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Carpenter CR, Lee S, Kennedy M, Arendts G, Schnitker L, Eagles D, Mooijaart S, Fowler S, Doering M, LaMantia MA, Han JH, Liu SW. Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments. Acad Emerg Med 2024. [PMID: 38757369 DOI: 10.1111/acem.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test-treatment thresholds for ED delirium screening. METHODS We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta-analysis and estimated delirium screening thresholds. RESULTS Full-text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta-analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7-20.7) and rule out (pooled negative likelihood ratio [LR-] 0.18, 95% CI 0.09-0.34) delirium. We also conducted meta-analysis of two studies that quantified the accuracy of the Abbreviated Mental Test-4 (AMT-4) and found that the pooled LR+ (4.3, 95% CI 2.4-7.8) was lower than that observed for the 4AT, but the pooled LR- (0.22, 95% CI 0.05-1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%. CONCLUSIONS The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED-based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM-ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single-center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single-center study.
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Affiliation(s)
| | - Sangil Lee
- University of Iowa, Iowa City, Iowa, USA
| | - Maura Kennedy
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Glenn Arendts
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Linda Schnitker
- Bolton Clarke Research Institute, Bolton Clarke School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Simon Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Susan Fowler
- University of Connecticut Health Sciences, Farmington, Connecticut, USA
| | - Michelle Doering
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Jin H Han
- Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Carter L, Yadav A, O'Neill S, O'Shea E. Extended length of stay and related costs associated with dementia in acute care hospitals in Ireland. Aging Ment Health 2022; 27:911-920. [PMID: 35603799 DOI: 10.1080/13607863.2022.2068128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To estimate the additional impact of dementia on in-patient length of stay (LOS) and related costs in Irish acute hospitals. Both principal and secondary diagnosis effects are estimated and valued. METHODS This is a cross-sectional study based on administrative data collected on all public hospital in-patient discharges in Ireland for people aged 65 years and older in 2019. Coarsened exact matching (CEM) was undertaken to account for observed confounders between dementia and non-dementia groups, while generalised linear modelling (GLM) was used to compare differences in LOS. RESULTS Patients with a principal diagnosis of dementia spent on average 17.5 (CI: 15.42, 19.56; p < .01) d longer in hospital than similar patients with no principal diagnosis of dementia. LOS was 6.7 (CI: 6.31, 7.14; p < .01) d longer for patients with a secondary diagnosis of dementia compared to similar patients with no secondary diagnosis of dementia. The additional annual cost of care for patients in hospitals with a secondary (principal) diagnosis of dementia was €62.0 million (€13.2 million). CONCLUSIONS This study highlights the economic impact of extended LOS for patients with dementia in Irish acute hospitals. Addressing specific dementia-related needs of people in hospital is likely to optimise resource use and decrease health care costs in acute care settings.
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Affiliation(s)
- L Carter
- Centre for Economic and Social Research on Dementia, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland
| | - A Yadav
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - S O'Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - E O'Shea
- Centre for Economic and Social Research on Dementia, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland
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Kassir ZM, Li J, Harrison C, Johnson JT, Nilsen ML. Disparity of perception of quality of life between head and neck cancer patients and caregivers. BMC Cancer 2021; 21:1127. [PMID: 34670507 PMCID: PMC8527693 DOI: 10.1186/s12885-021-08865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Caregivers are invaluable sources of support for individuals recovering from head and neck cancer (HNC). Accordingly, minimizing caregiver distress is essential to promote the well-being of both caregivers and their patients. This study assessed if psychosocial distress (i.e., anxiety and depression) among HNC caregivers is associated with a difference in how caregivers and their patients perceive patients’ quality of life (QOL) after treatment completion. Methods Caregivers’ and patients’ perceptions of patient QOL were assessed using the University of Washington QOL Questionaire (UWQOL), a validated HNC-specific health-related QOL questionnaire. The survey is interpreted in terms of its two composite scores: a physical QOL score and a social-emotional QOL score with higher scores indicating better QOL. Caregiver anxiety was assessed using the Generalized Anxiety Questionaire-7 (GAD-7) and caregiver depression was assessed using the Patient Health Questionaire 8 (PHQ-8). Patients completed the UWQOL as part of clinic intake while caregivers were asked to complete the UWQOL for their patients in addition to the PHQ-8 and GAD-7 in private. Linear regression was used to analyze the association between differences in caregivers’ and patients’ QOL scores (both social-emotional and physical QOL subscale scores) and GAD-7 and PHQ-8 scores. Results Of 47 caregivers recruited, 42.6% (n = 20) viewed patients’ social-emotional QOL more negatively than patients themselves, while 31.9% viewed patients’ physical QOL more negatively. After controlling for covariates, differences in perception of social-emotional QOL (p = .01) and differences in perception of physical QOL (p = .007) were significantly associated with caregiver depression, but not anxiety. Caregivers who disagreed with patients regarding patients’ social-emotional QOL scored 6.80 points higher on the PHQ8 than agreeing caregivers. Caregivers who disagreed regarding patients’ physical QOL scored 6.09 points higher. Conclusion Caregivers commonly view patients’ QOL more negatively than patients themselves. These caregivers tend to have greater psychosocial distress than caregivers who agree with their patients. Interventions designed to identify and aid at-risk caregivers are critically needed. We propose screening for differences in perception of patient QOL as a way of identifying distressed caregivers as well as provider-facilitated communication between patients and caregivers as possible interventions that should be examined in future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08865-7.
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Affiliation(s)
- Zachary M Kassir
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye & Ear Institute, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jinhong Li
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Christine Harrison
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye & Ear Institute, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye & Ear Institute, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marci L Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye & Ear Institute, 203 Lothrop Street, Pittsburgh, PA, 15213, USA. .,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, 318A Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.
