Faculty Opinions recommendation of Fibrosis with inflammation at one year predicts transplant functional decline.

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.

Download Full-text

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

Download Full-text

P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽

10.1017/cem.2016.259 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S106-S106

Author(s):

E. Losier ◽

A. McCollum ◽

P. Jarrett ◽

R. McCloskey ◽

P. Nicholson ◽

...

Keyword(s):

Emergency Department ◽

Assisted Living ◽

Demographic Data ◽

Care Home ◽

Functional Decline ◽

Retrospective Chart Review ◽

Community Services ◽

Level 3 ◽

Ed Visits ◽

One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

Download Full-text

Baseline Functional Status and One-year Mortality After Hospital Admission in Elderly Patients: a prospective cohort study

Revista de la Facultad de Ciencias Médicas de Córdoba ◽

10.31053/1853.0605.v77.n3.28771 ◽

2020 ◽

Vol 77 (3) ◽

pp. 143-148

Author(s):

Victoria Sáenz ◽

Nicolas Zuljevic ◽

Cristina Elizondo ◽

Iñaki Martin Lesende ◽

Diego Caruso

Keyword(s):

Cohort Study ◽

Elderly Patients ◽

Hospital Admission ◽

Functional Status ◽

Prospective Cohort ◽

Functional Decline ◽

Long Term Outcomes ◽

One Year

Introduction: Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients. Methods: Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified “VIDA” questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes. Results: 297 patients were included in the present study. 12.8% died during hospitalization and 86 patients (33.2%) died within one year after hospital discharge. Functional status prior to hospital admission, measured by the VIDA questionnaire (e.g., one point increase), was associated with a lower hazard of all-cause mortality during follow-up (Hazard Ratio [HR]: 0.96; 95% Confidence Interval [CI]: 0.94–0.98). Finally, functional decline measured at 15 days after hospital discharge, was associated with higher risk of all-cause death during follow-up (HR: 2.19, 95% CI: 1.09–4.37) Conclusion: Pre-morbid functional status impacts long term outcomes after unplanned hospitalizations in elderly adults. Future studies should confirm these findings and evaluate the potential impact on clinical decision-making.

Download Full-text

Association between advanced glycation end-products and functional performance in Alzheimer's disease and mixed dementia

International Psychogeriatrics ◽

10.1017/s1041610217000886 ◽

2017 ◽

Vol 29 (9) ◽

pp. 1525-1534 ◽

Cited By ~ 6

Author(s):

Hans Drenth ◽

Sytse U. Zuidema ◽

Wim P. Krijnen ◽

Ivan Bautmans ◽

Cees van der Schans ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Advanced Glycation End Products ◽

Functional Performance ◽

Early Stage ◽

Functional Decline ◽

Mixed Dementia ◽

Advanced Glycation ◽

Glycation End Products ◽

End Products ◽

One Year

ABSTRACTBackground:People with Alzheimer's disease (AD) experience, in addition to the progressive loss of cognitive functions, a decline in functional performance such as mobility impairment and disability in activities of daily living (ADL). Functional decline in dementia is mainly linked to the progressive brain pathology. Peripheral biomechanical changes by advanced glycation end-products (AGEs) have been suggested but have yet to be thoroughly studied.Methods:A multi-center, longitudinal, one-year follow-up cohort study was conducted in 144 people with early stage AD or mixed Alzheimer's/Vascular dementia. Linear mixed model analyses was used to study associations between AGE-levels (AGE reader) and mobility (Timed Up and Go), and ADL (Groningen Activity Restriction Scale and Barthel index), respectively.Results:A significant association between AGE levels and mobility (β = 3.57, 95%CI: 1.43–5.73) was revealed; however, no significant association between AGE levels and ADL was found. Over a one-year time span, mean AGE levels significantly increased, and mobility and ADL performance decreased. Change in AGE levels was not significantly correlated with change in mobility.Conclusions:This study indicates that high AGE levels could be a contributing factor to impaired mobility but lacks evidence for an association with ADL decline in people with early stage AD or mixed dementia. Future research is necessary on the reduction of functional decline in dementia regarding the effectiveness of interventions such as physical activity programs and dietary advice possibly in combination with pharmacologic strategies targeting AGE accumulation.

Download Full-text

One-Year Risk of Institutionalization in Demented Outpatients With Caretaking Relatives

International Psychogeriatrics ◽

10.1017/s1041610297004328 ◽

1997 ◽

Vol 9 (2) ◽

pp. 175-182 ◽

Cited By ~ 11

Author(s):

Kati Juva ◽

Matti Mäkelä ◽

Raimo Sulkava ◽

Timo Erkinjuntti

Keyword(s):

Home Care ◽

Activities Of Daily Living ◽

Daily Living ◽

Functional Decline ◽

Good Prognosis ◽

Main Concern ◽

Home Based ◽

One Year ◽

Functional Problems ◽

At Home

In order to determine the factors associated with good and poor 1-year prognosis of demented patients, the caretakers of 100 home-based patients attending a specialist memory clinic were inteviewed. After the follow-up, 71% continued to live at home. Mild dementia, independence in activities of daily living, fair independence in functions of instumental activities of daily living, and lack of depression were clear signs for a good prognosis. Some patients with severe dementia and poor functional capacity continued to live at home. Continuing home care was also more likely if memory impairment, as opposed to functional problems, was expressed as the main concern. The proportion of caretakers mentioning memory decline as the main problem decreased during 1 year from 38% to 9% and the proportion mentioning functional problems increased from 48% to 64% among those continuing in home care. Memory disturbances are the first to appear and cause problems, but only functional decline threatens living at home.

