Discharge In Elderly Patients Research Articles

Prediction of Neurological Outcomes in Elderly Patients With Head Trauma Using the Geriatric Trauma Outcome Score: A Retrospective Observational Study.

Introduction Head trauma in elderly people is a problem in today's aging society. Elderly people are susceptible to head trauma because of their declining physical function; this tends to be severe. Outcome prediction is important in decision-making regarding treatment strategies; however, there is no unified method for predicting neurological outcomes in elderly patients with head trauma. Methods Elderly patients with head trauma admitted to the Japan Red Cross Narita Hospital between January 2019 and August 2023 were enrolled in this single-center, retrospective observational study. A favorable neurological outcome was defined as a cerebral performance category scale of 1 or 2. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to investigate the association between geriatric trauma outcome scores and outcomes and to evaluate the predictive value of geriatric trauma outcome scores. The primary outcome was a favorable neurological outcome at discharge, and the secondary outcome was in-hospital mortality. Results A total of 313 elderly patients with head trauma were eligible for analysis. Multivariate logistic regression analysis revealed that the geriatric trauma outcome score was significantly associated with a favorable neurological outcome at discharge (odds ratio 0.94, P <0.0001). In the receiver operating characteristic curve analysis, the geriatric trauma outcome score had a good predictive value for favorable neurological outcomes at discharge (area under the receiver operating characteristic curve 0.83). Conclusions The geriatric trauma outcome score had good predictive value for favorable neurological outcomes at discharge in elderly patients with head trauma and has the potential to aid in decision-making regarding treatment strategies for elderly patients with head trauma.

Random forest predictive modeling of prolonged hospital length of stay in elderly hip fracture patients.

In elderly individuals suffering from hip fractures, a prolonged hospital length of stay (PLOS) not only heightens the probability of patient complications but also amplifies mortality risks. Yet, most elderly hip fracture patients present compromised baseline health conditions. Additionally, PLOS leads to increased expenses for patient treatment and care, while also diminishing hospital turnover rates. This, in turn, jeopardizes the prompt allocation of beds for urgent cases. A retrospective study was carried out from October 2021 to November 2023 on 360 elderly hip fracture patients who underwent surgical treatment at West China Hospital. The 75th percentile of the total patient cohort's hospital stay duration, which was 12 days, was used to define prolonged hospital length of stay (PLOS). The cohort was divided into training and testing datasets with a 70:30 split. A predictive model was developed using the random forest algorithm, and its performance was validated and compared with the Lasso regression model. Out of 360 patients, 103 (28.61%) experienced PLOS. A Random Forest classification model was developed using the training dataset, identifying 10 essential variables. The Random Forest model achieved perfect performance in the training set, with an area under the curve (AUC), balanced accuracy, Kappa value, and F1 score of 1.000. In the testing set, the model's performance was assessed with an AUC of 0.846, balanced accuracy of 0.7294, Kappa value of 0.4325, and F1 score of 0.6061. This study aims to develop a prognostic model for predicting delayed discharge in elderly patients with hip fractures, thereby improving the accuracy of predicting PLOS in this population. By utilizing machine learning models, clinicians can optimize the allocation of medical resources and devise effective rehabilitation strategies for geriatric hip fracture patients. Additionally, this method can potentially improve hospital bed turnover rates, providing latent benefits for the healthcare system.

Perioperative Morbidity Associated with Same-day Discharge in Elderly Patients.

