Geriatric Acute Care Unit Research Articles

Usability of the digit-tracking technique in a geriatric population of inpatients with and without neurocognitive disorders: The DIGICOG-start study.

Tools for the early diagnosis of neurocognitive disorders (NCD) both accessible, fast, fun and efficient are currently needed. A digit-tracking technique (Digitrack) has been developed based on the exploration of blurred images on a tablet with the finger, related to the exploration of images during eye-tracking. The present study aimed at assessing the objective usability and the subjective User eXperience (UX) of the Digitrack by older adults according to the presence and the severity of NCD. A total of 135 patients were included in a geriatric acute care unit. Objective usability was assessed through the number of patients able to complete the Digitrack's training (3 images) and evaluation (20 images) phases. UX was measured through standard questionnaires (AttrakDiff and meCUE), and through the description of engagement behaviors following an internally developed scale which included 5 levels (interactive, constructive, active, passive and disengaged behaviors). The success rate of the device was 94.1%. The Digitrack had a very good overall attractiveness, standard hedonic and pragmatic qualities, and the emotions perceived were predominantly positive. These findings were not homogeneously observed in the whole studied population. Patients highly impaired due to NCD tended to rate the device with more neutral scores and to perceive more negative emotions. The participants mainly demonstrated active behaviors, but patients with severe major NCD were mostly passive. The study showed promising results regarding the usability and acceptability of a digit-tracking technique within older adults. Further studies should evaluate the potential of this novel methods to make a cognitive diagnosis.

Short-Term Multicomponent Exercise Impact on Muscle Function and Structure in Hospitalized Older at Risk of Acute Sarcopenia.

Hospitalization exacerbates sarcopenia and physical dysfunction in older adults. Whether tailored inpatient exercise prevents acute sarcopenia is unknown. This study aimed to examine the effect of a multicomponent exercise programme on muscle and physical function in hospitalized older adults. We hypothesized that participation in a brief tailored exercise regimen (i.e., 3-5 days) would attenuate muscle function and structure changes compared with usual hospital care alone. This randomized clinical trial with blinded outcome assessment was conducted from May 2018 to April 2021 at Hospital Universitario de Navarra, Spain. Participants were 130 patients aged 75 years and older admitted to an acute care geriatric unit. Patients were randomized to a tailored 3- to 5-day exercise programme (n = 64) or usual hospital care (control, n = 66) consisting of physical therapy if needed. The coprimary endpoints were between-group differences in changes in short physical performance battery (SPPB) score and usual gait velocity from hospital admission to discharge. Secondary endpoints included changes in rectus femoris echo intensity, cross-sectional area, thickness and subcutaneous and intramuscular fat by ultrasound. Among 130 randomized patients (mean [SD] age, 87.7 [4.6] years; 57 [44%] women), the exercise group increased their mean SPPB score by 0.98 points (95% CI, 0.28-1.69 points) and gait velocity by 0.09 m/s (95% CI, 0.03-0.15 m/s) more than controls (both p < 0.01). No between-group differences were observed in any ultrasound muscle outcomes. There were no study-related adverse events. Three to 5 days of tailored multicomponent exercise provided functional benefits but did not alter muscle or fat architecture compared with usual hospital care alone among vulnerable older patients. Brief exercise may help prevent acute sarcopenia during hospitalization. ClinicalTrials.gov identifier: NCT04600453.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia.

Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Left bundle branch blocks do not predict mortality in oldest-old patients hospitalized for COVID-19: The GERIA-COVID cohort study

This cohort study aimed to determine whether left bundle branch blocks (LBBB) in COVID-19 were associated with 28-day and 3-month mortality in oldest-old patients. LBBB were sought on electrocardiogram on hospital admission in patients aged 80 years or more admitted for COVID-19 to the geriatric acute care unit of Angers University Hospital, France, during the first wave of the pandemic. Eighty-five participants were included (mean ± SD, 88.3 ± 5.3 years; 48.2 % women; 14.1 % with LBBB; 18.8 % mortality after 28 days and 28.2 % after 3 months). LBBB was associated neither with 28-day (HR = 1.65, P = 0.58) nor with 3-month (HR = 1.08, P = 0.92) mortality, in fully-adjusted Cox regression.

