PDB22 ANTIHYPERGLYCEMIC TREATMENT REGIMENS BEFORE AND AFTER A SKILLED NURSING FACILITY STAY AMONG PATIENTS WITH TYPE 2 DIABETES

IntroductionHospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes.ObjectiveWe aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF).DesignA retrospective single-centre before-and-after cohort study.Setting and participantsStudy population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016–25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed.InterventionOGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (−OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT).Main outcome measuresUnplanned hospital readmission between 4 hours and 30 days following initial discharge.ResultsTotally 847 patients were included (440 −OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in −OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with –OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period.ConclusionFollow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.

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Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.10.010 ◽

2016 ◽

Vol 17 (3) ◽

pp. 225-231 ◽

Cited By ~ 17

Author(s):

Bianca M. Buurman ◽

Ling Han ◽

Terrence E. Murphy ◽

Evelyne A. Gahbauer ◽

Linda Leo-Summers ◽

...

Keyword(s):

Older Persons ◽

Skilled Nursing Facility ◽

Nursing Facility ◽

Skilled Nursing ◽

Before And After

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Group B streptococcus meningitis complicated by periodic lateralising epileptiform discharges in an elderly patient with type 2 diabetes mellitus

BMJ Case Reports ◽

10.1136/bcr-2018-228040 ◽

2019 ◽

Vol 12 (8) ◽

pp. e228040 ◽

Cited By ~ 3

Author(s):

Nicholas Germano ◽

Maria Gunnes Sibbel ◽

Douglas Summerfield ◽

Abbey Pitzenberger

Keyword(s):

Bacterial Meningitis ◽

Skilled Nursing Facility ◽

Group B Streptococcus ◽

The Elderly ◽

Chronic Illnesses ◽

Nursing Facility ◽

Skilled Nursing ◽

Epileptiform Discharges ◽

Group B

Streptococcus agalactiae (group B streptococcus or GBS) is the most common cause of bacterial meningitis in infants, but is rarely the cause in adults. Across all non-pregnant adults it comprises 7% of bacterial meningitis cases, with a mortality rate of 56% in the elderly. Therefore, while rare, GBS should be a part of a patient’s differential when initiating antibiotics in adults with chronic illnesses. We report a 78-year-old diabetic female admitted to the hospital with suspected meningitis. Lumbar puncture revealed grossly purulent cerebrospinal fluid (CSF) and she was started on antibiotics for empiric treatment of expected Streptococcus pneumoniae. Thirty-one hours post-sampling, the CSF culture results returned positive for beta haemolytic GBS and treatment was altered accordingly. The case was complicated by concomitant periodic lateralising epileptiform discharges which were treated simultaneously. After 14 days of hospitalisation, the patient was discharged to a skilled nursing facility for further recovery.

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Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012973 ◽

1999 ◽

Vol 27 (2) ◽

pp. 203-203

Author(s):

Kendra Carlson

Keyword(s):

Health Care ◽

Supreme Court ◽

Health Care Providers ◽

Elder Abuse ◽

Skilled Nursing Facility ◽

Pressure Sores ◽

Care Providers ◽

Nursing Facility ◽

Skilled Nursing ◽

The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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