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Ajmera Y, Paul K, Khan MA, Kumari B, Kumar N, Chatterjee P, Dey AB, Chakrawarty A. The evaluation of frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults'. Asian J Psychiatr 2024; 94:103990. [PMID: 38447233 DOI: 10.1016/j.ajp.2024.103990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Delirium is a common complication in hospitalized older adults with multifactorial etiology and poor health outcomes. AIM To determine the frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults. METHODS A prospective observational study was performed in patients aged ≥60 years consecutively admitted to geriatric ward. Potential risk factors were assessed within 24 hours of hospital admission. Delirium screening was performed on admission and daily thereafter throughout the hospital stay using Confusion Assessment Method (CAM). Patients were followed up at 1-year post-discharge. RESULTS The study included 200 patients with mean age 73.1 ± 8.83 years. Incidence and prevalence rate of delirium were 5% and 20% respectively. Multivariable regression analysis revealed emergency admission (OR= 5.12 (1.94-13.57), p=0.001), functional dependency (Katz index of Independence in Activities of Daily Living (Katz-ADL) score <5) 2 weeks before admission (OR= 3.08 (1.30-7.33), p=0.011) and more psychopathological symptoms (higher Brief Psychiatric Rating Scale (BPRS) total score) (OR=1.12 (1.06-1.18), p=0.001) to be independently associated with delirium. Patients in delirium group had significantly high in-hospital mortality (OR= 5.02 (2.12-11.8), p=0.001) and post-discharge mortality (HR= 2.02 (1.13-3.61), p=0.017) and functional dependency (Katz-ADL score <5) (OR= 5.45 (1.49-19.31), p=0.01) at 1-year follow up. CONCLUSION Delirium is quite frequent in geriatric inpatients and is associated with high in-hospital and post-discharge mortality risk and long-term functional dependency. Emergency admission, pre-hospitalization functional dependency, and more general psychopathological symptoms are independently associated factors. Hence, earliest identification and treatment with early implementation of rehabilitation services is warranted.
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Affiliation(s)
- Yamini Ajmera
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karandeep Paul
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bharti Kumari
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Yang Y, Hou DL. Association of depressive symptoms and dementia among middle-aged and elderly community-dwelling adults: Results from the China Health and Retirement Longitudinal Study (CHARLS). Acta Psychol (Amst) 2024; 243:104158. [PMID: 38277731 DOI: 10.1016/j.actpsy.2024.104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND There has been a long-standing debate on whether depressive symptoms are associated with dementia. The aim of this study was to examine whether depressive symptoms were associated with a high risk for dementia in Chinese adults. METHODS A total of 13,426 Chinese adults (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS) baseline were selected for analysis. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CESD-10). Dementia was assessed by the Community Screening Instrument for Dementia (CSI-D). When using linear regression for sensitivity analysis, there is still a correlation between depressive symptoms and dementia. RESULTS Of the 13,426 respondents, the mean (SD) age was 60 (10) years old. The prevalence of depressive symptoms and dementia among participants was 38 % (n = 945) and 18.3 % (n = 2457), respectively. After fully adjusted for demographic factors, health behavior and psychological factors, living and working conditions factors, social network factors, and social policy factors, the cross-sectional analyses showed that depressive symptoms had an increased risk of dementia (OR = 1.390, 95%CI: 1.253-1.543), compared with those without depressive symptoms. In addition, sensitivity analyses of the association between depressive symptoms and dementia were unchanged when reanalyzing using linear regression. CONCLUSIONS In this study, depression symptoms may be associated with dementia. Regardless of whether depressive symptoms acts as a dementia risk factor or an early symptom, monitoring depressive symptoms is crucial to watch for potential dementia onset.
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Affiliation(s)
- Yang Yang
- Jinan Third People's Hospital, Jinan, China
| | - Da Long Hou
- Shandong Provincial Third Hospital, Shandong University, Jinan, China.
