Patients In Geriatric Wards Research Articles

2225 Geriatric patients in virtual wards; technology adoption style, ease of use, and adherence to remote monitoring technology

Abstract Introduction NHS England is committed to the expansion of virtual wards, necessitating patient engagement with home care technology. Literature suggests there is a technology adoption lag among older populations. We investigated if this lag was evident in geriatric virtual ward patients. Methods Data from three NHS trusts using a virtual care platform (March 2021–August 2023) were aggregated to assess differences in perceived ease of use, technology adoption style, and measures of adherence. All patients received the Telehealth Usability Questionnaire Ease of Use (EOU) subsection (higher scores indicate higher EOU). Patients completed surveys via tablet, wore monitoring devices, and took blood pressure readings. We dichotomised age (<75 vs. 75+) and used Fisher’s exact and Wilcoxon-Mann–Whitney tests. Results Of 857 patients, 36.9% were geriatric (mean age 81.5 years). The younger group (mean age 59.1 years) had 541 patients. Gender was evenly split between age groups (p = 0.62). Median EOU scores were 5.5 (geriatric) and 6.2 (younger) (p < 0.001). Geriatric patients were more likely to avoid or delay technology adoption (82% vs. 56% in younger patients, p < 0.001). Geriatric patients had higher adherence to the wearable device (median 95.3%) compared to younger patients (93.3%, p < 0.001). Blood pressure (median 81.6%) and survey adherence (median 83.3%) did not significantly differ between groups (p = 0.076, p = 0.0501). Conclusions Despite perceptions and literature suggesting older patients are less comfortable with technology, our findings demonstrate high engagement in virtual ward technology. While differences exist in technology adoption and EOU scores, geriatric patients exhibit equal or higher adherence to remote monitoring tasks. These results challenge stereotypes and underscore the importance of incorporating technology in geriatric care.

Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults

This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.

Embedding a Quality Framework for medication safety standards in delirium and dementia: A Singapore Study in a geriatric psychiatry liaison service

Introduction Research on prescribing processes for psychotropic medication review in older adult patients with severe behavioural symptoms of delirium and dementia appears limited. We aimed to improve and achieve 100% clinical documentation of psychotropic medication reviews against defined medication safety standards in older adult patients in geriatric wards with delirium occurrence and dementia without delirium referred to the geriatric psychiatry liaison service. The secondary aim evaluated any reduction in psychotropic medications as defined by medication safety standards by comparing pre-and post-assessments. Methods A baseline measurement in April 2022 showed no documentation records of the study’s first three standards. PDSA methodology was employed to evaluate whether a medication review occurred following the creation and implementation of medication safety standards 1 to 4 in cycle one and adding the fifth standard in cycle 2. The first, second and third standards were medication reviews of all hypnotics, antipsychotics, and psychotropic polypharmacy. The fourth standard reviewed the anticholinergic burden scores measured by the Anticholinergic Effect on Cognition scale. The fifth standard reviewed blood pressure and postural hypotension monitoring. Results Using a quality improvement framework that embeds defined medication safety standards as an intervention, we have demonstrated good documentation records for a medication review to improve psychotropic prescribing processes in the older adult’s psychiatry liaison service in geriatric wards in all standards in the 2 study cycles. There was a reduction in all psychotropic medications at post-assessment as defined by the medication safety standards 1 to 4 in at least one cycle in delirium occurrence and dementia without delirium, except for zopiclone in delirium. Conclusions The study’s findings in a geriatric ward setting in a public hospital in Singapore support the feasibility of embedding medication review using defined medication safety standards to improve psychotropic medication prescribing processes in older adults with delirium occurrence and dementia without delirium.

Association of Chronic Heart Failure with Frailty, Malnutrition, and Sarcopenia Parameters in Older Patients—A Cross-Sectional Study in a Geriatric Ward