Comparison of length of stay between direct entry and emergency admission in acute care geriatric unit after hotline regulation

Development of the geriatric care allows direct hospitalization and avoid unnecessary emergency admissions. In Clermont-Ferrand, a specific hotline regulates direct entry from home and emergencies in the geriatric acute care unit. The aim of this study was to evaluate the impact of the entry mode (home or emergency) on the length of stay of patients hospitalized in acute care geriatric unit. We have retrospectively collected data on hospitalization of patients over 75 years in the Geriatric Acute care unit from January to March 2019. We also collected socio-demographic data, autonomy score, MMS, co-morbidity score, exit mode, previous year’s hospitalization and polymedication on hospitalization reports. We included 88 patients in the “direct” group and 184 patients in the “emergency” group. The characteristics of the two groups were comparable. The median length of stay for the “emergency” group was 14 days [9.5; 20] versus 12 [8.5; 18] for the “direct” group (p=0.03). In multivariate analysis, ADL score and home lifestyle were correlated with duration of stay. The development of direct entrance pathways into the geriatric short-stay department by establishing specific hotlines decreases length of stay.

Physical Activity and Fall Prevention in Geriatric Inpatients in an Acute Care Unit (AGIR Study): Protocol for a Usability Study

BackgroundFalls are one of the world’s top 10 risks associated with disability in people older than 60 years. They also represent more than two-thirds of adverse events in hospitals, mainly affecting patients older than 65 years. Physical activity is a central intervention in fall prevention for older people. Whatever the details of the prevention strategy that is adopted (ie, how a mono- or multifactorial intervention is evaluated, the category of person the intervention targets, and where it is used), it is important to ensure that the proposed intervention is feasible and usable for the patient and the health care team.ObjectiveThe primary objective is to study the usability of carrying out a physical activity intervention, including 3 types of exercises, in older patients hospitalized in a geriatric acute care unit and categorized according to 3 fall risk levels: low, moderate, and high. The secondary objectives are to determine the difficulty of the physical exercise for patients with different fall risk levels, to study the health care team’s perceptions of the intervention’s feasibility, and to study the benefits for patients.MethodsThis is an open-label, unicenter, nonrandomized, usability prospective clinical trial. The intervention tested is a daily physical activity program. It consists of 3 types of physical exercise: staying out of bed for at least 3 hours, performing balance exercises while standing for 2 minutes, and the Five Times Sit to Stand transfer exercise. These exercises are carried out under the supervision of the health care team. Fall risk in the patients is classified with the Brief Geriatric Assessment tool. The exercise program starts on the second day of hospitalization after inclusion in the study. Patient assessment continues until the last day of hospitalization or the 20th day of hospitalization, whichever is earlier. For each fall-risk group and each type of exercise, the intervention will be defined as usable if at least 80% of the participants complete 75% or more of the exercises (ie, the ratio between the number of days when the patient completes a type of exercise and the total number of hospitalization days). The perceived feasibility by the health care team is measured with 2 scales, measuring perceived difficulty and time spent with the patient. The intervention benefit is evaluated using the performance of the Five Times Sit to Stand test before and after the intervention.ResultsThe first patient was recruited on March 16, 2015. The study enrolled 266 patients, including 75 with low fall risk, 105 with moderate risk, and 85 with high risk.ConclusionsWe have not yet analyzed the results, but our observations suggest that the usability of each type of exercise for a given patient will depend on their fall risk level.Trial RegistrationClinicalTrials.gov NCT02393014; https://clinicaltrials.gov/ct2/show/NCT02393014International Registered Report Identifier (IRRID)DERR1-10.2196/32288

