scholarly journals Prediction model to delirium in hospitalized elderly people

2021 ◽  
Author(s):  
Wylson Azevedo ◽  
Eduardo Augusto Schutz ◽  
Mayara Menezes Attuy ◽  
Thamara Graziela Flores ◽  
Melissa Agostini Lampert
Keyword(s):  
Elderly People ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Charlson Index ◽  
Hospital Environment ◽  
Cross Sectional ◽  
Predictive Variables ◽  
Hospitalized Elderly ◽  
One Year ◽  
The Impact

Introduction: Delirium has a high prevalence in hospitalized elderly patients. This is due to low hospital detection and the absence of a screening instrument. Objective: evaluate predictive variables in the development of delirium in na in-hospital environment. Methods: Cross-sectional study. Data collection was carried out between 2015-2016, with a sample of 493 elderly people. The variables used were age, sex, the reason for hospitalization, Identification of Elderly at Risk (ISAR), delirium during hospitalization using the Confusion Assessment Method, frailty using the Edmonton Scale, the impact of comorbidities by the Charlson Index and hospital immobility. Predictive variables were identified through logistic regression. Results: 469 elderly people were taken. The presence of delirium during hospitalization was mostly observed between 80 and 89 years old (n = 12), female (n = 16), with the most common reasons for hospitalization due to fractures (n = 6) and accident brain vascular (n = 11), 79% chance of surviving in one year using the Charlson Index (n = 11) and with ISAR> 2 (n = 26). There are important associations for the development of delirium for patients who have a 98% chance of surviving in one year (p = 0.05) and with ISAR <2 (p = 0.027), with a 34% increased chance and 38%, respectively. Conclusion: It is observed that, by the results, the predictive variables of inhospital delirium are patients with a 98% chance of survival and with ISAR <2.

scholarly journals Survival Analysis of Hospitalized Elderly People with Fractures in Brazil Over One Year

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Brenda Kelly Gonçalves Nunes ◽  
Brunna Rodrigues de Lima ◽  
Lara Cristina da Cunha Guimarães ◽  
Rafael Alves Guimarães ◽  
Claci Fátima Weirich Rosso ◽  
...  
Keyword(s):  
Elderly People ◽  
Cox Regression ◽  
Age Groups ◽  
The Elderly ◽  
Diabetic Patients ◽  
Related Factors ◽  
Hospitalized Elderly ◽  
Study Results ◽  
One Year ◽  
The Impact

Objective: This study analyzes the causes of death, survival, and other related factors in hospitalized elderly people with fractures over the course of one year. Methods: We followed 376 fracture patients for one year in a prospective cohort study to a reference hospital in central Brazil. The Cox regression model was used to analyze factors associated with survival. Results: The results indicate that the one-year mortality rate was high (22.9%). The independent factors linked to lower overall survival were as follows: patients aged ≥80 years with previous intensive care unit (ICU) admission and presence of comorbidities (diabetes mellitus [DM] and dementia). Conclusion: Our study results may contribute to a better understanding of the impact of fractures on the elderly population and reinforce the need to oversee age-groups, diabetic patients, and patients with complications during hospitalization.

scholarly journals Delirium in elderly inpatients admitted to clinical wards Prevalence and investigation of clinical conditions in a Brazilian sample

2018 ◽  
Vol 12 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Fernando de Bortoli Pereira ◽  
Marcos Antonio Lopes
Keyword(s):  
Elderly Patients ◽  
Confusion Assessment Method ◽  
Cross Sectional Study ◽  
Assessment Method ◽  
Cross Sectional ◽  
Brazilian Sample ◽  
Medical Diagnoses ◽  
Hospitalized Elderly ◽  
Elderly Inpatients ◽  
Risk Patients

Abstract In Brazil there is scarce data about the occurrence of delirium among hospitalized elderly patients. Objective: This study aimed to evaluate the prevalence of delirium among elderly patients hospitalized in clinical wards. Methods: This cross-sectional study examined a sample of elderly inpatients admitted to three clinical wards of a general hospital between July 2011 and May 2012. The presence of delirium was detected by applying the Confusion Assessment Method (CAM). Dementia diagnosis was conducted in two steps: screening and diagnosis (Cambridge Examination, CAMDEX, was applied during hospitalization at a second timepoint). Other medical diagnoses and medications in use were extracted from medical records. Results: A sample of 173 elderly inpatients was examined; mean age 71.2 years (SD: 7.8; 60-92 years); 64.2% male. Thirty-one patients were diagnosed with delirium; prevalence of 17.9% (95% CI: 12.2-23.6). Delirium was directly associated with Urinary Tract Infection, Renal Failure and Dementia (p<0.05). Conclusion: The principal findings of this study were a high prevalence of delirium and the identification of associated factors, helping to guide preventive approaches and clinical management for at-risk patients in a Brazilian sample.

