Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

2018 ◽  
Vol 45 (1-2) ◽  
pp. 121-129 ◽  
Author(s):  
Neus Gual ◽  
Alessandro Morandi ◽  
Laura Monica Pérez ◽  
Laura Brítez ◽  
Pamela Burbano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Functional Recovery ◽  
Older Patients ◽  
Functional Decline ◽  
Main Risk Factor ◽  
Living Situation ◽  
Functional Loss ◽  
Postacute Care ◽  
Tract Infections

Background: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. Methods: This is a prospective cohort study including patients ≥65 years old admitted to an SCU for 12 months. We collected demographics, comprehensive geriatric assessments, and presence of dementia and delirium at admission. Outcomes included discharge to previous living situation, mortality, and functional evolution. Due to the high prevalence of dementia, a subgroup analysis was performed to investigate specific risk factors for delirium and related outcomes. Results: Of 909 patients (mean age [±SD] 85.8 ± 6.7; 60% women, 47.5% with dementia), 352 (38.7%) developed delirium. The main risk factor for delirium was dementia (HR [95% CI] 5.2 [3.5–7.7]); age, functional status, and urinary tract infections were also independently associated with delirium. In dementia patients, only age (HR [95% CI] 1.0 [1.004–1.1]) and being male (HR [95% CI] 1.7 [1.04–2.6]) were associated with delirium. Delirium was associated with greater mortality (10.8 vs. 3.9%; p < 0.001) and greater functional decline in the entire sample (–12.3 vs. –6.4 Barthel index points; p < 0.001). In the dementia subgroup, patients with delirium experienced greater functional loss (p = 0.013) and less functional recovery (p = 0.025). Conclusions: In older patients admitted to postacute care, dementia is the main risk factor for delirium, and delirium carries worse clinical and functional outcomes. In patients with dementia, delirium is also relevant, since it entails a functional loss at admission and lower functional recovery.

Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19556-e19556
Author(s):  
Kitsada Wudhikarn ◽  
Radhika Bansal ◽  
Arushi Khurana ◽  
Matthew Hathcock ◽  
Michael Ruff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Older Patients ◽  
Clinical Course ◽  
International Prognostic Index ◽  
Age Groups ◽  
Central Nervous System Involvement ◽  
Microvascular Disease ◽  
B Cell Lymphoma ◽  
Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

scholarly journals Risk Model for Decline in Activities of Daily Living Among Older Adults Hospitalized With Acute Myocardial Infarction: The SILVER‐AMI Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Alexandra M. Hajduk ◽  
John A. Dodson ◽  
Terrence E. Murphy ◽  
Sui Tsang ◽  
Mary Geda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Older Patients ◽  
Risk Model ◽  
Functional Decline ◽  
Activity Of Daily Living ◽  
Mobility Impairment

Background Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long‐term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient‐centered outcome. Methods and Results We used data from the prospective SILVER‐AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. Conclusions We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.

Regaining a satisfactory quality of life and predicting functional decline after major cancer surgery in older adults: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12051-12051
Author(s):  
Isacco Montroni ◽  
Giampaolo Ugolini ◽  
Nicole Saur ◽  
Antonino Spinelli ◽  
Siri Rostoft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Functional Decline ◽  
Geriatric Oncology ◽  
Cancer Surgery ◽  
Before And After ◽  
After Cancer