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Reynish E, Hapca S, Walesby R, Pusram A, Bu F, Burton JK, Cvoro V, Galloway J, Ebbesen Laidlaw H, Latimer M, McDermott S, Rutherford AC, Wilcock G, Donnan P, Guthrie B. Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions.
Objective
This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013.
Design
For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost.
Data sources
Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set.
Results
In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower.
Limitations
A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders.
Conclusions
Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways.
Future work
Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital.
Study registration
This study is registered as PROSPERO CRD42015024492.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma Reynish
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Simona Hapca
- School of Medicine, University of Dundee, Dundee, UK
| | - Rebecca Walesby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Angela Pusram
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Feifei Bu
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Jennifer K Burton
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Vera Cvoro
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - James Galloway
- Health Informatics Centre, University of Dundee, Dundee, UK
| | | | - Marion Latimer
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | | | - Gordon Wilcock
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Peter Donnan
- School of Medicine, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- School of Medicine, University of Dundee, Dundee, UK
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Lau JH, Abdin E, Jeyagurunathan A, Seow E, Ng LL, Vaingankar JA, Chong SA, Subramaniam M. The association between caregiver burden, distress, psychiatric morbidity and healthcare utilization among persons with dementia in Singapore. BMC Geriatr 2021; 21:67. [PMID: 33468059 PMCID: PMC7816438 DOI: 10.1186/s12877-021-02014-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Caregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. The present paper examines how these are associated with healthcare utilization of the PWD in Singapore. METHODS The data of 399 caregiver-PWD dyads were extracted from a national cross-sectional survey. PWD completed the Client Service Receipt Inventory, which provided information on their healthcare utilization (i.e. emergency service use, hospital admission, length of stay in hospital, and number of outpatient visits) within a frame of 3 months. The Zarit Burden Interview (ZBI), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Self Reporting Questionnaire (SRQ-20) were administered to caregivers. Information on severity of dementia, physical multimorbidity of the PWD, household composition, and caregivers' sociodemographic characteristics such as age, gender, and education were collected. Variables significantly associated with healthcare utilization in the univariate analyses were selected and included in the final regression models. Emergency service use and hospital admission were investigated using logistic regression analyses, whilst negative binomial models were utilized for length of stay in hospital and number of outpatient visits. RESULTS After adjusting for significant correlates such as dementia severity and multimorbidity, only caregiver distress from responsive behaviours was positively associated with emergency room utilization, while caregiver burden was positively associated with length of hospital stay in the final regression model. Psychiatric morbidity was associated with healthcare utilization outcomes at the univariate level but did not reach statistical significance in final models. CONCLUSION The study identifies caregiver variables associated with the healthcare utilization of PWD. Policy makers and healthcare professionals should provide interventions to ease burden and distress amongst caregivers of PWD.
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Affiliation(s)
- Jue Hua Lau
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Esmond Seow
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Li Ling Ng
- Department of Rheumatology & Immunology, Singapore General Hospital, SingHealth, Singapore, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
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Zebrak KA, Campione JR. The Effect of National Family Caregiver Support Program Services on Caregiver Burden. J Appl Gerontol 2020; 40:963-971. [PMID: 31971062 DOI: 10.1177/0733464819901094] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extant evidence on the effectiveness of caregiver programs in alleviating caregiver burden is mixed, underscoring the need for further investigations. This study evaluated the effect of the National Family Caregiver Support Program (NFCSP) educational services and respite care on caregiver burden. We used survey data from caregivers assigned to program (n = 491) or comparison (n = 417) group based on their reported use of NFCSP services. Adjusted difference-in-differences (DiD) analysis found an increase in mean burden scores for both groups from baseline to 6 or 12 months. Among program caregivers receiving ≥4 hr of NFCSP respite care per week (n = 307) and matched comparisons (n = 370), burden scores decreased slightly for program caregivers (-0.095 points), but increased for comparison caregivers (+0.145 points). The DiD (0.239 points) was not statistically significant. More research is needed to determine the minimum amount of respite care needed to positively impact caregiver burden.
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Bouaziz W, Schmitt E, Vogel T, Lefebvre F, Leprêtre PM, Kaltenbach G, Geny B, Lang PO. Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: A randomised controlled trial in sedentary seniors. Int J Clin Pract 2019; 73:e13219. [PMID: 29963733 DOI: 10.1111/ijcp.13219] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/26/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Interval aerobic training programme with active recovery bouts (IATP-R) has shown to improve tolerance to IATP among seniors. However, data concerning its benefits for seniors' health are still limited. PURPOSE The purpose of this study was to examine the effects of IATP-R on seniors' health status. METHODS Sedentary volunteers (n = 60, aged ≥70 years) were randomly assigned to either IATP-R or maintained sedentary lifestyle for 9.5 weeks. IATP-R consisted of 30-minute cycling (6 × 4 minutes at first ventilatory threshold (VT1 ) intensity + 1 minute at 40% of VT1 ) twice a week. Cognitive and functional performances were assessed with the Trail Making Test (TMT-A; TMT-B); Paced Auditory Serial Addition Test (PASAT); Timed Up and Go (TUG) test; 6-Minute Walk Test (6-MWT); one-leg balance test; and the Short Physical Performance Battery (SPPB) tests, respectively. QoL and anxiety/depression status were measured by the Short Form-12 and the Goldberg's Scale, respectively. All participants were assessed at baseline and 9.5 weeks later. RESULTS Compared to controls, IATP-R improved cognitive functions (TMT-A: +1.5% vs -21.5%; TMT-B: +0.9% vs -13.3%; PASAT: +1.4% vs -14.6%; semantic fluency: -1.1% vs +11.7%), functional performance (TUG: +5.4% vs -16.5%; 6-MWT: -3.2% vs +11.5%; SPPB: -3.2% vs +14.6%; One-leg balance: -16.3% vs +25.0%); QoL (physical health: -13.3% vs +23.1%; mental health: -7.1% vs +8.2%); and depressive symptoms (+26.3% vs -42.8%). Significant impacts were measured neither on letter modality of fluency tasks nor on anxiety score. CONCLUSION These data showed that IATP-R is an effective training programme to improve functional and cognitive performances, mental health and well-being in sedentary seniors. Trial registration ClinicalTrials.gov NCT02263573. Registered October 1, 2014.
