Elderly Inpatients Research Articles

Acceptance status and influencing factors of advance care planning among elderly patients with chronic disease.

The aging population has become a severe public health issue both in China and globally. Over 180 million elderly people in China have chronic diseases, with 75% of them suffering from 2 or more chronic diseases, posing significant threats to their independence and quality of life, and imposing immense mental and disease burdens on patients and their families. So our research analyzes the influencing factors based on the current acceptance status of advance care planning (ACP) among elderly patients with chronic diseases. Using convenience sampling, 120 elderly inpatients from the geriatrics department of a tertiary hospital in Beijing, from June 2023 to March 2024, were selected. Surveys included a general information questionnaire, an ACP acceptance questionnaire, and the revised version of the Terminal Care Experience and Death Attitude Profile. The total ACP acceptance score among elderly patients with chronic diseases was 73.98 ± 9.84 points. Factors influencing ACP acceptance included fear of death, whether the patient had cared for a dying relative, duration of chronic illness, presence of complications, natural acceptance, and religious beliefs (P < .05). The acceptance level of ACP among elderly patients with chronic diseases is moderately high. Medical staff should provide more choices to enhance the life value of elderly patients with chronic diseases based on fully respecting their wishes.

Anxiety and depression as potential risk factors for limited pain management in patients with elderly knee osteoarthritis: a cross-lagged study

BackgroundPain management for knee osteoarthritis (KOA) patients is challenging. Pain arises from both physiological and psychological interactions, with anxiety and depression potentially contributing as risk factors that hinder effective pain management in KOA patients.MethodsBefore treatment(T1), A total of 206 elderly inpatients with KOA were enrolled based on initial screening criteria. After treatment (T2), patients were selected based on inclusion and exclusion criteria, and completed follow-up through phone or online questionnaires. The interval between T1 and T2 was three months. Outcome measures included the Visual Analogue Scale (VAS) for pain intensity, Beck Anxiety Inventory (BAI) for anxiety, and Geriatric Depression Scale (GDS) for depression. Descriptive and bivariate analyses were used to evaluate the pain, anxiety and depression of the participants. A cross-lagged model was used to examine the temporal and causal associations among pain, anxiety, and depression.Results91% of elderly patients with KOA experienced at least mild depression. Furthermore, 31% of patients reported mild or higher levels of anxiety. At the same time, pain, depression, and anxiety were significantly correlated and mutually predictive(all p < 0.01). Across the different time points, Depression and anxiety at T1 positively predicted pain at T2,with correlation coefficients of 0.19 (p < 0.05) and 0.07 (p < 0.05), respectively.ConclusionsAnxiety and depression may be potential risk factors limiting the effectiveness of pain management in KOA patients. Clinical treatment should regularly evaluate anxiety and depression levels and integration of psychological interventions or appropriate antianxiety and antidepressant medications.Clinical trial numberNot applicable, for the investigative research nature of the study.

Personalized diet order compliance is associated with an improved functional independence measure (FIM) score in elderly patients: An eight-week follow-up study in a convalescent hospital.

It is important to establish the relationship between appropriate nutritional intake and improvements in activities of daily living (ADLs) in elderly hospitalized patients. This prospective observational study aimed to investigate diet order compliance (DOC) during 8 weeks of hospitalization and calculate the odds of improved functional independence measure (FIM) scores for high- and low-DOC groups using covariate-adjusted models in geriatric convalescent hospitals. The study subjects were elderly inpatients (>65 years old) with degenerative disease who consumed prescribed oral meals (Functional Oral Intake Scale (FOIS) = 6/7) and who did not receive physical/occupational therapy. The personalized diet order was prescript, and the DOC was calculated using dietitian-monitored daily intake data. The 73 patients were divided into a low-DOC group (< 84.0%, n = 35) and a high-DOC group (≥ 84.0%, n = 38) on the basis of the median DOC (84.0%, average for 8 weeks). Twenty (52.6%) high-DOC patients and nine (25.7%) low-DOC patients experienced motor-FIM improvements (P = 0.017). After 8 weeks, the change in motor-FIM in the high-DOC group (1.6±0.3) was greater than that in the low-DOC group (0.3±0.1; P = 0.001). According to the baseline and nutrition-intake-adjusted model of multiple logistic regression analysis, in the high-DOC group, the motor-FIM improvement OR was 5.102 (95% CI: 1.100-16.233, P = 0.036), and the total-FIM improvement OR was 5.273 (95% CI: 1.102-25.238, P = 0.037). High compliance with individualized nutritional prescriptions can increase FIM scores in clinical settings. Thus, comprehensive approaches to increase dietary compliance are needed for elderly long-term care patients.

