1
|
Nowak J, Jabczyk M, Jagielski P, Hudzik B, Brukało K, Borszcz J, Zubelewicz-Szkodzińska B. Could vitamin D concentration be a marker of a long hospital stay in older adults patients? Front Nutr 2023; 10:1277350. [PMID: 37927497 PMCID: PMC10622960 DOI: 10.3389/fnut.2023.1277350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
Background and aims Vitamin D plays a pleiotropic role in the human body. Some studies have suggested that hypovitaminosis D may serve as a marker of comorbidity severity and length of hospital stay. Hospitalized older adults patients with a higher comorbidity burden tend to have lower vitamin D status, which negatively impacts the length of their hospital stay. Vitamin D deficiency has been identified as a significant risk factor for a prolonged hospital stay. This study aimed to investigate the link between vitamin D status and prolonged hospital stays, focusing on geriatric patients, and to assess the variation in hospitalization duration among geriatric patients with different vitamin D statuses. Methods The study sample comprised of 422 patients aged over 60 years admitted to the geriatric department. Blood samples were collected in the morning on the day of admission. According to the diagnostic threshold defining serum 25(OH)D concentration approved for Central Europe, patients were divided into two groups (deficiency group and suboptimal group). Patients were divided into two groups based on hospitalization duration: the first, "shorter hospitalization," included stays up to 11 days, whereas the second, "longer hospitalization," encompassed stays of 12 days and above. Results In total, 242 Caucasian patients, primarily women (172 women and 70 men), were recruited in the study. Patients with vitamin D deficiency had extended hospital stays compared with those with vitamin D levels below 49.92 nmol/L: 10.0 (8.00-13.00) days vs. 9.00 (8.00-11.00) days, P = 0.044. Hospitalization length (in days) had a negative correlation with vitamin D blood status (nmol/L) (P = 0.0005; R = -0.2243). ROC analysis indicated that patients with vitamin D levels below 31.2 nmol/L had a 47% higher chance of extended hospitalization, whereas those with levels above 31.2 nmol/L had a 77% higher chance of avoiding it. A significant majority of patients with suboptimal 25(OH)D levels experienced shorter hospital stays (≤11 days) than those with vitamin D deficiency (64.6%), P = 0.045. Conclusion The study findings indicate that lower serum levels of 25(OH)D in hospitalized patients within the geriatric department are linked to extended hospital stays. Vitamin D holds potential as a predictor of hospitalization duration in geriatric patients. Nonetheless, further research is imperative to account for additional factors affecting health status and hospitalization duration in older adults individuals.
Collapse
Affiliation(s)
- Justyna Nowak
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Marzena Jabczyk
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Paweł Jagielski
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Bartosz Hudzik
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
- Third Department of Cardiology, Silesian Center for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Katarzyna Brukało
- Department of Health Policy, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Jakub Borszcz
- Student Scientific Circle Affiliated of Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Barbara Zubelewicz-Szkodzińska
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
- Department of Endocrinology, District Hospital, Piekary Śląskie, Poland
| |
Collapse
|
2
|
Clinical Identification of Hypovitaminosis D among Elderly Attending Primary Care Centre in Saudi Arabia. Res Lett Biochem 2022; 2022:6341645. [PMID: 36276259 PMCID: PMC9581707 DOI: 10.1155/2022/6341645] [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: 05/29/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background A large proportion of elderly people suffer from hypovitaminosis D, and depending on the severity of the condition, they develop complications that are detrimental to their health. Objective To determine the consistency between the results of the vitamin D level in the blood compared to the result with the score of a simple questionnaire (Physician Vitamin D Status Predictor - VDSP) for elderly patients. Subjects and methods. This is a cross-sectional study conducted during the period between October 2018 and November 2019 in 3 primary health care centres (PHCCs) in Jeddah, Saudi Arabia. The subjects for this study were patients aged 60 or older. Data were collected in two phases: a questionnaire approach as the first phase, while the second phase involved blood testing for vitamin D levels. The validated questionnaire used in this study was the Physician`s Vitamin D Status Predictor (VDSP). Results The study included 335 participants who ranged between 60 and 107 years old with a mean age of 68.2 years and standard deviation (SD) of 7.3 years. Females represented 66.9% of the total participants. The prevalence of vitamin D deficiency was 60.8%; among them, 7.2% were categorized as severe deficiency, whereas the prevalence of vitamin D insufficiency was 29.9%. The outcomes of VDSP survey were not directly associated with serum 25(OH)D levels in elderly people, except for the number of medications. In addition, vitamin D supplementation was associated with serum 25(OH)D levels among those patients. Conclusion Vitamin D supplementation was significantly associated with serum 25(OH)D levels. Moreover, this study showed a significant association between serum 25(OH)D levels and the number of medications taken by the participants.