We compared postoperative complications in elderly patients discharged on POD#0 versus POD#1 after prolapse repair. Data were obtained from the National Surgical Quality Improvement database. A total of 20,984 women 65years and older who underwent prolapse repair between 2014 and 2020 were analyzed. Patient demographics, comorbidities, readmission, reoperation, and 30-day postoperative complications were compared in patients discharged on POD#0 versus POD#1. A sensitivity analysis was completed to examine outcomes in patients who underwent an apical prolapse repair. Multivariate logistic regression was performed to evaluate for potential confounders. Age, race, ethnicity, American Society of Anesthesiologists class, prolapse repair type, and operative time were significantly different in patients discharged on POD#0 vs POD#1 (all p < 0.01). Patients discharged on POD#0 had significantly fewer postoperative complications (2.63% vs 3.44%) and readmissions (1.56% vs 2.18%, all p < 0.01). On multivariate regression modeling, postoperative discharge day was independently associated with complications, but not with readmissions or reoperation after. Patients who underwent an apical prolapse repair and were discharged on POD#0 had significantly more postoperative complications (3.5% vs 2.5%, p = 0.02) and readmissions (2.42% vs 10.08%, p < 0.01) than those discharged on POD#1. In this group, multivariate regression modeling demonstrated that postoperative discharge day was independently associated with any postoperative complication. For elderly women undergoing prolapse repair, the type of surgery should be considered when determining postoperative admission versus same-day discharge. Admission overnight does not seem to benefit women undergoing vaginal repairs but may decrease overall morbidity and risk of readmission in women undergoing an apical prolapse repair.

Predictors of postoperative physical functional decline at hospital discharge in elderly patients with prolonged intensive care unit stay after cardiac surgery

BackgroundA prolonged stay in the intensive care (ICU) is associated with physical function decline following cardiac surgery. To predict physical function decline after cardiac surgery, it may be important to evaluate physical function in the ICU. ObjectivesThis study aimed to determine that physical function examination at ICU discharge was independently associated with physical functional decline at hospital discharge in elderly patients who had undergone cardiac surgery and prolonged the ICU stay. MethodsWe assessed physical function before and after cardiac surgery in elderly patients who had spent ≥72 h in the ICU in this retrospective cohort study using the short physical performance battery (SPPB). At hospital discharge, a decrease of at least 1 point on the SPPB was considered a postoperative physical functional decline. Postoperative physical functional decline at hospital discharge was predicted using multiple logistic regression. ResultsWe revealed postoperative physical functional deterioration in 28.0% of patients who spent ≥72 h in the ICU following cardiac surgery. The Medical Research Council sum score (MRC-SS) (OR: 0.96, 95% CI: 0.82–0.99) and mechanical ventilation days (OR: 1.27, 95% CI: 1.01–1.64) were independently associated with physical functional decline at hospital discharge. ConclusionsPhysical function at ICU discharge and mechanical ventilation days were predictors of postoperative physical functional decline at hospital discharge in patients. MRC-SS was more accurate in predicting postoperative physical functional decline at hospital discharge when performed at the time of ICU discharge.

Postoperative cognitive worsening in seniors with an age above life expectancy: a prospective longitudinal study.

The growing number of elderly patients in hospitals is a challenge for healthcare systems. The main objective is to measure the postoperative change in the cognitive status at hospital discharge and one year after discharge in elderly patients undergoing planned or deferrable surgery. We planned a prospective longitudinal study, single-center study: secondary care level hospital, enrolment from September 2018 to May 2019. We enroll elderly patients, aged above life expectancy in Italy, who underwent planned or deferrable surgery (men over 80.5 years old, women over 85.0 years old). In six months, we enrolled 76 eligible patients. We collected the scores of the clinical impairment scales Charlson Index, Barthel Index, and Six-Item Cognitive Impairment Test (6CIT). The primary endpoint was the postoperative worsening of the cognitive status at one-year follow-up. Secondary endpoints aimed to describe postoperative disabilities and complications, to investigate possible risk factors for cognitive worsening, and to measure the role of anesthesia in cognitive changes. We recorded an increased rate of pathological 6CIT values during the hospitalization period, rising from 39.47% to 55.26% (McNemar test, P=0.007), and this rate was still increased at 55.56% (P=0.021) one year after discharge. Anesthesia did not show any significant harmful effect on cognitive status. The preoperative hemoglobin value seems to be a risk factor for cognitive status and one-year mortality. Elderly patients had a significantly worse 6CIT value after planned surgery, which may derive in part from age and in part from hospitalization. It is difficult to determine if general anesthesia alone has no harmful effects on cognitive performance in patients at discharge and one year later. Further data are necessary.

