Frailty and adverse outcomes: impact of multiple bed moves for older inpatients

ABSTRACTBackground:A consequence of pressure on hospitals to accommodate care needs of older patients is “boarding” or out-lying from their home ward. This may have greater adverse effects on older inpatients who are frail.Methods:A retrospective matched cohort study was conducted in an outer metropolitan general hospital. Randomly selected patients hospitalized between July 2012 and June 2013 under the care of an Older Person Evaluation Review and Assessment (OPERA) team (n = 300) were age and sex matched with patients under the care of general physicians (n = 300). Frequency of boarding and number of bed moves were recorded for all patients. For patients who had three or more moves, adverse outcomes were compared between the two groups.Results:A higher proportion of OPERA patients (n = 143; 47.7%) were out-lied from medical wards compared with 94 (31.3%) General Medicine patients (p < 0.001). Three or more bed moves were recorded for 67 (22.3%) OPERA and 24 (8%) General Medicine patients (p < 0.001). Of those with multiple moves, OPERA patients were more likely to have pre-morbid cognitive impairment (p = 0.005), to be moderately to severely frail (p = 0.016) and to suffer acute delirium and falls during admission (p = 0.03), compared with General Medicine patients. OPERA patients were also more at risk of adverse outcomes such as increased dependence, discharge to residential care or death (p = 0.023).Conclusion:Compared with age- and sex-matched General Medicine patients, OPERA patients were more likely to undergo multiple bed moves and out-lying, which may have contributed to negative outcomes for these patients.

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An Innovative Personalised Management Program for Older Adults with Parkinson’s Disease: New Concepts and Future Directions

Journal of Personalized Medicine ◽

10.3390/jpm11010043 ◽

2021 ◽

Vol 11 (1) ◽

pp. 43

Author(s):

Piyush Varma ◽

Lakshanaa Narayan ◽

Jane Alty ◽

Virginia Painter ◽

Chandrasekhara Padmakumar

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Older Persons ◽

Clinical Manifestations ◽

Clinical Syndrome ◽

Management Program ◽

Older Person ◽

Care Needs ◽

Future Directions ◽

New Concepts

Introduction: Parkinson’s disease is a heterogeneous clinical syndrome. Parkinson’s disease in older persons presents with a diverse array of clinical manifestations leading to unique care needs. This raises the need for the healthcare community to proactively address the care needs of older persons with Parkinson’s disease. Though it is tempting to categorise different phenotypes of Parkinson’s disease, a strong evidence based for the same is lacking. There is considerable literature describing the varying clinical manifestations in old age. This article aims to review the literature looking for strategies in personalising the management of an older person with Parkinson’s disease.

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Structure and processes of emergency observation units with a geriatric focus: a scoping review

BMC Geriatrics ◽

10.1186/s12877-021-02029-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pieter Heeren ◽

Annabelle Hendrikx ◽

Janne Ceyssens ◽

Els Devriendt ◽

Mieke Deschodt ◽

...

Keyword(s):

Scoping Review ◽

Emergency Care ◽

Older Patients ◽

Clinical Care ◽

Care Needs ◽

Post Discharge ◽

Care Services ◽

Observation Units ◽

Primary Care Services ◽

Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

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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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SPMSQ for risk stratification of older patients in the emergency department

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-019-01626-z ◽

2019 ◽

Vol 52 (S4) ◽

pp. 222-228 ◽

Cited By ~ 1

Author(s):

A. Schönstein ◽

H.-W. Wahl ◽

H. A. Katus ◽

A. Bahrmann

Keyword(s):

Emergency Department ◽

Nursing Home ◽

Risk Stratification ◽

Predictive Validity ◽

Older Patients ◽

Area Under The Curve ◽

Composite Endpoint ◽

Adverse Outcomes ◽

Nursing Home Admission ◽

Initial Contact

Abstract Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

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Mortality of Public Mental Health Patients: A Singapore Experience

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679309072121 ◽

1993 ◽

Vol 27 (1) ◽

pp. 36-41 ◽

Cited By ~ 5

Author(s):

