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Martín Moreno V, Martínez Sanz MI, Fernández Gallardo M, Martín Fernández A, Benítez Calderón MP, Alonso Samperiz H, Pérez Rico E, Calderón Jiménez L, Guerra Maroto S, Sánchez Rodríguez E, Sevillano Fuentes E, Sánchez González I, Recuero Vázquez M, Herranz Hernando J, León Saiz I. The influence of nationwide COVID-19 lockdown on the functional impairment and long-term survival of dependent people for carrying out basic activities of daily living in a neighborhood of the city of Madrid, Spain: Orcasitas Cohort Longitudinal Study. Front Public Health 2024; 12:1385058. [PMID: 39045161 PMCID: PMC11263189 DOI: 10.3389/fpubh.2024.1385058] [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: 02/11/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
Background Prolonged confinement can lead to personal deterioration at various levels. We studied this phenomenon during the nationwide COVID-19 lockdown in a functionally dependent population of the Orcasitas neighborhood of Madrid, Spain, by measuring their ability to perform basic activities of daily living and their mortality rate. Methods A total of 127 patients were included in the Orcasitas cohort. Of this cohort, 78.7% were female, 21.3% were male, and their mean age was 86 years. All participants had a Barthel index of ≤ 60. Changes from pre- to post-confinement and 3 years afterward were analyzed, and the effect of these changes on survival was assessed (2020-2023). Results The post-confinement functional assessment showed significant improvement in independence over pre-confinement for both the Barthel score (t = -5.823; p < 0.001) and the classification level (z = -2.988; p < 0.003). This improvement progressively disappeared in the following 3 years, and 40.9% of the patients in this cohort died during this period. These outcomes were associated with the Barthel index (z = -3.646; p < 0.001) and the level of dependence (hazard ratio 2.227; CI 1.514-3.276). Higher mortality was observed among men (HR 1.745; CI 1.045-2.915) and those with severe dependence (HR 2.169; CI 1.469-3.201). Setting the cutoff point of the Barthel index at 40 provided the best detection of the risk of death associated with dependence. Conclusions Home confinement and the risk of death due to the COVID-19 pandemic awakened a form of resilience in the face of adversity among the population of functionally dependent adults. The Barthel index is a good predictor of medium- and long-term mortality and is a useful method for detecting populations at risk in health planning. A cutoff score of 40 is useful for this purpose. To a certain extent, the non-institutionalized dependent population is an invisible population. Future studies should analyze the causes of the high mortality observed.
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Affiliation(s)
- Vicente Martín Moreno
- Orcasitas Health Care Center and i+12 Research Institute of the Doce de Octubre Hospital, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - María Inmaculada Martínez Sanz
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Miriam Fernández Gallardo
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Amanda Martín Fernández
- Polibea Concert, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - María Palma Benítez Calderón
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Helena Alonso Samperiz
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Elena Pérez Rico
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Laura Calderón Jiménez
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Sara Guerra Maroto
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Elena Sánchez Rodríguez
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Eva Sevillano Fuentes
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Irene Sánchez González
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Miguel Recuero Vázquez
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Nursing Home Care Unit of the Center, Madrid, Spain
| | - Julia Herranz Hernando
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
| | - Irene León Saiz
- Orcasitas Health Care Center, Grupo de Investigación sobre Dependencia en Orcasitas (GIDO Collaborative Group), Madrid, Spain
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Harale M, Oommen A, Faruqi AA, Mundada M, Pancholi T, Yammanuru B, Yekkaluru SV, Reddy RH, Gupta AD. Cross-Sectional Study Comparing Activities of Daily Living Using Barthel Index Within a Geriatric Population Having Non-Communicable Diseases. Cureus 2024; 16:e65046. [PMID: 39165449 PMCID: PMC11335172 DOI: 10.7759/cureus.65046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/21/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction Disabilities and non-communicable diseases (NCDs) are prevalent among the elderly, significantly affecting their quality of life. Comprehensive population-based data are essential for effective healthcare planning and rehabilitation. This study aims to determine the prevalence of self-reported disabilities and compare Barthel Index scores among elderly individuals with and without NCDs. Methods A cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Pune, involving 102 patients aged 60 years and above. Patients with a history of strokes or limb amputations were excluded. Data on demographics, comorbidities, and functional status were collected using a structured questionnaire designed based on Barthel Index scoring to assess the activities of daily living (ADL). Results The study included 102 participants: 58 males (56.9%) and 44 females (43.1%). Age distribution showed 73.5% in the 60-74 age group, 22.5% in the 75-84 age group, and 3.9% in the 85+ age group. Comorbidity data revealed that 37.3% had no comorbidities, 26.4% had one comorbidity, and 36.3% had two or more comorbidities. The mean Barthel Index scores were 87.11 for those without comorbidities, 83.89 for those with one comorbidity, and 82.30 for those with two or more comorbidities. The most affected activities were stair climbing (75.7%), bowel control (48.5%), and mobility (47.1%). Conclusion NCDs significantly impact daily activities in the elderly, underscoring the need for targeted healthcare interventions to improve their quality of life. This study highlights the importance of comprehensive care strategies to address the specific needs of elderly patients with comorbidities.
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Affiliation(s)
- Manasi Harale
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Arun Oommen
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ahsan A Faruqi
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Mayank Mundada
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Tushar Pancholi
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Bhavya Yammanuru
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sree Vidya Yekkaluru
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Raju Hansini Reddy
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Abishak D Gupta
- General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
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Thorsted AB, Thygesen LC, Jezek AH, Pedersen MM, Jorgensen MG, Vinding K, Kannegaard PN, Pedersen SGH. The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study. Arch Gerontol Geriatr 2024; 120:105325. [PMID: 38237375 DOI: 10.1016/j.archger.2024.105325] [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: 11/05/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility. METHODS A nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0-24), low mobility (DEMMI=27-39), moderately reduced mobility (DEMMI=41-57), and independent mobility (DEMMI=62-100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. RESULTS HRs for readmission within 30-days were 1.36 (1.24-1.48) for very low mobility, 1.30 (1.20-1.42) for low mobility and 1.17 (1.08-1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29-10.53) for lowest compared with the highest DEMMI mobility subcategory. CONCLUSION In geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.
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Affiliation(s)
- Anne B Thorsted
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Andrea H Jezek
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Mette M Pedersen
- Department of Clinical Research and Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital at Amager and Hvidovre, Kettegaard alle 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin G Jorgensen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Vinding
- Diagnostic Center, Department of Medicine, Odense University Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark
| | - Pia N Kannegaard
- Department of Geriatric and Palliative Medicine, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Solvejg G H Pedersen
- Department of Medicine 2, Geriatric section, Holbaek University Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.
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Mohammadnejad A, Ryg J, Ewertz M, Jylhävä J, Hjelmborg JVB, Galvin A. Association of cancer with functional decline at old age: a longitudinal study in Danish twins. Scand J Public Health 2024:14034948241240823. [PMID: 38570302 DOI: 10.1177/14034948241240823] [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: 04/05/2024]
Abstract
INTRODUCTION There is evidence that older adults with cancer have a higher risk of functional decline than cancer-free older adults. However, few studies are longitudinal, and none are twin studies. Thus, we aimed to investigate the relationship between cancer and functional decline in older adult (aged 70+ years) twins. MATERIALS AND METHODS Cancer cases in the Longitudinal Study of Aging Danish Twins were identified through the Danish Cancer Registry. Functional status was assessed using hand grip strength (6 years follow-up), and self-reported questions on mobility (10 years follow-up), and cut-offs were defined to assess functional decline. Cox regression models were performed for all the individual twins. In addition, we extended the analysis to discordant twin pairs (twin pairs with one having cancer and the other being cancer-free), to control to a certain extent for (unmeasured) shared confounders (genetic and environmental factors). RESULTS The analysis based on individual twins showed that individual twins with cancer are at increased hazard of worsening hand grip strength (hazard ratio (HR) 1.37, 95% confidence interval (CI) 1.04, 1.80) than cancer-free twins. Among the discordant twin pairs, twins with cancer had a higher hazard of worsening hand grip strength (HR 3.50, 95% CI 1.15, 10.63) than cancer-free cotwins. In contrast, there was no evidence of a difference between the hazard of experiencing mobility decline for twins with cancer compared with cancer-free twins, in both individual twins and discordant twin pairs analyses. DISCUSSION Cancer was associated with hand grip strength functional decline in old individual twins and discordant pairs. Our results strengthen the importance of comprehensive geriatric assessment in older adults with cancer, as well as the importance of routine assessment of functional status. Promoting physical activity through exercise training programmes could enable the prevention of functional decline in older adults with cancer.
