scholarly journals Pre-fracture Mobility Using Standardized Scale as an Early Indicator of High Health Risk in Patients with a Hip Fracture

2021 ◽  
Author(s):  
Keefai Yeong ◽  
Radcliffe Lisk ◽  
Hazel Watters ◽  
Peter Enwere ◽  
Jonathan Robin ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Health Risk ◽  
Fracture Analysis ◽  
Adverse Outcomes ◽  
Discharge Destination ◽  
Early Indicator ◽  
Increased Risk ◽  
Standardized Measure ◽  
Mobility Status

AbstractHip fracture in older adults is associated with poor prognosis. We tested the hypothesis that a single standardized measure, pre-fracture mobility, can be used as an early indicator of patients at high health risk after a hip fracture. Analysis of prospectively collected data of older adults admitted with a hip fracture between April-2009 and June-2019 in a single NHS hospital, UK. Pre-fracture mobility status (freely mobile, mobilising outdoors with one aid or with two aids, and limited to indoors), was used to predict length of stay (LOS) and mortality in hospital, and discharge destination. Among 3073 (2231 women, 842 men) admitted from their own home (mean ± SD age = 82.7 ± 9.3 yr), 159 died and 2914 survived to discharge: 1834 back to their home, 772 to rehabilitation, 66 to residential care, 141 to nursing care and 101 to unknown destinations. Compared with LOS of 15.9 ± 15.6 days in patients who mobilised freely before fracture (reference), those who were able to mobilise outdoors with one aid stayed 3.5 days, and those with two aids or confined to indoor mobility stayed one week longer in hospital. In-patient mortality was increased among patients who mobilised outdoors with two aids: OR = 2.1 (95%CI = 1.3–3.3), and those limited to indoors: OR = 2.1 (1.3–1.5). Finally, a change in residence on discharge was more likely in those who mobilised outdoors with two aids (OR = 1.8, 95%CI = 1.2–2.6), and those limited to indoors (OR = 1.9, 95%CI = 1.2–2.9). In conclusion, pre-fracture mobility may be a useful early indicator for identifying patients at increased risk of adverse outcomes after an acute hip fracture.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

2020 ◽  
Vol 107 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Radcliffe Lisk ◽  
Keefai Yeong ◽  
David Fluck ◽  
Christopher H. Fry ◽  
Thang S. Han
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Adverse Events ◽  
Nursing Care ◽  
Risk Group ◽  
Area Under The Curve ◽  
High Risk Group ◽  
Discharge Destination ◽  
Increased Risk ◽  
Surgery Rates

Abstract The Nottingham Hip Fracture Score (NHFS) has been developed for predicting 30-day and 1-year mortality after hip fracture. We hypothesise that NHFS may also predict other adverse events. Data from 666 patients (190 men, 476 women), aged 60.2–103.4 years, admitted with a hip fracture to a single centre from 1/10/2015 and 7/12/2017 were analysed. The ability of NHFS to predict mobility within 1 day after surgery, length of stay (LOS) find mortality, and discharge destination was evaluated by receiver operating characteristic curves and two-graph plots. The area under the curve (95% confidence interval [CI]) for predicting mortality was 67.4% (58.4–76.4%), prolonged LOS was 59.0% (54.0–64.0%), discharge to residential/nursing care was 62.3% (54.0–71.5%), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care was 64.8% (59.0–70.6%). NHFS thresholds at 4 and 7 corresponding to the lower and upper limits of intermediate range where sensitivity and specificity equal 90% were identified for mortality and prolonged LOS, and 4 and 6 for discharge to residential/nursing care, which were used to create three risk categories. Compared with the low risk group (NHFS = 0–4), the high risk group (NHFS = 7–10 or 6–10) had increased risk of in-patient mortality: rates = 2.0% versus 7.1%, OR (95% CI) = 3.8 (1.5–9.9), failure to mobilise within 1 day of surgery: rates = 18.9% versus 28.3%, OR = 1.7 (1.0–2.8), prolonged LOS (> 17 days): rates = 20.3% versus 33.9%, OR = 2.2 (1.3–3.3), discharge to residential/nursing care: rates = 4.5% vs 12.3%, OR = 3.0 (1.4–6.4), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care: rates = 10.5% versus 28.6%, 3.4 (95% CI 1.9–6.0), and stayed 4.1 days (1.5–6.7 days) longer in hospital. High NHFS associates with increased risk of mortality, prolonged LOS and discharge to residential/nursing care, lending further support for its use to identify adverse events.

