Elderly Inpatients Research Articles

Timed Up and Go test and gastrointestinal disorders among hospitalized older adults with fall risk

Purpose of the researchThe study aimed to examine the correlation between underlying medical conditions and gait analysis parameters as well as determine the key determiners of fall risk. Materials and methodsThis was a cross-sectional study. A total of 120 hospitalized older adults, recruited from a medical center in northern Taiwan, completed three instruments: the Timed Up and Go (TUG) test, a demographic questionnaire, and the Morse Fall Scale. The inferential statistics were subjected to the chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and Spearman's rank correlation coefficient analysis to determine the correlations among the demographic variables, gait analysis parameters, and fall risk in elderly inpatients. Logistic regression was used to analyze the predictors of elderly inpatients’ fall risk. ResultsThe results showed that longer TUG test times, slower walking speeds, or shorter stride lengths are related to higher fall risk. The new finding was that longer TUG test times and slow gait speeds were correlated with lower gastrointestinal as well as hepatobiliary and pancreatic diseases. ConclusionsThis study confirms that gait analysis parameters are significantly correlated with fall risk among older inpatients and that TUG is an important indicator of frailty, prefrailty, or metabolic state. Early detection of the symptoms of gastrointestinal disorders and the provision of adequate nutrition could potentially improve inpatients’ gait and prevent falls.

VALIDATION OF GLIM CRITERIA ON MALNUTRITION IN CHINESE OLDER INPATIENTS

Abstract Backgrounds Malnutrition is a nutritional disorder that has a high incidence and can lead to multiple poor prognoses, such as frailty. Early identification and correct evaluation of malnutrition are essential for improving clinical outcomes. Objective: Therefore, we aimed to explore the applicability and effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criterion for identifying undernutrition in older inpatients. Methods In total, 223 participants aged ≥60 years were involved. Nutrition was evaluateded employing MNA-FF and GLIM criteria, which adopts a two-step procedure. The first step was to use three different methods for nutritional risk screening: NRS-2002, MNA-SF, and MUST. The second step is to diagnose undernutrition. The Clinical Frailty Scale was used to assess frailty. Sensitivity, specificity, Youden index, kappa values, and positive and negative predictive values were measured to test the validity of the GLIM criteria. Logistic regression models were used to assess whether there was a correlation between malnutrition and frailty. Results We found that 32.3–49.8% of inpatients were at risk of malnutrition based on the GLIM diagnosis using the three different screening tools, 19.3–27.8% of patients were malnourished. The GLIM criteria with MNA-SF as the diagnostic validation and MNA-FF as a reference showed high consistency (k = 0.629; p < 0.001), sensitivity (90.5%), and specificity (86.4%). Logistic regression analysis showed that malnutrition, using MNA-SF with the GLIM criteria, was relevant to higher likelihood of frailty (OR=1.887; 95% CI: 1.184–2.589). Conclusions: The GLIM criteria with the MNA-SF may be a more reliable malnutrition assessment process in elderly inpatients.

A three-week in-hospital multidisciplinary body weight reduction program exerts beneficial effects on physical and mental health and fatiguability of elderly patients with obesity.

Obesity represents one of the most serious problems of public health affecting elderly populations in an increasingly relevant way. The aim of the current study was to assess the effects of a 3-week in-hospital multidisciplinary body weight reduction program (BWRP) in a sample of elderly patients with obesity on reducing body mass index (BMI), improving fatigue, muscle performance, and psychological well-being. Two hundred and thirty-seven consecutive elderly in-patients with obesity (males = 84; females = 153; age range = 65-86 yrs.; mean BMI = 43.7) undergoing a three-week multidisciplinary BWRP participated in the study. Data on BMI, fatiguability (measured with the Fatigue Severity Scale, FSS), muscle performance (evaluated with the Stair Climbing Test, SCT), and psychological well-being (assessed with the Psychological General Well- Being Index, PGWBI) were collected before and after the intervention. Results showed that BWRP was capable to reduce BMI [F(1.00, 235.00) = 1226.8; p < 0.001; ƞ 2 = 0.024], improve perceived fatigue [F(1,234) = 296.80125; p < 0.001; ƞ 2 = 0.129], physical performance [F(1.00,158.00) = 119.26; p < 0.001; ƞ 2 = 0.026], and enhance psychological well-being [F(1,235) = 169.0; p < 0.001; ƞ 2 = 0.103] in both males and females. Although it will be necessary to demonstrate with further longitudinal studies whether the reported beneficial effects will be maintained over time, the effectiveness of a 3-week BWRP on different aspects involved in determining a level of autonomy and good quality of life of elderly obese patients appears to represent a valid attempt to counteract - at least in part - the unavoidable and progressive disability of these patients.

