262 Training and Use of the 4AT by a Multi-disciplinary Team to Screen for Delirium in the Frail Adult

Abstract Background Detection of delirium risk may improve outcomes. We assessed the prevalence of patients at risk of delirium assessed by a trained interdisciplinary team. Methods An interdisciplinary team: dietitian, physiotherapist and speech and language therapist was trained to use the 4AT. Community dwelling patients, identified as frail during triage in a hospital emergency department, were assessed including a 4AT, over a 2 month period. Age, gender, Clinical Frailty Score (CFS), 4AT, Modified Barthel index (mBI), polypharmacy (as defined by 5 or more medications) and presence of hearing or visual impairment were entered onto Excel. Performance of the 4AT was at the discretion of the assessor. Results 150 consecutive patients were assessed. The mean(SD) age was 83(5.1). Female to male ratio was 1.2:1. Mean(SD) CFS was 5.6(1.0). 29(19%) patients did not have a 4AT performed. 63(42%) patients had a 4AT of 1-3. 16(11%) patients had a 4AT of 4 or greater. 42(28%) had a 4AT of zero. Patients with a 4AT 4 or greater were older, mean(SD) age 86(4.2)years. Polypharmacy was present in 10(60%) patients with 4AT 4 or greater and 40(38%) with 4AT less than 4. 10(60%) of patients with 4AT 4 or greater had hearing and visual impairment. 16(15%) patients with a 4AT less than 4 had hearing and visual impairment. 10(60%) of patients with 4AT 4 or greater had a reduction in mBI. 33(31%) of patients with a 4AT less than 4 had a reduction in mBI. Conclusion Interdisciplinary teams can screen for delirium risk in ED. Frail patients at risk of delirium are older, have higher rates of polypharmacy, visual and hearing impairment and functional decline. It is possible to evaluate delirium in ED. Further work is needed to explore the relationship between the 4AT and frailty.

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158 Malnutrition Screening by an Interdisciplinary Integrated Care Team is an Essential Component of Comprehensive Geriatric Assessment

Age and Ageing ◽

10.1093/ageing/afz103.92 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Ciara Pender ◽

Karen Sayers ◽

Isweri Pillay ◽

Christina Donnellan ◽

Jennifer Maher ◽

...

Keyword(s):

At Risk ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Screening Tool ◽

Interdisciplinary Team ◽

Female Ratio ◽

Nutritional Interventions ◽

Frail Patients ◽

Patients At Risk ◽

The Mean

Abstract Background Malnutrition plays a key role in the pathogenesis of frailty and nutritional interventions may reduce the incidence. Comprehensive Geriatric Assessment (CGA) is the gold standard in assessment once frailty has been identified. Recent Nutritional Screening Data indicated that only 20% of Irish hospitals screened 76-100% of patients. Twenty-three percent of those aged 60-79 years and 30% of those >80 years were at risk of malnutrition (Russell & Elia, 2011). This emphasises the importance of a validated malnutrition screening tool as an integral component of CGA. This study evaluates the use of the Malnutrition Screening Tool (MST) by an integrated interdisciplinary team aimed at early identification of frail patients at risk of malnutrition. Methods A prospective study of consecutive frail patients, admitted through the emergency department (ED) to an acute hospital over five months was performed. Each patient had an interdisciplinary assessment (IA) performed. The IA included a MST tool. Patients were identified as frail using the Variable Indicative of Placement (VIP). Team members, consisting of a physiotherapist, speech and language therapist and advanced nurse practitioner candidates were trained by the team dietitian to use MST. Age, gender, Clinical Frailty Score (CFS) and MST were recorded in an excel datasheet. A patient scoring ≥2 on the MST indicated risk of malnutrition and the need for Dietetic Assessment (Wu et al. 2012). Results Three-hundred and sixty CGA’s were completed by an integrated interdisciplinary team over five months. The mean age (+/-SD) was 82.4 (+/-7). The male to female ratio was 1:1. The mean CFS (+/-SD) was 5.5 (+/-1.2) (mildly to moderately frail). Ninety-two percent (n=331) were screened using the MST. Thirty-five percent (n=115) were at risk of malnutrition. Conclusion Integrated interdisciplinary team training on the MST, resulted in successful identification of 35% (n=115) of frail patients “At Risk of Malnutrition”. Identification, combined with appropriate dietetic intervention, may reverse frailty in some of these patients.

