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Karjalainen KJ, Tuori H, Salminen M, Peltonen J, Rantanen S, Viikari P, Viitanen M, Nuotio MS, Viikari L. AEGIS-AcutE Geriatric Intervention Study: pilot study of frontline acute geriatric assessment to improve quality of care in emergency department. Age Ageing 2024; 53:afae171. [PMID: 39113469 PMCID: PMC11306315 DOI: 10.1093/ageing/afae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/31/2024] [Indexed: 08/11/2024] Open
Abstract
INTRODUCTION Due to the increasing number of older patients in emergency departments (EDs) with frailty, cognitive impairment and multimorbidity, there is a need for geriatric expertise in EDs. METHODS This retrospective study is of older patients visiting Turku University Hospital ED between 2 January and 31 December 2022. Patients aged 75 years of older were screened for frailty using Triage Risk Screening Tool (TRST) and Clinical Frailty Scale (CFS). Nonacute, frail patients (CFS ≥4) suitable for Targeted Geriatric Assessment (TGA) (n = 1096) were scanned for the risk of delirium, cognitive impairment, change in functional status, falls, malnutrition and depression. A comprehensive patient record was made with recommendations for future care. RESULTS TRST was completed in 70% of the ED visits, and two-thirds of those were considered high-risk. Among the patients assessed by the geriatric team (TGA), nonspecific complaint (38%) and falls (35%) were the main reasons for ED admission. Cognitive impairment was present in over 60% and orthostatic hypotension in 40% of the patients. The 72-hour revisit rate for TGA-patients was 2.3%. For the real-life control group, the 72-hour revisit rate was 4.6% (P = .001). Thirty-day revisit rates were 10% and 16%, respectively (P < .001). The need for rehabilitation, cognitive evaluation and intensifying home care were the main recommendations for future care. CONCLUSIONS TGA approach provides structured and accurate information on older patients' background. This may lead to more precise diagnostics, a thorough consideration of hospital intake and a secure discharge from the ED. Ensuring continuity of care may help to reduce readmissions to EDs.
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Affiliation(s)
- Kaisa J Karjalainen
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | - Hannele Tuori
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
- Tyks Acute/Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | - Marika Salminen
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
- Department of General Practice, Faculty of Medicine/Clinical Medicine, University of Turku and The wellbeing services county of SouthwestFinland
| | - Juha Peltonen
- Tyks Acute/Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | - Sirpa Rantanen
- Tyks Acute/Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | - Paula Viikari
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | - Matti Viitanen
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Maria S Nuotio
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | - Laura Viikari
- Department of Geriatric Medicine, Faculty of Medicine/Clinical Medicine, University of Turku and Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
- Tyks Acute/Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
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Väisänen V, Ruotsalainen S, Hietapakka L, Sulander J, Sinervo T. The role of workday characteristics on perceived stress and time pressure among nurses in Finnish long-term care - a cross-sectional study. BMC Health Serv Res 2024; 24:878. [PMID: 39095796 PMCID: PMC11295524 DOI: 10.1186/s12913-024-11294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Aging populations and nursing workforce issues are causing challenges for long-term care globally, and therefore, improving the work-related wellbeing and retention of nurses is crucial. As such, gaining a further understanding of the factors that affect work strain in long-term care is important. Previously, the effect of job demands on the wellbeing of nurses has been researched principally by subjective instruments. In this study, we examined the relationship between indirectly measured workday characteristics and perceived stress and time pressure among nurses working in Finnish long-term care (assisted living facilities with 24-hour assistance). METHODS A total of 503 nurses from 44 assisted living facilities across Finland completed time measurement surveys and wellbeing questionnaires. The data were linked with client characteristics from the Resident Assessment Instrument register. The relationships between the measured number of care events during the workday, clients' care needs, and the amount of breaktime and perceived stress and time pressure were analyzed using multivariate logistic regression. RESULTS Nurses who had more care events and clients with greater care needs were at higher odds of having high stress. More care events and reduced breaktime were associated with high time pressure. Disruptions during the workday were strongly associated with both high stress and time pressure. Last, nurses who were under high stress and time pressure worked more often in teams with lower team autonomy. CONCLUSIONS Our findings on indirectly measured job demands indicate that dividing the workload equally among nurses through better work division can help reduce the stress and time pressure of nurses in long-term care. In addition, ensuring sufficient breaktime and preventing unnecessary disruptions is important. To help recruit and retain the care workforce, fair management of work that accounts for varying client care needs and workload is needed. In addition, legislative and governance tools, such as staffing level regulation, and further consideration of job demands might aid in reducing the job strain of nurses. PATIENT OR PUBLIC CONTRIBUTION Patients or nurses were not involved in the design of the study, analysis, or interpretation of the results, or in the preparation of the manuscript.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland.