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

Objective mobility goals for elderly hospitalised medical patients remain debated. We therefore studied steps parameters of elderly patients hospitalised for an acute illness, to determine goals for future interventional trials and medical practice. Observational study conducted from February to November 2018 in a medical ward of the Lausanne University Hospital, Switzerland. We measured the step parameters of consecutive medical patients aged ≥65 years admitted for an acute medical illness using a wrist accelerometer (Geneactiv). We also collected demographic, somatic and functional factors. Overall, 187 inpatients had their step parameters (daily step count, walking cadence and bout duration) measured with accelerometers worn for a mean of 3.6 days (standard deviation [SD] 3.2). Elderly inpatients (81.5 years, SD 8.5) walked a median of 603 steps daily (interquartile range [IQR] 456-809), at a median cadence of 100 steps/minute (IQR 99-101) with median walking bouts of 33 seconds (IQR 27-37) and with 70% of the walking bouts lasting less than 30 seconds. Patients walking ≥600 steps were younger (80.4 years, SD 8.9 vs 82.8 years,SD 7.9, p = 0.050) and had a longer length of stay (7.8 days, SD 5.1 vs 6.1 days, SD 4.1, p = 0.011) than those walking <600 steps. Patients at high risk of bed sores walked less (564 steps, IQR 394-814 vs 626, IQR 526-840) than those with a lower risk of sores. During a hospitalisation for an acute medical illness, patients aged ≥65 years walk a mere 603 steps daily and most of the time for periods of less than 30 seconds. This information should be used to build up future interventional trials or to set mobility goals for patients hospitalised in Swiss hospitals.

Agreement and predictive performance of fall risk assessment methods and factors associated with falls in hospitalized older adults: A longitudinal study

Falls in hospitalized older adults are of concern and, despite the availability of fall risk assessment methods and knowledge about factors associated with falls, their validity and agreement remain poorly investigated. In a prospective study, we enrolled 102 hospitalized older adults (median [P25-P75]) 67 (64-73) years, 52 [51%] men, length of stay 20 [8-41] days). Fall risk was assessed at hospital admission using the Functional Independence Measure; Morse Fall Scale; St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients; Johns Hopkins Fall Risk Assessment Tool; and polypharmacy. The St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients method showed the highest predictive performance (accuracy 92%) for the identification of fallers during hospitalization. A slightly better-then-chance agreement was estimated between all methods (Light's κ = 0.120). Fall risk assessment methods and factors associated with falls should not be used interchangeably as their overall and pairwise agreement are fair at best.

Development of a dysphagia cup to improve patients’ fluid intake and reduce caregiver burden

Ensuring that the elderly drink adequate fluids to meet their recommended daily allowance is often a challenge, especially among the elderly in hospitals and long-term care settings. The complex interplay...

Nurses’ competence in recognition and management of delirium in older patients: development and piloting of a self-assessment tool

BackgroundDelirium is a common condition in elderly inpatients. Health care professionals play a crucial role in recognizing delirium, initiating preventive measures and implementing a multicomponent treatment strategy. Yet, delirium often goes unrecognized in clinical routine. Nurses take an important role in preventing and managing delirium. This study assesses clinical reasoning of nurses using case vignettes to explore their competences in recognizing, preventing and managing delirium.MethodsThe study was conducted as an online survey. The questionnaire was based on five case vignettes presenting cases of acutely ill older patients with different subtypes of delirium or diseases with overlapping symptoms. In a first step, case vignettes were developed and validated through a multidisciplinary expert panel. Scoring of response options were summed up to a Geriatric Delirium Competence Questionnaire (GDCQ) score including recognition and management tasks The questionnaire was made available online. Descriptive analyses and group comparisons explores differences between nurses from different settings. Factors explaining variance in participants’ score were evaluated using correlations and linear regression models.ResultsThe questionnaire demonstrated good content validity and high reliability (kappa = 0.79). The final sample consisted of 115 nurses. Five hundred seventy-five case vignettes with an accuracy of 0.71 for the correct recognition of delirium presence or absence were solved. Nurses recognized delirium best in cases describing hyperactive delirium (79%) while hypoactive delirium was recognized least (44%). Nurses from geriatric and internal medicine departments had significantly higher GDCQ-score than the other subgroups. Management tasks were correctly identified by most participants.ConclusionsOverall, nurses’ competence regarding hypoactive delirium should be strengthened. The online questionnaire might facilitate targeting training opportunities to nurses’ competence.

