Factors Associated With Older Adults’ In-Hospital Mobility: A Comparison Between Israel and Denmark

Abstract Low levels of in-hospital mobility and excessive bed rest are widely described across the globe as a major risk factor for hospital associated disabilities. Different predictors of in-hospital and post-discharge mobility limitations have been proposed across studies, including age, admission diagnosis, physical performance, cognitive impairment, performance of activities of daily living, and length of stay. However, it is unknown whether similar risk factors across countries are associated with in-hospital mobility given different mobility measurement methods, variations in measurement of predictors and differences in populations studied. In the current study, we investigated the relationship between in-hospital mobility and a set of similar risk factors in functionally independent older adults (65+) hospitalized in acute care settings in Israel (N=206) and Denmark (N=113). In Israel, mobility was measured via ActiGraph and in Denmark by ActivPal for up to seven hospital days. Parallel analysis of covariance (ANCOVA) in each sample showed that community-mobility before hospitalization, mobility performance at admission and length of stay were associated with in-hospital mobility in both countries, whereas age and self-reported health status were associated with mobility only in Denmark. This comparison indicates that despite slightly different measurement approaches, similar risks are attributed to older adults’ low in-hospital mobility and emphasizes the contribution of commonly used pre-hospitalization mobility measures as strong and consistent risk factors. This knowledge can support a better understanding of the need of both standard risk assessments and country-based tailored approaches.

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Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽

10.1161/str.48.suppl_1.wp182 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Urvish K Patel ◽

Priti Poojary ◽

Vishal Jani ◽

Mandip S Dhamoon

Keyword(s):

Risk Factors ◽

Older Adults ◽

Young Adults ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

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Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

The Journals of Gerontology Series A ◽

10.1093/gerona/gly281 ◽

2018 ◽

Vol 74 (10) ◽

pp. 1650-1656 ◽

Cited By ~ 4

Author(s):

Esmee M Reijnierse ◽

Sjors Verlaan ◽

Vivien K Pham ◽

Wen Kwang Lim ◽

Carel G M Meskers ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Muscle Mass ◽

Older Patients ◽

Test Score ◽

Handgrip Strength ◽

Bed Rest ◽

Post Discharge ◽

Male Sex ◽

Prospective Longitudinal

Abstract Background Approximately 10% of older adults are annually admitted to a hospital. Hospitalization is associated with a higher risk of falls and mortality after discharge. This study aimed to identify predictors at admission for falls and mortality 3 months post-discharge in hospitalized older patients. Methods The Evaluation of Muscle parameters in a Prospective cohort of Older patients at clinical Wards Exploring Relations with bed rest and malnutrition (EMPOWER) study is an observational, prospective longitudinal inception cohort of 378 patients aged 70 years and older who were subsequently admitted to a tertiary hospital (the Netherlands). Potential predictors for falls and mortality 3 months post-discharge were tested using univariate and multivariate logistic regression analyses and included the following domains: demographic (age, sex, living independently), lifestyle (alcohol, smoking), nutrition (SNAQ score), muscle mass (absolute, relative), physical function (handgrip strength, Katz ADL score), cognition (six-item cognitive impairment test score), and disease (medications, diseases). Results The mean age was 79.6 years (standard deviation 6.23) and 50% were male. Within 3 months post-discharge, 19% reported a fall and 13% deceased. Univariate predictors for falls were higher age, lower absolute muscle mass and higher six-item cognitive impairment test score. Lower absolute muscle mass independently predicted falls post-discharge (multivariate). Univariate predictors for mortality were higher age, male sex, no current alcohol use, higher SNAQ score, lower absolute and higher relative muscle mass, higher Katz ADL score and higher number of diseases. Male sex, higher SNAQ score, and lower absolute muscle mass independently predicted mortality post-discharge (multivariate). Conclusions In hospitalized older adults, muscle mass should be measured to predict future outcome. Future intervention studies should investigate if increasing muscle mass prevent short-term falls and mortality.

