scholarly journals Does Frailty influence Inhospital Management and Outcomes of COVID-19 in Older Adults in the US?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 974-975
Author(s):  
Soko Setoguchi ◽  
Richard Kennedy ◽  
Nathaniel Kuhrt ◽  
Timothy Bergquist ◽  
Jessica Islam ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Systemic Corticosteroid ◽  
Adverse Outcomes ◽  
Inpatient Mortality ◽  
Icu Admission ◽  
Patient Demographics ◽  
The Us ◽  
Large Representative ◽  
Frailty Score

Abstract Older age has been consistently associated with adverse COVID-19 outcomes. Frailty, a syndrome characterized by declining function across multiple body systems is common in older adults and may increase vulnerability to adverse outcomes among COVID-19 patients. However, the impacts of frailty on COVID-19 management, severity, or outcomes have not been well characterized in a large, representative US population. Using the National COVID Cohort Collaborative, a multi-institutional US repository for COVID-19 research, we calculated the Hospital Frailty Risk Score (HFRS), a validated EHR-based frailty score, among COVID-19 inpatients age ≥ 65. We examined patient demographics and comorbidities, length of stay (LOS), systemic corticosteroid and remdesivir use, ICU admission, and inpatient mortality across subgroups by HFRS score. Among 58,964 inpatients from 53 institutions (51% male, 65% White, 18% Black, 9% Hispanic, mean age 75, mean Charlson comorbidity count 3.0, and median LOS 7 days), 38,692 (66%), 4,180 (7%), 3,531 (6%), 3,525 (6%) and 7,862 (13%) had HFRS scores of 0-1, 2, 3, 4, and >=5 , respectively. Frailty was only moderately correlated with age and comorbidity (□=0.178 and 0.348, respectively, p<0.001). Overall, 34% received systemic corticosteroid and 19% received remdesivir. We observed 4% ICU admissions and 16% inpatient death. Among non-ICU admissions, after adjusting for demographics and comorbidities, frailty (HFRS ≥ 2) was associated with 79% greater systemic corticosteroid use and 22% greater remdesivir use, whereas a higher HRFS score was marginally associated with higher rates of severe COVID disease, inpatient death, or ICU admission.

scholarly journals MP32: Mid-morning huddle: a coordinated team approach to facilitating disposition of older adults

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S54
Author(s):  
N. Kelly ◽  
S. Campbell
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Average Length ◽  
Adverse Outcomes ◽  
Team Approach ◽  
Discharge Disposition ◽  
Consulting Services ◽  
Discharge Rates ◽  
The Impact ◽  
Bounce Back

Background: Older adults in the emergency department (ED) take an increasingly larger portion of resources, have increased length of stay and a higher likelihood of adverse outcomes. In many cases bad planning, multiple vague handovers, and lack of coordinated care exacerbate this problem. With the impending onset of our aging population this is a situation that can be expected to compound in complexity in the years to come. Aim Statement: We describe daily interdisciplinary review of ED patients over the age of 75 years (or otherwise identified as a challenging discharge) to discuss barriers and facilitators to discharge/disposition. We will use data to identify the impact of this particular population to ED flow. Measures & Design: This initiative developed from our participation in the Acute Care of the Elderly (ACE) Collaborative and applies Plan/Do/Study/Act (PDSA) cycles and run reports to compare: length of stay; Identification of Seniors at Risk (ISAR) screening tool; ED census, admission/discharge rates, bounce back rates, consulting services, and interdisciplinary participation. Evaluation/Results: The average daily census of our ED between the months of July-October of 2018 was over 211 patients/day, of which over 12% were patients 75 years and older. We conducted over 70 huddles, reviewing an average of 11 patients per day. The average length of stay for patients at the time of the huddle was 19 hours, significantly higher than the general emergency population. Next day admission and discharge rates were comparable, 44.8% and 43.1% respectively with the additional patients remaining in the ED with no disposition. Internal medicine was consulted on 30% of all huddle patients and 38.4% subsequently admitted. Thirty day bounce back rates for huddle patients discharged home was 29.3%. Around 60% of patients 75 and older were screened with the ISAR and 55.7% of these were positive (2 or more questions). Discussion/Impact: Older patients consume a disproportionate amount of ED resources. Daily interdisciplinary ‘geriatric huddles’ improved communication between members of the ED team and with consulting services. The huddles enhanced awareness of the unique demands that older adults place on the flow of the ED, and identified opportunities to enhance patient flow.

scholarly journals Different aspects of frailty and COVID-19: points to consider in the current pandemic and future ones

