scholarly journals How Do Geriatric Scores Predict 1-Year Mortality in Elderly Patients with Suspected Pneumonia?

Geriatrics ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 112
Author(s):  
Alberto Nascè ◽  
Astrid Malézieux-Picard ◽  
Landry Hakiza ◽  
Thomas Fassier ◽  
Dina Zekry ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Rating Scale ◽  
Nutritional Assessment ◽  
Univariate Analysis ◽  
Mini Nutritional Assessment ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Long Term Outcomes ◽  
Long Term Prognosis

Background: Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. We aimed to assess the ability of scores that evaluate patients’ comorbidities (cumulative illness rating scale—geriatric, CIRS-G), malnutrition (mini nutritional assessment, MNA) and functionality (functional independence measure, FIM) to predict 1-year mortality in a cohort of older patients having a suspicion of pneumonia. Methods: Our prospective study included consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia enrolled in a monocentric cohort from May 2015 to April 2016. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. Results: 200 patients were included (51% male, mean age 83.8 ± 7.7). Their 1-year mortality rate was 30%. FIM (p < 0.01), CIRS-G (p < 0.001) and MNA (p < 0.001) were strongly associated with poorer long-term outcomes in univariate analysis. CIRS-G (p < 0.05) and MNA (p < 0.05) were significant predictors of 1-year mortality in multivariate analysis. Conclusion: Long-term prognosis of patients hospitalized for pneumonia was poor and we identified that scores assessing comorbidities and malnutrition seem to be important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients’ prognosis, levels and goals of care.

scholarly journals One-Year Mortality Prediction in Elderly Patients With Suspected Pneumonia: The Usefulness of a Holistic Approach

2021 ◽  
Author(s):  
Alberto Nascè ◽  
Astrid Malézieux-Picard ◽  
Landry Hakiza ◽  
Thomas Fassier ◽  
Dina Zekry ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Rating Scale ◽  
Nutritional Assessment ◽  
Univariate Analysis ◽  
Pneumonia Severity Index ◽  
Mini Nutritional Assessment ◽  
Functional Independence ◽  
Pneumonia Severity ◽  
Severity Scores

Abstract Background Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. The purpose of this study was to identify the predictors of 1-year mortality in older patients having a suspicion of pneumonia, using usual pneumonia severity scores and geriatric evaluation’s scores focused on comorbidities, nutritional status and functionality. Methods Consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia were enrolled in a monocentric cohort from May 2015 to April 2016. Three scores were used to assess patients’ comorbidities (Cumulative Illness Rating Scale-Geriatric, CIRS-G), malnutrition (Mini Nutritional Assessment, MNA), functionality (Functional Independence Measure, FIM) respectively. Severity of pneumonia was assessed by using the Confusion, Urea, Respiratory Rate, Blood Pressure, and 65-years old score (CURB65), the Pneumonia Severity Index (PSI) and Sequential Organ Failure Assessment score (SOFA). With the exception of CIRS-G, all the scores were obtained prospectively within 48 hours after admission. The main outcome was 1-year mortality. Dates of death were obtained by consulting the cantonal register of deaths. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. Results 200 patients were included (51 % male, mean age 83.8 +/- 7.7). The 1-year mortality rate was 30%. Scores associated with 1-year mortality were CURB-65 (p < .001), SOFA (p < .05), FIM (p < .01), CIRS-G (p < .001) and MNA (p < .001) in univariate analysis. Only CIRS-G (p < .05) and MNA (p < .05) were significant predictors of 1-year mortality in multivariate analysis. Conclusions Long-term prognosis of pneumonia was poor and we identified that scores assessing comorbidities and malnutrition were important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients’ prognosis, levels and goals of care.

The Functional Independence Measure and the Functional Assessment Measure (FIM + FAM) as an effective tool for the evaluation of functional status in stroke rehabilitation

2021 ◽  
Author(s):  
L. Shuranova ◽  
J. Vacková
Keyword(s):  
Functional Assessment ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Hospital Treatment ◽  
Common Cause ◽  
Assessment Measure ◽  
Rehabilitation Period

