Early Mobilization in Older Adults with Acute Cardiovascular Disease

2020 ◽  
Author(s):  
Michael Goldfarb ◽  
Koorosh Semsar-kazerooni ◽  
José A Morais ◽  
Diana Dima
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Healthcare Facility ◽  
Adverse Event Rate ◽  
Hospital Death ◽  
Critical Care Units ◽  
Cardiac Intensive Care

Abstract Background Early mobilization (EM) is beneficial in critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods Consecutive admissions of adults ≥80 years old to a Cardiac Intensive Care Unit (CICU) prior to and following implementation of a nurse-driven EM program were reviewed. Mobility was measured using the Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 meters). The primary outcome was discharge home. Results There were 412 patients included (N = 234, intervention; N = 178, preintervention). There was no difference in age between groups (overall 86.3 ± 4.8 years old) or sex (overall female N = 215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prehospitalization and in 209 patients (89.3%) on admission. Nearly half of patients (N = 107; 45.7%) improved their LOF by ≥1 during admission. Mobilization occurred during nearly all opportunities (838/850; 98.6%), and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2% adverse event rate]) and transient. Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4 vs. 65.7%, P = 0.047, respectively) and had a lower rate of in-hospital death (6.4 vs. 14.6%, P = 0.006, respectively). There was no difference in mean length of hospital stay, 30-day emergency department visit or hospital re-admission. Conclusion EM is safe in older adults in the CICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Goldfarb ◽  
Koorosh Semsar-kazerooni ◽  
Jose Morais ◽  
Diana Dima
Keyword(s):  
Older Adults ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Hospital Death ◽  
Healthcare Team ◽  
Tertiary Care Centre ◽  
Discharge Home

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

scholarly journals Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 141 (2) ◽  
Author(s):  
Abdulla A. Damluji ◽  
Daniel E. Forman ◽  
Sean van Diepen ◽  
Karen P. Alexander ◽  
Robert L. Page ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Intensive Care ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Assessment Tools ◽  
Age Related ◽  
Geriatric Conditions ◽  
Cardiac Intensive Care

Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.

scholarly journals AVALIAÇÃO DE UM PROTOCOLO DE MOBILIZAÇÃO PRECOCE EM UMA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 3 ◽  
pp. 92
Author(s):  
Cassia Cinara Costa ◽  
Briane Da Silva Leite ◽  
Claudia Kist Fortino ◽  
Vinicius Gonçalves Bastos
Keyword(s):  
Intensive Care ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Pulmonary Complications ◽  
Control Group ◽  
Strength Gain ◽  
Early Ambulation ◽  
Peripheral Muscle ◽  
Terapia Intensiva

RESUMOAvaliar se o protocolo de mobilização precoce contribui para a redução do tempo de internação na Unidade de Terapia Intensiva (UTI) em pacientes submetidos a ventilação mecânica invasiva (VMI), analisar o tempo de assistência à VMI e os efeitos da mobilização precoce na força da musculatura periférica, através de um estudo de coorte concorrente com amostra consecutiva, realizado em 14 pacientes que estiveram internados em uma UTI de um hospital do Vale dos Sinos/RS. Os pacientes foram divididos em Grupo Controle, que realizou a fisioterapia do setor, e Grupo Intervenção, que recebeu o protocolo de mobilização precoce proposto por Morris et al. (2008). Os pacientes do Grupo Intervenção permaneceram um tempo menor no VMI e de internação na UTI, além de terem um ganho de força muscular periférica quando comparado ao Grupo Controle. O protocolo de mobilização precoce pode reduzir a incidência de complicações pulmonares, acelerar a recuperação, diminuir o tempo da VMI e o tempo de internação da UTI.Palavras-chave: Deambulação precoce. Fisioterapia. Reabilitação. Unidades de Terapia Intensiva.ABSTRACTTo evaluate whether the early mobilization protocol contributes to the reduction of the length of hospital stay in the Intensive Care Unit (ICU) in patients undergoing mechanical ventilation (NIV), to analyze the time of NIV care and the effects of early mobilization on the strength of the peripheral musculature. Through a concurrent cohort study with a consecutive sample, performed in 14 patients who were hospitalized in an ICU of a Vale dos Sinos / RS hospital. The patients were divided into a Control Group that performed the physiotherapy of the sector, and Intervention Group that received the protocol of early mobilization proposed by Morris et al. (2008). The Intervention Group patients remained shorter in the NIV and in the ICU, in addition to having a peripheral muscle strength gain when compared to the Control Group. The early mobilization protocol can reduce the incidence of pulmonary complications, accelerate recovery, decrease NIV time and ICU length of stay.Keywords: Early Ambulation. Intensive Care Units. Physical Therapy Specialty. Rehabilitation.

