Hospitalized Elderly Patients Research Articles

S233 Prevalence, Trends, and Mortality of Clostridium difficile Infection in Hospitalized Elderly Patients with HIV: A Nationwide Analysis From 2016-2019

S233 Prevalence, Trends, and Mortality of Clostridium difficile Infection in Hospitalized Elderly Patients with HIV: A Nationwide Analysis From 2016-2019

Association Between Nutritional Status and Depression in Hospitalized Elderly Patients

Association Between Nutritional Status and Depression in Hospitalized Elderly Patients

Intelligent Monitoring Model for Fall Risks of Hospitalized Elderly Patients.

Early detection of high fall risk is an important process of fall prevention in hospitalized elderly patients. Hospitalized elderly patients can face several falling risks. Monitoring systems can be utilized to protect health and lives, and monitoring models can be less effective if the alarm is not invoked in real time. Therefore, in this paper we propose a monitoring prediction system that incorporates artificial intelligence. The proposed system utilizes a scalable clustering technique, namely the Catboost method, for binary classification. These techniques are executed on the Snowflake platform to rapidly predict safe and risky incidence for hospitalized elderly patients. A later stage employs a deep learning model (DNN) that is based on a convolutional neural network (CNN). Risky incidences are further classified into various monitoring alert types (falls, falls with broken bones, falls that lead to death). At this phase, the model employs adaptive sampling techniques to elucidate the unbalanced overfitting in the datasets. A performance study utilizes the benchmarks datasets, namely SERV-112 and SV-S2017 of the image sequences for assessing accuracy. The simulation depicts that the system has higher true positive counts in case of all health-related risk incidences. The proposed system depicts real-time classification speed with lower training time. The performance of the proposed multi-risk prediction is high at 87.4% in the SERV-112 dataset and 98.71% in the SV-S2017 dataset.

Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit.

Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly “fallers” using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in patients over 65 years of age and hospitalized in an acute geriatric unit. This work was carried out in the Acute Geriatric Medicine Unit, Saint-Julien Hospital, Center Hospitalier Universitaire de Rouen from 1 June 2016 to 15 August 2016. Results: 172 patients were included during the collection period, with a female predominance of 115 patients (66.9%). The average age of the sample was 79.37 years old (65–85). The average CHARLSON score was 6.93 (3–16). Patients came from home in 81.4% of cases (i.e., 140 patients), and from a nursing home in 18.6% of cases (i.e., 32 patients). The risk of falling, as assessed by the Monopodal Support Test, returned as abnormal for 127 patients. In our series, there was a statistically strong link between the risk of falling and the presence of a dementia pathology (p = 0.009), the presence of a vitamin D deficiency (p = 0.03), the presence of frailty, as assessed by the three scales (modified SEGA scale, Fried scale and CFS/7 (<0.001), a high comorbidity score (p = 0.04), and a disturbed autonomy assessment according to IADL (p = 1.02 × 10−5) and according to ADL (p = 6.4 × 10−8). There was a statistically strong link between the risk of falling and the occurrence of death (p = 0.01). Conclusion: The consequences of the fall in terms of morbidity and mortality and the frequency of this event with advancing age and its impact on the quality of life as well as on health expenditure justify a systematic identification of the risk of falling in the elderly population. It is therefore important to have sensitive, specific, and reproducible tools available for identifying elderly people at high risk of falling.

Agreement Between Different Nutritional Assessments Tools Used for Elderly Hospitalized Patients

