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[Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit]. Rev Esp Geriatr Gerontol 2019; 55:18-24. [PMID: 31594677 DOI: 10.1016/j.regg.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.
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De-Rosende-Celeiro I, Torres G, Seoane-Bouzas M, Ávila A. Exploring the use of assistive products to promote functional independence in self-care activities in the bathroom. PLoS One 2019; 14:e0215002. [PMID: 30958846 PMCID: PMC6453482 DOI: 10.1371/journal.pone.0215002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Abstract
In homes, problems in daily functioning of older people often occur in the bathroom, especially in the transfers to the toilet and/or shower/bath. Assistive products have the potential to maximise functional independence (i.e. performance without assistance from another person) in everyday activities; however, more research is needed to better understand the impact of this technology on independence in the transfers in the bathroom. Additionally, little is known about the role of the environmental factors in the process of implementing bathroom adaptations. Therefore, this cross-sectional study aimed to examine the relationship between the use of assistive products and independence in the transfers in the bathroom. The secondary objective was to determine the role of the environmental factors in predicting the implementation of bathroom adaptations. 193 community-dwelling older adults with disabilities in the basic activities of daily life, who requested public long-term care services in Spain, were included. Data was collected in the participant´s homes using a standardised assessment procedure. There was no significant association between the number of categories of assistive products used in the toilet transfer and the independent performance of this task. In a multivariate model, the number of categories of assistive products used in the transfer to shower/bath was positively associated with the independent performance of this transfer (OR = 2.59, 95%CI = 1.48–4.53; p = 0.001). A multivariate analysis revealed that social functioning was significantly associated with the implementation of a bathroom adaptation; social risk was lower in participants who made an adaptation (OR = 0.76, 95%CI = 0.63–0.93; p = 0.006). Assistive products may play an important role in promoting independence in the bathroom. Assistive product needs should be addressed when planning community-based interventions aimed at improving daily life. Moreover, social functioning had a strong influence on the installation of bathroom adaptations, suggesting the importance of paying special attention to social factors in the home adaptations planning process.
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Affiliation(s)
| | - Gabriel Torres
- Department of Physical and Sports Education, University of A Coruña, A Coruña, Spain
| | | | - Adriana Ávila
- Department of Health Sciences, University of A Coruña, A Coruña, Spain
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The association between patient participation and functional gain following inpatient rehabilitation. Aging Clin Exp Res 2017; 29:729-736. [PMID: 27590904 DOI: 10.1007/s40520-016-0625-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. METHODS All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. RESULT A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). CONCLUSION This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.
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Baztán JJ, De la Puente M, Socorro A. Frailty, functional decline and mortality in hospitalized older adults. Geriatr Gerontol Int 2017; 17:664-666. [DOI: 10.1111/ggi.12925] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Juan J. Baztán
- Geriatric Department; Hospital Central Cruz Roja; Madrid Spain
| | | | - Alberto Socorro
- Geriatric Department; Hospital Central Cruz Roja; Madrid Spain
