Comparison of a geriatric unit with a general ward in Mexican elders

Comparison of older patient's self-care abilities in acute geriatric and internal medicine departments

BACKGROUND

There is ongoing controversy whether patients show better functional outcomes when care is provided in acute geriatric (AG) or internal medicine (IM) departments.

OBJECTIVE

This study compared the recovery of acutely ill patients concerning activities of daily living (ADL) and instrumental activities of daily living (IADL).

MATERIAL AND METHODS

A total of 274 patients (≥70 years old, 67 in AG, 207 in IM) were included consecutively (AG intervention) or data were obtained (IM comparison) in a Swiss hospital with 2 locations. The ADL/IADL data were collected 14 days before admission (t1, retrospectively), on admission (t2), at discharge (t3), and 30 days after admission (t4). This study consisted of a prospective study with a longitudinal quasi-experimental design.

RESULTS

The AG patients had a significantly higher probability to gain independence in mobility (between t2/t3, P = 0.008), grooming of the lower body (between t2/t3, P = 0.037) and defecation (between t2/t4, P < 0.001). The IM patients were significantly more independent in IADL at t4 (all P < 0.05) except for meal preparation. The odds for nursing home admission in AG with dependency at t1 were significantly lower in every ADL (all P < 0.05) and with shopping in IADL (P = 0.008).

CONCLUSION

This study shows a positive effect of AG compared to IM in self-care with a lower probability for nursing home admission. There is need for further education and research to improve outcomes in older hospitalized patients.

Acute Care for Elders (ACE) Team Model of Care: A Clinical Overview

The Institute of Medicine (IOM) Reports of To Err is Human and Crossing the Quality Chasm have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles have demonstrated outcomes in-line with the IOM goals. The objective of this overview is to provide a concise summary of studies that describe outcomes of ACE models of care published in 1995 or later. Twenty-two studies met the inclusion. Of these, 19 studies were from ACE Units and three were evaluations of ACE Services, or teams that cared for patients on more than one hospital unit. Outcomes from these studies included increased adherence to evidence-based geriatric care processes, improved patient functional status at time of hospital discharge, and reductions in length of stay and costs in patients admitted to ACE models compared to usual care. These outcomes represent value-based care. As interprofessional team models are adopted, training in successful team functioning will also be needed.

Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79–0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.

Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study

BACKGROUND

The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs.

METHODS

A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures.

RESULTS

A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to the caregivers of elderly hospitalized in the geriatric unit. The final model showed that type of service and satisfaction had the largest coefficients (-0.68 and 0.662 respectively, p<0.001).

CONCLUSIONS

This study allowed us to identify associated factors of economic burden in elderly hospitalized in acute care units. It opens as well, an issue that should not be overlooked in framing public policies regarding elderly health care.