Inpatients In Geriatric Hospital Research Articles

191 FRAILTY PREVALENCE AMONG GERIATRIC HOSPITAL INPATIENTS, AND ITS ASSOCIATION WITH ECONOMIC INDICATORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 467,779 INPATIENTS

Abstract Background Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators. Methods Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality. Results Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 7/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators. Conclusion Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.

Assessing the feasibility and impact of specially adapted exercise interventions, aimed at improving the multi-dimensional health and functional capacity of frail geriatric hospital inpatients: protocol for a feasibility study

BackgroundFrailty is a common and clinically significant condition in older adults, predominantly due to its association with adverse health outcomes such as hospitalisation, disability and mortality. Exercise interventions have been...

Frailty Levels In Geriatric Hospital paTients (FLIGHT)—the prevalence of frailty among geriatric populations within hospital ward settings: a systematic review protocol

IntroductionFrailty is a common and clinically significant condition in geriatric populations, associated with adverse health outcomes such as hospitalisation, disability and mortality. Although there are systematic reviews/meta-analyses assessing the prevalence...

Effects of Meatal Care with Essential Oil on the Meatal Status of Elderly Women Patients

Purpose: This study was done to examine the effects of meatal care with essential oil on meatal E-coli and pH of inpatients in geriatric hospital. Met hods: The participants were 40 patients admitted to J geriatric hospital in G city, Korea. Twenty patients were assigned to the experimental group and 20 to the control group. Participants in the experimental group received meatal care with essential oil (application of essential oil mixture consisting of lavender, tea tree, and frankincense). The control group received meatal care with saline. The meatal care was performed twice daily for one week in both groups. The scores for meatal odor, meatal pH and bacterial count for E-coli were measured before and after the treatment. Results: The score for meatal odor were significantly lower in the experimental group compared to the control group. The meatal pH and bacterial count for E-coli significantly decreased in the experimental group compared to the control group. Conclusion: Findings indicate that meatal care with essential oil is an effective nursing intervention to reduce meatal odor, meatal pH and bacterial count for E-coli for elderly women inpatients in geriatric hospitals.

환자평가표에 의한 요양병원 입원 노인들의 일상생활사 의사결정 인식기술 상태와 일상생활수행능력 간의 관계

환자평가표에 의한 요양병원 입원 노인들의 일상생활사 의사결정 인식기술 상태와 일상생활수행능력 간의 관계

노인요양병원 입원환자들의 삼킴기능이 삶의 질과 일상생활동작에 미치는 영향

This study was to evaluate the influences of swallowing function on quality of life and activity of daily living of inpatients in geriatric hospital. The subjects were consisted of elderly patients over the age of 65, 50 people in geriatric hospital of gwangju and jeonnam area. The results are as follows: First, swallowing function score of the subjects is <TEX>$29.90{\pm}5.27$</TEX>, SWAL-QOL score is <TEX>$158.12{\pm}33.36$</TEX>, ADL score is <TEX>$80.40{\pm}22.91$</TEX>. Second, swallowing function, SWAL-QOL details and ADL details of each other showed a statistically significant correlation. Third, the items of swallowing function affecting on quality of life are 'oral cavity in residue', 'to eat solid food', and 'phlegm obstructs the throat'. In conclusion, this study showed that swallowing function of inpatients in geriatric hospital is closely associated with the quality of life and the activity of daily living. Therefore, future development of programs for the improvement of swallowing function is required in order to improve the quality of life of inpatients in geriatric hospital.

Nutritional and hydration status in elderly subjects: Clinical rating versus bioimpedance analysis

Malnutrition and dehydration are common in elderly. A simple, reliable instrument to assess nutritional and hydration status would be very helpful. Bioelectrical impedance analysis (BIA) has been promising in this context, but data of elderly persons and geriatric in-hospital patients are rare. Therefore, we first compared BIA measurements (resistance, reactance, phase angle and a resulting vectorgraph) with a clinical assessment in 31 community-dwelling women and 30 female nursing-home residents. The results of the BIA measurement correlated well to weight, hand grip strength, and calf circumference. We then compared BIA measurements with clinical judgement of hydration status in 103 acute geriatric hospital in-patients. Concordance between the results of clinical judgement and BIA measurements was only 43.7%. In assessing geriatric in-patients, there is little concordance between the clinical and the bioelectrical evaluation of the hydration status.