The need to assess sarcopenia and frailty in patients with chronic heart failure (HF) has recently been raised. This cross-sectional study of 416 geriatric ward patients (median age (Me)-82 (IQR, 77-86) years, 77.4% female, 96.9% community dwelling) aimed to assess the prevalence of dynapenia, frailty syndrome, functional and nutritional health, and co-morbidity regarding their HF status. We collected data from comprehensive geriatric assessment. We observed HF in 162 (38.9%) patients, with 80 (49.4%) classified as New York Heart Association (NYHA) class III or IV. HF patients were significantly older, more frequently male, obese, hospitalized in the previous year, burdened with multimorbidity and polypharmacy, classified as frail, dependent on daily living activities, and physically non-active. Ischemic heart disease, atrial fibrillation, diabetes, peripheral arterial disease, anemia, chronic kidney disease, history of myocardial infarction, and stroke were found significantly more often in the HF group. A considerably higher percentage of HF patients had dynapenia (54.9% versus 41.9%, p = 0.02), but the difference was significant only in women. We found no significant difference between HF and no-HF groups regarding muscle performance, except for lower median gait speed in the HF group-0.53 m/s (0.35-0.89 m/s) versus 0.68 m/s (0.44-0.99 m/s), p = 0.02). HF patients significantly more often had low grip strength accompanied by slow gait, suggesting probable severe sarcopenia (40.4% vs. 29% in patients without HF, p = 0.046). In the regression analysis, significantly higher odds for HF were observed for lower mid-arm circumference (MAC) and dynapenia when controlling for age, sex, body mass index (BMI), calf circumference (CC), peripheral arterial disease, history of stroke, ischemic heart disease, atrial fibrillation, and diabetes mellitus. Conclusions: HF geriatric patients are often burdened with frailty, obesity, multimorbidity, and polypharmacy. As a result, they are more likely to present low muscle strength (potential sarcopenia), which is frequently accompanied by functional limitations (suggestive of more advanced stages of sarcopenia). This tendency is evident mainly in older women. Nevertheless, sarcopenia can be independently associated with HF in older patients with multimorbidity and disability who are hospitalized in a geriatric department, as a multivariable logistic regression analysis demonstrated.

Health Centres 75+ as a New Model to Improve Care for Older People in Poland.

According to a recent national audit, the cost of treating patients in geriatric wards is 20–30% less compared to those treated in internal medicine wards. Yet, geriatric care remains largely underdeveloped in Poland, with few human, material, and financial resources. Despite numerous attempts to raise the profile of geriatrics over the years, little progress has been achieved. In 2019, experts under the President of Poland proposed the creation of a network of Health Centres 75+ as the first pillar of geriatric care. These are meant to provide ambulatory services for older people and coordinate provision of other health and social care services at the county level. The goal is to create a community model of care, whereby older people would receive needed services close to their place of residence, allowing them to live independently for as long as possible. Although the proposal has been welcomed by the geriatric community and the patients, the acute shortages of human, physical, and financial resources raise concerns about its feasibility. However, the new strategic plans for the health system propose solutions that appear to be supportive of the new proposal, and the Office of the President is discussing joining forces with the Ministry of Health to improve its chances of implementation. Given the increasing pace of population ageing and underdeveloped provision of geriatric services, these efforts are very much needed.

“Honor thy father and thy mother”: the contribution of verbal concerns to the understanding of elderly patients’ satisfaction

Purpose This study aims first, to provide a typology of complaints concerning the treatment of elderly patients in geriatric wards; second, to estimate reported satisfaction with treatment; and third, to assess the link between verbal concerns and satisfaction. Design/methodology/approach Using the “Survey of Geriatric Wards, 2019” a sample of 4,725 family members of patients, hospitalized in 99 geriatric wards in Israel were asked to rate their overall satisfaction with treatment; they also were asked to provide verbal information on the hospitalization experience through an open-ended question. A content analysis was applied to the verbal answers, to classify them into distinct qualitative categories; a regression analysis was applied to examine the impact of the concerns on the level of patient satisfaction, net of patient’s characteristics. Findings Level of satisfaction among family members is very high (8.16 on a scale from 1–10), with only very few expressing verbal concerns (2.3%). Content analysis reveals five reoccurring themes: physical violence (33.3%), verbal violence (19.2%), discrimination (21.2%), lack of dignified hospitalization conditions (8.1%) and communication (18.2%). Further analysis reveals that satisfaction among those who complained, especially about interpersonal relations, is considerably and significantly lower than others. Originality/value Despite high levels of satisfaction with medical care in geriatric wards, the findings underscore voiced complaints as major source for explaining dis-satisfaction with hospitalization. Complaints in the realm of interpersonal relations, especially regarding verbal violence, discrimination and communication, seem to be most consequential for lowering levels of satisfaction with treatment.

Evaluation of balance and fall risk in geriatric ward patients.

Background. The physical changes inherent to aging can reduce autonomy and functional independence, which may directly or indirectly lead to falls. Aim of the study. The aim of this study was to assess the risk of falls in patients over 75 years of age. Materials and methods. Fifty elderly patients were examined. The subjects were divided into the three age groups: 75–79, 80–84 and 85–90 years old. The Berg Balance Scale was used to assess the risk of falls related to the balance skills. Results. The average Berg Balance Scale score in the 75–79 age group was 37.6 points; for 80–84, 33.53 points; and for 85–90, 27.81 points. The difference between the youngest and oldest age group was statistically significant (p=0.01). The highest risk of falls was reported in the oldest age group (p<0.05). Conclusions. People over 75 years of age have a high risk of falling. With age, the number of independent people decreases and the number of people who should be walking with assistance or use a wheelchair increases. It appears important to implement actions that prevent falls in older people.

