Elderly Patients In General Hospital Research Articles

A Study of Nurses’ Awareness of the Importance, Educational Needs, and Nursing Competence on Comprehensive Nursing Assessment for Hospitalized Elderly Patients in General Hospital

A Study of Nurses’ Awareness of the Importance, Educational Needs, and Nursing Competence on Comprehensive Nursing Assessment for Hospitalized Elderly Patients in General Hospital

A Scoping Review of Nursing to Prevent and Reduce the Need for Physical Restraints for Elderly Patients in General Hospitals of Japan

A Scoping Review of Nursing to Prevent and Reduce the Need for Physical Restraints for Elderly Patients in General Hospitals of Japan

The Prevalence of Dementia and Cognitive Impairment in Hospitals.

The care of elderly patients with comorbid dementia poses an increasing challenge in the acute inpatient setting, yet there remains a lack of representative studies on the prevalence and distribution of dementia in general hospitals. We conducted a cross-sectional study of patients aged 65 and older in randomly selected general hospitals in southern Germany. Patients were excluded if they were in an intensive care unit or isolation unit or if they were on specialized wards for psychiatry, neurology, or geriatric medicine. The findings are derived from patient interviews, neuropsychological testing, standardized rating scales, questioning of nursing staff, and the patients' medical records. 1469 patients on 172 inpatient wards of 33 hospitals were studied. 40.0% of them (95% confidence interval, [36.2; 43.7]) had at least mild cognitive impairment. The point-prevalence of dementing illnesses was 18.4% [16.3; 20.7]. Delirium, most often on the basis of dementia, was present in 5.1% [3.9; 6.7]. 60.0% had no cognitive impairment. Dementia was more common among patients of very advanced age, those who were dependent on nursing care, those who lived in old-age or nursing homes, and those with a low level of education. Among patients with dementia, only 36.7% had a documented diagnosis of dementia in the medical record. Patients with dementia were treated more often for dehydration, electrolyte disturbances, urinary tract infections, contusions, and bone fractures, as well as for symptoms and findings of an unknown nature, and much less often for cancer or musculoskeletal diseases. Two out of five elderly patients in general hospitals suffer from a cognitive disturbance. Patients with severe impairments such as dementia or delirium often need special care. Guidelines and model projects offer approaches by which the inpatient care of patients with comorbid dementia can be improved.

Short-term cognitive effects after recovery from a delirium in a hospitalized elderly sample.

The aim of this study was to examine early cognitive performance after a delirium in elderly general hospital patients. Patients were divided into a delirium (n = 47) and a control (n = 25) group. One week before discharge and after delirium had cleared in the first group, all patients completed a neuropsychological test battery (The Cambridge Cognitive Examination-Revised [CAMCOG-R]). Group differences in cognitive performance were analyzed adjusting for differences in baseline sociodemographic and clinical variables. Adjusting for group differences in baseline variables, the delirium group performed significantly worse than the control group on CAMCOG-R; its subdomains language, praxis, and executive functioning; and on Mini Mental State Examination derived from CAMCOG-R. The occurrence of delirium in hospital thus detrimentally affects early cognitive performance.

Improving quality of referral to consultation liaison service using SBAR communication tool to provide rapid and timely interventions to elderly patients in general hospital

Improving quality of referral to consultation liaison service using SBAR communication tool to provide rapid and timely interventions to elderly patients in general hospital

Assessment of Nutritional Status of Hospitalized Elderly Patients in Makkah Governorate

A cross sectional study was conducted to assess the nutritional status of a sample of 102 recently hospitalized elderly patients in general hospitals at Makkah Governorate by using the Mini Nutritional Assessment (MNA) tool. Among the studied patients, 22.6% were classified as malnourished, 57.8% were at risk of malnutrition and 19.6% were as well nourished. Low body mass index, history of weight loss during the last 3 months, living independently, taking > 3 prescription of drugs per day and presence of neuropsychological problems were associated with malnutrition (p<0.05). The elderly classified as malnourished and those at risk of malnutrition and well nourished differed significantly in all dietary assessment variables of the MNA score (p<0.05). It is concluded that malnutrition is a common problem among older people. MNA test should be performed for elderly upon admission to hospitals and more attention need to be paid to this vulnerable group of people.