Does vitamin D stop inpatients falling? A randomised controlled trial

Vitamin D deficiency is common in older people and may increase risk of falls and fracture. Hospital inpatients are at particular risk of falling. Previous studies suggest that vitamin D improves neuromuscular function and reduces falls. To determine whether routine supplementation with vitamin D plus calcium reduces numbers of fallers and falls in a cohort of hospital admissions while they are inpatients. Randomised, double-blind, controlled study. two hundred and five acute admissions >65 years to a geriatric medical unit. Patients were randomised to intervention of daily vitamin D 800 iu plus calcium 1,200 mg or control group of daily calcium 1,200 mg, until discharge or death. Baseline characteristics were similar in both groups with a median age 84 years and a median length of stay = 30 days (IQR 14.75-71.00). In a pre-selected sub-group (54/205 participants), median admission vitamin D level = 22.00 nmol/l (IQR 15.00-30.50). This did not significantly increase in the treatment versus control group. Median study drug adherence = 88%, with no significant difference between study groups (Mann-Whitney: P = 0.711). Although there were fewer fallers in the vitamin D cohort, this did not reach statistical significance (vitamin D: calcium = 36:45 fallers; RR 0.82 (CI 0.59-1.16). Neither the mean number of falls (vitamin D: calcium = 1.040:1.155; Mann-Whitney P = 0.435) or time to first fall (Log-rank test P = 0.377) differed between groups. In a population of geriatric hospital inpatients, vitamin D did not reduce the number of fallers. Routine supplementation cannot be recommended to reduce falls in this group.

A programme for short‐term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality

Objective We tested the hypothesis that a short-term programme for withdrawal of benzodiazepines (BZD) is feasible in hospitalized geriatric patients. Methods Fifty-six geriatric subjects who had been taking BZD for at least 3 months were asked to discontinue these drugs upon admission to the inpatient ward. A withdrawal programme including initial substitution therapy combined with psychological consulting was offered. The usual BZD medication was replaced by either lormetazepam 1 mg or trazodone 50 mg, administered at bedtime. After 1 week of replacement therapy all sedative medication was stopped. The subjective estimations of sleep quality were evaluated four times during a period of 6 weeks. Results Forty-nine patients agreed to participate. In this group four subjects (8.2%) resumed BZD use while in the hospital and another seven subjects (14.3%) relapsed after discharge. Therefore, the overall success rate was 77.6% in the group of volunteers and 67.9% in the total group of eligible patients. The data of the present study further demonstrate that no major withdrawal symptoms occurred and that the subjective quality of sleep remained virtually unchanged in the course of the programme. The sleep quality was not significantly different in patients on trazodone versus patients on lormetazepam. The success rate was similar in both drug substitution groups. Conclusions Short-term withdrawal of BZD may be achieved in two-thirds of elderly hospital inpatients without deterioration of sleep quality or other deleterious side-effects. Copyright © 1999 John Wiley & Sons, Ltd.

A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality

We tested the hypothesis that a short-term programme for withdrawal of benzodiazepines (BZD) is feasible in hospitalized geriatric patients. Fifty-six geriatric subjects who had been taking BZD for at least 3 months were asked to discontinue these drugs upon admission to the inpatient ward. A withdrawal programme including initial substitution therapy combined with psychological consulting was offered. The usual BZD medication was replaced by either lormetazepam 1 mg or trazodone 50 mg, administered at bedtime. After 1 week of replacement therapy all sedative medication was stopped. The subjective estimations of sleep quality were evaluated four times during a period of 6 weeks. Forty-nine patients agreed to participate. In this group four subjects (8.2%) resumed BZD use while in the hospital and another seven subjects (14.3%) relapsed after discharge. Therefore, the overall success rate was 77.6% in the group of volunteers and 67. 9% in the total group of eligible patients. The data of the present study further demonstrate that no major withdrawal symptoms occurred and that the subjective quality of sleep remained virtually unchanged in the course of the programme. The sleep quality was not significantly different in patients on trazodone versus patients on lormetazepam. The success rate was similar in both drug substitution groups. Short-term withdrawal of BZD may be achieved in two-thirds of elderly hospital inpatients without deterioration of sleep quality or other deleterious side-effects.