Collapse
|
3
|
Hypovitaminosis D: A Disease Marker in Hospitalized Very Old Persons at Risk of Malnutrition. Nutrients 2019; 11:nu11010128. [PMID: 30634546 PMCID: PMC6357065 DOI: 10.3390/nu11010128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Hypovitaminosis D is a frequent condition in elderly subjects. Vitamin D adequacy is best determined by measurement of the 25-hydroxyvitamin D-25(OH)D-concentration in the serum. An inverse association exists between 25(OH)D and cardiovascular, infectious, glucose metabolism, cognitive disorders, and all-cause mortality. Whether 25(OH)D is a marker of organ diseases is still under debate. We aimed to investigate whether comorbidities were associated with serum 25(OH)D levels in geriatric inpatients. Methods: This is a retrospective study, including 237 subjects consecutively admitted to an acute care geriatric unit, with available data of 25(OH)D serum concentrations. 25(OH)D serum levels were defined according to the following cutoffs: 50–30 ng/mL (125–75 nmol/L): optimal range; 30–20 ng/mL (75–50 nmol/L): insufficiency; 20–10 ng/mL (5–25 nmol/L): deficiency; and <10 ng/mL (<25 nmol/L): severe deficiency. Comorbidity was assessed using the Cumulative Illness Rating Scale-Geriatric (CIRS-G). Two summary measures were obtained, the Illness Severity Index (CIRS-SI) and the Comorbidity Index (CIRS-CI). Results: 177 (74.68%) women and 60 (25.32%) men with mean age of 85 ± 6 years old were enrolled. The majority of subjects (68.6%) were at risk of malnutrition. Overall, the burden of comorbidity was 1.87 ± 1.33 for CIRS-CI and 1.18 ± 0.40 for CIRS-SI. 25(OH)D serum concentrations were 10.58 ± 7.68 ng/mL, with 98.7% of subjects having vitamin D below 30 ng/mL and 56.6% with severe deficiency. An inverse correlation was found between 25(OH)D and both CIRS-SI (r: −0.312; p < 0.0001) and CIRS-CI (r: −0.306; p < 0.0001). Independent of multiple covariates an inverse association between both CIRS-SI (p < 0.0001) and CIRS-CI (p < 0.0001) and 25(OH)D was confirmed. Both CIRS-SI (r = 0.251, p < 0.0001) and CIRS-CI (r = 0.137, p = 0.016) were positively correlated with the length of hospital stay. An inverse correlation was confirmed between serum 25(OH)D concentrations and CRP (r = −0.142; p = 0.041). CRP, in turn, positively correlated with CIRS-SI (r = 0.209, p = 0.003) and CIRS-CI (r = 0.158, p = 0.023). Both CIRS-SI (r = 0.251, p < 0.0001) and CIRS-CI (r = 0.137, p = 0.016) were positively correlated with the length of hospital stay. Conclusions: In hospitalized very old subjects, a higher comorbidity burden is associated with lower 25(OH)D serum levels. Hypovitaminosis D was correlated with higher inflammatory status, which, together with the comorbidities burden, negatively influenced the length of hospital stay.
