scholarly journals Improvement in ADLs during a Nursing Home Stay for Older Adults with Stroke, Joint Replacement or Hip Fracture

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 912-912
Author(s):  
Warona Mathuba ◽  
Brian Downer ◽  
Rachel Deer
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Acute Care ◽  
Joint Replacement ◽  
Patient Characteristics ◽  
The Elderly ◽  
Fee For Service ◽  
Data Set ◽  
Indwelling Catheters ◽  
Poor Outcomes

Abstract Regularly assessing the health and function of older adults who are in the hospital is important for preventing poor outcomes. Such information may also be useful in post-acute care settings, such as skilled nursing facilities (SNFs) to identify older adults who are high risk for poor outcomes. This study had two objectives: Map items from the Acute Care for the Elderly (ACE) Tracker to items from the Minimum Data Set (MDS). (2) Examine the association between ACE Tracker items and improvement in activities of daily living (ADLs) during a SNF stay. We identified Medicare fee-for-service beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n=118,790), joint replacement (n=245,845), or stroke (n=64,153). Items from the ACE Tracker were matched to patients’ first MDS assessment. The first and last MDS assessments were used to calculate a total score for self-performance on seven ADLs. Multivariable logistic regression models were used to identify patient characteristics associated with the odds for improvement in ADL function. Severe ADL limitations at admission and greater hours of physical and occupational therapy were associated with significantly higher odds of ADL improvement. Cognitive impairment, vision limitations, indwelling catheters, and unhealed pressure ulcers were associated with significantly lower odds of ADL improvement. The characteristics associated with improved ADL function were similar between patients with joint replacement, hip fracture, and stroke. Many of the health and functional characteristics routinely measured in hospital settings are also collected in SNFs and are associated with improvement in ADL function.

scholarly journals Hip fractures among the elderly in Kyoto, Japan: a 10-year study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maki Asada ◽  
Motoyuki Horii ◽  
Kazuya Ikoma ◽  
Tsuyoshi Goto ◽  
Naoki Okubo ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Incidence Rate ◽  
Acute Care ◽  
Hip Fractures ◽  
Age Groups ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Age Group ◽  
Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

End-of-Life Orders, Resource Utilization, and Costs Among Injured Older Adults Requiring Emergency Services

2020 ◽  
Author(s):  
Amber L Lin ◽  
Craig Newgard ◽  
Aaron B Caughey ◽  
Susan Malveau ◽  
Abby Dotson ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Resource Utilization ◽  
Emergency Services ◽  
Patient Characteristics ◽  
Vital Statistics ◽  
Fee For Service ◽  
Post Discharge ◽  
Index Event ◽  
Hospice Use

Abstract Background: Portable Orders for Life-Sustaining Treatment (POLST) are increasingly utilized to assist patients approaching the end of life in documenting goals of care. We evaluated the association of POLST, resource utilization, and costs to 1 year among injured older adults requiring emergency services.Methods: This was a retrospective cohort of injured older adults ≥65 years with continuous Medicare fee-for-service coverage transported by emergency medical services (EMS) in 2011 across 4 counties in Oregon. Data sources included EMS, Medicare claims, vital statistics, and state POLST, inpatient and trauma registries. Outcomes included hospital admission, receipt of aggressive medical interventions, costs, and hospice use. We matched patients on patient characteristics and comorbidities to control for bias.Results: We included 2116 patients of which 484 (22.9%) had a POLST form prior to 911 contact. Of POLST patients, 136 (28.1%) had orders for full treatment, 194 (40.1%) for limited interventions, and 154 (31.8%) for comfort measures. There were no significant associations for care during the index event. However, in the year after the index event, patients with care limitations had higher adjusted hospice use (limited interventions OR 1.7 [95% CI: 1.2–2.6]; comfort OR, 2.0 [95% CI: 1.3–3.0]) and lower adjusted post-discharge costs (no POLST, $32,399 [95% CI: 30,041–34,756]; limited interventions, $18,729 [95% CI: 12,913–24,545]; and comfort $15,593 [95% CI: 12,091–19,095]). There were no significant associations for all other outcomes.Conclusions: Care limitations specified in POLST forms among injured older adults transported by EMS are associated with increased use of hospice and decreased costs to 1 year.