The effect of direct admission to acute geriatric units compared to admission after an emergency department visit on length of stay, postacute care transfers and ED return visits

BackgroundCompared with conventional hospitalization, admission to an acute geriatric care unit (AGU) is associated with better outcomes in elderly patients. In 2012, 50% of the hospitalizations of elderly patients were preceded by an emergency department (ED) visit. Hospital occupancy, access blocks and overcrowding experienced by patients during ED visits are associated with increased morbidity.ObjectiveOur aim was to evaluate the effect of direct admission (DA) to an AGU on both the hospital length of stay and morbidity of elderly patients.DesignThis study was a retrospective cohort study conducted using electronic medical records and administrative claims data from the Greater Paris University Hospitals (APHP) health data warehouse involving 19 different AGUs.ParticipantsWe included all patients ≥ 75 years old who were admitted to an AGU for more than 24 h between January 1, 2013, and December 31, 2018.InterventionDirect admission to the AGU compared to admission after an ED visit.Main measuresThe main outcome was hospital length of stay. Two outcomes were used to analyse morbidity: postacute care and rehabilitation ward transfer at the end of the index hospitalization and ED return visit within 30 days after the index hospitalization (for those who survived to hospitalization). We used an inverse probability of treatment weighting (IPTW) approach to balance the differences in patient baseline variables between the two groups. Univariate linear and logistic regression models were built to estimate the effect of DA on hospital length of stay and the likelihood of postacute care transfer and ED return visit.Key resultsAmong the 6583 patients included in the study, DA was associated with a lower hospital length of stay (estimate = -1.28; 95% CI = -1.76–0.80), and a lower likelihood of postacute care transfer (OR = 0.87; 95% CI = 0.77–0.97). It was not significantly associated with a lower risk of ED return visits (OR = 0.81; 95% CI = 0.60–1.08) in the following month.ConclusionDA should be prioritized, and reorganization of the geriatric pathway around DA should be encouraged due to the frailty of elderly individuals.

Impact of the COVID-19 pandemic on drug-related problems and pharmacist interventions in geriatric acute care units

ObjectivesTo assess and compare the pharmaceutical analysis on drug management in a geriatric acute care unit prior to and during the COVID-19 pandemic.MethodsThis was a single-centre, retrospective, and comparative cohort study. All Pharmacist Interventions (PIs) carried out in the unit between 27 January 2020 and 30 April 2020 were distinguished according to whether they were conducted prior to or during the first wave of COVID-19. The main outcome measure was the rate of PIs per patient and per prescription lines analysed. Other data collected were the drug class managed by the PI, the Drug Related Problems (DRP) identified, the nature of the advice given, and the acceptance rate by geriatricians.ResultsA total of 355 patients were analysed, with PIs generated for 21.7% of the patients prior to COVID-19, and for 53.4% of the patients during the first wave (p < 0.001). Among the 4402 prescription lines analysed, 54 PIs were carried out for prescriptions prior to COVID-19, and 177 during the first wave (p = 0.002). DRPs were mostly related to anti-infectious drugs during the pandemic (20.3%, p = 0.038), and laxatives prior to the pandemic (13.0%, p = 0.023). The clinical impact of the PIs was mainly moderate (43.7%). The acceptance rate was 59.3%.ConclusionsA greater amount of DRPs were detected and more therapeutic advice was proposed during the first wave of COVID-19, with a focus on drugs used for the management of COVID-19 rather than geriatric routine treatments. The needs for clinical pharmacists were strengthened during the pandemic.