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26 Clogged Feeding Tubes: Why Does It Matter?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.031 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S22-S23

Author(s):

Sarah Zavala ◽

Ashley Wang ◽

Cheryl W Zhang ◽

Jennifer M Larson ◽

Yuk Ming Liu

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Nutritional Support ◽

Total Body Surface Area ◽

Tube Feeding ◽

Feeding Tube ◽

Admission Diagnosis ◽

Burn Patients ◽

Feeding Tubes ◽

Burn Unit

Abstract Introduction Many patients treated on a burn unit require tube feeding as their primary caloric source or as supplemental feeding due to their injuries. Burn patients specifically require higher caloric intake due to the hypermetabolic state of burn injuries. Inadequate nutritional support contributes to longer ICU stays and higher mortality. Clogged feeding tubes reduce nutrition provided due to temporary discontinuation of feeding. The objective of this study was to identify risk factors for the incidence of tube clogging. Methods This was a single-center retrospective chart review of all patients admitted to an American Burn Association-verified Burn Unit between August 2017 and October 2019 who received tube feeds during their admission. Data collected included baseline demographics, clinical outcomes, and details about tube feed formulations, number of clogs, and details leading up to the clog. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test. Results A total of 170 patients were included; admission diagnoses included burn (97), soft tissue infections (29), SJS/TEN (11), and others (33). At least one clogged feeding tube was experienced by 51 patients and some experienced up to seven separate clogs. SJS/TEN patients were less likely to experience a clog (9.2 vs 0%, p = 0.035) and frostbite patients were more likely to experience a clog (0 vs 5.9%, p = 0.026). Burn mechanism did not affect incidence of tube feed clog, but patients with larger total body surface area (TBSA) burned were more likely to have a clog (15.55 vs 25.03%, p = 0.004). It was a median of 12 days until the first clog occurred (IQR 7.8–17.3). Two tube feed formulas demonstrated an increased likelihood of clog: a renal formulation (16.8 vs 33.3%, p = 0.017) and a polymeric concentrated product (5.0 vs 17.6%, p = 0.008). Both products have a high viscosity. Patients who experienced a clog had a longer length of stay (21.5 vs 44.0 days, p = 0.001). Conclusions This study identified several risk factors associated with higher incidence of clogged feeding tube in the burn unit including tube feed formulation and viscosity, admission diagnosis, and larger TBSA in burn patients. This study also confirms that clogged feeding tubes, and the resultant insufficient nutritional support, may contribute to an increased length of stay.

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Malnutrition and related risk factors in older adults from different health-care settings: an enable study

Public Health Nutrition ◽

10.1017/s1368980019002271 ◽

2019 ◽

Vol 23 (3) ◽

pp. 446-456 ◽

Cited By ~ 2

Author(s):

Eva Kiesswetter ◽

Miriam G Colombo ◽

Christa Meisinger ◽

Annette Peters ◽

Barbara Thorand ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Older Age ◽

Dietary Behaviour ◽

Individual Risk ◽

Mobility Limitations ◽

Cross Sectional ◽

Living Situation ◽

Poor Appetite ◽

Individual Risk Factors

AbstractObjective:The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.Design:Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.Setting:Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).Participants:CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.Results:Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.Conclusions:The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.

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Factors associated with homelessness referrals for an acute young adult psychiatric unit

International Journal of Social Psychiatry ◽

10.1177/0020764020970239 ◽

2020 ◽

pp. 002076402097023

Author(s):

Alexander Dymond ◽

Grace Branjerdporn

Keyword(s):

Mental Health ◽

Risk Factors ◽

Young Adult ◽

Length Of Stay ◽

Bipolar Affective Disorder ◽

Psychiatric Ward ◽

Chart Audit ◽

Post Discharge ◽

Acute Presentation ◽

Clinical Risk

Background: Homelessness is correlated with significant mental illness. Homelessness is a key psychosocial issue leading to significant use of hospital resources outside medical intervention. Aim: This study examines the characteristics, post-discharge pathway and length of stay of individuals presenting with homelessness in an acute young adult psychiatric ward. Method: Prospective chart audit was conducted to assess the demographic information, acute presentation, clinical risk and length of stay for homelessness referrals to Social Work. Participants ( N = 88) were aged 18 to 25 years old and admitted to a tertiary level psychiatric ward specifically for this age group. Acute risk presentations of all psychiatric conditions, such as Schizophrenia, Emotionally Unstable Personality Disorder, Bipolar Affective Disorder, Drug Induced Psychosis and Anorexia Nervosa, may be admitted to the unit. Descriptive statistics, one sample t-tests and Pearson’s correlations were completed. Results: No homeless patient was accommodated by local area services due to lack of availability. Change in homelessness status tended to worsen during hospitalisation, with 24% having worse accommodation upon discharge compared to 13% who improved. Length of stay was significantly longer for homeless patients compared to non-homeless patients, but not when excluding the length of time spent attempting to address homeless risk. Homeless patients presenting with an eating disorder acute presentation spent longer time in hospital, and those with psychotic acute presentations had more dynamic risk factors. Length of stay and static risk factors were positively correlated with government mental health community follow-up. Conclusion: Hospitalisation is not an effective intervention for homelessness and the Gold Coast Mental Health units are not resourced or linked to provide accommodation outcomes in a positive or economic manner. Future consideration should be given to health and community resources around homelessness, including health-specific housing interventions and community mental health teams incorporating homelessness risk vulnerability into their ongoing clinical risk mitigation.