scholarly journals Turning Difficulty Characteristics of Adults Aged 65 Years or Older

2000 ◽  
Vol 80 (12) ◽  
pp. 1174-1187 ◽  
Author(s):  
Mary T Thigpen ◽  
Kathye E Light ◽  
Gwenda L Creel ◽  
Sheryl M Flynn
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Hip Fracture ◽  
Early Identification ◽  
Elderly Adults ◽  
Total Absence ◽  
Movement Characteristics ◽  
Increased Risk ◽  
Group Methods ◽  
Age Range

Abstract Background and Purpose. Falls that occur while walking have been associated with an increased risk of hip fracture in elderly people. This study's purpose was to describe movement characteristics in older adults that serve as indicators of difficulty in turning while walking. Subjects. Three groups were assessed: young adults who had no difficulty in turning (age range=20–30 years, n=20) (YNDT group), elderly adults who had no difficulty in turning (age range=65–87 years, n=15) (ENDT group), and elderly adults who had difficulty in turning (age range=69–92 years, n=15) (EDT group). Methods. All subjects were videotaped performing a self-paced 180-degree turn during the Timed “Up & Go” Test. Movement characteristics of each group were identified. Four characteristics were used to identify difficulty in turning: (1) the type of turn, (2) the number of steps taken during the turn, (3) the time taken to accomplish the turn, and (4) staggering during the turn. Results. In general, the EDT group took more steps during the turn and more time to accomplish the turn than the YNDT and ENDT groups did. Although the only turning strategy used by the YNDT group was a pivot type of turn, there was an almost total absence of a pivot type of turn in the EDT group. No differences were found among the groups on the staggering item, yet the EDT group was the only group in which staggering was present. We believe these changes observed in the 4 characteristics only in the EDT group are indicators of difficulty in turning while walking. Conclusion and Discussion. These indicators of difficulty may be useful for the early identification of individuals aged 65 years or older who are having difficulty in turning and may well serve as the basis for the development of a scale for difficulty in turning in older adults. Preliminary findings indicate the need for further study into the reliability, validity, and sensitivity of measurements obtained with such a scale.

Association between the use of benzodiazepines and opioids with the risk of falls and hip fractures in older adults

2017 ◽  
Vol 30 (7) ◽  
pp. 941-946 ◽  
Author(s):  
Manuel E. Machado-Duque ◽  
Juan Pablo Castaño-Montoya ◽  
Diego A. Medina-Morales ◽  
Alejandro Castro-Rodríguez ◽  
Alexandra González-Montoya ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Case Control Study ◽  
Case Control ◽  
Increased Risk ◽  
Female Predominance ◽  
Risk Of Falls ◽  
Risk Of Fall ◽  
Control Study

ABSTRACTBackground:To determine the association between the use of opioids and benzodiazepines and the risk of falls with hip fracture in populations older than 65 years in Colombia.Methods:A case-control study with patients older than 65 years with diagnosis of hip fracture. Two controls were obtained per case. The drugs dispensed in the previous 30 days were identified. Sociodemographic, diagnostic, pharmacological (opioids and benzodiazepines), and polypharmacy variables were analyzed. A logistic regression model was used to analyze the risk of fall with hip fracture while using these drugs.Results:We included 287 patients with hip fractures and 574 controls. There was a female predominance (72.1%) and a mean age of 82.4 ± 8.0 years. Of the patients, 12.7% had been prescribed with opioids and 4.2% with benzodiazepines in the previous month. The adjusted multivariate analysis found that using opioids (OR:4.49; 95%CI:2.72–7.42) and benzodiazepines (OR:3.73; 95%CI:1.60–8.70) in the month prior to the event was significantly associated with a greater probability of suffering a fall with hip fracture.Conclusions:People who are taking opioids and benzodiazepines have increased risk for hip fracture in Colombia. Strategies to educate physicians regarding the pharmacology of older adults should be strengthened.

scholarly journals Influence of Frailty on Discharge Setting for Older Adults With Hip Fracture at Inpatient Rehabilitation Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Christine Tocchi ◽  
Shamatree Shakya ◽  
Sathya Amarasekara ◽  
Michael Cary
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Functional Status ◽  
Hip Fractures ◽  
Value Added ◽  
Inpatient Rehabilitation ◽  
Assessment Instrument ◽  
Discharge Destination ◽  
White Race ◽  
Rehabilitation Facilities