scholarly journals ROLE OF SOCIAL DETERMINANTS IN ENROLLMENT AND DISENROLLMENT IN MEDICARE INSURANCE PLANS IN OLDER MEXICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S563-S563
Author(s):  
Amit Kumar ◽  
Maricruz Rivera-Hernandez ◽  
Lin-Na Chou ◽  
Amol Karmarkar ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Mexican Americans ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Fee For Service ◽  
Clinical Factor ◽  
Medical Risk ◽  
Medicare Data ◽  
Dual Eligible

Abstract Objective: The objective of this study is to examine the association between social-medical risk factor with disenrollment from Medicare Fee-for-Service (FFS) and enrollment in a Medicare Advantage (MA) plan in Older Mexican Americans. Methods: The sample included older adults participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly linked with Medicare data. We used logistic regression to estimate odds ratios (OR) for the association of each sociodemographic and clinical factor with insurance plan switching. Results: FFS enrollees were more likely to speak Spanish, less educated, lower income, disability, and be dual eligible compared to MA enrollees. At 2-year follow up, older adults with social support had higher odds of switching from FFS to MA after controlling for all covariates (OR; 1.73, 95% CI: 1.11-2.69). Conclusion: Having social support from family and the community was strongly associated with disenrollment from FFS and transition to an MA plan.

scholarly journals Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931881397 ◽  
Author(s):  
Aunaly Palmer ◽  
Lisa A. Taitsman ◽  
May J. Reed ◽  
Bala G. Nair ◽  
Itay Bentov
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Demographic Data ◽  
Geriatric Medicine ◽  
The Elderly ◽  
Energy Mechanism ◽  
Intraoperative Hypotension ◽  
Short Term Mortality ◽  
The Mean ◽  
Poor Outcomes

Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.

scholarly journals Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery

2013 ◽  
Vol 2 (4) ◽  
pp. 71 ◽  
Author(s):  
John D. FitzGerald ◽  
Haoling Weng ◽  
Nelson F. Soohoo ◽  
Susan L. Ettner
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Acute Care ◽  
Joint Replacement ◽  
Management Practices ◽  
Orthopedic Procedures ◽  
Strong Impact ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Residual Variation

Objective: To examine change in regional variations variation in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy. Methods: Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996–2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis. Results: In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location. Conclusions: NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.

scholarly journals Gaining Insights Into the Estimation of the Circadian Rhythms of Social Activity in Older Adults From Their Telephone Call Activity With Statistical Learning: Observational Study (Preprint)

2020 ◽  
Author(s):  
Timothée Aubourg ◽  
Jacques Demongeot ◽  
Nicolas Vuillerme
Keyword(s):  
Older Adults ◽  
Circadian Rhythms ◽  
Statistical Learning ◽  
Elderly Population ◽  
Social Activity ◽  
The Elderly ◽  
Telephone Call ◽  
Data Set ◽  
Age Related ◽  
The Social