Nutrition assessment enables early diagnosis of patients at risk of malnutrition and those who are already malnourished. The main objective of the study was to evaluate the agreement between Mini Nutrition Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) as tools for nutritional assessment against the Subjective Global Assessment (SGA) among elderly hospitalized patients. One hundred and fifty hospitalized elderly patients were enrolled in this cross-sectional study. All elderly hospitalized patients aged 65 years who were admitted into medical and surgical departments and signed the consent form were recruited for the study. Socio-demographic and socioeconomic data, medical and nutritional characteristics, anthropometric measurements, biochemical measurements, SGA, MNA, and GNRI were collected from all respondents. The study was approved by the local Helsinki Committee (PHRC/HC/721/20). According to SGA, MNA, and GNRI results, 52.7%, 20.7%, and 4% of hospitalized elderly patients were suffering from malnutrition, respectively. More than half of the respondents were obese. All measured anthropometric parameters in the malnutrition group in all nutritional assessment tools were significantly lower than the non-malnutrition group. With reference to the SGA; the sensitivity, specificity, PPV, and NPV for the GNRI were 0.075, 1, 1, and 0.493, respectively, while those for the MNA were 0.354, 0.957, 0.903, and 0.571, respectively. The AUC of the GNRI was comparable to that of the MNA (0.711 and 0.860, respectively). Moreover, the optimal malnutrition cutoff value for the GNRI and MNA was 108.919 and 21.75, respectively. Results of this study indicated that elderly patients were suffering from different degrees of malnutrition and unfortunately they are undetected. GNRI and MNA show low sensitivity and NPV. Both the GNRI and MNA have a high Area Under the Curve (AUC), thus enabling the discovery of malnutrition in patients. The newly emerging cutoff points of GNRI and MNA for the Palestinian elderly indicated the highest sensitivity and specificity values than the original cutoff points.

Feasibility and Safety of Peripherally Inserted Central Catheters in Hospitalized Elderly Patients

Background &amp; Aims. The frequency of peripherally inserted central catheter use is increasing in elderly patients. Multiple comorbidities and changes in consciousness due to long-term hospitalisation can cause several problems. We aimed to determine the feasibility and safety, including the incidence of and risk factors for complications and accidental withdrawal, of using a peripherally inserted central catheter in hospitalised elderly patients. Methods. A retrospective, single-centre study of elderly patients with peripherally inserted central catheters was performed between July 2015 and July 2020. We analysed the patient-, device-, and procedure-related characteristics to determine the feasibility and safety of the insertion procedure, including complications and accidental withdrawal. Odds ratios (ORs) with 95% confidence intervals were generated. Results. Among 703 patients, insertion of peripherally inserted central catheters was successful in 689 (98.00%) patients. The procedure was unsuccessful in 14 (1.99%) patients. Among those who underwent successful catheter insertion, 52 (7.55%) patients developed procedure- related complications. Logistic regression analysis revealed that complications were associated with pneumonia (OR, 2.136), renal insufficiency (OR, 2.518), chronic obstructive pulmonary disease (OR, 3.050), and double-lumen catheters (OR, 5.524). Accidental withdrawal occurred in 63 (9.14%) patients and was associated with delirium (OR, 2.788) and admission for orthopedic surgery (OR, 2.400). Conclusions. Use of peripherally inserted central catheters are feasible and safe for hospitalised elderly patients. Comorbidities such as pneumonia, renal insufficiency, and chronic obstructive pulmonary disease were risk factors for complications, and delirium was a risk factor for accidental withdrawal.

Analysis of Potentially Inappropriate Drug Prescribing in Hospitalized Elderly Patients

Abstract The study was conducted at the Clinical Centre Kragujevac, during the period March-May 2016. The study population consisted of patients older than 65 that were treated at different departments of the Clinic for Internal Medicine. Data were collected from hospital medical records of patients and anonymous semi-structured questionnaires. STOPP (screening tool of older people's prescriptions)/ START (screening tool to alert to right treatment) criteria from 2014 were used to monitor the outcome of interest. Based on the outcome PIM (potentially inappropriate drugs)/PPO (potential prescribing omissions), respondents were divided into groups of cases - patients to whom at least one potentially inappropriate drug determined by STOPP criteria was prescribed and those with at least one potential prescribing omission determined by START criteria. Control groups were patients without these outcomes. Most commonly, PIM was detected in the treatment of cardiovascular system diseases (27.12%), followed by the use of drugs that predispose falls in elderly (20.34%). The most important risk factors for the occurrence of PIM were female gender (OR=3.27; 95% CI 1.01-10.64), polypharmacy (5-8 drugs used simultaneously) (OR=3.10; 95% CI 1.11-12.04) and with whom the patient lives (OR=11.26; 95% CI 1.46-86.68). The use of STOPP/START criteria is proved to be efficient in the detection of PIM/PPO at the secondary level of health care. Full attention should always be paid to patients who are at the highest risk for inappropriate drug prescription. Doctors should make their decisions conscientiously and in line with clinical evidence, not blindly believing the pharmaceutical representatives.

