Geriatric Inpatients Research Articles

Mental disorders of geriatric inpatients: symptom characteristics and treatment outcome.

The aim of this study was to describe neuropsychiatric disorders of geriatric inpatients, to investigate associations of psychopathological symptomatology with clinical variables and to determine its impact on treatment outcome. From January to April 2018, treatment data of geriatric inpatient records were collected retrospectively. Clinical diagnoses of neuropsychiatric disorders, that is, depression, dementia, and delirium, were identified. Clinical correlations were calculated by χ2-tests and t-tests. Confounding variables for determined correlations were ascertained by analyses of variance. Functional measurements (Barthel Index, Timed Up and Go, Tinetti Test, and De Morton Immobility Index) were assessed at start and end of geriatric inpatient treatment. The mean age of the included 280 inpatients was 84 years, 71% were female, and the mean duration of treatment was 19.5 days. Twenty-nine percent of cases suffered from dementia, 27% from depression, and 15% from delirium at the time of geriatric treatment onset. Mentally ill inpatients, in addition, presented with a significantly higher number of comorbidities, compared to the group of mentally healthy inpatients. In contrast to the dementia and the delirium group of inpatients, prescription of analgetics was highest among the mentally healthy inpatients and inpatients with depression. Improvement was observed in each of the defined groups, and significant functional differences between all groups were found. Neuropsychiatric disorders occur quite often in a geriatric hospital department, especially depression and dementia. Clinical correlations determined in this study suggest a close relationship of mental and somatic disorders in geriatric inpatients. This study further demonstrates that neuropsychiatric disorders in multimorbid, elderly patients do not prevent functional improvement.

Medical Comorbidities and Association With Mortality Risk in Alzheimer's Disease: Population-Based Study of 132,405 Geriatric Inpatients.

ObjectivesWe used the Nationwide Inpatient Sample (NIS) to identify the demographic predictors and study the impact of chronic comorbidities on the risk of in-hospital mortality in Alzheimer’s disease (AD).MethodsWe included 132,405 AD patients from the NIS (2012-2014). We used descriptive statistics to discern the differences in demographics and comorbidities by in-hospital mortality. Logistic regression analysis was used to evaluate the predictors and impact of comorbidities that increase the risk of association with in-hospital mortality.ResultsThe in-hospital mortality in AD inpatients is 1.69%, and a greater proportion were female (58.4%) and white (81.5%). Male and hispanic had a higher mortality risk than their counterparts. Hypertension (72%) is the most prevalent comorbidity. Congestive cardiac failure (CCF) and renal failure were significantly associated with a higher risk of in-hospital mortality in AD inpatients by 1.4 and 1.5 times, respectively. Psychiatric comorbidities (depression 20.4%, and psychosis 21.4%) were prevalent in AD inpatients but were negatively associated with mortality. Comorbid tumors without metastasis (1.2%) and metastatic cancer (0.3%) were least prevalent but significantly increased the risk of in-hospital mortality by 1.6 times and 2.2 times, respectively.ConclusionCCF and renal failure were significantly associated with a higher risk of in-hospital mortality in AD patients. Less prevalent comorbidities, tumors with/without metastasis increased in-hospital mortality by 59% to 117%. An integrated care model is required to manage comorbidities in AD patients to improve health-related quality of life and reduce morbidity and mortality.

Considerations for Postacute Rehabilitation for Survivors of COVID-19.

Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible.

Relationship between Sarcopenia and Mortality in Elderly Inpatients.

Sarcopenia, a geriatric syndrome, is an indicator of poor prognosis in elderly inpatients. In this study, we aimed to determine the effect of sarcopenia on mortality in elderly patients. Mobile/immobile geriatric inpatients, treated in the internal medicine ward between February and November 2018, were included in the study between Days 2 and 7 of hospitalization. The patients' fat-free mass (FFM) was measured by bioimpedance. The FFM index (FFMI) (kg/m2) was determined by dividing fat-free mass by body surface area (FFM/BSA). Sarcopenia was defined as a FFMI value at least two standard deviations below the gender-specific mean of normal young adults. The study included 200 geriatric inpatients; 96 (48.0%) were men, and the mean age was 74.49±6.32 years. Sarcopenia was detected in 28 (14%) of the patients. Diabetes mellitus was associated with a significantly lower sarcopenia prevalence (p=0.006). The risk of sarcopenia was 9.046 times higher in malnourished patients. The sarcopenia group had more deaths (p=0.012). Sarcopenia in geriatric inpatients increased the length of hospital stay and mortality. Our findings may guide future studies examining the relationship between sarcopenia and mortality among elderly inpatients in other hospitals.

