Time trends in hospital discharges in patients aged 85 years and older in Spain: data from the Spanish National Discharge Database (2000-2015)

Psychometric evaluation of the elderly mobility scale in Indonesia

BACKGROUND

The Elderly Mobility Scale (EMS) is widely used to identify mobility limitations in older adults, though it has not been validated in Indonesia.

AIM

To evaluate the reliability and validity of the Indonesian version of the EMS (EMS-I).

METHOD

A cross-sectional design involving 230 older adults in South Tangerang City, Indonesia, was used. The EMS was translated and culturally adapted following a multistage process. Psychometric testing included content validity, exploratory, and confirmatory factor analysis.

RESULTS

The participants had a mean age of 70, with 65.7 % female. Results demonstrated high internal consistency (Cronbach's alpha = .942) and item content validity index (I-CVI > .75). Exploratory factor analysis confirmed a unidimensional structure, with confirmatory factor analysis supporting a good model fit.

CONCLUSION

The EMS-I shows high reliability and validity, enabling healthcare professionals to monitor mobility status and facilitate targeted interventions for enhancing well-being in community-dwelling older adults in Indonesia.

The impact of an integrative healthcare system on longevity in a nonagenarian population in Northern Mexico: an observational study

BACKGROUND

Despite the growth in the older population, there is a noticeable research gap regarding integrative health systems for older people and their impact on longevity in nonagenarians. This study aimed to evaluate the effect of an integrative health system consisting of medical services, recreational facilities, and housing on longevity in a population of nonagenarians in Northern Mexico.

METHODS

This was a cross-sectional, retrospective, descriptive-analytical study in which we measured and analyzed medical history such as number of hospitalizations, visits to geriatric consultation, hypertension, history of chronic pain, polypharmacy, dementia, rheumatic disease, diabetes mellitus, insomnia, depression, ischemic cardiomyopathy, among others. We also measured social engagement and number of caregivers. A logistic regression was performed to evaluate the predictors of mortality in this population.

RESULTS

We included one hundred and ninety-five nonagenarians with a mean (SD) age of 94 (4.2) years and of which 112 (55.7%) were female. The findings from logistic regression analysis indicated that a higher frequency of hospitalizations was associated with an elevated mortality risk (OR = 1.272, p = 0.049). Conversely, increased visits to geriatric consultation services as primary care were linked to a reduced mortality risk (OR = 0.953, p = 0.002). Additionally, social engagement displayed a protective effect (OR = 0.336, p = 0.05).

CONCLUSIONS

This study highlighted the role of systemic health approaches in extending life through insights into nonagenarian patients' involvement in primary care, as measured by consultation frequency, and participation in social activities, mitigating mortality risks. Meanwhile, it emphasized the potential consequences of higher hospitalization rates on increased mortality risk.

A Comparison of the Clinical Characteristics of Short-, Mid-, and Long-Term Mortality in Patients Attended by the Emergency Medical Services: An Observational Study

AIM

The development of predictive models for patients treated by emergency medical services (EMS) is on the rise in the emergency field. However, how these models evolve over time has not been studied. The objective of the present work is to compare the characteristics of patients who present mortality in the short, medium and long term, and to derive and validate a predictive model for each mortality time.

METHODS

A prospective multicenter study was conducted, which included adult patients with unselected acute illness who were treated by EMS. The primary outcome was noncumulative mortality from all causes by time windows including 30-day mortality, 31- to 180-day mortality, and 181- to 365-day mortality. Prehospital predictors included demographic variables, standard vital signs, prehospital laboratory tests, and comorbidities.

RESULTS

A total of 4830 patients were enrolled. The noncumulative mortalities at 30, 180, and 365 days were 10.8%, 6.6%, and 3.5%, respectively. The best predictive value was shown for 30-day mortality (AUC = 0.930; 95% CI: 0.919-0.940), followed by 180-day (AUC = 0.852; 95% CI: 0.832-0.871) and 365-day (AUC = 0.806; 95% CI: 0.778-0.833) mortality.

DISCUSSION

Rapid characterization of patients at risk of short-, medium-, or long-term mortality could help EMS to improve the treatment of patients suffering from acute illnesses.

Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study

The long-term predictive validity of early warning scores (EWS) has not been fully elucidated yet. The aim of the present study is to compare seven prehospital EWS to predict 1-year mortality. A prospective, multicenter, ambulance-based study of adult patients with an acute illness involving six advanced life support units and 38 basic life support units, referring to five emergency departments in Spain. The primary outcome was long-term mortality with a 1-year follow-up. The compared scores included: National Early Warning Score 2, VitalPAC early warning score, modified rapid emergency medicine score (MREMS), Sepsis-related Organ Failure Assessment, Cardiac Arrest Risk Triage Score, Rapid Acute Physiology Score, and Triage Early Warning Score. Discriminative power [area under the receiver operating characteristic curve (AUC)] and decision curve analysis (DCA) were used to compare the scores. Additionally, a Cox regression and Kaplan-Meier method were used. Between 8 October 2019, and 31 July 2021, a total of 2674 patients were selected. The MREMS presented the highest AUC of 0.77 (95% confidence interval, 0.75-0.79), significantly higher than those of the other EWS. It also exhibited the best performance in the DCA and the highest hazard ratio for 1-year mortality [3.56 (2.94-4.31) for MREMS between 9 and 18 points, and 11.71 (7.21-19.02) for MREMS > 18]. Among seven tested EWS, the use of the MREMS presented better characteristics to predict 1-year mortality; however, all these scores present moderate performances.

Development of a prehospital lactic acidosis score for early-mortality. A prospective, multicenter, ambulance-based, cohort study

BACKGROUND

Lactic acidosis is a clinical status related to clinical worsening. Actually, higher levels of lactate is a well-established trigger of emergency situations. The aim of this work is to build-up a prehospital early warning score to predict 2-day mortality and intensive care unit (ICU) admission, constructed with other components of the lactic acidosis besides the lactate.

METHODS

Prospective, multicenter, observational, derivation-validation cohort study of adults evacuated by ambulance and admitted to emergency department with acute diseases, between January 1st, 2020 and December 31st, 2021. Including six advanced life support, thirty-eight basic life support units, referring to four hospitals (Spain). The primary and secondary outcome of the study were 2-day all-cause mortality and ICU-admission. The prehospital lactic acidosis (PLA) score was derived from the analysis of prehospital blood parameters associated with the outcome using a logistic regression. The calibration, clinical utility, and discrimination of PLA were determined and compared to the performance of each component of the score alone.

RESULTS

A total of 3334 patients were enrolled. The final PLA score included: lactate, pCO2, and pH. For 2-day mortality, the PLA showed an AUC of 0.941 (95%CI: 0.914-0.967), a better performance in calibration, and a higher net benefit as compared to the other score components alone. For the ICU admission, the PLA only showed a better performance for AUC: 0.75 (95%CI: 0.706-0.794).

CONCLUSIONS

Our results showed that PLA predicts 2-day mortality better than other lactic acidosis components alone. Including PLA score in prehospital setting could improve emergency services decision-making.

Pulse Wave Velocity and Blood Pressure Variability as Prognostic Indicators in Very Elderly Patients

There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population.

Factors Affecting Attitudes towards Older People in Undergraduate Nursing Students

Background: The population of older people is increasing worldwide. The social and healthcare systems need many nurses to care for the elderly. Positive attitudes increase the preference to work with older people and improve the quality of care. This study describes attitudes towards the elderly in a sample of nursing students, and analyzes the potential factors influencing these attitudes. Methods: A cross-sectional study was carried out in nursing students during the academic course 2017–2018. Kogan’s Attitude Toward Old People Scale was used to assess student attitudes towards older people. Results: The study included 377 undergraduate nursing students, of which 75.9% were women. The mean age was 22.23 (5.69) years. Attitude proved positive, with a mean Kogan’s score of 131.04 (12.66). Women had higher scores than men, with a mean difference of 7.76 (95% CI: 4.87–10.66; p < 0.001). The male sex, age ≥ 25 years, and previous experience with institutionalized older adults worsened attitudes, while studying the subject of geriatrics, each higher course within the degree, work placements in hospitals and nursing homes, and previous experience with community older adults or with older relatives favored a more positive attitude. Participants with no interest in working with older adults yielded lower scores. Conclusions: Attitudes towards the elderly among nursing students are positive. Women have a more positive attitude. Analyzing the factors that improve attitudes in nursing students is suggested, as it may contribute to improve nursing care.