Acute Geriatric Ward Research Articles

Use of a trigger tool to describe and screen drug-related hospital admissions in older adults: the TRIGGAge retrospective cohort study.

Drug-related hospital admissions (DRAs) can account for 5%-40% of total hospital admissions in older adults, with a significant proportion deemed preventable. To increase the detection of DRAs, in 2021, a revised trigger tool listing 21 frequent causes of admissions and medications at risk was proposed. This study aimed to describe DRAs using this trigger tool in a French acute geriatric ward and to assess the performance of the tool. This was a retrospective cohort study in a 20-bed geriatric unit including all patients hospitalised in 2023. During the first quarter of 2024, each patient's chart was adjudicated by using a two-step standardised review procedure to assess whether the admission was a DRA. The potentially at cause medications and reasons for admission were also assessed. During the study period, 483 patients were hospitalised in the acute-care geriatric ward (mean age 86.7 ± 6.15years). After adjudication, 207 admissions (43%) were identified as DRAs; 70% were considered preventable. The main causes of DRAs were falls/fractures (33%), bleeding (23%) and delirium (14%). The drugs most frequently responsible were diuretics (21%), renin-angiotensin system inhibitors (20%) and direct oral anticoagulants (15%). The overall sensitivity and specificity of the tool for detecting DRAs was 90% (95% CI 88-93) and 72% (68-76), respectively. After adjudication, the trigger tool helped detect 83% more DRAs as compared with the attending geriatrician. DRAs are frequent in a geriatric population and often preventable. Their detection may be improved by the use of a trigger tool.

Validation of the German version of the SarQoL® questionnaire in sarcopenic and probable sarcopenic patients

BackgroundThe German version of the SarQoL®, a sarcopenia-specific quality of life (QoL) questionnaire, has not been validated hindering its widespread use. This study aimed to evaluate the psychometric properties of the German SarQoL®.MethodsVia a cross-sectional study participants were recruited in two geriatric outpatient facilities and one acute geriatric ward in Munich (Germany). Sarcopenia and probable sarcopenia were diagnosed with the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm. From 185 participants (age 79.8 ± 6.1), 77 had probable sarcopenia, and 51 had sarcopenia. Participants completed the SarQoL® and the European Quality-of-Life 5-Dimension (EQ-5D) questionnaires. The validation included examination of the discriminative power, construct validity, internal consistency, test-retest reliability, and floor/ceiling effects.ResultsLower SarQoL®scores for sarcopenic (p = 0.002) and probable sarcopenic subjects (p < 0.001) compared to controls indicated good discriminative power. Consistent construct validity was found for sarcopenic subjects: moderate to high correlations with domains capturing similar constructs of the EQ-5D: ‘Activities of daily living’ (r = -0.58, p < 0.001), ‘Mobility’ (r = -0.72, p < 0.001) and low correlations with domains related to different constructs like ‘Pain’ (r = -0.32, p < 0.022). Similar correlations were found for probable sarcopenic subjects. The Cronbach’s alpha was 0.8. Test-retest reliability was excellent (intraclass coefficient correlation of = 0.96; 95% CI = 0.91–0.99), and no floor/ceiling effects were observed.ConclusionQoL was similarly reduced in both patient cohorts compared to controls. The German SarQoL® is a valid and reliable instrument for measuring QoL in patients > 65 years of age with sarcopenia and probable sarcopenia and can now be used in epidemiological studies and clinical trials in a German-speaking population.Trial registrationGerman Clinical Trials Register (DRKS)-ID: DRKS00020504 (March 12th, 2021) .

Short-term mortality and associated factors among older hospitalized patients: A narrative retrospective analysis of end-of-life care in an acute geriatric unit

ObjectivesTo explore short-term mortality and its predictors among older patients hospitalized in a acute geriatric ward (AGW) in Northwestern Italy. DesignRetrospective observational single-center cohort study. Material and methodsPatients consecutively admitted for any reason between June 2021 and May 2022 were included in the analysis. Along with sociodemographic, clinical, and functional variables, prognosis estimation (Palliative Prognostic Index; PPI) at the time of admission was registered. Short-term all-cause mortality (in-hospital and within 3 months of discharge) was the primary outcome. ResultsAbout one-third of the total sample died in the short-term (32.4 %). Along with PPI score (OR 1.115, 95 %CI 1.034–1.202), short-term mortality was independently associated with functional dependency (OR 1.278, 95 %CI 1.170–1.395). ConclusionsThe high short-term mortality in our sample should call for the inclusion of palliative prognostic tools within the in-hospital comprehensive geriatric assessment to better recognize and appropriately manage older patients at the end of life.