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Affiliation(s)
- Walid Bouaziz
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
- Research Laboratory Mitochondria, Oxidative stress and muscle resistance (MSP, EA-3072), Department of Physiology, Faculty of Medicine, Strasbourg University, Strasbourg, France
- Research Unit of the University of Rouen (CETAPS, EA-3832), Faculty of Sport Sciences, University of Rouen Normandy, Mont Saint-Aignan, France
| | - Elise Schmitt
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
- Research Laboratory Mitochondria, Oxidative stress and muscle resistance (MSP, EA-3072), Department of Physiology, Faculty of Medicine, Strasbourg University, Strasbourg, France
| | - Thomas Vogel
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
- Research Laboratory Mitochondria, Oxidative stress and muscle resistance (MSP, EA-3072), Department of Physiology, Faculty of Medicine, Strasbourg University, Strasbourg, France
| | - François Lefebvre
- Department of Medical Information, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre-Marie Leprêtre
- Laboratory of Exercise Physiology and Rehabilitation (APERE, EA-3300), UFR-STAPS, University of Picardie Jules Verne, Amiens, France
- Unit of cardiovascular rehabilitation, Hospital center of Corbie, Corbie, France
| | - Georges Kaltenbach
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Research Laboratory Mitochondria, Oxidative stress and muscle resistance (MSP, EA-3072), Department of Physiology, Faculty of Medicine, Strasbourg University, Strasbourg, France
- Functional Explorations Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre-Olivier Lang
- Health and Wellbeing Academy, Anglia Ruskin University, Cambridge, UK
- Geriatric and Rehabilitation Geriatric Division, University Hospital and University of Lausanne, Lausanne, Switzerland
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Majidi Shad M, Saberi A, Shakiba M, Rezamasouleh S. Evaluating the Duration of Hospitalization and Its Related Factors Among Stroke Patients. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2018. [DOI: 10.29252/cjns.4.15.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Saarelainen L, Tolppanen AM, Koponen M, Tanskanen A, Sund R, Tiihonen J, Hartikainen S, Taipale H. Risk of Hip Fracture in Benzodiazepine Users With and Without Alzheimer Disease. J Am Med Dir Assoc 2017; 18:87.e15-87.e21. [DOI: 10.1016/j.jamda.2016.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/29/2022]
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Toh HJ, Lim ZY, Yap P, Tang T. Factors associated with prolonged length of stay in older patients. Singapore Med J 2016; 58:134-138. [PMID: 27609507 DOI: 10.11622/smedj.2016158] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Prolonged stay in acute hospitals increases the risk of hospital-acquired infections in older patients, and disrupts patient flow and access to care due to bed shortages. We aimed to investigate the factors associated with prolonged length of stay (pLOS) among older patients (aged ≥ 78 years) in a tertiary hospital, to identify the potentially modifiable risk factors that could direct interventions to reduce length of stay (LOS). METHODS During a three-month period from January 2013 to March 2013, we identified 72 patients with pLOS (LOS ≥ 21 days) and compared their demographic and clinical variables with that of 281 randomly selected control patients (LOS < 21 days) using univariate and multivariate logistic regression analyses. RESULTS The mean age of the patients was 85.30 ± 5.34 years; 54% of them were female and 72% were of Chinese ethnicity. Logistic regression revealed the following significant factors for increased LOS: discharge to intermediate and long-term care services (odds ratio [OR] 9.22, 95% confidence interval [CI] 3.56-23.89; p < 0.001); increased severity of illness (OR 2.41, 95% CI 1.12-5.21; p = 0.025); and presence of caregiver stress (OR 3.85, 95% CI 1.67-8.91; p = 0.002). CONCLUSION Presence of caregiver stress and nursing home placement are potential modifiable risk factors of pLOS among older patients. Early identification and management of caregiver stress, as well as expediting discharge planning, may help to reduce the length of stay for this cohort.
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Affiliation(s)
- Hui Jin Toh
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Zhen Yu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Terence Tang
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
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Chang KJ, Lee S, Lee Y, Lee KS, Back JH, Jung YK, Lim KY, Noh JS, Kim HC, Roh HW, Choi SH, Kim SY, Joon Son S, Hong CH. Severity of White Matter Hyperintensities and Length of Hospital Stay in Patients with Cognitive Impairment: A CREDOS (Clinical Research Center for Dementia of South Korea) Study. J Alzheimers Dis 2016; 46:719-26. [PMID: 25854927 DOI: 10.3233/jad-142823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND & OBJECTIVE White matter hyperintensities (WMHs) contribute to aggravation of dementia or geriatric syndrome, thereby resulting in functional impairment. However, evidence of direct association between WMHs and medical resource utilization indicated by length of hospital stay (LOS) is scarce in patients with cognitive impairment. This study aimed to examine the relationship between the severity of WMHs and LOS in patients with cognitive impairment. METHODS 4,253 older adults with cognitive impairment were enrolled in this study. We defined LOS as the total sum of days from January 1, 2008 to December 31, 2012. The severity of periventricular (PVWMHs), deep (DWMHs), and overall white matter hyperintensities (Overall WMHs) was evaluated by a visual rating scale. We conducted multinomial logistic regression to demonstrate the relationship between LOS and severity of PVWHMs, DWHMs, and Overall WMHs, respectively. RESULTS The median LOS was 20 days. Severe PVWMHs had a higher likelihood of longer LOS (Q3: odd ratio/OR = 1.32, 95% confidence interval/CI = 1.06-1.64; Q4: OR = 1.33, 95% CI = 1.07-1.65; Q5: OR = 1.55, 95% CI = 1.26-1.91). As for DWMHs, moderate DWMHs were related to longer LOS (Q4: OR = 1.33, 95% CI = 1.03-1.71; Q5: OR = 1.63, 95% CI = 1.26-2.11). Finally, severity of overall WMHs was independently associated with LOS, which was similar to the results of DWMHs. CONCLUSION These findings would advocate for prevention of WMHs to stave off excess medical resource utilization in patients with cognitive impairment.