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Affiliation(s)
- Afsaneh Mohammadnejad
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Denmark
| | - Jesper Ryg
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Marianne Ewertz
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
- Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, University of Tampere, Finland
| | - Jacob vB Hjelmborg
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Denmark
- The Danish Twin Registry, University of Southern Denmark, Denmark
| | - Angéline Galvin
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Denmark
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, France
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Li G, Ma Q, Li Y, Tan F, Li X, Chen J. Effects of general and spinal anesthesia on postoperative rehabilitation in older adults after lower limb surgery: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1386797. [PMID: 38606152 PMCID: PMC11007150 DOI: 10.3389/fmed.2024.1386797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Objective To investigate the effects of perioperative general anesthesia (GA) and spinal anesthesia (SA) on postoperative rehabilitation in elderly patients with lower limb surgery. Methods This retrospective propensity score-matched cohort study included patients aged 65 years or older who underwent lower limb surgery between January 1, 2020, and May 31, 2023. The GA and SA were selected at the request of the orthopedic surgeon, patient, and their family members. The main outcomes included the incidence of the patient's inability to self-care at discharge, postoperative complications including pulmonary infection, thrombus of lower extremity veins, infection of incisional wound and delirium, length of hospital stay, and incidence of severe pain in the first 2 days postoperatively. Results In total, 697 patients met the inclusion criteria, and 456 were included in the final analysis after propensity score matching. In the GA and SA groups, 27 (11.84%) and 26 (11.40%) patients, respectively, could not care for themselves at discharge. The incidence rates did not differ between the groups (p = 0.884). In contrast, the incidence of postoperative complications (GA: 10.53% and SA: 4.39%; p = 0.013) and the length of hospital stay (GA: 16.92 ± 10.65 days and SA: 12.75 ± 9.15 days; p < 0.001) significantly differed between the groups. Conclusion The choice of anesthesia is independent of the loss of postoperative self-care ability in older patients (>65 years) and is not a key factor affecting postoperative rehabilitation after lower limb surgery. However, compared with GA, SA reduces the incidence of postoperative complications and a prolonged hospital stay. Thus, SA as the primary anesthetic method is a protective factor against a prolonged hospital stay.
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Affiliation(s)
- Guifei Li
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qingjing Ma
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yizhen Li
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Furong Tan
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xuan Li
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Pan L, Wang H, Cao X, Ning T, Li X, Cao Y. A Higher Postoperative Barthel Index at Discharge is Associated with a Lower One-Year Mortality After Hip Fracture Surgery for Geriatric Patients: A Retrospective Case‒Control Study. Clin Interv Aging 2023; 18:835-843. [PMID: 37251305 PMCID: PMC10224694 DOI: 10.2147/cia.s409282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose To evaluate the relationship between the postoperative Barthel index assessing activities of daily living at discharge and the one-year mortality after hip fracture surgery. Methods Patients with hip fracture admitted to Peking University First Hospital from January 2015 to January 2020 were enrolled retrospectively according to the inclusion and exclusion criteria. The Barthel index and other related confounding variables were collected. Logistic regression and Kaplan‒Meier survival curves were constructed to explore the relationship between the postoperative Barthel index at discharge and the one-year mortality of geriatric patients after hip fracture surgery. Results A total of 444 patients with a mean age of 81.61±6.14 years were included. A significant difference was not observed in the preoperative Barthel index at admission between the deceased group and the surviving group (38.90±15.83 vs 36.96±10.74, p=0.446). However, the difference in the postoperative Barthel index at discharge between these two groups was statistically significant (43.08±14.40 vs 53.18±13.43, P<0.001). The multivariable logistic regression analysis revealed that the postoperative Barthel index at discharge was an independent risk factor for one-year mortality after adjustment for confounding variables (adjusted OR 0.73, 95% CI 0.55-0.98, p˂0.05). The Kaplan‒Meier survival curve showed that patients who had a high Barthel index (≥50) at discharge had a significantly lower mortality in the long term than patients with a low Barthel index (<50) at discharge (P< 0.001). Conclusion The postoperative Barthel index at discharge was independently associated with the one-year mortality of geriatric patients after hip fracture surgery. A higher postoperative Barthel index at discharge indicated a lower mortality after hip fracture surgery. The Barthel index at discharge has the potential to provide essential prognostic information for early risk stratification and directing future care.
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Affiliation(s)
- Liping Pan
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Hao Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiangyu Cao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Taiguo Ning
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
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Onishi R, Hatakeyama Y, Hirata K, Matsumoto K, Seto K, Wu Y, Kitazawa T, Hasegawa T. Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan. BMC Geriatr 2023; 23:235. [PMID: 37072735 PMCID: PMC10114477 DOI: 10.1186/s12877-023-03957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limited. In this study, we developed and calculated a hospital standardized ADL ratio (HSAR) using Japanese administrative claims data to measure the quality of hospitalization care for patients with cerebral infarction. METHODS This study was designed as a retrospective observational study using the Japanese administrative claim data from 2012 to 2019. The data of all hospital admissions with a primary diagnosis of cerebral infarction (ICD-10, I63) were used. The HSAR was defined as the ratio of the observed number of ADL maintenance patients to the expected number of ADL maintenance patients multiplied by 100, and ratio of ADL maintenance patients was risk-adjusted using multivariable logistic regression analyses. The c-statistic was used to evaluate the predictive accuracy of the logistic models. Changes in HSARs in each consecutive period were assessed using Spearman's correlation coefficient. RESULTS A total of 36,401 patients from 22 hospitals were included in this study. All variables used in the analyses were associated with ADL maintenance, and evaluations using the HSAR model showed predictive ability with c-statistics (area under the curve, 0.89; 95% confidence interval, 0.88-0.89). CONCLUSIONS The findings indicated a need to support hospitals with a low HSAR because hospitals with high/low HSAR were likely to produce the same results in the subsequent periods. HSAR can be used as a new quality indicator of in-hospital care and may contribute to the assessment and improvement of the quality of care.
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Affiliation(s)
- Ryo Onishi
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Yosuke Hatakeyama
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Koki Hirata
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Kunichika Matsumoto
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Kanako Seto
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, 800 Dongchuan RD, Minhang District, Shanghai, 200240, China
| | - Takefumi Kitazawa
- Department of Nursing, Faculty of Health Sciences, Tokyo Kasei University, 2-15-1, Inariyama, Sayama, 350-1398, Japan
| | - Tomonori Hasegawa
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan.
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Ramos-Rincon JM, Lopez-Sampalo A, Cobos-Palacios L, Ricci M, Rubio-Rivas M, Díaz-Simón R, Martín-Escalante MD, Castañeda-Pérez S, Fernández-Madera-Martínez R, Beato-Perez JL, García-García GM, García-Andreu MDM, Arnalich-Fernandez F, Molinos-Castro S, Vargas-Núñez JA, Artero A, Freire-Castro SJ, Fernández-Gómez J, Cubo-Romano P, Hernández-Milián A, Inés-Revuelta SM, Boixeda R, Fernández-Pedregal E, Gómez-Huelgas R. Nosocomial COVID-19: A Nationwide Spanish Study. Gerontology 2023:1-13. [PMID: 36682355 PMCID: PMC9893008 DOI: 10.1159/000527711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/14/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 is a highly contagious virus, and despite professionals' best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. METHODS This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. RESULTS Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59-0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12-1.72; p = 0.003), sepsis (aOR: 1.73; 1.33-2.54; p < 0.001), and readmission (aOR: 1.35; 1.03-1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81-2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. CONCLUSIONS NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Clinical Medicine Department, Miguel Hernandez University of Elche, Alicante, Spain,*Jose-Manuel Ramos-Rincon,
| | - Almudena Lopez-Sampalo
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
| | - Lidia Cobos-Palacios
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
| | - Michele Ricci
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
| | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital–IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Díaz-Simón
- Internal Medicine Department, 12 Octubre University Hospital, Madrid, Spain
| | | | - Sabela Castañeda-Pérez
- Internal Medicine Department, Internal Medicine Department, Gregorio Marañon University Hospital, Madrid, Spain
| | | | | | | | | | | | - Sonia Molinos-Castro
- Internal Medicine Department, Santiago de Compostela Clinic Hospital, Santiago de Compostela, A Coruña, Spain
| | | | - Arturo Artero
- Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain
| | | | | | - Pilar Cubo-Romano
- Internal Medicine Department, Infanta Cristina University Hospital, Madrid, Spain
| | | | | | - Ramon Boixeda
- Internal Medicine Department, Mataró Hospital, Barcelona, Spain
| | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga and Biomedical Research Institute of Málaga (IBIMA), and University of Málaga (UMA), Málaga, Spain
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9
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Wen Z, Mo X, Zhao S, Qi Z, Fu D, Wen S, Cheung WH, Chen B. Study on Risk Factors of Primary Non-traumatic OVCF in Chinese Elderly and a Novel Prediction Model. Orthop Surg 2022; 14:2925-2938. [PMID: 36168985 PMCID: PMC9627056 DOI: 10.1111/os.13531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Prevention of fragility fractures is one of the public health priorities worldwide, whilst the incidence of osteoporotic vertebral compression fractures (OVCF) continues to rise and lacks the corresponding accurate prediction model. This study aimed to screen potential causes and risk factors for primary non‐traumatic osteoporotic vertebral compression fractures (NTOVCF) in the elderly by characterizing a patient population with NTOVCF and comparing it with a population of osteoporotic patients. Methods Between January 2013 and January 2022, 208 elderly patients with unequivocal evidence of bone fragility manifested as painful NTOVCF were enrolled, and compared with 220 patients with osteoporosis and no fractures. The demographic data, bone turnover markers, blood routine, serum biochemical values, and radiological findings were investigated. Differences between the fracture and non‐fracture groups were analyzed, and variables significant in univariate analysis and correlation analysis were included in the logistic analysis to build the risk prediction model for osteoporotic vertebral fractures. Univariate analysis using student's t‐tests for continuous variables or a chi‐squared test for categorical variables was conducted to identify risk factors. Results No significant differences were revealed regarding age, gender, BMI, smoking, alcohol consumption, blood glucose, propeptide of type I procollagen (P1NP), and N‐terminal middle segment osteocalcin (N‐MID) (P > 0.05). Parathyroid Hormone (PTH), 25(OH)D, serum albumin (ALB), hemoglobin (HB), bone mineral density (BMD), and cross‐sectional area (CSA) of the paraspinal muscle in the fracture group were significantly lower than those in the control group; however, b‐C‐terminal telopeptide of type I collagen (β‐CTX), total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C), non‐prostatic acid phosphatase (NACP), and fatty degeneration ratio (FDR) were significantly higher than those in the control group (P < 0.05). Logistic regression analysis showed that ALB, HB, CSA, and BMD were negatively correlated with NTOVCF, while β‐CTX, HDL‐C, NACP, and FDR were positively correlated with NTOVCF. Conclusion Decreased physical activity, anemia, hypoproteinemia, imbalances in bone metabolism, abnormal lipid metabolism, and degenerative and decreased muscle mass, were all risk factors for OVCF in the elderly, spontaneous fractures may be the consequence of cumulative declines in multiple physiological systems over the lifespan. Based on this risk model, timely detection of patients with high OVCF risk and implementation of targeted preventive measures is expected to improve the effect of fracture prevention.
