliation(s)
- Roman Romero-Ortuno
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Duncan R Forsyth
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kathryn Jane Wilson
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ewen Cameron
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Stephen Wallis
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Richard Biram
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Victoria Keevil
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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Amjad H, Wong SK, Roth DL, Huang J, Willink A, Black BS, Johnston D, Rabins PV, Gitlin LN, Lyketsos CG, Samus QM. Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial. Health Serv Res 2017; 53:556-579. [PMID: 28083879 DOI: 10.1111/1475-6773.12647] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate effects of a novel dementia care coordination program on health services utilization. DATA SOURCES/STUDY SETTING A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). STUDY DESIGN Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. DATA COLLECTION/EXTRACTION METHODS Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. PRINCIPAL FINDINGS From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). CONCLUSIONS While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use.
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Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD.,Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Amber Willink
- Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Betty S Black
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deirdre Johnston
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter V Rabins
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura N Gitlin
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Community Public Health Nursing, School of Nursing, The Johns Hopkins University, Baltimore, MD
| | - Constantine G Lyketsos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Quincy M Samus
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Rushton C, Edvardsson D. Reconciling conceptualisations of the body and person-centred care of the older person with cognitive impairment in the acute care setting. Nurs Philos 2016; 18. [PMID: 27882680 DOI: 10.1111/nup.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/12/2016] [Indexed: 11/27/2022]
Abstract
In this article, we sought reconciliation between the "body-as-representation" and the "body-as-experience," that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary "technologies" and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter-bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the "body-as-representation" with the "body-as-experience" to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person-centred care which evokes nurses to respond appropriately to the older person's "otherness," their "variation of being" while enabling them to enact a continuation of themselves and their own version of normality.
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Affiliation(s)
- Carole Rushton
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - David Edvardsson
- Austin Health, Northern Health Clinical Schools of Nursing, La Trobe University, Heidelberg, VIC, Australia.,College of Science, Health and Engineering, La Trobe University, Heidelberg, VIC, Australia.,Department of Nursing, Umea University, Umea, Sweden
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39
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Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JPW. Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare. JAMA Intern Med 2016; 176:1371-8. [PMID: 27454945 PMCID: PMC5061498 DOI: 10.1001/jamainternmed.2016.3553] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Poor continuity of care may contribute to high health care spending and adverse patient outcomes in dementia. OBJECTIVE To examine the association between medical clinician continuity and health care utilization, testing, and spending in older adults with dementia. DESIGN, SETTING, AND PARTICIPANTS This was a study of an observational retrospective cohort from the 2012 national sample in fee-for-service Medicare, conducted from July to December 2015, using inverse probability weighted analysis. A total of 1 416 369 continuously enrolled, community-dwelling, fee-for-service Medicare beneficiaries 65 years or older with a claims-based dementia diagnosis and at least 4 ambulatory visits in 2012 were included. EXPOSURES Continuity of care score measured on patient visits across physicians over 12 months. A higher continuity score is assigned to visit patterns in which a larger share of the patient's total visits are with fewer clinicians. Score range from 0 to 1 was examined in low-, medium-, and high-continuity tertiles. MAIN OUTCOMES AND MEASURES Outcomes include all-cause hospitalization, ambulatory care sensitive condition hospitalization, emergency department visit, imaging, and laboratory testing (computed tomographic [CT] scan of the head, chest radiography, urinalysis, and urine culture), and health care spending (overall, hospital and skilled nursing facility, and physician). RESULTS Beneficiaries with dementia who had lower levels of continuity of care were younger, had a higher income, and had more comorbid medical conditions. Almost 50% of patients had at least 1 hospitalization and emergency department visit during the year. Utilization was lower with increasing level of continuity. Specifically comparing the highest- vs lowest-continuity groups, annual rates per beneficiary of hospitalization (0.83 vs 0.88), emergency department visits (0.84 vs 0.99), CT scan of the head (0.71 vs 0.83), urinalysis (0.72 vs 1.09), and health care spending (total spending, $22 004 vs $24 371) were higher with lower continuity even after accounting for sociodemographic factors and comorbidity burden (P < .001 for all comparisons). The rate of ambulatory care sensitive condition hospitalization was similar across continuity groups. CONCLUSIONS AND RELEVANCE Among older fee-for-service Medicare beneficiaries with a dementia diagnosis, lower continuity of care is associated with higher rates of hospitalization, emergency department visits, testing, and health care spending. Further research into these relationships, including potentially relevant clinical, clinician, and systems factors, can inform whether improving continuity of care in this population may benefit patients and the wider health system.