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Alviz Núñez M, Villa García MM, Gonzalez MC, Urrea MB, Velásquez-Tirado JD, Ocampo MV, Trzepacz PT, Franco JG. Practical Application of a Battery of Brief Tools to Evaluate Geriatric Medical Inpatients for the Three Ds. J Neuropsychiatry Clin Neurosci 2023; 36:63-69. [PMID: 37667628 DOI: 10.1176/appi.neuropsych.20230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The investigators aimed to identify the clinical characteristics of patients with or without delirium and preexisting depression, dementia, both, or neither by using validated tools easily administered in clinical practice. METHODS In this cross-sectional prospective observational study conducted in Medellín, Colombia, 200 geriatric inpatients were evaluated with the Delirium Diagnostic Tool-Provisional (DDT-Pro), Informant Questionnaire on Cognitive Decline in the Elderly, Hachinski Ischemic Scale, Cornell Scale for Depression in Dementia, and Charlson Comorbidity Index-short form. Delirium motor subtype, mortality, and length of hospital stay were assessed. RESULTS The study included 134 patients without delirium (67%), 14 with delirium only (7%), 16 with delirium and dementia (8%), 13 with delirium and depression (7%), and 23 with delirium, dementia, and depression (the three Ds) (12%). Prevalence rates of dementia (59%) and depression (55%) among 66 patients with delirium were higher than prevalence rates among patients without delirium (13% and 28%, respectively), suggesting that both conditions are risk factors. Main medical diagnoses, mortality, and dementia type did not differ among groups. Motor subtypes were similar among delirium groups. Patients in the delirium groups, except those in the delirium and depression group, were older than patients without delirium. Medical burden was highest among the patients with delirium and dementia and those with all three conditions. Delirium and dementia were more severe when comorbid with each other. Depression was most severe among patients with delirium and depression. Patients with all three conditions had a longer length of hospital stay than those without delirium. CONCLUSIONS Using brief tools to detect dementia and depression in conjunction with the DDT-Pro to assess delirium diagnosis and severity is feasible and enables a more in-depth evaluation of elderly hospitalized patients. Because previous longitudinal research suggests that these comorbid conditions influence prognosis following a delirium episode, better identification of the three Ds offers proactive interventional opportunities. Depression is an underrecognized risk factor for delirium.
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Affiliation(s)
- Marcela Alviz Núñez
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - María Margarita Villa García
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - Maria Carolina Gonzalez
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - María Botero Urrea
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - Juan D Velásquez-Tirado
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - María V Ocampo
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - Paula T Trzepacz
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - José G Franco
- Liaison Psychiatry Research Group, Medicine Faculty, Universidad Pontificia Bolivariana, Medellín, Colombia (Alviz Núñez, Villa García, Gonzalez, Botero Urrea, Velásquez-Tirado, Ocampo, Franco); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
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Masel EK, Antunes B, Schulz-Quach C. Palliative care in severe mental illnesses. BMC Palliat Care 2023; 22:31. [PMID: 36991479 DOI: 10.1186/s12904-023-01152-1] [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: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
In this editorial, we highlight the interaction between patients who are diagnosed with severe mental illness and their treatment within palliative care, a clinical area of specialized focus which has a multitude of complex impacts on affected patients, their (chosen) family members and caregivers, as well as the healthcare professionals who are caring for them.
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Affiliation(s)
- Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Bárbara Antunes
- Primary Care Unit, Department of Public Health and Primary care, Palliative and End of Life Care Research Group, University of Cambridge, Cambridge, UK
| | - Christian Schulz-Quach
- Centre for Mental Health, University Health Network, Toronto, Canada
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Division of Consultation and Liaison Psychiatry, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Long S, Hu L, Luo Y, Li Y, Ding F. Incidence and risk factors of falls in older adults after discharge: A prospective study. Int J Nurs Sci 2022; 10:23-29. [PMID: 36860715 PMCID: PMC9969166 DOI: 10.1016/j.ijnss.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to determine the incidence of falls and risk factors associated with falling in discharged older adults. Methods A prospective study was conducted on older adults who had been issued a discharge order in a Class A tertiary hospital in Chongqing, China, from May 2019 to August 2020. The risk of falling, depression, frailty, and daily activities were evaluated at discharge using the mandarin version of the fall risk self-assessment scale, Patient Health Questionnaire-9 (PHQ-9), FRAIL scale, and Barthel Index, respectively. The cumulative incidence function estimated the cumulative incidence of falls in older adults after discharge. And the risk factors of falls were explored using the sub-distribution hazard function in the competing risk model. Results In a total of 1,077 participants, the total cumulative incidence of falls at 1, 6 and 12 months after discharge was 4.45%, 9.03%, and 10.80%, respectively. The cumulative incidence of falls in older adults with depression (26.19%, 49.93%, and 58.53%, respectively) and those with physical frailty (21.59%, 41.67%, and 48.73%, respectively) was much higher than that in those without depression and physical frailty (P < 0.05). Depression, physical frailty, Barthel Index, length of hospital stay, re-hospitalization, being cared for by others, and the self-assessed risk of falling were directly associated with falls. Conclusions The incidence of falls among older adults discharged from the hospital has a cumulative effect with the lengthening of the discharge time. It is affected by several factors, especially depression and frailty. We should develop targeted intervention strategies to reduce falls for this group.
