Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls

Background: Despite National Surgical Quality Improvement guidelines to integrate frailty into surgical elder assessments, a quick, accurate, and simple frailty assessment tool suitable for busy clinical settings is still not available. Recently, we have demonstrated that a simple upper-extremity function (UEF) test based on wearable sensors could identify frailty with high agreement with conventional assessments by testing 20-s repetitive elbow flexion and extension. Objective: We examined whether UEF parameters are sensitive for predicting adverse health outcomes in bedbound older adults admitted to hospital due to ground-level fall injuries. Study Design: Frailty was assessed in 101 eligible older adults (age: 79 ± 9 years) admitted to a trauma setting using the UEF test at the time of admission. All participants were followed up for 2 months using phone calls and chart reviews. The measured health outcomes included (1) discharge disposition (favorable: discharge home or rehabilitation; unfavorable: discharge to skilled nursing facility or death), (2) hospital length of stay, (3) 30-day readmission, (4) 60-day readmission, and (5) 30-day prospective falls. Multivariate analyses were used to identify independent predictors of adverse health outcomes based on participants' demographic parameters (i.e., age, gender, and body mass index [BMI]) and UEF index. Results: Based on the UEF frailty status, 53 (52%) of the participants were frail and 48 (48%) were non-frail. Among all adverse health outcomes, age was only a significant predictor of 30-day prospective falls (p = 0.023). On the other hand, the UEF index was a significant predictor of all measured outcomes except hospital length of stay (p < 0.010). Among the UEF parameters, those indicating slowness, weakness, and exhaustion had the highest effect sizes to predict an unfavorable discharge disposition (p < 0.010; effect size = 0.65-0.92). Conclusion: The results of this study suggest that a 20-s UEF test is practical in the trauma setting and could be used as a quick measure for predicting adverse events and outcomes among bedbound patients after discharge. Assessing frailty using UEF may assist in objective triage, treatment, and post-discharge decision-making with regard to geriatric trauma patients.

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The Accuracy of Four Frequently Used Frailty Instruments for the Prediction of Adverse Health Outcomes Among Older Adults at Two Dutch Emergency Departments: Findings of the AmsterGEM Study

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2021.04.027 ◽

2021 ◽

Author(s):

Carmen S. van Dam ◽

Marijke C. Trappenburg ◽

Marieke M. ter Wee ◽

Emiel O. Hoogendijk ◽

Henrica C. de Vet ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Emergency Departments ◽

Adverse Health ◽

Adverse Health Outcomes

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Self-Reported Energy Trajectories Predict Adverse Health Outcomes in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.2880 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 794-795

Author(s):

Briana Sprague ◽

Xiaonan Zhu ◽

Rebecca Ehrenkranz ◽

Qu Tian ◽

Theresa Gmelin ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Mixed Models ◽

Single Item ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Observational Cohort ◽

Outcome Performance ◽

Future Work ◽

Mortality Hazard Ratio

Abstract Declining energy may indicate homeostatic dysregulation and predict adverse health outcomes. We hypothesized that declining energy would predict greater frailty (1-10), greater mortality, and faster mood (CES-D) and cognition (3MS) decline over time. This observational cohort studies included 2,443 older adults (mean age=74.6, 62.5% White, 47.8% men) from the Health ABC Study with up to eight years of data. Energy was assessed using a single-item question about prior month’s energy (baseline mean=6.7, SD=1.7, range=0–10, lower=less energy). We used linear mixed models to create energy change scores (mean=-.07 points/year, SD=.05, range=-0.32-0.21, negative=decreased energy). In regression models adjusting for baseline outcome performance and energy and demographics, declining energy predicted greater frailty (β=-2.72, 95%CI = -3.39,-2.06), greater mortality (hazard ratio=.07, p<.001), and faster CES-D (β=-.93, 95%CI=-1.10,-0.75) but not 3MS decline. Energy changes are easy to assess and predict clinically-relevant outcomes. Future work should consider mechanisms of declining energy on disability-related outcomes. Part of a symposium sponsored by Brain Interest Group.

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Serious Fall Injury History and Adverse Health Outcomes After Initiating Hemodialysis Among Older U.S. Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glx260 ◽

2018 ◽

Vol 73 (9) ◽

pp. 1216-1221 ◽

Cited By ~ 9

Author(s):