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Santana R, Marques A, Lopes S, Boto P, Telles J, Félix S, Mestre R, Matos R, Moita B. A Influência das Características dos Prestadores e dos Utentes no Consumo de Recursos em Unidades de Cuidados Continuados. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2017. [DOI: 10.1159/000479756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introdução:</i></b> O envelhecimento populacional, o aumento da prevalência de doenças crónicas e de multipatologia, são fenómenos que encontraram novas respostas com a criação da Rede Nacional de Cuidados Continuados Integrados (RNCCI) em Portugal, a partir de 2006. É esperado que esta estrutura adicional de oferta de cuidados permita contribuir para a criação de valor aos seus utentes. <b><i>Objetivo:</i></b> O presente estudo teve como objetivos estimar o consumo de recursos medido através da duração de internamento em unidades de internamento em cuidados continuados (UICC) em Portugal e analisar a associação com as características dos utentes e dos prestadores de cuidados. <b><i>Método:</i></b> Foi realizado um estudo transversal e retrospetivo, que utilizou informação da atividade das unidades da RNCCI entre 2010 e 2012. Recorreu-se a modelos de regressão lineares múltiplos, utilizando a duração de internamento como variável dependente e, como preditores, variáveis representativas das características individuais dos utentes e dos prestadores. <b><i>Resultados:</i></b> Para os 30.090 episódios incluídos, a duração média de internamento foi de 34,2 dias nas unidades de convalescença, 84,1 dias nas unidades de média duração e reabilitação e 106 dias nas unidades de longa duração e manutenção. A dispersão da duração de internamento foi elevada em todas as tipologias e regiões. Isoladamente, as variáveis associadas às características dos utentes apresentaram capacidade preditiva muito reduzida. A inclusão das variáveis associadas à organização da oferta de cuidados aumentou a capacidade do modelo explicar a variabilidade do tempo de internamento dos utentes. <b><i>Conclusão:</i></b> Os resultados do modelo de regressão linear múltipla sugerem que são as características associadas à oferta de cuidados que apresentam maior relevância para explicar a variabilidade da duração de internamento em cuidados continuados. Sugere-se que futuros desenvolvimentos incluam melhorias nas práticas de registo e a implementação de um sistema de classificação de utentes específico, internacionalmente validado para a estratificação do risco em cuidados continuados.
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Socorro García A, de la Puente M, Perdomo B, López Pardo P, Baztán JJ. Functional status and mortality at month and year in nonagenarians hospitalized due to acute medical illness. Eur J Intern Med 2015; 26:705-8. [PMID: 26320014 DOI: 10.1016/j.ejim.2015.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To analyze risk factors associated with short and long-term mortality in nonagenarians hospitalized due to acute medical conditions. DESIGN, SETTING, AND PARTICIPANTS Prospective study of all patients aged 90 years or older admitted in a geriatric unit during 2009 due to medical acute illness. Baseline variables were collected at admission (sex, cause of admission, Charlson index, serum albumin, functional, and mental status), functional loss at admission (as the difference between Barthel index(BI) 2 weeks before admission and BI at admission), and functional loss at discharge(as the difference between BI 2 weeks before admission and BI at discharge). The association of these variables with mortality at 1 month and 1 year after admission was analyzed by multivariate Cox regression analysis. RESULTS Out of all patients admitted, 434 (33%) were 90 years old or older and 76.3% were female. Mortality at 1 month and 1 year after admission was 19% and 57%, respectively. In the month mortality multivariate analysis, being older (HR, 1.11; 95% CI=1.02 to 1.20), a previous Barthel index less than 40 points (HR, 5.87; 95% CI=1.16 to 29.67), and functional loss at admission (HR; 1.13; 95% CI=1.03 to 1.25) were independent risk factors. When patients that died 1 month after admission were excluded, the presence of hypoalbuminemia <3g/dl (HR, 2.70; 95% CI=1.69 to 4.32) and functional loss at discharge (HR-1.08, 95% CI=1.03 to 1.14) were the factors associated with 1 year mortality. CONCLUSIONS In nonagenarians, functional impairment is the most important risk factor associated with short and long-term mortality after hospitalization due to acute medical illness.
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Affiliation(s)
- Alberto Socorro García
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain.