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Association between obstructive sleep apnea and persistent-postural perceptual dizziness

Journal of Vestibular Research ◽

10.3233/ves-201508 ◽

2021 ◽

pp. 1-6

Author(s):

Anand K. Bery ◽

Jayson Lee Azzi ◽

Andre Le ◽

Naomi S. Spitale ◽

Judith Leech ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Berlin Questionnaire ◽

Future Studies ◽

Obstructive Sleep ◽

Chronic Dizziness ◽

Patients At Risk ◽

The Mean ◽

The Relationship

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS: We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS: Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with OSA, and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p = 0.0006) and had higher BMI (32 versus 26, p = 0.0078), but there was no clear gender bias (56% versus 64% female, p = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS: The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD.

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Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02087-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Javier Jiménez-Candil ◽

Olga Duran ◽

Armando Oterino ◽

Jendri Pérez ◽

Juan Carlos Castro ◽

...

Keyword(s):

At Risk ◽

Secondary Prevention ◽

Beta Blocker ◽

Cycle Length ◽

Close Relationship ◽

Appropriate Therapy ◽

The Mean ◽

Ventricular Tachycardias ◽

The Relationship

Abstract Background ICD patients with episodes of nonsustained ventricular tachycardias (NSVT) are at risk of appropriate therapies. However, the relationship between the cycle length (CL) of such NSVTs and the subsequent incidence of appropriate interventions is unknown. Methods 416 ICD patients with LVEF < 45% were studied. ICD programming was standardized. NSVT was defined as any VT of 5 or more beats at ≥ 150 bpm occurred in the first 6 months after implantation that terminated spontaneously and was not preceded by any appropriate therapy. The mean follow-up was 41 ± 27 months. Results We analyzed 2201 NSVTs (mean CL = 323 ms) that occurred in 250 patients; 111 of such episodes were fast (CL ≤ 300 ms). Secondary prevention (HR = 1.7; p < 0.001), number of NSVT episodes (HR = 1.05; 95% CI 1.04–1.07; p < 0.001) and beta-blocker treatment (HR = 0.7; p = 0.04) were independent predictors of appropriate interventions; however, the mean CL of NSVTs was not (p = 0.6). There was a correlation between the mean CL of NSVTs and the CL of the first monomorphic VT: r = 0.88; p < 0.001. This correlation was especially robust in individuals with > 5 NSVTs (r = 0.97; p < 0.001), with an agreement between both values greater than 95%. Patients with any fast NSVT experienced a higher incidence of VF episodes (26%) compared to those without NVSTs (3%) or with only slow NSVTs (7%); p < 0.001. Conclusions Unlike the burden, the CL of NSVTs is not a predictor of subsequent appropriate interventions. However, there is a close relationship between the CL of NSVTs and that of arrhythmias that will later lead to appropriate therapies.

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Poster #M155 MEDIATION MODELS OF THE RELATIONSHIP BETWEEN CHILDHOOD TRAUMA AND DEPRESSIVENESS IN PATIENTS AT-RISK FOR PSYCHOSIS AND IN HELP-SEEKING CONTROLS

Schizophrenia Research ◽

10.1016/s0920-9964(14)70705-4 ◽

2014 ◽

Vol 153 ◽

pp. S246

Author(s):

Stefanie J. Schmidt ◽

Stephan Ruhrmann ◽

Benno G. Schimmelmann ◽

Joachim Klosterkötter ◽

Frauke Schultze-Lutter

Keyword(s):

At Risk ◽

Childhood Trauma ◽

Help Seeking ◽

Patients At Risk ◽

The Relationship ◽

Mediation Models

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Abstract P014: Lower eGFR and Proteinuria Were Independently Associated With Lower Cognitive Abilities in Community-dwelling Men in Japan: SESSA study

Circulation ◽

10.1161/circ.135.suppl_1.p014 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Akira Fujiyoshi ◽

Takayoshi Ohkubo ◽

Katsuyuki Miura ◽

Akihiko Shiino ◽

Naoko Miyagawa ◽

...