Exploring accessibility, user experience and engagement of digital media among older patients with depression: a pilot and observational screening study protocol of the DiGA4Aged study

IntroductionThe prevalence of mental health problems is increasing worldwide, particularly in the vulnerable group of older people. The limited availability of therapists, long wait periods and increasing shortage of healthcare...

Updating Relatives of Patients Lacking Capacity in General Medicine: A Quality Improvement Project in a District Hospital in the United Kingdom.

Background Patient-centred care involves focussing on the individual's needs. Where patients lackcapacity, it is important to involverelativesto better understand their needs, encourage positive healthcare outcomes and provide good quality care. Cultivating good rapport between clinicians and families also improves patient safety and satisfaction. Aim This project aims to improve the process ofupdatingrelativesregularly within various medical departments in the hospital. The quality improvement (QI) also strongly advocates for a minimum of two updates within a week of admission, for patients who lack capacity and who are on Deprivation of Liberty Safeguards (DOLS). This framework can be extrapolated to different medical settings to ensure ongoing patient care is conveyed and discussed effectively with families at regular and frequent intervals. Methodology This was a retrospective study that involved a total of 121 patients who lacked capacity and who were admitted to the acute medical unit, cardio-respiratory wards and geriatric wards in a district hospital. The project was designed using Plan-Do-Study-Act (PDSA) cycles and conducted over four months. Data mainly focused on details ofrelative updatesfrom the time of admission, which were extracted from electronic records. Two interventions were conducted, with data gathering done before and after each intervention to ensure completeness of each PDSA cycle and measure the efficacy of the intervention. The firstand second audits involved 56 and65 patients, respectively. Results Data were collected regarding the number of relatives being updated within the first 48 hours and first week of admission. Collected data also involved details of the staff involved in these updates and the contentof the updates. Clinicians accounted for the larger proportion of the staff conducting relative updates for patients on DOLS. Five (36%) in the first audit and 8 (37%) in the second audit of acute medical wards saw doctors at various training levels and roles carrying out the relative updates. In Cardio-Pulmonary wards, these numbers were 50% (8) in Audit 1 and 44% (7) in Audit 2. The greatest clinician burdenwas observed in geriatric wards wherein 73% (19) in Audit 1 and 53% (15) in Audit 2 of relative update data showed clinicians performing these updates. Coming to the frequency, collated data showan overall positive trend across all the wards where relatives were updatedwithin one week.A positive trend was noted, especially in the Geriatric and Cardio-Pulmonary wards, withimprovement in the first week of updates going up, from 35% to 46% and 29% to 48%, respectively. Significant room for improvement in updatingrelativeswithin 48 hours of admission still exists. About 53% of the updates included information about the patient's condition. Details regarding follow-up were only noted in 41% of the updates. Conclusions This study highlights the need to ensure that the relativesof patients who lack capacity are updated more regularly. Colleagues are encouraged to useappropriate documentation methods such as relative progress notes to ensure ease of future updates. It is essential that relatives are updated not only on the patients' condition and diagnosis but also, whenever possible, on investigations, management, and follow-up. A minimum of two updates in the first week is highly advisable. Effective communication and regularupdates improvedischarge planning and patient outcomes.

The potential of body mass index-adjusted calf circumference as a proxy for low muscle mass in the global leadership initiative on malnutrition criteria

