scholarly journals Factors associated with length of stay in hospital among the elderly patients using count regression models

2021 ◽  
Author(s):  
Arezoo Orooji ◽  
Eisa Nazar ◽  
Masoumeh Sadeghi ◽  
Ali Moradi ◽  
Zahra Jafari ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Regression Models ◽  
The Elderly ◽  
Factors Associated

scholarly journals Mortality due to acquired immunodeficiency syndrome and associated social factors: a spatial analysis

2020 ◽  
Vol 73 (suppl 5) ◽  
Author(s):  
Thatiana Araújo Maranhão ◽  
Carlos Henrique Alencar ◽  
Mônica de Avelar Figueiredo Mafra Magalhães ◽  
George Jó Bezerra Sousa ◽  
Leonardo Miranda Ribeiro ◽  
...  
Keyword(s):  
Social Factors ◽  
Regression Models ◽  
Ecological Study ◽  
Spatial Regression ◽  
Social Indicators ◽  
The Elderly ◽  
Income Generation ◽  
Factors Associated ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

ABSTRACT Objective: To analyze the spatial pattern of AIDS mortality and social factors associated with its occurrence. Methods: An ecological study that considered 955 AIDS deaths of residents in Piauí, reported in the Mortality Information System (MIS) from 2007 to 2015. Non-spatial and spatial regression models were used to identify social determinants of AIDS mortality, with a significance of 5%. Results: The predictors of AIDS mortality were illiteracy rate in males (p = 0.020), proportion of households with water supply (p = 0.015), percentage of people in households with inadequate walls (p = 0.022), percentage of people in households vulnerable to poverty and in whom no one has completed primary education (p = 0.000) and percentage of people in households vulnerable to poverty and dependent on the elderly (p = 0.009). Conclusion: Social indicators related to education, job and income generation and housing were associated with AIDS mortality.

P6260ACS-group 75+: real clinical practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Kruchinova ◽  
S A Raff
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Clear Trend ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Frequent Use ◽  
Receive Treatment ◽  
Common Manifestation ◽  
Real Clinical Practice

Abstract Purpose to evaluate the features of treatment and outcomes in elderly patients with acute coronary syndrome. Methods The elderly group comprised 2385 (28.9%) patients ≥75 years of the 8249 patients enrolled in the KRACS registry. Results When comparing patients of different ages, it was shown that among the elderly, dyspnoea was the most common manifestation of ACS, 9% vs 4% (p=0.015), they were less often hospitalized in “invasive” hospitals - 36% vs 49% (p=0.003), At admission, they often had the class Killip ≥ II - 36% vs 17% (p<0.001), a high risk for the GRASE-68% vs 30% (p<0.001). In addition, in elderly patients significantly lowered levels of Hb and increased creatinine were detected more often. Drug treatment of elderly patients was characterized by less frequent use of ticagrelor - 3% vs 21% (p<0.001), LMWH or fondaparinux - 4% vs 12% (p=0.004). Thrombolytic therapy in STEMI in the elderly was more often streptokinase - 30% vs 18% (p=0.04), less often - tissue activator plasminogen - 2% vs 10% (p=0.03). The frequency of performing any invasive interventions for any type of ACS in elderly patients was significantly lower - 16.7% vs 46.3% (p<0.0001), and the incidence of fatal outcomes during hospitalization for any type of ACS was significantly higher - 16, 0% vs 6.1% (p<0.0001). When assessing the incidence of fatalities in different facilities, it was found that STEMI, patients ≥75 years old hospitalized in “invasive” hospitals died significantly less frequently than when they got into “non-invasive” hospitals - 15.6% vs 50.0% (p=0.013). At the same time, among patients <75 years hospital mortality in “invasive” and “non-invasive” hospitals was not significantly different - 14.7% vs 9.9% (p=0.50). There was also a clear trend towards a higher incidence of deaths among elderly patients who were left without PCI, compared with those who had been intervened. In patients <75 years, this trend was absent. Conclusion thus, the results obtained indicate that elderly patients, with a higher risk and worse outcomes, receive treatment that is less consistent with the requirements of modern guidelines for the treatment of ACS. Important factors associated with better outcomes in elderly patients is their hospitalization in “invasive” hospitals and the implementation of PCI.

scholarly journals Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

2020 ◽  
Vol 34 (11) ◽  
pp. 4727-4740 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Santhosh Karri ◽  
James R. Bundred ◽  
Richard P. T. Evans ◽  
Aaron Lin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Elderly Population ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Bile Leaks