感染症予防のためのデンチャープラークコントロール Ｃａｎｄｉｄａｓｐｐ．とＨｅｌｉｃｏｂａｃｔｅｒ ｐｙｌｏｒｉを中心として

Many bacteria cover denture surfaces as denture plaque in the form of a biofilm, especially dentures of geriatric hospital inpatients. Dentures may act as a reservoir of microorganisms which cause opportunistic infection such as aspiration pneumonia. Oral health care, including denture plaque control could prevent such infection. Overviews of Candida spp. and Helicobacter pylori in denture plaque and the approach to denture plaque control for the prevention of systemic infection are presented in this report.

Depression and dementia in geriatric inpatients: Diagnostic comparisons between psychiatrists, geriatricians and test scores

AbstractA clinical and psychometric survey of depression and dementia in acute geriatric admissions (n = 50) found clinical evidence of depression and dementia in 25% and 35% of patients respectively, consistent with the results of prevalence surveys of geriatric hospital inpatients. There was a significant correlation between clinical assessment of dementia by geriatricians, and psychiatrists, and cognitive impairment using the Middlesex Elderly Assessment Memory Schedule (p &lt; 0.01). Although an intercorrelation between clinical diagnosis of depression by geriatricians, psychiatrists and scores on the Geriatric Depression Scale (GDS) just reached significance (p &lt; 0.05), there was no association between diagnosis of depression by geriatricians and GDS at a cutoff score of 11/30. The relationship was significant at a cutoff score of 16/30 (p &lt; 0.02). In contrast, the associations between diagnosis of depression by psychiatrists and GDS were highly significant at both cutoff points (p &lt; 0.002 and p &lt; 0.001 respectively). No significant differences were found between geriatricians and psychiatrists on indications for (1) antidepressant medication, (2) referral to liaison psychiatry, or (3) referral to a community mental health team. None of the inpatients assessed were receiving antidepressant medication at the time of their discharge from hospital although depression was diagnosed in a quarter of all inpatients and geriatricians supported the use of antidepressant treatment in 40% of those cases identified. Factor analysis suggested that geriatricians were identifying a subgroup of patients as depressed who were not recognized either by psychiatrists or by psychometric testing. Patients with abnormal scores on psychometric testing were followed up after discharge and retested. There was evidence of a significant fall in GDS scores and a non‐significant trend to increased fail scores on the MEAMS test suggesting an improvement in depressive symptoms with physical recovery and further cognitive decline following discharge. The results of the present study underline the need for active liaison between geriatricians and psychiatrists to improve the recognition and treatment of concurrent psychological problems during inpatient episodes.

An inverse relationship between serum zinc and C-reactive protein levels in acutely ill elderly hospital patients

Serum zinc and C-reactive protein (CRP) levels were measured in two groups of acutely ill geriatric hospital in-patients. Serum CRP levels were greater than 10 mg/l in 62% of the first group and 47% of the second. There was a significant negative correlation between zinc and CRP in both groups (r = -0.33, P less than 0.001, n = 103) and (r = -0.29, P less than 0.001, n = 135 respectively). The serum CRP was raised in 30% of long stay patients (n = 50) and 23% of a control group of elderly hospital patients with a normal serum albumin (n = 71), but there was no correlation between zinc and CRP in these patient groups. The results indicate that an acute phase response influences serum zinc levels in acutely ill geriatric patients. There is reason to believe that a distinction should be made between true zinc deficiency and a low serum zinc secondary to acute zinc redistribution during an inflammatory response. Measurement of CRP may help to distinguish between these two situations. We advise that if the serum zinc is low and CRP is significantly raised, zinc supplements should be avoided and a source of infection should be sought. Following recovery from severe infection low serum zinc levels return to normal while elevated CRP levels fall.

The dental care of geriatric patients in hospitals

This paper, which includes the results of a survey to assess the dental treatment needs of 97 geriatric hospital in-patients emphasizes the continuing inadequacy of the dental services afforded to this expanding group of patients. The possible beneficial effects of improving geriatric patients' dental health have been reviewed, and policies and treatment priorities for an effective dental care programme have been described.