BACKGROUND Understanding the social mechanisms of the circadian rhythms of activity represents a major issue in better managing the mechanisms of age-related diseases occurring over time in the elderly population. The automated analysis of call detail records (CDRs) provided by modern phone technologies can help meet such an objective. At this stage, however, whether and how the circadian rhythms of telephone call activity can be automatically and properly modeled in the elderly population remains to be established. OBJECTIVE Our goal for this study is to address whether and how the circadian rhythms of social activity observed through telephone calls could be automatically modeled in older adults. METHODS We analyzed a 12-month data set of outgoing telephone CDRs of 26 adults older than 65 years of age. We designed a statistical learning modeling approach adapted for exploratory analysis. First, Gaussian mixture models (GMMs) were calculated to automatically model each participant’s circadian rhythm of telephone call activity. Second, k-means clustering was used for grouping participants into distinct groups depending on the characteristics of their personal GMMs. RESULTS The results showed the existence of specific structures of telephone call activity in the daily social activity of older adults. At the individual level, GMMs allowed the identification of personal habits, such as morningness-eveningness for making calls. At the population level, k-means clustering allowed the structuring of these individual habits into specific morningness or eveningness clusters. CONCLUSIONS These findings support the potential of phone technologies and statistical learning approaches to automatically provide personalized and precise information on the social rhythms of telephone call activity of older individuals. Futures studies could integrate such digital insights with other sources of data to complete assessments of the circadian rhythms of activity in elderly populations.

Inclusion of 30-Day Postdischarge Detection Triples the Incidence of Hospital-Onset Methicillin-Resistant Staphylococcus aureus

2012 ◽  
Vol 33 (2) ◽  
pp. 114-121 ◽  
Author(s):  
Taliser R. Avery ◽  
Ken P. Kleinman ◽  
Michael Klompas ◽  
Ann Aschengrau ◽  
Susan S. Huang
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Patient Characteristics ◽  
Hospital Length Of Stay ◽  
Administrative Claims ◽  
Data Set ◽  
Methicillin Resistant ◽  
Increased Risk ◽  
The Impact

Background.Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge.Objective.We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge.Design.Retrospective cohort study.Setting.Twenty-seven acute care hospitals in Orange County, California.Participants.Adult acute care admissions (2002–2007).Methods.Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients.Results.Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P<.0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA.Conclusions.On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.Infect Control Hosp Epidemiol 2012;33(2):114-121

scholarly journals Gaining Insights Into the Estimation of the Circadian Rhythms of Social Activity in Older Adults From Their Telephone Call Activity With Statistical Learning: Observational Study

10.2196/22339 ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. e22339
Author(s):  
Timothée Aubourg ◽  
Jacques Demongeot ◽  
Nicolas Vuillerme
Keyword(s):  
Older Adults ◽  
Circadian Rhythms ◽  
Statistical Learning ◽  
Elderly Population ◽  
Social Activity ◽  
The Elderly ◽  
Telephone Call ◽  
Data Set ◽  
Age Related ◽  
The Social

Background Understanding the social mechanisms of the circadian rhythms of activity represents a major issue in better managing the mechanisms of age-related diseases occurring over time in the elderly population. The automated analysis of call detail records (CDRs) provided by modern phone technologies can help meet such an objective. At this stage, however, whether and how the circadian rhythms of telephone call activity can be automatically and properly modeled in the elderly population remains to be established. Objective Our goal for this study is to address whether and how the circadian rhythms of social activity observed through telephone calls could be automatically modeled in older adults. Methods We analyzed a 12-month data set of outgoing telephone CDRs of 26 adults older than 65 years of age. We designed a statistical learning modeling approach adapted for exploratory analysis. First, Gaussian mixture models (GMMs) were calculated to automatically model each participant’s circadian rhythm of telephone call activity. Second, k-means clustering was used for grouping participants into distinct groups depending on the characteristics of their personal GMMs. Results The results showed the existence of specific structures of telephone call activity in the daily social activity of older adults. At the individual level, GMMs allowed the identification of personal habits, such as morningness-eveningness for making calls. At the population level, k-means clustering allowed the structuring of these individual habits into specific morningness or eveningness clusters. Conclusions These findings support the potential of phone technologies and statistical learning approaches to automatically provide personalized and precise information on the social rhythms of telephone call activity of older individuals. Futures studies could integrate such digital insights with other sources of data to complete assessments of the circadian rhythms of activity in elderly populations.

Sign in / Sign up

Export Citation Format

Share Document