Risk factors of Pressure Ulcers in hospitalized elderly Egyptian people

Background: Pressure ulcers affect a large scale of elderly people. Despite advances in technology, the rate continues to increase. This increases morbidity, health care costs and mortality. Aim: searching for risk factors of pressure ulcers in elderly patients admitted to acute geriatric care units. Methods: A case control study was conducted recruiting100 elderly male and female patients above the age of six ty. History and physical examination were done, as well as nutritional and functional assessment. Nursing care was assessed using a checklist and Braden scale was done as a risk assessment scale for pressure ulcers. Blood samples were collected for laboratory measures. Results: pressure ulcers result from contribution of many factors as cardiovascular and cerebrovascular diseases, urinary incontinence, poor nutrition, immobility. Patients free from pressure ulcers had better nursing care with more frequent repositioning and use of air mattress (in more than 80%, compared use of air mattress in about 40% only of patients acquiring pressure ulcers). Braden scale was highly sensitive for the occurrence of pressure ulcers (cutoff point ≤ 17) with 77.4% positive predictive value and 97.3% negative predictive value. Conclusion: Pressure ulcers are multifactorial in origin. Nursing care is of utmost importance for their prevention. Braden scale should be applied to elderly pa tients upon admission to hospitals

Terms used by physicians when deciding to withhold treatment for older patients not having received palliative care in an acute geriatric care unit.

There are no guidelines or consensus statements on the terms to be used when discussing withholding of treatment for patients in acute geriatric care units and who have not received palliative care. The objective of the present study was to analyze the terms used in medical records to refer to the withholding of treatment for patients who died in an acute geriatric care unit and did not receive palliative care. We conducted an ambispective multicentre cohort study based on the DAMAGE study. Data on 53 patients who died in the acute geriatric care unit and who had not received palliative care were extracted from medical records. The verbatims referring to the withholding of treatment were analyzed in terms of keywords and then key concepts, as defined by several reviewers in a consensus-based approach. The mean age of the patients was 86.4years, 34.1% were male. Terms referring to the withholding of treatment were found for 25 of the 53 patients (47.2%). Most of the decisions on the withholding of treatment were recorded in the week following admission to the acute geriatric care unit. Our analysis of the terms identified 11 key concepts: treatment limitation, no resuscitation, withholding diagnostic procedures, justification of care, ethical considerations, disease progression, uncertainty, the patient's wishes, the family's wishes, patient's comfort, and collegiality. The terms used to describe key concepts varied markedly from one physician to another. Decisions about the withholding of treatment are frequently noted in the medical records of patients who die in the acute geriatric care unit without having received palliative care. The broad variety of key concepts and differences in the choice of words highlight the need for standardized terms.

Complicaciones intrahospitalarias en una unidad geriátrica de agudos

ResumenIntroducción.Las complicaciones hospitalarias ocurren con gran frecuencia en personas mayores de 65 años hospitalizadas y conllevan peores resultados clínicos. Son pocos los estudios sobre los factores asociados con las complicaciones hospitalarias en la atención de adultos mayores.Objetivo.Evaluar los factores asociados con las complicaciones hospitalarias en una unidad geriátrica de agudos en Bogotá, Colombia.Materiales y métodos.Se hizo un estudio observacional analítico basado en una cohorte retrospectiva que incluyó 1.657 pacientes mayores de 65 años atendidos en una unidad de hospitalización en Bogotá, Colombia. La variable dependiente fueron las complicaciones hospitalarias y, las independientes, la dependencia funcional, la demencia, el estado nutricional, el soporte social, las comorbilidades y la polifarmacia. Se utilizó el modelo de regresión lineal de Poisson para determinar las variables asociadas.Resultados.En el análisis bivariado se encontró que la dependencia funcional (razón de prevalencia, RP=2,092; p≤0,001) y la malnutrición (RP=2,850; p≤0,001) eran factores asociados con una mayor tasa de complicaciones hospitalarias. En el análisis multivariado aparecían como factores independientes (dependencia funcional: RP=1,931 y p=0,003; malnutrición: RP=2,502 y p=0,002).Conclusión.El hacer una evaluación integral que permita determinar la dependencia funcional y la malnutrición en el momento de ingreso en las unidades de hospitalización, permitiría predecir complicaciones hospitalarias.

