scholarly journals Delirium: Prevalence and outcome in the very old in 27 medical departments during a one-year prospective study

2021 ◽  
pp. 1-6
Author(s):  
Justus Marquetand ◽  
Leonie Bode ◽  
Simon Fuchs ◽  
Jutta Ernst ◽  
Roland von Känel ◽  
...  
Keyword(s):  
Intensive Care ◽  
Assisted Living ◽  
University Hospital ◽  
Assisted Living Facilities ◽  
Prevalence Rates ◽  
Term Care ◽  
Very Old ◽  
One Year ◽  
The One ◽  
Simple Logistic

Abstract Objective The prevalence and effects of delirium in very old individuals aged ≥80 years have not yet been systematically evaluated. Therefore, this large single-center study of the one-year prevalence of delirium in 3,076 patients in 27 medical departments of the University Hospital of Zurich was conducted. Methods Patient scores on the Delirium Observation Screening scale, Intensive Care Delirium Screening Checklist, Diagnostic and Statistical Manual, 5th edition, and electronic Patient Assessment–Acute Care (nursing tool) resulted in the inclusion of 3,076 individuals in 27 departments. The prevalence rates were determined by simple logistic regressions, odds ratios (ORs), and confidence intervals. Results Of the 3,076 patients, 1,285 (41.8%) developed delirium. The prevalence rates in the 27 departments ranged from 15% in rheumatology (OR = 0.30) to 73% in intensive care (OR = 5.25). Delirious patients were more likely to have been admitted from long-term care facilities (OR = 2.26) or because of emergencies (OR = 2.24). The length of their hospital stay was twice as long as that for other patients. Some died before discharge (OR = 24.88), and others were discharged to nursing homes (OR = 2.96) or assisted living facilities (OR = 2.2). Conclusion This is the largest study to date regarding the prevalence of delirium in patients aged ≥80 years and the medical characteristics of these patients. Almost two out of five patients developed delirium, with a high risk of loss of independence and mortality.

The prevalence rates and sequelae of delirium at age older than 90 years

2020 ◽  
pp. 1-6
Author(s):  
Samuel Gehrke ◽  
Leonie Bode ◽  
Annina Seiler ◽  
Jutta Ernst ◽  
Roland von Känel ◽  
...  
Keyword(s):  
Intensive Care ◽  
Functional Impairment ◽  
Assisted Living ◽  
Prevalence Rates ◽  
Elective Admission ◽  
Diagnostic And Statistical Manual ◽  
Care Services ◽  
Wide Range ◽  
And Gender ◽  
Simple Logistic

Abstract Objective Although age and pre-existent dementia are robust risk factors for developing delirium, evidence for patients older than 90 years is lacking. Therefore, this study assesses the delirium prevalence rates and sequelae in this age group. Method Based on a Diagnostic and Statistical Manual (DSM)-5, Delirium Observation screening scale (DOS), and Intensive Care Delirium Screening Checklist (ICDSC) construct, in this prospective cohort study, the prevalence rates and sequelae of delirium were determined in 428 patients older than 90 years by simple logistic regressions and corresponding odds ratios (ORs). Results The overall prevalence delirium rate was 45.2%, with a wide range depending upon specialty: intermediate and intensive care services (83.1%), plastic surgery and palliative care (75%), neurology (72%), internal medicine (69%) vs. dermatology (26.5%), and angiology (14.5%). Delirium occurred irrespective of age and gender; however, pre-existent dementia was the strongest delirium predictor (OR 36.05). Delirious patients were less commonly admitted from home (OR 0.47) than from assisted living (OR 2.24), indicating functional impairment. These patients were more severely ill, as indicated by emergency (OR 3.25) vs. elective admission (OR 0.3), requirement for intensive care management (OR 2.12) and ventilation (OR 5.56–8.33). At discharge, one-third did not return home (OR 0.22) and almost half were transferred to assisted living (OR 2.63), or deceased (OR 47.76). Significance of results At age older than 90 years, the prevalence and sequelae of delirium are substantial. In particular, functional impairment and pre-existent dementia predicted delirium and subsequently, the loss of independence and death were imminent.