Keyword(s):

Cognitive Function ◽

Cognitive Abilities ◽

Estimated Glomerular Filtration Rate ◽

Subclinical Atherosclerosis ◽

Community Dwelling ◽

Community Based ◽

Lower Egfr ◽

The Mean ◽

The Relationship

Introduction: The relationship between chronic kidney disease (CKD) and cognitive function remains to be determined. Existing studies focused primarily on estimated glomerular filtration rate (eGFR) but not proteinuria in relation to cognitive function. Hypothesis: In a community-based sample, lower eGFR and presence of proteinuria are cross-sectionally independently associated with lower cognition. Methods: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined participants from Shiga, Japan in 2006-08 at baseline. Among 824 male participants in the follow-up exam (2010-12), we restricted our analyses to those who underwent the Cognitive Abilities Screening Instrument (CASI), age ≥65 years-old, free of stroke, with no missing pertinent covariates. We calculated eGFR (creatinine-based) according to the 2012-guideline by the Japanese Society of Nephrology. We then divided the participants into three groups by eGFR of ≥60, 59-40, and <40 (mL/min/1.73m 2 ), and separately divided into three groups according to proteinuria using urine dipstick: (-), (-/+), and ≥(1+). We defined CKD as either eGFR <60 or proteinuria ≥ (-/+). In linear regression with CASI score being a dependent variable, we computed the score adjusted for age, highest education attained, smoking, drinking, body mass index, hypertension, diabetes, and dyslipidemia. Results: We analyzed 541 men. The mean [standard deviation] of age and unadjusted score were 72.6 [4.3] years and 89.7 [6.0]. Prevalence of CKD was 56%. The score was significantly lower in participants with CKD than those without it (P=0.03). eGFR and proteinuria categories were separately and jointly associated with lower CASI score in a graded fashion (Ps for trend <0.05 in all the models tested. Table 1 ). Conclusions: Lower eGFR and higher degree of proteinuria were independently associated with lower cognitive function in the community-based men. CKD even in its early phase may predispose to lower cognitive function.

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Abstract 83: Effect of Dietary Cholesterol and Egg Consumption On Mortality And Cardiovascular Risk in the REGARDS Study

Stroke ◽

10.1161/str.46.suppl_1.83 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

J David Spence ◽

Suzanne Judd ◽

Virginia Howard ◽

Monika Safford ◽

George Howard

Keyword(s):

At Risk ◽

Racial Differences ◽

Cardiovascular Events ◽

Dietary Cholesterol ◽

Total Mortality ◽

Egg Yolk ◽

Community Dwelling ◽

Egg Consumption ◽

Patients At Risk ◽

Regards Study

Background and purpose: It has long been recommended that patients at risk of cardiovascular events limit their intake of dietary cholesterol to <200 mg/day. One large egg yolk contains more than 200mg of cholesterol, and also contains 250mg of phosphatidylcholine, which is converted by intestinal bacterial to trimethylamine. In the face of increasingly widespread belief that consumption of dietary cholesterol and eggs is harmless, we analyzed the effects of these dietary constituents on mortality and cardiovascular outcomes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study population. Methods: A longitudinal cohort study of 30,239 community-dwelling black and white individuals aged 45+ years, recruited between January 2003 and October 2007 from the 48 contiguous states. The study oversampled black participants (44%), and residents of the southeastern “stroke belt” (56%). We analyzed total mortality and atherosclerotic events (ischemic stroke, myocardial infarction and revascularization) after 4.9 (SD 1.7) years of followup. Hazard ratios were computed for egg consumption and cholesterol consumption by quartiles, adjusted for race, age, sex, income, education, region, dyslipidemia, exercise, hypertension, diabetes, smoking, atrial fibrillation and caloric intake. Results: As shown in the table, there was a dose-related increase in all-cause mortality and atherosclerotic events with both cholesterol intake and egg consumption. Conclusions: Recommendations to limit the intake of cholesterol remain good advice for patients at risk of cardiovascular events. As one large egg yolk contains more than the daily recommended intake of cholesterol, egg yolk consumption should also be limited.