12051 Background: Older cancer patients value quality of life (QoL) and functional outcomes as much as survival but surgical studies lack specific data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ QoL and functional recovery (FR) after cancer surgery and to assess predictors of FR Methods: GOSAFE prospectively collected functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes were recorded (30, 90, and 180 days post-operatively) with QoL (EQ-5D-3L) and FR (Activities of Daily Living (ADL), Timed Up and Go (TUG) and MiniCog), 26 centers enrolled patients from February 2017 to April 2019. Results: 942 patients underwent a major cancer resection. Median age was 78 (range 70-95); 52.2% males, ASA III-IV 49%. 934 (99%) lived at home, 51% lived alone, and 87% were able to go out. Patients dependent (ADL < 5) were 8%. Frailty was detected by means of G8 ≤14 in 68.8% and fTRST ≥2 in 37% of patients. Major comorbidities (CCI > 6) were reported in 36% and 21% had cognitive impairment according to MiniCog (2.2% self-reported). 25% had > 3 kg weight loss, 27% were hospitalized in the last 90 days, 54% had ≥3 medications (6% none). Postoperative overall morbidity was 39.1% (30 day) and 22.5% (90 day), but Clavien-Dindo III-IV complications were only 13.4% and 6.9% respectively. 30/90/180-day mortality was 3.6/6/8.9% (10/30/33% in patients with severe functional disability). At 3 months after surgery, QoL was stable/improved (mean EQ-5D index 0.78 was equivalent before vs. after surgery, while the EQ-5D VAS score > 60 raised from 74.3% at baseline to 80.2%, p < 0.01). 76.6% experienced postoperative FR/stability. Logistic regression analysis showed that ASA 3-4, CCI≥7 and CD III-IV complications are significantly associated with functional decline while a G8 > 14 has a positive association with functional recovery. Age is not associated with functional outcomes. Conclusions: The largest prospective study on older patients undergoing structured frailty assessment before and after major elective cancer surgery has shown that QoL remains stable/improves after cancer surgery. The majority of patients return to independence and G8 can predict functional recovery. Older patients with multiple comorbidities, high ASA score or postoperative severe complications are likely to functionally deteriorate after oncologic surgery Clinical trial information: NCT03299270 .

Risk factors for sporadic Shiga toxin-producingEscherichia coliO157 and non-O157 illness in The Netherlands, 2008–2012, using periodically surveyed controls

2014 ◽  
Vol 143 (7) ◽  
pp. 1360-1367 ◽  
Author(s):  
I. H. M. FRIESEMA ◽  
M. SCHOTSBORG ◽  
M. E. O. C. HECK ◽  
W. VAN PELT
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
The Netherlands ◽  
Shiga Toxin ◽  
Age Groups ◽  
Meat Products ◽  
Farm Animals ◽  
Severe Illness ◽  
Main Risk Factor ◽  
Using Data

SUMMARYShiga toxin-producingEscherichia coli(STEC) infections have been associated with severe illness. Ruminants are seen as the main reservoir and the major transmission route is considered to be foodborne. In The Netherlands, a case-control study was conducted, using data collected during 2008–2012. Patients were interviewed and controls completed a self-administered questionnaire. Patients travelling abroad were excluded from the analyses. STEC O157 and non-O157 were examined separately and differentiated into two age groups (<10 years, ⩾10 years). We included 130 O157 cases, 78 non-O157 cases and 1563 controls. In both age groups of O157 patients, raw spreadable sausage was the main risk factor for infection. For STEC non-O157 cases aged <10 years, contact with farm animals was the main risk factor and in non-O157 cases aged ⩾10 years, consumption of beef was the main risk factor. During 2008–2012, risk factors for STEC infections in the Dutch population differed between age groups and serogroup categories, and were related to eating meat and contact with farm animals. Advising the public about the risks of consuming raw or undercooked meat (products) and hygiene habits in case of contact with farm animals, could help in the prevention of STEC infections.

scholarly journals THE RESULTS OF PREVENTIVE MEDICAL EXAMINATION FOR ADULTS IN SHPAKOVSKY DISTRICT OF STAVROPOL REGION IN 2015–2017

2018 ◽  
pp. 16-18
Author(s):  
N.E. Afanasev ◽  
A.K. Shishmanidi ◽  
I.V. Koshel
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Medical Examination ◽  
Endocrine Disorders ◽  
Main Risk Factor ◽  
Genitourinary System ◽  
Stavropol Region ◽  
Unbalanced Diet

The article presents the results analysis of preventive medical examination for adults in the Shpakovsky region of Stavropol region for 2015–2017. In the disease structure cardiovascular diseases ranks first, endocrine disorders has the second highest rate of incidence, genitourinary system diseases ranked third. The main risk factor for the chronic non-communicable diseases is unbalanced diet (35,74 %). Low physical activity ranks second accroding to the results of questionnaire (31,23 %) and high blood pressure ranked third (24,45 %). Frequency rate of chronic non-comminicable risk factors detection had been decreased during the years.

scholarly journals Gender Differences in Risk Factors for Stice’s Bulimia in a Non-Clinical Sample