Abstract Background Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. Method A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. Results This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI95% 2.00–2.78), major complication (OR 1.79, CI95% 1.45–2.20), risk of conversion to open cholecystectomy (OR 2.17, CI95% 1.84–2.55), risk of bile leaks (OR 1.50, CI95% 1.07–2.10), risk of postoperative mortality (OR 7.20, CI95% 4.41–11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI95% 1.24–3.18). Conclusion Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cut-offs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent.

scholarly journals Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Lili Yu ◽  
Yanbin Zhu ◽  
Wei Chen ◽  
Hui Bu ◽  
Yingze Zhang
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Individual Risk ◽  
Factors Associated ◽  
Postoperative Stroke

Abstract Objectives Stroke is one of the rare but devastating complications after hip fracture in the elderly. By far, there is still scarce data on postoperative stroke in elderly patients with hip fractures. Methods This was a retrospective study of prospectively collected data. Between October 2014 to December 2018, patients aged above 65 years who underwent operative treatment for hip fractures were included. Inpatient medical surveillance and scheduled telephone follow-up at 1, 3, 6, and 12 months after operation was conducted to identify who developed an incident stroke. Variables of interests were extracted from patients’ inpatient medical records. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors associated with stroke. Results During the study period, a total of 3743 patients were included, among whom 56 were found to have a stroke after operation, representing an incidence of 1.5% (95% CI, 1.1 to 1.9%). The multivariate analyses showed that advanced age (1-year increment; OR, 1.32; 95% CI, 1.08 to 1.48), history of previous stroke (OR, 4.79; 95% CI, 1.86 to 6.56), ASA III and above (OR, 2.62; 95% CI, 1.27 to 3.68), long-term use of aspirin (OR, 3.63; 95% CI, 1.41 to 4.78), and elevated RDW level (each increment of 1%, OR, 1.21; 95% CI, 1.02 to 1.36) were independently associated with postoperative stroke. Conclusions Although most are not modifiable, these risk factors help in counseling patients regarding the risk of postoperative stroke, individual risk stratification, and targeted optimization of medical conditions and should be firmly kept in treating surgeon’s mind.

scholarly journals PENGARUH HASIL SKRINING BERDASARKAN METODE MNA (MINI NUTRITIONAL ASSESTMENT) TERHADAP LAMA RAWAT INAP DAN STATUS PULANG PASIEN LANJUT USIA DI RSUP DR. SARDJITO YOGYAKARTA

2017 ◽  
Vol 13 (1) ◽  
pp. 69
Author(s):  
Wahyu Hardi Prasetyo ◽  
I Dewa Putu Pramantara ◽  
R. Dwi Budiningsari
Keyword(s):  
At Risk ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Elderly People ◽  
The Elderly ◽  
Nutrition Status ◽  
Inpatient Ward ◽  
Discharge Status ◽  
Initial Hospitalization ◽  
Nutrition Problem