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Affiliation(s)
- Zhenxing Wen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyi Mo
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhichao Qi
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Orthopaedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Dan Fu
- Department of Orthopaedics, Kiang Wu Hospital, Macau, China
| | - Shifeng Wen
- Department of Spine Surgery, Guangzhou First People's Hospital, Guangzhou, China
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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10
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Corrao S, Natoli G, Nobili A, Mannucci PM, Perticone F, Arcoraci V, Argano C. The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes. Healthcare (Basel) 2022; 10:healthcare10081459. [PMID: 36011116 PMCID: PMC9408695 DOI: 10.3390/healthcare10081459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes.
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Affiliation(s)
- Salvatore Corrao
- Internal Medicine Department IGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (G.N.); (C.A.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence: or ; Tel.: +39-091-655-2065; Fax: +39-091-666-3167
| | - Giuseppe Natoli
- Internal Medicine Department IGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (G.N.); (C.A.)
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Pier Mannuccio Mannucci
- Scientific Direction, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Christiano Argano
- Internal Medicine Department IGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (G.N.); (C.A.)
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11
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Walter N, Rupp M, Bärtl S, Uecker C, Alt V. The Definition of the Term "Orthogeriatric Infection" for Periprosthetic Joint Infections. Geriatr Orthop Surg Rehabil 2022; 13:21514593221111649. [PMID: 35794870 PMCID: PMC9251973 DOI: 10.1177/21514593221111649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction In the background of the aging population, an increase of geriatric patients with specific age-related co-morbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients. Material and methods In this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (≤70 years), geriatric multimorbidity and the Barthel index (≤30). Results Applying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71) revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, P = .007 and n = 24, 13.0% vs n = 5, 7.0%, P = .005). The Barthel index showed a significant correlation with mortality (r = -.22, P = .011). Discussion We propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects. Conclusion The inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Susanne Bärtl
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Claus Uecker
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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12
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Chen Q, Shen W, Sun H, Zhang H, Liu C, Chen Z, Yu L, Cai X, Ke J, Li L, Zhang L, Fang Q. The effect of coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation on shaping early reorganization of the motor network after stroke. Brain Res 2022; 1790:147959. [PMID: 35654120 DOI: 10.1016/j.brainres.2022.147959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Neural plasticity is a major factor driving cortical reorganization after stroke. This study aimed to evaluate functional connectivity (FC) changes in the cortical motor network after coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment and to assess the correlation between FC changes and functional recovery, further characterizing the neural mechanisms underlying the beneficial effects of rTMS. We randomly divided 63 patients with acute stroke into four groups: (1) Group A received coupled inhibitory-facilitatory rTMS [1 Hz over the contralesional primary motor cortex (M1) and 10 Hz over ipsilesional M1]; (2) Group B received a contralesional sham stimulation and ipsilesional 10 Hz stimulation; (3) Group C received a contralesional 1 Hz rTMS and ipsilesional sham stimulation; and (4) Group D received bilateral sham stimulation only. Standardized rehabilitation therapy was performed immediately after rTMS, and each group was treated with their respective treatment modalities for 4 weeks. Twenty-four hours before and after the intervention, participants underwent resting-state functional magnetic resonance imaging. Additional functional assessments were conducted at baseline, after treatment, and at the 3 month follow-up. The rTMS treatment significantly changed the FCs of intra- and inter-hemispheric cortical motor networks in the rTMS groups (A and B) compared with the sham group (Group D). This effect was more pronounced in Group A, which displayed a changed FC between the contralesional postcentral gyrus and contralesional superior parietal gyrus, between the contralesional precentral gyrus and contralesional postcentral gyrus, and between the ipsilesional postcentral gyrus and contralesional superior parietal gyrus, when compared with Groups B and C. Importantly, FC changes were significantly correlated with improvement of motor function. In the early stages of ischemic stroke, coupled rTMS was more conducive to motor recovery by modulating the FCs of intra-hemispheric and inter-hemispheric motor networks. Our results suggested that FC changes were related to motor function recovery for early-stage cerebral stroke patients treated with coupled rTMS. These findings could help to understand the mechanism of coupled rTMS and further the use of this therapy as an adjunct rehabilitation technique in motor recovery.
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Affiliation(s)
- Qingmei Chen
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Wenjun Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Hanjun Zhang
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Chuandao Liu
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Zhiguo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Li Li
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
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13
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Su WC, Wu WT, Peng CH, Yu TC, Lee RP, Wang JH, Yeh KT. The Short-Term Changes of the Sagittal Spinal Alignments After Acute Vertebral Compression Fracture Receiving Vertebroplasty and Their Relationship With the Change of Bathel Index in the Elderly. Geriatr Orthop Surg Rehabil 2022; 13:21514593221100238. [PMID: 35546967 PMCID: PMC9083049 DOI: 10.1177/21514593221100238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/03/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Fragility vertebral compression fractures (VCFs) are of major concern due to aging populations worldwide, which may occur after a fall from standing or due to severe osteoporosis, impacting greatly the life quality of the elderly. This study thus determined the factors independently associated with poor functional recovery from a new VCF and changes in sagittal spinal alignment after vertebroplasty in elderly patients with osteoporosis. Materials and Methods The data were collected from patients older than 70 years and diagnosed with a new VCF. Logistic regression analysis was performed to determine factors independently associated with function and radiographic status. Results We enrolled 8 male and 34 female patients with a mean age of 80.74 ± 8.31 years between January and July 2020. Compared with preoperative data, post-vertebroplasty lumbar sagittal alignments and functional scores improved significantly, and function recovered gradually over 12 weeks. Climbing stairs was the most influential performance indicator at the beginning of the recovery process. At each postoperative follow-up, changes in the C7-sacrum sagittal vertical axis exhibited an influence on functional recovery. Male patients were better able to move from a chair to a bed at the 2-week postoperative follow-up, and positive changes in the spino-sacral angle led to improved function in terms of stair climbing at the 6-week postoperative follow-up. Conclusions Vertebroplasty seemed to be effective for functional recovery related to sagittal spinal alignment improvement of the elderly with VCFs during postoperative 12 weeks, which may be a critical stage for the recovery for their life activities. The recovery rate for stair climbing after vertebroplasty was slower than for the other functional performance indicators in our study. In addition, if a patient was unable to demonstrate a marked improvement in sagittal alignment, they were likely to have ongoing impaired function and a poor prognosis after surgery.
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Affiliation(s)
- Wen-Chin Su
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Huan Peng
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Kuang-Ting Yeh, MD, PhD, Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan.
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14
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Caro-Martínez E, Abad-Collado S, Escrivá-Cerrudo B, García-Almarza S, García-Ródenas MDM, Gómez-Merino E, Serrano-Mateo MI, Ramos-Rincón JM. Nosocomial COVID-19 Infection in a Long-Term Hospital in Spain: Retrospective Observational Study. Medicina (B Aires) 2022; 58:medicina58050566. [PMID: 35629983 PMCID: PMC9143631 DOI: 10.3390/medicina58050566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives. The aim of this study is to compare clinical and epidemiological characteristics and outcomes in patients with versus without nosocomial COVID-19 after exposure to SARS-CoV-2 and to analyze the risk factors for severe outcomes of COVID-19 in a long-term hospital in Spain. Materials and methods. This retrospective, single-center observational study included all inpatients in a long-term hospital during a COVID-19 outbreak from 21 January to 15 March 2021. Results. Of 108 admitted patients, 65 (60.2%) were diagnosed with nosocomial COVID-19 disease (n = 34 women (52.3%), median age 77 years). In the univariable analysis, risk factors associated with nosocomial COVID-19 were dementia (OR 4.98 95% CI 1.58–15.75), dyspnea (OR 5.34 95% CI 1.69–16.82), asthenia (OR 5.10, 95% CI 1.40–18.60) and NECesidades PALiativas (NECPAL) (OR 1.28 95% CI 1.10–1.48). In the multivariable analysis, risk factors independently associated with nosocomial COVID-19 infection were dyspnea (aOR 7.39; 95% CI 1.27–43.11) and NECPAL (aOR 1.25; 95% CI 1.03–1.52). Of the 65 patients diagnosed with nosocomial COVID-19, 29 (44.6%) died, compared to 7/43 (16.2%) non-infected patients (OR 4.14, 95% CI 1.61–10.67). Factors associated with mortality in nosocomial COVID-19 were confusion (aOR 3.83; 95% CI 1.03–14.27) and dyspnea (aOR 7.47; 95% CI 1.87–29.82). The NECPAL tool played an important predictive role in both nosocomial COVID-19 infection and mortality (aOR 1.19, 95% CI: 1.00–1.41). Conclusions. In a long-term hospital, nosocomial COVID-19 main clinical characteristics associated with infection were dyspnea and NECPAL. Mortality was higher in the group with nosocomial COVID-19; risk factors were confusion and dyspnea. The NECPAL tool may help to predict progression and death in COVID-19.
