scholarly journals Hospital-Associated Disability Associated With Delirium Among Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 584-584
Author(s):  
Richard Kennedy ◽  
Hyun Freeman ◽  
Roy Martin ◽  
Caroline Whittington ◽  
John Osborne ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Admission ◽  
Mixed Models ◽  
Cognitive Status ◽  
Common Complication ◽  
Mediation Analyses ◽  
Nursing Delirium Screening Scale ◽  
Hospitalized Older Adults ◽  
Screening Scale

Abstract Hospital-associated disability (HAD), defined as a loss of activities of daily living (ADLs) occurring during hospitalization, is a common complication among older adults. Delirium is also a common complication during hospitalization and is associated with multiple long-term sequelae. We sought to determine the effect of delirium and known covariates on the risk of incident HAD in hospitalized older adults. We examined electronic health record (EHR) data for 35,201 older adults ≥ 65 years of age admitted to the general inpatient (non-ICU) units of UAB Hospital from January 1, 2015 to December 31, 2019. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission, and HAD defined as a decline on the Katz ADL scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations for individuals with multiple admissions. We found that 21.2% of older adults developed HAD during their hospitalization and experienced higher delirium rates as compared to those not developing HAD (25.2% vs. 16.3%). Presence of delirium, medical comorbidity score, baseline cognitive status, and baseline ADL function were associated (all p <0.001) with incident HAD. Mediation analyses also showed that 8% of the effect of comorbidity on incident HAD was due to delirium (p < 0.001). Reducing rates of delirium can be one component of a comprehensive approach to reduce rates of HAD in older adults.

The Association Between Body Mass Index, Frailty and Long-term Clinical Outcomes in Hospitalized Older Adults

2021 ◽  
Author(s):  
Prarthna V. Bhardwaj ◽  
Vida Rastegar ◽  
Rohini Meka ◽  
Khalid Sawalha ◽  
Maura Brennan ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Hospitalized Older Adults

scholarly journals IN-HOSPITAL NURSE CARE CONTINUITY: DOES IT MATTER?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S740-S740
Author(s):  
Orly Tonkikh ◽  
Anna Zisberg ◽  
Efrat Shadmi
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Interpersonal Relationship ◽  
Severity Of Illness ◽  
Cognitive Status ◽  
Cognitive Outcomes ◽  
Full Time ◽  
Hospital Nursing ◽  
Hospitalized Older Adults ◽  
Time Standard

Abstract In-hospital cognitive decline affects up to 40% of hospitalized older adults and is associated with post-hospitalization worsening of medical and functional status. Studies pointed to the substantial role of the interpersonal relationship between older adults with cognitive impairment and the nurses who care for them. We investigated the association between nursing interpersonal continuity and cognitive outcomes in a cohort of 646 older adults aged 70 or older admitted to internal units for non-disabling conditions. Cognitive decline was defined as at least one point decline in the Short Portable Mental Status Questionnaire from at admission to discharge assessments. Nursing interpersonal continuity was measured using continuity of care index (CoC). CoC assesses the extent of different nurses assigned to take care of each patient during the hospital stay (2 shifts per day) and ranges from 0 (none of the nurses is the same) to 0.4 (highest feasible score according to full time standard shift plan and length of stay (LOS)). Multivariate logistic regression showed that achieving 25% of the highest feasible in-hospital nursing CoC was associated with lower odds of cognitive decline (OR=0.67, 95% CI=0.47-0.97), controlling for age, sex, premorbid activities of daily living status, at admission cognitive status, comorbidities, severity of illness and LOS. This study shows that in-hospital nursing continuity is negatively associated with older adults’ cognitive decline, even in low-continuity levels. Future studies should investigate in-hospital continuity patterns and interventions maintaining continuity in larger and more heterogenic samples.

scholarly journals Long-Term Acute Care Hospital Use of Non-Mechanically Ventilated Hospitalized Older Adults

2018 ◽  
Vol 66 (11) ◽  
pp. 2112-2119 ◽  
Author(s):  
Anil N. Makam ◽  
Oanh Kieu Nguyen ◽  
Lei Xuan ◽  
Michael E. Miller ◽  
Ethan A. Halm
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Mechanically Ventilated ◽  
Hospitalized Older Adults ◽  
Hospital Use

scholarly journals Prevention of reducing functional decline in hospitalized older adults

2021 ◽  
pp. 357-362
Author(s):  
O. N. Tkacheva ◽  
N. K. Runikhina ◽  
Yu. V. Kotovskaya ◽  
N. V. Sharashkina
Keyword(s):  
Older Adults ◽  
Daily Activity ◽  
Long Term Care ◽  
Functional Decline ◽  
Older Patient ◽  
Term Care ◽  
Care Protocol ◽  
Hospitalized Older Adults

Preventing decreased physical and functional activity in older adults during hospitalization is a geriatric care protocol for nurses. The frailty and the formation of long-term care dependence is a stronger predictor of mortality and is more important for assessing the prognosis for the quality of life and surviving an older patient than even the presence of specific diseases and maintaining a baseline level of daily activity for the patient. Activities aimed at maintaining physical, cognitive, and social functioning (increasing physical activity, socialization, etc.) will help ensure an increase in the level of physical functioning and older patients' safety.

scholarly journals Does Cognitive Impairment Influence Visual-Somatosensory Integration and Mobility in Older Adults?