A multifaceted intervention package to improve the diagnosis and management of delirium

2014 ◽  
Vol 27 (2) ◽  
pp. 337-342 ◽  
Author(s):  
J. Fleet ◽  
S. Chen ◽  
F.C. Martin ◽  
T. Ernst
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multifaceted Intervention ◽  
Junior Doctors ◽  
Intervention Package ◽  
Post Intervention ◽  
Convenience Sample ◽  
Pharmacological Management ◽  
Hospital Patients ◽  
The Impact

ABSTRACTBackground:Delirium is a major cause of morbidity and mortality amongst hospital patients. Previous studies have shown that it is often poorly recognized and managed. We wanted to assess the impact of a multifaceted intervention on delirium management.Methods:A pre/post-intervention design was used. The local hospital delirium guideline was adapted into A7 sized cards and A3/A2 posters. Cards were distributed to junior doctors and teaching sessions were held. Computer screen savers were displayed and delirium promotion days held. The pre/post-intervention data were used to audit the following: delirium knowledge through questionnaires, documented use of the confusion assessment method (CAM) and identification and management of eight common precipitating factors. Re-audit was four months post baseline with interventions within this period. χ2 tests were used for statistical analysis.Results:A convenience sample of randomly selected doctors in postgraduate training posts completed 100 questionnaires and 25 clinical notes were selected via retrospective identification of delirium. Results from questionnaires demonstrated significant improvements in: recognizing CAM as the diagnostic tool for delirium (24% vs. 71%, p < 0.01); identifying haloperidol as first line in pharmacological management (55% vs. 98%, p <0.01) and its correct dose (40% vs. 67%, p <0.01). In clinical practice, there was significant improvement in documentation of CAM for inpatient delirium assessments (0% vs. 77%, p <0.01). Trainees found the delirium card “very helpful” (82%) and carried it with them at all times (70%).Conclusion:This multifaceted intervention increased CAM use in delirium recognition and improved the knowledge of pharmacological management. The delirium card was highly popular.

scholarly journals Comorbidity and Healthcare Expenditure in Women with Osteoporosis Living in the Basque Country (Spain)

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Roberto Nuño-Solinis ◽  
Carolina Rodríguez-Pereira ◽  
Edurne Alonso-Morán ◽  
Juan F. Orueta
Keyword(s):  
Healthcare Cost ◽  
Healthcare Expenditure ◽  
Basque Country ◽  
Clinical Care ◽  
Population Group ◽  
Deprivation Level ◽  
Chronic Patients ◽  
Cross Sectional ◽  
One Year ◽  
The Impact

Objectives.This study aimed to establish the prevalence of multimorbidity in women diagnosed with osteoporosis and to report it by deprivation index. The characteristics of comorbidity in osteoporotic women are compared to the general female chronic population, and the impact on healthcare expenditure of this population group is estimated.Methods.A cross-sectional analysis that included all Basque Country women aged 45 years and over (N= 579,575) was performed. Sociodemographic, diagnostic, and healthcare cost data were extracted from electronic databases for a one-year period. Chronic conditions were identified from their diagnoses and prescriptions. The existence of two or more chronic diseases out of a list of 47 was defined as multimorbidity.Results.9.12% of women presented osteoporosis and 85.04% of them were multimorbid. Although multimorbidity in osteoporosis increased with age and deprivation level, prevalence was higher in the better-off groups. Women with osteoporosis had greater risk of having other musculoskeletal disorders but less risk of having diabetes (RR = 0.65) than chronic patients without osteoporosis. People with poorer socioeconomic status had higher healthcare cost.Conclusions.Most women with osteoporosis have multimorbidity. The variety of conditions emphasises the complexity of clinical management in this group and the importance of maintaining a generalist and multidisciplinary approach to their clinical care.