Lessons learnt from a nosocomial COVID-19 outbreak in a geriatric acute care ward with a high attack rate

Nosocomial COVID-19 in older patients has a high mortality rate. We describe an outbreak of COVID-19 in a geriatric acute care unit (GACU) in March/April 2020 and the lessons learnt regarding prevention. Thirty-six patients were diagnosed with COVID-19 during that 2-month period, in France's “first wave” of SARS-CoV-2 infections. Thirty (83.3%) were considered nosocomial. Attributable mortality reached 33.3% in these patients. Healthcare workers (HCW) were not spared, with an overall attack rate of 36.8%, but the rate was especially high among nurse assistants (68.2%). Repeated testing, single rooms, hand hygiene, and good use of personal protective equipment are paramount in GACUs to prevent in-hospital COVID-19 outbreaks.

Taking Care of the Staff We Take Care of the Patients: Project for the Humanization of an Acute Geriatric Care Unit

Taking Care of the Staff We Take Care of the Patients: Project for the Humanization of an Acute Geriatric Care Unit

Factors associated with lethality from pneumonia in an acute care for the elderly unit: a retrospective cohort

ResumenIntroducción. La neumonía es la principal causa de muerte por infección en el mundo y afecta principalmente a la población de adultos mayores.Objetivo. Determinar los factores de riesgo asociados con la letalidad a 30 días en pacientes con neumonía en una unidad de atención del paciente geriátrico agudo. Materiales y métodos. Se hizo un estudio observacional y analítico de cohorte retrospectiva. Se incluyeron 114 pacientes de 60 años o más hospitalizados en una unidad de atención del paciente geriátrico agudo con diagnóstico de neumonía. El resultado primario fue la letalidad a 30 días. Se hicieron análisis de regresión log-binomial bivariado y multivariable para explorar la relación entre las variables independientes y el resultado primario.Resultados. La letalidad a 30 días fue de 26,3 % y la edad media de 84,45 ± 7,37 años. El 54,4 % de los participantes era de sexo masculino. En el análisis multivariable se encontró que una edad de 90 años o más (riesgo relativo, RR=1,62; IC95%: 1,05-2,68; p=0,04), el compromiso multilobar (RR=1,92; IC95%: 1,12-3,32; p=0,02), el° nitrógeno ureico elevado (mediana≥22,5; RR=3,93; IC95%: 1,67-9,25; p<0,01), y un puntaje de cero en la escala de Lawton al ingreso (RR=3,20; IC95% 1,05-9,78; p=0,04) fueron factores predictores independientes de la letalidad a 30 días en adultos mayores con neumonía. Conclusión. En los pacientes adultos mayores hospitalizados por neumonía en una unidad de atención del paciente geriátrico agudo la edad muy avanzada, la presencia de compromiso multilobar, la dependencia en el estado funcional y los niveles de nitrógeno ureico elevados fueron los principales factores de riesgo de letalidad a corto plazo.

A Nurse-Led Bridging Program to Reduce 30-Day Readmissions of Older Patients Discharged From Acute Care Units

ObjectivesOlder hospitalized patients are at high risk of early readmissions, requiring the implementation of enhanced coordinated transition programs on discharge. The objective of this study was to evaluate the impact of a nurse-led transition bridging program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric acute care units. DesignA stepped-wedge cluster randomized trial. Setting and ParticipantsSeven hundred five patients aged ≥75 years hospitalized in one of 10 acute geriatric units, with at least 2 readmission risk-screening criteria (derived from the Triage Risk Screening Tool), were included from July 2015 to August 2016. MethodsThe intervention condition consisted in a nurse-led hospital-to-home bridging program with 4 weeks postdischarge follow-up (2 home visits and 2 telephone calls). Unscheduled hospital readmission or emergency department (ED) visits were compared in intervention and control condition within 30 days from discharge. ResultsThe rate of 30-day readmission or ED visit was 15.5% in the intervention condition vs 17.6% in the control condition [hazard ratio stratified on clusters: 0.61 (upper limit unilateral 95% confidence interval = 1.11), P = .09]. Rate of presence of professional caregivers was increased in the intervention condition (P < .001). Conclusions and ImplicationsAlthough the intervention resulted in an increase in the rate of implementation of a package of care at the 4-week of follow-up, we could not demonstrate a reduction in the rate of 30-day readmissions or ED visits of older patients at risk of readmission. These findings support the evaluation of this type of program on the longer term.