Perioperative morbidity associated with same day discharge in elderly patients

Perioperative morbidity associated with same day discharge in elderly patients

Construction and validation of a risk prediction model for delayed discharge in elderly patients with hip fracture

BackgroundBecause of their poor physical state, elderly hip fracture patients commonly require prolonged hospitalization, resulting in a drop in bed circulation rate and an increased financial burden. There are currently few predictive models for delayed hospital discharge for hip fractures. This research aimed to develop the optimal model for delayed hospital discharge for hip fractures in order to support clinical decision-making.MethodsThis case-control research consisted of 1259 patients who were continuously hospitalized in the orthopedic unit of an acute hospital in Tianjin due to a fragility hip fracture between January and December 2021. Delayed discharge was defined as a hospital stay of more than 11 days. The prediction model was constructed through the use of a Cox proportional hazards regression model. Furthermore, the constructed prediction model was transformed into a nomogram. The model’s performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). the STROBE checklist was used as the reporting guideline.ResultsThe risk prediction model developed contained the Charlson Comorbidity Index (CCI), preoperative waiting time, anemia, hypoalbuminemia, and lower limbs arteriosclerosis. The AUC for the risk of delayed discharge was in the training set was 0.820 (95% CI,0.79 ~ 0.85) and 0.817 in the testing sets. The calibration revealed that the forecasted cumulative risk and observed probability of delayed discharge were quite similar. Using the risk prediction model, a higher net benefit was observed than when considered all patients were at high risk, demonstrating good clinical usefulness.ConclusionOur prediction models could support policymakers in developing strategies for the optimal management of hip fracture patients, with a particular emphasis on individuals at high risk of prolonged LOS.

Abstract 167: Effects Of Cardiac Rehabilitation After Discharge On Frailty And Balance In Elderly Patients With Cardiovascular Disease

Background: Cardiac rehabilitation (CR) improves patients’ overall health. However, the benefits of CR after discharge in elderly patients with cardiovascular disease (CVD) are unknown. We therefore compared cardiac function, exercise capacity, and balance between elderly patients who received CR and those who received the current standard of clinical care. Methods: In this retrospective study, elderly patients (n=185; mean age, 79.8 years) admitted due to worsening CVD were divided into two groups: those who underwent CR comprising aerobic exercise and resistance training once weekly for 4 months (group C, n=85) and those who received standard clinical care (group U, n=100). All patients underwent cardiopulmonary exercise testing, Kihon Checklist (KCL) frailty assessment, walking speed and timed up-and-go (TUG) measurement, and the Short Physical Performance Battery (SPPB) at discharge and 4 months afterward. Results: In group C, the anaerobic threshold (AT) increased from 10.0±1.8 mL/min/kg at baseline to 10.5±2.1 mL/min/kg at 4 months (p=0.032). Comfortable walking speed, TUG, and SPPB at 4 months were improved in group C (p&lt;0.05), but TUG and SPPB did not differ between discharge and 4 months in group U. After adjustment for age, gender, and baseline data, KCL score tended to be improved (p=0.089) and AT, walking speed, TUG, and SPPB were significantly improved in group C (p&lt;0.05). Conclusions: CR after discharge is beneficial for elderly patients with CVD. Rather than further increasing cardiac function, CR after discharge decreased frailty and increased exercise capacity, ease of movement, and balance. CR after discharge should be recommended more often for elderly patients with CVD.

Association of long–term exposure to PM2.5 with cause-specific mortality in elderly patients with the previous history of ischemic heart disease

