Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

Mapping Intimacies ◽

10.21203/rs.3.rs-1182649/v1 ◽

2022 ◽

Author(s):

Laura Tay ◽

Melvin Chua ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Functional Decline ◽

Oral Intake ◽

Index Admission ◽

Geriatric Syndromes ◽

Poor Oral Intake ◽

Hospitalized Older Adults ◽

Minimal Adjustment

Abstract Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

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Poor functional recovery after delirium is associated with other geriatric syndromes and additional illnesses

International Psychogeriatrics ◽

10.1017/s1041610214002658 ◽

2014 ◽

Vol 27 (5) ◽

pp. 793-802 ◽

Cited By ~ 7

Author(s):

Monidipa Dasgupta ◽

Chris Brymer

Keyword(s):

Functional Recovery ◽

Functional Decline ◽

Oral Intake ◽

Geriatric Syndromes ◽

Physical Restraints ◽

Security Services ◽

Increased Risk ◽

Poor Oral Intake ◽

Discharge From Hospital

ABSTRACTBackground:Delirious individuals are at increased risk for functional decline, institutionalization and death. Delirium is also associated with other geriatric syndromes, behavioral care issues, and new illnesses. The objectives of this study were to determine how often certain geriatric syndromes, care issues, and additional diagnoses occur in delirious individuals, and to see whether they correlate with worse functional recovery.Methods:Consecutive delirious older medical in-patients (n = 343) were followed for the occurrence of geriatric syndromes (falls, pressure ulcers, poor oral intake, and aspiration), care issues (refusing treatments or care, need for sitters, security services, physical restraints, and new neuroleptic medications) and additional diagnoses occurring after the third day of admission. Poor functional recovery was defined by any one of death, permanent institutionalization or increased dependence for activities of daily living (ADLs) at discharge or three months after discharge from hospital, elicited through chart review or a follow-up telephone interview.Results:Poor functional recovery was seen in 237 (69%) delirious patients. Geriatric syndromes and additional illnesses were common and associated with poor functional recovery (falls in 21%, adjusted OR 2.27; possible aspiration in 26%, adjusted OR 3.06; poor oral intake in 49%, adjusted OR = 2.31; additional illnesses in 38%, adjusted OR 3.54). Care issues were also common (range 9%–54%) but not associated with poor recovery.Conclusions:Geriatric syndromes, behavioral care issues and additional illnesses are common in delirium. Future studies should assess whether monitoring for and intervening against geriatric syndromes and additional illnesses may improve functional outcomes after delirium.

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Associations Between Depressive Symptoms, Appetite and Food Intake Among Hospitalized Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3376 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 919-919

Author(s):

Amos Rogozinski ◽

Anna Zisberg

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Food Intake ◽

Food Consumption ◽

Functional Decline ◽

Secondary Data ◽

Established Risk Factor ◽

Hospitalized Older Adults ◽

Inadequate Food Intake ◽

Food Consumed

Abstract Inadequate food intake is common among hospitalized older adults and is linked to negative hospitalization outcomes, including functional decline and mortality. Depression is a well-established risk factor in inadequate food intake in the community but its role in food consumption during hospitalization is poorly studied. To examine the associations between depressive symptoms, appetite and the quantity of food consumed by older inpatients, we conducted a secondary data analysis of 724 hospitalized adults aged 69 to 95 using a prospective cohort dataset: Hospitalization Process Effects on Functional Outcomes and Recovery. Depression was evaluated with Tucker’s Short Zung Instrument at time of admission. Food intake and appetite were examined daily for three consecutive days, using self-reports of food consumed at breakfast, lunch and supper, based on the nDay Express Questionnaire. Approximately 40% of respondents reported eating half or less than half of each meal. The risk of depression was prevalent among a third of respondents, 54% of whom were identified at high risk of depression. The association between depression and inadequate food intake was found to be negative [F(2,716)=9.00 ,p=0.000 ,η2=0.025]. Low appetite was significantly linked to reduced food consumption [β=-0.39, t=-12.06, p=0.000] and made a considerable contribution to the explained variance of food consumed [F-change (1,717)=145.41 , p=0.000]. Finally, decreased appetite partially mediated the association between depressive symptoms and food intake during hospitalization (B=-0.001, UCI=-0.001; LCI=-0.002). These findings contribute to the understanding of inadequate food intake during hospitalization and indicate the importance of screening for depression among hospitalized older adults.

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Guest Editorial: Focus on Functional Decline in Hospitalized Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/57.9.m567 ◽

2002 ◽

Vol 57 (9) ◽

pp. M567-M568 ◽

Cited By ~ 25

Author(s):

D. R. Thomas

Keyword(s):

Older Adults ◽

Guest Editorial ◽

Functional Decline ◽

Hospitalized Older Adults

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Effectiveness of acute geriatric unit care on functional decline and process outcomes among older adults admitted to hospital with acute medical complaints: a protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2021-050524 ◽

2021 ◽

Vol 11 (10) ◽

pp. e050524

Author(s):