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hani Hussien ◽  
Andra Nastasa ◽  
Mugurel Apetrii ◽  
Ionut Nistor ◽  
Mirko Petrovic ◽  
...  
Keyword(s):  
Older Adults ◽  
Poor Response ◽  
Adverse Outcomes ◽  
Exclusion Criterion ◽  
Clinical Frailty Scale ◽  
Time Saving ◽  
Acute Setting ◽  
Icu Admission ◽  
The Impact ◽  
Microbiota Diversity

Abstract Background Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus disease 2019 (COVID-19) management and outcomes. We also try to point out the role of inflamm-ageing, immunosenescence and reduced microbiota diversity in developing a severe form of COVID-19 and a different response to COVID-19 vaccination among older frail adults. Additionally, we attempt to highlight the impact of frailty on intensive care unit (ICU) outcomes, and hence, the rationale behind using frailty as an exclusion criterion for critical care admission. Similarly, the importance of using a time-saving, validated, sensitive, and user-friendly tool for frailty screening in an acute setting as COVID-19 triage. We performed a narrative review. Publications from 1990 to March 2021 were identified by searching the electronic databases MEDLINE, CINAHL and SCOPUS. Based on this search, we have found that in older frail adults, many mechanisms contribute to the severity of COVID-19, particularly cytokine storm; those mechanisms include lower immunological capacity and status of ongoing chronic inflammation and reduced gut microbiota diversity. Higher degrees of frailty were associated with poor outcomes and higher mortality rates during and after ICU admission. Also, the response to COVID-19 vaccination among frail older adults might differ from the general population regarding effectiveness and side effects. Researches also had shown that there are many tools for identifying frailty in an acute setting that could be used in COVID-19 triage, and before ICU admission, the clinical frailty scale (CFS) was the most recommended tool. Conclusion Older frail adults have a pre-existing immunopathological base that puts them at a higher risk of undesired outcomes and mortality due to COVID-19 and poor response to COVID-19 vaccination. Also, their admission in ICU should depend on their degree of frailty rather than their chronological age, which is better to be screened using the CFS.

PREDICTORS FOR ADVERSE OUTCOMES IN DIABETIC KETOACIDOSIS IN A MULTIHOSPITAL HEALTH SYSTEM

2020 ◽  
Vol 26 (3) ◽  
pp. 259-266
Author(s):  
Allen C. Xu ◽  
David T. Broome ◽  
James F. Bena ◽  
M. Cecilia Lansang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Health System ◽  
Diabetic Ketoacidosis ◽  
Disease Duration ◽  
Adverse Outcomes ◽  
White Race ◽  
Icu Admission

Objective: To determine predictors of prolonged length of stay (LOS), 30-day readmission, and 30-day mortality in a multihospital health system. Methods: We performed a retrospective review of 531 adults admitted with diabetic ketoacidosis (DKA) to a multihospital health system between November 2015 and December 2016. Demographic and clinical data were collected. Linear regression was used to calculate odds ratios (ORs) for predictors and their association with prolonged LOS (3.2 days), 30-day readmission, and 30-day mortality. Results: Significant predictors for prolonged LOS included: intensive care unit (ICU) admission (OR, 2.12; 95% confidence interval [CI], 1.38 to 3.27), disease duration (nonlinear) (OR, 1.28; 95% CI, 1.10 to 1.49), non-white race (OR, 1.73; 95% CI, 1.15 to 2.60), age at admission (OR, 1.03; 95% CI, 1.01 to 1.04), and Elixhauser index (EI) (OR, 1.21; 95% CI, 1.13 to 1.29). Shorter time to consult after admission (median [Q1, Q3] of 11.3 [3.9, 20.7] vs. 14.8 [7.4, 37.3] hours, P<.001) was associated with a shorter LOS. Significant 30-day readmission predictors included: Medicare insurance (OR, 2.35; 95% CI, 1.13 to 4.86) and EI (OR, 1.31; 95% CI, 1.21 to 1.41). Endocrine consultation was associated with reduced 30-day readmission (OR, 0.51; 95% CI, 0.28 to 0.92). A predictive model for mortality was not generated because of low event rates. Conclusion: EI, non-white race, disease duration, age, Medicare, and ICU admission were associated with adverse outcomes. Endocrinology consultation was associated with lower 30-day readmission, and earlier consultation resulted in a shorter LOS. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EI = Elixhauser index; HbA1c = hemoglobin A1c; ICD = International Classification of Diseases; ICU = intensive care unit; LOS = length of stay; OR = odds ratio; Q = quartile

scholarly journals Relative Clinical and Cost Burden of Community-Acquired Pneumonia Hospitalizations in Older Adults in the United States—A Cross-Sectional Analysis

Vaccines ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 59 ◽  
Author(s):  
Omotola Olasupo ◽  
Hong Xiao ◽  
Joshua Brown
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Disease Burden ◽  
Preventive Treatment ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Inpatient Mortality ◽  
Cross Sectional ◽  
The Mean ◽  
Sectional Analysis

