The cumulated ambulation score is superior to the new mobility score and the de Morton Mobility Index in predicting discharge destination of patients admitted to an acute geriatric ward; a 1-year cohort study of 491 patients

Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to investigate (1) the time spent walking during hospitalization by geriatric patients referred to physical and/or occupational therapy and (2) the development in time spent walking during hospitalization. In this observational study, 24-hr accelerometer data (ActivPal) were collected from inclusion to discharge in 124 patients at an acute geriatric ward. The median time spent walking was 7 min per day. During the first quartile of hospitalization, the patients spent 4 (IQR:1;11) min per day walking, increasing to 10 (IQR:1;29) min during the last quartile. Improvement in time spent walking was primarily observed in the group able to perform the Timed Up & Go task at admission. When walking only 7 min per day, patients could be classified as inactive and at risk for functional decline; nonetheless, the physical activity level increased significantly during hospitalization.

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Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study

Drugs & Aging ◽

10.1007/s40266-014-0185-1 ◽

2014 ◽

Vol 31 (8) ◽

pp. 623-630 ◽

Cited By ~ 27

Author(s):

Barbara Caecilia Wimmer ◽

Elsa Dent ◽

Renuka Visvanathan ◽

Michael David Wiese ◽

Kristina Johnell ◽

...

Keyword(s):

Cohort Study ◽

Older People ◽

Hospital Discharge ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Discharge Destination ◽

Medication Regimen ◽

Factors Associated ◽

Medication Regimen Complexity ◽

Regimen Complexity

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108 A Multidisciplinary Team Initiative to End PJ Paralysis Was Successful in Achieving Cultural Change on An Acute Geriatric Ward

Age and Ageing ◽

10.1093/ageing/afab030.69 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

J Butler ◽

T Welford

Keyword(s):

Cultural Change ◽

The Elderly ◽

Recovery Phase ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Service Development ◽

Steady Increase ◽

Geriatric Ward ◽

Additional Equipment ◽

Acute Geriatric Ward

Abstract Introduction Prolonged bedrest amongst the elderly causes deconditioning leading to; increased hospital length of stay, additional social costs and decreased quality of life. An audit on an acute geriatric ward in November 2018, found that over a third of patients medically fit (PMF) to sit out remained in bed all day. Therefore, a service development initiative was undertaken, addressing the misconception that keeping elderly patients in bed is safe, when in fact, unintentional harm results. Method In a root cause analysis, four main reasons for bedrest were identified: risk aversion, unknown function, widespread “bed is safe” culture and lack of equipment. The project tasked getting PMF out of bed each day and was audited daily from November 2018 to present, involving all members of the multi-disciplinary team (MDT) and using a “plan, do, study, act” approach. Results Initially, the project showed an increase in percentage of PMF sitting out each day, but this subsequently decreased with winter pressures. However, for a whole year (February 2019–February 2020) a sustained and significant improvement was achieved (64.3%–89.7%). The pre-COVID19 period (February–March 2020) saw fluctuations in PMF sitting out. Data collection halted during the COVID19 peak, although observationally most patients remained in bed. Auditing resumed from June 2020 (COVID19 recovery phase) which showed a steady increase in PMF out of bed, with recent figures surpassing pre-COVID19 levels (97.8%). Conclusion Cultural change takes time to embed and needs persistent reviewing by a dedicated and engaged MDT. Improvements were made through more accessible doctor’s advice, better MDT education and communication, daily feedback of data and sourcing additional equipment. Disruption to working patterns over the COVID19 period made this unachievable and the project lost impetus. In the COVID19 recovery phase, the specialized MDT reformed and worked successfully to restore the cultural change as evidenced by audited data.

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Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: Retrospective Cohort Study

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2019.04.012 ◽

2019 ◽

Vol 105 (5) ◽

pp. 949-955 ◽

Cited By ~ 12

Author(s):

Corentin Roger ◽

Emmanuel Debuyzer ◽

Massinissa Dehl ◽

Yassine Bulaïd ◽

Adnane Lamrani ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Readmission Rate ◽

Discharge Destination ◽

Factors Associated

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Quality of Life during the First Two Years Post Stroke: The Restore4Stroke Cohort Study

Cerebrovascular Diseases ◽

10.1159/000441197 ◽

2015 ◽

Vol 41 (1-2) ◽

pp. 19-26 ◽

Cited By ~ 31

Author(s):

Maria L. van Mierlo ◽

Caroline M. van Heugten ◽

Marcel W.M. Post ◽

Tibor R.S. Hajós ◽

L. Jaap Kappelle ◽

...

Keyword(s):

Quality Of Life ◽

Life Satisfaction ◽

Cohort Study ◽

Marital Status ◽

Discharge Destination ◽

Confounding Effect ◽

Level Of Education ◽

Post Stroke ◽

Status Level

Background: Little information is available about the course of quality of life (QoL) post stroke and how dependency on activities of daily living (ADL) influences this course. The aim of this study was therefore to describe the course of QoL from 2 months up to 2 years post stroke and to study the influence of ADL dependency in the first week post stroke. Methods: This is a multicenter prospective longitudinal cohort study in which 368 stroke patients were included and data were collected at 1 week, 2 months, 6 months, 12 months and 24 months post stroke. QoL assessment included measures of health-related quality of life (HRQoL) (short stroke-specific Quality of Life Scale), emotional functioning (Hospital Anxiety and Depression Scale), participation (Utrecht Scale for Evaluation of Rehabilitation-Participation), and life satisfaction (2LS). Dependency on ADL was defined as having a Barthel Index score ≤17 four days post stroke. Generalized Estimating Equations analyses were performed to examine the course of the 4 domains of QoL. Furthermore, the possible confounding effect of age, gender, marital status, level of education and discharge destination was examined. Results: Results showed that HRQoL, participation and life satisfaction improved during the first year post stroke, with most changes occurring in the first 6 months. Furthermore, patients dependent in ADL scored consistently lower on all 4 QoL domains and test occasions compared to ADL-independent patients. In both patient groups separately, no changes over time were found in emotional functioning. ADL-independent patients improved in HRQoL (p = 0.002), participation (p < 0.001) and life satisfaction (p = 0.020) between 2 and 6 months and in life satisfaction (p = 0.003) between 6 and 12 months also. ADL-dependent patients improved in HRQoL (p = 0.009) between 2 and 6 months and in participation between 2 and 6 months (p = 0.001) and between 6 and 12 months (p = 0.031). Furthermore, they experienced no changes in life satisfaction. No confounding effect was found after adding age, gender, marital status, level of education and discharge destination. Conclusions: Most improvement in QoL occurred up to 6 months post stroke and showed different patterns for specific domains of QoL and for patients with and without dependency in ADL in the first week post stroke. It is therefore important to differentiate between these different domains of QoL when the long-term perspective is considered. Furthermore, patients dependent in ADL consistently scored lower on all QoL domains and did not reach the level of QoL of patients independent of QoL.

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