Perioperative patient blood management in the aged-more than only transfusion? : Review of the 4th symposium of the working group on anemia on the occasion of the annual meeting of the German Geriatric Society in Frankfurt 2019

Anemia is frequent in older people with one in two geriatric inpatients being affected. Therefore, in elective surgery, such as endoprosthetic treatment it is very likely that anemia is already present in apreoperative setting. So far there are no particular guidelines about perioperative management of anemia in geriatric patients. The existing recommendations of the Patient Blood Management (PBM) network cooperation and the current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines on preoperative anemia refer to all patients aged >18years but without particular consideration of the growing number of oldest old orthogeriatric patients. This is more problematic as anemia in the aged has been shown to be different from anemia in younger patients in terms of diagnostics and treatment. Based on several interdisciplinary lectures, this year the symposium of the working group on anemia of the German Geriatric Society (DGG) focused on the problems of perioperative PBM in orthogeriatric patients and encouraged the discussion about developing PBM treatment recommendations for this patient group.

Motor, cognitive and mobility deficits in 1000 geriatric patients: protocol of a quantitative observational study before and after routine clinical geriatric treatment \u2013 the ComOn-study

BackgroundMotor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany).MethodsThis is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week’s inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters.DiscussionThis study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.

27 Re-Audit of Orthostatic Blood Pressure Measurement to Prevent Falls and Fall-Related Complications for Geriatrics Inpatients from A Secondary Care Hospital

Abstract Introduction Orthostatic Hypotension is a common cause of falls leading to injury and morbidity in older adults. In the National Audit of Inpatient Falls 2015 audit, only 16% of 4846 patients had an orthostatic Blood Pressure (L/S BP) recorded by their third day in the hospital. There is also variation in the understanding of how doctors and nurses perform orthostatic BP. This could have adverse effects on detection rates and accuracy of the procedure resulting in misdiagnosis. As a result, the Royal College of Physicians (RCP) has released guidance on Orthostatic BP measurements to perform the standardising practice and improving accuracy. The purpose of this quality improvement project (QIP) is to work on the action plan from the orthostatic BP measurement QIP has done in 2017, by introducing laminated guidelines in patient’s notes and re-audited in 2018 to record any improvement. The re-audit of 2018 showed remarkable improvement but still not as equal as the gold standard as RCP. Therefore, the second loop of re-audit performed in 2019 in major Geriatrics wards and other wards while involved larger sample (patient) numbers. We used four questioners as the audit proforma. Methods Wards were audited to find out whether orthostatic BP is measured as per RCP guidelines. Afterward, a laminated copy of the RCP recommended method of measuring orthostatic BP was put into all Early Warning Score ‘Observation’ folders with a sheet designed specifically for recording Orthostatic (L/S BP). The procedure of L/S BP measurement was re-audited after the intervention to find out changes in performing orthostatic (L/S BP) (as per RCP guidelines). Results There is a remarkable improvement of outcome reveals in the second loop of re-audit. Regarding RCP guideline compliance, it is 93.33% which is closer to the gold standard. And in case of symptoms identification and documentation, it is 100%, which is equal to the RCP gold standard. Conclusions Inclusion of guidelines in notes improves investigation; inclusion of supplementary recording sheet improves documentation. Re-audit reflects the remarkable improvement to compliance with RCP guidelines in measuring Orthostatic BP measurement and patient’s symptoms documentation.