The relative burden of community-acquired pneumonia (CAP) in older adults (≥65 years old) compared to other serious diseases is important to prioritize preventive treatment. A retrospective analysis was conducted using the 2014 National Readmission Database to evaluate the length of stay, inpatient mortality, 30-day readmissions, and costs of CAP compared to diabetes mellitus (DM), myocardial infarction (MI), and stroke. 275,790 hospitalizations were analyzed and represented a national estimate of 616,300 hospitalizations, including 269,961 for CAP, 71,284 for DM, 126,946 for MI, and 148,109 for stroke. The mean length of stay in CAP was 5.2 days, which was higher than DM (4.6) and MI (4.3) but similar to stroke (5.6). The inpatient mortality risk was lower for DM (RR: 0.37, 95% CI: 0.29–0.46) but higher for MI (RR: 1.67, 95% CI: 1.50–1.85) and stroke (RR: 1.67, 95% CI: 1.51–1.83). The median costs for CAP ($7282) were higher compared to DM ($6217) but lower compared to MI ($14,802) and stroke ($8772). The 30-day readmission rate was 17% in CAP, which was higher compared to MI (15%) and stroke (11.5%) and lower compared to DM (20.3%). In patients with CAP, disease burden is on par with other serious diseases. CAP should be prioritized for prevention in older adults with strategies such as vaccination and smoking cessation.

scholarly journals 1609 Patient Demographics and Outcomes Following Acute Presentation with An Inguinal Hernia; A 15-Year Retrospective Cohort Study from The North of England

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Clyde ◽  
L Li ◽  
R Swan ◽  
R McLean ◽  
L Brown
Keyword(s):  
Inguinal Hernia ◽  
Length Of Stay ◽  
Inpatient Mortality ◽  
Median Length ◽  
Patient Demographics ◽  
Acute Presentation ◽  
The North ◽  
Emergency Presentation ◽  
Increased Risk ◽  
Significant Difference

Abstract Aim Although inguinal hernia repair is one of the most common elective procedures performed, emergency repair carries a far greater risk to patients. This study aimed to report on patient demographics and outcomes following emergency presentation with an inguinal hernia. Method Patients ≥18 years admitted acutely with an inguinal hernia across NHS trusts in the North of England between 2002-2016 were identified. Data were collected on demographics, investigations, and operative interventions. Outcomes including length of stay (LoS) and 30-day mortality were analysed. Results A total of 4698 patients presented over the 15-year study period. The cohort were predominantly male (n = 4133, 88.0%) with median age of 71 years (IQR: 56-81). Whilst no significant difference in age or gender were found across the study period, comorbidities, as measured by Charlson score, increased over time (p &lt; 0.001). In those who underwent operative intervention (n = 2580), median length of stay was 3 days (IQR: 2-5) and 30-day inpatient mortality rate was 2.5%. Advanced age and comorbidity were associated with higher overall 30-day mortality and post-operative 30-day mortality (both p &lt; 0.001). Conclusions This study highlights the frailty of patients presenting as emergency with complications secondary to inguinal hernia. Given the increased risk observed in this patient group, it is vital that perioperative care is optimised, and patients are counselled appropriately.

scholarly journals Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Adverse Outcomes ◽  
Point Prevalence ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
National Programme ◽  
Diagnostic And Statistical Manual ◽  
Multivariable Analyses ◽  
The Uk

Abstract Background Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes. Methods We conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions. Results The point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21). Conclusions Delirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

scholarly journals Factors Associated With Increased Hospital Length of Stay in Peritoneal Dialysis Patients With Peritonitis: A Need for Antimicrobial Stewardship?

2018 ◽  
Vol 55 (1) ◽  
pp. 50-57
Author(s):  
Taylor Morrisette ◽  
Robert B. Canada ◽  
Danielle Padgett ◽  
Joanna Q. Hudson
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Dialysis Patients ◽  
Factors Associated ◽  
Icu Admission ◽  
Patient Demographics