2015 ◽  
Vol 18 ◽  
Author(s):  
Pablo Ruisoto ◽  
Raúl Cacho ◽  
José J. López-Goñi ◽  
Eulogio Real Deus ◽  
Silvia Vaca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Eating Disorders ◽  
Risk Factor ◽  
Body Dissatisfaction ◽  
Dietary Restraint ◽  
Social Pressure ◽  
Equation Modeling ◽  
Main Risk Factor ◽  
Increased Risk

AbstractSome females are at an increased risk of developing bulimia. However, etiological factors and their interplay remain controversial. The present study analyzed Sticefe Model for eating disorders in a non-clinical population by examining gender differences with respect to the following risk factors: body mass index (BMI), body dissatisfaction, perceived social pressure to be thin, body-thin internalization, and dieting behavior. A sample of 162 American college students (64 males and 91 females) was surveyed, and validated scales were used. The Sticey model was tested using Structural Equation Modeling. Our results supported Stice r Dual Pathway Model of bulimic pathology for females but not for males. Females reported significantly higher body dissatisfaction, perceived pressure to be thin and weight-loss oriented behaviors than males (p < .05), but no gender differences were found in their degree of body thin internalization (p > .05), a key predictor of body dissatisfaction (r = .33; p < .01). Participants with higher BMI reported greater social pressure to be thin than those with lower BMI (p < .05). However, females engaged in dietary restraint, the main risk factor for eating disorders, regardless of their BMI (p > .05) although their BMI was significantly lower than males (d = 0,51). The results of this study fail to support the role of BMI as a predictor of dietary restraint in females, the main risk factor of eating disorders. Males may abstain from dietary restraint to gain muscular volume and in turn increase their BMI. Implications are discussed.

scholarly journals Acute Coronary Syndrome in the Young - Risk Factors and Angiographic Pattern

1970 ◽  
Vol 2 (2) ◽  
pp. 175-178 ◽  
Author(s):  
AFMS Haque ◽  
AR Siddiqui ◽  
SMM Rahman ◽  
SA Iqbal ◽  
NN Fatema ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Older Patients ◽  
Young Patients ◽  
Military Hospital ◽  
Coronary Risk Factors ◽  
Coronary Risk ◽  
Common Risk Factor ◽  
Coronary Syndrome

Background: Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. There is documented evidence that South Asian people develop CAD at a higher rate and also at an early age. If the affected individual is 40 yrs old or below, the tragic consequences are catastrophic. Methods: It was a retrospective observational study to find out the pattern of acute coronary syndrome in the young (40 years old or less) in a military hospital (CMH Dhaka) from July 2007 to July 2008 and to analyze the risk factors and the angiographic characteristics of coronary vessels. Consecutive 64 young patients including both male and female admitted into this hospital were the study subjects. Out of these patients 53 were males and 11 were females. Among these patients coronary risk factors and angiographic pattern were studied. 64 older patients with Acute coronary syndrome (age more than 40 years) were also studied. Results: Out of 64 young patients 15.6% patients presented to this hospital as UA, 9.37% presented as Non-Q MI, 28.12% Acute Anterior MI, 14.06% Acute Anteroseptal MI, 26.56% Acute Inferior MI, 6.25% Acute Infero-posterior MI. Smoking was the most common risk factor among these young patients. 64.06% patients were smoker. Dyslipidaemia was present among 50% patients, 37.55% were hypertensive, 15.62% were diabetic, and 15.62% were obese. SVCAD was the most common lesion and it was 53.12%. 26.56% patients had DVCAD and TVCAD was present among 20.31% patients. In the older group (more than 40 years) most common risk factor was dyslipidaemia (71.88%) and smoking was present among 48.43% patients. Conclusion: Young patients have a different risk factor profile in comparison with older patients. Smoking is a strong and quite common coronary risk factor in the young ACS patients who are 40 years or less. Risk factor identification and control is very crucial in the primary and secondary prevention in young patients with CAD. Keywords: Acute coronary syndrome; Risk factors; Coronary Angiography DOI: 10.3329/cardio.v2i2.6635Cardiovasc. j. 2010; 2(2) : 175-178

scholarly journals Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

CJEM ◽  
2012 ◽  
Vol 14 (05) ◽  
pp. 295-305 ◽  
Author(s):  
Lyne Filiatrault ◽  
Rachel M. McKay ◽  
David M. Patrick ◽  
Diane L. Roscoe ◽  
Grahame Quan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Antibiotic Resistance ◽  
Risk Factor ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Adult Females ◽  
Tract Infections