C Barrett Bowling ◽

Rasheeda K Hall ◽

Anjali Khakharia ◽

Harold A Franch ◽

Laura C Plantinga

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Skilled Nursing Facility ◽

Prognostic Significance ◽

Dialysis Initiation ◽

First Year ◽

Prognostic Information ◽

Fall Injury ◽

Adverse Health ◽

Adverse Health Outcomes

Abstract Background Although older adults with predialysis chronic kidney disease are at higher risk for falls, the prognostic significance of a serious fall injury prior to dialysis initiation has not been well described in the end-stage renal disease population. Methods We examined the association between a serious fall injury in the year prior to starting hemodialysis and adverse health outcomes in the year following dialysis initiation using a retrospective cohort study of U.S. Medicare beneficiaries ≥ 67 years old who initiated dialysis in 2010–2012. Serious fall injuries were defined using diagnostic codes for falls plus an injury (fracture, joint dislocation, or head injury). Health outcomes, defined as time-to-event variables within the first year of dialysis, included four outcomes: a subsequent serious fall injury, hospital admission, post-acute skilled nursing facility (SNF) utilization, and mortality. Results Among this cohort of 81,653 initiating hemodialysis, 2,958 (3.6%) patients had a serious fall injury in the year prior to hemodialysis initiation. In the first year of dialysis, 7.6% had a subsequent serious fall injury, 67.6% a hospitalization, 30.7% a SNF claim, and 26.1% died. Those with versus without a serious fall injury in the year prior to hemodialysis initiation were at higher risk (hazard ratio, 95% confidence interval) for a subsequent serious fall injury (2.65, 2.41–2.91), hospitalization (1.11, 1.06–1.16), SNF claim (1.40, 1.30–1.50), and death (1.14, 1.06–1.22). Conclusions For older adults initiating dialysis, a history of a serious fall injury may provide prognostic information to support decision making and establish expectations for life after dialysis initiation.

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Underlying Vulnerabilities to the Cytokine Storm and Adverse COVID-19 Outcomes in the Aging Immune System

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa209 ◽

2020 ◽

Cited By ~ 1

Author(s):

Lolita S Nidadavolu ◽

Jeremy D Walston

Keyword(s):

Older Adults ◽

Immune System ◽

Chronic Disease ◽

Health Outcomes ◽

Innate Immune System ◽

Innate Immune ◽

Cytokine Storm ◽

Adverse Health ◽

Disease States ◽

Adverse Health Outcomes

Abstract Older adults are far more vulnerable to adverse health outcomes and mortality after contracting COVID-19. There are likely multiple age-related biological, clinical, and environmental reasons for this increased risk, all of which are exacerbated by underlying age-associated changes to the immune system as well as increased prevalence of chronic disease states in older adults. Innate immune system overactivity, termed the cytokine storm, appears to be critical in the development of the worst consequences of COVID-19 infection. Pathophysiology suggests that viral stimulation of the innate immune system, augmented by inflammatory signals sent from dying cells, ramps up into a poorly controlled outpouring of inflammatory mediators. Other aging-related changes in cells such as senescence as well as higher prevalence of chronic disease states also likely ramp up inflammatory signaling. This in turn drives downstream pathophysiological changes to pulmonary, cardiovascular, skeletal muscle, and brain tissues that drive many of the adverse health outcomes observed in older adults. This article provides an overview of the underlying etiologies of innate immune system activation and adaptive immune system dysregulation in older adults and how they potentiate the consequences of the COVID-19-related cytokine storm, and possible uses of this knowledge to develop better risk assessment and treatment monitoring strategies.

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Self-Reported Cognitive Frailty Predicts Adverse Health Outcomes for Community-Dwelling Older Adults Based on an Analysis of Sex and Age

The journal of nutrition health & aging ◽

10.1007/s12603-019-1217-7 ◽

2019 ◽

Vol 23 (7) ◽

pp. 654-664 ◽

Cited By ~ 3

Author(s):

Mika Okura ◽

M. Ogita ◽

H. Arai

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Community Dwelling ◽

Cognitive Frailty ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Community Dwelling Older Adults

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Poor Social Network, Not Living Alone, Is Associated With Incidence of Adverse Health Outcomes in Older Adults

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2019.02.021 ◽

2019 ◽

Vol 20 (11) ◽

pp. 1438-1443 ◽

Cited By ~ 16

Author(s):

Ryota Sakurai ◽

Hisashi Kawai ◽

Hiroyuki Suzuki ◽

Hunkyung Kim ◽

Yutaka Watanabe ◽

...

Keyword(s):

Older Adults ◽

Social Network ◽

Health Outcomes ◽

Living Alone ◽

Adverse Health ◽

Adverse Health Outcomes

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Decreasing Hospital Length of Stay: Effects on Daily Functioning in Older Adults

Journal of the American Geriatrics Society ◽

10.1111/jgs.14767 ◽

2017 ◽

Vol 65 (6) ◽

pp. 1214-1221 ◽

Cited By ~ 14

Author(s):

Majogé van Vliet ◽

Martijn Huisman ◽

Dorly J. H. Deeg

Keyword(s):

Older Adults ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Daily Functioning

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Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018190 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018190 ◽

Cited By ~ 18

Author(s):

Marcel Émond ◽

Valérie Boucher ◽

Pierre-Hugues Carmichael ◽

Philippe Voyer ◽

Mathieu Pelletier ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Hospital Length ◽

Cognitive Status ◽

Hospital Ward ◽

Hospital Length Of Stay ◽

Multicentre Cohort Study ◽

Multicentre Cohort

ObjectiveWe aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment.DesignThis is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward.SettingThe study took place in four Canadian EDs.Participants338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent.Main outcome(s) and measure(s)The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes.ResultsMean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5–47.9) hours and hospital LOS was 146.6 (75.2–267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient.ConclusionsAn incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.

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