| | - María de la Puente
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Beatriz Perdomo
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Patricia López Pardo
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Juan J Baztán
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
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Sánchez-Rodríguez D, Miralles R, Muniesa JM, Mojal S, Abadía-Escartín A, Vázquez-Ibar O. Three measures of physical rehabilitation effectiveness in elderly patients: a prospective, longitudinal, comparative analysis. BMC Geriatr 2015; 15:142. [PMID: 26515028 PMCID: PMC4627405 DOI: 10.1186/s12877-015-0138-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rehabilitation success is measured by instruments that assess performance of activities of daily living. Guidelines on the use and choice of these instruments are lacking. The present study aimed to analyse prognostic indicators of physical rehabilitation effectiveness in elderly patients according to three rehabilitation impact indices. METHODS Prospective, longitudinal study in a post-acute care unit. The study included rehabilitation-eligible deconditioned elderly in-patients prospectively admitted to post-acute care (n = 685, aged 83.2 ± 8.3 years, mean length of stay 15 ± 9.2 days). DATA COLLECTION Premorbid health status variables (PHSV): age, sex, comorbidity (Charlson index), medical history (heart failure, pulmonary disease, cerebrovascular disease, dementia), previous living situation and pre-admission functional status (premorbid Lawton and Barthel indices). Admission health status variables (AHSV): main diagnoses, referral source, physical (Barthel-adm) and cognitive function (Pfeiffer test), undernutrition and dysphagia. OUTCOME MEASURES Absolute functional gain (AFG, admission-to-discharge Barthel change), relative functional gain (RFG, achieved percentage of potential gain) and rehabilitation efficiency index (REI, AFG over length of stay). Univariate analysis considered these parameters, along with PHSV and AHSV. Multivariate logistic regression analysis was performed for AFG ≥20, RFG ≥35 % and REI ≥ 0.50. RESULTS Greater AFG was associated with 14 variables, 8 PHSV (57.1 %) and 6 AHSV (42.8 %); greater RFG with 9 variables, 3 PHSV (33.3 %) and 6 AHSV (66.6 %); and REI with 9 variables, 4 PHSV (44.4 %) and 5 AHSV (55.5 %). Mean AFG value was 34.5 ± 15.8 in patients who achieved complete recovery (RFG 100 %, n = 189, 27.5 %) and 35.3 ± 15.0 (p = 0.593) in the remaining patients (n = 311, 45.4 %). In multivariate analysis, only Barthel-adm was related to all three rehabilitation impact indices. CONCLUSIONS Both premorbid and acute-process variables have a greater impact on AFG and REI, compared to RFG. Although AFG gives information about the degree of reduction in dependence, it does not provide clinical information about post-rehabilitation functional status (mean AFG values did not differ between patients with and without complete recovery). A future implication for evaluating rehabilitation effectiveness in elderly patients is to recommend RFG corrected by premorbid Barthel score, which is less affected by previous health conditions, as the optimum method to assess the degree to which maximum potential improvement was achieved.
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Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department, Parc de Salut Mar Centre Fòrum Hospital del Mar (Llull, 410), Universitat Autònoma, Barcelona, (08019), Spain.
| | - Ramon Miralles
- Geriatrics Department, Parc de Salut Mar Centre Fòrum Hospital del Mar (Llull, 410), Universitat Autònoma, Barcelona, (08019), Spain.
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar Hospital de l´Esperança (Sant Josep de la Muntanya, 12), Universitat Autònoma, Barcelona, (08024), Spain.
| | - Sergio Mojal
- Biomedical Research Methods Consultant, Hospital del Mar Medical Research Institute (IMIM) (Doctor Aiguader 88), Barcelona, (08003), Spain.
| | - Anna Abadía-Escartín
- Geriatrics Department, Parc de Salut Mar Hospital de l´Esperança (Sant Josep de la Muntanya 12), Barcelona, (08024), Spain.
| | - Olga Vázquez-Ibar
- Geriatrics Department, Parc de Salut Mar Centre Fòrum Hospital del Mar (Llull, 410), Universitat Autònoma, Barcelona, (08019), Spain.
