Oropharyngeal dysphagia in older patients with hip fracture

2021 ◽  
Author(s):  
Jesús Mateos-Nozal ◽  
Elisabet Sanchez Garcia ◽  
Estela Romero Rodríguez ◽  
Alfonso J Cruz-Jentoft
Keyword(s):  
Hip Fracture ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Oropharyngeal Dysphagia ◽  
Multivariate Logistic Regression Analysis ◽  
University Hospital ◽  
Post Surgery ◽  
Volume Viscosity ◽  
Fracture Management ◽  
A Prospective Study

Abstract Background oropharyngeal dysphagia (OD) and hip fracture are common problems in older patients, both associated with important complications. Objective the aim of this study was to measure the prevalence and identify the main risk factors of dysphagia in older patients with hip fracture. Design a prospective study in an orthogeriatric unit of a university hospital over 10 months. Methods a total of 320 patients (mean age 86.2 years, 73.4% women) were assessed for dysphagia within 72 hours post-surgery using the Volume-Viscosity Swallow Test. Geriatric assessment, hip fracture management and complications were examined to determine their relationship with the presence of OD. Results dysphagia was present in 176 (55%) patients. Multivariate logistic regression analysis showed that the presence of delirium during hospitalization and the inability to perform instrumental activities of daily living before admission were associated with OD. Conclusions the prevalence of OD is high in hip fracture patients. Objective dysphagia assessment should be routinely included as part of the geriatric assessment of such patients.

scholarly journals Correction to: Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture

2019 ◽  
Vol 140 (4) ◽  
pp. 493-493
Author(s):  
Babette C. van der Zwaard ◽  
Charlotte E. Stein ◽  
Janet E. M. Bootsma ◽  
Hendrikus J. A. A. van Geffen ◽  
Conny M. Douw ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients

Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture

2019 ◽  
Vol 140 (4) ◽  
pp. 487-492 ◽  
Author(s):  
Babette C. van der Zwaard ◽  
Charlotte E. Stein ◽  
Janet E. M. Bootsma ◽  
Hendrikus J. A. A. van Geffen ◽  
Conny M. Douw ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients

scholarly journals Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture

2020 ◽  
Vol 17 (20) ◽  
pp. 7467
Author(s):  
María Plaza-Carmona ◽  
Carmen Requena-Hernández ◽  
Sonia Jiménez-Mola
Keyword(s):  
Hip Fracture ◽  
Medical Information ◽  
Multivariate Logistic Regression Analysis ◽  
Arterial Occlusion ◽  
Major Complication ◽  
University Hospital ◽  
Acute Confusional State ◽  
Confusional State ◽  
Functional Level ◽  
Cognitive Frailty

Introduction: Since delirium is a major complication that can arise after a patient with a hip fracture has been hospitalized, it is considered to be one of the most common geriatric conditions. Therefore, its prevention and early detection are essential for reducing both the length of the patient’s stay in the hospital and complications during the hospitalization process. Objective: To identify and analyze the predictors for developing delirium in octogenarians who were admitted to hospital for a hip fracture. Methodology: A prospective study conducted with a sample of 287 patients aged 80 years and older (mean age 87.2 ± 3.2 years; 215 women, 72 men), recruited from the Trauma Unit of the University Hospital of León (Spain). Further, 71.1% of the patients lived in a family member’s home, while the other 28.9% lived in a nursing home. After observing each patient’s interactions with their doctor in a clinical setting, the data for this study were obtained by reviewing the selected patients’ charts. The variables analyzed were sociodemographic information (age, sex, and place of residence), medical information (type of hip break and surgical intervention), cognitive impairment (MMSE score), functional level (Barthel Index score), and clinical information (pharmacological, comorbidities, complications, and the diagnosis and assessment of the severity of delirium in a patient). The univariate and multivariate logistic regression analysis showed a significant relationship between acute confusional state and the following variables: anemia, American Society of Anesthesiologists (ASA) III and IV patients, state of cognitive frailty and functional level, a urinary tract infection, changes in the visual field, renal arterial occlusion, and the type and dosage of drugs administered (this variable was identified in the multivariate model). The inverse relationship between anemia and acute confusional state is surprising. Conclusion: This research shows that clinical observation of acute confusional state is necessary but not sufficient for addressing this condition early and adequately in older adults who have been hospitalized for a hip fracture.