Prevalence of Comorbidities among Elderly Patients in a General Hospital of Bangladesh

Background: The life expectancy of human is increasing worldwide, and the elderly population represents a large group throughout the world and also in Bangladesh. Globally it is a challenge to overcome elderly comorbidities, and now it is also a challenge that how our elder people can lead a good health and we can use that elderly population as a partner of our socio-economic development. The objectives were to find out the most common comorbidities in elderly population in our society and to give more emphasis for prevention and better management of those comorbid conditions and allow them to lead a healthy living. Methods: This prospective observational study was done in a General Hospital in Faridpur of Bangladesh from October 2019 to December 2020 for a period of one year and three month. Patients of age 60 years and above were selected randomly of all sexes and races. All the information was recorded in fixed protocol. Results: The study was included total 1043 elderly patients, among this male patients were 34.49% and female patients were 65.51%. Most of them presented with single disease in 53.30%. Others presented with two, three and four or more comorbidities (27.99%, 13.32%, and 5.36% respectively). Most common comorbidities were Hypertension (HTN) in 35.37%, Diabetes mellitus (DM) in 28.37%, obstructed airway diseases in 26.84%, Osteoarthritis in 19.94%, Ischemic Heart Diseases (IHD) in 18.88%, Osteoporosis 7.47% and cerebrovascular diseases 4.60%. Conclusion: A large proportion of the population, especially those aged 60, is affected by multicomorbidities. The comorbidities found most of them are preventable. Bangladesh J Medicine 2022; 33: 269-273

Drug Utilization Pattern in Elderly Hospitalized Patients in Tertiary Care Hospitals of Quetta, Pakistan

Background: Changes in Pharmacokinetics and pharmacodynamics in different age groups, especially in elderly age group, have extensively been documented and studied and concurrent chronic diseases may underlie polypharmacy in elderly. Aim: The aim of this study was to assess drug utilization pattern in elderly hospitalized patients in tertiary care hospitals of Quetta. Methods: Specifically, designed questionnaire based, cross sectional study was conducted in Bolan Medical Complex Hospital and Sandeman Provincial Hospital Quetta with total of 397 participants. Non-Probability convenience sampling technique was used in this study. Cronbach alpha test was applied to check reliability of questionnaire, Cronbach alpha value was 0.886 that is acceptable range. Results: Majority of the participants were from age group 60 to 70 years (n=301, 75.8%), fever and cough were present in majority of hospitalized patients (n=180,11.7%). Majority (n=232, 58.4%) of participants were having uncontrolled disease with yearly health service utilization of more than 3 times (n=234, 58.9), medication recommended to majority (146, 36.8%) of participants were 4. Ceftriaxone was mostly prescribed in cough (n=162,90%), hypertension (n=114, 67.1%), fever (n=154, 85.6%) of cases, while in gastritis omeprazole was mostly prescribed (n=84, 73.7%). Most of the hospitalized patients were complaint to ceftriaxone, omeprazole, dimenhydrinate and diclofenac sodium. Conclusion: Ceftriaxone was most prescribed drugs among elderly patients that were admitted in different specialty departments. Most of the elderly patients had uncontrolled disease status. This study concluded that the compliance to medication was 82.1% of elderly patients.