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Socorro García A, de la Fuente Hermosín I, Baztán J. Serum albumin and total cholesterol as prognostic factors of mortality in very old patients hospitalized by acute illness. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tan S, Ramage L, McMurdo M, Witham M. Predicting failure to improve during rehabilitation for older patients using routinely collected clinical data. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Baztán JJ, Cáceres LA, Llanque JL, Gavidia JJ, Ruipérez I. Predictors of functional recovery in older hospitalized adults. J Am Geriatr Soc 2012; 60:187-9. [PMID: 22239317 DOI: 10.1111/j.1532-5415.2011.03716.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baztán JJ, Gavidia JJ, Gómez-Pavón J, Esteve A, Ruipérez I. HIGH VITAMIN B12 LEVELS AND IN-HOSPITAL MORTALITY. J Am Geriatr Soc 2010; 58:2237-8. [DOI: 10.1111/j.1532-5415.2010.03116.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mas MA, Renom A, Vazquez O, Miralles R, Bayer AJ, Cervera AM. Interruptions to rehabilitation in a geriatric rehabilitation unit: associated factors and consequences. Age Ageing 2009; 38:346-9. [PMID: 19252203 DOI: 10.1093/ageing/afp010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M A Mas
- Department of Geriatric Medicine of Institut Municipal d'Assistència Sanitària, Hospital del Mar, Institut d'Atenció Geriàtrica i Sociosanitària, Barcelona, Catalonia, Spain
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Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Physical Functioning and Depression Among Older Persons with Cancer. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1523-5394.2001.91004.pp.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weiss CO, Hoenig HM, Fried LP. Compensatory strategies used by older adults facing mobility disability. Arch Phys Med Rehabil 2007; 88:1217-20. [PMID: 17826472 DOI: 10.1016/j.apmr.2007.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 07/17/2007] [Indexed: 11/18/2022]
Abstract
Preclinical disability in mobility tasks can be recognized by asking people without overt mobility disability whether they have changed the way, either the manner or the frequency, of doing a mobility task because of a health or physical condition. Like other compensatory strategies, preclinical mobility disability has a dual nature as both a risk marker associated with impairment or limitation and a mediating factor affecting the natural history of disability. The method of ascertaining preclinical disability through self-report has been shown to have construct validity, to be reliable, and to identify people at an elevated risk of developing overt mobility disability over 1 to 2 years. Many worthy research questions in this field remain to be addressed, especially regarding qualitative heterogeneity (doing more vs doing less) and interactions among compensatory strategies. Nonetheless, there is sufficient evidence to apply what is known about preclinical disability to screening in clinical settings. This area of research and practice constitutes an opportunity for physical medicine and rehabilitation and geriatric medicine to jointly make a large beneficial impact on population health through strategies to prevent disability because rapidly growing numbers of older adults will experience this early and potentially malleable stage.
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Affiliation(s)
- Carlos O Weiss
- Division of Geriatric Medicine & Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224-2734, USA.
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Affiliation(s)
- Carole W Agin
- Chronic Pain Management Center, Department of Anesthesiology, State University of New York at Stony Brook
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Miralles R, Sabartés O, Ferrer M, Esperanza A, Llorach I, García-Palleiro P, Cervera AM. Development and validation of an instrument to predict probability of home discharge from a geriatric convalescence unit in Spain. J Am Geriatr Soc 2003; 51:252-7. [PMID: 12558724 DOI: 10.1046/j.1532-5415.2003.51066.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To develop and validate an instrument to predict probability of home discharge upon hospital admission. DESIGN Prospective cohort study. SETTING Geriatric convalescence unit (GCU) in Spain. PARTICIPANTS Seven hundred eighty-one patients aged 65 and older consecutively admitted to a GCU over a 4-year period. The total sample was randomized and divided into two subgroups; the first (n = 575) was used to construct the predictive instrument (development subgroup) and the second (n = 206) for the validation process (validation subgroup). MEASUREMENTS All patients were evaluated within the first 72 hours after admission. Age, sex, functional status before admission, diagnostic categories, functional status on admission, comorbidity, cognitive function, and social support were assessed. RESULTS Logistic regression analysis identified three patient characteristics as independent predictors of home discharge in the development subgroup: higher scores on functional status at admission (Barthel index), normal Mini-Mental State Examination scores, and lower scores on Social Familial Evaluation Scale. A scoring system ranging from 0 to 5 was constructed using these variables to predict probability of home discharge (PHD). Different PHD scores (0-1, 2, 3, 4, and 5) identified patients with different probabilities of returning home on discharge in the validation subgroup (36.5%, 53.6%, 60.8%, 83.3%, and 100%, respectively). PHD scores of 4 and 5 demonstrated substantially higher posttest than pretest probability, with moderate and high clinical effect value. Scores of 0 or 1 demonstrated substantially lower posttest than pretest probability. CONCLUSION A PHD instrument may be useful in identifying patients most likely to be discharged to home from the GCU. Patients with low probability of home discharge may also be identified early.