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Affiliation(s)
- Siyu Long
- Department of Nephrology, South China Hospital of Shenzhen University, Shenzhen, China
| | - Liangzhu Hu
- Department of Vascular Surgery, South China Hospital of Shenzhen University, Shenzhen, China
| | - Yetao Luo
- Department of Infectious Diseases, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yaling Li
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu Ding
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Corresponding author.
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The Effectiveness of the Integrated Care Model among Community-Dwelling Older Adults with Depression: A Quasi-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063306. [PMID: 35328996 PMCID: PMC8954662 DOI: 10.3390/ijerph19063306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Abstract
Depression is the second-leading cause of disability among older patients worldwide. This study examined the effectiveness of the Integrated Care Model (ICM) intervention in decreasing depression, suicide ideation, and psychological symptoms and improving life satisfaction among old patients with depression living in communities. The participants were allocated to either the intervention (n = 67) or control group (n = 76) from July 2018 to November 2018. All participants received the usual geriatric care for three months in eastern Taiwan. Additionally, participants in the intervention group were treated according to the ICM, including the assessment and management of health problems, improvements in spiritual and mental wellbeing, helping with activities of daily life and mobility, providing social welfare resources, and prevention of elder abuse. The patients in the experimental group showed significant improvement in the group-by-time effect on the Center for Epidemiologic Studies Depression Scale, the Brief Symptom Rating Scale, suicide ideation measures, and the Life Satisfaction Index over 18 weeks. The ICM should be included in routine geriatric care and adopted in hospitals, long-term care facilities, and communities
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Idaiani S, Indrawati L. Functional status in relation to depression among elderly individuals in Indonesia: a cross-sectional analysis of the Indonesian National Health Survey 2018 among elderly individuals. BMC Public Health 2021; 21:2332. [PMID: 34969381 PMCID: PMC8719407 DOI: 10.1186/s12889-021-12260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression among elderly individuals is related to physical illness, functional status, prolonged treatment and other factors. Depression is not effectively treated with medication but can be alleviated by treating the physical illness and improving functional status. Therefore, this study aims to determine the relationship between functional status and depression in elderly individuals in Indonesia. METHODS The data used were obtained from a national survey dataset, namely, the Basic Health Research and Socio-Economic Survey in 2018, which was carried out in 34 provinces and 514 districts or cities. The total number of respondents was 93,829, aged ≥60 years. Functional status and depression were assessed using the Barthel index and MINI (Mini International Neuropsychiatric Interview), respectively. Furthermore, data processing was carried out with the Statistical Package for Social Sciences (SPSS) version 26 program and analyzed using the chi-square test and multiple logistic regression with the complex sample method. RESULTS Elderly individuals with severe dependence were at the greatest risk of becoming depressed compared to those without functional impairment or with independence after considering sociodemographic factors and disease history have 5.730 (95% CI = 4.302-7.632) the adj odds. Furthermore, this figure was higher than that of individuals with total dependence have 4.147 (95% CI = 3.231-5.231) the adj odds. The physical illness experienced also played a role in the risk for depression, which was higher among elderly individuals with stroke and a history of injury. The sociodemographic factors involved include low education and economic levels. In contrast, the area of residence and marital status had no statistically significant effect on the relationship between functional disorders and depression. CONCLUSIONS Elderly individuals with decreased functional status are prone to depression. The highest probability for depression was observed among those with severe dependence compared to those with total dependence. Consequently, interventions that involve various sectors, including social and family support, are needed.