Collapse
|
4
|
Kostoglou-Athanassiou I, Pantazi E, Kontogiannis S, Kousouris D, Mavropoulos I, Athanassiou P. Vitamin D in acutely ill patients. J Int Med Res 2018; 46:4246-4257. [PMID: 30157690 PMCID: PMC6166351 DOI: 10.1177/0300060518792783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate 25(OH)D3 levels and their relationship to survival in a cohort of acutely ill patients on admission to an intensive care unit. Methods This study enrolled acutely ill patients at admission to an intensive care unit and a group of sex- and age-matched healthy control subjects. The 25(OH)D3 levels were measured using an enzyme immunoassay. C-reactive protein and procalcitonin levels were also measured using immunoassays. Results A total of 50 acutely ill patients and 50 healthy control subjects were enrolled in the study. The mean ± SEM 25(OH)D3 levels were significantly lower in the acutely ill patients compared with the control group (11.74 ± 0.88 ng/ml versus 24.66 ± 1.60 ng/ml, respectively). The 25(OH)D3 levels were not related to survival. An inverse relationship was observed between 25(OH)D3 levels and C-reactive protein levels. A weak inverse relationship was also observed between 25(OH)D3 levels and procalcitonin levels. Conclusions The 25(OH)D3 levels were decreased in acutely ill patients admitted to an intensive care unit compared with healthy control subjects. 25(OH)D3 levels may be inversely related to C-reactive protein and procalcitonin levels.
Collapse
Affiliation(s)
| | - Eleni Pantazi
- 2 Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Sofoklis Kontogiannis
- 3 Advanced Care Unit, Department of Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Dimitrios Kousouris
- 3 Advanced Care Unit, Department of Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | | | | |
Collapse
|
5
|
Annweiler C, Riou J, Alessandri A, Gicquel D, Henni S, Féart C, Kabeshova A. Clinical Identification of Geriatric Patients with Hypovitaminosis D: The 'Vitamin D Status Predictor for Geriatrics' Study. Nutrients 2017; 9:nu9070658. [PMID: 28653996 PMCID: PMC5537778 DOI: 10.3390/nu9070658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 02/07/2023] Open
Abstract
The 16-item Vitamin D Status Predictor (VDSP) tool identifies healthy older community-dwellers at risk of hypovitaminosis D and may guide the use of blood tests in this population. The objective of the present hospital-based study was to test the efficacy of the VDSP to identify geriatric patients with hypovitaminosis D. The study included 199 nonsupplemented geriatric in- and outpatients consecutively admitted to Angers University Hospital, France (mean ± SD, 82.0 ± 7.8 years; 53.3% female). Serum 25-hydroxyvitaminD (25(OH)D) was measured at the time of the physician-administered VDSP. Hypovitaminosis D was defined as serum 25(OH)D concentration ≤ 75 nmol/L for vitamin D insufficiency, 25(OH)D ≤ 50 nmol/L for vitamin D deficiency, and 25(OH)D ≤ 25 nmol/L for severe vitamin D deficiency. We found that 184 participants (92.4%) had vitamin D insufficiency, 136 (68.3%) had vitamin D deficiency, and 67 (33.7%) had severe vitamin D deficiency. The VDSP identified severe vitamin D deficiency with an area under curve (AUC) = 0.83 and OR = 24.0. The VDSP was able to identify vitamin D deficiency and vitamin D insufficiency with less accuracy (AUC = 0.71 and AUC = 0.73, respectively). In conclusion, the 16-item VDSP is a short questionnaire that accurately identifies geriatric patients with severe vitamin D deficiency. This tool may guide the use of blood collection for determining geriatric patients’ vitamin D status.
Collapse
Affiliation(s)
- Cédric Annweiler
- Department of Neurosciences and Aging, Division of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, University of Angers, UPRES EA 4638, UNAM, 49035 Angers, France.
- Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Jérémie Riou
- INSERM, MINT, 1066, University of Angers, 49035 Angers, France.