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Risk Factors for Adverse Drug Events in Older Adults with Mobility Limitations in the Community Setting

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2006.01034.x ◽

2007 ◽

Vol 55 (1) ◽

pp. 29-34 ◽

Cited By ~ 39

Author(s):

Elizabeth Chrischilles ◽

Linda Rubenstein ◽

Rachel Van Gilder ◽

Margaret Voelker ◽

Kara Wright ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Adverse Drug Events ◽

Community Setting ◽

Mobility Limitations

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Correlation of Pre-Hypertension with Carotid Artery Damage in Middle-Aged and Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207686 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7686

Author(s):

Jinkee Park ◽

Yongseong Na ◽

Yunjung Jang ◽

Song-Young Park ◽

Hyuntae Park

Keyword(s):

Risk Factors ◽

Older Adults ◽

Risk Factor ◽

Carotid Artery ◽

Multinomial Logistic Regression ◽

Intima Media Thickness ◽

Analysis Of Covariance ◽

Cvd Risk ◽

Blood Pressures ◽

Independent Risk Factors

The intima–media thickness (IMT), luminal diameters (LDs), flow velocities (FVs), compliance, and β-stiffness of the carotid artery (CA) are considered as independent risk factors for cardiovascular diseases (CVDs). Pre-hypertension (PHT) is also an independent CVD risk factor. This study investigated the association between CA damage (CAD) and PHT. A total of 544 adults participated; their blood pressures (BPs) and CA characteristics were measured using a mercury-free sphygmomanometer and ultrasound. Analysis of covariance (ANCOVA) was performed to assess the differences in the CA characteristics according to the BPs, multinomial logistic regression to evaluate the risk of CAD associated with PHT. In ANCOVA, the CA characteristics of PHT were significantly different from normotensive. The odds ratios (ORs) of IMTmax, LDmax, LDmin, peak-systolic FV (PFV), end-diastolic FV (EFV), PFV/LDmin, EFV/LDmax, compliance, and β-stiffness of PHT were 4.20, 2.70, 3.52, 2.41, 3.06, 3.55, 3.29, 2.02, and 1.84 times higher than those of the normotensive, respectively, in Model 2. In Model 3 adjusted for age, the ORs of LDmax, LDmin, EFV, PFV/LDmin, and EFV/LDmax of PHT were 2.10, 2.55, 1.96, 2.20, and 2.04 times higher than those of the normotensive, respectively. Therefore, the present study revealed that CAD is closely correlated with pre-hypertensive status in adults.

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Characteristics and Outcomes of Younger Adults with Embolic Stroke of Undetermined Source (ESUS): A Retrospective Study

Stroke Research and Treatment ◽

10.1155/2019/4360787 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Ali M. Al Khathaami ◽

Bayan Al Bdah ◽

Abdulmjeed Alnosair ◽

Abdulkarim Alturki ◽

Rayan Alrebdi ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Retrospective Study ◽

Length Of Stay ◽

Older Patients ◽

Embolic Stroke ◽

Stroke Severity ◽

Median Length ◽

Younger Adults ◽

Significant Difference

Introduction. Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia. Patients and Methods. A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Results. Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; P=0.004), diabetes (35.9% vs. 57.4%; P=0.03), and dyslipidaemia (12.8% vs. 28.7%; P=0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay. Discussion. Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors. Conclusion. This study showed that 26.5% of patients with ESUS were aged ≤50 years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.

