Prognosis of Treatment Outcomes by Cognitive and Physical Scales

Prevalence and risk factors of delirium and subsyndromal delirium in older adults

Background

Delirium is a common geriatric problem associated with poor outcomes. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium yet, not satisfying the definition of full-blown delirium, defined by categorical elements, and is usually referred to as the presence of one or more symptoms in the confusion assessment method (CAM). This study aimed to investigate the prevalence and risk factors of delirium and SSD in older adults admitted to the hospital. Five hundred eighty-eight elderly (above 65 years) Egyptian patients were recruited from January 2019 to February 2020. After explaining the purpose of the study and assuring the confidentiality of all participants, an informed consent was obtained from the participant or a responsible care giver for those who were not able to give consent. All patients were subjected ‘on admission’ to thorough history taking, clinical examination, and comprehensive geriatric assessment including confusion assessment tools, mini-mental state examination, and functional assessment using Barthel index score.

Results

The current study showed that 19.6% of patients had delirium and 14.1% of patients had SSD with combined prevalence of 33.7%. Most common causes included metabolic, infection, organic brain syndrome, and dehydration. The current study reported significant proportionate relation between cognitive assessment and functional ability, so patients with a score of 23 MMSE had good functional ability, while cognitive assessment using mini-mental score shows inversed relation to delirium and SSD using CAM score.

Conclusion

Delirium is independently associated with adverse short-term and long-term outcomes, including an increase in mortality, length of hospital stay, discharge to an institution, and functional decline on discharge. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium, not yet satisfying the definition of full-blown delirium but it can identify patients with early cognitive and functional disabilities, and because of high prevalence of delirium and SSD. Efforts to prevent or early detection may identify patients who warrant clinical attention.

Discharge Planning and Home Care Needs Assessment for Older Patients in a Nursing Hospital

Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and to identify their home care needs by applying the international InterRAI Home Care (HC) assessment form. Material and methods: 152 geriatric patients (older than 65 years of age) discharged after a 90-120-day stay at a nursing hospital were examined using face-to-face interviews. The data from the medical records were also assessed. The capacities of patients were discussed with the patients themselves, nursing personnel, and relatives of the patients. Results: The analysis revealed that 45.4% of the respondents had severely impaired cognitive skills, while 27.6% had moderately impaired cognitive skills for decision making in daily living. People with greater cognitive difficulties were more dependent during daily instrumental activities and ordinary daily activities. The strongest relationship was established among the cognitive skills and management of medications, management of finances, and ordinary housework. For the greater part of respondents, a special need for permanent nursing (57.9%) or assistance (25.7%) was determined, i.e., official, state-funded nursing at home was appointed. The remaining respondents (16.4%) were not appointed further state-funded nursing or assistance at home, but an assessment of the independence of these patients based on the InterRai Activities of Daily Living Hierarchy Scale indicated that these skills varied from moderate independence (decision making was difficult only in new situations) to severely impaired skills (made no independent decisions or they were scarce). Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Conclusions: The low independence observed in all participants, as well as their limited capacities, prove the need for nursing services at home and the necessity of their continuity. Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing.

Functional limitations and cognitive impairment predict the outcome of dysphagia in older patients after an acute neurologic event

BACKGROUND

Dysphagia prevalence increases with age and a significant contribution is given by stroke survivors; its treatment is mainly based on rehabilitation, but outcome cannot be easily predicted.

OBJECTIVE

The aim of this study is to detect possible predictors of the outcome of dysphagia in patients beginning rehabilitation after a major Central Nervous System injury.

METHODS

Dysphagia severity was measured in 95 consecutive patients (71 with ischemic or hemorrhagic stroke) upon admission to our neurorehabilitation unit and at discharge, during the year 2017. The initial evaluation included also demographic data, functional and geriatric multidimensional assessment, laboratory test results and comorbidities. Their possible predictive value on the degree of recovery of the swallowing process at discharge has been analyzed.

RESULTS

Poor functional conditions and the presence of cognitive impairment on admission appear to be associated with a worse outcome of dysphagia at discharge. A significant correlation exists between scores at functional scales at the beginning of rehabilitation and dysphagia score at discharge. Patients with cognitive impairment at the beginning (n = 60) showed a significantly lower degree of recovery of dysphagia at discharge.

CONCLUSION

Other factors, beside the degree of dysphagia itself, are important to predict its outcome. Their knowledge not only allows an initial prognostic assessment; it can also be useful to decide which aspects should receive greater attention when treating patients with dysphagia.