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Affiliation(s)
- Halima Amjad
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Donald Carmichael
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Chiang-Hua Chang
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Julie P W Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire3Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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40
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Reconciling concepts of space and person-centred care of the older person with cognitive impairment in the acute care setting. Nurs Philos 2016; 18. [DOI: 10.1111/nup.12142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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de Vries K, Drury-Ruddlesden J, Gaul C. 'And so I took up residence': The experiences of family members of people with dementia during admission to an acute hospital unit. DEMENTIA 2016; 18:36-54. [PMID: 27328693 PMCID: PMC6343471 DOI: 10.1177/1471301216656097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is estimated that a quarter of acute hospital beds are in use by older people with dementia at any one time. Little empirical research has been carried out that has specifically examined the day-to-day input of family members into the care of people with dementia during an acute hospital admission. In this article, we present the results of analysis of interviews with 26 family members of people with dementia about their experiences of supporting an admission of a person with dementia to an acute hospital unit in New Zealand. For all family members, the desire to support the person with dementia during their admission was at the forefront and was their primary focus. The theme, ‘And so I took up residence’, exemplifies fully the experiences of all of the family member participants. This study provides evidence that family members are a resource that may be unrecognised, untapped and unsupported in the event of hospitalisation of people with dementia.
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Affiliation(s)
- Kay de Vries
- School of Health Sciences, University of Brighton, UK
| | - Jenny Drury-Ruddlesden
- Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, New Zealand
| | - Chris Gaul
- Nursing, Nelson Marlborough Institute of Technology, New Zealand
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Jackson TA, MacLullich AMJ, Gladman JRF, Lord JM, Sheehan B. Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium: a prospective cohort study. Age Ageing 2016; 45:505-11. [PMID: 27076526 DOI: 10.1093/ageing/afw065] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/16/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND delirium and dementia co-exist commonly in hospital. Older people with delirium have high rates of undiagnosed dementia, but delirium affects the use of cognitive testing in dementia diagnosis. Novel methods to detect dementia in delirium are needed. The purpose of the study was to investigate the diagnostic test accuracy of informant tools to detect dementia in hospitalised older people with delirium. METHODS the presence of dementia on admission was assessed using the short form of the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE-SF) and Alzheimer's Disease 8 (AD8) in people over 70 years old with delirium. Reference standard diagnosis was made using Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria at 3 months. The main outcome measures were the diagnostic test accuracy of the IQCODE-SF and the AD8 in diagnosing DSM-IV dementia. RESULTS dementia prevalence at 3 months was 61%. The area under the receiver operating characteristic curve (AUROC) was 0.93 (P < 0.0005) for admission IQCODE-SF and 0.91 (P < 0.0005) for admission AD8. An IQCODE-SF test result of >3.82 on admission had a sensitivity of 0.91 (0.79-0.97) and specificity of 0.93 (0.76-0.99) for detecting dementia. An AD8 of >6 had a sensitivity of 0.83 (0.69-0.92) and specificity of 0.90 (0.72-0.97) for detecting dementia. CONCLUSION the IQCODE-SF and AD8 are sensitive and specific tools to detect prior dementia in older people with delirium. The routine use of either tool in practice could have important clinical impact, by improving the recognition and hence management of those with dementia.