scholarly journals Dementia and patient outcomes after hip surgery in older patients: A retrospective observational study using nationwide administrative data in Japan

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249364
Author(s):  
Noriko Morioka ◽  
Mutsuko Moriwaki ◽  
Jun Tomio ◽  
Kiyohide Fushimi ◽  
Yasuko Ogata
Keyword(s):  
Older Adults ◽  
Adverse Events ◽  
Observational Study ◽  
Hospital Stay ◽  
Nursing Care ◽  
Length Of Hospital Stay ◽  
Hip Surgery ◽  
Hospital Death ◽  
Care Environment ◽  
Hospital Stays

Objective To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. Design and setting Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016—March 2017). Participants A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. Methods Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. Results Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19–39) and 25 (19–37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95–1.33), 0.95 (0.51–1.80), and 1.08 (0.92–1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6–0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. Conclusions Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.

Hydration and Cognitive Function in Older Adults With Cardiovascular Disease

2008 ◽  
Author(s):  
John Gunstad ◽  
Mary B. Spitznagel ◽  
Kelly Stanek ◽  
Faith Luyster ◽  
James Rosneck ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cognitive Function

Myelodysplastic Syndromes and the Risk of Cardiovascular Disease in Older Adults: A SEER-Medicare Analysis

2019 ◽  
Author(s):  
Diego Adrianzen Herrera ◽  
Kith Pradhan ◽  
Rose Snyder ◽  
Siddharth Karanth ◽  
Murali Janakiram ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Myelodysplastic Syndromes

Effects of Cardiovascular Disease and Related Risk Factors on Neurocognition

2019 ◽  
pp. 83-116
Author(s):  
Spencer W. Liebel ◽  
Lawrence H. Sweet
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cognitive Processing ◽  
Health Care Providers ◽  
The United States ◽  
Research Literature ◽  
Neurocognitive Functioning ◽  
Care Providers ◽  
Cardiac Events ◽  
Related Risk

Cardiovascular disease (CVD) affects approximately 44 million American adults older than age 60 years and remains the leading cause of death in the United States, with approximately 610,000 each year. With improved survival from acute cardiac events, older adults are often faced with the prospect of living with CVD, which causes significant psychological, social, and economic hardship. The various disease processes that constitute CVD also exert a deleterious effect on neurocognitive functioning. Although existing knowledge of neurocognitive functioning in CVD and its subtypes is substantial, a review of these findings by CVD type and neurocognitive domain does not exist, despite the potential impact of this information for patients, health care providers, and clinical researchers. This chapter provides a resource for clinicians and researchers on the epidemiology, mechanisms, and neurocognitive effects of CVDs. This chapter includes a discussion of neurocognitive consequences of CVD subtypes by neuropsychological domain and recommendations for assessment. Overall, the CVD subtypes that have the most findings available on specific neurocognitive domains are heart failure, hypertension, and atrial fibrillation. Despite a large discrepancy between the number of available studies across CVD subtypes, existing literature on neurocognitive effects by domain is consistent with the literature on the neurocognitive sequelae of unspecified CVD. Specifically, the research literature suggests that cognitive processing speed, attention, executive functioning, and memory are the domains most frequently affected. Given the prevalence of CVDs, neuropsychological assessment of older adults should include instruments that allow consideration of these potential neurocognitive consequences of CVD.

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