Background & AimsReduced muscle mass is one of the diagnostic components for Global Leadership Initiative on Malnutrition (GLIM), with various assessment methods proposed. Calf circumference (CC), a representative anthropometric marker of skeletal muscle mass, is now recommended to adjustment based on body mass index (BMI). This study aimed to evaluate the validity and efficacy of BMI-adjusted CC in very older adults, compared with other methods of assessing muscle mass. MethodsThis prospective cohort study included 284 patients aged 65 years and older who were admitted to the Department of Geriatric Medicine at the National Center for Geriatrics and Gerontology Hospital. Health indicators, including nutritional status, were assessed upon admission. Three months after discharge, a telephone survey was conducted to assess patients’ living conditions and survival status. Skeletal muscle mass was estimated using a dual-energy X-ray absorptiometry (DXA); moreover, anthropometric measurements (unadjusted and BMI-adjusted CC) were used as markers of muscle mass. Logistic regression analysis was performed to examine the association between mortality and GLIM-based malnutrition, using each muscle mass assessment method. ResultsThe mean age of the patients was 86.2 ± 6.2 years, and 60.9% were women. The prevalence of GLIM-based malnutrition ranged from 55.3% to 58.8% across the three methods used to assess reduced muscle mass. Three months after discharge, 244 patients were followed up, of whom 29 (11.9%) died. Multivariate logistic regression analysis, adjusted for age, sex, and comorbidities, showed that all methods significantly predicted 3-month mortality, with odds ratios of 5.67, 5.44, and 4.90 for unadjusted CC, BMI-adjusted CC, and appendicular skeletal muscle mass index using DXA, respectively. The prevalence and survival-predictive ability were similar across all methods. ConclusionGLIM-based malnutrition, diagnosed using different methods for assessing muscle mass, similarly predicted 3-month mortality in patients admitted to an acute geriatric ward. These results suggest that BMI-adjusted CC are sufficient alternatives when technical measurements such as DXA are not feasible.

2347 EXPEDITE: a sustainable initiative to improve average length of stay (ALOS) in an acute geriatric Ward in Singapore

Abstract Introduction Prolonged hospitalisation is associated with increased mortality, increased risk of hospital acquired infections, functional decline and institutionalisation in older adults. Baseline data collected for patients admitted to the Acute Geriatric ward of Alexandra Hospital, a tertiary hospital in Singapore, from 28 Feb to 31 Aug 2022 (n = 299, age &amp;gt; 65 years) revealed an average LOS of 12.3 days. Potential contributing factors identified • 98% did not have a documented medical clearance date • 3.54 days required to decide for medical social worker referral • 9 days before discharge plans are communicated to family. Aim: To reduce average length of stay (ALOS) from 12.3 days in Aug 2022 to 9.81 days by Aug 2023. This was a target set at the hospital level on our Geriatric service in the setting of a rising national pressure for inpatients beds. Method The EXPEDITE Huddle was a regular 30 minute huddle introduced, in addition to the existing weekly multidisciplinary meeting. It was developed based on the QI methodology and streamlined from 3x/week frequency to 1x/week following PDSA cycles. A chat group on the secure hospital mobile phone messaging system was also created for ease of communication among stakeholders. Results • ALOS reduced from 12.3 days to 9.1 days (3.4 days) • 91.8% of patients (n = 154) now have a documented medical clearance date • Communication on discharge plans initiated within 3 days from admission • Sustainability: -In light of positive results, a discharge care navigator (DCN) to lead the discharge planning efforts was offered by the hospital to the Geriatric service. -The EXPEDITE huddle (now led by the DCN) continues and ALOS has remained within target. Conclusion(s) Early discharge planning with a focus on system level factors that contribute to delayed discharge can help reduce ALOS in hospitalised older adults.

On-admission serum 25(OH)D level and mortality within one year in older patients

BackgroundMounting evidence suggests that vitamin D deficiency is associated with a higher risk of many chronic non-skeletal, age-associated diseases as well as mortality.AimTo determine, in older patients aged ≥ 80, the prevalence of vitamin D deficiency and its association with comorbidity, laboratory tests, length of stay and mortality within one year from blood withdrawal on admission to acute geriatrics ward.MethodsWe retrospectively surveyed electronic hospital health records of 830 older patients. The recorded data included patient demographics (e.g., age, sex, stay duration, readmissions number, death within one year from blood withdrawal on admission), medical diagnoses, laboratory results, including 25-hydroxyvitamin D [25(OH)D], and medications. We compared the characteristics of the patients who survived to those who died within one year.ResultsOn admission, in 53.6% patients, vitamin D levels were lower than 50 nmol/L, and in 32%, the levels were ≤ 35 nmol/L. Persons who died were likely to be older, of male sex, were likely to be admitted for pneumonia or CHF, were likely to have lower level of albumin or hemoglobin, lower level of vitamin D or higher vitamin B12 and higher level of creatinine, were also likely to have had a lengthier hospitalization stay, a greater number of hospitalizations in the last year, a higher number of comorbidities, to have consumption of ≥5 drugs or likely to being treated with insulin, diuretics, antipsychotics, anticoagulants or benzodiazepines. Higher age, male sex, on-admission CHF, higher number of drugs, lower albumin, higher vitamin B12, vitamin D < 50 nmol/L, and consumption of antipsychotics and anticoagulants – were predictors of mortality.ConclusionHypovitaminosis D is predictive of mortality in older patients within one year from hospitalization in the acute geriatric ward, but a causal relationship cannot be deduced. Nevertheless, older patients in acute care settings, because of their health vulnerability, should be considered for vitamin D testing. In the acutely ill patients, early intervention with vitamin D might improve outcomes. Accurate evaluation of mortality predictors in this age group patients may be more challenging and require variables that were not included in our study.

