scholarly journals The predictive utility of functional status at discharge: a population-level cohort analysis

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Mats L. Junek ◽  
Aaron Jones ◽  
George Heckman ◽  
Catherine Demers ◽  
Lauren E. Griffith ◽  
...  
Keyword(s):  
Functional Status ◽  
Long Term Care ◽  
Care Home ◽  
Cohort Analysis ◽  
Care Facility ◽  
Population Level ◽  
Population Based ◽  
Post Discharge ◽  
Term Care

Abstract Background Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes. Methods In this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge. Results A total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission. Conclusion Routinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults.

scholarly journals The Predictive Utility of Functional Status at Discharge: A Population-level Cohort Analysis

2021 ◽  
Author(s):  
Mats L Junek ◽  
Aaron Jones ◽  
George Heckman ◽  
Catherine Demers ◽  
Lauren E Griffith ◽  
...  
Keyword(s):  
Functional Status ◽  
Long Term Care ◽  
Care Home ◽  
Cohort Analysis ◽  
Care Facility ◽  
Population Level ◽  
Service Planning ◽  
Post Discharge ◽  
Term Care

Abstract Background: Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes.Methods: In this population-based retrospective cohort study, Adults 65+ who experienced an acute hospitalization between 4 November 2008 and 16 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care (HOBIC) tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge.Results: A total of 80,020 patients were included. 38,928 (48.6%) re-presented to the ED, 24,222 (30.3%) were re-admitted, 5,037 (6.3%) were LTCF ready, and 9,047 (11.3%) died at 180 days. Beyond age, functional status at discharge was the factor most associated with LTCF readiness (Odds Ratio [OR] 4.11; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission.Conclusion: Routinely collected functional status at discharge meaningfully improves models to predict long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and service planning for older adults.

Use of vitamin and mineral supplements in long-term care home residents

2012 ◽  
Vol 37 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Navita Viveky ◽  
Lynda Toffelmire ◽  
Lilian Thorpe ◽  
Jennifer Billinsky ◽  
Jane Alcorn ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Long Term Care ◽  
Care Home ◽  
Care Facility ◽  
Dementia Diagnosis ◽  
Term Care ◽  
Supplement Use ◽  
Supplement Usage

Vitamin–mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall “pill count” from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar (p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1–6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences (p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse.

scholarly journals Vaccine effectiveness after 1st and 2nd dose of the BNT162b2 mRNA Covid-19 Vaccine in long-term care facility residents and healthcare workers – a Danish cohort study

2021 ◽  
Author(s):  
Ida Rask Moustsen-Helms ◽  
Hanne-Dorthe Emborg ◽  
Jens Nielsen ◽  
Katrine Finderup Nielsen ◽  
Tyra Grove Krause ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Long Term Care ◽  
Care Facility ◽  
Dose Schedule ◽  
Population Based ◽  
Vaccine Effectiveness ◽  
Calendar Time ◽  
Term Care

AbstractBackgroundAt the end of 2020, Denmark launched an immunization program against SARS-CoV-2. The Danish health authorities prioritized persons currently living in long-term care facilities (LTCF residents) and frontline healthcare workers (HCW) as the first receivers of vaccination. Here we present preliminary population based vaccine effectiveness (VE) estimates in these two target groups.MethodsThe study was designed as a retrospective registry- and population-based observational cohort study including all LTCF residents and all HWC. The outcome was a polymerase chain reaction confirmed SARS-CoV-2, and VE was estimated for different periods following first and second dose. We used Poisson and Cox regressions to estimate respectively crude and calendar time-adjusted VE for the BNT162b2 mRNA Covid-19 Vaccine from Pfizer/BioNTech with 95% confidence intervals (CI) for vaccinated versus unvaccinated.ResultsA total of 39,040 LTCF residents (median age at first dose; 84 years, Interquartile range (IQR): 77-90) and 331,039 HCW (median age at first dose; 47 years, IQR: 36-57) were included. Among LTCF residents, 95.2% and 86.0% received first and second dose from 27 December 2020 until 18 February 2021, for HWC the proportion was 27.8% and 24.4%. During a median follow-up of 53 days, there were 488 and 5,663 confirmed SARS-CoV-2 cases in the unvaccinated groups, whereas there were 57 and 52 in LTCF residents and HCW within the first 7 days after the second dose and 27 and 10 cases beyond seven days of second dose. No protective effect was observed for LTCF residents after first dose. In HCW, VE was 17% (95% CI; 4-28) in the > 14 days after first dose (before second dose). Furthermore, the VE in LTCF residents at day 0-7 of second dose was 52% (95% CI; 27-69) and 46% (95% CI; 28-59) in HCW. Beyond seven days of second dose, VE increased to 64% (95% CI; 14-84) and 90% (95% CI; 82-95) in the two groups, respectively.ConclusionThe results were promising regarding the VE both within and beyond seven days of second vaccination with the BNT162b2 mRNA Covid-19 Vaccine currently used in many countries to help mitigate the global SARS-CoV-2 pandemic.Impact of the researchSo far, observational studies of the real-word effectiveness of the mRNA Vaccine BNT162b2 has been limited to the period after the administration of the first dose. This is the first report to date to present vaccine effectiveness (VE) estimates after the second BNT162b2 mRNA Covid-19 Vaccine. We estimated a VE of 52% and 46% in LTCF residents and HCW within seven days, which increased to 64% and 90% in the two groups respectively beyond seven days of immunization. These findings supports maintaining a two-dose schedule of the BNT162b2 mRNA Covid-19 Vaccine.

scholarly journals Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021

2021 ◽  
Vol 26 (24) ◽  
Author(s):  
Clara Mazagatos ◽  
Susana Monge ◽  
Carmen Olmedo ◽  
Lorena Vega ◽  
Pilar Gallego ◽  
...  
Keyword(s):  
Long Term Care ◽  
Screening Method ◽  
Care Facility ◽  
Population Based ◽  
Data Sources ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

Residents in long-term care facilities (LTCF) experienced a large morbidity and mortality during the COVID-19 pandemic in Spain and were prioritised for early COVID-19 vaccination. We used the screening method and population-based data sources to obtain estimates of mRNA COVID-19 vaccine effectiveness for elderly LTCF residents. The estimates were 71% (95% CI: 56–82%), 88% (95% CI: 75–95%), and 97% (95% CI: 92-99%), against SARS-CoV-2 infections (symptomatic and asymptomatic), and COVID-19 hospitalisations and deaths, respectively.

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