Polypharmacy problems in geriatric practice of Kyrgyz Republic

World statistics shows increasing numbers of aging population and increasing number of patients with multiple comorbidities, i. e. polymorbidity, which today is an urgent problem of modern clinical geriatric practice. During clinical examination of elderly and senile patients, at least 4-5 diseases and manifestations of pathological processes are diagnosed on the average. Because of this many medicines are prescribed to elderly patients at the same time, unfortunately, often unreasonably, which becomes a widespread phenomenon and is called polypharmacy. Polypharmacy is associated with an increased risk of adverse reactions that can lead to hospitalization or even death, as well as a significant increase in health care costs.In this regard, an analysis of medication prescribing in elderly inpatients with cardiovascular disease using the Medication Rationality Index (MAI) was conducted. As a result, it was found that professionals who provide care to patients are not sufficiently aware of the peculiarities of the use of drugs in elderly patients and in our health care sector there are no regulatory documents on the care of elderly patients.

Screening of Toxin Genes in Methicillin-Resistant Staphylococcus aureus Clinical Isolates from a Hospital Setting in a Tertiary Hospital in Northern Cyprus.

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant opportunistic pathogen with a wide repertoire of virulence characteristics. Data regarding the molecular profile of MRSA in Northern Cyprus is limited. The current study aimed to examine the virulence profiles of MRSA with a focus on toxin-associated factors. Ninety-one S. aureus isolates collected at a university hospital were included in the study. Identification and antibiotic susceptibility testing were performed with BD Phoenix™ automated system. Methicillin resistance was evaluated by the disc diffusion assay and mecA detection. The presence of nuc was confirmed by conventional PCR. Confirmed MRSA isolates were assessed for the presence of virulence genes hla, eta, etb, etd and tst using molecular methods. Among 91 S. aureus isolates identified as MRSA using the BD Phoenix™ platform, 80.85% (n = 76/91) were confirmed as MRSA using phenotypic and genotypic methods. All confirmed MRSA isolates (n = 76, 100%) were positive for the nuc. MRSA rates were statistically higher in elderly inpatients. The prevalence of toxin-encoding genes was 97.3% (n = 74/76) for hla, 2.63% (n = 2/76) for eta, 1.3% (n = 1/76) for etb, and 2.63% (n = 2/76) for tst. None of the screened isolates harbored the etd gene. These results represent the first report to investigate multiple virulence factors in MRSA isolates in Northern Cyprus.

Loneliness in Elderly Inpatients

Purpose: Loneliness among the elderly is a widespread phenomenon and is connected to various negative health outcomes. Nevertheless, loneliness among elderly inpatients, especially those with a psychiatric diagnosis, has hardly been examined. Our study assessed loneliness in elderly inpatients, identified predictors, and compared levels of loneliness between inpatients on psychiatric and somatic wards. Methods: N = 100 elderly inpatients of a somatic and psychiatric ward were included. Levels of loneliness were assessed, as were potential predictors such as depression, psychological resilience, severity of mental illness, well-being, daily functioning, and psychiatric diagnosis. Analyses of group differences and hierarchical multiple regression analysis were conducted. Results: 37% of all inpatients reported elevated levels of loneliness. Significant predictor variables were self-reported depressive symptoms, well-being, severity of mental illness, being single and living with a caregiver. Hierarchical multiple regression analysis revealed that the full model explained 58% of variance in loneliness. Psychiatric inpatients’ loneliness was significantly higher than loneliness in somatic inpatients. When analyzing group differences between inpatients with different main psychiatric diagnoses, highest levels were found in patients with an affective disorder, followed by those treated for organic mental disorder. Since the study took place during the COVID-19 pandemic, potential influence of different measurement points (lockdown vs. no lockdown) were analyzed: Differences in loneliness depending on the phase of the pandemic were non-significant. Conclusion: Elderly inpatients experience high levels of loneliness, especially those with a mental disorder. Interventions to reduce loneliness in this population should address predictors of loneliness, preferably through multiprofessional interventions.