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Affiliation(s)
- Elena Caro-Martínez
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
- Correspondence:
| | - Susana Abad-Collado
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - Blanca Escrivá-Cerrudo
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - Shaila García-Almarza
- Geriatric Unit, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain;
| | | | - Elena Gómez-Merino
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - María-Isabel Serrano-Mateo
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - Jose-Manuel Ramos-Rincón
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
- Internal Medicine Department, Alicante General University Hospital, 03010 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, 03550 Elche, Spain
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15
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Ferré C, Llopis F, Martín-Sánchez FJ, Cabello I, Albert A, García-Lamberechts EJ, Del Castillo JG, Martínez C, Jacob J. The utility of the Barthel index as an outcome predictor in older patients with acute infection attending the emergency department. Australas Emerg Care 2022; 25:316-320. [PMID: 35398013 DOI: 10.1016/j.auec.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional decline and frailty are common in older adults and influence the risk of adverse outcomes. We aimed to assess the value of a Barthel index at the Emergency Department (ED-BI) score in predicting 30-day mortality and ED reconsultation among older patients with acute infection. METHODS We performed a prospective multicentre cohort study of older patients (≥75 years) diagnosed with acute infection in 69 Spanish EDs. Demographic, comorbidities, functional status, clinical and analytical data were collected. Unadjusted and adjusted logistic regression models were used to assess the association between ED-BI score, mortality and ED reconsultation. RESULTS In total 1596 patients with a mean age of 84.7 years were included in the study and 51.7% female. The most frequent focus of infection was respiratory in 918 patients (57.5%). Patients with an ED-BI< 60 points were significantly older, predominantly female, more likely institutionalized and more urinary infections. When comparing patients with an ED-BI score ≥ 60 points with those< 60 points no differences were found in ED reconsultation but in the latter group mortality at 30-days was higher (p < 0.001). CONCLUSION An ED-BI score< 60 points appears to be a strong predictor of mortality at the 30-day follow up in older patients with acute infection. DATA AVAILABILITY The data used to support the findings of this study are included within the article.
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Affiliation(s)
- Carles Ferré
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Llopis
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Irene Cabello
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa Albert
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Concepción Martínez
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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16
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Huang HH, Lin PY, Chen TY, Wang TY, Chang JCY, Peng LN, Yen DHT. Geriatric syndromes predict mortality of people aged 75+ years in the observation room of emergency department: Towards function-centric emergency medicine. Arch Gerontol Geriatr 2022; 100:104662. [DOI: 10.1016/j.archger.2022.104662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 01/04/2023]
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17
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Fernández-Araque A, Giaquinta-Aranda A, Moreno-Sainz C, Martínez-Martínez MC, Velasco-González V, Sainz-Gil M, Martín-Arias LH, Carretero-Molinero S, García-Hidalgo M, Verde Z. Haplotypes in the GC, CYP2R1 and CYP24A1 Genes and Biomarkers of Bone Mineral Metabolism in Older Adults. Nutrients 2022; 14:259. [PMID: 35057442 PMCID: PMC8778395 DOI: 10.3390/nu14020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/07/2022] Open
Abstract
Candidate gene studies have analyzed the effect of specific vitamin D pathway genes on vitamin D availability; however, it is not clear whether genetic variants also affect overall bone metabolism. This study evaluated the association between genetic polymorphisms in GC, CYP2R1 and CYP24A1 and serum levels of total 25(OH)D, iPTH and other mineral metabolism biomarkers (albumin, total calcium and phosphorus) in a sample of 273 older Spanish adults. We observed a significant difference between CYP2R1 rs10741657 codominant model and total 25(OH)D levels after adjusting them by gender (p = 0.024). In addition, the two SNPs in the GC gene (rs4588 and rs2282679) were identified significantly associated with iPTH and creatinine serum levels. In the case of phosphorus, we observed an association with GC SNPs in dominant model. We found a relationship between haplotype 2 and 25(OH)D levels, haplotype 4 and iPTH serum levels and haplotype 7 and phosphorus levels. In conclusion, genetic variants in CYP2R1 and GC could be predictive of 25(OH)D and iPTH serum levels, respectively, in older Caucasian adults. The current study confirmed the role of iPTH as one of the most sensitive biomarkers of vitamin D activity in vivo.
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Affiliation(s)
- Ana Fernández-Araque
- Department of Nursery, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain; (A.F.-A.); (A.G.-A.); (S.C.-M.)
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
| | - Andrea Giaquinta-Aranda
- Department of Nursery, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain; (A.F.-A.); (A.G.-A.); (S.C.-M.)
- Department of Hemodialysis, Hospital Santa Bárbara, 42005 Soria, Spain
| | - Carmelo Moreno-Sainz
- Department of Clinic Biochemistry, Hospital Santa Bárbara, 42005 Soria, Spain; (C.M.-S.); (M.C.M.-M.)
| | | | - Verónica Velasco-González
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Department of Nursery, University of Valladolid, 47005 Valladolid, Spain
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
| | - María Sainz-Gil
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), University of Valladolid, 47005 Valladolid, Spain
| | - Luis H. Martín-Arias
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), University of Valladolid, 47005 Valladolid, Spain
| | - Silvia Carretero-Molinero
- Department of Nursery, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain; (A.F.-A.); (A.G.-A.); (S.C.-M.)
| | | | - Zoraida Verde
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
- Departamento de Bioquímica, Biología Molecular y Fisiología, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain
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18
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Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry. Healthcare (Basel) 2022; 10:healthcare10010086. [PMID: 35052252 PMCID: PMC8775367 DOI: 10.3390/healthcare10010086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. METHODS In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSi) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. RESULTS Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. CONCLUSIONS Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes.
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Chen QM, Yao FR, Sun HW, Chen ZG, Ke J, Liao J, Cai XY, Yu LQ, Wu ZY, Wang Z, Pan X, Liu HY, Li L, Zhang QQ, Ling WH, Fang Q. Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients. Restor Neurol Neurosci 2021; 39:419-434. [PMID: 34924405 DOI: 10.3233/rnn-211195] [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: 11/15/2022]
Abstract
BACKGROUND The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. OBJECTIVES To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. METHODS 44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. RESULTS The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). CONCLUSIONS Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.
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Affiliation(s)
- Qing-Mei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Fei-Rong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Hai-Wei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhi-Guo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Juan Liao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiu-Ying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Li-Qiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhen-Yan Wu
- Health Management Center, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhi Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xi Pan
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Hao-Yu Liu
- Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Li Li
- Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Quan-Quan Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wei-Hua Ling
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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20
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Ramos-Rincón JM, Bernabeu-Whittel M, Fiteni-Mera I, López-Sampalo A, López-Ríos C, García-Andreu MDM, Mancebo-Sevilla JJ, Jiménez-Juan C, Matía-Sanz M, López-Quirantes P, Rubio-Rivas M, Paredes-Ruiz D, González-San-Narciso C, González-Vega R, Sanz-Espinosa P, Hernández-Milián A, Gonzalez-Noya A, Gil-Sánchez R, Boixeda R, Alcalá-Pedrajas JN, Palop-Cervera M, Cortés-Rodríguez B, Guisado-Espartero ME, Mella-Pérez C, Gómez-Huelgas R. Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 77:e138-e147. [PMID: 34626477 DOI: 10.1093/gerona/glab305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS This is a cross-sectional analysis within a retrospective cohort of hospitalized patients≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS Of 6,189 patients≥75 years, 1,185 (19.1%) were LTCF residents and 4,548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs. 82.1 years), mostly female (61.6% vs. 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs. 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p<.001). Mortality risk factors in LTCF residents were severe functional dependence (aOR:1.79;95%CI:1.13-2.83;p=.012), dyspnea (1.66;1.16-2.39;p=.004), SatO2<94% (1.73;1.27-2.37;p=.001), temperature≥37.8ºC (1.62;1.11-2.38; p=.013); qSOFA index≥2 (1.62;1.11-2.38;p=.013), bilateral infiltrates (1.98;1.24-2.98;p<.001), and high C-reactive protein (1.005;1.003-1.007;p<.001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR:0.74,95%CI:0.62-0.87;p<.001). CONCLUSION Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.