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Affiliation(s)
- Sri Idaiani
- National Institute of Health Research and Development, Ministry of Health of Republic of Indonesia, Jalan Percetakan Negara. 29, Jakarta, 10560 Indonesia
| | - Lely Indrawati
- National Institute of Health Research and Development, Ministry of Health of Republic of Indonesia, Jalan Percetakan Negara. 29, Jakarta, 10560 Indonesia
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Williams S, Morrissey AM, Steed F, Leahy A, Shanahan E, Peters C, O'Connor M, Galvin R, O'Riordan C. Early supported discharge for older adults admitted to hospital with medical complaints: a protocol for a systematic review. BMJ Open 2021; 11:e049297. [PMID: 34711593 PMCID: PMC8557271 DOI: 10.1136/bmjopen-2021-049297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. The concept has been researched extensively in the stroke population, showing reduced length of stay for patients and improved functional outcomes. This systematic review aims to explore the totality of evidence for the use of ESD in an older adult population who have been hospitalised with medical complaints. METHODS A systematic review of randomised controlled trials and quasi randomised controlled trials will be carried out in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies will be included if they provide an ESD intervention to older adults admitted to hospital for medical complaints compared with continuing inpatient care. MEDLINE, CINAHL, CENTRAL and EMBASE databases will be searched. The primary outcome measure will be length of hospital stay, secondary outcomes will include functional abilities, falls, quality of life, carer and patient satisfaction, unplanned emergency department re-presentation, unscheduled hospital readmission, nursing home admission or mortality. Titles and abstracts of studies will be screened independently by two authors. The Cochrane Risk of Bias Tool will be used independently by two reviewers to assess the methodological quality of the included studies. GRADE will be used to assess the quality of the body of evidence. A pooled meta-analysis will be conducted using RevMan software V.5.4.1, depending on the uniformity of the data. ETHICS AND DISSEMINATION The authors will present the findings of the review to a patient and public involvement stakeholder panel of older people that has been established at the Ageing Research Centre in the University of Limerick. Formal ethical approval is not required for the review as all data collected will be secondary data and will be analysed anonymously. PROSPERO REGISTRATION NUMBER CRD42021223112.
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Affiliation(s)
- Susan Williams
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
- University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Ann-Marie Morrissey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Fiona Steed
- University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
- University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Catherine Peters
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Clíona O'Riordan
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
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Boltz M, Kuzmik A, Resnick B, BeLue R. Recruiting and Retaining Dyads of Hospitalized Persons with Dementia and Family Caregivers. West J Nurs Res 2021; 44:319-327. [PMID: 34382886 DOI: 10.1177/01939459211032282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persons with dementia have high rates of hospitalization, and along with their caregivers commonly experience negative hospital outcomes. The recruitment and retention of acutely ill older adults with dementia and caregivers can pose a challenge to investigators and threaten the validity of findings. The challenges encountered in an ongoing cluster randomized clinical trial in dyads of hospitalized persons with dementia and family care partners are described. The trial tests the efficacy of a nurse-family partnership model that aims to improve the following: (a) the physical and cognitive recovery in hospitalized persons with dementia, and (b) caregiver preparedness and anxiety. Strategies that address challenges include careful preplanning and preparation with the hospital site, strong communication with dyads and between team members, and honoring preferences and needs related to communication.
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Affiliation(s)
- Marie Boltz
- The Pennsylvania State University, College of Nursing, University Park, PA, USA
| | - Ashley Kuzmik
- The Pennsylvania State University, College of Nursing, University Park, PA, USA
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Shaji P, McCabe C. A narrative review of preventive measures for postoperative delirium in older adults. ACTA ACUST UNITED AC 2021; 30:367-373. [PMID: 33769884 DOI: 10.12968/bjon.2021.30.6.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postoperative delirium (POD) is an acute neurological condition associated with changes in cognition and attention and disorganised thinking. Although delirium can affect patients from any age group, it is common in older patients and could lead to a longer hospital stay and a higher risks of mortality. This article presents findings from a literature review that identifies various strategies used by health professionals globally to prevent POD. A database search resulted in 25 articles that met the inclusion criteria. Thematic analysis and coding were used to combine recurrent ideas that emerged from the literature. Three themes were identified: early identification and screening, modifiable risk factors, and preventive interventions. Further research focusing on education and improving awareness about POD among nurses is essential.