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Affiliation(s)
- Ki Jung Chang
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soojin Lee
- Department of Medicare Administration, Backseok Arts University, Seoul, Republic Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Gangnam, Republic of Korea
| | - Joung Hwan Back
- Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea
| | - Young Ki Jung
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Young Lim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jai Sung Noh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Chung Kim
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.,Memory impairment center, Ajou University Hospital, Suwon, Republic of Korea
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Chang CC, Lin PH, Chang YT, Chen NC, Huang CW, Lui CC, Huang SH, Chang YH, Lee CC, Lai WA. The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes: A Hospital-Based Cohort in Taiwan with 4 Years Longitudinal Follow-Ups. Medicine (Baltimore) 2015; 94:e2091. [PMID: 26579820 PMCID: PMC4652829 DOI: 10.1097/md.0000000000002091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases.
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Affiliation(s)
- Chiung-Chih Chang
- From the Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (CCC, YTC, NCC, CWH); Department of Health and Beauty, Shu-Zen College of Medicine and Management, Kaohsiung, Taiwan (PHL); Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (CCL, CCL); Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (SHH, YHC); and Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (WAL)
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Launay CP, Rivière H, Kabeshova A, Beauchet O. Predicting prolonged length of hospital stay in older emergency department users: use of a novel analysis method, the Artificial Neural Network. Eur J Intern Med 2015; 26:478-82. [PMID: 26142183 DOI: 10.1016/j.ejim.2015.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]) of a 10-item brief geriatric assessment (BGA) for the prediction of prolonged length hospital stay (LHS) in older patients hospitalized in acute care wards after an emergency department (ED) visit, using artificial neural networks (ANNs); and to describe the contribution of each BGA item to the predictive accuracy using the AUROC value. METHODS A total of 993 geriatric ED users admitted to acute care wards were included in this prospective cohort study. Age >85years, gender male, polypharmacy, non use of formal and/or informal home-help services, history of falls, temporal disorientation, place of living, reasons and nature for ED admission, and use of psychoactive drugs composed the 10 items of BGA and were recorded at the ED admission. The prolonged LHS was defined as the top third of LHS. The ANNs were conducted using two feeds forward (multilayer perceptron [MLP] and modified MLP). RESULTS The best performance was reported with the modified MLP involving the 10 items (sensitivity=62.7%; specificity=96.6%; PPV=87.1; NPV=87.5; positive LR=18.2; AUC=90.5). In this model, presence of chronic conditions had the highest contributions (51.3%) in AUROC value. CONCLUSIONS The 10-item BGA appears to accurately predict prolonged LHS, using the ANN MLP method, showing the best criteria performance ever reported until now. Presence of chronic conditions was the main contributor for the predictive accuracy.
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Affiliation(s)
- C P Launay
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - H Rivière
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - A Kabeshova
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - O Beauchet
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Department of Medicine, Division of Geriatrics, Jewish General Hospital, McGill University, Montreal, Canada; Biomathics, Paris, France.
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14
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Nund RL, Rumbach AF, Debattista BC, Goodrow MNT, Johnson KA, Tupling LN, Scarinci NA, Cartmill B, Ward EC, Porceddu SV. Communication changes following non-glottic head and neck cancer management: The perspectives of survivors and carers. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:263-272. [PMID: 25764915 DOI: 10.3109/17549507.2015.1010581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Head and neck cancer (HNC) survivors may experience functional changes to their voice, speech and hearing following curative chemoradiotherapy. However, few studies have explored the impact of living with such changes from the perspective of the HNC survivor and their carer. The current study employed a person-centred approach to explore the lived experience of communication changes following chemoradiotherapy treatment for HNC from the perspective of survivors and carers. METHOD Participants included 14 survivors with non-glottic HNC and nine carers. All participants took part in in-depth interviews where they were encouraged to describe their experiences of living with and adjusting to communication changes following treatment. Interviews were analysed as a single data set. RESULT Four themes emerged including: (1) impairments in communication sub-systems; (2) the challenges of communicating in everyday life; (3) broad ranging effects of communication changes; and (4) adaptations as a result of communication changes. CONCLUSION These data confirm that communication changes following chemoradiotherapy have potentially negative psychosocial impacts on both the HNC survivor and their carer. Clinicians should consider the impact of communication changes on the life of the HNC survivor and their carer and provide adequate and timely education and management to address the needs of this population.