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Affiliation(s)
| | - Máximo Bernabeu-Whittel
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain.,Medicine Department, University of Seville, Sevilla, Spain
| | | | - Almudena López-Sampalo
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carmen López-Ríos
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | | | - Juan-José Mancebo-Sevilla
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carlos Jiménez-Juan
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | - Marta Matía-Sanz
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Pablo López-Quirantes
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department. Bellvitge University Hospital- -IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Diana Paredes-Ruiz
- Internal Medicine Department. 12 Octubre University Hospital, Madrid, Spain
| | | | - Rocío González-Vega
- Internal Medicine Department, Costa del Sol Hospital, Marbella (Malaga), Spain
| | - Pablo Sanz-Espinosa
- Internal Medicine Department. Rio Hortega University Hospital, Valladolid, Spain
| | | | - Amara Gonzalez-Noya
- Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain
| | | | - Ramon Boixeda
- Internal Medicine Department. Mataró Hospital, Mataró (Barcelona), Spain
| | | | - Marta Palop-Cervera
- Internal Medicine Department. Sagunto University Hospital, Sagunto (Valencia), Spain
| | | | | | - Carmen Mella-Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, (Ferrol) A Coruna, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Medicine Department, University of Malaga, Malaga, Spain
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21
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Ramos‐Rincon J, Moreno‐Perez O, Pinargote‐Celorio H, Leon‐Ramirez J, Andres M, Reus S, Herrera‐García C, Martí‐Pastor A, Boix V, Gil J, Sanchez‐Martinez R, Merino E. Clinical Frailty Score vs Hospital Frailty Risk Score for predicting mortality and other adverse outcome in hospitalised patients with COVID-19: Spanish case series. Int J Clin Pract 2021; 75:e14599. [PMID: 34227196 PMCID: PMC8420333 DOI: 10.1111/ijcp.14599] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID-19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID-19. MATERIAL AND METHODS This retrospective cohort study included adult (≥18 years) inpatients with COVID-19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in-hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity. RESULTS Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4-23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8-27.7). Prevalence of frailty increased with age according to both measures: 50-64 years, CFS 1.9% vs HFRS 12.3%; 65-79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P < .001). CFS-defined frailty was independently associated with risk of death (OR 3.67, 95% CI 1.49-9.04) and less treatment with tocilizumab (OR 0.28, 95% CI 0.08-0.93). HFRS-defined frailty was independently associated with length of hospital stay over 10 days (OR 2.89, 95% CI 1.53-5.44), ICU admission (OR 4.18, 95% CI 1.84-9.52) and invasive mechanical ventilation (OR 5.93, 95% CI 2.33-15.10). CONCLUSION In the spring 2020 wave of the COVID-19 pandemic in Spain, CFS-defined frailty was an independent predictor for death, while frailty as measured by the HFRS was associated with length of hospital stay over 10 days, ICU admission and use of invasive mechanical ventilation.
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Affiliation(s)
- Jose‐Manuel Ramos‐Rincon
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
| | - Oscar Moreno‐Perez
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Endocrinology and Nutrition DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Hector Pinargote‐Celorio
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Jose‐Manuel Leon‐Ramirez
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Mariano Andres
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Rheumatology DepartmentAlicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Sergio Reus
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Cristian Herrera‐García
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Ana Martí‐Pastor
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Vicente Boix
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Joan Gil
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Rosario Sanchez‐Martinez
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Esperanza Merino
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
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22
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Pan H, Zhao Y, Wang H, Li X, Leung E, Chen F, Cabrera J, Tsui KL. Influencing factors of Barthel index scores among the community-dwelling elderly in Hong Kong: a random intercept model. BMC Geriatr 2021; 21:484. [PMID: 34488653 PMCID: PMC8422750 DOI: 10.1186/s12877-021-02422-4] [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: 11/29/2020] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Barthel Index (BI) is one of the most widely utilized tools for assessing functional independence in activities of daily living. Most existing BI studies used populations with specific diseases (e.g., Alzheimer’s and stroke) to test prognostic factors of BI scores; however, the generalization of these findings was limited when the target populations varied. Objectives The aim of the present study was to utilize electronic health records (EHRs) and data mining techniques to develop a generic procedure for identifying prognostic factors that influence BI score changes among community-dwelling elderly. Methods Longitudinal data were collected from 113 older adults (81 females; mean age = 84 years, SD = 6.9 years) in Hong Kong elderly care centers. Visualization technologies were used to align annual BI scores with individual EHRs chronologically. Linear mixed-effects (LME) regression was conducted to model longitudinal BI scores based on socio-demographics, disease conditions, and features extracted from EHRs. Results The visualization presented a decline in BI scores changed by time and health history events. The LME model yielded a conditional R2 of 84%, a marginal R2 of 75%, and a Cohen’s f2 of 0.68 in the design of random intercepts for individual heterogeneity. Changes in BI scores were significantly influenced by a set of socio-demographics (i.e., sex, education, living arrangement, and hobbies), disease conditions (i.e., dementia and diabetes mellitus), and EHRs features (i.e., event counts in allergies, diagnoses, accidents, wounds, hospital admissions, injections, etc.). Conclusions The proposed visualization approach and the LME model estimation can help to trace older adults’ BI score changes and identify the influencing factors. The constructed long-term surveillance system provides reference data in clinical practice and help healthcare providers manage the time, cost, data and human resources in community-dwelling settings.
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Affiliation(s)
- Hao Pan
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hailiang Wang
- School of Design, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Eman Leung
- School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank Chen
- Department of Management Sciences, City University of Hong Kong, Hong Kong, China
| | - Javier Cabrera
- Department of Statistics, Rutgers University, New Brunswick, NJ, USA
| | - Kwok Leung Tsui
- School of Data Science, City University of Hong Kong, Hong Kong, China.,Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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23
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Sørensen SR, Frederiksen JD, Anru PL, Masud T, Petrovic M, Rosholm JU, Ryg J. Use of Drugs with Anticholinergic Properties at Hospital Admission Associated with Mortality in Older Patients: A Danish Nationwide Register-Based Cohort Study. Drugs Real World Outcomes 2021; 9:129-140. [PMID: 34414558 PMCID: PMC8844340 DOI: 10.1007/s40801-021-00270-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Use of drugs with anticholinergic properties (DAP) has a negative impact on older people. OBJECTIVE Our aim was to examine the association between DAP at hospital admission and mortality in older patients. PATIENTS AND METHODS We performed a nationwide population-based cohort study including patients aged ≥ 65 years admitted to Danish geriatric medicine departments during 2005-2014. National health registers were used to link with individual-level data. Patients were followed to emigration, death, or study termination (31 December 2015). DAP was defined as medications included in the anticholinergic cognitive burden (ACB) scale, which assigns each DAP a score between 1 and 3. The individual ACB score was calculated and the number of DAP counted. We used Cox proportional-hazard regressions to estimate the crude and adjusted hazard ratios adjusting for age, activities of daily living, marital status, index admission period, BMI, and prior hospitalizations (model 1), and additionally Charlson Comorbidity Index (model 2). RESULTS We included 74,589 patients aged (median [IQR]) 83 (77-88) years. Use of one or more DAP (62.5%) was associated with increased mortality compared with those with no use (p < 0.001). In the fully adjusted model 2, compared with no use, higher mortality risks (HR [95% CI]) were seen with ACB score of 2 and number of DAP ≥ 5 for 30-day (1.46 [1.32-1.61] and 1.46 [1.09-1.95]), 1-year (1.34 [1.28-1.41] and 1.48 [1.29-1.70]), and overall mortality (1.27 [1.23-1.31] and 1.44 [1.31-1.59]), respectively. CONCLUSIONS Use of DAP at hospital admission is associated with short- and long-term mortality in geriatric patients. Deprescribing studies are warranted to study whether the impact on mortality can be attenuated.
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Affiliation(s)
- Søren Ramsdal Sørensen
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jeppe Dalskov Frederiksen
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pavithra Laxsen Anru
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Geriatric Department, Nottingham University Hospital, Nottingham, UK
| | - Mirko Petrovic
- Deaprtment of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Jens-Ulrik Rosholm
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Thomsen K, Fournaise A, Matzen LE, Andersen-Ranberg K, Ryg J. Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study. BMJ Open 2021; 11:e046698. [PMID: 34389564 PMCID: PMC8365788 DOI: 10.1136/bmjopen-2020-046698] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes. OBJECTIVE We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF). DESIGN A retrospective single-centre before-and-after cohort study. SETTING AND PARTICIPANTS Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016-25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed. INTERVENTION OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (-OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT). MAIN OUTCOME MEASURES Unplanned hospital readmission between 4 hours and 30 days following initial discharge. RESULTS Totally 847 patients were included (440 -OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in -OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with -OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period. CONCLUSION Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.
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Affiliation(s)
- Katja Thomsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anders Fournaise
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Vejle, Denmark
| | - Lars Erik Matzen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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Ryg J, Anru PL, Engberg H, Jorgensen MG, Masud T, Christensen K, Andersen-Ranberg K. Association of Body Mass Index With All-Cause Mortality in Acutely Hospitalized Older Patients. J Am Med Dir Assoc 2021; 23:507-513.e1. [PMID: 34389336 DOI: 10.1016/j.jamda.2021.07.015] [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: 03/03/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim was to examine the relationship between body mass index (BMI) and mortality in older hospitalized patients taking activities of daily living (ADLs) into account. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Nationwide population-based study of all patients aged ≥65 years admitted to Danish geriatric medical departments during 2005 to 2014 and included in the National Danish Geriatric Database. METHODS Patients were followed until death, emigration, or study termination (December 31, 2015). Primary outcome was all-cause mortality. BMI and ADLs were routinely assessed on admission and linked at an individual level to the Danish national health registers. Kaplan-Meier analysis was used to estimate crude survival according to each BMI subcategory and Cox regression to examine the association with mortality adjusting for age, comorbidity, polypharmacy, ADLs, marital status, prior hospitalizations, and admission year. RESULTS In total, 74,589 patients (63% women) were included aged [mean (SD)] 82.5 (7.5) years with BMI [mean (SD)] of 23.9 (5.1) kg/m2. During follow-up 51,188 died. Follow-up time was 191,972 person-years. Unadjusted and adjusted hazard ratio (HR) for overall, 30-day, and 1-year mortality decreased significantly with increasing BMI. In women, the highest adjusted HR (95% confidence interval) for overall mortality was seen for underweight patients (BMI <16) 1.83 (1.72-1.95) and the lowest for obesity grade II patients (BMI = 35.0-39.9) 0.66 (0.60-0.73) when using normal weight (BMI = 18.5-24.9) as reference. In men, the HR for BMI <16 and BMI = 35.0-39.9 were 1.98 (1.76-2.23) and 0.56 (0.49-0.65), respectively. CONCLUSIONS AND IMPLICATIONS In hospitalized older patients, association between mortality and BMI did not show a U-shaped or J-shaped curve after adjustment of multiple confounders, including ADLs. Instead, mortality was highest in patients with low BMI and decreased with increasing BMI before leveling off in the obese range. Our study highlights the need for a debate and reassessment of what should be the ideal BMI in this vulnerable patient group.