Abstract: The number of elderly people (over 60 years old) is growing rapidly in this 21th century, reaching as many as 425 millions (+ 6,8%) worldwide in 2000. This figure is estimated almost twice in 2025. In Indonesia, percentage the elderly people in 1995 was as much as 7.5%. In line with the increasing of live expectancy the number of the elderly will grow bigger. This is related to greater need of health service for the elderly. In older people, nutrition problem is closely associated with disease. One factor that causes nutrition problem in the elderly is the increase of morbidity. Increased risk for disease and nutrition problem in the elderly requires early identification of risk for malnutrition in the elderly. Routine assessment of preliminary nutrition status of patients being hospitalized is essential in order to get an overview of nutrition status patients at a time, detect high risk patients and help to identify nutrition treatment specifically for each patient so that appropriate nutrition support can be given to improve nutrition status of patient. The study aimed to identify impact of result screening nutrition based on MNA  method to length of stay and discharge status of elderly patients at inpatient ward of internal medicine and neurology of Dr Sardjito Hospital Yogyakarta. The study was observational that used prospective cohort design and was undertaken at inpatient ward of internal in medicine and neurology of Dr. Sardjito,  Yogyakarta in August-November 2009. Data were collected by the researcher with the help of an enumerator, i.e. nutritionist at inpatient ward. The result of study showed that impact of result screening during initial hospitalization to length of stay of elderly patients based on MNA method was RR 1.63. This indicated that malnourished patients were at risk for being hospitalized > 7 days 1.63 times longer than those not malnourished. Impact  of  result screening during initial hospitalization to discharge status  of elderly patients based on MNA method was RR 1.29. This indicated that malnourished patient were at risk for uncovered discharged as much as 1.29 greater than those not malnourished. There was impact of result screening in admission to length of stay. There was impact of nutrition status to length of discharged status.  Keywords: discharge home, length of stay, nutritional status in initial admission   Abstrak: Pertumbuhan penduduk lanjut usia (umur ≥60 tahun) meningkat secara cepat pada abad 21 ini, yang pada 2000 di seluruh dunia telah mencapai 425 juta jiwa (± 6,8%). Jumlah ini diperkirakan akanmengalami peningkatan hampir dua kali lipat pada 2025. Di Indonesia, persentase lanjut usia pada 1995 mencapai 7,5%. Dengan meningkatnya angka harapan hidup, jumlah lanjut usia pun akan bertambah banyak. Hal ini terkait dengan perlunya peningkatan pelayanan kesehatan lanjut usia. Pada lanjut usia, masalah gizi erat kaitannya dengan penyakit. Salah satu faktor yang menyebabkan lanjut usia menjadi rawan gizi yaitu peningkatan morbiditas penyakit (Darmojo, 2006). Dengan meningkatnya risiko penyakit dan disertai gangguan nutrisi pada lanjut usia, sehingga perlu dilakukan identifikasi risiko malnutrisi pada lanjut usia sedini mungkin. Penilaian status gizi awal pasien masuk rumah sakit sangat penting  dilakukan secara rutin karena dapat menggambarkan status gizi pasien saat itu, mendeteksi pasien-pasien yang beresiko tinggi dan membantu mengidentifikasi perawatan gizi secara spesifik pada masing-masing pasien sehingga dukungan nutrisi yang tepat dapat diterapkan untuk meningkatan status gizi pasien. Untuk mengetahui pengaruh hasil skrining awal berdasarkan metode MNA (Mini Nutritional Assessment) terhadap lama rawat inap dan status pulang pasien lanjut pada ruang rawat inap penyakit dalam dan saraf di RSUP Dr.Sardjito Yogyakarta. Jenis penelitian ini adalah penelitian observasional dengan menggunakan rancangan kohort prospektif. Penelitian ini dilakukan di ruang rawat inap penyakit dalam dan  saraf pada pasien lanjut usia  di Rumah Sakit Umum Pusat Dr. Sardjito Yogyakarta. Penelitian dilaksanakan pada bulan Agustus-November 2009. Pengumpulan data dilakukan oleh peneliti dengan bantuan enumerator yaitu  ahli gizi yang bertugas di ruang rawat inap. Berdasarkan hasil skrining dengan metode MNA pada  pasien lanjut usia terhadap lama rawat inap, maka diketahui bahwa nilai RR=1,63. Hal ini menunjukkan bahwa pasien yang terpapar (malnutrisi) berisiko dirawat selama ≥ 7 hari adalah 1,63 kali lebih besar daripada pasien yang tidak terpapar (tidak malnutrisi). Berdasarkan hasil regresi logistik tidak ada pengaruh antara hasil skrining dengan lama rawat inap. Ada pengaruh secara statistik antara usia, jenis penyakit dan kelas perawatan terhadap lama rawat inap. Berdasarkan hasil regresi logistik, jenis penyakit memiliki pengaruh yang paling dominan dengan nilai RR  3,88 terhadap lama rawat inap.Berdasarkan hasil skrining awal masuk rumah sakit terhadap status pulang pasien lanjut usia berdasarkan metode MNA, maka diketahui nilai RR=1,29. Hal ini menunjukkan bahwa pasien yang terpapar (malnutrisi) berisiko keluar dalam keadaan tidak sembuh sebesar 1,29 kali lebih besar daripada pasien yang tidak terpapar (tidak malnutrisi). Berdasarkan hasil uji regresi logistik ada pengaruh antara hasil skrining dengan status pulang dengan nilai OR 9,21. Demikian pula ada pengaruh antara usia dan jenis kelamin dengan status pulang (p< 0,05). Tidak ada pengaruh antara hasil skrining dengan lama rawat inap. Ada pengaruh antara usia, jenis penyakit dan kelas perawatan terhadap lama rawat inap. Ada pengaruh antara hasil skrining dengan status pulang. Kata-kata kunci: skrining, lama rawat inap, status pulang pasien

scholarly journals Outcomes of an accelerated nonsurgical management protocol for hip fractures in the elderly