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Affiliation(s)
- Rebecca L Nund
- School of Health and Rehabilitation Sciences, The University of Queensland , St Lucia, Brisbane , Australia
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15
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Nund RL, Scarinci NA, Cartmill B, Ward EC, Kuipers P, Porceddu SV. Third-party disability in carers of people with dysphagia following non-surgical management for head and neck cancer. Disabil Rehabil 2015; 38:462-71. [DOI: 10.3109/09638288.2015.1046563] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Dunne TJ, Gaboury I, Ashe MC. Falls in hospital increase length of stay regardless of degree of harm. J Eval Clin Pract 2014; 20:396-400. [PMID: 24814338 DOI: 10.1111/jep.12144] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 01/29/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Acute inpatient falls are common and serious adverse events that lead to injury, prolonged hospitalization and increased cost of care. To determine the difference in total acute hospital care length of stay (LOS) for patients with and without an in-hospital fall (IHF), regardless of degree of harm. METHODS This was a retrospective observational study at a 728-bed acute care teaching hospital. We used propensity scores to match 292 patients with 330 controls by case mix group, sex, Resource Intensity Weights and week of admission. We used two administrative databases: hospital fall incident reporting system and Discharge Abstract Database. We reviewed all IHF incidents for patients 18 years and older, admitted to inpatient acute care hospital units/programs between 1 November 2009 and 31 August 2011. RESULTS The average LOS for IHF cases was 37.2 days [median 26.5 days; interquartile range (IQR) 14, 54] and 25.7 days (median 13 days; IQR 5, 33) for matched control patients. Survival analysis results indicated that patients who did not have an IHF were 2.4 times (95% CI 2.1, 2.7; P < 0.001) more likely to be discharged earlier from acute care than patients who had an IHF. CONCLUSIONS Experiencing either an injurious or a non-injurious fall during an acute care hospitalization was associated with prolonged LOS.
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Affiliation(s)
- Tanya J Dunne
- Regional Fall and Injury Prevention Program, Vancouver Coastal Health Authority, Vancouver, BC, Canada
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17
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Beauchet O, Launay CP, Merjagnan C, Kabeshova A, Annweiler C. Quantified self and comprehensive geriatric assessment: older adults are able to evaluate their own health and functional status. PLoS One 2014; 9:e100636. [PMID: 24968016 PMCID: PMC4072604 DOI: 10.1371/journal.pone.0100636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/28/2014] [Indexed: 01/24/2023] Open
Abstract
Background There is an increased interest of individuals in quantifying their own health and functional status. The aim of this study was to examine the concordance of answers to a self-administered questionnaire exploring health and functional status with information collected during a full clinical examination performed by a physician among cognitively healthy adults (CHI) and older patients with mild cognitive impairment (MCI) or mild-to-moderate Alzheimer disease (AD). Methods Based on cross-sectional design, a total of 60 older adults (20 CHI, 20 patients with MCI, and 20 patients with mild-to-moderate AD) were recruited in the memory clinic of Angers, France. All participants completed a self-administered questionnaire in paper format composed of 33 items exploring age, gender, nutrition, place of living, social resources, drugs daily taken, memory complaint, mood and general feeling, fatigue, activities of daily living, physical activity and history of falls. Participants then underwent a full clinical examination by a physician exploring the same domains. Results High concordance between the self-administered questionnaire and physician's clinical examination was showed. The few divergences were related to cognitive status, answers of AD and MCI patients to the self-administered questionnaire being less reliable than those of CHI. Conclusion Older adults are able to evaluate their own health and functional status, regardless of their cognitive status. This result needs to be confirmed and opens new perspectives for the quantified self-trend and could be helpful in daily clinical practice of primary care.
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Affiliation(s)
- Olivier Beauchet
- Department of Neuroscience, Angers University Hospital, Angers, France
- Biomathics, Paris, France
- * E-mail:
| | - Cyrille P. Launay
- Department of Neuroscience, Angers University Hospital, Angers, France
| | - Christine Merjagnan
- Department of Neuroscience, Angers University Hospital, Angers, France
- Biomathics, Paris, France
| | | | - Cédric Annweiler
- Department of Neuroscience, Angers University Hospital, Angers, France
- Department of Medical Biophysics, the University of Western Ontario, London, Canada
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Longacre ML, Ross EA, Fang CY. Caregiving Choice and Emotional Stress Among Cancer Caregivers. West J Nurs Res 2013; 36:806-24. [PMID: 24221954 DOI: 10.1177/0193945913510211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caring for a relative or friend with cancer may be highly demanding and emotionally burdensome. Theory suggests that personal characteristics of a caregiver may contribute directly to a caregiver's emotional health. An underexplored variable is a caregiver's perception of choice in providing care to a relative or friend. Thus, this study sought to characterize perceived choice in providing care among family cancer caregivers and examine its association with emotional stress. This study is a secondary analysis of cross-sectional telephone interviews of 1,247 family caregivers, which included 104 cancer caregivers. The findings indicated that a high majority of cancer caregivers expressed elevated emotional stress. Most caregivers perceived themselves to have had a choice in providing care; however, a perceived lack of choice in providing care was significantly associated with greater emotional stress. Assessing clinical and policy-related strategies for alleviating concerns related to choice may be of value in the cancer context.
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Affiliation(s)
| | - Eric A Ross
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay. ACTA ACUST UNITED AC 2013; 2013. [PMID: 24377056 PMCID: PMC3873143 DOI: 10.1155/2013/312348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis. Methods Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours. Results Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, P = 0.0010). A larger proportion of patients with pLOS developed an infection (P < 0.0001), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17–4.32, P = 0.0148). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83–3.35, P = 0.1443). Conclusions The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay.
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Bail K, Berry H, Grealish L, Draper B, Karmel R, Gibson D, Peut A. Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study. BMJ Open 2013; 3:bmjopen-2013-002770. [PMID: 23794540 PMCID: PMC3669724 DOI: 10.1136/bmjopen-2013-002770] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. DESIGN Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. SETTING Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. PARTICIPANTS 426 276 overnight hospital episodes for patients aged 50 and above (census sample). MAIN OUTCOME MEASURES Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. RESULTS Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium. CONCLUSIONS Compared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions.