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Apolipoprotein E Genotype and Sex Influence Glucose Tolerance in Older Adults: A Cross-Sectional Study

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000444079 ◽

2016 ◽

Vol 6 (1) ◽

pp. 78-89 ◽

Cited By ~ 10

Author(s):

Angela J. Hanson ◽

William A. Banks ◽

Hector Hernandez Saucedo ◽

Suzanne Craft

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Glucose Metabolism ◽

Glucose Tolerance ◽

Fasting Glucose ◽

Analysis Of Covariance ◽

Oral Glucose ◽

Cross Sectional ◽

Glucose Levels

Background: Glucose intolerance and apolipoprotein ε4 allele (E4+) are risk factors for Alzheimer's disease (AD). Insulin sensitizers show promise for treating AD, but are less effective in E4+ individuals. Little is known about how the APOE genotype influences glucose metabolism. Methods: Cross-sectional analysis of 319 older adults who underwent oral glucose tolerance tests; a subset had insulin, amyloid beta (Aβ42), and Mini Mental Status Examination. Glucose and insulin patterns with respect to cognitive diagnosis, E4 status, and sex were examined with analysis of covariance and Pearson correlation. Results: People with cognitive impairment had higher fasting insulin levels. E4 status did not affect fasting glucose values, whereas men had higher fasting glucose levels than women. E4+ men had the lowest and E4+ women had the highest glucose levels, compared to E4- groups; insulin did not differ by sex or E4 group. E4 status and sex moderated correlations between metabolic measures and AD risk factors including age and Aβ. Conclusions: Insulin resistance was associated with cognitive impairment, and sex, E4 status, and glucose values are interrelated in older adults at risk of AD. Understanding glucose metabolism for different APOE and sex groups may help elucidate differences in therapeutic responses.

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Do Patient Risk Factors Impact 90-Day Readmission after Total Ankle Arthroplasty?

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000016 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Samuel Adams ◽

Daniel Cunningham ◽

Vasili Karas ◽

Mark Easley ◽

James DeOrio ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Joint Replacement ◽

Readmission Rate ◽

Patient Characteristics ◽

Post Discharge ◽

Ankle Arthroplasty ◽

Asa Score ◽

Bundled Payments ◽

Icd 10

Category: Ankle,Ankle Arthritis Introduction/Purpose: The Comprehensive Care for Joint Replacement model (CJR) provides bundled payments for in-hospital and 90-day post-discharge care of patients undergoing lower extremity joint replacement including hip, knee, and ankle arthroplasty (THA, TKA, and TAA). Pre-operative risk factors influencing in-hospital and post-discharge costs are, thus, of keen interest. While THA and TKA have been reported to have a 5.3% 90-day readmission rate associated with race, gender, increased BMI, >2 medical comorbidities, increased length of stay, and discharge to inpatient rehab, little is known about factors that influence readmission rates after TAA. The purpose of this study is to identify risk factors associated with 90-day readmission after TAA. Methods: 1,048 patients undergoing TAA (ICD-9 81.56 or ICD-10 0SRF/G) at a single academic institution were prospectively enrolled into an ongoing, IRB-approved longitudinal TAR outcome study between 2007 and 2016. Records were retrospectively reviewed to determine patient, operative, and post-operative characteristics including age, gender, race, risk factors of the Charlson-Deyo comorbidity and Elixhauser indices, post-discharge disposition, BMI, length of stay, and ASA score. Pre-operative Elixhauser and Charlson-Deyo comorbidities were recorded using standardized ICD-9 and ICD-10 codes. Univariate tests of significance (t-tests for continuous inputs and chi-square tests for categorical inputs) were performed to determine the potential relationship between patient characteristics and 90-day readmission using JMP Pro version 13.0.0. The tables display pre-operative cohort-level and outcome-specific patient characteristics as well as the results of significance testing for comorbidities with >1% prevalence. Results: Thirty of 1048 (2.9%) patients were readmitted after TAA during the 90 day post-discharge window. Twenty-two (73%) of the patients were readmitted for surgical wound complication. The majority of the remaining 8 admissions were for medical illnesses not clearly related to the index procedure. Prevalent comorbidities included hypertension, cardiac arrhythmias, depression, obesity, rheumatoid arthritis, diabetes, hypothyroidism, and chronic obstructive pulmonary disease. However, there were no significant differences in patient characteristics between those who were readmitted and those who were not readmitted although patients that were readmitted tended to be slightly older, were less likely to be discharged to SNF or in-hospital rehabilitation, and had higher ASA score and Charlson-Deyo comorbidity index. No individual patient comorbidities were statistically associated with 90-day readmission. Conclusion: The 90-day readmission rate of 2.9% after TAA at our institution is lower than reported rates for THA and TKA nationally (5.3%). Although our patient population had a similar prevalence of risk factors when compared to THA/TKA patients, none of these factors were significantly associated with 90-day readmission. These data suggest that grouping TAA with THA and TKA for CJR may not be advisable. In an emerging era of bundled payments, further work is needed to delineate factors strongly associated with costly readmissions specific to surgical treatment and individualized based on pre-operative patient profile.

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