P2656Real-world Outcomes for STEMI in octogenarians and nonagenarians: A 5-year review from an Irish primary PCI centre

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Kumar ◽  
C E Homer ◽  
A Buckley ◽  
J Kumar ◽  
C O'conner ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Nursing Home Care ◽  
University Hospital ◽  
Very Old ◽  
Level Data ◽  
Poor Outcomes ◽  
One Year ◽  
The One

Abstract Background Progress made by modern healthcare has led to improved life expectancy across the globe. This progress, however, also means that individuals are living with more chronic illnesses and co-morbidities than in previous generations. Due to this aging population, we can expect increasing rates of STEMI in octogenarians and nonagenarians in the future. The challenge of older patients with STEMI is that they are particularly high-risk for complications. At present, very little is known about the outcomes of STEMI in the very old population because they were under-represented in previous studies. Many cardiologists around the world have been hesitant in performing primary percutaneous coronary intervention (PPCI) in octogenarians and nonagenarians due to fear of complications and poor outcomes. Purpose To review the trend of octogenarians and nonagenarians presenting with STEMI and to assess the 30-day and 1-year mortality rates. Methods A single-centre retrospective observational study was conducted. All patients presenting with STEMI between January 2012 and December 2017 were reviewed. Individuals aged 80 years or older were included for the purpose of this analysis. Patient level data was collected by chart review and individuals were identified using the local STEMI database. Standard Bayesian statistics were employed for analysis. Results 1,268 patients presented with STEMI during this period. 172 (13.6%) were 80 years or older. Of this subgroup, 159/172 (92.4%) were true STEMI (figure 1). 124/159 (77.9%) patients were brought to the catheterization lab and 35/159 (22%) were managed medically on the ward.107/159 (67.29%) were treated with PPCI. Patients in the PPCI group had a 30-day mortality rate of 20.6% while those in the medically managed group had a mortality rate of 37.1%; with a trend towards statistical significance (p=0.07). The one-year mortality rate in patients treated with PPCI was 22.4% which was significantly lower than those who received medical management 48.6% (p=0.005). Conclusions This review demonstrates that there is a high mortality rate with STEMI in those aged 80 years or above, however, patients who are treated with PPCI tend to do better and have a significantly lower mortality rate at 1-year. The incidence of STEMI in the very old cohort is likely to continue to rise and this may prove challenging. PPCI remains the most feasible treatment approach towards STEMI and this should not be biased based on age, however, interventionists will need to take into account patient suitability on a case-by case basis. Octogenarians who undergo angiography and PPCI as required have 77.6% survival at 1 year (figure 1) with 92.4% likelihood of going home and don't require long term nursing home care. Acknowledgement/Funding University Hospital Limerick

scholarly journals Challenges, Barriers, Strategies Implementing an Oral Hygiene Program in Assisted Living Facilities Post COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 935-935
Author(s):  
Kim Attanasi ◽  
Victoria Raveis
Keyword(s):  
Oral Health ◽  
Assisted Living ◽  
Oral Hygiene ◽  
Health Program ◽  
Dental Hygiene ◽  
Oral Disease ◽  
Final Decision ◽  
Assisted Living Facilities ◽  
New York University ◽  
Term Care

Abstract [Objective] Almost 8% of the U.S. population, 65 and older, reside in long term care facilities with limited delivery of essential dental care to prevent and manage oral health disease. By 2050, this population is expected to increase by 1.6 billion. Multiple bi-directional connections exist between oral disease and overall health. [Methods] Faculty from the Dental Hygiene Department, New York University College of Dentistry conducted an extensive outreach effort and randomly selected assisted living facilities. Facilities were offered the opportunity to receive at no-cost, a dental hygiene-led, educational, preventive oral health program delivered virtually to their residents as a community service. Incentives discussed. [Results] Twenty-one facilities were contacted, 17 (94.4%) had no oral healthcare program; one had an oral health component. In 13 (72%), the concierge functioned as gatekeeper, unwilling to transfer calls or deliver messages. In five (28%), calls were directed to the activity coordinator. Feasibility concerns and uncertainty about oral health service necessity and resident safety were voiced. Two facilities mentioned familiarity with dental hygiene professionals. Strategic changes in outreach resulted in successfully engaging with facility administrators. Strategies included identifying directors with familiarity or experience with dental hygiene profession, establishing a portfolio and utilizing technology that facilitate incorporating COVID-19 protocols. [Conclusions] Efforts to initiate a dental hygiene-led virtual oral health program encountered gatekeeper challenges. Although facility activity coordinators acknowledged benefits for their population, they were not final decision-makers. It was necessary to implement strategies that facilitated discussing the virtual oral hygiene program directly with the facility’s executive leadership.

scholarly journals Student-Led Fall Prevention Care Management Reduced Fall Risks at Assisted Living Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 238-238
Author(s):  
Hiroko Kiyoshi-Teo ◽  
Claire McKinley-Yoder ◽  
Erin Lemon ◽  
Olivia Ochoa
Keyword(s):  
Older Adults ◽  
Assisted Living ◽  
Fall Prevention ◽  
Fall Risk ◽  
Care Management ◽  
Assisted Living Facilities ◽  
Care Needs ◽  
Term Care ◽  
Fall Risks ◽  
The Impact