BACKGROUND AND AIM: Numerous studies have reported an association between fine particulate matter (PM2.5) and cardiovascular disease (CVD) morbidity and mortality. However, the association between PM2.5 and mortality among those with a previous history of ischemic heart disease (IHD) is less understood. We aimed to evaluate whether long-term exposure to PM2.5 is related to mortality after hospital discharge in elderly patients with IHD. METHODS: We followed-up 306,418 IHD elderly patients residing in seven major cities between 2008 and 2016 using the Korean National Health Insurance Database and identified cause-specific mortality after the hospital admission. We linked the modelled PM2.5 data corresponding to each patient’s administrative districts. We used time-varying Cox hazard models after adjusting for the individual- and area-level confounders. Subgroup analyses were conducted by age group (65–74 vs ≥ 75), sex, and income- and wealth-based insurance premiums. RESULTS:Of a total of 306,418 IHD elderly patients, 43.1 (%) were male, mean age was 76.8 years, and 105,913 died during a mean follow-up of 21.4 years. The adjusted hazard ratio (HR) of all-cause mortality was 1.10 [95% confidence intervals (CI): 1.07, 1.14] per 10 μg/m3 increase in a 12–month moving average PM2.5. The HRs were greater for cause-specific mortality: 1.17 (95% CI: 1.11, 1.24), 1.17 (95% CI: 1.06, 1.30), and 1.25 (95% CI: 1.15, 1.35) for CVD, stroke, and IHD, respectively. The subgroup analyses showed that for all–cause mortality, 65–74 age group, men, and low wealth-based insurance premiums were more susceptible to PM2.5 exposure. CONCLUSIONS:We found an association between long-term exposure to PM2.5 and mortality among elderly IHD patients, particularly for CVD-related mortality. Our results suggest that those with a previous history of IHD were more susceptible to PM2.5 exposure. KEYWORDS: Cohort Studies, Ischemic heart disease, Mortality,Particulate matter, Republic of Korea

Impaired cognitive performance on MoCA testing at discharge in elderly patients following day endoscopy and its relationship to preoperative mild cognitive impairment

In patients admitted to hospital, preoperative mild cognitive impairment predicts postoperative complications. The effect of mild cognitive impairment on discharge readiness among the day stay surgery population is unknown. Our aims were to determine the incidence of impaired cognitive performance at discharge after day stay endoscopy and whether pre-existing mild cognitive impairment was associated with its development. A single-centre cohort study of elective day stay endoscopy patients was undertaken. Over a three-month period, data were collected from 69 patients aged 65 years and over. Patients were cognitively assessed on admission and discharge using the Montreal cognitive assessment tool and the three-minute diagnostic confusion assessment method. At baseline, patients who scored 1.5 or more standard deviations below age-adjusted levels on the Montreal cognitive assessment tool in conjunction with a subjective memory complaint were classified as having mild cognitive impairment. At discharge, patients were classified as having impaired cognitive performance if there was a reduction in the Montreal cognitive assessment tool score by at least two points. We also assessed delirium and subsyndromal delirium at discharge using the three-minute diagnostic confusion assessment method. We identified mild cognitive impairment in 23 patients (33.3%) on admission, and impaired performance on the Montreal cognitive assessment tool test at discharge in 35 (50.7%) patients. There was no association between mild cognitive impairment on admission and impaired cognitive performance at discharge (50.0% versus 51.1%, P = 0.94). This study demonstrates that evidence of impaired cognitive performance on the Montreal cognitive assessment tool testing is present after day stay endoscopy in over 50% of elderly patients, but this is not associated with preoperative cognitive status.

Predictors of Successful Early Discharge for Total Hip and Knee Arthroplasty in Octogenarians.

Background: Decreased length of stay after total joint arthroplasty (TJA) is becoming a more common way to contain healthcare costs and increase patient satisfaction. There is little evidence to support "early" discharge in elderly patients. Purpose: We sought to identify preoperative factors that correlated with early discharge (by postoperative day [POD] 1) in comparison to late discharge (after POD2) in octogenarians after TJA. Methods: In a retrospective cohort study from a single institution, we identified 482 patients ages 80 to 89 who underwent primary TJA from January 2014 to December 2017; 319 had total knee arthroplasty (TKA) and 163 had total hip arthroplasty (THA). Data collected included preoperative knee range of motion (ROM), demographics, and comorbidities; 90-day readmission and mortality rates were also evaluated. P values for continuous data were calculated using student's t test and for categorical data using χ2 testing. Results: Of octogenarian patients, 30.9% were discharged by POD1. Early discharge was associated with being male, married, and nonsmoking, as well as having an American Society of Anesthesiologists (ASA) score of 2, independent preoperative ambulation, and a postoperative caregiver. Type of procedure (TKA vs THA), body mass index, laterality, preoperative range of motion (ROM) for TKA, and single vs multilevel home did not affect the probability of early discharge. Discharge on POD1 was not associated with increased 90-day readmission rates. There were no deaths. Conclusion: Early discharge for octogenarians can be successfully implemented in a select subset of patients without increasing 90-day readmission or death rates. There are multiple factors that predict successful early discharge.