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Affiliation(s)
- Kasia Bail
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Helen Berry
- Centre for Research and Action in Public Health, The University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Laurie Grealish
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Brian Draper
- University of New South Wales, Academic Department for Old Age Psychiatry, Euroa Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rosemary Karmel
- Data Linkage Unit, Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Diane Gibson
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Ann Peut
- Ageing and Aged Care, Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
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Beauchet O, Launay CP, Fantino B, Lerolle N, Maunoury F, Annweiler C. Screening for elderly patients admitted to the emergency department requiring specialized geriatric care. J Emerg Med 2013; 45:739-45. [PMID: 23746718 DOI: 10.1016/j.jemermed.2012.11.110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/11/2011] [Accepted: 11/29/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is a need for a brief geriatric assessment (BGA) tool to screen elderly patients admitted to the Emergency Department (ED) for their risk of a long hospital stay. OBJECTIVE To examine whether a BGA administered to elderly patients admitted to the ED may predict the risk of a long hospital stay in the geriatric acute care unit. METHODS This study had a prospective cohort study design, enrolling 424 elderly patients (mean age 84.0 ± 6.5 years, 31.6% male) who were evaluated in the ED using a BGA composed of the following items: age, gender, number of medications taken daily, history of falls during the past 6 months, Mini-Mental State Examination (MMSE) score, and non-use of home-help services (i.e., living alone without using any formal or informal home services or social help). The length of stay (LOS) was calculated in days. Patients were separated into three groups based on LOS: low (<8 days), intermediate (8-13 days), and high (>13 days). RESULTS The prevalence of male gender was higher among patients with the longest LOS compared to those with intermediate LOS (p = 0.002). There were more patients with a history of falls in the high LOS group compared to the intermediate LOS group (p = 0.001) and the low LOS group (p < 0.001). The classification tree showed that male patients with an MMSE score <20 who fell with age under 85 years formed the end node with the greatest relative risk (RR) of a long hospital stay (RR = 14.3 with p < 0.001). CONCLUSIONS The combination of a history of falls, male gender, cognitive impairment, and age under 85 years identified elderly ED patients at high risk of a long hospital stay.
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Affiliation(s)
- Olivier Beauchet
- UPRES EA 4638, UNAM, Angers University, Angers, France; Department of Neuroscience, Division of Geriatric Medicine, Angers Univiserty Hospital, Angers, France; Angers University Memory Clinic, Angers, France.
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Beauchet O, Launay CP, Maunoury F, de Decker L, Fantino B, Annweiler C. Association between vitamin D deficiency and long hospital stay in geriatric acute care unit: results from a pilot cohort study. Aging Clin Exp Res 2013; 25:107-9. [PMID: 23740640 DOI: 10.1007/s40520-013-0010-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 12/16/2011] [Indexed: 10/27/2022]
Abstract
Finding a biomarker of long length-of-stay (LOS) would provide a simple solution to target frail older inpatients at such risk. The aim of this study was to determine whether serum 25-hydroxyvitamin D (25OHD) deficiency, defined as serum concentration <25 nmol/L, was associated with long LOS among inpatients admitted to a geriatric acute care unit. Three hundred and six older inpatients (mean age 84.6 ± 6.4 years, 61.8% women) were consecutively included in this longitudinal prospective cohort study. Patients were separated into two groups according to LOS tertiles: highest tertile (≥14 days; n = 120) versus the other two tertiles combined (<14 days; n = 186). Serum 25OHD deficiency (58.3 vs. 38.7%, P = 0.001) and the prevalence of male gender (58.3 vs. 28.5%, P < 0.001) were higher among inpatients with the highest LOS compared with those with lower LOS. Serum 25OHD deficiency [odds ratio (OR) = 2.22, P = 0.001 for unadjusted model; OR = 1.87, P = 0.012 for fully adjusted model) and male gender (OR = 2.87, P < 0.001 for unadjusted model; OR = 2.64, P = 0.001 for full model) were associated with a high LOS. Vitamin D deficiency and male gender were risk factors for a long LOS in this pilot study. Using these risk factors to identify inpatients at risk of long LOS may be helpful in adapting early care plans, and thus improving inpatients' health and shortening LOS.
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Beauchet O, Launay C, de Decker L, Fantino B, Kabeshova A, Annweiler C. Who is at risk of long hospital stay among patients admitted to geriatric acute care unit? Results from a prospective cohort study. J Nutr Health Aging 2013; 17:695-9. [PMID: 24097024 DOI: 10.1007/s12603-013-0333-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE (1) To confirm that vitamin D deficiency, defined as serum 25-hydroxyvitamin D (25OHD) concentration < 25 nmol/L, was associated with long length-of-stay (LOS) among older inpatients admitted to geriatric acute care unit; and (2) to examine which combination of risk factors of longer LOS including vitamin D deficiency best predicted longer LOS. STUDY DESIGN AND SETTING Based on a prospective cohort study with a 25-day follow-up on average, 531 consecutive older inpatients (mean age 85.0±7.2 years, 59.1% women) admitted to the geriatric acute care unit of Angers University Hospital, France, were included. RESULTS Linear regression models showed that male gender (P<0.025), delirium (P<0.015) and vitamin D deficiency (P<0.001) were independently associated with a longer LOS. The highest risk of a longer LOS was shown while combining vitamin D deficiency with male gender (Odds ratio (OR)=3.70 with P< 0.001). The risk increased significantly while delirium was associated with these two baseline characteristics (OR=4.76 with P=0.001). Kaplan-Meier distributions of discharge differed significantly between participants who had or not the combination of the 3 criteria (P<0.007). CONCLUSIONS Vitamin D deficiency, delirium and male gender were significant risk factors for a longer LOS in the studied sample of older inpatients.
