Impaired hydration status in acutely admitted older patients: prevalence and impact on mortality

2020 ◽  
Author(s):  
Gianfranco Sanson ◽  
Ilaria Marzinotto ◽  
Daniela De Matteis ◽  
Giuliano Boscutti ◽  
Rocco Barazzoni ◽  
...  
Keyword(s):  
Older People ◽  
Serum Sodium ◽  
Older Patients ◽  
Nutritional Risk ◽  
Early Warning Score ◽  
Hydration Status ◽  
Early Assessment ◽  
Serum Osmolarity ◽  
Short And Long Term

Abstract Background impaired hydration is common in the older people, however studies of its effects on outcome in the acute setting are limited. Objectives to assess (i) the prevalence of impaired hydration, (ii) its relationship with laboratory markers of altered hydration and with (iii) short- and long-term mortality. Design retrospective cohort study. Setting University Hospital-Internal Medicine Department. Subjects a total of 5,113 older patients consecutively acutely admitted from October 2015 to July 2016. Methods according to calculated serum osmolarity at admission hydration status was stratified in: low osmolarity (<275 mmol/L), euhydration (275–295 mmol/L), impending (296–300 mmol/L) and current dehydration (>300 mmol/L). Relationships with serum sodium, potassium, glucose, urea, estimated glomerular filtration rate (eGFR), haematocrit, urea/creatinine ratio (Urea/Cr) and urine specific gravity (USG) were determined. Charlson Comorbidity Index, Modified Early Warning Score, Glasgow Prognostic Score, Norton score and Nutritional Risk Screening-2002 were calculated. Results current and impending dehydration, euhydration and low-osmolarity were detected in 51.7, 17.1, 28.5 and 2.7% of the patients, respectively. Osmolarity correlated with urea (r = 0.846). Associations with serum sodium, creatinine, eGFR and urea/Cr were low but significant, being negligible that with USG and haematocrit. Serum sodium and urea increased in the transition from low- to high-osmolarity (P < 0.001 in all pairwise comparisons). In multivariate modelling current dehydration, functional dependence, clinical instability and high nutritional risk were associated (P < 0.001) with reduced short- and long-term survival. Conclusions impaired hydration is common in older people acutely admitted to medical care and is associated with poor outcome. Early assessment of calculated serum osmolarity is mandatory to target dehydration and hypoosmolar disorders.

scholarly journals Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

2021 ◽  
Author(s):  
Michela Zanetti ◽  
Giovanna Marzaro ◽  
Paolo De Colle ◽  
Gabriele Toigo ◽  
Dario Bianchini ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Older Patients ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Hydration Status ◽  
Predictive Tool ◽  
Serum Osmolarity ◽  
Long Term Mortality

Abstract Background Frailty, demographic and clinical variables linked to incident diseases (e.g., dehydration, inflammation) contribute to poor outcomes in older patients acutely hospitalized. Their predictivity on short-, intermediate- and long-term mortality in a comprehensive model has been scarcely investigated. Aims To test the performance of a predictive tool considering frailty and inflammation as well as age, sex and impaired hydration status on 1-year mortality in acutely admitted older patients. Methods Retrospective observational study including 529 medical patients (age 84.6 ± 7.3 years). At hospital admission, frailty was assessed by the Multidimensional Prognostic Index (MPI). The Glasgow Prognostic Score (GPS) was used to grade systemic inflammation. Serum osmolarity was calculated to assess hydration. Results After adjusting for age, sex, GPS and osmolarity, the severe-risk MPI was a strong predictor for 1-year mortality (OR 4.133; 95% CI 2.273–7.516; p < 0.001). Age > 85 years, male sex, GPS-2 and serum osmolarity > 300 mOsm/L were independent predictors of mortality in the same multivariable model. The MPI alone showed a moderate discrimination power (AUC 0.678; 95% CI 0.628–0.729; p < 0.001) on 1-year mortality, which increased by 12.5% after the addition of the above predictors in the fully adjusted regression model (AUC 0.763; 95% CI 0.719–0.807; p < 0.001). The severe-risk MPI adjusted for the same factors was also an independent predictor of mortality after 60 and 180 days since hospital admission. Discussion Inflammation and impaired hydration are potentially modifiable risk factors for severe outcomes in older acutely hospitalized patients. A model combining GPS, age, gender, and plasma osmolarity improved the accuracy of MPI at admission in predicting long-term mortality.

Exercise therapy is effective at improving short- and long-term mobility, ADL and balance in older patients following hip fracture: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Signe Hulsbæk ◽  
Carsten Juhl ◽  
Alice Røpke ◽  
Thomas Bandholm ◽  
Morten Tange Kristensen
Keyword(s):  
Hip Fracture ◽  
Exercise Therapy ◽  
Lower Limb ◽  
Older Patients ◽  
Meta Analysis ◽  
Term Effect ◽  
Short Term ◽  
Short And Long Term ◽  
Moderate Effect

Abstract Background A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. Methods Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. Results Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. Conclusion We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.