Prevalence and Factors Associated with Sarcopenia in Hospitalized Elderly Patients

Prevalence and Factors Associated with Sarcopenia in Hospitalized Elderly Patients

Prognostic value of handgrip strength and functional indicators in elderly patients in a southern brazilian hospital

Background: the handgrip strength (HGS) is an important functional indicator in the elderly. The aim of this work was to evaluate the prognostic value of HGS, sociodemographic and functional indicators in elderly patients in a hospital in southern Brazil. Methods: prospective cohort observational study in individuals aged 60 years or older who were admitted to the clinical sectors in a tertiary Hospital of a southern Brazil. Results: a total of 218 participants were evaluated, of which 55% were men, with median age (p25-p75) of 72 years (65.7-78.0). The most prevalent hospitalization diagnoses were respiratory (19.7%) and vascular (19.3%) disorders. The median values (p25-p75) of HGS for men and women were, respectively, 50.00 (25.0-65.0) and 30.0 (20.0-40.0) kgf. As to the outcome, 44 (20.2%) individuals eventually died. The study showed that there was higher chance of mortality in aged patients (OR = 1.063; CI 95% 1.021-1.108) with higher Charlson Comorbidity Index scores (OR = 1.293; CI 95% 1.149-1.256), Glasgow Coma Scale Index scores &lt;15 (OR = 15.656; CI 95% 7.161-34.228), Katz Index scores &lt;6 (OR = 15.617; CI 95% 6.496-37.545), laboratory tests indicating leukocytosis (OR = 4.118; CI 95% 1.984-8.546) and anemia (OR = 3.104; CI 95% 1.307-7.369), lower HGS values (Men: OR = 0.901; CI 95% 0.862-0.941; Women: OR = 0.926; CI 95% 0.896-0.956), and longer length of stay in hospital (OR = 1.088; CI 95% 1.042-1.136). Conclusion: HGS and other epidemiological indicators are highly relevant in the prognostic evaluation of elderly people in hospital admission.&#x0D;

Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients.

Background: Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk—Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d’ Evaluation du Risque de Perte d’Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward. Methods: A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily living (ADL), and screening instruments. The Barthel Index was used to measure functional disability. Functional decline was defined as a decline of at least five points on the Barthel Index 30 days after discharge compared to that at pre-admission. Results: Patients had a mean age of 77.7 years, with 55.7% being female. Functional decline was observed in 39.1% of all patients. The best cutoff point, sensitivity, specificity, and area under the receiver operating characteristic curve were 2.5, 96.1%, 52.5%, and 0.751 for ISAR-HP; 1.5, 83.1%, 62.5%, and 0.761 for VIP; and 4.75, 89.6%, 54.2%, and 0.758 for SHERPA, respectively. Conclusions: All three instruments showed moderate diagnostic accuracy as indicated by their best cutoff points. Therefore, the results presented herein can guide health care professionals in selecting the appropriate assessment tool for predicting functional decline among hospitalized elderly patients in a clinical setting.

Application of Hardware Equipment in Preventing Falls in Elderly Hospitalized Patients

Objective: To apply hardware equipment to elderly hospitalized patients and analyze its effect.Methods: Convenience sampling method was adopted, and 116 patients admitted to the geriatrics department of a tertiary hospital in Chifeng City from October 2021 to February 2022 were included in the study. Grouping by random number table method, the final experimental group and control group included 58 cases each. The patients in the control group were given routine care, and the patients in the experimental group were given hospital hardware equipment on this basis. The incidence of falls and nursing satisfaction in the two groups of patients during hospitalization were analyzed.Results: After applying hardware equipment to elderly inpatients, the difference was not statistically significant (P&gt;0.05), but the incidence of falls in the experimental group was lower than that in the control group; the nursing satisfaction of the patients in the experimental group was higher than that in the control group, and the difference was statistically significant Significance (P&lt;0.05).Conclusion: In view of the particularity of the elderly hospitalized patients, in the process of nursing them, the application of hardware equipment can reduce the incidence of falls and improve the nursing satisfaction of patients, which is worthy of popularization and application in clinical practice.