The Functional Independence Measure and Functional Assessment Measure (FIM + FAM) is an effective, efficient, and objective tool for tracking changes in the motor, cognitive, and psychosocial functions of patients over the entire treatment and rehabilitation period. It is estimated that in the Czech Republic (CR), stroke is the third most common cause of death and the most common cause of adult disability. To develop faster, better, and more cost‑effective stroke treatments and reduce or mitigate functional losses and restrictive situations, it is very important that patients be objectively evaluated, relative to their functional abilities, as soon as possible after a stroke. A critical part of stroke treatment is to calculate the length of in‑hospital treatment and estimate the length of the rehabilitation period after the stroke. Contemporary methods for evaluating and analyzing a patient’s condition are based on test results and evidence.The FIM offers a more sensitive rating scale compared to BI due to the presence of cognitive items and is used worldwide for assessment during the acute stage of the disease. Thus, it is an efficient instrument for setting therapy goals and evaluating the effects of rehabilitation. Not only can it assist the therapist in clinical decision making, but it also functions as a tool for evaluating rehabilitation outcomes. Based on this test, short‑term and long‑term rehabilitation plans can be determined. At the end of the rehabilitation process, assessing the patient’s functional condition helps to predict the specific long‑term rehabilitation services the patient will need as they return to society and regain their quality of life.

scholarly journals Correlation of cardiovascular and respiratory comorbidities with motor functional independence in the elderly after hip fracture

2021 ◽  
Vol 74 (1-2) ◽  
pp. 20-24
Author(s):  
Natasa Radosavljevic ◽  
Dejan Nikolic ◽  
Sofija Radosavljevic ◽  
Mirko Grajic ◽  
Ksenija Boskovic
Keyword(s):  
Hip Fracture ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Severity Index ◽  
The Elderly ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Significant Difference ◽  
Different Levels

Introduction. The aim of the study was to evaluate the correlation between different levels of examined comorbidities using the Cumulative Illness Rating Scale for Geriatrics and motor Functional Independence Measure test in the elderly after hip fracture. Material and Methods. The study included 203 geriatric patients, 65 years of age and older, who were referred to a rehabilitation program at the Institute for Rehabilitation after hip fracture. The following comorbidities were analyzed: cardiac, vascular, and respiratory. The motor component of Functional Independence Measure was used to assess functional recovery. The Cumulative Illness Rating Scale for Geriatrics was used to calculate the comorbidity index. The patients were assessed on 4 different occasions: on admission, on discharge, 3 months after discharge, and 6 months after discharge. The short-term and long-term efficiency of rehabilitation treatment was measured. Results. There is a significant difference in motor Functional Independence Measure scores between different levels of vascular (p = 0.010) and respiratory (p = 0.047) comorbidities only on admission, while at other times of observation no significant difference (p > 0.05) was found. The highest level of correlation was found in level 3 comorbidity severity index for cardiac comorbidity (discharge/3 months) (Pearson?s correlation - R = 0.938) and vascular comorbidity (discharge/3 months) (R = 0.912), and level 2 comorbidity severity index for respiratory comorbidity (discharge/3 months) (R = 0.941). Conclusion. Rehabilitation treatment of the elderly after hip fracture plays a significant role both in short-term and long-term recovery, particularly in the functional domains even in persons with significant comorbidities. Early inclusion and an individually designed rehabilitation program with continuous monitoring of the elderly after hip fractures results in functional improvement and better quality of life.

scholarly journals Impact of Malnutrition on Long-Term Mortality in Elderly Patients with Acute Myocardial Infarction

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 224 ◽  
Author(s):  
Klara Komici ◽  
Dino Vitale ◽  
Angela Mancini ◽  
Leonardo Bencivenga ◽  
Maddalena Conte ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Troponin I ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Grace Score ◽  
Long Term Mortality

Background: Malnutrition is a frequent condition in the elderly, and is associated with prolonged hospitalization and increased mortality. However, the impacts of malnutrition among elderly patients with acute myocardial infarction have not been clarified yet. Methods and Results: We enrolled 174 patients aged 65 years and over, admitted with the diagnosis of acute myocardial infarction (AMI), who underwent evaluation of nutritional status by Mini Nutritional Assessment (MNA) and evaluation of mortality risk by GRACE Score 2.0. All-cause mortality was the outcome considered for this study. Over a mean follow-up of 24.5 ± 18.2 months, 43 deaths have been registered (24.3%). Non-survivors were more likely to be older, with worse glomerular filtration rate, lower systolic blood pressure, lower albumin and MNA score, higher prevalence of Killip classification III-IV grade, and higher Troponin I levels. Multivariate Cox proportional analysis revealed that GRACE Score and MNA showed a significant and independent impact on mortality, (HR = 1.76, 95%, CI = 1.34–2.32, and HR = 0.56, 95% CI = 0.42–0.73, respectively). Moreover, the clinical decision curve revealed a higher clinical net benefit when the MNA was included, compared to the partial models without MNA. Conclusion: Nutritional status is an independent predictor of long-term mortality among elderly patients with AMI. MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with, or at risk of, malnutrition in order to apply interventions to improve nutritional status, and maybe survival in this population.