Lionel Chee-Chong Lim ◽

Li-Ping Sim ◽

Peak-Chiang Chiam

Keyword(s):

Mental Health ◽

General Population ◽

Older Patients ◽

Public Mental Health ◽

Younger Patients ◽

Standardised Mortality Ratio ◽

Common Diagnosis ◽

Mental Health Patients ◽

Mortality Ratio ◽

Age And Sex

This study reports the Standardised Mortality Ratio (SMR) by age and sex among public mental health patients in Singapore. The authors also examine the differences between those who were classified as “inpatient deaths” and those who were classified as “outpatient deaths”. Mortality was 5.1 times that of the general population and the SMR was most accentuated in the younger, female patients. Of the 217 deaths documented over two years, schizophrenia was the most common diagnosis. Inpatient deaths (N = 120) occurred in older patients with prior physical illness who died of natural causes. In contrast, outpatient deaths (N = 97) involved younger patients with no previous illness and the majority jumped to their deaths. Mortality studies are necessary in monitoring the efficacy of mental health provisions.

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Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052237 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2237

Author(s):

Youn-Jung Son ◽

Da-Young Kim ◽

Mi Hwa Won

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Older Adults ◽

Sex Differences ◽

Older Adult ◽

Hospital Readmission ◽

Older Patients ◽

Adverse Outcomes ◽

Prognostic Impact ◽

Male And Female

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

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DOES THIS SOUND FAMILIAR?

PEDIATRICS ◽

10.1542/peds.55.2.286 ◽

1975 ◽

Vol 55 (2) ◽

pp. 286-286

Author(s):

R. G. Petersdorf

Keyword(s):

General Medicine ◽

House Staff ◽

Teaching Load ◽

General Physicians

The major problems of departments of medicine are increased in teaching load, dispersion of house staff through several affiliated hospitals, a lack of resources to do all the tasks asked of them, and a schizophrenia concerning the departments' mission to tertiary subspecialty medicine as opposed to primary or general medicine. The major issue confronting departments of medicine is a solution to the problem of training general physicians.

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Stepping Stones to Caring for Our Children

10.1542/9781581109290 ◽

2014 ◽

Author(s):

◽

Keyword(s):

Food Service ◽

Community Action ◽

Special Health Care Needs ◽

Adverse Outcomes ◽

Health Care Needs ◽

Stepping Stones ◽

Care Needs ◽

Special Health Care ◽

Healthy Development ◽

Special Health

Must-have collection of selected standards from Caring for Our Children, 3rd Edition which, when put into practice, are most likely to prevent serious adverse outcomes in child care and early education settings. Contents include: *Staffing *Program Activities for Healthy Development *Health Promotion and Protection *Nutrition and Food Service *Facilities, Supplies, Equipment, and Environmental Health *Play Areas/Playgrounds and Transportation *Infectious Disease *Children with Special Health Care Needs and Disabilities *Policies *Licensing and Community Action

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246Use of The ‘Surprise Question’ in Predicting Adverse Outcomes Among Frail Older Patients after Hospital Admission

Age and Ageing ◽

10.1093/ageing/afy141.39 ◽

2018 ◽

Vol 47 (suppl_5) ◽

pp. v1-v12

Author(s):

Laura Gaffney ◽

Conor Judge ◽

Laura Morrison ◽

Maria Costello ◽

Stephanie Robinson ◽

...

Keyword(s):

Hospital Admission ◽

Older Patients ◽

Adverse Outcomes ◽

Surprise Question

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The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

CJEM ◽

10.1017/cem.2015.73 ◽

2015 ◽

Vol 18 (1) ◽

pp. 54-61 ◽

Cited By ~ 8

Author(s):

Judah Goldstein ◽

Jennifer McVey ◽

Stacy Ackroyd-Stolarz

Keyword(s):

Older Adults ◽

Primary Care ◽

Emergency Medical Services ◽

Acute Care ◽

Functional Independence ◽

Adverse Outcomes ◽

Medical Services ◽

Care Needs ◽

Frail Older Adults ◽

Emergency Medical

AbstractCaring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

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