Abstract Inpatient rehabilitation Facilities (IRFs) provide intensive rehabilitation therapy to patients to reduce functional impairment, enhance independence and return patients back to the community. Determination of eligibility for IRF is currently based on a preadmission screening. Frailty, a pervasive characteristic in older adults with hip fractures has not been examined as a clinical factor influencing function and discharge destination IRF outcomes. This study purpose was to determine the prevalence of frailty among older adult IRF patients with hip fractures and determine the association between frailty and function and discharge destination among IRF hip fracture patients. A retrospective cohort study design using CMS 2014 Inpatient Rehabilitation Facility-Patient Assessment Instrument file. Frailty was measured using a Frailty Index of 30 items. The final sample included 26,134 patients. Frailty, pre-frailty, and nonfrailty were present in 0.92% (n=24043), 3.3% (n=862), and .076% (n=199) of hip fracture patients, respectively. The majority (65%) of the patients were discharged home. There were significantly greater proportion of females than males discharged home and those of white race, 65 to 74 years of age, and those with higher functional status. Regression analysis showed significantly lower functional status at discharge (p < .0001) for males and those of non-white race, older age and frail. Study implications include the use of frailty status to identify hip fracture patients at high risk for adverse outcomes and need for future studies to explore the potential of frailty to provide value-added utility to IRF clinical settings and identify ongoing opportunities to guide person-centered care.

scholarly journals Motivating rural older residents to prepare for disasters: moving beyond personal benefits

2015 ◽  
Vol 36 (10) ◽  
pp. 2117-2140 ◽  
Author(s):  
SATO ASHIDA ◽  
ERIN L. ROBINSON ◽  
JANE GAY ◽  
MARIZEN RAMIREZ
Keyword(s):  
Older Adults ◽  
Social Relationships ◽  
Rural Areas ◽  
Process Model ◽  
Service Providers ◽  
Social Groups ◽  
The United States ◽  
Adverse Outcomes ◽  
Medical Needs ◽  
Increased Risk

ABSTRACTIn the United States of America (USA), older adults in rural areas are at increased risk for adverse outcomes of disasters, partly due to medical needs, limited or long geographic distances from community resources, and less knowledge and motivation about preparedness steps. Older residents and ageing service providers in a rural community in the USA were interviewed regarding their perceptions about disasters and preparedness, and their reactions to the preparedness training programme using the concepts of the Extended Parallel Process Model. Participants generally indicated low motivation to engage in preparedness behaviours despite perceptions of personal risk and beliefs that preparedness behaviours were easy and could improve disaster outcomes. A theme of social relationships emerged from the data, with participants identifying social relationships as resources, barriers and motivators. People surrounding older adults can support or deter their preparedness behaviours, and sometimes elicit a desire to protect the wellbeing of others. Findings suggest two potential strategies to facilitate preparedness behaviours by moving beyond personal benefits: highlighting older adults' increased ability to protect the wellbeing of younger generations and their community by being prepared themselves, and engaging family, friends and neighbours in preparedness programmes to enhance the resilience of their social groups. Older adults in many cultures have a desire to contribute to their society. Novel and effective approaches to increase preparedness could target their social groups.

scholarly journals The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

2020 ◽  
Author(s):  
Tianhang Zhang ◽  
Lijing Yan ◽  
Huashuai Chen ◽  
Haiyu Jin ◽  
Chenkai Wu
Keyword(s):  
Older Adults ◽  
Allostatic Load ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Chinese Older Adults ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Wear And Tear

Abstract Background Allostatic load, as multiple biomarker measures of ‘wear and tear’ on physiological systems, has shown some promise that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest aging population in the world. This study is to examine the association between allostatic load (AL) and all-cause mortality among Chinese adults aged at least 60 years. Methods Data were from 2,439 participants in the Chinese Longitudinal Healthy Longevity Survey. The final analytic sample consisted of 1,519 participants. Cox models were used to examine the association between AL and mortality among men and women, separately. Analysis were also adjusted for potential confounders including age, ethnicity, education, and marital status, smoking and exercise. Results In the fully adjusted model, males with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 34% and 128% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden. Discussion Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong evidence about Allostatic load was associated with specific causes of death over the same follow-up period among women. In conclusion Intervention programs targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

scholarly journals Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rasheeda K. Hall ◽  
Sarah Morton ◽  
Jonathan Wilson ◽  
Patti L. Ephraim ◽  
L. Ebony Boulware ◽  
...  
Keyword(s):  
Older Adults ◽  
Functional Limitations ◽  
Adverse Outcomes ◽  
Dialysis Initiation ◽  
Prescribing Patterns ◽  
Potentially Inappropriate Medications ◽  
Antihypertensive Medications ◽  
Risk Of Death ◽  
Increased Risk ◽  
Before And After