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Affiliation(s)
| | - Catherine McCabe
- Associate Professor, Trinity College Dublin, School of Nursing and Midwifery, Dublin
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Wang Y, Li H, Ye H, Xie G, Wu S, Song S, Cheng B, Fang X. Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7-day cohort study from the International Surgical Outcomes Study. Psychogeriatrics 2021; 21:158-165. [PMID: 33415803 DOI: 10.1111/psyg.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
AIM Despite initiatives to increase elderly patients' access to surgical treatments, the prevalence and impact of postoperative infectious complications (PICs) in elderly patients in China are poorly described. The aim of our study was to describe PICs and associated mortality in elderly patients undertaking elective surgery in China. METHODS We analyzed data about elderly patients from China during the International Surgical Outcomes Study (ISOS), a 7-day prospective cohort study of outcomes after elective surgery in in-patient adults. All elderly patients (age ≥60 years) from 28 hospitals in China included in the ISOS study were included in this study as well. A review of 2014 elderly patients who underwent elective surgery in April 2014 was conducted. RESULTS Of 2014 elderly patients, 209 (10.4%) developed at least one postoperative complication. Infectious complications were most frequent, affecting 154 patients (7.6%); there was one death, or 0.6% 30-day mortality, which was a significantly higher rate than among patients without PICs (0%). The most frequent infectious complication was superficial surgical-site infection (3.3%). The length of hospital stay was longer in elderly patients with PICs than in those without PICs. Moreover, a total of 142 elderly patients (7.1%) were routinely sent to critical care after surgery, of whom 97 (68.3%) developed PICs. Compared to elderly patients admitted to a standard ward, those admitted to critical care immediately after surgery had a higher postoperative complication rate and critical care admission rate to treat complications. CONCLUSIONS The present prospective, multicentre study found that 7.6% of elderly patients in China had PICs after elective surgery that could prolong hospital stay and increase 30-day mortality. The clinical effectiveness of admission to critical care after surgery on elderly patients is not identified. Initiatives to increase elderly patients' access to surgical interventions should also enhance safe perioperative care to reduce PICs in China.
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Affiliation(s)
- Yan Wang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Li
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Ye
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guohao Xie
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuijing Wu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shengwen Song
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Baoli Cheng
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiangming Fang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Volland J, Fisher A, Drexler D. Management of hospital-acquired delirium. Nurs Manag (Harrow) 2020; 51:20-26. [PMID: 32842007 DOI: 10.1097/01.numa.0000694856.08598.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jennifer Volland
- Jennifer Volland is the vice president of program development at NRC Health in Lincoln, Neb. Anna Fisher is the director of education and quality at Hillcrest Health Services in Bellevue, Neb. Diane Drexler is the CNO at Yavapai Regional Medical Center in Prescott, Ariz
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Negro A, Leggieri C, Villa G, Lembo R, Signò F, Lanzalaco MR, Miconi L, Tira T, Ponzetta G, Dossi M, Marzo E, Rolandi S, D'Aloia P, Manara DF, Iannaccone S. Delirium prevalence point: an observational monocentric study in a tertiary university hospital. Ir J Med Sci 2020; 190:793-798. [PMID: 32812115 DOI: 10.1007/s11845-020-02348-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delirium is a serious and common condition that needs an upgrade of the scientific and clinical attention. AIM To assess the delirium prevalence in an Italian university hospital. METHODS The monocentric 1-day observational study cohort has been conducted on March 15, 2018; the population was composed of adult hospitalized patients. All the eligible patients have been evaluated for the presence of delirium with the 4AT. RESULTS We enrolled 596 patients. Twenty-nine Acute and 3 Rehabilitation Units were involved in the study. The median age of the sample was 60 (IQR 48-74) and 52% (n = 313) were male. Patients from medical units were 42% (n = 252), from surgery units 41% (n = 249), and from rehabilitation units 15% (n = 95). Results of 4AT showed that 5.4% (n = 32) had delirium (4AT = 4), 12% (n = 73) had cognitive impairment (4AT = 1-3), and 82% (n = 491) had no delirium or cognitive impairment (4AT = 0). We found association between delirium and age, BMI, mortality at 30 days, and hospital mortality. Delirium was related with Barthel Index, dementia, and anticholinesterase inhibitors. About devices in use, we observed a correlation of delirium with central venous catheter, feeding tube, and urinary catheter. Physical restraints were also correlated to delirium. CONCLUSIONS We confirmed the presence of delirium across the hospital units, more in medical than in surgical ones. We found associations of delirium with conditions that limit movement, such as dementia, physical restraints, or devices. The development of delirium initiates a cascade of events culminating in the loss of independence and increased morbidity.