Clinical validation of implementing Enhanced Recovery After Surgery protocol in elderly colorectal cancer patients.

PurposeThe aim of this study was to evaluate the safety and feasibility of applying enhanced recovery after surgery (ERAS) protocol in elderly colorectal cancer patients.MethodsThe medical records of patients who underwent elective colorectal cancer surgery at our institution, from January 2017 to December 2017, were reviewed. Patients were divided into 2 groups: the young group (YG, patients aged 70 and under 70 years) and the old group (OG, patients over 70 years old). Perioperative outcomes and length of hospital stay were compared between both groups.ResultsIn total, 335 patients were enrolled; 237 were YG and 98 were OG. Despite the poorer baseline characteristics of OG, the perioperative outcomes were similar. Length of hospital stay was not different between the groups (YG, 5 days vs. OG, 5 days; P=0.320). When comparing the postoperative complications using the comprehensive complication index (CCI), there was no significant difference (YG, 8.0±13.2 vs. OG, 11.7±23.0; P=0.130). In regression analysis, old age (>70 years) was not a risk factor for high CCI in all patients. In multivariate analysis, C-reactive protein (CRP) level on postoperative day (POD) 3 to 4 was the only strong predictive factor for high CCI in elderly patients.ConclusionImplementing the ERAS protocol in patients aged >70 years is safe and feasible. High CRP (≥6.47 mg/dL) on POD 3 to 4 can be used as a safety index to postpone discharge in elderly patients.

Risk of falls after hospital discharge in elderly patients who underwent lumbar surgery

Risk of falls after hospital discharge in elderly patients who underwent lumbar surgery

Effects of the Cardiac and Comorbid Conditions Heart Failure (3C-HF) Score at Admission on Life Space at Three Months after Hospital Discharge in Elderly Patients with Heart Failure: A Short Report.

We assessed 22 elderly patients with heart failure, 3 months after hospital discharge. We examined and compared factors that predict small life space after discharge with the same factors before discharge. Life-Space Assessment was used to classify the participants as either having “small living spaces” or “large living spaces”. We collected data regarding characteristics, Cardiac and Comorbid Conditions Heart Failure Score (3C-HF score), and evaluated motor function. We also collected data on the patients’ lifestyle habits. We investigated spreading life space at 3 months after discharge by mailing a questionnaire to the subjects. Using multiple logistic regression analysis, we were able to predict the patients having a small life space at 3 months after discharge by the Cardiac and Comorbid Conditions Heart Failure (3C-HF) score (odds ratio, 1.19; 95% confidence interval, 1.01–1.39; p = 0.038) at admission. Overall, the 3C-HF score at admission may be associated with the size of life space at 3 months after hospital discharge in elderly patients with heart failure. Future multicenter studies should be conducted to validate the results of this study by measuring post-discharge activity with a more objective index.

Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction.

The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.

Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge.

ObjectivesThe aims of this study were to evaluate changes in health-related quality of life (HRQoL) before ICU admission and after ICU discharge in elderly patients and to determine predictors of this HRQoL.Materials and methodsThis prospective study has been realized in the medical ICU (August 2012-March 2013). All patients 65 years of age or older who were hospitalized for ≥48 hours in our medical ICU have been included. The HRQoL was assessed 1 month prior to ICU admission in all the patients at admission and 3 months after ICU discharge for survivors using the Arabic version of MOS SF-36 questionnaire.ResultsWe enrolled 118 patients (66 M: 55.9% and 52 F: 44.1%). The mean age was 72 ± 6 years. ICU mortality rate was 47.5% and three-month mortality rate was 55.1%. The reliability and validity of MOS SF-36 were satisfactory. Among the 53 survivors at follow-up, the subscales of MOS SF-36 decreased significantly at 3 months after ICU stay except the “Bodily Pain”. The physical component score (PCS) and mental component score (MCS) decreased also significantly. The independent factors strongly associated with PCS and its variations were: age (β = −1.56, p = 0.001), prior functional status (β = −22.10, p = 0.002) and SAPSII (β = −0.16, p = 0.04). For MCS, these factors were: live alone (β = 16.50, p = 0.006), previous functional status (β = −9.09, p = 0.008) and existence of education level (β = 2.98, p = 0.037).ConclusionWe demonstrated a fall in the physical and psychical aspects of HRQoL 3 months after ICU discharge in the elderly patients. In addition to factors such as age, prior functional status and severity of illness, family status and educational level seem decisive in the post-ICU HRQoL.How to cite this articleZeggwagh Z, Abidi K, Kettani MNZ, Iraqi A, Dendane T, Zeggwagh AA. Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge. Indian J Crit Care Med 2020;24(7):531–538.

Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy.

Development of laparoscopic gastrectomy and the Enhanced Recovery After Surgery (ERAS) protocol enable early discharge to home of patients with gastric cancer (GC). However, a significant proportion of patients are still discharged to inpatient facilities after surgery. We aimed to identify predictive factors of non-home discharge in patients with GC who undergo gastrectomy. We enrolled 517 patients with histopathologically confirmed diagnosis of GC who underwent gastrectomy. The number of patients with non-home discharge was 23 (4.4%), and non-home discharge was only observed in patients with GC aged ≥65years. Patients were divided into the mFIHigh (≥0.272) and mFILow (<0.272) groups according to the cut-off value determined by ROC analysis. The mFIHigh classification was significantly more frequent in patients aged ≥75years, who underwent either total or proximal partial gastrectomy, who underwent limited lymph node dissection, and with non-home discharge than in patients aged <75years (p = 0.0002), those who underwent distal partial gastrectomy (p = 0.032), those who underwent standard lymph node dissection (p = 0.036), and those without non-home discharge (p = 0.0071). Multivariate analysis revealed mFI as an independent predictive indicator of non-home discharge, along with postoperative complications and surgical approach, in patients with GC aged ≥65years. The frequency of patients with non-home discharge was significantly associated with the number of these three predictive factors in GC patients aged ≥65years (p < 0.0001). The combination of mFI, postoperative complications, and surgical approach is useful for predicting non-home discharge in patients aged ≥65years who underwent gastrectomy for GC.

Skeletal muscle mass index predicts normal food intake at discharge in elderly patients with pneumonia

Skeletal muscle mass index predicts normal food intake at discharge in elderly patients with pneumonia

Rising time from bed in acute phase after hospitalization predicts frailty at hospital discharge in patients with acute heart failure

BackgroundThe early prediction of frailty at discharge in elderly patients hospitalized with heart failure (HF) is essential for clinical management and therapeutic decision-making. This study was performed to examine whether the rising time from bed measured immediately after admission can be used as a predictor of frailty in these patients. MethodsA retrospective cohort study was performed in a population of 387 consecutive elderly patients with HF. Rising time from bed was measured within 2 days after admission when cardiac rehabilitation was started. Frailty was assessed at hospital discharge using a composite of four markers as a frailty score (range, 0–12): gait speed, handgrip strength, serum albumin, and activities of daily living status. The patients were divided into two groups based on frailty score <5 (non-frail) or ≥5 (frail). ResultsThe study population had a mean age of 75 years and 63.6 % were men. The median rising time was 6.8s, and 53.5 % were classified as frail. After adjustment for various factors, rising time was independently associated with frailty (odds ratio=1.10; 95 % confidence index=1.04–1.18). The area under the receiver operating characteristics curve of rising time for frailty was 0.71, and the cut-off value for rising time to identify those at high risk of frailty was 7.1s. ConclusionsRising time from bed measured within 2 days after admission was shown to be an independent predictor of frailty at hospital discharge in elderly patients hospitalized for HF.

Improvement in Nutritional Status is Associated with Achieving an Adequate Gait Speed at Discharge in Elderly Patients Hospitalized with Acute Heart Failure

Elderly patients have impaired physical function, which is further reduced by the incidence of hospitalization for heart failure. In these patients, nutritional status also deteriorates during hospitalization, which may cause impairment in their physical function. In this study, we repeatedly measured physical function using gait speed (GS) during hospitalization, and evaluated the factors including nutritional status that are associated with GS at discharge in elderly patients with acute heart failure who underwent exercise training.