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880340 ◽  
Author(s):  
Wei Xiang Lim ◽  
Ernest Beng Kee Kwek
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Hip Fractures ◽  
The Elderly ◽  
Operative Management ◽  
Nonsurgical Treatment ◽  
P Value ◽  
Complication Rates ◽  
Nonsurgical Management ◽  
Management Protocol

The majority of hip fractures in elderly patients are managed surgically with superior outcomes. However, for patients who refuse surgery or are deemed medically unfit, traction used to be the mainstay of nonsurgical treatment, which is associated with prolonged hospitalization and inpatient complications from immobility. This study, therefore, aims to evaluate the outcomes of an early wheelchair mobilization protocol as an alternative nonsurgical treatment option. This is a retrospective study of 87 elderly patients who were managed nonsurgically for their hip fractures over a 1-year period. The accelerated rehabilitation protocol did not have them on traction but were instead mobilized with assistance as soon as possible after admission. Variables collected electronically include patient demographics, fracture characteristics, inpatient mobilization milestones, inpatient complications, Modified Functional Ambulation Classification (MFAC), Modified Barthel Index (MBI) scores, and radiological findings. Patients who were younger, could sit up earlier and had a shorter length of stay, were able to ambulate better at 6 months ( p value < 0.05). Patients with femoral neck fractures and shorter length of stay had better MFAC scores. A total of 58% of patients with radiological follow-up had displacement of their fractures with age, type of fracture, and length of stay as predictors ( p value < 0.05) The Charlson’s score, day to sitting up, and day to transfer affect fracture healing ( p value < 0.05). The mean length of stay was 17 days and the 1-year mortality was 18%. Surgical therapy remains the preferred choice of management for patients with hip fractures. Early wheelchair mobilization leads to a shorter length of stay compared to traditional traction methods and comparable 1-year mortality rates with operative management. Despite this, complication rates remain high and only 48% of patients achieved ambulation by 1 year, with healing in only 24% of fractures.

To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

2018 ◽  
Vol 32 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Albert H. Zhou ◽  
Sei Y. Chung ◽  
Michael J. Sylvester ◽  
Michael Zaki ◽  
Peter S. Svider ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
The Elderly ◽  
Primary Diagnosis ◽  
Pulmonary Complications ◽  
Nasal Packing ◽  
Hospital Charges ◽  
Cardiac Complications ◽  
The Impact

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

scholarly journals Antibiotics prescription and guidelines adherence in elderly: impact of the comorbidities

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anthony Dylis ◽  
Anne Sophie Boureau ◽  
Audrey Coutant ◽  
Eric Batard ◽  
François Javaudin ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Charlson Comorbidity Index Score ◽  
Rehabilitation Services ◽  
Multivariable Logistic Regression Analysis ◽  
Negatively Associated ◽  
Factors Associated ◽  
Comorbidity Index ◽  
Guidelines Adherence ◽  
High Comorbidity

Abstract Background Although the interest of antibiotics is well known, antibiotics prescription is associated with side effect, especially in patients with multiples comorbidities. One way to reduce the incidence of side effects is to respect antibiotics prescriptions guidelines. Our objective was to investigated the factors associated with guidelines adherence in elderly patients with multiples comorbidities. Methods From October 2015 to December 2016, antibiotics prescription and guidelines adherence were analyzed in two post-acute care and rehabilitation services of a 2600-bed, university-affiliated center. Results One hundred and twenty-eight patients were included, fifty-nine (46%) patients had antibiotics prescription according to guidelines. In Multivariable logistic regression analysis, prescription of 2 antibiotics or more (OR = 0.168, 95% IC = 0.037–0.758, p < 0.05), 85 years of age and more (OR = 0.375, 95% IC = 0.151–0.931, p < 0.05) and the Charlson comorbidity index score (OR = 0.750, 95% IC = 0.572–0.984, p < 0.05) were negatively associated with antibiotics prescriptions according to guidelines. Conclusions High comorbidity in the elderly was negatively associated with the guidelines adherence of antibiotiсs prescriptions. These criteria should be considered to optimize antibiotics prescriptions in elderly patients.

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