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
| | - Salla Ruotsalainen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
| | - Laura Hietapakka
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
| | - Juhani Sulander
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
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Korhonen K, Moustgaard H, Murphy M, Martikainen P. Trends in Life Expectancy in Residential Long-Term Care by Sociodemographic Position in 1999-2018: A Multistate Life Table Study of Finnish Older Adults. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae067. [PMID: 38629853 PMCID: PMC11157624 DOI: 10.1093/geronb/gbae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES Residential long-term care (LTC) use has declined in many countries over the past years. This study quantifies how changing rates of entry, exit, and mortality have contributed to trends in life expectancy in LTC (i.e., average time spent in LTC after age 65) across sociodemographic groups. METHODS We analyzed population-register data of all Finns aged ≥65 during 1999-2018 (n = 2,016,987) with dates of LTC and death and sociodemographic characteristics. We estimated transition rates between home, LTC, and death using Poisson generalized additive models, and calculated multistate life tables across 1999-2003, 2004-2008, 2009-2013, and 2014-2018. RESULTS Between 1999-2003 and 2004-2008, life expectancy in LTC increased from 0.75 (95% CI: 0.74-0.76) to 0.89 (95% CI: 0.88-0.90) years among men and from 1.61 (95% CI: 1.59-1.62) to 1.83 (95% CI: 1.81-1.85) years among women, mainly due to declining exit rates from LTC. Thereafter, life expectancy in LTC decreased, reaching 0.80 (95% CI: 0.79-0.81) and 1.51 (95% CI: 1.50-1.53) years among men and women, respectively, in 2014-2018. Especially among women and nonmarried men, the decline was largely due to increasing death rates in LTC. Admission rates declined throughout the study period, which offset the increase in life expectancy in LTC attributable to declining mortality in the community. Marital status differences in life expectancy in LTC narrowed over time. DISCUSSION Recent declines in LTC use were driven by postponed LTC admission closer to death. The results suggest that across sociodemographic strata older adults enter LTC in even worse health and spend a shorter time in care than before.
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Affiliation(s)
- Kaarina Korhonen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heta Moustgaard
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Institute for Social Sciences and Humanities (HSSH), University of Helsinki, Helsinki, Finland
| | - Michael Murphy
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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sm-Rahman A, Meinow B, Hydén LC, Kelfve S. Long-term care use among people living with dementia: a retrospective register-based study from Sweden. BMC Geriatr 2022; 22:998. [PMID: 36572863 PMCID: PMC9793631 DOI: 10.1186/s12877-022-03713-0] [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: 05/13/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although many people with dementia need progressive support during their last years of life little is known to what extent they use formal long-term care (LTC). This study investigates the use of LTC, including residential care and homecare, in the month preceding death, as well as the number of months spent in residential care, among Swedish older decedents with a dementia diagnosis, compared with those without a dementia diagnosis. METHODOLOGY This retrospective cohort study identified all people who died in November 2019 in Sweden aged 70 years and older (n = 6294). Dementia diagnoses were collected from the National Patient Register (before death) and the National Cause of Death Register (death certificate). The use of LTC was based on the Social Services Register and sociodemographic factors were provided by Statistics Sweden. We performed regression models (multinomial and linear logistic regression models) to examine the association between the utilization of LTC and the independent variables. RESULTS Not only dementia diagnosis but also time spent with the diagnosis was crucial for the use of LTC in the month preceding death, in particular residential care. Three out of four of the decedents with dementia and one fourth of those without dementia lived in a residential care facility in the month preceding death. People who were diagnosed more recently were more likely to use homecare (e.g., diagnosis for 1 year or less: home care 29%, residential care 56%), while the predicted proportion of using residential care increased substantially for those who had lived longer with a diagnosis (e.g., diagnosis for 7 + years: home care 11%, residential care 85%). On average, people with a dementia diagnosis stayed six months longer in residential care, compared with people without a diagnosis. CONCLUSIONS People living with dementia use more LTC and spend longer time in residential care than those without dementia. The use of LTC is primarily influenced by the time with a dementia diagnosis. Our study suggests conducting more research to investigate differences between people living with different dementia diagnoses with co-morbidities.