A COMPREHENSIVE GERIATRIC INTERVENTION REDUCES SHORT- AND LONG-TERM MORTALITY IN OLDER PEOPLE WITH HIP FRACTURE

2006 ◽  
Vol 54 (4) ◽  
pp. 711-712 ◽  
Author(s):  
Antonella Barone ◽  
Andrea Giusti ◽  
Monica Pizzonia ◽  
Monica Razzano ◽  
Ernesto Palummeri ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Geriatric Intervention ◽  
Short And Long Term ◽  
Long Term Mortality

A COMPREHENSIVE GERIATRIC INTERVENTION REDUCES SHORT- AND LONG-TERM MORTALITY IN OLDER PEOPLE WITH HIP FRACTURE

2006 ◽  
Vol 54 (7) ◽  
pp. 1145-1147 ◽  
Author(s):  
Antonella Barone ◽  
Andrea Giusti ◽  
Monica Pizzonia ◽  
Monica Razzano ◽  
Ernesto Palummeri ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Geriatric Intervention ◽  
Short And Long Term ◽  
Long Term Mortality

scholarly journals Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults

2019 ◽  
Vol 35 (10) ◽  
pp. 1746-1752 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
John Q Yap ◽  
Qi Qian
Keyword(s):  
Hospital Stay ◽  
Serum Sodium ◽  
Reference Range ◽  
Length Of Hospital Stay ◽  
Sodium Concentration ◽  
Dependent Manner ◽  
Short And Long Term ◽  
Dose Dependent ◽  
Long Term Mortality

Abstract Background This study aimed to evaluate short-term and long-term mortalities in a cohort of unselected hospitalized patients with serum sodium concentration ([Na+]) variations within and outside of reference range. Methods All adult patients admitted to the Mayo Clinic, Rochester, MN, USA from January 2011 to December 2013 (n = 147358) were retrospectively screened. Unique patients admitted during the study period were examined. The main exposure was serum [Na+] variation. Outcome measures were hospital and 1-year all-cause mortalities. Results A total of 60944 patients, mean age 63 ± 17 years, were studied. On admission, 17% (n = 10066) and 1.4% (n = 852) had hypo- and hypernatremia, respectively. During the hospital stay, 11044 and 4128 developed hypo- and hypernatremia, respectively, accounting for 52.3 and 82.9% of the total hypo- and hypernatremic patients. Serum [Na+] variations of ≥6 mEq/L occurred in 40.6% (n = 24 740) of the 60 944 patients and were significantly associated with hospital and 1-year mortalities after adjusting potential confounders (including demographics, comorbidities, estimated glomerular filtration rate, admission serum [Na+], number of [Na+] measurements and length of hospital stay). Adjusted odds ratios for hospital and 1-year mortalities increased with increasing [Na+] variations in a dose-dependent manner, from 1.47 to 5.48 (all 95% confidence intervals &gt;1.0). Moreover, in fully adjusted models, [Na+] variations (≥6 mEq/L) within the reference range (135–145 mEq/L) or borderline hypo- or hypernatremia (133–137 and 143–147 mEq/L, respectively) compared with 138–142 mEq/L were associated with increased hospital and 1-year mortalities. Conclusion In hospitalized adults, [Na+] fluctuation (≥6 mEq/L) irrespective of admission [Na+] and borderline hypo- or hypernatremia are independent predictors of progressively increasing short- and long-term mortality burdens.

Critical illness and intensive care

2017 ◽  
pp. 237-246
Author(s):  
Maria Carlo Duggan ◽  
Kwame Frimpong ◽  
E. Wesley Ely
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Older Patients ◽  
Evidence Based ◽  
Psychological Consequences ◽  
Long Term Outcomes ◽  
Icu Patients ◽  
Younger Patients ◽  
Short And Long Term

Older adults constitute the majority of intensive care unit (ICU) patients, and are increasing in both absolute and relative numbers. Critical care for elderly people should be tailored to their unique physiology, susceptibilities to complications, social circumstances, values, and goals for their care. Knowledge of the short and long-term outcomes of critical illness should guide therapy and goals of care. With a growing number of elderly ICU survivors, the functional, cognitive, and psychological consequences of critical illness and ICU exposure will become a more prominent problem to address. In this chapter, we will discuss morbidity and mortality of elderly ICU patients, provide an evidence-based bundle for the management of pain, agitation, and delirium that has been developed with the vulnerabilities of older patients in mind (though it is also being applied broadly to younger patients as well), and explore the long-term physical, cognitive, and psychological consequences that ICU survivors face.

Telephone communication between practice nurses and older patients with long term conditions – a systematic review

2016 ◽  
Vol 23 (1) ◽  
pp. 142-148 ◽  
Author(s):  
Deborah Raphael ◽  
Susan Waterworth ◽  
Merryn Gott
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Older People ◽  
Older Patients ◽  
Health Indicators ◽  
Long Term Conditions ◽  
Telephone Communication ◽  
Practice Nurses ◽  
Primary Health

Background and aims Long term conditions are a significant health problem faced by older people worldwide. Telephone communication is often used to deliver health care to patients and is an important tool in improving access to care. Previous research has shown that primary health care nurses communicate with patients by telephone, but little is known about the way in which telephone communication can be used to benefit older patients with long term conditions. The aims of this review were to identify the range and scope of telephone use between practice nurses working in primary health care and older people with long term conditions, explore which elements of this communication has been successful, and determine whether older people see telephone communication as useful for their needs. Methods A systematic search of the literature was conducted through CINAHL, Medline, Web of Science and EMBASE between July and August 2015. Included were English language articles containing older adults, primary care nurses and both qualitative and quantitative designs. Results Five studies met the inclusion criteria. All were intervention studies, and none looked at routine telephone communication between nurse and patient. Most studies showed that telephone based interventions were successful in improving pre-determined disease-specific health indicators. Conclusions All telephone communication interventions in this review focused on a specific long term condition, which they aimed to help patients self-manage. While all studies' samples included older patients, they did not consider them separately in relation to the effectiveness of the intervention. What was also lacking was the patient perspective regarding effectiveness in all but one study.

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