scholarly journals Cardiovascular risk factors associated with frailty syndrome among hospitalized elderly people: a cross-sectional study

2016 ◽  
Vol 134 (5) ◽  
pp. 393-399 ◽  
Author(s):  
Darlene Mara dos Santos Tavares ◽  
Camila Gigante Colamego ◽  
Maycon Sousa Pegorari ◽  
Pollyana Cristina dos Santos Ferreira ◽  
Flávia Aparecida Dias ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Elderly People ◽  
Cross Sectional Study ◽  
Frailty Syndrome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Hospitalized Elderly

ABSTRACT CONTEXT AND OBJECTIVE: Identification of frailty syndrome and its relationship with cardiovascular risk factors among hospitalized elderly people is important, since this may contribute towards broadening of knowledge regarding this association within tertiary-level services. This study aimed to evaluate the cardiovascular risk factors associated with frailty syndrome among hospitalized elderly people. DESIGN AND SETTING: Observational cross-sectional study in a public teaching hospital. METHODS: The participants were elderly patients admitted to clinical and surgical wards. The cardiovascular risk factors assessed were: body mass index (BMI), waist circumference, systemic arterial hypertension (SAH), blood glucose, total cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL) and triglycerides. To identify frailty syndrome, the method proposed by Fried was used. The data were analyzed through descriptive statistics, chi-square test (P < 0.10) and multinomial logistic regression (P < 0.05). RESULTS: A total of 205 individuals were evaluated. It was found that 26.3% (n = 54) of the elderly people were frail, 51.7% (n = 106) were pre-frail and 22% (n = 45) were non-frail. The preliminary bivariate analysis (P < 0.10) for the regression model showed that frailty was associated with BMI (P = 0.016), LDL cholesterol (P = 0.028) and triglycerides (P = 0.093). However, in the final multivariate model, only overweight remained associated with the pre-frail condition (odds ratio, OR = 0.44; 95% confidence interval, CI = 0.20-0.98; P = 0.045). CONCLUSION: States of frailty were highly present in the hospital environment. The pre-frail condition was inversely associated with overweight.

scholarly journals Hubungan Faktor Demografi Dan Dukungan Sosial Dengan Depresi Pascasalin

2018 ◽  
Vol 11 (2) ◽  
Author(s):  
Nurfatimah Nurfatimah ◽  
Cristina Entoh
Keyword(s):  
Social Support ◽  
Postnatal Depression ◽  
Economic Status ◽  
Depression Scale ◽  
Dominant Factor ◽  
Research Subjects ◽  
Cross Sectional ◽  
One Year ◽  
The Impact ◽  
The Relationship

Postnatal depression is a mental disorder after the birth of her child and can last up to one year. Maternal postnatal mood disorder not an easy matter. The impact can be devastating life of the mother and her child. Currently there are many women who experienced postnatal depression but has not been detected. The purpose of this study was to analyze the relationship between demographic factors and social support in postnatal depression in The Working Area Of Puskesmas Kayamanya.The design of this research is cross sectional. Research subjects were followed for 56 respondents ranging from childbirth to 7 days postnatal. The samples was chosen by using consequtive sampling. The instruments used in this research are the Edinburgh Postnatal Depression Scale (EPDS) and standard social support questionnaire. The results reveal that the age is not significantly associated with depression postnatal (p = 0.514) and education (p = 0.154); but it is significantly parity (p = 0.012); economic status (p = 0.030), social support include the family (p = 0.035); friends (p = 0.017); and midwives (p = 0.005). The multivariate analysis reveals that midwifes support (wald=4,236; p= 0,04) is the dominant factor causing postnatal depression.

scholarly journals A study of etiological profile of acute confusional state

2019 ◽  
Vol 7 (1) ◽  
pp. 138
Author(s):  
Jaspreet Kaur ◽  
Gurinder Mohan ◽  
S. B. Nayyar ◽  
Ranjeet Kaur
Keyword(s):  
Hospital Stay ◽  
The Elderly ◽  
Final Diagnosis ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Acute Confusional State ◽  
Provisional Diagnosis ◽  
Metabolic Encephalopathy ◽  
Common Diagnosis ◽  
One Year

Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77±18.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6±3.67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.

scholarly journals High rate of major drug–drug interactions of lopinavir–ritonavir for COVID-19 treatment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Juan Macías ◽  
Ana Pinilla ◽  
Francisco A. Lao-Dominguez ◽  
Anaïs Corma ◽  
Enrique Contreras-Macias ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Drug Interactions ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Charlson Index ◽  
High Rate ◽  
Cross Sectional ◽  
Concomitant Medications ◽  
The Impact ◽  
Major Drug

AbstractThe impact of drug–drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI 69–85%) patients, and in 33 (26%, 95% CI 19–35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p = 0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥ 5: 85 (10–731), p < 0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04–0.53), p = 0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.

Abstract P194: A Prospective Study of the Association of Flushing Bother, Impact, Treatment Satisfaction and Discontinuation of Niacin Therapy

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Josephine M Norquist ◽  
Jane Liao ◽  
Tiffany B Miller ◽  
Lori D Bash ◽  
Douglas J Watson ◽  
...  
Keyword(s):  
Side Effects ◽  
Real World ◽  
Treatment Satisfaction ◽  
Patient Adherence ◽  
Alternative Methods ◽  
Cross Sectional ◽  
Niacin Therapy ◽  
One Year ◽  
A Prospective Study ◽  
The Impact

Background: Niacin has proven lipid-modifying efficacy and cardiovascular benefit. Previous cross-sectional and retrospective studies have suggested that niacin-induced flushing (NIF) significantly limits patient adherence to therapy. We conducted a one-year ‘real-world’ prospective observational study to characterize the impact and severity of NIF symptoms in subjects newly prescribed extended-release (ER) niacin. Methods: Subjects were surveyed daily during week 1 of therapy and thereafter via telephone at weeks 5, 9, 13 and months 6, 9 and 13. Surveys included the Global Flushing Symptom Score (GFSS), Flushing Impact Questionnaire (FIQ), and Treatment Satisfaction Questionnaire for Medication (TSQM). Results: A total of 306 subjects were recruited of which 43.5% (n=133) discontinued ER niacin by the end the study. Among those who discontinued, the median duration of ER niacin use was 95 days (range 2-402 days). At discontinuation, 3 (2.3%) subjects were on 250mg, 71 (54%) on 500mg, 1 (0.8%) on 750mg, 27 (20.3%) on 1000mg, 6 (4.5%) on 1500mg, and 4 (3.1%) on 2000mg. Dose was not available for 21 subjects. Over half of the discontinuers experienced flushing symptoms; 82% reported moderate to extreme flushing (GFSS≥4) and 68% reported severe to extreme (GFSS≥7) prior to discontinuation. About 74% of the discontinuers reported that moderate was the greatest degree of flushing they could tolerate before discontinuation. Those who discontinued and reported experiencing flushing side effects reported high degrees of impact in the FIQ Irritation/Frustration domain: mean (SD) 3.0 (1.3) (0=not at all, 4=extremely) and high dissatisfaction due to side effects as measured by the TSQM Side Effect domain: mean (SD) 63.3 (33.8) (0=extremely dissatisfied, 100=extremely satisfied). In addition, subjects who reported moderate or greater flushing bother during week 1 were 3.3 times more likely to discontinue due to flushing than those who reported less bother (95% CI: 1.01-10, p<0.05). Conclusion: Results from this study suggest that in a “real-world” setting, flushing side effects are bothersome and have an impact on continuation of ER niacin therapy. Further research is needed into alternative methods for increasing ER niacin acceptability.

Dementia in acutely-ill medical elderly patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S190-S190 ◽  
Author(s):  
P. Sá Esteves ◽  
D. Loureiro ◽  
E. Albuquerque ◽  
F. Vieira ◽  
L. Lagarto ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Barthel Index ◽  
Medical Condition ◽  
Neuropsychiatric Symptoms ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Adverse Outcomes ◽  
Dementia Prevalence ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients

IntroductionDementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.ObjectivesDetermine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.ResultsThe final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).ConclusionsThere is a high prevalence of dementia and an appreciable rate of delirium among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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