A prospective, multidimensional follow-up study of a geriatric hospitalised population: predictors of discharge and well-being

Dagani, Jessica; Ferrari, Clarissa; Boero, Maria Elena; Geroldi, Cristina; Giobbio, Gian Marco; Maggi, Paolo; Melegari, A.L.; Sattin, G.; Signorini, Matteo; Volpe, Daniele; Zanetti, Orazio; Girolamo, Giovanni de

doi:10.1007/s40520-013-0153-3

Cited by 16 publications

(17 citation statements)

References 35 publications

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“…We used features found helpful in other studies, including those detailing increased rates of rehospitalisation in older adults with poor ambulation,28 increased rates of ED visits by older adult patients with cognitive impairment29 30 and an approximately 50% increased rate of hospital admissions in elderly patients with visual impairment compared with aged-matched controls 31. One possibility is that perceptions of patients may be more or equally useful in identifying home care needs than objective (non-contextual/non-perceived) deficits.…”

Section: Discussionmentioning

confidence: 99%

Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors

et al. 2015

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“…Among the 165 patients with available ADL data at discharge, 30 (18.2%) showed functional decline during the rehabilitation stay and 51 (30.9%) had a HAI (Table 1). Median ADL at discharge from the rehabilitation unit was significantly lower for patients with than without functional decline (4 [1][2][3][4][5][6][7][8][9] , P = 1). On univariate analysis, global CIRS-G and CIRS-G Index were significantly higher for patients with than without functional decline.…”

Section: Resultsmentioning

confidence: 94%

“…Hospital admissions are important causes of functional decline among older patients (1). The decline has important effects on quality of life and is associated with increased risk of longer hospital stay, death, nursing home transfer, and rehospitalization (2)(3)(4). Older age, preexisting altered functional status, cognitive impairment, low mobility during the stay and length of stay have been reported to increase the risk of functional decline in acute unit (5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

Laurent

Oubaya

Poitrine

et al. 2020

Preprint

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Background: Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods: We used a prospective cohort of consecutive patients aged ≥ 75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results : Among the 252 eligible patients, 165 (median age 85 years [interquartile range (IQR) 81-90] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [9-13], 24 (14.5%) had a pulmonary HAI; 30 (18.2%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P=0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P=0.03, or psychiatric disease, P=0.02) and albumin level < 35 g/l (p=0.02). Significant association were found between functional decline and CIRS-G for respiratory diseases (CIRS-G-R) (OR 2.82 [95% CI 1.18-6.71], p=0.016), between functional decline and pulmonary HAI (OR 4.09 [1.48-11.34],p=4.09), and between CIRS-G-R and pulmonary HAI (OR 10.9 [5.26-22.5],p=0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 1.91 [0.71-5.16], p=0.20) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion : Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

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“…None of these frailty indicators were associated with one-year mortality in our study population. In contrast to other studies that have included more unselected patients (45)(46)(47), our aim was to study mortality in selected patients that all suffered from mild to severe frailty. Our inclusion criteria (multimorbidity and dependence upon home nursing) were chosen accordingly.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

Wang-Hansen

Kersten

Wyller³

2020

Preprint

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Background: Due to expansion of longevity, the proportion of elderly people with multimorbidity is increasing. Our aim was to identify risk factors for all-cause mortality in elderly multimorbid medical in-patients one year after acute hospitalization. Information regarding risk factors is important to support targeted care plans after discharge. Methods: Prospective cohort study of patients acutely admitted to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, received home care services before hospitalization, were aged 75+, and suffered from two or more chronic conditions. Inclusion period was 1. April – 31. October 2012. Candidate variables were number of daily prescribed drugs, Cumulative Illness Rating Scale for Geriatrics score, delirium, body mass index (BMI), handgrip strength, Barthel Activities of Daily Living Index score, and the laboratory analyses haemoglobin (Hgb), sodium (Na) and estimated glomerular filtration rate (eGFR). Results: We included 227 patients; mean age 86 years, 59% women, 71% lived alone. During the year after hospitalization, 39% died. In the adjusted cox proportional hazards regression analysis, significant and independent risk factors were BMI (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.88-0.98 per kg/m2), Hgb (HR 0.87, 95% CI 0.76-0.98 per g/100 mL), Na (HR 0.94, 95% CI 0.90-0.99 per mmol/L) and eGFR < 60 mL/min/1.73 m2 (HR 1.82, 95% CI 1.07-3.08).Conclusions: In this cohort of multimorbid elderly internal medicine patients, low body mass, hyponatremia, impaired renal function and anaemia were identified as independent and significant risk factors for one-year mortality.

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A prospective, multidimensional follow-up study of a geriatric hospitalised population: predictors of discharge and well-being

Cited by 16 publications

References 35 publications

Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors

Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors

Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

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