Medication Counselling in Older Patients Prior to Hospital Discharge: A Systematic Review

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

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Fall prevention education for older people being discharged from hospital: Educators’ perspectives

Health Education Journal ◽

10.1177/00178969211032711 ◽

2021 ◽

pp. 001789692110327

Author(s):

Jacqueline Francis-Coad ◽

Den-Ching A Lee ◽

Terry P Haines ◽

Meg E Morris ◽

Steven M McPhail ◽

...

Keyword(s):

Hospital Discharge ◽

Fall Prevention ◽

Older Patients ◽

Education Programme ◽

Prevention Strategies ◽

Post Intervention ◽

Prevention Education ◽

Barriers And Enablers ◽

Education Delivery ◽

Fall Prevention Education

Objective: Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme. Design: Qualitative sequential design. Setting: Three rehabilitation hospitals in Western Australia. Method: Three experienced physiotherapists trained as ‘educators’ to deliver a tailored fall prevention education programme to 195 older patients prior to hospital discharge, together with monthly telephone follow-up for 3 months after discharge. Educator–patient interactions were recorded in a standardised educator diary. Post-intervention, educators participated in a mini-focus group, providing their perspectives regarding education delivery and its impact on patient abilities to engage in fall prevention strategies. Data were analysed using deductive content analysis. Results: Educators followed up 184 (94%) patients, identifying multiple barriers and enablers affecting patient engagement in planned fall prevention strategies. Key barriers included unresolved medical conditions, reluctance to accept assistance on discharge, delays in assistive service provision, patient beliefs and perceptions about falls and, in some cases, patients’ absolving responsibility for recovery. Enablers were related to programme design, the completion of hospital discharge processes and support networks following discharge. Conclusion: Educators identified several barriers and enablers to programme delivery, receipt and enactment by older patients that contributed to the fidelity of the education programme. The consistent need for more patient support to enable improved enactment of plans and assist with safe recovery long after discharge warrants further attention at policy and health system levels.

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ACUTE HOSPITAL DISCHARGE OF OLDER PATIENTS AND EXTERNAL CONTROL

Home Health Care Services Quarterly ◽

10.1300/j027v03n01_04 ◽

1982 ◽

Vol 3 (1) ◽

pp. 39-57

Author(s):

Betsy C. Robinson ◽

Joseph C. Barbaccia

Keyword(s):

Hospital Discharge ◽

Older Patients ◽

Acute Hospital ◽

External Control

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Older people's satisfaction with intermediate care: a systematic review

Reviews in Clinical Gerontology ◽

10.1017/s0959259808002475 ◽

2007 ◽

Vol 17 (3) ◽

pp. 199-218 ◽

Cited By ~ 3

Author(s):

Andrew Wilson ◽

Suzanne Richards ◽

Janette Camosso-Stefinovic

Keyword(s):

Systematic Review ◽

Older People ◽

Older Patients ◽

Hospital Care ◽

Patient Choice ◽

Intermediate Care ◽

Care Services ◽

The Relationship

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

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Perioperative mortality in older patients: a systematic review with a meta-regression analysis and meta-analysis of observational studies

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2020.110160 ◽

2021 ◽

Vol 69 ◽

pp. 110160

Author(s):

Karen S. Braghiroli ◽

Sharon Einav ◽

Michael A. Heesen ◽

Paulo J.F. Villas Boas ◽

Jose R.C. Braz ◽

...

Keyword(s):

Systematic Review ◽

Regression Analysis ◽

Older Patients ◽

Observational Studies ◽

Meta Analysis ◽

Perioperative Mortality ◽

Meta Regression ◽

Meta Regression Analysis

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Characterizing Cefepime Neurotoxicity: A Systematic Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx170 ◽

2017 ◽

Vol 4 (4) ◽

Cited By ~ 30

Author(s):

Ayesha A Appa ◽

Rupali Jain ◽

Robert M Rakita ◽

Shahin Hakimian ◽

Paul S Pottinger

Keyword(s):

Systematic Review ◽

Status Epilepticus ◽

Renal Dysfunction ◽

Older Patients ◽

Review Of The Literature ◽

Single Center ◽

Level Of Consciousness ◽

The Mean ◽

Convulsive Seizures ◽

New Onset

Abstract Neurotoxicity due to cefepime has not been well characterized. We performed a systematic review of the literature and included 5 additional cases from our center. Of the 198 cases found, the mean age was 67 years and 87% of patients had renal dysfunction. The most common clinical features were diminished level of consciousness (80%), disorientation/agitation (47%), and myoclonus (40%). It is worth noting that nonconvulsive status epilepticus was relatively common with 31% of cases, whereas only 11% had convulsive seizures. Single-center estimate of incidence was 1 in 480 courses of cefepime. Cefepime neurotoxicity should be considered in older patients with renal dysfunction and new onset encephalopathy, especially if concurrent myoclonus is present. More work is needed to prospectively assess incidence and outcomes related to cefepime neurotoxicity.

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