Predictors of clinical events occurring during hospital stay among elderly patients admitted to medical wards in Italy

2016 ◽  
Vol 32 ◽  
pp. 38-42 ◽  
Author(s):  
Paolo Dionigi Rossi ◽  
Claudio Bilotta ◽  
Dario Consonni ◽  
Alessandro Nobili ◽  
Sarah Damanti ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Clinical Events ◽  
Medical Wards

scholarly journals The effect of low dose lofepramine in depressed elderly patients in general medical wards.

1994 ◽  
Vol 37 (4) ◽  
pp. 321-324 ◽  
Author(s):  
RS Tan ◽  
RJ Barlow ◽  
C Abel ◽  
S Reddy ◽  
AJ Palmer ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Low Dose ◽  
Medical Wards

scholarly journals Use of the Flugelman index for identifying patients who are difficult to discharge from the hospital

2013 ◽  
pp. 103-108
Author(s):  
Chiara Bozzano ◽  
Ilario Lancini ◽  
Elena Mei ◽  
Maida Lucarini ◽  
Roberta Mastriforti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Discharge Planning ◽  
District General Hospital ◽  
Feeding Problems ◽  
Care Needs ◽  
Socioeconomic Condition ◽  
Factors Affecting ◽  
Effective Discharge ◽  
Medical Wards

Introduction: To evaluate the use of multidimensional assessment based on the Fluegelman Index (FI) to identify internal medicine patients who are likely to be difficult to discharge from the hospital. Materials and methods: Have been evaluated all patients admitted to the medical wards of the District General Hospital of Arezzo from September 1 to October 31, 2007. We collected data on age, sex, socioeconomic condition, cause of admission, comorbidity score preadmission functional status (Barthel Index), incontinence, feeding problems, length of hospitalization, condition at discharge, and type of discharge. The FI cut off for difficult discharge was > 17. Results: Of the 413 patients (mean age 80 + 11.37 years; percentage of women, 56.1%) included in the study, 109 (26.39%) had Flugelman Index > 17. These patients were significantly older than the patients with lower FIs (85 + 9.35 vs 78 + 11.58 years, p < 0.001), more likely to be admitted for pneumonia (22% vs. 4.9% of those with lower FIs; p < 0,001). They also had more comorbidity, loss of autonomy, cognitive impairment, social frailty, and nursing care needs. The subgroup with FIs>17 had significantly higher in-hospital mortality (30.28% vs 6.25%, p < 0.001), longer hospital stay (13 vs. 10 days, p < 0.05), and higher rates of discharge to nursing homes. Conclusions: Evaluation of internal medicine patients with the Flugelman Index may be helpful for identifying more critical patients likely to require longer hospitalization and to detect factors affecting the hospital stay. This information can be useful for more effective discharge planning.

scholarly journals P1502IS AGE JUST A NUMBER? - HEMODIALYSIS IN OCTOGENARIAN PATIENTS IN A PORTUGUESE CENTRAL HOSPITAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Daniela Alferes ◽  
Marinha Silva ◽  
Joana Couto ◽  
Ana Ventura ◽  
Clemente Sousa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Vascular Access ◽  
Functional Activity ◽  
Hospital Admissions ◽  
Central Hospital ◽  
Karnofsky Score ◽  
Dialysis Therapy ◽  
Dialysis Treatment