Íde O’Shaughnessy ◽

Katie Robinson ◽

Margaret O'Connor ◽

Mairéad Conneely ◽

Damien Ryan ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

Functional Decline ◽

Index Admission ◽

Research Centre ◽

Cochrane Library ◽

Process Outcomes

IntroductionOlder adults are clinically heterogeneous and are at increased risk of adverse outcomes during hospitalisation due to the presence of multiple comorbid conditions and reduced homoeostatic reserves. Acute geriatric units (AGUs) are units designed with their own physical location and structure, which provide care to older adults during the acute phase of illness and are underpinned by an interdisciplinary comprehensive geriatric assessment model of care. This review aims to update and synthesise the totality of evidence related to the effectiveness of AGU care on clinical and process outcomes among older adults admitted to hospital with acute medical complaints.DesignUpdated systematic review and meta-analysisMethods and analysisMEDLINE, Cumulative Index of Nursing and Allied Health Literature, Controlled Trials in the Cochrane Library and Embase electronic databases will be systematically searched from 2008 to February 2021. Trials with a randomised design that deliver an AGU intervention to older adults admitted to hospital for acute medical complaints will be included. The primary outcome measure will be functional decline at discharge from hospital and at follow-up. Secondary outcomes will include length of stay, cost of index admission, incidence of unscheduled hospital readmission, living at home (the inverse of death or institutionalisation combined; used to describe someone who is in their own home at follow‐up), mortality, cognitive function and patient satisfaction with index admission. Title and abstract screening of studies for full-text extraction will be conducted independently by two authors. The Cochrane risk of bias 2 tool will be used to assess the methodological quality of the included trials. The quality of evidence for outcomes reported will be assessed using the Grading of Recommendations Assessment, Development and Evaluations framework. A pooled meta-analysis will be conducted using Review Manager, depending on the uniformity of the data.Ethics and disseminationFormal ethical approval is not required as all data collected will be secondary data and will be analysed anonymously. The authors will present the findings of the review to a patient and public involvement stakeholder panel of older adults that has been established at the Ageing Research Centre in the University of Limerick. This will enable the views and opinions of older adults to be integrated into the discussion section of the paper.PROSPERO registration numberCRD42021237633.

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Aspirin and statin therapy for primary prevention of cardiovascular disease in older adults

Heart ◽

10.1136/heartjnl-2021-320154 ◽

2021 ◽

pp. heartjnl-2021-320154

Author(s):

Sophie Montgomery ◽

Michael D Miedema ◽

John Dodson

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Decision Making ◽

Cognitive Impairment ◽

Primary Prevention ◽

Absolute Risk ◽

Functional Decline ◽

Calcium Score ◽

Risk Of Death ◽

Therapeutic Decisions

The value of primary preventative therapies for cardiovascular disease (CVD) in older adults (age ≥75 years) is less certain than in younger patients. There is a lack of quality evidence in older adults due to underenrolment in pivotal trials. While aspirin is no longer recommended for routine use in primary prevention of CVD in older adults, statins may be efficacious. However, it is unclear which patient subgroups may benefit most, and guidelines differ between expert panels. Three relevant geriatric conditions (cognitive impairment, functional impairment and polypharmacy) may influence therapeutic decision making; for example, baseline frailty may affect statin efficacy, and some have advocated for deprescription in this scenario. Evidence regarding statins and incident functional decline are mixed, and vigilance for adverse effects is important, especially in the setting of polypharmacy. However, aspirin has not been shown to affect incident cognitive or functional decline, and its lack of efficacy extends to patients with baseline cognitive impairment or frailty. Ultimately, the utility of primary preventative therapies for CVD in older adults depends on potential lifetime benefit. Rather than basing treatment decisions on absolute risk alone, consideration of comorbidities, polypharmacy and life expectancy should play a significant role in decision making. Coronary calcium score and new tools for risk stratification validated in older adults that account for the competing risk of death may aid in evaluating potential benefits. Given the complexity of therapeutic decisions in this context, shared decision making provides an important framework.

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Neuropsychological and Functional Impact of COVID-19 on Mild Cognitive Impairment

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317520960875 ◽

2020 ◽

Vol 35 ◽

pp. 153331752096087

Author(s):

Kalpana P. Padala ◽

Christopher M. Parkes ◽

Prasad R. Padala

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Case Report ◽

Mild Cognitive Impairment ◽

Activities Of Daily Living ◽

Older Adult ◽

Daily Living ◽

Functional Decline ◽

Depression And Anxiety ◽

Physically Active

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.

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The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215518815218 ◽

2018 ◽

Vol 33 (3) ◽

pp. 439-449 ◽

Cited By ~ 4

Author(s):

Chandra da Silveira Langoni ◽

Thais de Lima Resende ◽

Andressa Bombardi Barcellos ◽

Betina Cecchele ◽

Juliana Nunes da Rosa ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Mild Cognitive Impairment ◽

Intervention Group ◽

Depression Scale ◽

Community Dwelling ◽

Effect Sizes ◽

Control Group ◽

Community Dwelling Older Adults

Objective: To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment. Design: Single blinded, randomized, matched pairs clinical trial. Setting: Four primary healthcare units. Subjects: Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index, and Addenbrooke’s Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26). Intervention: The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities’ public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine. Main measures: Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric Depression Scale-15) were assessed before and after the intervention. Results: Before the intervention, the two groups did not differ statistically. After, the intervention group showed significant improvement ( P < 0.05) in balance (before: 53 ± 3; after: 55.1 ± 1.1 points), mobility (before: 10.7 ± 2.9 seconds; after: 8.3 ± 2 seconds), and depressive symptoms (median punctuation (interquartile range) before: 4 (1.8–6); after: 2.5 (1–4)). The control group presented a significant increase in their depressive symptoms (median before: 3.5 (2–7.3); after: 4 (2–5.3)), while their balance and mobility showed no significant modification. Small effect sizes were observed in the intervention group and control group depressive symptoms, as well as in the control group’s mobility and balance. Large effect sizes were observed the intervention group’s mobility and balance. Conclusion: Group exercises improved balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

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