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Assessing Older Adults’ Frequency of Going Outside and Physical Performance: NHATS 2017

Innovation in Aging ◽

10.1093/geroni/igaa057.2876 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 793-794

Author(s):

Justine Sefcik ◽

Janeway Granche ◽

Martha Coates ◽

Zachary Hathaway ◽

Rose Ann DiMaria-Ghalili

Keyword(s):

Older Adults ◽

Physical Performance ◽

Logistic Model ◽

Interdisciplinary Teams ◽

Community Dwelling ◽

Outdoor Activity ◽

Mobility Devices ◽

Unit Increase ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Little is known about community-dwelling older adults’ outdoor activity and the relationship between physical function and frequency of going outside. Using the 2017 NHATS (N = 4,465), we looked at self-reported outdoor frequency (Likert scale: every day to once a week or less) and the Short Physical Performance Battery (SPPB; participants completed five different physical activities to measure physical performance; total scores ranged from 0, not attempted, to 12, the best). A logistic model comparing community-dwelling older adults going out most days (18.3%), some days (10.3%), or rarely/never (3.4%) to those going out every day found ORs of 0.85, 0.70, and 0.58 respectively (all p<0.0001) for a one-unit increase in SPPB score. Interdisciplinary teams can use findings to assess disabled community-dwelling older adults’ frequency of going outdoors. Implications for interventions to assist with increasing times leaving the home (e.g. mobility devices, caregiver assistance) will be discussed.

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Predictive Validity of a Postal Questionnaire for Screening Community-dwelling Elderly Individuals at Risk of Functional Decline

Age and Ageing ◽

10.1093/ageing/25.2.159 ◽

1996 ◽

Vol 25 (2) ◽

pp. 159-167 ◽

Cited By ~ 74

Author(s):

RáJEAN HáBERT ◽

GINA BRAVO ◽

NICOL KORNER-BITENSKY ◽

LOUIS VOYER

Keyword(s):

At Risk ◽

Predictive Validity ◽

Functional Decline ◽

Postal Questionnaire ◽

Community Dwelling ◽

Elderly Individuals

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Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0241276 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241276

Author(s):

Dorothy Li Bai ◽

Tsai-Wen Liu ◽

Hsiu-Ling Chou ◽

Yeh-Liang Hsu

Keyword(s):

At Risk ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Temperature Sensitive ◽

Observational Prospective Cohort Study ◽

Cohort Study Design ◽

Pressure Injury ◽

Patients At Risk ◽

The Relationship

Background and purpose Pressure injuries remain a significant health care issue in various settings. The purpose of this study was to examine the relationship between a pressure redistributing foam mattress (PRFM) and the development of pressure injuries. Methods This study employed an observational prospective cohort study design. We enrolled 254 participants from the intensive care unit who were at risk of developing pressure injuries. Participants were exposed to either a nonpressure redistributing foam mattress (NPRFM), which was the standard mattress used at the study site, or a PRFM made of viscoelastic, temperature-sensitive, polyurethane memory foam. The patients’ assignment to either a PRFM or NPRFM was performed upon their admission, before the study eligibility screening. The relationship between the PRFM and the development of pressure injuries was studied using a logistic regression model. Results The overall incidence of pressure injuries was 5.9% (15/254) in our study, with 1.6% (2/127) for participants who used a PRFM and 10.2% (13/127) for those using a NPRFM. After adjusting for potential confounding variables, use of a PRFM was associated with an 88% reduced risk of pressure injury development (OR = 0.12, 95% CI: 0.03, 0.56, P = 0.007). The use of a PRFM also contributed to a postponed occurrence of pressure injuries by 4.2 days on average in comparison with that of a NPRFM (P = 0.041). Conclusions A PRFM is associated with a significantly reduced incidence and postponed occurrence of pressure injuries. It is recommended to use a PRFM for patients at risk of developing pressure injuries.

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