Abstract Background and Aims The option of a non-dialytic or conservative approach to elderly patients with End-Stage Renal Disease (ESRD) as an alternative to dialysis has a great interest in clinical practice. Among elderly patients with ESRD, the octogenarian ones raise the most difficult decisions with respect to indication and dialysis therapy management, furthermore the evidence about the clinical outcomes is lacking in this group of patient. The main objectives of this study were the analysis the comorbidities and clinical condition of pre-ESRD octogenarians who initiated dialysis and the estimation of the effect of such treatment on this patient group’s comorbid status. Method The authors performed a retrospective and statistical analysis on patients with aged ≥ 80 years who initiated hemodialysis treatment in a Portuguese Central Hospital between 2007 and 2017. A total of 88 patients were included in the study. Results The mean age of the group was 84±2.8 years; 61.4% were men. Nearly all the patients (97.7%) had one or more comorbid conditions of which the most common were hypertension (86.4%), heart disease (58%) and diabetes (43.2%). In 60.2% of the patients the functional activity was normal (Karnofsky score ≥80). Hemodialysis was initiated in an emergency situation in 58% of the patients and the majority (59.1%) had an arteriovenous fistula as vascular access. In the 2 years previous to dialysis therapy, most patients (54.5%) had at least one hospitalization (min=1; max=4). During the two years of follow-up, the number of hospital admissions decreased (p=0.034) and only 39.8% of the patients required hospital admission (min=1; max=3) (table 1), with shorter average hospital stay (p=0.013) (table 2). The main causes of hospitalization in the pre-dialysis period were renal related-diseases, in contrast the admissions were due to non-access related infections and vascular access complications after dialysis had initiated. Most patients died (67%) at the end of follow-up mainly due to non-vascular access infections or sepsis (32.2%). The significant causes of death found by Cox regression were chronic kidney disease secondary to systemic disease, Karnofsky score and hospital stay in the 2-year-dialysis period (table 3). Conclusion Advanced age in itself should not be used as an excluding factor of dialysis treatment. Comorbidity and performance status are the factors that should exert the greatest influence on such decision. In this sample, the majority of patients had few comorbidities, a good functional activity and they initiated dialysis by an autologous vascular access which may have contributed to the good outcomeS. This study found a decrease in the number of hospitalizations in the dialysis period which can be explained by regular clinical monitoring in every dialysis treatment, preventing or even treating intercurrent illnesses and avoiding hospital admissions.

scholarly journals Pacemaker therapy in the elderly and very elderly: comorbidity-burden vs age, as prognostic factors for excess of length of in-hospital stay, complications and mortality

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Marschall ◽  
H Del Castillo Carnevali ◽  
F Goncalves Sanchez ◽  
M Torres Lopez ◽  
F A Delgado Calva ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
Clinical Scenarios ◽  
Comorbidity Burden ◽  
The Impact ◽  
Complications And Mortality

Abstract Background The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Recent studies suggest that comorbidity burden may have an equal, if not greater, effect on length of in-hospital stay (LOS), complications and mortality, as age in a variety of clinical scenarios. Objective The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate the impact of comorbidities, as compared to age, on excess of length of in-hospital stay and mortality. Methods This is a retrospective observational study of a single centre. Patients that underwent (both elective and non-elective) PM implantation between June 2016 and December 2018 in our centre, were included for chart review. Elderly patients were defined as those with age 80–89 years, whereas very elderly patients were defined as those with ≥90 years of age. Excess in LOS was defined as an in-hospital stay &gt;3 days. Results A total of 507 patients were included in the study with a mean age of 80.6 (±8.5) years. 255 elderly and 60 very elderly patients were included. Median follow-up time was 24 months. Baseline clinical characteristics are presented in Table 1. The mortality rate for elderly patients was 18.8% for the elderly and 36.7% for the very elderly (p=0.002). The presence of ≥2 comorbidities (defined in Table 1) resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 7.1 (4.4–11.4), p&lt;0.001); HR: 1.01 (0.9–1.1), p=0.56, respectively). Neither age, nor comorbidity burden predicted the appearance of device related complications. Both comorbidites and age predicted mortality. However, the association was stronger for the presence of comorbidites, than for age (HR: 1.9 (1.1–3.1), p=0.002 vs HR: 1.1 (1.1–1.2), p&lt;0.001, respectively). Elderly patients with low comorbidity burden (&lt;2 comorbidities) showed no significant differences with regards to LOS and mortality when compared to younger patients (2 (2–4) vs 3 (2–5) days, p=0.529 and 18.3% vs 17.4%, p=0.702; respectively). Conclusions Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Enhanced Recovery After Colorectal Surgery (ERAS) in Elderly Patients Is Feasible and Achieves Similar Results as in Younger Patients

2017 ◽  
Vol 3 ◽  
pp. 233372141770629 ◽  
Author(s):  
Håvard Mjørud Forsmo ◽  
Christian Erichsen ◽  
Anne Rasdal ◽  
Hartwig Körner ◽  
Frank Pfeffer
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Patient Adherence ◽  
Controlled Trial ◽  
Age Groups ◽  
Postoperative Hospital Stay ◽  
Younger Patients ◽  
Eras Protocol