Background: Peritonitis remains a complication of peritoneal dialysis (PD) and contributes to morbidity. Adherence to evidence-based recommendations should resolve peritonitis within 5 days; however, hospital length of stay (LOS) for patients with PD-associated peritonitis (PDAP) varies. Factors contributing to increased LOS and vigilance with antimicrobial stewardship (ASP) in this population are not well described. Methods: This was a system-wide, retrospective cohort of adult patients presenting with PDAP from August 2012 to August 2017. Patients were divided into 2 groups based on LOS: <7 days (reduced LOS) versus ≥7 days (prolonged LOS). Patient demographics, resolution of peritonitis by day 5, intensive care unit (ICU) admission, infectious diseases (ID) consultation, changes in dialysis modality, blood glucose, and pathogen/antimicrobial characteristics were compared. In-hospital mortality and 30-day readmissions were also evaluated. Results: Of the 401 patients screened, 90 were included: 53% women, 88% African American, age 52 ± 2 years (reduced LOS: 46 patients; prolonged LOS: 44 patients). Increased LOS was associated with ICU admission ( P = .014), ID consultation ( P = .015), PD catheter removal ( P = .001), hemodialysis conversion ( P < .001), antifungal therapy ( P = .021), and days with blood glucose >180 mg/dL ( P = .028). Opportunities for antimicrobial de-escalation were identified in 24 (52%) and 22 (50%) patients in the reduced and prolonged LOS groups, respectively; however, de-escalation occurred in only 5 (21%) and 6 (27%) of these patients. There were no differences in mortality or 30-day readmissions. Conclusions: Longer LOS was influenced by acuity of illness and possibly lack of enforced ASP. Improvement of ASP within the PDAP population is necessary.

scholarly journals How Do COVID-19 Inpatients in the Denver Metropolitan Area Measure Up?

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Paula J. Watts ◽  
Trevor Wojcik ◽  
Christina Baker-Sparr ◽  
Jason L. Kelly ◽  
Surit Sharma ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Metropolitan Area ◽  
Metropolitan Areas ◽  
The United States ◽  
Age Group ◽  
Inpatient Mortality ◽  
Area Measure ◽  
Patient Demographics ◽  
Icu Length Of Stay ◽  
Number Of Patients

Background. Inpatient data for COVID-19 (SARS-CoV-2) afflicted inpatients remain sparse. Data are needed to create accurate projections for resource consumption as the pandemic continues. Published reports of inpatient data have come from China, Italy, Singapore, and both the East and West coasts of the United States. Objective. The objective is to present our inpatient experience with COVID-19. Design, Setting, and Participants. This is a retrospective study of 681 patients with laboratory-confirmed COVID-19 from six hospitals in the Denver metropolitan area admitted between February 18 and April 30, 2020. Clinical outcomes of patients discharged or expired by April 30, 2020, were analyzed. Main Outcomes. We compiled patient demographics, length of stay, number of patients transferred to or admitted to the ICU, ICU length of stay, mechanical ventilation requirements, and mortality rates. Results. Of the 890 patients with laboratory-confirmed COVID-19, 681 had discharged and were included in this analysis. We observed 100% survival of the 0–18 age group (n = 2), 97% survival of the 19–30 age group, 95% survival of the 31–64 age group, 79% survival of the 65–84 age group, and 75% survival of the 85 and older age group. Our total inpatient mortality was 13% (91 patients), rising to 29% (59 patients) for those requiring ICU care. Conclusions. Compared to similar reports from other metropolitan areas, our analysis of discharged or expired COVID-19 patients from six major hospitals in the Denver metropolitan area revealed a lower mortality. This includes the subset of patients admitted to the ICU regardless of the need for intubation. A lower ICU length of stay was also observed.

scholarly journals 1365 Analysis of Outcomes Pre- and Post-Physiotherapy Protocol for Centenarian Patients Presenting with Neck of Femur Fractures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shaladi ◽  
I Abdelkarim ◽  
J Kitson
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Inpatient Mortality ◽  
Neck Of Femur ◽  
Mortality And Morbidity ◽  
Patient Demographics ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
Improved Outcomes ◽  
Future Management

Abstract Aim The number of centenarians has quadrupled over the last 2 decades with an increase in the number presenting with proximal femur fractures. Very little is known about mortality and morbidity in this age group. There is a subjective assumption that they are too frail and may not do well with surgery. This audit aims to outline improved outcomes of surgery in centenarian patients with NOF fractures following dedicated modified physiotherapy intervention. Method Data reviewing centenarian NOF outcomes over a two-year period (2015-2016) was compared with outcomes following a dedicated post-operative physiotherapy trust protocol for centenarian NOF patients. 16 patients (15 female, 1 male) from Jan 2017- August 2019 were identified. Data was analysed for patient demographics, surgical details including anaesthesia, post-operative complications, physiotherapy outcomes and mortality. Results 10 patients had dynamic hip screws and 6 patients had hemiarthroplasties. Inpatient mortality was 0% compared to previous audit of 8.3%. The average length of stay had reduced from 23.3 days in previous audit to 18.5 days in current. 82% of patients could transfer with frame in the post-operative period. Conclusions Positive surgical outcomes are demonstrated even in centenarians particularly when given tailored post-operative physiotherapy with reduced length of stay, mortality, and high levels of physiotherapy compliance. Comparisons with younger elderly patients will help guide future management.

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