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Affiliation(s)
- Ramón Miralles
- Geriatric Department of the Municipal Geriatric Center, and Health Services Research Unit, Municipal Institute of Medical Investigation, Instituto Municipal de Asistencia Sanitaria, Barcelona, Spain
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Abstract
Older people make up the majority of participants in general rehabilitation programs. Stroke and hip fracture are the major diagnostic groups. Most older people with significant disability of recent onset have the potential to benefit from rehabilitation. Assessing an older person's premorbid functional and cognitive status, which are strong determinants of rehabilitation outcome, is an important component of management. The major goals of rehabilitation for older people are mobility and self-care without the assistance of another person. Evidence suggests that rehabilitation for older people involving a coordinated multidisciplinary team of health professionals (including nurses and doctors) is effective. Contemporary rehabilitation practice is not confined to traditional inpatient rehabilitation units; it also occurs in the community and other non-hospital settings, and involves general practitioners.
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Affiliation(s)
- Ian D Cameron
- Rehabilitation Studies Unit, PO Box 6, Ryde, NSW 1680, Australia.
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Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Physical functioning and depression among older persons with cancer. CANCER PRACTICE 2001; 9:11-8. [PMID: 11879268 DOI: 10.1046/j.1523-5394.2001.91004.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to help identify factors to assess which elderly patients are likely to experience problems with physical and psychological functioning in association with cancer or its treatment. DESCRIPTION OF STUDY A study was undertaken with a sample of 420 patients with cancer who were between the ages of 65 and 98 years and had received an incident diagnosis of breast, colon, lung, or prostate cancer. An analysis of covariance technique was used to determine how cancer site, treatment type, stage of disease, gender, age, comorbidity, symptom severity, and pre-diagnosis levels of physical functioning were related to physical functioning deficit, and how all of these in turn influenced patient depressive symptomatology. RESULTS Pre-diagnosis physical functioning, symptom severity, and days since surgery were significant predictors of physical functioning deficit. Patients who had been treated only with surgery experienced greater physical functioning deficits than did patients who had received both surgery and adjuvant therapy. This apparent anomaly was partly explained by the time interval from surgery to interview. Higher levels of symptom severity, lower levels of prior physical functioning, and greater physical functioning deficits all predicted higher levels of depressive symptomatology. CLINICAL IMPLICATIONS In the care of elderly patients with cancer, it is important for healthcare providers to consider the pre-diagnosis levels of physical functioning of patients with cancer to understand and anticipate the physical and psychological consequences of cancer and its treatment. Equally important is the proper management of patient symptoms in maximizing both the physical and psychological quality of life.
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Affiliation(s)
- M E Kurtz
- Department of Family and Community Medicine, Michigan State University, East Lansing, Michigan 48824, USA
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José Baztán Cortés J, Ignacio González-Montalvo J, José Solano Jaurrieta J, Hornillos Calvod M. Atención sanitaria al anciano frágil: de la teoría a la evidencia científica. Med Clin (Barc) 2000. [DOI: 10.1016/s0025-7753(00)71669-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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