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Affiliation(s)
- Alessandra Negro
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carlo Leggieri
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giulia Villa
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy.
| | - Rosalba Lembo
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Signò
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Lucia Miconi
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Tiziana Tira
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giuseppe Ponzetta
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Mauro Dossi
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Stefano Rolandi
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | | | - Sandro Iannaccone
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
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14
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Guerzoni V, Lanzoni A, Pozzi C, Paci M, Gatti R, Benedetti MG, Gentile S, Trabucchi M, Bellelli G, Morandi A. A two-year multicenter point prevalence study of older patients with hip fractures admitted to rehabilitation units in Italy. Eur Geriatr Med 2020; 11:573-580. [PMID: 32710164 DOI: 10.1007/s41999-020-00363-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To date in Italy we do not have sufficient information on the rehabilitation process of older patients with hip fractures especially in the context of dementia. The main aims of the study were to gather information on the characteristics of older patients with hip fracture admitted to rehabilitation units with a specific focus on geriatric syndromes and the rehabilitation process. METHODS A national multi-center "point prevalence study" was conducted in Italy over two index days in 2017 and 2018. All patients aged 70 years and older hospitalized on the index day in Rehabilitation Units after a hip fracture were eligible. RESULTS A total of 615 patients were included. Most of the hospitals involved were from northern Italy, to a lesser extent from central and from southern Italy. The mean age was 83.08 ± 7.9 years. Almost half of the patients lived alone before the hip fracture. Most of the falls happened at home and while walking. The prevalence of delirium, dementia and malnutrition was 9.1%, 36.6%, and 19.3%, respectively. Antidepressants were prescribed in 27% of the population. The multidisciplinary team was activated as follows: occupational therapist in 18.9% of the cases, psychologists in 14.5%, social workers in 15.3%, and speech therapists in 6.5%. CONCLUSION The study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the correct management of geriatric syndromes in this frail population. Future multicenter longitudinal studies are required to further study this population.
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Affiliation(s)
| | | | - Christian Pozzi
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland.,Geriatric Research Group, Brescia, Italy
| | - Matteo Paci
- Unit of Functional Rehabilitation, Azienda USL, Toscana Centro, Firenze, Italy
| | - Roberto Gatti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele and Humanitas Clinical and Research Center, Rozzano, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Gentile
- Geriatric Research Group, Brescia, Italy.,Unit of Functional Rehabilitation, Azienda USL, Toscana Centro, Firenze, Italy
| | - Marco Trabucchi
- Italian Psychogeriatric Association, Brescia, Italy.,Department of Health Science, University of Milano-Bicocca and Geriatric Clinic, S. Gerardo Hospital, Monza, Italy
| | - Giuseppe Bellelli
- Department of Health Science, University of Milano-Bicocca and Geriatric Clinic, S. Gerardo Hospital, Monza, Italy
| | - Alessandro Morandi
- Geriatric Research Group, Brescia, Italy. .,Department of Rehabilitation and Aged Care Hospital Ancelle, Fondazione Teresa Camplani, Cremona, Italy. .,Institute of Research and Parc Sanitari Pere Virgili, Barcelona, Spain. .,Rehabilitation Hospital Ancelle Di Cremona (Italy), Via Aselli 14, 26100, Cremona, CR, Italy.
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Gehlawat P, Singhai K, Suthar N. The 3 Ds of geriatric psychiatry: A case report. J Family Med Prim Care 2020; 9:2509-2510. [PMID: 32754531 PMCID: PMC7380787 DOI: 10.4103/jfmpc.jfmpc_221_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022] Open
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16
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Abstract
Hospital-acquired delirium often goes unnoticed because the signs and symptoms resemble those of dementia and depression, making diagnosis difficult. This article explores the differences between delirium, dementia, and depression and discusses the role of nursing in patient assessment and education.
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