2226 Assessing quantitative sonographic changes in the muscle mass of geriatric patients hospitalised using point of care ultrasound

Abstract Introduction One of the most important consequences of hospitalisation in older patients is sarcopenia. This study aims to determine the impact of hospitalisation on the muscle mass, functional status, nutritional status, and short-term clinical outcomes. Methods A prospective study of patients admitted to an Acute Geriatric Ward between 1st November and 30th December 2022. Muscle ultrasound, utilising Point of Care Ultrasound (POCUS) at bedside, was employed to estimate rectus femoris muscle thickness (MT), area (Ar), pennation angle (PA), and fascicle length (FL) at the time of hospital admission, 3 days post-admission, and at hospital discharge. Results 30 patients included, with a median age of 84 years (SD 72–93), 63.3% male, and 70% Clinical Frailty Scale score ≥ 4. Barthel Index and Functional Ambulation Category revealed median values of 72.33 and 3.87 respectively. Global Deterioration Scale median was 2.47. Mini Nutritional Assessment Short-Form (MNA) and total serum protein showed median values of 7.40 and 6.35 respectively. The median length of hospital stay was 5.79 days, with inpatient mortality rate of 10% and 53.3% incidence of delirium. Ultrasound showed a decrease in PA by 36.31%, Ar by 34.30%, and MT by 24.50%, and increase in FL by 10.47%. Sarcopenia classification at admission and discharge revealed an increase in mean index from 5.04 to 7.74. Conclusions In our cohort of patients admitted to an acute geriatric unit, POCUS identified real-time decreases in MT, Ar, and PA at the muscular level before these manifested as functional changes. It demonstrated an inverse relationship between frailty and muscle morphology as living with frailty associated further decreases in muscle mass at discharge. The study also established a direct relationship between MNA, muscle thickness, PA, and fascicles length at discharge. POCUS assessment of muscle mass could indirectly predict outcomes and guide decisions to address muscle mass abnormalities.

Clinical outcomes and phenotypes of respiratory failure in older subjects admitted to an acute care geriatric hospital ward.

Respiratory failure (RF) is frequent in hospitalized older patients, but was never systematically investigated in large populations of older hospitalized patients. We conducted a retrospective administrative study based on hospitalizations of a Geriatrics Unit regarding 2014, 2015, and 2016. Patients underwent daily screening for hypoxia. Hospital discharge records were coded through a standardized methodology. RF, defined as documented hypoxia on room air, was always coded, whenever present. We investigated how RF affected clinical outcomes, whether RF grouped into specific comorbidity phenotypes, and how phenotypes associated with the outcomes. RF was coded in 48.6% of the 1,810 hospitalizations. RF patients were older and more frequently had congestive heart failure (CHF: 49 vs 23%), chronic obstructive pulmonary disease (COPD: 27 vs 6%), pneumonia (14 vs 4%), sepsis (12 vs 7%), and pleural effusion (6 vs 3%), than non-RF patients. RF predicted longer length of stay (a-Beta 2.05, 95% CI 1.4-2.69; p < 0.001) and higher in-hospital death/intensive care units (ICU) need (aRR 7.12, 5-10.15; p < 0.001) after adjustment for confounders (linear and Poisson regression with robust error variance). Among RF patients, cerebrovascular disease, cancer, electrolyte disturbances, sepsis, and non-invasive ventilation predicted increased, while CHF and COPD predicted decreased in-hospital death/ICU need. The ONCO (cancer) and Mixed (cerebrovascular disease, dementia, pneumonia, sepsis, electrolyte disturbances, bedsores) phenotypes displayed higher in-hospital death/ICU need than CARDIO (CHF) and COPD phenotypes. In this study, RF predicted increased hospital death/ICU need and longer hospital stay, but also reflected diverse underlying conditions and clinical phenotypes that accounted for different clinical courses.