scholarly journals Evaluation of Cognitive Dysfunction, Functional Independence and Depression Severity Changes during Rehabilitation in Patients after Cerebral Stroke

2019 ◽  
Vol 2 (17) ◽  
Author(s):  
Gintarė Mankė ◽  
Lina Varžaitytė ◽  
Aistė Berkutė ◽  
Erika Karkauskienė
Keyword(s):  
Cognitive Dysfunction ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Cerebral Stroke ◽  
Depression Severity ◽  
Mild Depression ◽  
Before And After ◽  
The Mean ◽  
Long Term Prognosis

 Research background. Cognitive impairment and depression are frequent residual consequences of stroke. They have a large impact on the quality of life and long-term prognosis. The aim is to estimate changes of cognitive dysfunction, functional independence and depression severity before and after rehabilitation in patients after cerebral stroke. Methods. We used Mini-Mental State Examination (MMSE) to estimate cognitive dysfunction, Functional Independence Measure (FIM) – motor and cognitive functions, Montgomery–Asberg Depression Rating Scale (MADRS) – depression severity. Results. There were 14 research participants from Neurorehabilitation department in Hospital of LUHS Kauno klinikos who met with criteria for inclusion and were not included by criteria for exclusion. Before rehabilitation the meanscore of MMSE – 19.93 – mild cognitive dysfunction, the mean score of FIM – 57.71 – medium supervision needed, the mean score of MADRS – 17.71 – mild depression. After rehabilitation the mean score of MMSE – 23.86 – mild cognitive dysfunction, the mean score of FIM – 92.07 – supervision needed, the mean score of MADRS – 10.50 – mild depression. We determined that six women had medium cognitive dysfunction while men did not have it. Conclusions. Cognitive function after rehabilitation signifcantly got better but mild cognitive dysfunction remained. Functional independence improved after rehabilitation and most patients only needed supervision. Mild depression remained after rehabilitation but the score signifcantly reduced. Females had more severe cognitive dysfunctions.Keywords: cerebral stroke, post-stroke depression, cognitive dysfunction, functional independency.

scholarly journals Using the Mini Nutritional Assessment to Evaluate the Profile of Elderly Patients in a Geriatric Outpatient Clinic and in Long-Term Institutions

2011 ◽  
Vol 02 (05) ◽  
pp. 582-587 ◽  
Author(s):  
Valéria Maria Caselato-Sousa ◽  
Maria Elena Guariento ◽  
Gilberto Crosta ◽  
Mariângela Antunes da Silva Pinto ◽  
Valdemiro Carlos Sgarbieri
Keyword(s):  
Elderly Patients ◽  
Outpatient Clinic ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment

scholarly journals Clinical presentations and long term prognosis of childhood onset polyarteritis nodosa in single centre of Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong-Seon Lee ◽  
Joong-Gon Kim ◽  
Soyoung Lee
Keyword(s):  
Polyarteritis Nodosa ◽  
Clinical Manifestations ◽  
Long Term Outcomes ◽  
Childhood Onset ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
Long Term Prognosis ◽  
Digital Amputation

AbstractChildhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). We retrospectively analysed the data of nine patients with childhood-onset PAN from March 2003 to February 2020. The median ages at symptom onset, diagnosis, and follow-up duration were 7.6 (3–17.5), 7.7 (3.5–17.6), and 7.0 (1.6–16.3) years, respectively. All patients had constitutional symptoms and skin manifestations, while five exhibited Raynaud’s phenomenon. Organ involvement was observed in one patient. The median PVAS at diagnosis was 7 (range: 2–32). Prednisolone was initially used for induction in all patients, and other drugs were added in cases refractory to prednisolone. All patients survived, but three patients with high PVAS at diagnosis experienced irreversible sequelae, including intracranial haemorrhage and digital amputation. In conclusion, early diagnosis and treatment may minimise sequelae in patients with childhood-onset PAN. This study suggests that high PVAS score at diagnosis may be associated with poor prognosis.

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