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Affiliation(s)
- O Beauchet
- Olivier Beauchet, MD, PhD, Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France; 49933 Angers Cedex 9, France; E-mail: ; Phone: ++33 2 41 35 47 25; Fax: ++33 2 41 35 48 94
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Marengoni A, Nobili A, Romano V, Tettamanti M, Pasina L, Djade S, Corrao S, Salerno F, Iorio A, Marcucci M, Mannucci PM. Adverse clinical events and mortality during hospitalization and 3 months after discharge in cognitively impaired elderly patients. J Gerontol A Biol Sci Med Sci 2012; 68:419-25. [PMID: 22972941 DOI: 10.1093/gerona/gls181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Controversial findings are reported on hospital outcome in cognitively impaired patients. The aim of this study was to explore mortality risk according to cognitive status during hospitalization and after 3 months in elderly patients. METHODS Sixty-six internal medicine and geriatric wards in Italy participated in the "Registry Politerapie SIMI (REPOSI)" during 2010. Of the 1,380 in-patients, aged 65 and older enrolled, 1,201 were included. Cognition was evaluated with the Short Blessed Test (SBT). Logistic regression was used to evaluate the association of questionable and impaired cognition (according to SBT cutoff points) with mortality during hospitalization and at follow-up. Morbidity, function, and adverse events during hospitalization were covariates. RESULTS Four hundred and twenty-one participants were classified as normal, 219 questionable, and 561 cognitively impaired. Forty-nine patients died during hospitalization and 70 during follow-up. Sixty-seven point three percent versus 32.7% (p < .001) of patients who died during hospitalization and 54.3% versus 45.7% (p < .001) during follow-up had at least one adverse event. After multiadjustment, impaired cognition was associated with in-hospital mortality (odds ratio [OR] = 3.1; 95% confidence interval [CI] = 1.1-8.6) but not with mortality at follow-up. Increase severity of cognitive impairment was associated with higher odds of mortality (from 2.7 in those with moderate impairment to 4.2 in those with severe impairment). After stratification for adverse clinical events, impaired cognition resulted associated with mortality only in patients having at least one event. CONCLUSION Elderly patients with cognitive impairment are more likely to die during hospitalization with a severity-dependent association. Adverse events may represent an important target of prevention due to their high association with mortality and cognitive impairment.
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Affiliation(s)
- Alessandra Marengoni
- Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Italy.
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Beauchet O, Remondière S, Mahé M, Repussard F, Decavel F, Annweiler C. Geriatric inclusive art and length of stay in acute care unit: a case-control pilot study. J Am Geriatr Soc 2012; 60:1585-7. [PMID: 22889027 DOI: 10.1111/j.1532-5415.2012.04069.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Longacre ML, Ridge JA, Burtness BA, Galloway TJ, Fang CY. Psychological functioning of caregivers for head and neck cancer patients. Oral Oncol 2011; 48:18-25. [PMID: 22154127 DOI: 10.1016/j.oraloncology.2011.11.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 12/30/2022]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.
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Marengoni A, Corrao S, Nobili A, Tettamanti M, Pasina L, Salerno F, Iorio A, Marcucci M, Bonometti F, Mannucci PM. In-hospital death according to dementia diagnosis in acutely ill elderly patients: the REPOSI study. Int J Geriatr Psychiatry 2011; 26:930-6. [PMID: 21845595 DOI: 10.1002/gps.2627] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 07/29/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of the study was to explore the association of dementia with in-hospital death in acutely ill medical patients. METHODS Thirty-four internal medicine and 4 geriatric wards in Italy participated in the Registro Politerapie SIMI-REPOSI-study during 2008. One thousand three hundred and thirty two in-patients aged 65 years or older were enrolled. Logistic regression models were used to evaluate the association of dementia with in-hospital death. Socio-demographic characteristics, morbidity (single diseases and the Charlson Index), number of drugs, and adverse clinical events during hospitalization were considered as potential confounders. RESULTS One hundred and seventeen participants were diagnosed as being affected by dementia. Patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia, and a higher number of adverse clinical events during hospitalization. The percentage of patients affected by dementia who died during hospitalization was higher than that of patients without dementia (9.4 versus 4.9%). After multiadjustment, the diagnosis of dementia was associated with in-hospital death (OR = 2.1; 95% CI = 1.0-4.5). Having dementia and at least one adverse clinical event during hospitalization showed an additive effect on in-hospital mortality (OR = 20.7; 95% CI = 6.9-61.9). CONCLUSIONS Acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission. Having dementia and adverse clinical events during hospital stay increases the risk of death.
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Affiliation(s)
- A Marengoni
- Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Italy.