Long-Term Mortality in Very Old Survivors of COVID-19

ObjectivesThis report aimed to describe mortality at 18 months in older survivors of the first wave of COVID-19. DesignObservational cohort study. Setting and ParticipantsPatients aged ≥65 years hospitalized for COVID-19 in the acute geriatric wards of 2 centers. MethodsCharacteristics of deceased and survivors were compared by Fisher exact, Mann-Whitney U, or 2-tailed t tests. Survival rates were analysed by Cox proportional hazards regression models. ResultsOf a total of 323 patients admitted during the first wave, 196 survived the acute phase, with 34 patients who died in the 18 months after hospital discharge (17.3%). Higher mortality was observed in patients living in nursing homes (P = .033) and in those who were hospitalized after discharge during the follow-up period (97.1% vs 72.8%, P = .001). There was no difference in survival curves according to age, sex, presence of dyspnea, and dementia. Living in a nursing home significantly increased the mortality rates in the multivariate model adjusted for age and sex (hazard ratio 3.07, 95% CI 1.47-6.40; P = .007). Conclusions and ImplicationsNo excess mortality was observed during 18 months in older survivors of COVID-19. Living in a nursing home was associated with decreased survival rates.

Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review

BackgroundDysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson’s disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported.MethodsA scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024.ResultsA total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews.ConclusionMost of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.

'It helps you forget your worries': A pilot study exploring music therapy in the acute hospital aged care setting.

Few studies have explored music therapy (MT) in an acute aged care inpatient setting. We aimed to assess feasibility and patient/staff perceptions of an 8-week MT program on an acute geriatric ward. An 8-week in-person MT program, comprising brief receptive musical interventions up to twice-weekly. All patients admitted to the aged care ward were eligible for inclusion. A hard copy survey was used to assess patient and staff perceptions of MT. Themes raised in free-text responses were manually coded within a thematic analysis approach. A mixed methods approach was used to obtain and analyse data relating to feasibility and patient and staff perceptions of the MT intervention. The 8-week program ran to completion and was delivered to a median of 11 patients (IQR 9-12) each session (median 8 new/day). In total, 10 patients completed surveys, mean age 81.1 (SD 7.7); 60% were women and all had cognitive impairment. Following an MT session, eight of eight responding patients reported feeling happy and eight of eight reported they would recommend MT. Staff respondents (n = 19) reported patients appeared happy (19/19), relaxed (13/19) and all would recommend MT to other patients. Common themes were that MT was followed by improved patient behaviour and mood, and stimulated patients. An acute aged care inpatient MT program proves feasible and well-received by staff and patients. Future research may focus on more robust data collection in larger sample sizes, specific types of MT and more in-depth exploration of the patient and carer experiences.

Short-Term Opioid Treatment of Acute Locomotor Pain in Older Adults: Comparison of Effectiveness and Safety between Tramadol and Oxycodone: A Randomized Trial.

We conducted a head-to-head comparison of step 2 (tramadol) and step 3 (oxycodone) of the WHO pain ladder in older adults with moderate to severe acute locomotor pain. Multi-center prospective randomized study. Patients were 70 years or older, admitted to the acute geriatric ward of three hospitals, suffering from acute moderate to severe locomotor pain, and opioid-naive. Patients were randomized into two treatment groups: tramadol versus oxycodone. The Consort reporting guidelines were used. Forty-nine patients were included. Mean numeric rating scale (NRS) decreased significantly between day 0 and 2 of the inclusion in both groups. A sustained significant decrease in mean NRS was seen at day 7 in both groups. Nausea was significantly more prevalent in the tramadol group, with a trend towards a higher prevalence of delirium and falls and three serious adverse events in the same group. Opioid therapy may be considered as a short-term effective treatment for moderate to severe acute locomotor pain in older adults. Oxycodone may possibly be preferred for safety reasons. These results can have implications for geriatric practice, showing that opioids for treatment of acute moderate to severe locomotor pain in older patients are effective and safe if carefully monitored for side effects. Opioid therapy may be considered as a short-term treatment for moderate to severe acute locomotor pain in older adults, if carefully monitored for (side) effects, while oxycodone may possibly be preferred for safety reasons. These results can have implications for daily practice in geriatric, orthopedic, and orthogeriatric wards, as well as in terminal care, more precisely for the treatment of moderate to severe acute locomotor pain in older adults.

