Therapeutic advice issued by a geriatric mobile team and 3-year mortality in older inpatients

Abstract. Twelve older inpatients (M age = 66.8) with Major Depressive Disorder (MDD) participated in this controlled pilot trial either in a physical exercise group (PEG; n = 6; aerobic, strength, and coordination exercises) or an active control group (ACG; n = 6; relaxation exercises) twice a week for four weeks. While depressive symptoms decreased in both groups, reduction of symptoms was significantly larger in the PEG. However, the PEG had higher BDI scores compared to the ACG at pretest. Neurocognitive functioning and brain-derived neurotrophic factor (BDNF) concentration did not change significantly. A four-week exercise program may be a feasible adjunct therapy in older MDD patients but the efficacy of the program needs to be proven with larger samples.

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Faculty Opinions recommendation of Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718063029.793513708 ◽

2016 ◽

Author(s):

Andrew Dupont

Keyword(s):

Clostridium Difficile ◽

Multicentre Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Older Inpatients ◽

Antibiotic Associated Diarrhoea

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Faculty Opinions recommendation of Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718063029.793481928 ◽

2013 ◽

Author(s):

Eamonn Quigley

Keyword(s):

Clostridium Difficile ◽

Multicentre Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Older Inpatients ◽

Antibiotic Associated Diarrhoea

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Faculty Opinions recommendation of Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718063029.793481824 ◽

2013 ◽

Author(s):

Daniel Diekema

Keyword(s):

Clostridium Difficile ◽

Multicentre Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Older Inpatients ◽

Antibiotic Associated Diarrhoea

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Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

BMJ Open ◽

10.1136/bmjopen-2021-052755 ◽

2021 ◽

Vol 11 (7) ◽

pp. e052755

Author(s):

Filipa Pereira ◽

Henk Verloo ◽

Taushanov Zhivko ◽

Saviana Di Giovanni ◽

Carla Meyer-Massetti ◽

...

Keyword(s):

Cohort Study ◽

Hospital Readmission ◽

Hospital Readmissions ◽

Drug Regimen ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Day Hospital ◽

Medical Conditions ◽

Older Inpatients ◽

Drug Regimens

ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

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Follow-up services for delirium after COVID-19—where now?

Age and Ageing ◽

10.1093/ageing/afab014 ◽

2021 ◽

Author(s):

Shibley Rahman ◽

Kit Byatt

Keyword(s):

Service Utilisation ◽

Sustainable Business ◽

Community Based ◽

Care And Support ◽

Early Supported Discharge ◽

Business Cases ◽

Older Inpatients ◽

The Impact

Abstract Delirium is a common presentation in older inpatients with coronavirus disease 2019 (COVID-19), and a risk factor for cognitive decline at discharge. The glaring gaps in the service provision in delirium care, regardless of aetiology, after a hospital admission pre-existed the pandemic, but the pandemic arguably offers an opportunity now to address them. Whilst a delirium episode in itself is not a long-term condition, the context of it may well be, and therefore patients might benefit from personalised care and support planning. There is no reason to believe that the delirium following COVID-19 is fundamentally different from any other delirium. We propose that the needs of older patients who have experienced delirium including from COVID-19 could be addressed through a new model of post-acute delirium care that combines early supported discharge, including discharge-to-assess, with community-based follow-up to assess for persistent delirium and early new long-term cognitive impairment. Such a drive could be structurally integrated with existing memory clinic services. To succeed, such an ambition has to be flexible, adaptable and person-centred. To understand the impact on resource and service utilisation, techniques of quality improvement should be implemented, and appropriate metrics reflecting both process and outcome will be essential to underpin robust and sustainable business cases to support implementation of delirium care as a long-term solution.

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Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study

Gerontology ◽

10.1159/000514948 ◽

2021 ◽

pp. 1-9

Author(s):

Jing Jiao ◽

Na Guo ◽

Lingli Xie ◽

Qiaoyan Ying ◽

Chen Zhu ◽

...

Keyword(s):

Cohort Study ◽

Adverse Outcomes ◽

Hospital Ward ◽

Adverse Health Outcomes ◽

Multicentre Cohort Study ◽

Older Inpatients ◽

Ward Clustering ◽

Clustering Effect ◽

The Relationship ◽

Multicentre Cohort

Introduction: Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. Methods: We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. Results: We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59–6.38), readmission (OR 1.45; 95% CI 1.25–1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10–5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09–4.01), readmission (OR 1.38; 95% CI 1.21–1.57), and mortality (OR 6.50; 95% CI 4.00–7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. Conclusions: Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.

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