The role of geriatrician-hospitalists in the care of older adults: A retrospective cohort study

Sinvani, Liron; Carney, Maria; Kozikowski, Andrzej; Smilios, Christopher; Patel, Vidhi; Qiu, Guang; Zhang, Meng; Babalola, Olawumi; Kandov, Yakov; Rosenberg, David; Wolf‐Klein, Gisele; Pekmezaris, Renée

doi:10.1016/j.archger.2018.03.006

Cited by 15 publications

(18 citation statements)

References 33 publications

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“…Some barriers were reported about the possibility of geriatricians to treat HF patients, mainly related to the poor confidence of the patients and their caregivers in their skills in treating a cardiologic disease. Older adults with HF managed by geriatricians, despite being older and with a higher number of comorbidities, have similar healthcare costs and number of hospitalizations compared to those cared by other specialists [19], also for HF management [20,21]. Thus, the reported poor confidence is an issue that should be considered in the educational programs for the patients, to improve their awareness on the expertise of geriatricians in the management of this disease.…”

Section: Discussionmentioning

confidence: 99%

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics

et al. 2020

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Background Heart failure (HF) is often managed by geriatricians. Few data are available on their knowledge and attitudes about this condition. Aims To compare perceptions and knowledge on HF of specialists/fellows in geriatrics working in Italy. Methods This nationwide survey carried out by the Italian Society of Gerontology and Geriatrics in May-June 2019 enrolled 283 specialists/fellows in geriatrics in Italy. Results were stratified by qualification (specialist/fellow) and performance (lower/ higher quartile of correct answers). Results About half (55.5%) of the participants worked in acute care wards, 190 were residents, and 93 specialists. The overall proportion of correct answers was 70.8%, with no differences between specialists and fellows. There was a poor knowledge, with no differences between groups, about the target doses of ACE-inhibitors (36% of correct answers), the pharmacological treatment of HF with preserved ejection fraction (HFpEF) (37% of correct answers), and the inotropes indicated in acute HF (35% of correct answers). Compared to specialists, fellows performed better on indication (88% vs 76%, P = 0.019) and mechanism of action (93% vs 84%, P = 0.023) of sacubitril/valsartan, and on therapeutic indications of patients with atrial fibrillation (92% vs 75%, P < 0.001). Conclusions Globally, there was a good knowledge of the latest guidelines on the diagnosis and management of HF. However, for some important topics, such as HFpEF, that is the most common HF manifestation in older adults, the observed performance was relatively poor, indicating the need for focused educational campaigns.

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Section: Discussionmentioning

confidence: 99%

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics

et al. 2020

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“…Older patients, their relatives, or medical proxy can sign do-not-resuscitate (DNR) documents to avoid patients receiving cardiopulmonary resuscitation (CPR) during illness. In a study conducted in a tertiary academic acute care hospital, the documentation of DNR orders was significantly higher for patients under a geriatrician hospitalist service compared to staff or non-staff hospitalist service (31.6% vs. 15.7 and 10.6%, p < 0.001) [ 5 ]. In another study conducted in a Level I trauma center, there was a significant increment in the percentage of DNR or did not intubate, from 10.23% in the pre-intervention group to 38.22% in the post-intervention group ( p < 0.01) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with do-not-resuscitate document completion among patients hospitalized in geriatric ward

Jen

Chuang

et al. 2021

BMC Geriatr

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Background With a rapidly aging population, there is an increasing need for do-not-resuscitate (DNR) and advance care planning (ACP) discussions. This study investigated the factors associated with signing DNR documents of older patients in the geriatric ward. Methods We conducted a retrospective cohort study at a geriatric ward in a tertiary hospital in Southern Taiwan. Three hundred and thirty-seven hospitalized older patients aged ≥65 years in the geriatric ward from 2018 to 2019. The Hospital Information System and electronic medical records were accessed to obtain details regarding patients’ demographics, daily living activities, serum albumin level, nutrition screening score, intensive care unit transferal, resuscitation procedure, days of hospital stay, and survival status on discharge, and DNR status was recorded retrospectively. Patients were classified into DNR and non-DNR groups, with t-tests and Chi-square tests applied to compare the differences between groups. Logistic regression was performed to predict factors related to the DNR documents. Results A total of 337 patients were included, 66 of whom had signed a DNR during hospitalization. After multivariate logistic regression, age 85 or more compared to age 65–74 (adjusted odds ratio, aOR 5.94), poor nutrition with screening score two or more (aOR 2.71), albumin level less than 3 (aOR 3.24), Charlson Comorbidity Index higher than 2 (aOR 2.46) and once transferred to ICU (aOR 5.11) were independently associated with DNR documentation during hospitalization. Conclusions Several factors related to DNR documents for geriatric patients were identified which could provide clinical information for physicians, patients, and their families to discuss DNR and ACP.

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“…If a geriatric patient was truly experiencing anxiety, finding out the underlying cause and providing supportive measures would be the first line of treatment [3,14]. Otherwise prescribing an SSRI (e.g., escitalopram) or SNRI (e.g., Duloxetine) is a better medication for anxiety in geriatric patients [4].…”

Section: Discussionmentioning

confidence: 99%

“…Greater than 40% of hospitalized adults are 65 years and older and by the year of 2030 more than 70 million Americans will be senior citizens [2]. In response to these trends, hospitalists have begun to incorporate geriatric skills into their daily practice [3]. One such skill, and an important patient safety issue is whether hospitalists are currently adhering to evidence-based medication prescribing guidelines for geriatric inpatients.…”

Section: Introductionmentioning

confidence: 99%

The cascade of benzodiazepine prescribing for hospitalized geriatric patients

Wijeyakuhan

Gruber

Rattray

2020

Journal of Community Hospital Internal Medicine Perspectives

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Background: Hospitalists increasingly provide care for geriatric patients and little is known about the extent to which hospitalists adhere to evidence-based medication guidelines. This study aimed to characterize hospitalist adherence to BEERS guidelines for prescribing and monitoring benzodiazepines for older adults. Methods: We conducted a retrospective chart review of admitted patients aged 70-85 years who had been prescribed benzodiazepine. Charts from 351 patients were analyzed for documentation and decision rationale, which included 638 separate notes. Results: Benzodiazepines were prescribed 28.2% of the time to address anxiety, which is inconsistent with the BEERS criteria; 39% had adequate data in the impression and plan section of the note to reflect why benzodiazepine was prescribed. Of note, the majority of notes had partial or missing data. Conclusion: Physicians tended to follow guidelines more than advance practice providers. Wide variation persists in prescribing practices and documentation related to benzodiazepines and both could potentially be addressed with further training.

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The role of geriatrician-hospitalists in the care of older adults: A retrospective cohort study

Cited by 15 publications

References 33 publications

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics

Factors associated with do-not-resuscitate document completion among patients hospitalized in geriatric ward

The cascade of benzodiazepine prescribing for hospitalized geriatric patients

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