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Affiliation(s)
- Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK Centre for Translational Inflammation Research, Queen Elizabeth Hospital Mindelsohn Way, Birmingham B15 2WD, UK
| | - Alasdair M J MacLullich
- Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - John R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK Centre for Translational Inflammation Research, Queen Elizabeth Hospital Mindelsohn Way, Birmingham B15 2WD, UK
| | - Bart Sheehan
- Psychological Medicine, Oxford University Hospitals, Oxford, UK
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Jackson TA, MacLullich AMJ, Gladman JRF, Lord JM, Sheehan B. Undiagnosed long-term cognitive impairment in acutely hospitalised older medical patients with delirium: a prospective cohort study. Age Ageing 2016; 45:493-9. [PMID: 27076525 DOI: 10.1093/ageing/afw064] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/03/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND delirium and dementia are common in the general hospital, being present in nearly 50% of older unselected admissions to hospital. Cognitive impairment is a risk factor for delirium, but the prevalence of previously undiagnosed cognitive impairment (dementia or mild cognitive impairment) in patients with delirium is unknown. METHODS we performed a prospective cohort study of people over 70 years admitted to hospital with delirium to establish the prevalence of previously unrecognised prior cognitive impairment. Delirium was diagnosed at baseline using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Mild cognitive impairment and dementia were diagnosed 3 months following recruitment in survivors using the International Working Group on Mild Cognitive Impairment criteria and DSM-IV criteria, respectively. RESULTS delirium was identified in 17.9% of older patients, and 82 participants with delirium were assessed at 3 months: 5 (6%) had persistent delirium, 14 (17%) had mild cognitive impairment and 47 (57%) had dementia. In 17 participants with prior dementia and 14 with prior mild cognitive impairment, the diagnosis had been unrecognised, amounting to 31/82 (38%) of all patients with delirium having some form of previously undiagnosed cognitive impairment. CONCLUSION given that over 1/3 of older patients with delirium were found to have a previously undiagnosed cognitive impairment, the development and evaluation of services to follow-up and manage patients with delirium are warranted.
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Affiliation(s)
- Thomas A Jackson
- Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, Queen Elizabeth Hospital Mindelsohn Way, University of Birmingham, Birmingham B15 2WD, UK
| | - Alasdair M J MacLullich
- Geriatric Medicine, F1424, Royal Infirmary of Edinburgh 51, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK
| | - John R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Bart Sheehan
- Psychological Medicine, Oxford University Hospitals, John Radcliffe Hospital, Oxford, UK
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Naylor MD, Hirschman KB, Hanlon AL, Bowles KH, Bradway C, McCauley KM, Pauly MV. Effects of alternative interventions among hospitalized, cognitively impaired older adults. J Comp Eff Res 2016; 5:259-72. [PMID: 27146416 DOI: 10.2217/cer-2015-0009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Compare within site effects of three interventions designed to enhance outcomes of hospitalized cognitively impaired elders. METHODS Prospective, nonrandomized, confirmatory phased study. In Phase I, 183 patients received one of three interventions: augmented standard care (ASC), resource nurse care (RNC) or Transitional Care Model (TCM). In Phase II, 205 patients received the TCM. RESULTS Time to first rehospitalization or death was longer for the TCM versus ASC group (p = 0.017). Rates for total all-cause rehospitalizations and days were significantly reduced in the TCM versus ASC group (p < 0.001, both). No differences were observed between RNC versus TCM. CONCLUSION Findings suggest the TCM is more effective than ASC. However, potential effects of the RNC relative to the TCM warrant further study.