Characteristics and Economic Burden of Hospitalized Elderly Patients (&gt; 65 Years) Due to Community-Acquired Pneumonia

Objective : The prevalence hospitalization of elderly patients due to community acquired pneumonia (CAP) is high and increases the hospital cost. Characteristics and economic burden of hospitalized elderly patients (>65years) due to CAP were analyzed. Materials and Methods : We performed a retrospective analysis of the 180 patients who were hospitalized with pneumonia between 01.01.2015-15.11.2017. Patients older than 65 years old and hospitalized for CAP were followed up for up to 30 days from initial hospitalization for mortality and the patients who were discharged were followed up to 90 days of initial hospitalization. Hospital costs were analyzed. Results : 115(60%) patients were older than 65. 82.4% of the patients received oxygen therapy and 27.8% of them received noninvasive mechanical support. 16.5% of the patients needed intensive care support. PSI was increased with age(p=0.021). Thirty-day mortality was related with older age(p=0.048). Total treatment costs were increased with high PSI (p=0.003). Increased PSI and total cost were significantly associated with mortality (p=0.000). Thirty-day mortality was related with older age(p=0.048), but age was not related with 60-day and 90-day mortality (p=0.244, p=0.469). 30-day mortality was high in patients with COPD and malignancy (p=0.038, p=0.040). No associations were found between total hospital cost and additional diseases (p>0.05). Conclusion : CAP is a common cause of hospitalization in elderly patients. Older patients had more severe CAP which caused high mortality and high treatment costs; so it is important to identify elderly patients with risk factors for early adequate treatment.

Why are there so many hospital beds in Germany?

The place of hospitals in health systems is undergoing rapid change worldwide due to the high cost of hospital care and the changing health needs of the population. The Covid-19 pandemic has recently drawn public attention towards hospital capacity and has added new urgency to discussions on the future role of hospitals. In this context, recent experience in Germany provides valuable information for health systems seeking to manage hospital capacity. Despite reform efforts to reduce hospital capacity, Germany has the highest rates of intensive care beds among high-income countries and the highest overall hospital capacity in Europe. The capacity of the German hospital system can be explained in large part by the high number of elderly in-patients. This, in turn, is driven by (1) a fragmented ambulatory care system; (2) physicians admitting and maintaining elderly patients in hospital at a high rate; (3) a hospital market adding incentives to admit patients; and (4) a political commitment to egalitarian access and universal care. Additionally, recent policies to reduce hospital capacity have had limited impact because hospitals have not responded to financial incentives in the expected manner. Countries looking to learn from Germany's hospital capacity must therefore consider systemic features, political commitments, and unintended policy consequences.

Prediction of Atrial Fibrillation in Hospitalized Elderly Patients With Coronary Heart Disease and Type 2 Diabetes Mellitus Using Machine Learning: A Multicenter Retrospective Study.

BackgroundThe objective of this study was to use machine learning algorithms to construct predictive models for atrial fibrillation (AF) in elderly patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM).MethodsThe diagnosis and treatment data of elderly patients with CHD and T2DM, who were treated in four tertiary hospitals in Chongqing, China from 2015 to 2021, were collected. Five machine learning algorithms: logistic regression, logistic regression+least absolute shrinkage and selection operator, classified regression tree (CART), random forest (RF) and extreme gradient lifting (XGBoost) were used to construct the prediction models. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were used as the comparison measures between different models.ResultsA total of 3,858 elderly patients with CHD and T2DM were included. In the internal validation cohort, XGBoost had the highest AUC (0.743) and sensitivity (0.833), and RF had the highest specificity (0.753) and accuracy (0.735). In the external verification, RF had the highest AUC (0.726) and sensitivity (0.686), and CART had the highest specificity (0.925) and accuracy (0.841). Total bilirubin, triglycerides and uric acid were the three most important predictors of AF.ConclusionThe risk prediction models of AF in elderly patients with CHD and T2DM based on machine learning algorithms had high diagnostic value. The prediction models constructed by RF and XGBoost were more effective. The results of this study can provide reference for the clinical prevention and treatment of AF.

Chronic Kidney Disease (CKD) - A Brand Ambassador/Alarming Bell for Potentially Inappropriate Medication in Elderly Inpatients.