MDT approach to improve attendance of outpatient appointments and scans for geriatric inpatients

While working on a geriatric ward, I noticed many of the patients were not responsible for their own care and that often it was done by family/community teams. Thus, when they came into hospital, they were often missing planned outpatient appointments/investigations which were scheduled for them. This led to poor patient care and increased missed appointments. Imperatively many of these patients …

Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions

BackgroundGeriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization.MethodsA prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems.ResultsA total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212–9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029–2.450, p = 0.037).ConclusionsDrug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists’ intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists’ intervention was also substantially high.

Engaging Social Interest and Creating Awareness for the Behavioural and Psychological Symptoms of Dementia.

Novel multimodal sensing study that has been installed and tested in a geriatric psychiatry inpatient unit is reviewed. Perspectives and experiences of behavioural and psychological symptoms of dementia are also examined. Further, the Spare a Thought for Dementia Through the Your Story My Story campaign, a project that seeks to amplify empowering stories from persons living with dementia and their friends and family carers in order to combat stigma and show carers that they are not alone in their journeys, is also discussed.

Screening for Depression in Old Age With Very Short Instruments: The DIA-S4 Compared to the GDS5 and GDS4.

Purpose of the Study: This article presents a short form of the Depression in old Age Scale with four items (DIA-S4). The diagnostic accuracy of the DIA-S4 was tested and compared to short forms of the Geriatric Depression Scale (GDS5, GDS4). Methods: Using the Montgomery and Asberg Depression Rating Scale (MADRS) as gold standard, the scales were validated with a sample of N = 331 geriatric inpatients. Results: The DIA-S4 had an internal consistency of .70, the GDS5 of .55, and the GDS4 of .58. The test efficiency considering ROC analyses for the DIAS-4 was AUC = .86, for the GDS5 AUC = .78, and for the GDS4 AUC = .74. The best cut-off score for the DIA-S4 was 1.5 with a sensitivity of 87% and a specificity of 68%, for the GDS4 1.5 with a sensitivity of 58% and a specificity of 81%, and for the GDS5 1.5 with a sensitivity of 88% and a specificity of 49%. Conclusion: Based on the data of this study, the DIA-S4 shows better psychometrical qualities than the GDS5 and the GDS4. It can be used as a very short screening scale for depression in old age in research and clinical practice.

Impact of psychiatric disorders on the outcome of acute geriatric inpatient treatment: an exploratory investigation

Systematic study results of geriatric inpatient treatment assessing the impact of psychiatric disorders on treatment outcome are so far missing. This exploratory study investigated the impact of dementia, depression and delirium on treatment outcome in ageriatric department, compared to those individuals without psychiatric symptoms at the beginning of treatment. From January to June 2018 treatment data from geriatric inpatient records were retrospectively evaluated. Functional measurements (Barthel index, timed up and go test, Tinetti test and the De Morton mobility index) were assessed at the start of geriatric treatment and at discharge. A multivariate variance analysis (MANOVA) was used to calculate the possible impact of psychiatric disorders on functional improvement during treatment and to find out if there were significant differences between the four defined groups (dementia, depression, delirium and mentally sound). A total of 280 geriatric inpatients with an average age of 84years, were included in this study and showed anoticeable prevalence of psychiatric disorders: dementia 29%, depression 27%, and delirium 15%. As expected, the patients in the sample showed ahigh level of multimorbidity and polypharmacy. Functional improvement was present in each of the defined groups and significant differences between all groups were found. The results of MANOVA showed that none of the possible confounding variables, e.g. age, mini mental status examination (MMSE), degree of care, cognitive impairment, social status, gender and comorbid illness, had an important influence on the group results. This study of an acute geriatric department demonstrated that psychiatric disorders in these multimorbid, aged patients did not prevent functional improvement by treatment, showed significant differences during the course of treatment and outcome and compared to inpatients without psychiatric symptoms.