Abstract 11721: Frailty Assessed by a Composite Assessment of Cognitive and Physical Frailty Predicts Long-Term Outcomes in Elderly Pre-Clinical Heart Failure Patients

Introduction: We combined the Fried phenotype and the mini-mental state examination (MMSE) +clock drawing test (CDT) to assess frailty in elderly pre-clinical heart failure (HF) patients, and aimed to evaluated the prevalence and prognostic value of frailty assessed by this simple composite scoring system in this population. Methods: we conducted a single-center prospective observational cohort study in which enrolled inpatients≥ 65 years and followed up for 2 years. The primary outcomes were 2-year all-cause mortality or readmission. Multivariate Cox proportional hazard model was used to test the predictive validity. Results: Overall, 531 elderly pre-clinical HF inpatients were included in our study (mean age: 75.4±6.47 years, male: 230 [43.3%]). Among them, 11.7% (62/531) were assessed as cognitive impairment without physical frailty, 15.1% (80/531) were assessed as physical frailty without cognitive dysfunction and 13.0% (69/531) were assessed as cognitive frailty with physical frailty and cognitive impairment. The cognitive frailty individuals were older (P&lt;0.05), had shorter time of education (P&lt;0.001), higher level of N-terminal pro-B-type natriuretic peptide (P&lt;0.05), and were more likely to have comorbidities of peripheral arterial disease and the history of stroke (P&lt;0.05) and take ≥5 medications (P&lt;0.05). Physical frailty patients (P=0.019) and cognitive frailty patients (P=0.003) both had a higher incidence of mortality or readmission during 2-year follow-up and had a 1.50-fold (95%CI 1.04-2.18, P=0.03) and 1.84-fold (95%CI 1.19-2.83, P=0.01) higher risk of 2-year adverse events, respectively, after adjusting age, sex, marital status,education years,diabetes and the history of stroke. Conclusions: In conclusion, cognitive frailty is common in elderly pre-clinical HF patients. Adding cognitive impairment to physical frailty could predict all-cause mortality or readmission better in this population in the long term.

Impact of early mobilization on the duration of delirium in elderly hospitalized patients: A retrospective cohort pilot study.

Development of delirium during hospitalization impairs the activities of daily living in elderly hospitalized patients. In clinical practice, early mobilization from bed is recommended to reduce delirium incidence and hospitalization stay. However, the effects of early mobilization on elderly inpatients with delirium have not been established yet. The aim of this study was to investigate the association between early mobilization and the duration of delirium in elderly inpatients with delirium. This retrospective cohort pilot study examined 45 participants (23 males, 22 females; mean age: 84.5 ± 6.6 years), who developed delirium during hospitalization. Of the participants, 28 were surgically treated and 17 were non-surgically treated. We classified early or delayed mobilization based on the median number of days until the start of mobilization and compared after propensity score matching to adjust for baseline characteristics. Additionally, we examined the correlation between the number of days until the start of mobilization and the duration of delirium. The duration of delirium was significantly shorter in the early mobilization group, particularly in terms of sitting on the bed and wheelchair use than that in the delayed mobilization group {median: 4.0 [interquartile range (IQR): 2.0-6.0] vs 8.0 [IQR: 7.0-14.5] days, P = .013; median: 3.0 [IQR: 2.0-5.5] vs 11.0 [IQR: 7.5-14.5] days, P = .004, respectively}. Moreover, the duration of delirium significantly positively moderate correlated with the time until the start of sitting on the bed and wheelchair use (Spearman r = 0.527; P = .012, Spearman r = 0.630; P = .002, respectively). The results of this study suggest that early mobilization from sitting on the bed or wheelchair use after hospitalization or surgery may shorten the duration of delirium. Because the sample size of this pilot study is small, careful interpretation is needed, and further research is warranted.