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Affiliation(s)
- Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Pavithra Laxsen Anru
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Henriette Engberg
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Geriatric Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Kaare Christensen
- Danish Ageing Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Increased Mortality in Elderly Patients Admitted with Hyponatremia: A Prospective Cohort Study. J Clin Med 2021; 10:jcm10143059. [PMID: 34300225 PMCID: PMC8303423 DOI: 10.3390/jcm10143059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Hyponatremia is the most common electrolyte disorder, commonly affecting older hospitalized individuals; however, the literature is not clear regarding its effect on mortality. The aim of this 2-year observational prospective cohort study was to evaluate the mortality and re-admission rates, the clinical and laboratory characteristics and the causes of hyponatremia in patients older than 65 years admitted with a corrected serum sodium of 130 mEq/L or less in an internal medicine ward of a tertiary Greek university hospital. During the observation period, 138 patients (mean age 80.5 years, 36.2% male) fulfilled the inclusion criteria and were prospectively followed for 1 year after admission. Symptoms of hyponatremia were present in 59.4% of patients. Hypovolemia was the main sole cause of hyponatremia, but in about one third of patients, hyponatremia was multifactorial. Only a low proportion of patients (12.3%) fulfilled the criteria of the syndrome of inappropriate antidiuresis (SIAD) at admission according to the current guidelines. The re-admission rates at 3- and 12-months following discharge was 34.2% and 51.8%, respectively. Mortality during hospitalization was 17.4% and was higher compared to non-hyponatremic admitted older patients, while the total mortality at 1 year after admission was 28.3%, indicating that hyponatremia at admission is a marker of significant mortality during and after hospitalization in elderly patients.
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Fumagalli C, Ungar A, Rozzini R, Vannini M, Coccia F, Cesaroni G, Mazzeo F, D'Ettore N, Zocchi C, Tassetti L, Bartoloni A, Lavorini F, Marcucci R, Olivotto I, Rasero L, Fattirolli F, Fumagalli S, Marchionni N. Predicting Mortality Risk in Older Hospitalized Persons With COVID-19: A Comparison of the COVID-19 Mortality Risk Score with Frailty and Disability. J Am Med Dir Assoc 2021; 22:1588-1592.e1. [PMID: 34334160 PMCID: PMC8249822 DOI: 10.1016/j.jamda.2021.05.028] [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: 02/18/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022]
Abstract
Objectives To assess the association of pre-morbid functional status [Barthel Index (BI)] and frailty [modified Frailty Index (mFI)] with in-hospital mortality and a risk scoring system developed for COVID-19 in patients ≥75 years diagnosed with COVID-19. Design Retrospective bicentric observational study. Setting and Participants Data on consecutive patients aged ≥75 years admitted with COVID-19 at 2 Italian tertiary care centers were collected from February 22 to May 30, 2020. Methods Overall, 221 consecutive patients with COVID-19 aged ≥75 years were admitted to 2 hospitals in the study period and were included in the analysis. Clinical, functional (BI), frailty (mFI), laboratory, and imaging data were collected. Mortality risk on admission was assessed with the COVID-19 Mortality Risk Score (COVID-19 MRS), a dedicated score developed for hospital triage. Results Ninety-seven (43.9%) patients died. BI, frailty, age, dementia, respiratory rate, Pao2/Fio2 ratio, creatinine, and platelet count were associated with mortality. Analysis of the area under the receiver operating characteristic (AUC) indicated that the predictivity of age was modest and the combination of BI, mFI, and COVID-19 MRS yielded the highest prediction accuracy (AUCCOVID-19MRS+BI+mFI vs AUCAge: 0.87 vs 0.59; difference: +0.28, lower bound–upper bound: 0.17-0.34, P < .001). Conclusions and Implications Premorbid BI and mFI are associated with mortality and improved the accuracy of the COVID-19 MRS. Functional status may prove useful to guide clinical management of older individuals.
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Affiliation(s)
- Carlo Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Renzo Rozzini
- Department of Geriatrics and Internal Medicine, Poliambulanza Hospital, Brescia, Italy
| | - Matteo Vannini
- Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Flaminia Coccia
- Department of Geriatrics and Internal Medicine, Poliambulanza Hospital, Brescia, Italy
| | - Giulia Cesaroni
- Department of Geriatrics and Internal Medicine, Poliambulanza Hospital, Brescia, Italy
| | - Francesca Mazzeo
- Department of Geriatrics and Internal Medicine, Poliambulanza Hospital, Brescia, Italy
| | - Nicoletta D'Ettore
- Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Chiara Zocchi
- Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Luigi Tassetti
- Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Internal and Emergency Medicine, Careggi Hospital, Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Laura Rasero
- Department of Public Health, University of Florence, Florence, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Department of Cardiothoracovascular Medicine, Careggi Hospital, Florence, Italy
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Ryg J, Engberg H, Anru PL, Pedersen SGH, Jorgensen MG, Vinding KL, Masud T, Andersen-Ranberg K. Activities of daily living at hospital admission and estimated survival time of older patients. Age Ageing 2021; 50:1200-1207. [PMID: 33247584 DOI: 10.1093/ageing/afaa251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Predicting expected survival time in acutely hospitalised older patients is a clinical challenge. OBJECTIVE To examine if activities of daily living (ADL) assessed by Barthel-Index-100 (Barthel-Index) at hospital admission adds useful information to clinicians on expected survival time in older patients. METHODS A nationwide population-based cohort study was used. All patients aged ≥65 years in the National Danish Geriatric Database from 2005 to 2014 were followed up until death, emigration or study termination (31 December 2015). Individual data were linked to national health registers. Barthel-Index was categorised into five-point subcategories with a separate category of Barthel-Index = 0. Kaplan-Meier analysis was used to assess crude survival proportions (95% CI) and Cox regression to examine association of Barthel-Index and mortality adjusting for age, Charlson comorbidity index, medication use, BMI, marital status, prior hospitalisations and admission year. RESULTS In total, 74,589 patients (63% women) aged (mean (SD)) 82.5(7.5) years with Barthel-Index (median (IQR)) 54(29-77) were included. In patients with Barthel-Index = 100-96 crude survival was 0.96(0.95-0.97) after 90-days, 0.88(0.87-0.89) after 1-year, and 0.79(0.78-0.80) after 2-years. Corresponding survival in patients with Barthel-Index = 0 was 0.49(0.47-0.51), 0.35(0.34-0.37) and 0.26(0.24-0.27). Decreasing Barthel-Index was associated with increasing mortality in the multivariable analysis. In women with Barthel-Index = 0, the mortality risk (HR (95% CI)) was 14.74(11.33-19.18) after 90-days, 8.40(7.13-9.90) after 1-year and 6.22(5.47-7.07) after 2-years using Barthel-Index = 100-96 as reference. In men, the corresponding risks were 11.36(8.81-14.66), 6.22(5.29-7.31) and 5.22(4.56-5.98). CONCLUSIONS ADL measured by Barthel-Index provides useful, easily accessible and independent information to clinicians on expected survival time in patients admitted to a geriatric department.
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Affiliation(s)
- Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henriette Engberg
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Pavithra Laxsen Anru
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | | | - Kirsten Laila Vinding
- Medical Department, Kolding Hospital, Kolding, Denmark
- Medical Department, Odense University Hospital, Svendborg, Denmark
| | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Nottingham University Hospital, Nottingham, UK
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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29
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Chen Q, Shen D, Sun H, Ke J, Wang H, Pan S, Liu H, Wang D, Su M, Fang Q. Effects of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation on motor recovery in patients following acute cerebral infarction. NeuroRehabilitation 2021; 48:83-96. [PMID: 33361618 DOI: 10.3233/nre-201606] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The treatment for patients suffering from motor dysfunction following stroke using continuous repetitive transcranial magnetic stimulation (rTMS) has the potential to be beneficial for recovery. However, the impact of explicit results on the coupling of various rTMS protocols on motor treatment in patients following acute cerebral infarction remain unexplored. OBJECTIVE The current study aims to design a sham-controlled randomized report to explore the capability of consecutive suppressive-facilitatory rTMS method to increase the motor results following acute stroke. METHODS A hundred ischemic stroke patients suffering from motor disorder were randomly assigned to obtain 4 week sessions of (1)10 Hz over the ipsilesional primary motor cortex (M1) and next 1 Hz over the contralesional M1; (2) contralesional sham stimulation and next ipsilesional real 10 Hz; (3) contralesional real 1 Hz rTMS and next ipsilesional sham stimulation; or (4) bilateral sham-control procedures. At 24 hours before and after the intervention, we obtained cortical excitability data from study subjects. At baseline, after treatment and 3 months follow up, we additionally evaluated patients with the clinical assessments. RESULTS At post-intervention, group A showed greater motor improvements in FMA, FMA-UL, NIHSS, ADL and mRS values than group B, group C and group D, that were continued for at least 3 months after the completion of the treatment time. Specifically, it is shown in the cortical excitability study that the motor-evoked potential (MEP) amplitude and resting motor threshold (rMT) more significantly improved in group A than other groups. The improvement in motor function and change in motor cortex excitability exhibit a significant correlation in the affected hemisphere. The combined 1 Hz and 10 Hz stimulation treatment showed a synergistic effect. CONCLUSIONS Facilitatory rTMS and coupling inhibitory produced extra satisfactory results in facilitating the motor's recovery in the subacute and acute phase following stroke compared to that acquired from alone single-course modulation.
