scholarly journals Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Celine Van de Vyver ◽  
Anja Velghe ◽  
Hilde Baeyens ◽  
Jean-Pierre Baeyens ◽  
Julien Dekoninck ◽  
...  
Keyword(s):  
Palliative Care ◽  
Prognostic Factor ◽  
Prospective Study ◽  
Gait Speed ◽  
Older Patients ◽  
Geriatric Ward ◽  
Patients At Risk ◽  
Acute Geriatric Ward ◽  
One Year ◽  
Usual Gait Speed

Abstract Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward.

scholarly journals Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study

2021 ◽  
pp. bmjspcare-2021-003042
Author(s):  
Ruth Piers ◽  
Isabelle De Brauwer ◽  
Hilde Baeyens ◽  
Anja Velghe ◽  
Lineke Hens ◽  
...  
Keyword(s):  
Palliative Care ◽  
Multicentre Study ◽  
Older Patients ◽  
Area Under The Curve ◽  
Prognostic Accuracy ◽  
Prospective Multicentre Study ◽  
Hospitalised Patients ◽  
Patients At Risk ◽  
One Year ◽  
Sensitivity Specificity

BackgroundAn increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population.AimTo validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients.DesignProspective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed.Setting/participantsPatients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals.ResultsIn total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs.ConclusionsSPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

scholarly journals Development of quantitative frailty and mortality prediction models on older patients as a palliative care needs assessment tool

2021 ◽  
Author(s):  
Vicent Blanes-Selva ◽  
Ascensión Doñate-Martínez ◽  
Gordon Linklater ◽  
Juan M. García-Gómez
Keyword(s):  
Palliative Care ◽  
Needs Assessment ◽  
Survival Time ◽  
Older Patients ◽  
Prediction Models ◽  
Frailty Index ◽  
Frailty Status ◽  
Mortality Model ◽  
One Year ◽  
The One

AbstractBackgroundPalliative care (PC) has demonstrated benefits for life-limiting illnesses. Cancer patients have mainly accessed these services, but there is growing consensus about the importance of promoting access for patients with non-malignant disease. Bad survival prognosis and patient’s frailty are usual dimensions to decide PC inclusion.ObjectivesThe main aim of this work is to design and evaluate three quantitative models based on machine learning approaches to predict frailty and mortality on older patients in the context of supporting PC decision making: one-year mortality, survival regression and one-year frailty classification.MethodsThe dataset used in this study is composed of 39,310 hospital admissions for 19,753 older patients (age >= 65) from January 1st, 2011 to December 30th, 2018. All prediction models were based on Gradient Boosting Machines. From the initial pool of variables at hospital admission, 20 were selected by a recursive feature elimination algorithm based on the random forest’s GINI importance criterion. Besides, we run an independent grid search to find the best hyperparameters in each model. The evaluation was performed by 10-fold cross-validation and area under the receiver operating characteristic curve and mean absolute error were reported. The Cox proportional-hazards model was used to compare our proposed approach with classical survival methods.ResultsThe one-year mortality model achieved an AUC ROC of 0.87 ± 0.01; the mortality regression model achieved an MAE of 329.97 ± 5.24 days. The one-year frailty classification reported an AUC ROC of 0.9 ± 0.01. The Spearman’s correlation between the admission frailty index and the survival time was –0.1, while the point-biserial correlation between one-year frailty index and survival time was –0.16.ConclusionsOne-year mortality model performance is at a state-of-the-art level. Frailty Index used in this study behaves coherently with other works in the literature. One-year frailty classifier demonstrated that frailty status within the year could be predicted accurately. To our knowledge, this is the first study predicting one-year frailty status based on a frailty index. We found mortality and frailty as two weakly correlated and complementary PC needs assessment criteria. Predictive models are available online at http://demoiapc.upv.es.

scholarly journals Ability to detect potentially inappropriate prescribing in older patients: comparative analysis between PIM-Check and STOPP/STARTv2

2021 ◽  
Author(s):  
Akram Farhat ◽  
Alice Panchaud ◽  
Amal Al-Hajje ◽  
Pierre-Olivier Lang ◽  
Chantal Csajka
Keyword(s):  
Comparative Analysis ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Inappropriate Prescribing ◽  
University Hospital ◽  
Potentially Inappropriate Prescribing ◽  
Geriatric Ward ◽  
Start Criteria ◽  
Acute Geriatric Ward ◽  
Geriatric Settings

Abstract Purpose Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. Methods First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. Results The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. Conclusions By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.

scholarly journals Can doctors identify older patients at risk of medication harm following hospital discharge? A multicentre prospective study in the UK