Effects of a Disability-Oriented Intensive Physiotherapy for Hip Fracture in Elderly Inpatients with Total Hip Arthroplasty : A Retrospective Study

Effects of a Disability-Oriented Intensive Physiotherapy for Hip Fracture in Elderly Inpatients with Total Hip Arthroplasty : A Retrospective Study

Exploring anxiety in elderly pulmonary tuberculosis inpatients using propensity score matching method

ObjectiveThe objective of this study is to explore the factors that influence anxiety in elderly hospitalized pulmonary tuberculosis patients using propensity score matching (PSM) methods.MethodsWe retrospectively analyzed the clinical data of elderly patients with pulmonary tuberculosis admitted to the tuberculosis Department of Lishui Hospital of Traditional Chinese Medicine from January 2021 to October 2023. The patients were then divided into anxiety and non-anxiety groups based on their GAD-7 scores. Propensity score matching was used to match the baseline data of the two groups, followed by multivariate logistic regression analysis to identify the influencing factors of anxiety in elderly hospitalized pulmonary tuberculosis patients.ResultsThe study included 795 elderly hospitalized patients with pulmonary tuberculosis, with 599 classified as carefree and 196 as anxious (32.72%). Using the propensity score matching method, we successfully matched 185 pairs of patients. After matching, there were no statistically significant differences in gender, age, occupation, or other aspects between the two groups of patients (all P > 0.05). Multivariate logistic regression analysis revealed that chronic comorbidities (OR = 2.36, 95% CI: 1.54–3.61), lack of daily social interaction (OR = 1.79, 95% CI: 1.15–2.76), tuberculosis recurrence (OR = 2.08, 95% CI: 1.35–3.21), and lack of daily behavioral ability (OR = 1.99, 95% CI: 1.23–3.23) were influencing factors for anxiety in elderly hospitalized pulmonary tuberculosis patients (P < 0.05).ConclusionAfter controlling for confounding factors through PSM, we found that chronic comorbidities, lack of daily social interaction, tuberculosis recurrence, and lack of daily behavioral ability are influencing factors for anxiety in elderly pulmonary tuberculosis inpatients. This suggests a need for clinical intervention.Clinical trial numberNot applicable.

Egg White Extract Supplementation Improves Albumin and IGF-1 Levels in Malnourished Elderly Patients: A Randomized Controlled Trial

Background: Malnutrition is a prevalent issue among the elderly, often leading to hypoalbuminemia (low albumin levels) and decreased serum Insulin-like growth factor 1 (IGF-1) levels. These conditions are associated with increased morbidity and mortality. Egg white extract (EWE) supplementation has shown promise in improving hypoalbuminemia. This study investigated the effects of EWE supplementation on serum albumin and IGF-1 levels in malnourished elderly patients. Methods: A double-blind randomized controlled trial was conducted, involving 46 malnourished elderly inpatients with hypoalbuminemia. Participants were randomly assigned to receive either EWE (30 grams daily) or a placebo for two weeks. Serum albumin and IGF-1 levels were measured before and after the intervention. Results: After two weeks, the EWE group showed a significant increase in both serum albumin and IGF-1 levels compared to the placebo group. The mean serum albumin level in the EWE group increased from 2.80 g/dL to 3.7 g/dL, while the placebo group remained unchanged. The mean serum IGF-1 level in the EWE group increased from 1.74 ng/mL to 24.74 ng/mL, while the placebo group experienced a smaller increase. There was a moderate positive correlation between changes in albumin and IGF-1 levels. Conclusion: EWE supplementation effectively improves serum albumin and IGF-1 levels in malnourished elderly patients with hypoalbuminemia. This intervention may help reduce malnutrition-related complications and improve overall health outcomes in this vulnerable population.

Assessing self-administration of medication: video-based evaluation of patient performance in the ABLYMED study.