INAPPROPRIATE PRESCRIPTION IN ELDERLY : SERIOUS GLOBAL HEALTH CONCERN, LITERATURE ANALYSIS

Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Methods: We searched research articles in pub med, google scholar using key words inappropriate prescription in elderly, beer's criteria, stop/start criteria in last 10 years. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer's criteria (2012) . Prevale Results : nce of at least one potential inappropriate prescription ( PIP) in elderly is 41.57 %. Prevalence of adverse drug event ( ADE ) due to PIP is 43 % . Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

Effect of Quality Nursing Service on Depression and Anxiety of Elderly Inpatients

Effect of Quality Nursing Service on Depression and Anxiety of Elderly Inpatients

The effectiveness of multimedia combined with teach-back method on the level of knowledge, confidence and behavior of professional caregivers in preventing falls in elderly patients: A randomized non-blind controlled clinical study.

Background:Teach-back is a teaching method that can quickly improve the acknowledge of target audience and change their behaviors effectively. However, this approach has not been reported in previous studies that were dedicated to reducing the incidence of falls in elderly inpatients. Therefore, we aimed to evaluate the effectiveness of the teach-back method for improving the knowledge, confidence, and behaviors (KCB) of professional caregivers on the fall prevention in elderly inpatients and to provide practical evidence for reducing the incidence of falls.Methods:This is a prospective study. At the recruitment, the demographic data of the professional caregivers were completely collected. Questionnaire about KCB of professional caregivers on fall prevention in elderly inpatients was used as an assessment scale, and the differences between the scores were analyzed. At the end of the study, the fall rate of the patients cared by different groups was counted and analyzed.Results:A total of 100 professional caregivers were recruited, all of which participated in the whole study process. There was no statistical differences in demographic data. Three or six months after the courses, the knowledge scores, confidence scores, and behavior scores of the two groups were significantly improved, and the observation group scores were significantly higher than it was in the control group (P < .05). During the study period, the incidence of falls in the observation group was 1.32%, while it was 0.30% in the control group (P < .05).Conclusion:Teach-back method can rapidly improve KCB of professional caregivers about fall prevention in elderly inpatients, which is worthy of clinical practice.

Potentially Inappropriate Medication (PIMs) Identification Using 2019 Beers Criteria at a Secondary Referral Hospital in Jakarta

Drug information about Potentially Inappropriate Medications (PIMs) for elderly inpatients based on Beers 2019 is still limited in Indonesia. This study aimed to identify the incidence of PIMs using the 2019 Beers criteria in elderly patients and determine the factors associated with the incidence of PIMs. This research was observational with a cross-sectional approach. Data collection was carried out in the medical records section of a secondary referral hospital in Jakarta during August and September 2019. The number of samples was calculated using a sample size calculator, and data were obtained from the medical records of inpatients for the period January 2018-December 2018. The sampling of medical records was conducted with a non-probability sample with a purposive sampling technique. Inclusion criteria were medical records of inpatients aged 60 years or older. The exclusion criteria were patient medical records with incomplete data. The Beers 2019 criteria were used to identify PIMs. The results showed that from 325 medical records analyzed, PIMs were found in 122 (37.5%) elderly patients with a total incidence of 181 PIMs. Furosemide (25.4%) was the most common PIMs, followed by spironolactone (18.2%) and ranitidine (16%). The use of 10 medicines or more p&lt;0.001, OR 4.26 95%CI (2.4-7.5) and a length of stay more than five days p=0.043 OR 1.65 95%CI (1.0- 2,6) was associated with a higher incidence of PIMs. However, age, gender, and the number of diagnoses were not significantly related to the incidence of PIMs. Health workers are advised to check serum creatinine in all hospitalized elderly patients and minimize the number of drugs used.

Diagnostic Values of Advanced Glycation End Products and Homocysteine in Patients with Alzheimer's Disease and Sarcopenia.