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Affiliation(s)
- Mary D Naylor
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Karen B Hirschman
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Alexandra L Hanlon
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Kathryn H Bowles
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA.,Center for Integrative Science in Aging (CISA), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christine Bradway
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA.,Center for Integrative Science in Aging (CISA), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kathleen M McCauley
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Mark V Pauly
- University of Pennsylvania Wharton School, Philadelphia, PA, USA
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Bell SP, Vasilevskis EE, Saraf AA, Jacobsen JML, Kripalani S, Mixon AS, Schnelle JF, Simmons SF. Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities. J Am Geriatr Soc 2016; 64:715-22. [PMID: 27059831 DOI: 10.1111/jgs.14035] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the prevalence, recognition, co-occurrence, and recent onset of geriatric syndromes in individuals transferred from the hospital to a skilled nursing facility (SNF). DESIGN Quality improvement project. SETTING Acute care academic medical center and 23 regional partner SNFs. PARTICIPANTS Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs (N = 686). MEASUREMENTS Project staff measured nine geriatric syndromes: weight loss, lack of appetite, incontinence, and pain (standardized interview); depression (Geriatric Depression Scale); delirium (Brief Confusion Assessment Method); cognitive impairment (Brief Interview for Mental Status); and falls and pressure ulcers (hospital medical record using hospital-implemented screening tools). Estimated prevalence, new-onset prevalence, and common coexisting clusters were determined. The extent to which treating physicians commonly recognized syndromes and communicated them to SNFs in hospital discharge documentation was evaluated. RESULTS Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for three or more coexisting syndromes. The most-prevalent syndromes were falls (39%), incontinence (39%), loss of appetite (37%), and weight loss (33%). In individuals who met criteria for three or more syndromes, the most common triad clusters were nutritional syndromes (weight loss, loss of appetite), incontinence, and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33% to 95% of syndromes present according to research personnel. CONCLUSION Geriatric syndromes in hospitalized older adults transferred to SNFs are prevalent and commonly coexist, with the most frequent clusters including nutritional syndromes, depression, and incontinence. Despite the high prevalence, this clinical information is rarely communicated to SNFs on discharge.
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Affiliation(s)
- Susan P Bell
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Eduard E Vasilevskis
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Avantika A Saraf
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - J M L Jacobsen
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.,Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.,Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - John F Schnelle
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Sandra F Simmons
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee
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Boltz M, Chippendale T, Resnick B, Galvin JE. Testing family-centered, function-focused care in hospitalized persons with dementia. Neurodegener Dis Manag 2016; 5:203-15. [PMID: 26107319 DOI: 10.2217/nmt.15.10] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. MATERIALS & METHODS A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). RESULTS The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. CONCLUSION Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.
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Affiliation(s)
- Marie Boltz
- Boston College, William F Connell School of Nursing, Chestnut Hill, MA 02467, USA
| | - Tracy Chippendale
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD 21201, USA
| | - James E Galvin
- Charles E Schmidt College of Medicine, Florida Atlantic University, FL, USA
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47
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Zhao YL, Kim H. Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors. J Gerontol Nurs 2015; 41:29-43; quiz 44-5. [PMID: 26126026 DOI: 10.3928/00989134-20150616-05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
The current integrative literature review of 23 studies aimed to identify multidimensional risk factors of falls among older adult patients in acute care hospitals. The incidence rate of fall-related injuries ranged from 6.8% to 72.1%. Advanced age was a major intrinsic risk factor, whereas being a patient in a geriatric unit was a significant extrinsic factor for inpatient falls and fall-related injuries based on statistical significance obtained from quantitative data analyses. Other critical risk factors were: (a) cognitive impairment; (b) impaired mobility; (c) prolonged length of hospital stay; and (d) fall history. Environmental/situational factors, such as patient ambulation and fall locations, also contributed to inpatient falls. In clinical practice, nurses need to know who are the most vulnerable patients in the hospital and develop comprehensive interventions to decrease intrinsic, extrinsic, and environmental risk factors. Prospective mixed-methods studies are needed to examine psychosocial factors and consequences of falls.