Older adults often face challenges in medication management due to multimorbidity and complex medication regimens, which frequently go unreported. Unrecognized problems, however, may lead to a loss of drug efficacy and harmful side effects. This study aimed to quantify the prevalence of such problems by applying a novel video-based assessment procedure in a sample of elderly patients. In this study, 67 elderly in-patients (≥70 years old and regularly taking ≥5 different drugs autonomously) from the ABLYMED study participated in a placebo-based assessment of medication management with five different dosage forms in an instructed manner while being filmed. Patient performance was quantified by the median value of two raters who evaluated each step of medication administration, which were summed to sum scores for each dosage form and an overall impression for each dosage form with a standardized and previously validated rating scheme. The median (Q1;Q3) sum score for tablets was 7.0 (5.0;8.0) with a theoretical range between 4.0 and 17.0, for eye-drops 2.0 (1.0;2.0) with a theoretical range between 1.0 and 5.0, for oral drops 4.0 (3.0;6.0) with a theoretical range between 3.0 and 12.0, for pens 7.0 (5.0;9.0) with a theoretical range between 4.0 and 17.0 and for patches 5.0 (4.0;7.0) with a theoretical range between 3.0 and 15.0. The most difficult step of medication administration was peeling off the protective liner of a patch: 30% had severe difficulties or it was not possible, 21% had moderate difficulties and 49% had mild or no difficulties. In a sample of patients with autonomous medication management, our novel assessment procedure identified a substantial fraction of patients with handling problems for each dosage form. This suggests that patients´ medication management problems should be assessed regularly in clinical routine and tackled by patient-individual training or modification of the prescribed drug regimens to achieve effective drug therapy in the elderly.

Low transthyretin concentration linked to adverse prognosis in elderly inpatients

BackgroundTo investigate the association between low transthyretin (prealbumin) concentration and mortality or readmission for all causes in elderly inpatients.MethodsThis analysis is based on a prospective cohort study conducted from September 2018 to April 2019 in ten wards of three tertiary referral hospitals in Beijing. Patients aged 65 years or older were enrolled, and their clinical data, laboratory test results, and auxiliary test results for patients were collected. A three-year follow-up was conducted with patients. Based on the 5th and 95th percentiles of transthyretin concentration, patients were split into three groups. The correlation between transthyretin concentration and the outcome of elderly hospitalized patients was investigated. The primary outcome of the research was death or readmission from all causes within three years.ResultsAmong the 636 individuals in the study, 335 (52.7%) were males, with a median age of 74.7 years (interquartile range [IQR]: 69.3–80.1). During a median follow-up period of 1,099.0 days (IQR: 1,016.3-1,135.0), 363 individuals (57.0%) experienced all-cause mortality or readmission events. Patients with transthyretin concentrations at or below the 5th percentile had a significantly increased risk of all-cause mortality or readmission compared to those with concentrations between the 5th and 95th percentiles (hazard ratio [HR]: 2.25; 95% confidence interval [CI]: 1.55–3.26). Even after adjusting for potential confounders, low transthyretin concentration remained an independent risk factor for poor prognosis in elderly inpatients (HR: 1.84; 95% CI: 1.03–3.28). Since women have consistently lower baseline transthyretin levels than men, we performed gender-specific analysis. We found that low transthyretin concentration is an independent risk factor for adverse prognosis in elderly male inpatients (HR: 2.99; 95% CI: 1.35–6.62) but not in females.ConclusionsLow transthyretin concentrations are associated with increased all-cause mortality or readmission in elderly inpatients, particularly among male patients.Graphical

Effect of a Financial Incentive Scheme for Medication Review on Polypharmacy in Elderly Inpatients With Dementia: A Retrospective Before-and-After Study.

Polypharmacy is an important healthcare issue, especially in elderly patients with dementia. As an incentive to reduce polypharmacy, a health insurance reimbursement scheme was introduced in 2016 for medication review and the reduction of medications for inpatients in Japan. However, the effects of these incentive schemes were not evaluated. We identified 1,465,881 inpatients aged ≥65 years with dementia. An interrupted time-series analysis was conducted by fitting a Prais-Winsten linear regression model. The outcome measure was the number of classes of medications prescribed during discharge. No significant changes were observed in the average number of medication classes at discharge immediately after the introduction of the scheme (coefficient: -0.022, 95% confidence interval [CI]: -0.17 to 0.13). The slope change, representing the effect of the intervention over time, was also not significant (coefficient: -0.00053, 95% confidence interval: -0.0012 to 0.00018). The incentive scheme was not associated with a reduction in the number of medication classes at discharge among older inpatients with dementia.

Malnutrition is associated with severe outcome in elderly patients hospitalised with COVID-19