Aim: Enhanced recovery after surgery (ERAS) is a multimodal approach that aims to optimize perioperative treatment. Whether elderly patients receiving colorectal surgery can adhere to and benefit from an ERAS approach is uncertain. The aim of this study was to compare patients in different age groups participating in an ERAS program. Method: In this substudy of a randomized controlled trial, we analyzed the interventional ERAS arm of adult patients eligible for laparoscopic or open colorectal resection with regard to the importance of age. Patients were divided into three groups based on age: ≤65 years ( n = 79), 66-79 years ( n = 56), and ≥80 years ( n = 19). The primary end point was total postoperative hospital stay (THS). Secondary end points were postoperative hospital stay, postoperative complications, postoperative C-reactive protein levels, readmission rate, mortality, and patient adherence to the different ERAS elements. All parameters and measuring the adherence to the ERAS protocol were recorded before surgery, on the day of the operation, and daily until discharge. Results: There were no significant differences in length of THS between age groups (≤65 years, median 5 [range 2-47] days; 66-79 years, median 5.5 [range 2-36] days; ≥80 years, median 7 [range 3-50] days; p = .53). All secondary outcomes were similar between age groups. Patient adherence to the ERAS protocol was as good in the elderly as it was in the younger patients. Conclusion: Elderly patients adhered to and benefited from an ERAS program, similar to their younger counterparts.

Clinical significance of controlling nutritional status score for predicting short-term clinical events in takotsubo syndrome: a multicenter study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Takahashi ◽  
M Sudo ◽  
A Ogaku ◽  
Y Saito ◽  
W Atsumi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Nutritional Status ◽  
Hospital Stay ◽  
Secondary Outcome ◽  
Takotsubo Syndrome ◽  
Short Term ◽  
Duration Of Hospital Stay ◽  
Clinical Events ◽  
Conut Score

Abstract Background The Controlling Nutritional Status (CONUT) score is well known as a marker of nutritional status. Previous studies have reported that CONUT score could predict a prognosis of acute or chronic heart failure, and infective endocarditis. Takotsubo syndrome (TTS) is said to have a relatively good prognosis, but some patients have a bad turning point in hospital stay. Lower systolic blood pressure on admission, history of diabetes mellitus, and β-blocker use before admission have been reported as predictors of in-hospital cardiac complications. However, the prognostic utility of CONUT score in TTS is unclear. The aim of study was to evaluate duration of hospital stay and short-term clinical events with CONUT score in TTS. Methods Seventy-nine TTS patients who were admitted to 3 medical centers in Japan between January 2011 and October 2019 were enrolled. The average age was 71.8±11.5 years old, and the prevalence of female sex was 81%. The CONUT score was calculated based on the serum albumin, total lymphocyte and total cholesterol on admission. We retrospectively investigated the association between the short-term clinical events and CONUT score. The duration of hospital stay was defined as the primely outcome, and all cause death and congestive heart failure in hospital stay as the secondary outcome. Results The average CONUT score was 3.7±3.0. A positive correlation was found between the CONUT score and the duration of hospital stay (r=0.56, p&lt;0.01). Twenty (25.3%) patients suffered from clinical events (all cause death and congestive heart failure in hospital). Those patients with clinical events had significantly higher the CONUT score than those without (all cause death, 7.2±2.6 vs. 3.5±2.9, p&lt;0.01, congestive heart failure, 5.3±3.4 vs. 3.3±2.8, p=0.02, composite clinical events, 5.8±3.2 vs. 3.0±2.6, p&lt;0.01). ROC curve analysis revealed that the optimal cut-off value of the CONUT score for the prediction of composite clinical events was 4.0 (AUC: 0.75, sensitivity: 80%, Specificity: 64%). The patients with CONUT score of 4 or more (high COUNT score) were more prevalent in patients who experienced composite clinical events than in those who didn't (80% vs. 35.6%, p&lt;0.01). The patients with a high CONUT score had a longer hospital stay and higher occurrence of composite clinical events than those with CONUT score less than 4 (respectively, 27.2±19.1 days vs. 13.8±8.3 days, p&lt;0.01, 25.3% vs. 9.5%, p&lt;0.01). Conclusions The CONUT score in TTS patients was strongly associated with the duration of hospital stay and clinical events in hospital. The CONUT score is a simple indicator that can be calculated with only three factors. Therefore, the CONUT score on admission may be useful for a predictor of short-term clinical events in TTS patients. Funding Acknowledgement Type of funding source: None

PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Jeroen Hol ◽  
Joos Heisterkamp ◽  
Barbara Langenhoff
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Tumor Type ◽  
Invasive Esophagectomy ◽  
Group 2 ◽  
Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

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