Chronic kidney disease and orthostatic hypotension in hospitalised older adults

Purpose Orthostatic hypotension (OH) may predispose older adults to health complications leading to functional impairment. Despite the central role of the kidney in blood pressure control, the contribution of renal function in orthostatic hypotension is poorly investigated. To verify the association between Chronic Kidney Disease (CKD) and OH a population of hospitalised elderly patients with comorbidities was studied. Materials and methods 174 patients were consecutively admitted to Acute Geriatric Wards. On admission, patients underwent postural systolic (SBP) and diastolic (DBP) blood pressure evaluation by automatic oscillometric device after 10 min rest in lying position, and in standing position at time 0, 1, 3 and 5 min. CKD was assumed for estimated glomerular filtration rate (e-GFR) less than 60 mL/min/1.73 m2. Results The mean age of the population enrolled was 74.4 ± 7.0. OH was found in 46.0% and CKD in 56.3% of patients, respectively. A lower e-GFR was observed in patients with (56.1 ± 16.7 mL/min/1.73 m2) than in those without OH (61.1 ± 15.9 mL/min/1.73 m2) (p < 0.05). A greater fall in SBP at 0-min (12.8 ± 6.3 vs. 7.7 ± 3.2 mmHg) and at 1-min (8.4 ± 4.5 vs. 5.7 ± 2.8 mmHg) was found in CKD patients in respect to patients without CKD during active standing test (p < 0.05). Similarly, a DBP reduction at 0-min and at 1-min was observed in CKD patients in respect to patients without CKD (p < 0.05). A multivariate logistic regression analysis showed that CKD was associated to OH (OR 2.426; 95%CI 1.192–4.937; p = 0.014). Conclusions CKD is associated to OH in hospitalised older adults.

Feasibility of a screening and prevention procedure for risks associated with dysphagia in older patients in geriatric units: the DYSPHAGING pilot study protocol

BackgroundDysphagia, particularly sarcopenic dysphagia, is frequent in frail older patients. Sarcopenic dysphagia is a swallowing disorder caused by sarcopenia, corresponding to a loss of muscle mass and strength. It frequently...

Predictors of 2-Year Post-Discharge Mortality in Hospitalized Older Patients.

Understanding prognostic factors for adverse health outcomes is clinically relevant for improving treatment decision-making processes, potentially leading to enhanced patient prognosis. This secondary analysis of a prospective observational study aimed to identify independent factors associated with 2-year post-discharge mortality in acutely hospitalized older patients. All-cause mortality and date of death of 115 patients (83.3 ± 6.3 years, females: n = 75, 65.2%) admitted to acute geriatric wards were determined two years after hospital discharge through telephone interviews. Potential prognostic factors measured at hospital admission included demographic and clinical characteristics, nutritional, cognitive, and psychological status, Fried frailty phenotype, functioning in activities of daily living, locomotor capacity, and 24 h in-hospital mobility and objectively measured physical activity (PA) behaviors. The 2-year mortality rate was 36.7% (n = 41). Univariate and multivariate Cox proportional hazards regression models revealed that mean daily PA level (hazards ratio (HR) = 0.59, 95% confidence interval (CI) 0.90-1.00; p = 0.042), frailty (HR = 3.39, 95% CI 1.20-9.51; p = 0.020), and underweight, in contrast to overweight (HR = 3.10, 95% CI 1.07-9.01; p = 0.038), at hospital admission were independently predictive of post-discharge mortality. PA, frailty, and underweight at hospital admission should be considered when evaluating long-term survival prognosis, establishing risk profiles, and developing personalized care pathways in acute hospital care of older adults.

Malnutrition prevalence according to GLIM and its feasibility in geriatric patients: a prospective cross-sectional study.

In 2019, the Global Leadership Initiative on Malnutrition (GLIM) suggested a 2-step diagnostic format for malnutrition including screening and diagnosis. Prospective validation and feasibility studies, using the complete set of the five GLIM criteria, are needed. The aims of this study were to determine the prevalence of malnutrition, and investigate how the prevalence varied with mode of screening. Furthermore, we assessed the feasibility of GLIM in geriatric patients. Consecutive patients from two acute geriatric wards were included. For screening risk of malnutrition, the Mini Nutritional Assessment-Short Form (MNA-SF) or Malnutrition Screening Tool (MST) were used. In accordance with GLIM, a combination of phenotypic and etiologic criteria were required for the diagnosis of malnutrition. Feasibility was determined based on % data completeness, and above 80% completeness was considered feasible. One hundred patients (mean age 82years, 58% women) were included. After screening with MNA-SF malnutrition was confirmed by GLIM in 51%, as compared with 35% after screening with MST (p = 0.039). Corresponding prevalence was 58% with no prior screening. Using hand grip strength as a supportive measure for reduced muscle mass, 69% of the patients were malnourished. Feasibility varied between 70 and 100% for the different GLIM criteria, with calf circumference as a proxy for reduced muscle mass having the lowest feasibility. In acute geriatric patients, the prevalence of malnutrition according to GLIM varied depending on the screening tool used. In this setting, GLIM appears feasible, besides for the criterion of reduced muscle mass.