Some studies have identified influencing factors of COVID-19 illness in elderly, such as underlying diseases, but research on the effect of nutritional status is still lacking. This study retrospectively examined the influence of nutritional status on the outcome of elderly COVID-19 inpatients. A retrospective analysis of the clinical data of 4241 COVID-19 patients who were admitted to a third-class hospital of Nanchang between November 1, 2022 and January 31, 2023 was conducted. Nutritional status was assessed using the prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). The influence of nutritional status on the outcome of COVID-19 patients was determined through multivariate adjustment analysis, restrictive cubic spline, and receiver operating characteristic curve (ROC). Compared with mild/no malnutrition, severe malnutrition substantially increased the critical outcome of COVID-19. A linear relationship was observed between the odds ratio (OR) and PNI and CONUT (P > 0.05). The area under the ROC curve indicated that PNI was the better predictor. The optimal cutoff value of PNI was 38.04 (95%CI: 0.797 ~ 0.836, AUC = 0.817), with a sensitivity of 70.7% and a specificity of 79.6%. The critical illness of elderly COVID-19 patients shows a linear relationship with malnutrition at admission. The use of PNI to assess the prognosis of COVID-19 eldeely patients is reliable, highlighting the importance for doctors to closely pay attention to the nutritional status of COVID-19 patients. Focusing on nutritional status in clinical practice can effectively reduce the critical illness of elderly COVID-19 patients.

Optimizing polypharmacy interventions and evaluating their impact on elderly inpatients using dual criteria and medication appropriateness index

Optimizing polypharmacy interventions and evaluating their impact on elderly inpatients using dual criteria and medication appropriateness index

Machine learning based on nutritional assessment to predict adverse events in elderly inpatients with possible sarcopenia

Machine learning based on nutritional assessment to predict adverse events in elderly inpatients with possible sarcopenia

Impact of the Kidney-Metabolic Pattern on Multimorbidity and Mortality among Elderly Inpatients in China

Impact of the Kidney-Metabolic Pattern on Multimorbidity and Mortality among Elderly Inpatients in China

Prognostic value of malnutrition using glim criteria and renal insufficiency in very elderly inpatients

Prognostic value of malnutrition using glim criteria and renal insufficiency in very elderly inpatients

Sarcopenic obesity and the clinical outcome of the elderly inpatients with COVID-19 infection: A prospective observational study

Sarcopenic obesity and the clinical outcome of the elderly inpatients with COVID-19 infection: A prospective observational study

Analysis on the cooperation between nurses and caregivers of elderly inpatients and its influencing factors

Analysis on the cooperation between nurses and caregivers of elderly inpatients and its influencing factors

Influence of dementia-specialized care team on clinical outcomes in a general hospital

BackgroundBecause of the increasing prevalence of dementia in Japan, the government introduced financial incentives for specialized care for dementia at acute care hospitals in 2016. Our hospital then introduced a multidisciplinary collaborative specialized team, referred to as dementia-specialized care team. The aim of this study is to examine the influence of dementia-specialized care team on clinical outcomes for elderly inpatients. MethodsIn this retrospective observational study at a general hospital with 650 beds in Japan, we compared clinical outcomes such as incidence of falls, prescription of hypnotics, length of hospital stay, in-hospital mortality, and discharge destinations in inpatients aged 65 years and older between a two-year pre-intervention period (2014–2015) and a two-year post-intervention period (2017–2018). ResultsDuring the observation period, a total of 34,097 patients were admitted, with 16,237 patients in the pre-intervention period and 17,860 patients in the post-intervention period. The proportion of patients receiving any hypnotics decreased from 21.2 % to 19.2 %, notably with benzodiazepine from 19.8 % to 13.2 %. The incidence of falls from a seated or lying position, particularly at night, was significantly lower (from 0.5 % to 0.2 %) as was the length of hospital stay (from 13.7 days to 13.2 days) during the post-intervention period. ConclusionAfter the implementation of dementia-specialized care team, favorable outcomes such as a reduction in the use of hypnotics, the incidence of falls, and the length of hospitalization were observed. Introduction of the team and associated incentives may be effective in improving clinical outcomes in elderly inpatients.

Prevalence Characteristics of Osteoporosis Fractures in the Elderly in Two Regions of China and Analysis of the Lag Effect of Air Pollutants on them.