Abstract Background and objectives After dialysis initiation, older adults may experience orthostatic or post-dialysis hypotension. Some orthostasis-causing antihypertensives (i.e., central alpha agonists and alpha blockers), are considered potentially inappropriate medications (PIMs) for older adults because they carry more risk than benefit. We sought to (1) describe antihypertensive PIM prescribing patterns before and after dialysis initiation and (2) ascertain the potential risk of adverse outcomes when these medications are continued after dialysis initiation. Design, setting, participants, and measurements Using United States Renal Data System data, we evaluated monthly prevalence of antihypertensive PIM claims in the period before and after dialysis initiation among older adults aged ≥66 years initiating in-center hemodialysis in the US between 2013 and 2014. Patients with an antihypertensive PIM prescription at hemodialysis initiation and who survived for 120 days were classified as ‘continuers’ or ‘discontinuers’ based on presence or absence of a refill within the 120 days after initiation. We compared rates of hospitalization and risk of death across these groups from day 121 through 24 months after dialysis initiation. Results Our study included 30,760 total patients, of whom 5981 (19%) patients had an antihypertensive PIM claim at dialysis initiation and survived ≥120 days. Most [65% (n = 3920)] were continuers. Those who continued (versus discontinued) were more likely to be black race (26% versus 21%), have dual Medicare-Medicaid coverage (31% versus 27%), have more medications on average (12 versus 9) and have no functional limitations (84% versus 80%). Continuers experienced fewer all-cause hospitalizations and deaths, but neither were statistically significant after adjustment (Hospitalization: RR 0.93, 95% CI 0.86, 1.00; Death: HR 0.89, 95% CI: 0.78–1.02). Conclusions Nearly one in five older adults had an antihypertensive PIM at dialysis initiation. Among those who survived ≥120 days, continuation of an antihypertensive PIM was not associated with increased risk of all-cause hospitalization or mortality.

scholarly journals The Association of Vision, Hearing, and Dual Sensory Impairments With Walking Speed and Incident Slow Walking

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 216-216
Author(s):  
Ahmed Shakarchi ◽  
Varshini Varadaraj ◽  
Lama Assi ◽  
Nicholas Reed ◽  
Bonnielin Swenor
Keyword(s):  
Older Adults ◽  
Walking Speed ◽  
Linear Models ◽  
Population Based ◽  
Adverse Outcomes ◽  
Sensory Impairment ◽  
Slow Walking ◽  
Increased Risk ◽  
Sensory Impairments ◽  
Walking Speeds

Abstract Vision (VI), hearing (HI) and dual sensory (DSI, concurrent VI and HI) impairments are increasing in prevalence as populations age. Walking speed is an established health indicator associated with adverse outcomes, including mortality. Using the population-based Health and Retirement Study, we analyzed the longitudinal relationship between sensory impairment and walking speed. In multivariable mixed-effects linear models, we found differences in baseline walking speed (m/s) by sensory impairment: Beta=-0.05 (95%CI=-0.07, -0.04), Beta=-0.02 (95%CI=--0.03, -0.003), and Beta=-0.07 (95%CI=--0.08, -0.05) for VI, HI and DSI, respectively, as compared to those without sensory impairment. However, similar annual declines (0.014 m/s) in walking speeds occurred in all groups. In time-to-event analyses, events were defined as “slow walking” (speed <0.60m/s) and “very slow walking” (<0.40m/s). Incident “slow walking” was 43% (95%CI=25%, 65%), 29% (95%CI=13%, 48%) and 35% (95%CI=13%, 61%) greater in VI, HI and DSI, respectively, than the no sensory impairment group, while incident “very slow walking” was 21% (95%CI=-4%, 54%), 30% (95%CI=3%, 63%) and 89% (95%CI=47%, 143%) greater; the increase was significantly greater in DSI than VI and HI. These results suggest that older adults with vision and hearing impairments walk slower and are at increased risk of slow walking than older adults without these sensory impairments. Additionally, older adults with DSI are at greatest risk of very slow walking.

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