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Affiliation(s)
- Atiqur sm-Rahman
- grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linköping University, Norrköping, Sweden
| | - Bettina Meinow
- grid.10548.380000 0004 1936 9377Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden ,grid.419683.10000 0004 0513 0226Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Lars-Christer Hydén
- grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linköping University, Norrköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Dementia Research (CEDER), Linköping University, Norrköping, Sweden
| | - Susanne Kelfve
- grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linköping University, Norrköping, Sweden ,grid.10548.380000 0004 1936 9377Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden ,grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Social Work (SOCARB), Linköping University, Norrköping, Sweden
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Vargese SS, Halonen P, Raitanen J, Forma L, Jylhä M, Aaltonen M. Comorbidities in dementia during the last years of life: a register study of patterns and time differences in Finland. Aging Clin Exp Res 2021; 33:3285-3292. [PMID: 33939125 PMCID: PMC8668841 DOI: 10.1007/s40520-021-01867-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Comorbidities have major implications for the care of people with dementia. AIM To investigate the patterns of comorbidities in dementia in the last five years of life and how these patterns differed between three cohorts. METHODS The study included people who died at age 70 and above in 2001 (n = 13,717), 2007 (n = 34,750) and 2013 (n = 38,087) in Finland. ICD-10 morbidity data for a five-year period prior to death were extracted from national registers. Principal component analysis was employed to identify patterns for several morbidities. The associations of principal component scores with dementia were analysed using binary logistic regression. Linear regression was used to examine changes in the number of morbidities in patterns over time. RESULTS The morbidity patterns identified in the last years of life were (1) cardiometabolic disorders, (2) neurological, (3) cerebrovascular diseases and (4) musculoskeletal, thyroid and psychiatric disorders. Among the patterns, neurological and musculoskeletal, thyroid and psychiatric disorders were associated with dementia. The number of diagnoses in the cerebrovascular pattern increased and those in the musculoskeletal, thyroid and psychiatric pattern decreased over time. DISCUSSION Comorbidity patterns identified in this nationwide register study are largely in line with previous evidence. Time difference in these patterns provide crucial information for service planning. CONCLUSIONS Comorbidities in dementia in the last years of life occur in patterns and change over time. More systematic monitoring and updated clinical guidelines are needed for the care of comorbidities with dementia.
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Affiliation(s)
- Saritha Susan Vargese
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland.
| | - Pauliina Halonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Leena Forma
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
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Viljanen A, Salminen M, Irjala K, Heikkilä E, Isoaho R, Kivelä SL, Korhonen P, Vahlberg T, Viitanen M, Wuorela M, Löppönen M, Viikari L. Chronic conditions and multimorbidity associated with institutionalization among Finnish community-dwelling older people: an 18-year population-based follow-up study. Eur Geriatr Med 2021; 12:1275-1284. [PMID: 34260040 PMCID: PMC8626405 DOI: 10.1007/s41999-021-00535-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
Aim The aim of the study is to assess the association of chronic conditions and multimorbidity with institutionalization in older people. Findings Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. Message These risk factors should be recognized in primary care when providing and targeting care and support for home-dwelling older people. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00535-y. Purpose The ageing population is increasingly multimorbid. This challenges health care and elderly services as multimorbidity is associated with institutionalization. Especially dementia increases with age and is the main risk factor for institutionalization. The aim of this study was to assess the association of chronic conditions and multimorbidity with institutionalization in home-dwelling older people, with and without dementia. Methods In this prospective study with 18-year follow-up, the data on participants’ chronic conditions were gathered at the baseline examination, and of conditions acquired during the follow-up period from the municipality’s electronic patient record system and national registers. Only participants institutionalized or deceased by the end of the follow-up period were included in this study. Different cut-off-points for multimorbidity were analyzed. Cox regression model was used in the analyses. Death was used as a competing factor. Results The mean age of the participants (n = 820) was 74.7 years (64.0‒97.0). During the follow-up, 328 (40%) were institutionalized. Dementia, mood disorders, neurological disorders, and multimorbidity defined as five or more chronic conditions were associated with a higher risk of institutionalization in all the participants. In people without dementia, mood disorders and neurological disorders increased the risk of institutionalization. Conclusion Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. These risk factors should be recognized when providing and targeting care and support for older people still living at home. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00535-y.
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Affiliation(s)
- Anna Viljanen
- Health Care Center, Municipality of Lieto, Hyvättyläntie 7, 21420, Lieto, Finland. .,Unit of Geriatrics, Department of Clinical Medicine, Faculty of Medicine, Turku City Hospital, FI-20014 University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.