Air pollution is increasing and threatening human health. The objective of this study is to investigate the population distribution characteristics of elderly osteoporosis fractures in Hebei Province and Xinjiang Uygur Autonomous Region and to analyze the effects of air pollutants on the number of elderly osteoporosis fracture inpatients in the two regions. A retrospective collection of elderly osteoporosis fracture cases was conducted in selected hospitals in Hebei Province and Xinjiang Uygur Autonomous Region from January 1, 2018 to December 31, 2022. The chi-square test was used to compare the distributional characteristics of the population in the two regions. Additionally, we used a distributed lag nonlinear model (DLNM) in order to assess the effect of air pollutants on the number of daily hospital admissions of elderly osteoporosis fracture patients in different regions. A total of 19,203 elderly osteoporosis fracture patients were included in the study. The average age of these patients was 76.66 ± 7.55 years, and the majority of them were female (13,514 instances, 70.37%). The disparities in age distribution (χ2 = 133.9 p < 0.001), fracture site (χ2 = 62.0 p < 0.001), and hospitalization cost (Z = -15.635 p < 0.001) between the two regions were statistically significant. The lag effect curves of PM2.5, PM10, and NO2 on the number of elderly osteoporosis fracture hospitalizations in Xinjiang Uygur Autonomous Region exhibited a similar pattern resembling a "W"-shaped curve. All three pollutants reached their highest values after a lag time of 14 days (PM2.5: RR = 1.053, 95% CI: 1.031, 1.074; PM10: RR = 1.031, 95% CI: 1.018, 1.043; NO2: RR = 1.125, 95% CI: 1.070, 1.182). In Hebei Province, the largest impacts of PM2.5 and PM10 were observed after a lag of 14 days (PM2.5: RR = 1.022, 95% CI: 1.013, 1.028; PM10: RR = 1.013, 95% CI: 1.008, 1.018). Similarly, the maximum effect of NO2 was observed after a lag of 11 days (RR = 1.020, 95% CI: 1.010, 1.028). There were differences in the epidemiological characteristics of hospitalized patients with osteoporosis fractures between the two regions, PM2.5, PM10, and NO2 increased the number of hospitalizations for osteoporosis fractures. Exposure to air pollutants such as PM2.5 increases the risk of osteoporosis fractures in the elderly population.

Investigation of functional constipation in elderly inpatients and analysis of its influencing factors: A cross-sectional study.

To investigate the prevalence of functional constipation (FC) in elderly hospitalized patients and analyze the influencing factors. This was a cross-sectional study in which 506 patients hospitalized in general surgery from February to June 2020 were selected. Information on patients' age, gender, ethnicity, body mass index, intake of vegetables, fruits, meat, and spicy foods, sleep, smoking, alcohol consumption, time of defecation, and mode of defecation was collected through questionnaires, and the factors affecting functional constipation were analyzed using binary logistic regression models; among 506 patients, 254 had FC, with a prevalence of 50.19%. Among the clinical symptoms of FC, the most common ones were straining to defecate (83.85%) and lumpy or hard stools (81.80%). Univariate analysis revealed statistically significant differences in family history of constipation (P = .033), sedentary (P = .004), self-care ability (P = .001), body mass index (P = .013), defecation time (P < .0001), spicy food intake in dietary preference (P = .001), age (P = .004), and education level (P = .016), and binary logistic regression analysis showed that defecation time and spicy food consumption were independent influencing factors of FC. For hospitalized elderly people, regular morning defecation and not eating spicy foods can more helpful to slow the occurrence of functional constipation.

Validation of the delirium diagnostic tool-provisional (DDT-Pro) in geriatric medical inpatients with diagnostic permutations of the 3Ds with and without delirium

ObjectiveValidations of brief delirium tools have not included analysis of psychiatric disorders comorbidities or control groups. We validated the Delirium Diagnostic Tool-Provisional (DDT-Pro) in 422 geriatric inpatients with high incidence of depression and/or dementia. MethodsCross-sectional study using two delirium reference standards, DSM-5-TR and Delirium Rating Scale-Revised-98 (DRS-R98). We assessed concurrent and construct DDT-Pro validity too. ResultsThere were 117 (27.7%) delirium cases using DDT-Pro, 104 (24.6%) per DSM-5-TR and 93 (22.0%) per DRS-R98; 133 patients (31.5%) had depression and 105 (24.9%) dementia, some comorbid with delirium. DDT-Pro accuracy (AUC under ROC curve) ranges were 88.3–95.9% vs DSM-5-TR and 92.7–95.0% vs DRS-R98 for whole sample and four diagnostic groups, without statistical differences. DDT-Pro ≤6 had the most balanced sensitivity-specificity for delirium diagnosis against both DSM-5-TR and DRS-R98 with similar specificity but higher sensitivity for DRS-R98 than DSM-5-TR delirium, with the highest values in patients with depression and dementia (≥92% sensitivity, ≥81% specificity). Positive and negative likelihood ratios support diagnostic strength. Concurrent validity was high reflected by significant correlations (p < 0.001) of DDT-Pro total and item scores with DRS-R98 and Delirium Frontal Index scores, highest in groups with comorbid depression and/or dementia. The DDT-Pro represented a single construct for delirium demonstrated by one factor with high item loadings and high internal consistency reliability of its items. ConclusionsThe DDT-Pro demonstrated strong performance metrics in general hospital elderly inpatients with preexisting depression and/or dementia, which is unique among brief delirium tools. Its optimized cutoff score was the same as in other populations.