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48
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Boltz M, Chippendale T, Resnick B, Galvin JE. Anxiety in family caregivers of hospitalized persons with dementia: contributing factors and responses. Alzheimer Dis Assoc Disord 2015; 29:236-41. [PMID: 25635341 PMCID: PMC4714710 DOI: 10.1097/wad.0000000000000072] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Baseline health and functional vulnerabilities increase the risk for complications in persons with dementia and predispose family caregivers (FCGs) to increased stress. METHODS This secondary analysis used a combined quantitative and qualitative approach. Regression analyses examined the contribution of patient and FCG characteristics to FCG anxiety. Interviews with FCGs explored the experiences and responses of FCGs during hospitalization of their family member with dementia. RESULTS Lower patient physical function and higher caregiver strain were associated with higher FCG anxiety. FCGs described the following themes related to the hospitalization: (1) added strain, (2) care-related worries, (3) keeping vigil, (4) need to be heard, and (5) enablers of FCGs. CONCLUSIONS Routine evaluation of caregiver strain and baseline patient function is integral to informing the transitional planning for persons with dementia. The FCG responses suggest that a multifactorial approach (family-centered policies of partnership in care, staff education addressing the specialized needs of patients and family members, and attention to promoting functional recovery) may benefit both hospitalized patients with dementia as well as FCGs and warrants future research.
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Affiliation(s)
- Marie Boltz
- Associate Professor, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Cushing Hall 203, Chestnut Hill, MA 02467
| | - Tracy Chippendale
- Assistant Professor, New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, New York, NY 10012, Phone: 212-998-9012
| | - Barbara Resnick
- Professor and Sonya Ziporkin Gershowitz Endowed Chair in Gerontology, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Phone: 410-706-5178
| | - James E. Galvin
- Professor of Neurology, Psychiatry, Nursing, Nutrition, and Population Health, Alzheimer Disease Center and Center for Cognitive Neurology, New York University Langone School of Medicine, 145 East 32nd St, 2nd Floor, New York, NY 10016, Phone: 212-263-0770
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49
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Nilsson A, Rasmussen BH, Edvardsson D. A threat to our integrity - Meanings of providing nursing care for older patients with cognitive impairment in acute care settings. Scand J Caring Sci 2015; 30:48-56. [DOI: 10.1111/scs.12220] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - David Edvardsson
- Department of Nursing; Umeå University; Umeå Sweden
- School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
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50
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Gage H, Cheynel J, Williams P, Mitchell K, Stinton C, Katz J, Holland C, Sheehan B. Service utilisation and family support of people with dementia: a cohort study in England. Int J Geriatr Psychiatry 2015; 30:166-77. [PMID: 24838443 DOI: 10.1002/gps.4118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to compare costs of caring for people with dementia in domiciliary and residential settings, central England. METHODS A cohort of people with dementia was recruited during a hospital stay 2008-2010. Data were collected by interview at baseline, and 6- and 12-month follow-up, covering living situation (own home with or without co-resident carer, care home); cognition, health status and functioning of person with dementia; carer stress; utilisation of health and social services; and informal (unpaid) caring input. Costs of formal services and informal caring (replacement cost method) were calculated. Costs of residential and domiciliary care packages were compared. RESULTS Data for 109 people with dementia were collected at baseline; 95 (87.2%) entered hospital from their own homes. By 12 months, 40 (36.7%) had died and 85% of the survivors were living in care homes. Over one-half of people with dementia reported social care packages at baseline; those living alone had larger packages than those living with others. Median caring time for co-resident carers was 400 min/day and 10 h/week for non co-resident carers. Residential care was more costly than domiciliary social care for most people. When the value of informal caring was included, the total cost of domiciliary care was higher than residential care, but not significantly so. Carer stress reduced significantly after the person with dementia entered a care home. CONCLUSIONS Caring for people with dementia at home may be more expensive, and more stressful for carers, than care in residential settings.
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