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Affiliation(s)
- Qingmei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dan Shen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jun Ke
- Department of Medical Imaging, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Hongxia Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shenjie Pan
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Haoyu Liu
- Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dapeng Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Min Su
- Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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30
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Ramos-Rincon JM, Buonaiuto V, Ricci M, Martín-Carmona J, Paredes-Ruíz D, Calderón-Moreno M, Rubio-Rivas M, Beato-Pérez JL, Arnalich-Fernández F, Monge-Monge D, Vargas-Núñez JA, Acebes-Repiso G, Mendez-Bailon M, Perales-Fraile I, García-García GM, Guisado-Vasco P, Abdelhady-Kishta A, Pascual-Pérez MDLR, Rodríguez-Fernández-Viagas C, Montaño-Martínez A, López-Ruiz A, Gonzalez-Juarez MJ, Pérez-García C, Casas-Rojo JM, Gómez-Huelgas R. Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 76:e28-e37. [PMID: 33103720 PMCID: PMC7797762 DOI: 10.1093/gerona/glaa243] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. METHODS We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1-May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. RESULTS A total of 2772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index < 60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n: 1301) and increased with age (80-84 years: 41.6%; 85-90 years: 47.3%; 90-94 years: 52.7%; ≥95 years: 54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: oxygen saturation < 90%; temperature ≥ 37.8°C; quick sequential organ failure assessment (qSOFA) score ≥ 2; and unilateral-bilateral infiltrates on chest x-rays. Some analytical findings were independent risk factors for death, including estimated glomerular filtration rate < 45 mL/min/1.73 m2; lactate dehydrogenase ≥ 500 U/L; C-reactive protein ≥ 80 mg/L; neutrophils ≥ 7.5 × 103/μL; lymphocytes < 0.8 × 103/μL; and monocytes < 0.5 × 103/μL. CONCLUSIONS This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor preadmission functional status-not comorbidities-are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.
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Affiliation(s)
| | - Verónica Buonaiuto
- Internal Medicine Department, Málaga Regional University Hospital, Spain
| | - Michele Ricci
- Internal Medicine Department, Málaga Regional University Hospital, Spain
| | | | - Diana Paredes-Ruíz
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Spain
| | | | | | | | | | | | | | - Isabel Perales-Fraile
- Internal Medicine Department, Infanta Sofía Hospital, S. S. de los Reyes, Madrid, Spain
| | | | - Pablo Guisado-Vasco
- Internal Medicine Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Spain
| | | | | | | | | | - Antonio López-Ruiz
- Internal Medicine Department, Axarquía Hospital, Vélez-Málaga, Málaga, Spain
| | | | - Cristina Pérez-García
- Internal Medicine Department, Do Salnes Hospital, Vilagarcía de Arousa (Pontevedra), Spain
| | - José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
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Lundby C, Glans P, Simonsen T, Søndergaard J, Ryg J, Lauridsen HH, Pottegård A. Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents. J Am Geriatr Soc 2021; 69:1508-1518. [PMID: 33598916 DOI: 10.1111/jgs.17054] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents. DESIGN Interview-based questionnaire study. SETTING Denmark. PARTICIPANTS Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8. MEASUREMENTS Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics. RESULTS Participants had a median age of 82 years (interquartile range [IQR] 76-89) and used a median of 8 medications (IQR 5-10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (ptrend = 0.001): Those using 1-4 medications daily had a median score of 25 (IQR 17-33) compared to 58 (IQR 42-75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (ptrend = 0.001) and a lower "appropriateness" score (ptrend < 0.001), respectively. CONCLUSION Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.
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Affiliation(s)
- Carina Lundby
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense C, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark
| | - Peter Glans
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
| | - Trine Simonsen
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark
| | - Jesper Ryg
- ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Henrik Hein Lauridsen
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark
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Activities of daily living at hospital admission associated with mortality in geriatric patients with dementia: a Danish nationwide population-based cohort study. Eur Geriatr Med 2021; 12:627-636. [PMID: 33393062 DOI: 10.1007/s41999-020-00431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Determining life expectancy in patients with dementia are challenging. We aimed at studying the association between basic activities of daily living as measured by the Barthel Index at hospital admission and mortality among older patients with dementia. METHODS All patients aged ≥ 65 years with diagnosed dementia in the population-based National Danish Geriatric Database from 2005 to 2014 were included and followed until death, emigration, or study termination (31.12.2015). Data on Barthel Index (BI) were used to assess ADL. Patients were categorized into four predefined standard BI subcategories according to the national Danish version of the statistical classification of diseases [BI = 0-24 (very low ADL), BI = 25-49 (low ADL), BI = 50-79 (moderate reduced ADL), and BI = 80-100 (independent ADL)]. Association with mortality was assessed using multivariable Cox regression analysis adjusting for age, marital status, Charlson Comorbidity Index, BMI, prior hospitalizations, year of admission and polypharmacy. RESULTS In total, 6550 patients (women 62%) were included, median (IQR) age 84 (79-88) years and BI 37 (13-63). Mortality increased significantly with decreasing BI in both the crude and multivariable analysis. In subcategories BI = (80-100) and BI = (0-24), survival time (median (95%)) was 3.6 (3.4-3.9) years and 0.8 (0.7-0.9) years, respectively. Also, in patients with BI = (0-24), the overall mortality risk (HR (95% CI)) was 2.5 (2.2-2.8), 30-day risk 11.8 (5.8-23.9), and 1-year risk 4.4 (3.6-5.5) when using BI = (80-100) as reference. CONCLUSION Barthel Index is independently associated with all-cause mortality among older patients with dementia admitted to hospital. BI may be a helpful tool for clinicians when discussing treatment and care strategies with patients and their families.
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Chen Q, Ke J, Cai X, Sun H, Chen Z, Li L, Su M, Fang Q. GABA-induced motor improvement following acute cerebral infarction. Am J Transl Res 2020; 12:7724-7736. [PMID: 33437357 PMCID: PMC7791484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023]
Abstract
γ-Aminobutyric acid (GABA) plays a key role in motor learning. In the aftermath of stroke, we monitored GABA+ content of primary motor cortex by magnetic resonance spectroscopy (MRS), assessing its relation to functional motor recovery following a standardized 4-week program of rehabilitation. The cohort included 20 patients, each experiencing stroke within 2 weeks of symptom onset. Twenty age-matched healthy subjects were also recruited as controls. GABA+ levels were determined at baseline and following rehabilitation, performed only once in sex- and age-matched control subjects. Motor functions were then measured via Fugl-Meyer Assessment (FMA). Processing of MRS data was driven by open-source Gannet software. Because GABA, macromolecules, and homocarnosine jointly contribute to MEscher-Garwood Point RESolved Spectroscopy (MEGA-PRESS) signals, the designation GABA+ (rather than GABA) was applied. Baseline GABA+/creatine (Cr) ratios proved significantly lower in patients with strokes than in control subjects (P<0.05). Following the 4-week rehabilitative regimen, significant improvement in FMA indices was evident across the test group. FMA scores and GABA+/Cr ratios correlated significantly at baseline, the GABA+/Cr ratio displaying a significant association with motor function (P=0.025). In the setting of acute stroke, GABA+/Cr ratios of primary motor cortex fell significantly below levels found in healthy subjects. The observed association between GABA+/Cr ratio and motor recovery underscores the utility of MRS-measured GABA as a key motor recuperative biomarker.
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Affiliation(s)
- Qingmei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
- Department of Rehabilitation, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Jun Ke
- Department of Medical Imaging, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Zhiguo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Li Li
- Department of Rehabilitation, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Min Su
- Department of Rehabilitation, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow UniversitySuzhou 215000, Jiangsu Province, China
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Ocagli H, Cella N, Stivanello L, Degan M, Canova C. The Barthel index as an indicator of hospital outcomes: A retrospective cross-sectional study with healthcare data from older people. J Adv Nurs 2020; 77:1751-1761. [PMID: 33277770 DOI: 10.1111/jan.14708] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/28/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in-hospital mortality, discharge destination, and Diagnosis-Related Groups-based cost. DESIGN This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016. METHODS A logistic regression model for categorical variables (length of stay, in-hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index. RESULTS A total of 13,484 admissions were included in the analysis. In-hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12-fold increased risk of death (OR = 12.81; 95% CI 9.22-18.14), a 4 times greater likelihood of safe discharge (OR = 4.64; 95% CI 3.96-5.45), and a 2-fold increase in length of stay (OR = 2.56; 95% CI 2.34-2.81). On the other hand, no significant association was found between the cost of hospitalization and the Barthel Index. CONCLUSIONS Barthel Index was strongly associated with in-hospital mortality, discharge destination, and length of stay. The costs of hospitalization, however, were not related to patients' functional impairment. IMPACT The study considers functional status as an indicator of hospital outcomes. Better comprehension of the relationship between functional status and healthcare outcomes may help with early and adequate healthcare planning and resource management.