Vitamin D and Delirium in Older Adults: A Case-Control Study in Geriatric Acute Care Unit.

Objective: Vitamin D is involved in brain health and function. Our objective was to determine whether the serum 25-hydroxyvitamin D (25OHD) concentration was associated with delirium in a case-control study of geriatric inpatients.Methods: Sixty cases with delirium (mean ± SD, 84.8 ± 5.7years; 58.3% female) and 180 age- and gender-matched controls were enrolled in a geriatric acute care unit between 2012 and 2014. The diagnosis of delirium was made using the Confusion Assessment Method. Hypovitaminosis D was defined using consecutively the consensual threshold value of 50 nmol/L and a threshold value calculated from a sensitivity-specificity analysis. Age, gender, number of acute diseases, use of psychoactive drugs, season of testing, and serum concentrations of calcium, parathyroid hormone, creatinine, albumin, TSH, vitamin B9 and vitamin B12 were used as potential confounders.Results: The 60 cases with delirium exhibited lower 25OHD concentration than 180 matched controls (35.4 ± 30.0 nmol/L vs. 45.9 ± 34.5 nmol/L, p = 0.035). Increased 25OHD concentration was associated with a decrease in delirium prevalence (OR = 0.99 [95CI: 0.98–0.99] per nmol/L of 25OHD, p = 0.038). The concentration distinguishing between cases and controls with the best sensitivity-specificity was found between 29.5 and 30.5 nmol/L. The regression models showed that delirium was associated with hypovitaminosis D defined either as 25OHD ≤ 50 nmol/L (OR = 2.37 [95CI: 1.07–5.25], p = 0.034) or as 25OHD ≤ 30 nmol/L (OR = 2.66 [95 CI: 1.30–5.45], p = 0.008).Conclusions: Decreased serum 25OHD concentrations were associated with delirium among acute geriatric inpatients. The threshold concentration to differentiate between cases and controls was around 30 nmol/L.

Medication appropriateness on an acute geriatric care unit: the impact of the removal of a clinical pharmacist.

evidence is largely available indicating benefits to adding a pharmacist on acute care wards. The benefits of maintaining pharmacotherapeutic consultant services on a geriatric ward remain unexplored. to determine the impact of the removal of a clinical pharmacist from an acute geriatric ward on patients' Medication Appropriateness Index (MAI) scores, admission-related outcomes and drug burdens. researchers consulted the archives for records of patients admitted to the geriatric care unit before and after the pharmacist's withdrawal. The primary outcome of differential MAI scores and secondary outcomes of rehospitalisations, emergency department visits, durations of hospitalisation and differential drug count were compared pre- and post-intervention. An interrupted time series analysis regression model was used for the primary outcome. a total of 305 patients admitted before (n= 208) and after (n= 97) the pharmacist's withdrawal were included in the study. The intervention had a significant impact on the primary outcome, increasing the relative differential MAI score (adjusted mean) by 9.3 points (95% confidence interval 3.9-14.6). As for the secondary outcomes, differences in admission-related outcomes were non-significant but the mean differential drug count significantly increased post-intervention from 0.02 to 1.36 (P< 0.001). the removal of the pharmacist led to an increase in inappropriate drug prescription. Careful consideration should be given to decisions regarding the removal of the pharmacist from acute geriatric care teams.