Since the past decade, prevalence of Potentially Inappropriate Medication (PIM) among elderly inpatients has increased drastically. However, limited data is available on PIM indicators and PIMs use among the elderly in patients suffering from Chronic Kidney Disease (CKD). The objective of this study is to determine the prevalence of PIMs in elderly hospitalized patients with CKD. A cross-sectional study was carried out on 102 patients in a tertiary care hospital. PIMs were identified using Beers criteria 2019. Chi-square test was used to identify the association between variables and PIMs use. PIMs, as assessed according to AGS updated Beers criteria 2019 was found to be in more than 68.6% of patients of median age 65 years and 3 diagnoses and 7 days median length of stay. Most of the patients (47.1%) had ≥4 diagnosis. The most common comorbidities in patient were diabetes mellitus (n=54) and hypertension (n=55). Most of the subjects (66.7%) were on polypharmacy (5-9 medications/day) and 25.5% were on a higher level of polypharmacy (>10 medicines/day). Approximately 90% of the patients were having very low CrCl < 21ml/min (calculated with the help of Cockcroft- Gault formula). A significant association between PIM use and an increased number of diagnoses, polypharmacy or high-level polypharmacy, was observed. The prevalence of PIMs in elderly inpatients suffering from CKD is quite high. The study clearly indicates negligence/ lack of awareness amongst physicians leading to increase in PIM use. Authors propose that the CKD patients should attract special attention of physician and should be treated as brand ambassadors/alarming bell for PIM use.

Study protocol for the evaluation of pharmacist-participated medication reconciliation at county hospitals in China: a multicentre, open-label, assessor-blinded, non-randomised, controlled study

IntroductionPharmacist-participated medication reconciliation proved an effective strategy to decrease the risk of medication discrepancy-related errors. However, it is still under pilot in China and its effectiveness in the Chinese healthcare...

Evaluation of Psychiatric Consultations of Elderly Hospitalized Patients: What are the Psychological Complaints and Diagnoses?

Evaluation of Psychiatric Consultations of Elderly Hospitalized Patients: What are the Psychological Complaints and Diagnoses?

Factors Associated With Mortality in Elderly Hospitalized Patients at Admission.

BackgroundSeveral factors have been associated with mortality prediction among older inpatients. The objective of this study was to assess the factors associated with mortality in hospitalized elderly patients.MethodsA total of 353 consecutively admitted elderly patients (47.9% women), with a median age of 83 years (interquartile range 75.00-88.00), were enrolled in the study and patient characteristics were recorded. Comorbidities were assessed using Charlson Comorbidity Index (CCI), activities of daily living by Barthel Index (BI), frailty was assessed using the Clinical Frailty Scale (CFS), cognition by Global Deterioration Scale (GDS) and symptom severity at admission by quick Sequential Organ Function Assessment (qSOFA) score. CFS, GDS and BI were estimated for the premorbid patients’ status. Parametric and non-parametric tests and binary logistic regression analysis were applied to identify the factors associated with mortality. A receiver operating characteristic (ROC) curve was used to analyse the prognostic value of CFS and qSOFA.ResultsIn total, 55 patients (15.6%) died during hospitalization. In regression analysis, the factors associated with mortality were the qSOFA score at admission (p=0.001, odds ratio [OR]=1.895, 95% confidence interval [CI] 1.282-2.802) and the premorbid CFS score (p=0.001, OR=1.549, 95% CI 1.1204-1.994). The classifiers both have almost similar area under the curve (AUC) scores, with CFS performing slightly better. More specifically, both CFS (AUC 0.79, 95% CI 0.73-0.85, p=0.001) and qSOFA (AUC 0.75, 95% CI 0.67-0.83, p<0.001) showed almost the same accuracy for predicting inpatients’ mortality.ConclusionThis study strengthens the perception of premorbid frailty and disease severity at admission as factors closely related to mortality in hospitalized elderly patients. Simple measures such as CFS and qSOFA score may help identify, in the emergency department, elderly patients at risk, in order to provide timely interventions.