Why older people stop to drive? A cohort study of older patients admitted to a rehabilitation setting

Background: Daptomycin-induced eosinophilic pneumonia (DEP) is a rare but severe adverse effect and the risk factors are unknown. The aim of this study was to determine risk factors for DEP. Methods: A retrospective cohort study was performed at the Bone and Joint Infection Unit of the Hospital Universitari Bellvitge (January 2014–December 2018). To identify risk factors for DEP, cases were divided into two groups: those who developed DEP and those without DEP. Results: Among the whole cohort (n = 229) we identified 11 DEP cases (4.8%) and this percentage almost doubled in the subgroup of patients ≥70 years (8.1%). The risk factors for DEP were age ≥70 years (HR 10.19, 95%CI 1.28–80.93), therapy >14 days (7.71, 1.98–30.09) and total cumulative dose of daptomycin ≥10 g (5.30, 1.14–24.66). Conclusions: Clinicians should monitor cumulative daptomycin dosage to minimize DEP risk, and be cautious particularly in older patients when the total dose of daptomycin exceeds 10 g.

Download Full-text

Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽

10.3390/geriatrics6020046 ◽

2021 ◽

Vol 6 (2) ◽

pp. 46

Author(s):

Tina Hansen ◽

Rikke Lundsgaard Nielsen ◽

Morten Baltzer Houlind ◽

Juliette Tavenier ◽

Line Jee Hartmann Rasmussen ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Cohort Study ◽

Systemic Inflammation ◽

Older Patients ◽

Time Course ◽

Assessment Tool ◽

Handgrip Strength ◽

Secondary Analysis ◽

Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

Download Full-text

Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042351 ◽

2020 ◽

Vol 10 (11) ◽

pp. e042351

Author(s):

Kathryn Eastwood ◽

Dhanya Nambiar ◽

Rosamond Dwyer ◽

Judy A Lowthian ◽

Peter Cameron ◽

...

Keyword(s):

Cohort Study ◽

Older Adult ◽

Retrospective Cohort Study ◽

Older Patients ◽

Retrospective Cohort ◽

Vital Signs ◽

Telephone Triage ◽

Ambulance Dispatch ◽

Emergency Ambulance ◽

Primary Triage

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

Download Full-text

Serum markers glial fibrillary acidic protein and neurofilament light for prognosis and monitoring in cognitively normal older people: a prospective memory clinic-based cohort study

The Lancet Healthy Longevity ◽

10.1016/s2666-7568(20)30061-1 ◽

2021 ◽

Vol 2 (2) ◽

pp. e87-e95

Author(s):

Inge M W Verberk ◽

Malika B Laarhuis ◽

Karlijn A van den Bosch ◽

Jarith L Ebenau ◽

Mardou van Leeuwenstijn ◽

...

Keyword(s):

Cohort Study ◽

Glial Fibrillary Acidic Protein ◽

Older People ◽

Prospective Memory ◽

Serum Markers ◽

Acidic Protein ◽

Memory Clinic ◽

Neurofilament Light ◽

Cognitively Normal

Download Full-text

Impairment in activities of daily living and readmission in older patients with heart failure: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044416 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044416

Author(s):

Tan Van Nguyen ◽

Huyen Thanh Dang ◽

Mason Jenner Burns ◽

Hiep HH Dao ◽

Tu Ngoc Nguyen

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Activities Of Daily Living ◽

Daily Living ◽

Older Patients ◽

Tertiary Hospital ◽

Logistic Regression Models ◽

Hospitalised Patients ◽

Patients With Heart Failure ◽

The Impact

ObjectivesThis study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.Design and settingsA prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.ResultsThere were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).ConclusionsIn summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.

Download Full-text

Trends in treatment for patients with depression in general practice in Norway, 2009–2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study)

BMC Health Services Research ◽

10.1186/s12913-021-06712-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sabine Ruths ◽

Inger Haukenes ◽

Øystein Hetlevik ◽

Tone Smith-Sivertsen ◽

Stefan Hjørleifsson ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

General Practice ◽

Cohort Study ◽

Drug Treatment ◽

Time Trends ◽

Older Patients ◽

Antidepressant Drug ◽

Depression Care ◽

Patient Gender

Abstract Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

Download Full-text