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Dramé M, Novella JL, Jolly D, Lanièce I, Somme D, Heitz D, Gauvain JB, Voisin T, De Wazières B, Gonthier R, Jeandel C, Couturier P, Saint-Jean O, Ankri J, Blanchard F, Lang PO. Rapid cognitive decline, one-year institutional admission and one-year mortality: analysis of the ability to predict and inter-tool agreement of four validated clinical frailty indexes in the SAFEs cohort. J Nutr Health Aging 2011; 15:699-705. [PMID: 21968868 DOI: 10.1007/s12603-011-0164-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the predictive ability of four clinical frailty indexes as regards one-year rapid cognitive decline (RCD - defined as the loss of at least 3 points on the MMSE score), and one-year institutional admission (IA) and mortality respectively; and to measure their agreement for identifying groups at risk of these severe outcomes. DESIGN One-year follow-up and multicentre study of old patients participating in the SAFEs cohort study. SETTING Nine university hospitals in France. PARTICIPANTS 1,306 patients aged 75 or older (mean age 85±6 years; 65% female) hospitalized in medical divisions through an Emergency department. MEASUREMENTS Four frailty indexes (Winograd; Rockwood; Donini; and Schoevaerdts) reflecting the multidimensionality of the frailty concept, using an ordinal scoring system able to discriminate different grades of frailty, and constructed based on the accumulation of identified deficits after comprehensive geriatric assessment conducted during the first week of hospital stay, were used to categorize participants into three different grades of frailty: G1 - not frail; G2 - moderately frail; and G3 - severely frail. Comparisons between groups were performed using Fisher's exact test. Agreement between indexes was evaluated using Cohen's Kappa coefficient. RESULTS All patients were classified as frail by at least one of the four indexes. The Winograd and Rockwood indexes mainly classified subjects as G2 (85% and 96%), and the Donini and Schoevaerdts indexes mainly as G3 (71% and 67%). Among the SAFEs cohort population, 250, 1047 and 1,306 subjects were eligible for analyses of predictability for RCD, 1-year IA and 1-year mortality respectively. At 1 year, 84 subjects (34%) experienced RCD, 377 (36%) were admitted into an institutional setting, and 445 (34%) had died. With the Rockwood index, all subjects who experienced RCD were classified in G2; and in G2 and G3 when the Donini and Schoevaerdts indexes were used. No significant difference was found between frailty grade and RCD, whereas frailty grade was significantly associated with an increased risk of IA and death, whatever the frailty index considered. Agreement between the different indexes of frailty was poor with Kappa coefficients ranging from -0.02 to 0.15. CONCLUSION These findings confirm the poor clinimetric properties of these current indexes to measure frailty, underlining the fact that further work is needed to develop a better and more widely-accepted definition of frailty and therefore a better understanding of its pathophysiology.
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Affiliation(s)
- M Dramé
- University of Reims Champagne-Ardenne, Faculty of Medicine, É.A 3797, Reims, F-51092, France
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Lafont C, Gérard S, Voisin T, Pahor M, Vellas B. Reducing "iatrogenic disability" in the hospitalized frail elderly. J Nutr Health Aging 2011; 15:645-60. [PMID: 21968859 DOI: 10.1007/s12603-011-0335-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospitalization is the first cause of functional decline in the elderly: 30 to 60% of elderly patients lose some independence in basic activities of daily living (ADL) during a stay in hospital. This loss of independence results from the acute condition that led to admission, but is also related to the mode of management. OBJECTIVE This paper is a review of the literature on functional decline in elderly hospitalized patients. It is the first stage in a project aiming to prevent dependence that is induced during the course of care. METHODS During a 2-day workshop in Monaco, a task force of 20 international experts discussed and defined the concept of "iatrogenic disability". RESULTS 1- "Iatrogenic disability" was defined by the task force as the avoidable dependence which often occurs during the course of care. It involves three components that interact and have a cumulative effect: a) the patient's pre-existing frailty, b) the severity of the disorder that led to the patient's admission, and lastly c) the hospital structure and the process of care. 2- The prevention of "iatrogenic disability" involves successive stages. - becoming aware that hospitalization may induce dependence. Epidemiological studies have identified at-risk populations by the use of composite scores (HARP, ISAR, SHERPA, COMPRI, etc). - considering that functional decline is not a fatality. Quality references have already been defined. Interventions to prevent dependence in targeted populations have been set up: simple geriatric consultation teams, single-factor interventions (aimed for example at mobility, delirium, iatrogenic disorders) or multidomain interventions (such as GEM and ACE units, HELP, Fast Track, NICHE). These interventions are essentially centered on the patient's frailty and have limited results, as they take little account of the way the institution functions, which is not aimed at prevention of functional decline. The process of care reveals shortcomings: lack of geriatric knowledge, inadequate evaluation and management of functional status. The group suggests that interventions must not only identify at-risk patients so that they may benefit from specialized management, but they must also target the hospital structure and the process of care. This requires a graded "quality approach" and rethinking of the organization of the hospital around the elderly person.
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Affiliation(s)
- C Lafont
- Gérontopôle, Department of Geriatric Medicine, CHU Toulouse, France
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Lang PO, Vogt-Ferrier N, Hasso Y, Le Saint L, Dramé M, Zekry D, Huber P, Chamot C, Gattelet P, Prudent M, Gold G, Michel JP. Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions. J Am Med Dir Assoc 2011; 13:406.e1-7. [PMID: 21592866 DOI: 10.1016/j.jamda.2011.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/25/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Potentially inappropriate medications and prescription omissions (PO) are highly prevalent in older patients with mental comorbidities. OBJECTIVE To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing. DESIGN Prospective and interventional study. SETTING Medical-psychiatric unit in an academic geriatric department. PARTICIPANTS Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition. INTERVENTION From admission to discharge, daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team. MEASUREMENTS Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge. RESULTS Compared with admission, the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 (P < .0001) and incidence rates for potentially inappropriate medications and PO reduced from 77% to 19% (P < .0001) and from 65% to 11% (P < .0001), respectively. Independent predictive factors for PIP at discharge were being a faller (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.43-2.09) and for PO, the increased number of medications (OR 1.54; 95% CI 1.13-1.89) and a Charlson comorbidity index greater than 2 (OR 1.85; 95% CI 1.38 - 2.13). Dementia and/or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge. CONCLUSION These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population. Further evaluations are, however, still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes, such as incidence of adverse drug events, rehospitalization, or mortality.
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Affiliation(s)
- Pierre Olivier Lang
- Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland.
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Que nous apprend la cohorte SAFEs sur l’adaptation des filières de soins intra-hospitalières à la prise en charge des patients âgés ? Presse Med 2010; 39:1132-42. [DOI: 10.1016/j.lpm.2010.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 05/04/2010] [Accepted: 05/10/2010] [Indexed: 11/23/2022] Open
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