Assessment Scales for Delirium

Delirium is a severe psychiatric syndrome that is highly prevalent in elderly general hospital patients. However, the diagnosis of delirium is often missed. The use of rating scales can be helpful in detecting and measuring delirium symptom severity. This article reviews recent developments regarding psychometric qualities, measurement goals, content and rating procedures of some of the available rating scales in clinical practice. Literature from the Medline files up to 2008 were collected, using the following search entries: delirium, (acute) confusion, assessment/rating scale and screening. Articles were selected if their title or summary were related to the development or applicability of delirium rating scales. The reference lists of relevant articles were searched for additional references. The rating scales were split up according to their purposes, screening or severity rating and were discussed for the following aspects: content (theoretical background, rating domains and items), interview (duration, format and assessors’ expertise) and psychometric qualities (reliability and validity). There were eight screening scales (Confusion Assessment Method [CAM], CAM for the Intensive Care Unit [CAM-ICU], Intensive Care Delirium Screening Checklist [ICDSC], Delirium Symptom Interview [DSI], NEECHAM Confusion Scale [NEECHAM], Cognitive Test for Delirium [CTD], Delirium Observation Screening [DOS] and Nursing Delirium Screening Scale [Nu-DESC]) and seven severity rating scales (Delirium Rating Scales [DRS], Memorial Delirium Assessment Scales [MDAS], Confusional State Evaluation [CSE], Delirium Severity Scales [DSS], Delirium Index [DI], Delirium-O-Meter [DOM] and Delirium Detection Scale [DDS] ) selected for further research. The CAM, NEECHAM and DOS and the CAM-ICU for the ICU appear to be the most suitable as screening instruments, depending on the type of rater (trained) physician or nurse. The (revised) Delirium Rating Scale (DRS-R-98) and the DOM appear to be particularly useful for measuring delirium severity or monitoring change.

Prevalence and Persistence of Mild Cognitive Impairment among Elderly Patients in General Hospitals

The aim of the present study was to determine the prevalence of mild cognitive impairment (MCI) in elderly patients in general hospitals and to investigate the persistence of the cognitive deficits after discharge from the hospital. In a sample consisting of 794 non-demented patients in general hospitals aged 65–85 years, we found an MCI prevalence of 36.1%. The positive predictive value for cognitive impairment 3.5 months after hospital discharge was 61.0%. The deficits in multiple-domain MCI proved to be particularly stable with a positive predictive value of 82.9%. Elderly patients in general hospitals represent a high-risk group for MCI. These results indicate that general hospitals offer an opportunity for the early detection of incipient dementia.

How Do Delirium and Dementia Increase Length of Stay of Elderly General Medical Inpatients?

The purpose of this study was to identify the proximate causes through which dementia and delirium extend length of stay (LOS) in elderly general hospital patients. Among 93 patients age >/=65 years admitted to a tertiary-care teaching hospital through the emergency department, admission ratings of cognitive impairment, delirium, and dementia predicted the emergence of mental and behavioral manifestations of delirium and dementia in the hospital and greater LOS. Mental and behavioral manifestations also predicted greater LOS. On average, mental manifestations appeared first and were followed by behavioral manifestations, and the appearance of both types of manifestations occurred before the mean LOS. The results suggest that elderly patients with dementia and/or delirium who become symptomatic after admission to a general hospital first show mental signs and symptoms, then show behavioral disturbances, which appear to be the proximate causes of greater LOS.

Effects of Medicare's prospective payment system on service use by depressed elderly inpatients

To determine the effects of Medicare's prospective payment system (PPS) on hospital care, changes in length of stay and intensity of clinical services received by 2,746 depressed elderly patients in 297 acute care general medical hospitals were studied. A pre-post design was used, and differences in sickness at admission were controlled for. Data on length of stay and use of specific clinical services were obtained from the medical record using a medical record abstraction form. Care provided on units exempt from PPS was compared with care provided in nonexempt units. After implementation of PPS, the average length of stay fell by up to three days within the different types of acute care settings studied, but this decline was partially offset by proportionately more admissions to psychiatric units, which had longer lengths of stay. Intensity of clinical services increased after PPS implementation, especially in nonexempt psychiatric units. Despite financial incentives for hospitals to reduce clinical services under PPS, its implementation was not associated with a marked decline in length of stay, when averaged across all treatment settings, and was associated with an increase in the intensity of many clinical services used by depressed elderly patients in general hospitals.