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Affiliation(s)
- Honoria Ocagli
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Nicoletta Cella
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,Department of Internal Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Lucia Stivanello
- Health professional Management Service (DPS) of the University Hospital of Padova, Padova, Italy
| | - Mario Degan
- Health professional Management Service (DPS) of the University Hospital of Padova, Padova, Italy
| | - Cristina Canova
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
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Projection of the Number of Elderly in Different Health States in Thailand in the Next Ten Years, 2020-2030. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228703. [PMID: 33238588 PMCID: PMC7700511 DOI: 10.3390/ijerph17228703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/05/2022]
Abstract
The objective of this study is to predict the volume of the elderly in different health status categories in Thailand in the next ten years (2020–2030). Multistate modelling was performed. We defined four states of elderly patients (aged ≥ 60 years) according to four different levels of Activities of Daily Living (ADL): social group; home group; bedridden group; and dead group. The volume of newcomers was projected by trend extrapolation methods with exponential growth. The transition probabilities from one state to another was obtained by literature review and model optimization. The mortality rate was obtained by literature review. Sensitivity analysis was conducted. By 2030, the number of social, home, and bedridden groups was 15,593,054, 321,511, and 152,749, respectively. The model prediction error was 1.75%. Sensitivity analysis with the change of transition probabilities by 20% caused the number of bedridden patients to vary from between 150,249 and 155,596. In conclusion, the number of bedridden elders will reach 153,000 in the next decade (3 times larger than the status quo). Policy makers may consider using this finding as an input for future resource planning and allocation. Further studies should be conducted to identify the parameters that better reflect the transition of people from one health state to another.
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Antileo-Pinto C, Lara-Madrid A, Montecinos-Muñoz N, Castillo-Orellana P, Martínez-Huenchullán S. [Length of hospital stay and functional status in patients with delayed start of physical therapy]. Rehabilitacion (Madr) 2020; 55:251-257. [PMID: 33070951 DOI: 10.1016/j.rh.2020.07.004] [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: 04/19/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the association between hospital stay, functional status and physical therapy delay (PT delay) in patients admitted to a surgery unit of a high complexity hospital. MATERIALS AND METHODS Observational, analytic and cross-sectional study. We included 279 patients (124 women). Days of PT delay (calculated as the difference between hospital admission and start of PT), days of bed rest, prolonged hospital stay (75th percentile of bed rest days), and functional status were registered to investigate the influence of PT delay on these variables. RESULTS The number of days of PT delay was strongly associated with the number of bed rest days (r2 = 0.74, p < 0.05). Moreover, a PT delay of five days or more was associated with extended lengths of stay in our sample (p < 0.05). However, physical therapy had similar effects on functional status, even when there were PT delays (p > 0.05). CONCLUSIONS PT delay is associated with extended length of stay in patients admitted to a surgery unit of a high complexity hospital. Future studies should investigate the associated factors that could explain the occurrence of PT delays in surgical patients.
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Affiliation(s)
- C Antileo-Pinto
- Escuela de Kinesiología, Facultad de Medicina, Universidad Austral de Chile, Chile.
| | - A Lara-Madrid
- Escuela de Kinesiología, Facultad de Medicina, Universidad Austral de Chile, Chile
| | - N Montecinos-Muñoz
- Escuela de Kinesiología, Facultad de Medicina, Universidad Austral de Chile, Chile
| | - P Castillo-Orellana
- Escuela de Kinesiología, Facultad de Medicina, Universidad Austral de Chile, Chile
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Association between number of medications and mortality in geriatric inpatients: a Danish nationwide register-based cohort study. Eur Geriatr Med 2020; 11:1063-1071. [DOI: 10.1007/s41999-020-00390-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022]
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Uçar Ö, Çelik S. Comparison of platelet-rich plasma gel in the care of the pressure ulcers with the dressing with serum physiology in terms of healing process and dressing costs. Int Wound J 2020; 17:831-841. [PMID: 32212258 PMCID: PMC7948873 DOI: 10.1111/iwj.13344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022] Open
Abstract
This research was carried out with the aim of comparing the effects of platelet-rich plasma (PRP) gel and gas dressing with serum physiologic applied to stage II pressure ulcer in coccyx of patients for 2 months on healing process and dressing costs. This prospective randomised controlled experimental study was conducted with 60 patients hospitalised in the palliative care unit after surgery. The experimental group (n = 30) was dressed with platelet-rich plasma gel. The control group (n = 30) was treated with serum physiologic dressing. At the end of the 20th observation of the patients in the experimental group, it was found that the mean scores of area, exudate, and tissue type in pressure sores decreased statistically (P < .001). In the control group, no significant difference was found between the mean PUSH score at the end of the 20th observation (P > .05). The study showed that PRP gel had a positive effect on healing of stage II pressure ulcers with platelet-rich plasma gel dressings. In addition, when evaluated in the long term, it was concluded that platelet-rich plasma gel is easily accessible and less costly than serum physiological dressing.
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Affiliation(s)
- Özge Uçar
- Department of Nursing, Faculty of Health SciencesBartın UniversityBartınTurkey
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Gregersen M, Hansen TK, Jørgensen BB, Damsgaard EM. Frailty is associated with hospital readmission in geriatric patients: a prognostic study. Eur Geriatr Med 2020; 11:783-792. [PMID: 32468431 DOI: 10.1007/s41999-020-00335-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/14/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Targeting health care interventions requires valid measurements when predicting unplanned hospital readmission. The Multidimensional Prognostic Index (MPI) based on Comprehensive Geriatric Assessment (CGA) enables the prediction of mortality and length of stay (LOS) in older hospitalized patients. Our aim was to validate if the MPI as a frailty tool could predict unplanned hospital readmission in geriatric patients. METHODS This prognostic study was conducted in geriatric wards. The target population was 65 + -year-old patients hospitalized with acute illness. The MPI tool is derived from eight CGA domains by an interdisciplinary team: social aspects, number of drugs, activities of daily living (ADL), instrumental-ADL, cognitive status, severity of morbidity, risk of developing pressure sores, and nutritional status. Patients assessed were categorized into three groups: non-frail (MPI-1), moderate frail (MPI-2) or severe frail (MPI-3). Primary outcome was 30-day unplanned readmission and secondary LOS and 90-day mortality. RESULTS In total 1467 patients were included from January 1, 2018, to October 1, 2019. Mean age was 84.2 years (± 7.4) and 59% were women. 15.7% were readmitted. Hazard ratio (HR) for readmission in the MPI-2 group (n = 635) was 2.57; 95% confidence interval (CI) 1.25-5.29 (p = 0.01), and 2.60; 95% CI 1.27-5.33 (p = 0.009) in the MPI-3 group (n = 711) compared to the MPI-1 group (n = 121). MPI was a predictor of LOS and mortality. CONCLUSION Using the MPI tool to identify the frail and non-frail patients is applicable to predict unplanned hospital readmission in geriatric patients. The MPI is superior to the prognostic value of each single domain. MPI will be of great value to health professionals' decision-making.
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Affiliation(s)
- Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Building, 8200, Aarhus N, Denmark.
| | - Troels K Hansen
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Building, 8200, Aarhus N, Denmark
| | - Bodil B Jørgensen
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Building, 8200, Aarhus N, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Building, 8200, Aarhus N, Denmark
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Chang J, Hou WW, Wang YF, Sun QM. Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3-5: A Case-Control Study. Clin Interv Aging 2020; 15:609-618. [PMID: 32431494 PMCID: PMC7200239 DOI: 10.2147/cia.s249137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Elderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients’ activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients. Patients and Methods A total of 303 elderly patients with CKD stage 3–5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models. Results The data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00–1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17–19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70–0.92, P=0.0012) were the independent risk factors of ADL impairment. Conclusion Decline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.
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Affiliation(s)
- Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Wen Hou
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan-Fei Wang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qian-Mei Sun
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Botana-Rial M, Martínez-Reglero C, Fernández Villar A. La dependencia para actividades como factor predictor de mortalidad tras una hospitalización por una agudización de enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2020; 56:291-297. [DOI: 10.1016/j.arbres.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/02/2019] [Accepted: 10/04/2019] [Indexed: 01/19/2023]
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Soejono CH, Sutanto H. The functional status, rehospitalization, and hospital cost reduction in geriatric patients after the implementation of the universal health coverage program in the national referral hospital Indonesia. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i4.3214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Universal health coverage program (UHCP) might implicate negatively toward geriatric care with its impact on higher cost. The evaluation had to be made, especially in functional status, rehospitalization, and cost-effectiveness.
METHODS Retrospective cohort study with historical control was done. Seventy two geriatric inpatients in the pre-UHCP group and 86 in the UHCP group were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects with geriatric syndromes admitted from July to December 2013 (pre-UHCP era) and January to June 2014 (UHCP era). Functional status changes, rehospitalization, and process indicators were observed. Cost reduction was calculated using the incremental cost-effectiveness ratio (ICER), whereby costs, functional status changes, and rehospitalization of both groups were used to identify the differences.
RESULTS Proportions of functional status increase were 35.3% and 34.8% in the pre- UHCP and UHCP groups, respectively (p = 1.00) and the decrease were 5.9% and 4.5% in the pre-UHCP and UHCP group, respectively (p = 1.00). Rehospitalization rates were 21.7% and 18.1% (p = 0.603) in the pre-UHCP and UHCP groups, respectively. Mean hospital expenses were between 17.1 million IDR (1,221 USD; 1 USD = 14,000 IDR) for the pre-UHCP group and 20.8 million IDR (1,486 USD) for the UHCP group. ICER showed that hospitalization cost was 3.7 million IDR (264 USD) higher to increase 1 activity of daily living score in the UHCP era. As for rehospitalization, the cost was 600,000 IDR (43 USD) less, with 3.6% smaller in readmission.
CONCLUSIONS There was no changes in patients’ functional status after the UHCP implementation. There was a reduction in rehospitalization with lower cost in the UHCP era.
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