Burning for Treatment: Impact of Staff Education on Asymptomatic Bacteriuria Management in the Elderly.

BackgroundStudies indicate that elderly patients are often inappropriately treated with antimicrobials for asymptomatic bacteriuria (ASB). Interprofessional education may help improve the assessment and management of ASB.MethodsRetrospective chart audits were conducted on two cohorts of positive urine cultures (n = 201) obtained from a geriatric acute care unit to determine the incidence of treated ASB. The first cohort (n = 101) was analyzed from January to July 2017. Education was provided to unit staff (e.g., nurses, physicians, pharmacists) in Fall 2017. The second cohort (n = 100) was analyzed from January to July 2018. Descriptive statistics were used to summarize and compare the results from the cohorts.Results152 patients (n = 201 positive urine cultures) were reviewed: 74% (159) of positive urine cultures were ASB and 21% (42) were urinary tract infections. The incidence of treated ASB was 15% (30) and untreated ASB was 65% (129). The incidence of UTI, treated ASB, and untreated ASB were not significantly different between the two cohorts examined.ConclusionThe implementation of education did not result in lasting changes in ASB management. Our study suggests that future systemic solutions are necessary to reduce the incidence of treated ASB in the geriatric population.

In-hospital interventions for reducing readmissions to acute care for adults aged 65 and over: An umbrella review.

The aim of this umbrella review was to synthesize existing systematic review evidence on the effectiveness of in-hospital interventions to prevent or reduce avoidable hospital readmissions in older people (≥65years old). A comprehensive database search was conducted in May 2019 through MEDLINE, EMBASE, CINAHL, the JBI Database of Systematic Reviews, DARE and Epistemonikos. Systematic reviews and other research syntheses, including meta-analyses, exploring the effectiveness of hospital-based interventions to reduce readmissions for people aged 65 and older, irrespective of gender or clinical condition, were included for review. If a review did not exclusively focus on this age group, but data for this group could be extracted, then it was considered for inclusion. Only reviews in English were included. Data extracted for each review included the review objective, participant details, setting and context, type of studies, intervention type, comparator and findings. Twenty-nine reviews were included for analysis. Within these reviews, 11 intervention types were examined: in-hospital medication review, discharge planning, comprehensive geriatric assessment, early recovery after surgery, transitional care, interdisciplinary team care, in-hospital nutrition therapy, acute care geriatric units, in-hospital exercise, postfall interventions for people with dementia and emergency department-based palliative care. Except for discharge planning and transitional care, none of the interventions significantly reduced readmissions among older adults. There is limited evidence to support the effectiveness of existing hospital-based interventions to reduce readmissions for people aged 65 and older.

Facilitators, Barriers, and Solutions in Pain Management for Older Adults with Dementia

BackgroundAlthough qualitative studies have been conducted to identify barriers and facilitators that influence the pain management of older adults with dementia, as far as we know, only a very recent study (Andrews et al., 2019) has used participatory action research (PAR) as a methodology for studying pain management. It allows nurses to examine and improve their practice based on their realities and within their context. AimTo reflect on nursing practice and identify facilitators and barriers in the management of pain in older adults with dementia and to propose actions for improvement. DesignWe used qualitative participatory action research. Participants/SettingsTen nurses from the geriatric acute care unit of a university hospital in Spain were recruited through convenience sampling. MethodsData were generated through a written questionnaire and three focus groups. ResultsOne of the main facilitators the participants identified was professional experience. The main barriers they identified were lack of knowledge and skills and lack of time. The participants proposed two main improvements: (1) a training program consisting of three courses (pain evaluation and management, dementia and pain, and pharmacology) and (2) the creation of a specific register for nurses to record patients’ pain. ConclusionsInvolving nurses directly in research on their practices can result in precise proposals for improvements based on their needs and oriented toward improving the quality of care. Moreover, our results confirm previous findings in other countries.