The prognostic validity of delirium severity as measured by Delirium Observation Screening Scale (DOS scale) on adverse outcomes.

To investigate whether an assessment of delirium severity at diagnosis using the Delirium Observation Screening Scale (DOS scale) predicts adverse outcomes in hospital and on discharge. A prospective cohort study was conducted on a convenience sample of patients admitted to an acute geriatric ward with delirium over an eight-month period. DOS scale was administered to the patients within 48 h of delirium diagnosis to measure delirium severity. Univariate logistic regression analysis was performed to evaluate the correlation between DOS scale and adverse outcomes. Fifty-nine patients were included in the study. There was a moderate correlation between increasing DOS scores and duration of delirium (r = 0.46, p < 0.001), as well as increasing DOS scores and decline in mobility on discharge (r = 0.35, p = 0.007). There was a weak correlation between increasing DOS scores and functional decline as measured by change in Katz Index from admission to discharge (r = -0.27, p = 0.04). No statistically significant correlations were found between DOS scores and in-hospital mortality, inpatient complication rates or discharge to higher level of care. Delirium severity as measured by DOS scale may be useful in predicting delirium duration and decline in mobility and function on discharge. Further research with larger sample sizes is needed to establish if this finding can be replicated and whether delirium severity predicts additional adverse outcomes. Measuring delirium severity at diagnosis may be useful for communicating prognostic information to family members and setting expectations and treatment goals.

The "Continu-A-mente" project: an interdisciplinary program to promote the continuity of care between hospital and community for people with dementia and their caregivers. Study Protocol.

Background: Nonpharmacological approaches are recommended as first-line treatment for the neuropsychiatric symptoms of persons living with dementia. Tailored Activity Program is a non-pharmacological approach which has shown to reduce neuropsychiatric symptoms and functional dependence of persons living with dementia at the community, as well as caregiver’s distress. The aim of the study is to assess the feasibility of a project in which the Tailored Activity Program is delivered partially at an acute hospital ward and partially at the patient's home. Material and Methods: The study is aimed at enrolling 50 dyads (patients/caregivers) from the memory clinic, acute geriatric ward, or short-stay emergency department at the IRCCS San Gerardo dei Tintori, Monza (Italy). Inclusion criteria are: the patient’s clinical diagnosis of dementia, clinically detectable neuropsychiatric symptoms (Neuro Psychiatric Inventory, NPI score &gt;6 in at least one item), the ability to participate in activities of daily living (Katz’s index ≥ 2), the presence of a caregiver (aged ≥ 21 years; minimum 4 hours of daily care), and the willingness of the dyad patient/caregiver to participate in the project. Treatment is delivered both i) in hospital (2 sessions) and ii) at home (6 sessions), including occupational therapy, telemedicine and nursing care provided once a week. The following variables are measured: Neuro Psychiatric Inventory, Time Up and Go Test, Katz’s Index and the level of caregiver’s sense of competence with the Sense of Competence Questionnaire. Data are collected both at baseline, at the end of the treatment, with a follow-up scheduled at 4 months after enrollment. Primary outcome measure is the dyad's retention rate at 4-month follow-up. Secondary outcomes are the reduction in the patient’s frequency and severity of NPS; the improvement in the patient’s Time Up and Go Test score; the improvement in the patient's levels of autonomy and participation in activities of daily living and improvement in the caregiver’s Sense of Competence Questionnaire score. Results and Conclusion: We seek to evaluate whether the Tailored Activity Program is well-received by the patient/caregiver dyad and, consequently, whether our project is feasible. If this objective is achieved, and if we also report some improvement in the secondary outcomes, we can then plan a larger multicenter study aimed at evaluating the effectiveness of this approach, partly delivered at the hospital and partly at patient’s home.