The Charlson Comorbidity and Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in unselected older patients admitted to the emergency department

2018 ◽  
Vol 31 (9) ◽  
pp. 1233-1242 ◽  
Author(s):  
Anke Bahrmann ◽  
Laura Benner ◽  
Michael Christ ◽  
Thomas Bertsch ◽  
Cornel C. Sieber ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Stay ◽  
Cardiovascular Mortality ◽  
Barthel Index ◽  
Older Patients ◽  
Length Of Hospital Stay

The neuropathogenesis of delirium

2002 ◽  
Vol 12 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Susan White
Keyword(s):  
Hospital Stay ◽  
Older Patients ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Advanced Age ◽  
Major Surgery ◽  
Common Disorder ◽  
Disturbance Of Consciousness ◽  
Short Period

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

Preventable hospitalizations among older patients with cognitive impairments and dementia

2018 ◽  
Vol 31 (3) ◽  
pp. 383-391 ◽  
Author(s):  
Dominik Wolf ◽  
Carolin Rhein ◽  
Katharina Geschke ◽  
Andreas Fellgiebel
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Ambulatory Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Older Patients ◽  
Hospital Admissions ◽  
Cognitive Impairments ◽  
Length Of Hospital Stay ◽  
Complication Rates

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

scholarly journals Impact of an acute medical admission unit on length of hospital stay, and emergency department 'wait times'

QJM ◽  
2005 ◽  
Vol 98 (4) ◽  
pp. 283-289 ◽  
Author(s):  
E.D. Moloney ◽  
D. Smith ◽  
K. Bennett ◽  
D. O'Riordan ◽  
B. Silke
Keyword(s):  
Emergency Department ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Wait Times ◽  
Medical Admission ◽  
Emergency Department Wait Times

scholarly journals Accelerometry Assessed Physical Activity of Older Adults Hospitalized with Acute Medical Illness - an Observational Study

2020 ◽  
Author(s):  
Plamena Tasheva ◽  
Vanessa Kraege ◽  
Peter Vollenweider ◽  
Guillaume Roulet ◽  
Marie Méan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Observational Study ◽  
Hospital Stay ◽  
Barthel Index ◽  
Older Patients ◽  
Medical Illness ◽  
Barthel Index Score ◽  
Physically Active ◽  
Walking Aids ◽  
Active Patients

Abstract Background: In a hospital setting and among older patients, inactivity and bedrest are associated with a wide range of negative outcomes such as functional decline, increased risk of falls, longer hospitalization and institutionalization. Our aim was to assess the distribution, determinants and predictors of physical activity (PA) levels using wrist-worn accelerometers in older patients hospitalized with acute medical illness.Methods: Observational study conducted from February to November 2018 at an acute internal medicine unit in the University hospital of Lausanne, Switzerland. We enrolled 177 patients aged ≥65 years, able to walk prior to admission. PA during acute hospital stay was continuously recorded via a 3D wrist accelerometer. Clinical data was collected from medical records or by interview. Autonomy level prior to inclusion was assessed using Barthel Index score. PA levels were defined as <30 mg for inactivity, 30-99 mg for light and ≥100 for moderate PA. Physically active patients were defined as 1) being in the highest quartile of time spent in light and moderate PA or 2) spending ≥20 minutes/day in moderate PA.Results: Median [interquartile range - IQR] age was 83 [74-87] years and 60% of participants were male. The median [IQR] time spent inactive and in light PA was 613 [518-663] and 63 [30-97] minutes/day, respectively. PA peaked between 8 and 10 am, at 12 am and at 6 pm. Less than 10% of patients were considered physically active according to definition 2. For both definitions, active patients had a lower prevalence of walking aids and a lower dependency level according to Barthel Index score. For definition 1, use of medical equipment was associated with a 70% reduction in the likelihood of being active: odds ratio (OR) 0.30 [0.10-0.92] p=0.034; for definition 2, use of walking aids was associated with a 75% reduction in the likelihood of being active: OR=0.24 [0.06-0.89], p=0.032.Conclusion: Older hospitalized patients are physically active only 10% of daily time and concentrate their PA around eating periods. Whether a Barthel Index below 95 prior to admission may be used to identify patients at risk of inactivity during hospital stay remains to be proven.

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