| | - Marika Salminen
- Welfare Division, City of Turku, Yliopistonkatu 30, 20101, Turku, Finland.,Unit of Family Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland
| | - Kerttu Irjala
- Unit of Clinical Chemistry, Department of Clinical Medicine, Faculty of Medicine, TYKSLAB, 20521, Turku, Finland
| | - Elisa Heikkilä
- Unit of Clinical Chemistry, Department of Clinical Medicine, Faculty of Medicine, TYKSLAB, 20521, Turku, Finland
| | - Raimo Isoaho
- Unit of Family Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,Social and Health Care, City of Vaasa, Ruutikellarintie 4, 65101, Vaasa, Finland
| | - Sirkka-Liisa Kivelä
- Unit of Family Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,Division of Social Pharmacy, Faculty of Pharmacy, University of Helsinki, 00014, Helsinki, Finland
| | - Päivi Korhonen
- Unit of Family Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland
| | - Tero Vahlberg
- Unit of Biostatistics, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Matti Viitanen
- Unit of Geriatrics, Department of Clinical Medicine, Faculty of Medicine, Turku City Hospital, FI-20014 University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Maarit Wuorela
- Unit of Geriatrics, Department of Clinical Medicine, Faculty of Medicine, Turku City Hospital, FI-20014 University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.,Welfare Division, City of Turku, Yliopistonkatu 30, 20101, Turku, Finland
| | - Minna Löppönen
- Social and Health Care for Elderly, City of Raisio, Sairaalakatu 5, 21200, Raisio, Finland
| | - Laura Viikari
- Unit of Geriatrics, Department of Clinical Medicine, Faculty of Medicine, Turku City Hospital, FI-20014 University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.,Welfare Division, City of Turku, Yliopistonkatu 30, 20101, Turku, Finland
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Salminen M, Laine J, Vahlberg T, Viikari P, Wuorela M, Viitanen M, Viikari L. Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study. Eur Geriatr Med 2020; 11:745-751. [PMID: 32500517 PMCID: PMC7550301 DOI: 10.1007/s41999-020-00338-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Abstract
Aim To examine the effect of predictive factors on institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic during a 3-year follow-up. Findings The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The use of home care, dementia, higher age and falls during the previous 12 months significantly predicted institutionalization during the follow-up. Message Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home. Purpose To examine the effect of predictive factors on institutionalization among older patients. Methods The participants were older (aged 75 years or older) home-dwelling citizens evaluated at Urgent Geriatric Outpatient Clinic (UrGeriC) for the first time between the 1st of September 2013 and the 1st of September 2014 (n = 1300). They were followed up for institutionalization for 3 years. Death was used as a competing risk in Cox regression analyses. Results The mean age of the participants was 85.1 years (standard deviation [SD] 5.5, range 75–103 years), and 74% were female. The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The mean age for institutionalization was 86.1 (SD 5.6) years. According to multivariate Cox regression analyses, the use of home care (hazard ratio 2.43, 95% confidence interval 1.80–3.27, p < 0.001), dementia (2.38, 1.90–2.99, p < 0.001), higher age (≥ 95 vs. 75–84; 1.65, 1.03–2.62, p = 0.036), and falls during the previous 12 months (≥ 2 vs. no falls; 1.54, 1.10–2.16, p = 0.012) significantly predicted institutionalization during the 3-year follow-up. Conclusion Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.
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Affiliation(s)
- Marika Salminen
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.
- Faculty of Medicine, Unit of Family Medicine, University of Turku, Joukahaisenkatu 3-5 A, 20014, Turku, Finland.
| | - Jonna Laine
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tero Vahlberg
- Institute of Clinical Medicine, Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014, Turku, Finland
| | - Paula Viikari
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Maarit Wuorela
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Matti Viitanen
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Laura Viikari
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
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Nakano Y, Kondo T, Murohara T, Yamauchi K. Option of Using Peripherally Inserted Central Catheters in Elderly Patients With Dementia: An Observational Study. Gerontol Geriatr Med 2020; 6:2333721420906922. [PMID: 32128353 PMCID: PMC7031784 DOI: 10.1177/2333721420906922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Peripherally inserted central catheters (PICCs) facilitate the treatment of several diseases. Here, we assessed the clinical course of elderly patients with dementia using PICCs. Methods: This retrospective observational study was conducted at a single dementia treatment center. PICCs were used in elderly inpatients with dementia who required (a) intravenous therapy, supplemental parenteral nutrition, and dysphagia rehabilitation during acute illness; (b) end-of-life care; (c) total parenteral nutrition (TPN); or (d) an alternative to peripheral vascular (PV) access. Results: Fifty-nine patients were enrolled (83.5 ± 6.9 years): 61% were in the acute treatment group, and 17% were in the end-of-life care group. The median catheter lifespan was 42 (23-87.5) days. The incidence of catheter-related bloodstream infection was 0.22 per 1,000 PICC-days, and that of deep venous thrombosis was 0.66 per 1,000 PICC-days. Among the patients in acute treatment group, 19% resumed sufficient oral intake after the treatment using PICC, and 36% resumed oral intake of gelatin-like food. Among the patients in the end-of-life care group, 91% received intravenous fluids continuously until death by initially inserted PICC. Conclusion: In elderly patients with dementia, PICCs might be one of the options during the treatment of acute illness as well as for prolonged support during end-of-life care.
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Affiliation(s)
- Yoshihisa Nakano
- Toin Hospital, Toin-cho, Japan.,Nagoya University Graduate School of Medicine, Japan
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