This study is aimed at exploring the diagnostic value of advanced glycation end products (AGEs) and homocysteine (Hcy) in Alzheimer's disease (AD) complicated with sarcopenia (SP) and to analyze the risk factors related to AD complicated with SP. A total of 168 patients admitted to our hospital from November 2019 to December 2021 were enrolled. Patients were divided into the NC (no SP and AD) group with 29 cases, the AD group with 39 cases, the AD+SP group with 35 cases, and the SP group with 65 cases. The general information, Mini-Mental State Examination (MMSE) scores, and serum levels of AGEs and Hcy among the four groups were compared. Unordered logistic regression was used to analyze the influencing factors of SP patients complicated with dementia. The AGE level was higher in the AD or AD+SP group than the NC or SP group (P < 0.05). There was no significant difference between the SP group and the NC group or between the AD group and the AD+SP group (P > 0.05). The Hcy level was higher in the SP or AD group than the NC group (P < 0.05). There were no significant differences between the AD group and NC group or between the SP group and AD+SP group (P > 0.05). The ROC curve of serum AGEs and Hcy for the diagnosis of AD showed that the area under curve (AUC) was 0.887, P < 0.05 (95% CI: 0.821-0.954, sensitivity: 80.95%, specificity: 73.81%) and 0.7423, P < 0.05 (95% CI: 0.6382-0.8465, sensitivity: 60.42%, specificity: 57.59%), respectively. The ROC curve of serum AGEs and Hcy for the diagnosis of SP showed that the AUC was 0.5533, P > 0.05 (95% CI: 0.4294-0.6771) and 0.8744, P < 0.05 (95% CI: 0.8006-0.9483). Age (P < 0.001), depression (P = 0.001), malnutrition (P = 0.002), and BMI (P < 0.001) were independent influencing factors of SP complicated with AD in elderly inpatients. In conclusion, combined serum AGEs and Hcy had a good diagnostic value for AD combined with SP, which may be helpful for early detection of patient condition.

Efficacy of Zinc Acetate in the Treatment of Zinc Deficiency in Elderly Inpatients and Effect of Total Dose on Its Replacement Therapy.

We aimed to determine the efficacy of zinc acetate hydrate (ZAH) treatment for hypozincemia in elderly inpatients and to identify the factors affecting its therapeutic effect. We enrolled 79 patients with a mean age of 82 years. The mean serum zinc level before ZAH administration was 53.4 ± 11.5 µg/dL. More than half of the patients (67%) had zinc deficiency (<60 µg/dL), whereas 33% had subclinical zinc deficiency (60-80 µg/dL). The median increase in serum zinc level per ZAH tablet (25 mg) was 1.00 µg/dL. Based on the cutoff value, two groups were identified: slight increase (<1.00 µg/dL) and marked increase (≥1.00 µg/dL) groups; the difference between the two groups was significant (0.57 ± 0.22 µg/dL, n = 39 vs. 1.68 ± 0.70 µg /dL, n = 40; p < 0.0001, Wilcoxon rank sum test). Logistic regression analysis using total zinc dose, serum albumin level, impaired renal function, and diuretics as multivariate variables revealed a significant difference in total zinc dose (total number of tablets per 25 mg tablet: odds ratio 1.056, 95% confidence interval 1.019-1.095, p = 0.003). A significant increase in serum zinc levels was observed in the group with a total zinc dose of less than 1000 mg. The results suggest that an increasing trend in total zinc dose is associated with a low increase in serum zinc levels. Therefore, for the treatment of zinc deficiency in elderly inpatients, serum zinc levels need to be measured once, at a total dose of 1000 mg after initiation of ZAH.

Medication‐related problems in geriatric psychiatry—a retrospective cohort study

Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. 230 patients (63.0% female, mean age 73.7±8.4years, median length of stay 18days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180). The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R2 =0.747). An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy. The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.

Interaction effects of multimorbidity and frailty on adverse health outcomes in elderly hospitalised patients

We quantified the interaction of multimorbidity and frailty and their impact on adverse health outcomes in the hospital setting. Using aretrospective cohort study of persons aged ≥ 75 years, admitted to hospital during 2010–2012 in New South Wales, Australia, and linked with mortality data, we constructed multimorbidity, frailty risk and outcomes: prolonged length of stay (LOS), 30-day mortality and 30-day unplanned readmissions. Relative risks (RR) of outcomes were obtained using Poisson models with random intercept for hospital. Among 257,535 elderly inpatients, 33.6% had multimorbidity and elevated frailty risk, 14.7% had multimorbidity only, 19.9% had elevated frailty risk only and 31.8% had neither. Additive interactions were present for all outcomes, with a further multiplicative interaction for mortality and LOS. Mortality risk was 4.2 (95% CI 4.1–4.4), prolonged LOS 3.3 (95% CI 3.3–3.4) and readmission 1.8 (95% CI 1.7–1.9) times higher in patients with both factors present compared with patients with neither. In conclusion, multimorbidity and frailty coexist in older hospitalized patients and interact to increase the risk of adverse outcomes beyond the sum of their individual effects. Their joint effect should be considered in health outcomes research and when administering hospital resources.