Download Full-text

Abstract 17085: The Modified US Heart Allocation System Improves Waitlist Mortality for Patients With Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.17085 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mark R Helmers ◽

Cody Fowler ◽

Peter Altshuler ◽

Amit Iyengar ◽

Jason J Han ◽

...

Keyword(s):

Functional Decline ◽

Heart Transplants ◽

Allocation Policy ◽

Bridge To Transplant ◽

Allocation System ◽

Transplant Patients ◽

October 17 ◽

One Year ◽

Waitlist Mortality ◽

New System

Introduction: On October 18, 2018, the US donor heart allocation policy was restructured to better stratify patients, decrease status exemptions, and improve inequities. Previously, HCM patients experienced significant waitlist mortality and functional decline, often requiring status exemptions to be transplanted. This study aims to examine changes in waitlist mortality and transplant rates of HCM patients in the new system. Methods: Retrospective analysis was performed of the UNOS Transplant Database for all isolated adult single-organ heart transplant patients listed between April 20, 2008 and December 6, 2019. Redo heart transplants were excluded. Patients were grouped by diagnosis (HCM or ICM & NICM) and divided into eras based on allocation system. Era 1 spanned April 20 th , 2008 to October 17 th , 2018 and Era 2 spanned October 18 th , 2018 to December 6 th , 2019. Results: During the study period, 28,930 patients were listed, with 26,354 in Era 1 (750 HCM, 2.8%) and 2,576 in Era 2 (107 HCM, 4.2%). Across eras, no differences in age, ethnicity, gender, dialysis, and mechanical ventilation were noted among HCM patients (p>0.05). ECMO usage for HCM at listing was 1.3% in Era 1 vs 2.8% in Era 2 (p=0.557). Use of bridge-to-transplant LVADs remained low in HCM patients (Era 1: 4.3% vs Era 2: 1.9%, p=0.505). Status upgrades for HCM patients decreased from 49% to 39% (p=0.06). Waitlist survival was improved in Era 2 for HCM patients (Figure 1, p=0.001). Transplant rates trended higher in Era 2 for HCM (Figure 1, p=0.344). Thirty-day mortality post-transplant in HCM patients was 2.36% in Era 1 and 1.47% in Era 2 (p=0.643). Conclusions: The new allocation system has led to significantly increased one-year waitlist survival and a near-significant decrease in status upgrades for HCM patients. Moreover, HCM patients trended towards higher transplant rates and shorter waitlist times in the new system. Continued investigation of listing practices and outcomes of HCM patients is warranted.

Download Full-text

Risk factors for functional decline and institutionalisation among community-dwelling older adults with mild to severe Alzheimer’s disease: one year of follow-up

Age and Ageing ◽

10.1093/ageing/afj059 ◽

2006 ◽

Vol 35 (3) ◽

pp. 308-310 ◽

Cited By ~ 17

Author(s):

Maria E. Soto ◽

Sandrine Andrieu ◽

Sophie Gillette-Guyonnet ◽

Christelle Cantet ◽

Fati Nourhashemi ◽

...

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Functional Decline ◽

Community Dwelling ◽

One Year ◽

Community Dwelling Older Adults

Download Full-text

Severe falls among older adults with resected stage II/III colon cancer receiving chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14550 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14550-e14550

Author(s):

Noelle K. LoConte ◽

Glenn Allen ◽

Ticiana A.B. Leal ◽

Jennifer Weiss ◽

Heather B. Neuman ◽

...

Keyword(s):

Colon Cancer ◽

Multinomial Logistic Regression ◽

Functional Decline ◽

Cognitive Change ◽

Stage Ii ◽

Medicare Beneficiaries ◽

Logistic Regression Models ◽

Resected Stage ◽

One Year ◽

Medicare Database

e14550 Background: Falls have significant implications for morbidity and mortality. The etiology of falls in elders includes cognitive change, polypharmacy, dizziness and anemia, all of which can be exacerbated by chemotherapy (chemo). We sought to determine the relation between chemotherapy receipt and falls resulting in injury and/or death among elders with colon cancer. Methods: Medicare beneficiaries >64 years with resected stage II or III colon cancer diagnosed from 1992-2005 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Falls within one year of surgery that resulted in hospitalization or ER visit were defined by E-codes. χ2 and 2-way ANOVA assessed differences in falls resulting or not resulting in death. Multivariable multinomial logistic regression models predicted a four-level falling/mortality variable (not falling (death), falling (death), not falling (no death), and falling (no death)) for patients receiving or not receiving chemo. Models controlled for patient demographics and tumor characteristics. We further controlled for use of mobility device, surgical complications, falls, hospitalizations and ER visits in the year before surgery, comorbidity risk score, frailty including dementia, and Medicaid status. Adjusted predicted probabilities and 95% CIs were calculated to assess the probability of each of the four outcome categories by receipt of chemotherapy. Results: Among 36,781 elders, falling was not increased among those who received adjuvant chemo. 14% of the total population fell during the year following surgery. The receipt of chemotherapy was not associated with increased rates of falls. Conclusions: Falling is not increased with the use of adjuvant chemo for stage II and III colon cancer among adults aged 65 years and above. The results suggest that oncologists may choose patients at least risk for functional decline when deciding upon chemo. [Table: see text]

Download Full-text