ABSTRACTIntroduction:We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.Methods:We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.Results:Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases.Escherichia coliaccounted for 82.3% of all UTIs, whereasStaphylococcus saprophyticusaccounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16–9.62) and TMP-SMX (OR 4.02, 95% CI 1.48–10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.Conclusions:E. coliwas the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.

scholarly journals Predictive Clinical Rule for Readmissions in OPAT. Improving in Security

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S335-S335 ◽  
Author(s):  
Itsaso Bengoetxea ◽  
Miren J Onaindia ◽  
Antonio Apezetxea ◽  
Montserrat Gomez ◽  
Muskilda Goyeneche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Area Under The Curve ◽  
Time Factors ◽  
Venous Access ◽  
Potential Risk Factors ◽  
L Value ◽  
Clinical Tools ◽  
Tract Infections ◽  
At Home

Abstract Background Outpatient Parenteral Antibiotic Therapy (OPAT) is a safe, effective and beneficial practice but studies report 10–20% of readmissions rate. The risk factors for readmissions in OPAT have been investigated, although there are no clinical tools that allow us to predict these situations. The main goal of this study is to develop and validate a predictive model for readmission in OPAT patients. Methods Prospective study was conducted during 1 year (10/2012–09/2013), 1488 patients with OPAT were recruited at 8 units of Hospital at Home in Spain. Potential risk factors related to patient demographics, lead-time factors, clinical and microbiologic features were collected. We developed the prediction model in a derivation sample and after that, we validated this model in the validation sample. Sensitivity, specificity and area under the curve were obtained and the calibration capacity of the models were evaluated using the Hosmer-Lemeshow test (H-L). Results The mean age of patients was 63 years (range 11–102), 58.74% men and most common diagnoses were urinary tract infections (23%). Our readmission rate during OPAT episode at home was 8.67% and the 30-days readmissions were 12.29%. The 72% of the readmissions during OPAT episode was related to the infectious pathology and 27.90% to the the patient’s comorbidity. The leading indicators for readmission were: gender, age, presence of caregivers, risk factor for infection, Charlsonand Barthel Index, microorganisme number, presence of multirresistent or micotic infection, venous access, antibiotic type and creatinine, proteine and leucocyte level at admissions. Finally, those factors included in the model were: antibiotic type (OR 3.93; IC 95% 1.90–8.11; P = 0.0002), presence of infection risk factor (OR 2.53; IC 95% 1.47–4.38; P = 0.001) and leucocytosis at admission (OR 2.21; IC 95% 1.32–3.71; P = 0.003). The AUC for the model was 0.72 (IC 95% 0.66–0.78) and the H-L value was 0.23. After the validation the AUC was 0.71 (IC 95% 0.64–0.78) and H-L value 0.9. Conclusion Patients at high risk of readmission during OPAT may be identified using predictive rules. This will allow us to implement measures that reduce the rate of readmissions and contribute to increase the safety of this therapy. Disclosures All authors: No reported disclosures.

scholarly journals How Can Diet Influence the Risk of Stroke?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Fernanda Medeiros ◽  
Marcela de Abreu Casanova ◽  
Julio Cesar Fraulob ◽  
Michelle Trindade
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Stroke Risk ◽  
Cerebrovascular Diseases ◽  
Dietary Interventions ◽  
Main Risk Factor ◽  
The World ◽  
Polyunsaturated Fats ◽  
High Glycemic Index

Cerebrovascular diseases are the second cause of mortality in the world, and hypertension is considered a main risk factor for occurrence of stroke. The mechanisms responsible for the increased stroke risk remain unclear. However, dietary interventions have been applied in the management and treatment of their risk factors, which include increased blood pressure levels, obesity, diabetes, and dyslipidemia. Further studies should be conducted to assess the effects of carotenoids, flavonoids, n-3 polyunsaturated fats, and lower salt and high glycemic index intake in risk of stroke.

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