The functional status, rehospitalization, and hospital cost reduction in geriatric patients after the implementation of the universal health coverage program in the national referral hospital Indonesia

BACKGROUND Universal health coverage program (UHCP) might implicate negatively toward geriatric care with its impact on higher cost. The evaluation had to be made, especially in functional status, rehospitalization, and cost-effectiveness.
 METHODS Retrospective cohort study with historical control was done. Seventy two geriatric inpatients in the pre-UHCP group and 86 in the UHCP group were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects with geriatric syndromes admitted from July to December 2013 (pre-UHCP era) and January to June 2014 (UHCP era). Functional status changes, rehospitalization, and process indicators were observed. Cost reduction was calculated using the incremental cost-effectiveness ratio (ICER), whereby costs, functional status changes, and rehospitalization of both groups were used to identify the differences.
 RESULTS Proportions of functional status increase were 35.3% and 34.8% in the pre- UHCP and UHCP groups, respectively (p = 1.00) and the decrease were 5.9% and 4.5% in the pre-UHCP and UHCP group, respectively (p = 1.00). Rehospitalization rates were 21.7% and 18.1% (p = 0.603) in the pre-UHCP and UHCP groups, respectively. Mean hospital expenses were between 17.1 million IDR (1,221 USD; 1 USD = 14,000 IDR) for the pre-UHCP group and 20.8 million IDR (1,486 USD) for the UHCP group. ICER showed that hospitalization cost was 3.7 million IDR (264 USD) higher to increase 1 activity of daily living score in the UHCP era. As for rehospitalization, the cost was 600,000 IDR (43 USD) less, with 3.6% smaller in readmission.
 CONCLUSIONS There was no changes in patients’ functional status after the UHCP implementation. There was a reduction in rehospitalization with lower cost in the UHCP era.

Risk factors for adverse drug reactions in older inpatients of geriatric wards at admission: Multicenter study.

To investigate the characteristics of adverse drug reactions (ADR) and their risk factors among very old patients in five geriatric wards in Japan. A retrospective observational multicenter study was carried out to investigate factors related to ADR in older inpatients from geriatric wards of five university hospitals in Japan. Data including drugs profile and short-form comprehensive geriatric assessment were obtained from medical charts. ADR were identified from geriatrician's reports. For each ADR, symptoms and causal drugs were clarified, and factors associated with ADR were analyzed statistically. In 1155 patients (52.5% women, mean age 82.8 ± 7.0 years), the proportion with ADR was 15.4%. There was a great variety of signs and symptoms of ADR, and a great variety of drugs suspected to be the cause of ADR. On multiple logistic regression analysis, ADR was significantly associated with an increase in drugs (odds ratio 1.11, 95% CI 1.07-1.16) and emergency admission (odds ratio 2.76, 95% CI 1.82-4.15). Receiver operating characteristic curve analysis showed that the optimal cut-off number of drugs for predicting ADR was ≥7. In geriatric inpatients, polypharmacy (especially ≥7 drugs) and emergency admission were associated with ADR. Because there was a great variety of ADR in the study, clinicians must consider reviewing all drugs to prevent adverse drugs reactions during admission in this vulnerable population. Geriatr Gerontol Int 2019; ••: ••-••. Geriatr Gerontol Int 2020; 20: 144-149.

Palliative needs of geriatric patients

In Germany, the group of geriatric patients is the biggest part of all decedents. That is the reason why the medical staff, who is taking care of elderly patients, needs not only curative, rehabilitative and preventive competencies butalso palliative skills. Recently, three guidelines were published (national guideline palliative care for patients with incurable cancer diseases, national guideline pain assessment in resident homes and German guideline geriatric assessment level 2). These three guidelines are useful for the detection of partial aspects in special palliative needs and make recommendations for the alleviation of suffering. However, there is no tool for the identification of palliative needs of geriatric inpatients in emergency rooms and in other places in the hospitals. In primary care, the Supportive and Palliative Care Indicators Tool (SPICT) is available for this purpose.

Resilience, frailty and outcomes in geriatric rehabilitation.

To assess relationships between resilience, frailty and outcomes in geriatric rehabilitation inpatients. Eighty-nine inpatients had Brief Resilience Scale (BRS) and frailty index (FI-CGA) completed. Pearson's or Spearman's correlation was used to determine correlation between BRS, FI-CGA and covariates. Multivariate logistic regression was used to determine associations between resilience, frailty and covariates with functional independence measure gain, length of stay (LOS)>21days, mortality and discharge care requirements. There was a negative correlation between BRS and premorbid FI-CGA (r=-0.31, P=0.03) and admission FI-CGA (r=-0.26, P=0.01) and between BRS and Mini-Mental State Examination score (rho=-0.26, P=0.02). BRS was not associated with observed outcomes. Premorbid FI-CGA was associated with inpatient mortality, and greater increase in FI-CGA during acute stay was associated with greater LOS. All patients who died were frail (FI-CGA>0.25). Resilience and frailty were inversely related. Frailty was an independent predictor of rehabilitation LOS and mortality.