- Delegation to Clinical Research and Innovation, Angers University Hospital, 49100 Angers, France.
| | | | - David Gicquel
- Health Faculty, School of Medicine, F-49045 Angers, France.
| | - Samir Henni
- Department of Sports Medicine and Vascular Investigations, Angers University Hospital, 49100 Angers, France.
| | - Catherine Féart
- Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, 61292 Bordeaux, France.
| | - Anastasiia Kabeshova
- Department of Neurosciences and Aging, Division of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, University of Angers, UPRES EA 4638, UNAM, 49035 Angers, France.
| |
Collapse
|
6
|
Maier GS, Maus U, Lazovic D, Horas K, Roth KE, Kurth AA. Is there an association between low serum 25-OH-D levels and the length of hospital stay in orthopaedic patients after arthroplasty? J Orthop Traumatol 2016; 17:297-302. [PMID: 27294830 PMCID: PMC5071239 DOI: 10.1007/s10195-016-0414-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/18/2016] [Indexed: 12/18/2022] Open
Abstract
Background The purpose of this observational study was to evaluate serum levels of 25-OH-D in patients scheduled to undergo elective hip or knee arthroplasty. We hypothesised that 25-OH-D level is an independent risk factor for length of stay in orthopaedic patients after elective hip or knee arthoplasty. Materials and methods 25-OH-D levels were measured in 1083 patients admitted to an orthopaedic surgery department to undergo elective hip or knee arthroplasty. Comparisons were performed using Chi square or Student’s t test, followed by univariate and multiple linear regression analysis examining the correlation between the length of stay in the orthopaedic department and 25-OH-D level while adjusting for possible confounders. Results Overall, 86 % of patients had insufficient serum levels of 25-OH-D, and over 60 % were vitamin D deficient. The mean length of stay was 13.2 ± 8.3 days. In patients with hypovitaminosis D, the length of stay was significantly longer compared to patients with normal serum 25-OH-D levels (15.6 ± 7.2 compared to 11.3 ± 7.9 days, P = 0.014). In univariate analyses, serum 25-OH-D level was inversely related to the length of stay in our orthopaedic department compared to patients with normal vitamin D levels (r = −0.16; P = 0.008). In multivariate analyses, the length of stay remained significantly associated with low 25-OH-D levels (P = 0.002), indicating that low vitamin D levels increase the length of stay. Conclusions We found a high frequency of hypovitaminosis D among orthopaedic patients scheduled to undergo elective arthroplastic surgery. Low vitamin D levels showed a significant inverse association to the length of stay in our orthopaedic department. Patients with vitamin D levels in the target range were hospitalised 4.3 days less than patients with hypovitaminosis D. Level 3 of evidence according to “The Oxford 2011 levels of evidence”.
Collapse
Affiliation(s)
- Gerrit Steffen Maier
- University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl von Ossietzky University, Medizinischer Campus Universität, Georgstrasse 12, 26121, Oldenburg, Germany.
| | - Uwe Maus
- University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl von Ossietzky University, Medizinischer Campus Universität, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Djordje Lazovic
- University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl von Ossietzky University, Medizinischer Campus Universität, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Konstantin Horas
- ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Klaus Edgar Roth
- Department of Orthopaedic Surgery, Johannes Gutenberg University, Mainz, Germany
| | - Andreas Alois Kurth
- Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Ratingen, Germany
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Vitamin D insufficiency in the elderly orthopaedic patient: an epidemic phenomenon. INTERNATIONAL ORTHOPAEDICS 2014; 39:787-92. [PMID: 25205247 DOI: 10.1007/s00264-014-2519-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this observational study was to evaluate serum levels of 25-OH-D of elderly patients presenting with orthopaedic illness. Furthermore, we enquired about potential confounders and risk factors of hypovitaminosis D in comorbidities and daily medication of the elderly. METHODS Vitamin D levels in 1,083 patients aged >70 years and admitted to an orthopaedic surgery department were measured. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels. RESULTS Overall, 86 % of patients had insufficient serum levels of 25-OH-D and >60 % were vitamin D deficient. Serum vitamin D levels were lower during winter and months with fewer sunshine hours. Patients presenting with obesity, hypertension and osteoporosis were more likely to have low vitamin D levels. CONCLUSIONS We found a high prevalence of hypovitaminosis D in elderly, nonhospitalized orthopaedic patients. Given the well-known effects of vitamin D on bone metabolism and muscle health, as well as its nonskeletal effects, vitamin D insufficiency may have a negative impact.