Abstract Older adults in residential care settings are four times more likely than those not living in care facilities to experience falls. Yet, fall prevention efforts at long-term care settings are under-resourced, under-regulated, and under-studied. To address this gap, we developed and studied the impact of a specialty clinical, Fall Prevention Care Management (FPCM), for nursing students to decrease older adults’ fall risks. We enrolled assisted living residents that facility liaison identified as being high fall risk (fall rates or fall risk were not tracked at the study sites) and MOCA ≥15, in 2 assisted living facilities in Northwest USA. Participants received weekly, 1-hour, individual, semi-structured, Motivational Interviewing-based care management visits by same students over 6 visits. Changes in fall risks were measured by the CDC STEADI assessment (unsteadiness & worry), Falls Self-Efficacy Scale International-Short (FESI-S), and Falls Behavioral Scale (FAB). Twenty-five residents completed the study. Students addressed the following (multiple responses possible): emotional needs (n=23), improved motivation to prevent falls (n=21), and individualized education/coaching (i.e., exercise, mobility aids) (n=10-17). FESI-S score improved from 16.0 to 14.4 (p=.001; decreased fear. FAB score improved from 2.94 to 3.10 (p=.05; more frequent fall prevention behaviors). Frequency of those who felt steady while standing or walking increased (24% to 40%, p=.07) and those who did not worry about falling increased (20% to 36%, p=.08). FPCM clinical offered valuable opportunity to address unmet care needs of older adults to reduce fall risks.

A Comparison of Wandering Behavior in Nursing Homes and Assisted Living Facilities

2005 ◽  
Vol 19 (2) ◽  
pp. 181-196 ◽  
Author(s):  
Elizabeth R. A. Beattie ◽  
JunAh Song ◽  
Shane LaGore
Keyword(s):  
Nursing Homes ◽  
Assisted Living ◽  
Challenging Behavior ◽  
Long Term Care ◽  
Assisted Living Facilities ◽  
Term Care ◽  
Training Requirements ◽  
Care Facilities ◽  
Staffing And Training

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF). This study compared wandering behavior of residents (N = 108) in 21 long-term care facilities (15 NH, 6 ALF). Staff used the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) to quantify wandering. While there were some differences in demographic variables (i.e., race, motor ability) between NH and ALF participants, no significant differences were found in either RAWS-NH overall or any of the 6 subscale scores. This suggests that the expression of wandering is similar in long-term care residents across all dimensions of the RAWS-NH regardless of facility type. Findings are of concern for those involved in the safe management and protection of residents at risk for wandering, particularly in long-term care facilities with underregulated staffing and training requirements.

482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Hanon ◽  
J Vidal ◽  
E Chaussade ◽  
J P David ◽  
N Boulloche ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Large Scale ◽  
Bleeding Risk ◽  
Geriatric Population ◽  
Very Old ◽  
The Mean ◽  
One Year ◽  
The One

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

Forensic Issues in Long-Term Care Psychiatry

2017 ◽  
Author(s):  
Marshall B. Kapp
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Psychiatric Treatment ◽  
Health Assessment ◽  
The United States ◽  
Assisted Living Facilities ◽  
Nursing Facilities ◽  
Care Providers ◽  
Term Care

This chapter focuses on medical-legal issues that may arise in the context of identifying psychiatric needs and providing psychiatric care for older persons in long-term care institutional settings, specifically residents of nursing facilities and assisted living facilities. Following general observations about the present regulatory climate in the United States governing nursing facilities and assisted living facilities, the chapter explores mental health assessment requirements for residents of those venues. Key legal responsibilities and restrictions regarding the psychiatric treatment of those residents are then discussed, as well as several areas of concern about potential exposure to litigation and liability on the part of long-term care providers. Finally, some of the most salient future legal and policy challenges confronting those who plan, fund, provide, and evaluate long-term care institutional psychiatric services are noted.

P2754Streptococcal infective endocarditis: distribution of species and their prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Chamat ◽  
A Dahl ◽  
C Hassager ◽  
M Arpi ◽  
L Oestergaard ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Device ◽  
Species Level ◽  
University Hospital ◽  
Heart Valve Disease ◽  
Significant Difference ◽  
Streptococcal Species ◽  
Species Groups ◽  
One Year ◽  
The One

Abstract Background Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes. Purpose To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes. Methods From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level. Results We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50). Distribution of streptococcal IE Conclusion Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species. Acknowledgement/Funding Supported by grants from Herlev-Gentofte University Hospital Research Foundation

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