2018 ◽  
Vol 84 (10) ◽  
pp. 2344-2351 ◽  
Author(s):  
Nikesh Parekh ◽  
Jennifer M. Stevenson ◽  
Rebekah Schiff ◽  
J. Graham Davies ◽  
Stephen Bremner ◽  
...  
Keyword(s):  
At Risk ◽  
Prospective Study ◽  
Hospital Discharge ◽  
Older Patients ◽  
Patients At Risk ◽  
The Uk ◽  
Multicentre Prospective Study

scholarly journals 250 Delirium, Common but Forgotten

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Hannah Smyth ◽  
Maham Mahmood ◽  
Owen Feely ◽  
Joanna Beirne ◽  
Conal Gallagher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Older Patients ◽  
Previous History ◽  
Management Plan ◽  
Medical Emergency ◽  
Geriatric Ward ◽  
Awareness Campaigns ◽  
Acute Geriatric Ward ◽  
Medical Teams ◽  
Prolonged Hospital

Abstract Background Delirium is a medical emergency prevalent amongst hospitalised older patients and associated with prolonged hospital stay, functional and cognitive decline, institutionalisation and increased mortality. In Irish hospitals, multiple strategies, e-learning courses, delirium guidelines and prevention programs have aimed to improve delirium care with better diagnosis and prevention. With the increasing awareness campaigns, we aimed to review the prevalence, screening and management of delirium in our cohort of older patients. Methods A review of medical notes of all patients admitted under medical teams to an acute geriatric ward was carried out. Data was collected over a 3 week period in an Irish model 3 hospital. The following information was obtained from medical records: 1) Previous diagnosis of delirium/dementia 2) Documentation of a diagnosis of delirium 3) Features of delirium 4) Development of delirium as an inpatient 5) Formal screening for delirium 6) Cause and management of delirium 7) Length of stay. Results Of 79 consecutive admissions to an acute geriatric ward (mean age 81.4, 57% female, 30% previous history of delirium or dementia), 25% (n=20) had a diagnosis of delirium documented. 22% (n=18) of patients had confusion and features of delirium highlighted but no formal diagnosis of delirium made during their inpatient stay. A further 20% (n=16) developed delirium on admission. Only 2.5% (n=2) of admissions had formal screening for delirium with the 4AT. 27.5% (n=11) of patients with delirium had a cause and management plan recorded. 70% (n=28) of patients with delirium had a length of stay of over 15 days. Conclusion This review showed delirium recognition, screening, prevention and management were overlooked to an alarming extent in our cohort of older patients. The next step is introduction of the 4AT screening tool and regular education sessions to increase the awareness of delirium amongst medical teams looking after older patients and improve care and outcomes.

Very Low Levels of Physical Activity in Older Patients During Hospitalization at an Acute Geriatric Ward: A Prospective Cohort Study

2015 ◽  
Vol 23 (4) ◽  
pp. 542-549 ◽  
Author(s):  
Morten Villumsen ◽  
Martin Gronbech Jorgensen ◽  
Jane Andreasen ◽  
Michael Skovdal Rathleff ◽  
Carsten Møller Mølgaard
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Older Patients ◽  
Geriatric Patients ◽  
Functional Decline ◽  
Activity Level ◽  
Accelerometer Data ◽  
Geriatric Ward ◽  
Acute Geriatric Ward ◽  
Low Levels

Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to investigate (1) the time spent walking during hospitalization by geriatric patients referred to physical and/or occupational therapy and (2) the development in time spent walking during hospitalization. In this observational study, 24-hr accelerometer data (ActivPal) were collected from inclusion to discharge in 124 patients at an acute geriatric ward. The median time spent walking was 7 min per day. During the first quartile of hospitalization, the patients spent 4 (IQR:1;11) min per day walking, increasing to 10 (IQR:1;29) min during the last quartile. Improvement in time spent walking was primarily observed in the group able to perform the Timed Up & Go task at admission. When walking only 7 min per day, patients could be classified as inactive and at risk for functional decline; nonetheless, the physical activity level increased significantly during hospitalization.

scholarly journals COVID-19 PANDEMIC UPDATES AND PERSPECTIVES. NEED FOR AN INTEGRATED AND EQUITABLE APPROACH.

2021 ◽  
Author(s):  
Grigoris Gerotziafas ◽  
Mariella Catalano ◽  
Ioannis Theodorou ◽  
Patrick van Dreden ◽  
Vincent Marechal ◽  
...  
Keyword(s):  
Mitigation Strategies ◽  
World Health ◽  
Learning Technology ◽  
Pharmacological Interventions ◽  
Health Crisis ◽  
Patients At Risk ◽  
Physical Barriers ◽  
Risk Of Disease ◽  
One Year ◽  
Health Organization

One year after the declaration of the COVID-19 pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Non-pharmacological interventions (NPI) are efficient mitigation strategies. The success of these intense NPI is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current issues: The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against SARS-CoV-2 and its variants. The need of a second and even third generation of vaccines and the possibility of potentially harmful side-effects of the vaccines (i.e. venous thromboembolism ) have already been acknowledged. Perspectives: There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion: The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organization (i.e. telemedicine, artificial intelligence and machine learning technology) is of major importance for the preservation of citizens’ health and life world-wide.

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