2019 ◽  
Vol 75 (3) ◽  
pp. 581-588 ◽  
Author(s):  
Jeannette R Mahoney ◽  
Joe Verghese
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Processes ◽  
Strong Predictor ◽  
Neural Circuitry ◽  
Cognitive Status ◽  
Probability Models ◽  
Future Studies ◽  
Mediation Analyses ◽  
Neuropsychological Status

Abstract Background Deficits in visual-somatosensory (VS) integration are linked to poor mobility. Given that sensory, motor, and cognitive processes rely on overlapping neural circuitry that are compromised in dementia and pre-dementia stages like mild cognitive impairment (MCI), we hypothesize that cognitive impairment will be associated with reduced VS integration, which will, in turn, impact the relation between VS integration and mobility. Methods A total of 345 older adults (mean age 76.88 ± 6.45 years; 52% female) participated in the current study. Cognitive impairment was defined as presence of MCI or dementia. Magnitude of VS integration was quantified using probability models. All participants completed assessments of general cognition (Repeatable Battery for the Assessment of Neuropsychological Status; RBANS), quantitative gait, and balance (unipedal stance). Results The magnitude of VS integration was lower in the 40 individuals with MCI (p = .02) and 12 with dementia (p = .04), relative to the 293 individuals without cognitive impairment. In fully adjusted models, magnitude of VS integration was only a strong predictor of performance on attention-based tests of the RBANS (β = 0.161; p < .01), regardless of cognitive status. Results from mediation analyses, however, reveal that cognitive impairment causes variation in magnitude of VS integration, which in turn causes variation in unipedal stance 95% confidence interval (CI) (−0.265, −0.002) and spatial aspects of gait 95% CI (−0.087, −0.001). Conclusions Cognitive impairment influences multisensory integration, which adversely impacts balance and gait performance in aging. Future studies should aim to uncover the precise neural circuitry involved in multisensory, cognitive, and mobility processes.

scholarly journals Severe Morbidity and Short- and Mid- to Long-term Mortality in Older Adults Hospitalized with Respiratory Syncytial Virus Infection

2020 ◽  
Vol 222 (8) ◽  
pp. 1298-1310 ◽  
Author(s):  
Hung Fu Tseng ◽  
Lina S Sy ◽  
Bradley Ackerson ◽  
Zendi Solano ◽  
Jeff Slezak ◽  
...  
Keyword(s):  
Older Adults ◽  
Respiratory Syncytial Virus ◽  
Clinical Epidemiology ◽  
Ventilatory Support ◽  
The United States ◽  
Rsv Infection ◽  
Hospitalized Older Adults ◽  
Syncytial Virus ◽  
Long Term Mortality

Abstract Background We describe the clinical epidemiology and outcomes among a large cohort of older adults hospitalized with respiratory syncytial virus (RSV) infection in the United States. Methods Hospitalized adults aged ≥60 years who tested positive for RSV between 1 January 2011 and 30 June 2015 were identified from Kaiser Permanente Southern California. Patient-level demographics, comorbidities, clinical presentation, utilization, complications, and mortality were evaluated. Results There were 664 patients hospitalized with RSV (61% female, 64% aged ≥75 years). Baseline chronic diseases were prevalent (all >30%); 66% developed pneumonia, 80% of which were radiographically confirmed. Very severe tachypnea (≥26 breaths/minute) was common (56%); 21% required ventilator support and 18% were admitted to intensive care unit. Mortality during hospitalization was 5.6% overall (4.6% in 60–74 year olds and 6.1% in ≥75 year olds). Cumulative mortality within 1, 3, 6, and 12 months of admission was 8.6%, 12.3%, 17.2%, and 25.8%, respectively. Conclusion RSV infection in hospitalized older adults often manifested as severe, life-threatening lower respiratory tract illness with high rates of pneumonia, requirement for ventilatory support, and short- and long-term mortality. Increased recognition of the substantial RSV disease burden in adults will be important in evaluation and use of urgently needed interventions.

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