Survey on psychosomatic treatment options in geriatric clinical routine: state of the art

Mental and physical disorders form acommon body of experience and suffering in old age that can negatively influence aging. Experience and handling of age-associated functional impairments are challenging for multimorbid patients, their relatives and the healthcare providers involved. Among patients aged 70years or older more than 50% suffer from psychopathological symptoms and 30-40% of geriatric inpatients have apsychosomatic or psychiatric comorbidity; however, despite this high prevalence of mental problems in older patients they are hardly ever treated and if treatment is offered it is carried out by specialists for somatic medicine. The aim of the present study of the working group on gerontopsychosomatics of the German Geriatric Society (DGG) was the evaluation of interdisciplinary co-management opportunities for geriatricians who treat inpatients with gerontopsychosomatic needs. Online survey among members of the DGG regarding experiences with interdisciplinary co-management of inpatients with gerontopsychosomatic needs. The majority of the respondents were senior physicians in a department for geriatrics. While every second institution had access to a psychiatric consultation service, psychosomatic cooperation was only offered in every fifth department. Psychosomatic co-management was particularly required in connection with neurogeriatric problems. There is need of gerontopsychosomatic co-management among geriatric inpatients; however, in comparison to gerontopsychiatric co-management the options are deficient and need to be strengthened.

RESILIENCE AND RECOVERY IN OLDER ADULTS: A COMPLEX SYSTEMS APPROACH

In medicine, we still cannot objectively assess who will recover from health stressors imposed by disease or its treatment. If resilience, the dynamic ability to respond to and recover from health stressors, is considered as an emergent feature of a complex system, then methodology from complexity science may help us quantify the health-promoting features that support the recovery process. This presentation describes ongoing work aimed at empirically testing the concept and predictive value of resilience by examining the extent to which small-scale responses of bodily systems (i.e. heart rate, activity) to natural (micro)perturbations and indicators of loss of complexity are related to physical functioning and recovery throughout the journey of 120 geriatric inpatients. Dynamic indicators of resilience (variance, autocorrelation) and multiscale entropy measures were estimated from continuous heart rate and accelerometer data and compared to measures of patients’ physical functioning (e.g., ADLs, frailty) at admission, discharge and 3 months later.

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...

Apilot observational study to analyze (in)activity and reasons for sedentary behavior of cognitively impaired geriatric acute inpatients.

Background and objectiveMobility decline and worsening of the cognitive status are all too often the result of acute hospital treatment in older patients. This is particularly pronounced in patients with pre-existing cognitive impairment. This study strived to analyze the routines of geriatric acute care and identify reasons and triggers for sedentary behavior during acute hospitalization of cognitively impaired inpatients.Methods and patientsA sample of 20 moderately cognitively impaired geriatric inpatients (average age 84 years) were recruited on an acute care ward. Information on persons attending the patient, daytime, location, context, patient’s activity behavior and difficulty of action were collected by behavioral mapping over a period of 35 1‑min timeslots and extrapolated to a period of 525 min. Routines were further analyzed via semi-structured interviews with five healthcare professionals (HCP).ResultsRelevant relations between various categorical and ordinal variables, such as patients’ activity behavior, persons attending the patient, daytime, location, difficulty of action and contextual factors were found. Extrapolated data showed that patients spent 396.9 min (75%) in their room, 342.0 min (65%) were spent alone and 236.2 min (45%) lying in bed. The time patients spent alone was grossly underestimated by HCP.ConclusionTime spent without company, lacking meaningful activities and continuous bedridden periods due to missing demands to leave the room might have led to time spent inactive and alone. These seem to be strong predictors for sedentariness. Routines of acute care should be reorganized to increase physical activity and thereby reduce sedentary behavior of this patient group.