Biomarkers for Length of Hospital Stay and Loss of Muscle Mass and Function in Old Medical Patients

Abstract Background: Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients.Methods: This study was a randomized double-blind controlled trial conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients aged ≥ 65 years hospitalized in the internal medicine service were randomized to quetiapine 12.5 mg or placebo once daily at bedtime for a maximum 7-day duration. The primary end point was delirium incidence. Secondary end points were delirium duration, length of hospital stay, ICU admission, rehospitalization and mortality within 30 and 90 days.Results: A total of 122 patients were enrolled in the study. Eight (6.6%) left the trial before receiving the first dose of the intervention, whereas 114 (93.4%) were included in an intention-to-treat analysis allocated to the quetiapine or placebo group (n=57 each). The delirium incidence rates in the quetiapine and placebo groups were 14.0% and 8.8% (OR=1.698, 95% CI 0.520-5.545, P=0.381), respectively. Other endpoints in the quetiapine and placebo groups were the median length of hospital stay, 6 (4-8) days versus 5 (4-8) days (P=0.133), respectively; delirium duration, 4 (2.3-6.5) versus 3 (1.5-4.0) days (P=0.557), respectively; ICU admission, 3 (5.3%) patients from both groups (P=1.000); and mortality in the quetiapine and placebo groups, 1 (1.8%) versus 2 (3.5%) at 30 days (P=0.566) and 7 (12.3%) versus 9 (15.8%) days at 90 days (P=0.591). There were no significant differences in other outcomes. None of the participants reported adverse events.Conclusions: Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients. The use of quetiapine to prevent delirium in this population group should not be recommended.Trial registration: This trial was retrospectively registered with the Thai clinical trials registry (TCTR) at clinicaltrials.in.th (TCTR20190927001) on September 26, 2019.

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Extended Length of Hospital Stay for Surgical and Medical Patients – Insights from Hospital and Psychosocial Predictors

10.24251/hicss.2022.447 ◽

2022 ◽

Author(s):

Chinedu Ossai ◽

Nilmini Wickramasinghe

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Psychosocial Predictors ◽

Medical Patients ◽

Extended Length

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Factors Associated With Skeletal Muscle Mass Increase by Rehabilitation in Older Adults With Vertebral Compression Fractures

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0475 ◽

2021 ◽

pp. 1-6

Author(s):

Takahiro Ogawa ◽

Yuki Sueyoshi ◽

Shintaro Taketomi ◽

Nobumasa Chijiiwa

Keyword(s):

Skeletal Muscle ◽

Hospital Stay ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Length Of Hospital Stay ◽

Functional Independence ◽

Vertebral Compression Fractures ◽

Skeletal Muscle Index ◽

Compression Fractures ◽

Factors Associated

Age-related sarcopenia and osteoporosis-related fractures are critical health issues. Therefore, this study aimed to assess skeletal muscle mass changes in older patients with vertebral compression fractures undergoing rehabilitation and to evaluate factors associated with muscle increases. This study included 179 patients aged ≥80 years in rehabilitation wards with vertebral compression fractures. Appendicular skeletal muscle index was significantly higher at discharge (5.22 ± 1.04 kg/m2, p < .001) than on admission (5.03 ± 1.00 kg/m2). Multiple logistic regression analysis showed that length of hospital stay was significantly associated with increased skeletal muscle index (odds ratios, 1.020; 95% confidence intervals [1.000, 1.032]), whereas age, sex, body mass index, functional independence measure, protein intake, and exercise therapy duration were not. Participants with vertebral compression fractures aged ≥80 years achieved significantly increased skeletal muscle mass in rehabilitation wards. In addition, length of hospital stay was the factor independently associated with increased skeletal muscle index.

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PP134-MON IMPAIRED FUNCTIONAL STATUS ASSESSED BY HANDGRIP INCREASES THE LENGTH OF HOSPITAL STAY IN HOSPITALIZED MEDICAL PATIENTS

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(12)70473-8 ◽

2012 ◽

Vol 7 (1) ◽

pp. 191

Author(s):

A.L. Dias ◽

J.E. Aguilar-Nascimento ◽

D.B. Dock-Nascimento

Keyword(s):

Hospital Stay ◽

Functional Status ◽

Length Of Hospital Stay ◽

Medical Patients

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A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

BMC Health Services Research ◽

10.1186/s12913-019-4629-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

E. Hurley ◽

S. McHugh ◽

J. Browne ◽

L. Vaughan ◽

C. Normand

Keyword(s):

Mixed Methods ◽

Hospital Stay ◽

Patient Care ◽

Hospital Admissions ◽

Hospital Setting ◽

Length Of Hospital Stay ◽

Comparative Case Study ◽

Medical Patients ◽

Acute Medicine ◽

The Impact

Abstract Background To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. Methods We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme’s outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme’s implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme’s outcomes can be explained by the level of implementation. Discussion This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

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Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02160-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saran Thanapluetiwong ◽

Sirasa Ruangritchankul ◽

Orapitchaya Sriwannopas ◽

Sirintorn Chansirikarnjana ◽

Pichai Ittasakul ◽

...

Keyword(s):

Hospital Stay ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Population Group ◽

Incidence Rates ◽

Medical Patients ◽

Double Blind ◽

Icu Admission ◽

Intention To Treat ◽

Delirium Prevention

Abstract Background Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. Methods This study was a randomized double-blind controlled trial conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients aged ≥65 years hospitalized in the internal medicine service were randomized to quetiapine 12.5 mg or placebo once daily at bedtime for a maximum 7-day duration. The primary end point was delirium incidence. Secondary end points were delirium duration, length of hospital stay, ICU admission, rehospitalization and mortality within 30 and 90 days. Results A total of 122 patients were enrolled in the study. Eight (6.6%) left the trial before receiving the first dose of the intervention, whereas 114 (93.4%) were included in an intention-to-treat analysis allocated to the quetiapine or placebo group (n = 57 each). The delirium incidence rates in the quetiapine and placebo groups were 14.0 and 8.8% (OR = 1.698, 95% CI 0.520–5.545, P = 0.381), respectively. Other endpoints in the quetiapine and placebo groups were the median length of hospital stay, 6 (4–8) days versus 5 (4–8) days (P = 0.133), respectively; delirium duration, 4 (2.3–6.5) versus 3 (1.5–4.0) days (P = 0.557), respectively; ICU admission, 3 (5.3%) patients from both groups (P = 1.000); and mortality in the quetiapine and placebo groups, 1 (1.8%) versus 2 (3.5%) at 30 days (P = 0.566) and 7 (12.3%) versus 9 (15.8%) days at 90 days (P = 0.591). There were no significant differences in other outcomes. None of the participants reported adverse events. Conclusions Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients. The use of quetiapine to prevent delirium in this population group should not be recommended. Trial registration This trial was retrospectively registered with the Thai clinical trials registry (TCTR) at clinicaltrials.in.th (TCTR20190927001) on September 26, 2019.

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