Collapse
|
9
|
Launay CP, Annweiler C, de Decker L, Kabeshova A, Fantino B, Beauchet O. Risk of in-hospital mortality following emergency department admission: results from the geriatric EDEN cohort study. J Nutr Health Aging 2014; 18:83-6. [PMID: 24402394 DOI: 10.1007/s12603-013-0038-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether being admitted to emergency department (ED) for social disorders may predict a higher risk of in-hospital mortality among older inpatients. DESIGN Prospective cohort study (mean follow-up: 9.1±10.0 days). SETTING Angers University Hospital, France. PARTICIPANTS Four hundred twenty-two inpatients (mean age 84.9±5.6years, 64.2% women). METHODS At their admission to ED, inpatients aged 75 years and over received an assessment composed of 6 items: age, gender, number of drugs daily taken, history of falls during the past 6 months, usual place of life, and use of formal and/or informal home and social services. The reasons for admission to ED as well the diagnosis at the time of hospital discharge were separated into social and health disorders. The length of hospital stay was calculated in number of days using the hospital registry. Inpatients were separated into 2 groups based on the occurrence or not of death during the hospital stay. RESULTS Older inpatients who died at hospital were more frequently institutionalized (P=0.034) and admitted to ED for social disorders (P=0.002) than those who did not. Multiple Cox regression model revealed that living in institution and social disorders as a reason for admission to ED were significantly associated with the occurrence of death at hospital (P=0.008 and P=0.036). Kaplan-Meier distributions of in-hospital mortality showed that home-living inpatients admitted to ED for social disorders died more and faster during hospitalization than those admitted for health disorders (P=0.016). CONCLUSION Being admitted to ED for social disorders and living in institution predicted a higher risk of in-hospital mortality.
Collapse
Affiliation(s)
- C P Launay
- Olivier Beauchet, MD, PhD; Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, 49933 Angers cedex 9, France; E-mail: ; Phone: ++33 2 41 35 45 27; Fax: ++33 2 41 35 48 94, Alternate corresponding author:
| | | | | | | | | | | |
Collapse
|
10
|
Hypovitaminosis D in geriatric acute care unit: a biomarker of longer length of stay. DISEASE MARKERS 2013; 35:525-9. [PMID: 24223464 PMCID: PMC3809738 DOI: 10.1155/2013/428479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Background. Hypovitaminosis D is linked to unstable health in older adults. Our objectives were to determine (i) the difference in length of stay (LOS) in geriatric acute care unit between inpatients with and without hypovitaminosis D and (ii) whether there was a linear association between serum 25-hydroxyvitamin D (25OHD) concentration and LOS. Methods. 253 inpatients admitted in 2008 to the geriatric acute care unit of Angers University Hospital, France, (mean age±standard deviation, 86.2 ± 6.0 years; 66.8% female) were included in this historical cohort study. LOS was calculated by subtracting day of admission from day of discharge. Hypovitaminosis D was defined as 25OHD≤50 nmol/L at the time of admission. Age, gender, place of life, functional independence, reason for admission, number of acute diseases and comorbidities, use of vitamin D supplements, and creatinine clearance were used as confounders. Results. Participants with hypovitaminosis D had longer LOS than their counterparts (15.2 ± 8.2 days versus 12.1 ± 7.0 days, P = 0.017), underlining a mean difference of 3 days. 25OHD concentration inversely correlated (r = −0.14, P = 0.028) and was inversely associated with LOS (adjusted β = −0.07 [95%CI: −0.14; −0.02], P = 0.043). Conclusions. We found an inverse linear association between serum 25OHD concentrations and LOS in a geriatric acute care unit. Participants with 25OHD>50 nmol/L were hospitalized on average 3 days less than those with 25OHD≤50 nmol/L.
Collapse
|
11
|
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.
Collapse
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
| | | | | | | | | | | |
Collapse
|