scholarly journals Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 863 ◽  
Author(s):  
Mᵃ Carmen Espinosa-Val ◽  
Alberto Martín-Martínez ◽  
Mercè Graupera ◽  
Olivia Arias ◽  
Amparo Elvira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Respiratory Infections ◽  
Oropharyngeal Dysphagia ◽  
Therapeutic Effects ◽  
Fluid Viscosity ◽  
Volume Viscosity ◽  
Texture Modification ◽  
Prospective Longitudinal

The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

Is treatment of geriatric hip fracture patients cost-covering? Results of a prospective study conducted at a German University Hospital

2017 ◽  
Vol 138 (3) ◽  
pp. 331-337 ◽  
Author(s):  
Rene Aigner ◽  
Juliana Hack ◽  
Daphne Eschbach ◽  
Steffen Ruchholtz ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Prospective Study ◽  
University Hospital ◽  
Geriatric Hip Fracture ◽  
A Prospective Study

In-hospital falls in older patients: A prospective study at the University Hospital of Heraklion, Crete, Greece

2016 ◽  
Vol 35 (1) ◽  
pp. 64-64
Author(s):  
Christos Koutserimpas ◽  
George Samonis ◽  
Emmanouil Vrentzos ◽  
Symeon Panagiotakis ◽  
Kalliopi Alpantaki
Keyword(s):  
Prospective Study ◽  
Older Patients ◽  
University Hospital ◽  
A Prospective Study ◽  
The University

scholarly journals Comprehensive geriatric assessment in older patients with cancer: an external validation of the Multidimensional Prognostic Index in a French prospective cohort study

2019 ◽  
Author(s):  
Chunyun Hu ◽  
Marc Paccalin ◽  
Simon Valero ◽  
Amelie Jamet ◽  
Thomas Brunet ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
External Validation ◽  
Prognostic Index ◽  
Risk Groups ◽  
University Hospital ◽  
Patients With Cancer ◽  
Cox Proportional Hazard Regression ◽  
One Year

Abstract Background: Older patients with cancer require specific and individualized management. The Multidimensional Prognostic Index (MPI) based on the Comprehensive Geriatric Assessment (CGA) has shown a predictive interest in terms of mortality.Methods: From 2015 to 2017, consecutive patients ≥75 years old with cancer in Poitiers University Hospital referred to an oncogeriatric consultation. Patients underwent CGA with MPI that is categorized into three risk groups of mortality at one year.Results: Overall, 433 patients were included (women 42%; mean age 82.8±4.8 years). Most common tumor sites were prostate (23%), skin (17%), colorectum (15%) and breast (12%); 29% patients had a metastatic disease; 231 patients (53%) belonged to "MPI-1" group, 172 (40%) to "MPI-2" group and 30 patients (7%) were classified in "MPI-3" group. One-year mortality rate was 32% (23% in MPI-1, 41% in MPI-2 and 53% in MPI-3, p=0.024). All domains of MPI except cognition and living status were significantly associated with mortality at one-year, as well as tumor sites and metastatic status. Cox proportional hazard regression analysis, adjusted on age, gender, tumor sites and metastatic status, validated MPI as being associated with a higher mortality risk (p<0.0001). The prognostic value of MPI was confirmed by the area under the ROC curve at 0.826 (P <0.0001).Conclusion: Our study confirmed the predictive value of MPI for one-year mortality in older patients with cancer. This practical prognostic tool may help to optimize the management of these vulnerable patients.

8 Geriatric assessment: a prospective study in older patients with AML and high-risk MDS

2006 ◽  
Vol 60 ◽  
pp. S26-S27 ◽  
Author(s):  
B. Deschler ◽  
G. Ihorst ◽  
M. Kuhn ◽  
B. Rüter ◽  
M. Lübbert
Keyword(s):  
High Risk ◽  
Prospective Study ◽  
Geriatric Assessment ◽  
Older Patients ◽  
A Prospective Study

scholarly journals Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

2021 ◽  
Vol 12 ◽  
Author(s):  
Simone Paterni ◽  
Chukwuma Okoye ◽  
Alessia M. Calabrese ◽  
Filippo Niccolai ◽  
Antonio Polini ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Geriatric Assessment ◽  
Mortality Risk ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Glycated Hemoglobin ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Significant Difference

BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or &lt; 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.AimTo investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.MethodsProspective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS &lt; 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c &lt; 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) &gt; 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.ResultsAmong the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p&lt;0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=&lt;0.05 for T3), while no difference was observed among those in T1.ConclusionsFrail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.

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