Type 2 Diabetes Correlates with Comorbidity and Nutritional Status but Not with Functional Health in Geriatric Ward Patients: A Cross-Sectional Study in Poland.

PurposeThe study aimed to assess the comorbidity profile, functional, and nutritional health in geriatric ward patients depending on their type 2 diabetes (DM) status.Patients and MethodsWe performed a cross-sectional study of 416 patients – median age 82 years (IQR 77–86), 77.4% female, 96.9% community-dwelling – consecutively admitted to the geriatric ward at the turn of 2014 and 2015. Comprehensive geriatric assessment results were analyzed (including self-care and instrumental activities of daily living, cognitive abilities, emotional health, risk of falls, frailty status, dynapenia, nutritional health, morbidity, biochemical parameters, and pharmacotherapy).ResultsDM was observed in 126 (30.3%) patients hospitalized in the study period; 4% of DM cases were newly diagnosed. In comparison to patients without DM, older adults with type 2 DM were significantly more frequently burdened with multimorbidity (61.1% versus 39.7%, P<0.001), polypharmacy (88.9% versus 74.7%, P=0.001), obesity (59.8% versus 34.5%, P<0.001), abdominal obesity (94.4% versus 75.5%, P<001), chronic kidney disease (61.1% versus 48.6%, P=0.02) and cardiovascular diseases: ischemic heart disease (66.7% versus 47.9%, P<0.001), congestive heart failure (50.0% versus 34.1%, P=0.002), atrial fibrillation (30.2% versus 20.7%, P=0.04) and peripheral arterial disease (24.6% versus 11.4%, p<0.001). There were no significant differences in all functional parameters evaluated.ConclusionType 2 DM patients were significantly more often burdened with multimorbidity, polypharmacy, obesity, and had an unfavorable profile of cardiovascular diseases than patients without DM, but – contrary to our expectations – they did not differ in any functional characteristic assessed. However, this may be due to the geriatric ward patients’ specificity of health problems in the advanced, more complex disablement process phases.

Dementia Diagnoses and Treatment in Geriatric Ward Patients: A Cross-Sectional Study in Poland.

PurposeThe study aimed to determine the prevalence of dementia, its types, and treatment in geriatric ward patients.Patients and MethodsA cross-sectional study of 406 patients (77.8% women, median age 82, IQR (77–86) years) who underwent a comprehensive geriatric assessment in one of the Polish hospitals between September 2014 and April 2015 was conducted.ResultsDementia was diagnosed in 132 (32.5%) patients (46% mixed dementia; 32% Alzheimer’s disease; 10%vascular dementia; 5% dementia in Parkinson’s disease; 4% frontotemporal; 3% atypical parkinsonism). A total of 95 (72%) dementia cases were not detected before, and in the above half of these patients, it was not mentioned in the referral document. Only 33.3% of dementia patients were on cognitive enhancers (donepezil, rivastigmine, or memantine); 36.4% received antipsychotics, 45.5% received anti-depressants, 25.8% received nootropics, and 16.7% received anxiolytics/hypnotics.DiscussionThe results confirmed the high incidence of underdiagnoses and undertreatment of dementia in patients admitted to the geriatric ward. It is partly due to the lack of systematic cognitive assessment in primary care settings, although other factors can play a role.

Hip Fracture Patients in Geriatric Rehabilitation Show Poor Nutritional Status, Dietary Intake and Muscle Health.

The aim of this study was to gain insight into the nutritional status, dietary intake and muscle health of older Dutch hip fracture patients to prevent recurrent fractures and to underpin rehabilitation programs. This cross-sectional study enrolled 40 hip fracture patients (mean ± SD age 82 ± 8.0 years) from geriatric rehabilitation wards of two nursing homes in the Netherlands. Assessments included nutritional status (Mini Nutritional Assessment), dietary intake on three non-consecutive days which were compared with Dietary Reference Intake values, and handgrip strength. Muscle mass was measured using Bioelectrical Impedance Analysis and ultrasound scans of the rectus femoris. Malnutrition or risk of malnutrition was present in 73% of participants. Mean energy, protein, fibre and polyunsaturated fat intakes were significantly below the recommendations, while saturated fat was significantly above the UL. Protein intake was <0.8 in 46% and <1.2 g/(kg·day) in 92%. Regarding micronutrients, mean intakes of calcium, vitamin D, potassium, magnesium and selenium were significantly below the recommendations. The prevalence of low muscle mass, low handgrip strength and sarcopenia were 35, 27 and 10%, respectively. In conclusion, a poor nutritional status, dietary intake and muscle health are common in older hip fracture patients in geriatric rehabilitation wards.

Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year-A Cross-Sectional Study in a Geriatric Ward.

Falls are a serious health problem in older adults. A limited number of studies assessed their multifactorial nature in geriatric ward patients. The aim of this study is to explore health, functional and nutritional correlates of experiencing fall(s) in the previous year by older inpatients. A cross-sectional study of patients admitted to the department of geriatrics was conducted. A “faller status” was defined based on positive history of falls in the previous 12 months. Health, functional and nutritional factors associated with falls were evaluated, and multivariable logistic regression analysis models were built. A total of 358 patients (median age 82 (IQR 76–86) years, 77.9% women) were recruited, 43.9% of whom reported falls. The “fallers” presented with a significantly higher number of chronic diseases, higher prevalence of Parkinson’s disease, peripheral arterial disease, chronic osteoarthritis, more frequently reported urinary incontinence and were dependent on others for daily living activities. They had significantly worse results for the assessment of gait, balance and frailty status. The Mini Nutritional Assessment-Short Form scores and the mean value of serum albumin were significantly lower in the fallers’ group. Parkinson’s disease (OR = 2.82, CI—1.07–7.45; p = 0.04) and osteoarthritis (OR = 2.08, CI—1.02–4.23; p = 0.04) were the main variables for the outcome prediction, according to the direct multivariable logistic regression analysis. Our findings suggest that Parkinson’s disease and osteoarthritis are the main predictors independently associated with a history of falls in patients admitted to the geriatric ward, although the influence of some factors may be underestimated due to the tendency of not taking the history of falls in very frail, functionally dependent and bedridden individuals.

P2635Prevalence of appropriate treatment in elderly heart failure patients and impact on clinical outcomes: a subgroup analysis from REPOSI registry

Abstract Introduction Therapeutic appropriateness in chronic diseases is a key factor in obtaining better clinical outcomes over clinical follow-up, in particular in elderly patients. Data about therapeutic appropriateness in elderly patients with heart failure (HF) are scarce. Purpose To describe the prevalence of appropriate treatment in elderly HF patients and its impact on clinical outcomes. Methods REgistro POliterapie SIMI (REPOSI) cohort was used to assess study aims. REPOSI is an Italian Nationwide Registry of elderly (≥65 years) hospitalized patients in Internal Medicine and Geriatric wards. HF diagnosis was assessed at hospital admission according to ICD-9 code 428.XX. Therapeutic appropriateness was defined according to International Guidelines. Results Among the 7003 patients originally enrolled, a total of 1095 (15.6%) patients reported a diagnosis of HF at hospital admission. At admission, 230 (21.0%) patients were considered as treated appropriately, with 245 (22.4%) treated appropriately during hospitalization and 249 (22.7%) at discharge (p=0.0.248). Focusing on patients aged ≥80 years, prevalence of appropriate treatment was respectively: 18.9% at admission, 20.3% during hospitalization and 21.0% at discharge (p=0.266). Among the 1095 patients with HF, 815 (74.4%) had available follow-up data. Patients appropriately treated at discharge, compared to those not treated appropriately, had a lower rate of CV death (5.1% vs. 11.9%, p=0.006) and all-cause death (7.2% vs. 26.1%, p&lt;0.001) during follow-up, with no difference in rates of rehospitalization and CV rehospitalization. A logistic regression analysis adjusted for age, sex, risk factors, comorbidities and polypharmacy, showed that appropriate therapy at discharge was inversely associated with the risk of CV death and all-cause death (Table). In patients ≥80 years, appropriate HF treatment was inversely associated with risk of all-cause death (Table). Logistic Regression Analysis All Patients ≥80 years OR (95% CI) OR (95% CI) CV Death 0.46 (0.23–0.94) 0.59 (0.26–1.36) All-Cause Death 0.26 (0.14–0.46) 0.27 (0.14–0.53) CI = Confidence Interval; CV = Cardiovascular; OR = Odds Ratio. Conclusions In elderly hospitalized HF patients, prevalence of therapeutic appropriateness was consistently low at admission, during hospitalization and at discharge, particularly in patients ≥80 years. Appropriate HF therapy was inversely associated with the risk of CV death and all-cause death in all patients and with the risk of all-cause death in patients ≥80 years. Acknowledgement/Funding None

P4517Heart failure in elderly and very elderly hospitalized patients: an epidemiological analysis from the REPOSI registry

Abstract Introduction Epidemiological data about heart failure (HF) in the elderly and, in particular, very elderly patients are lacking. Purpose To provide the epidemiological profile of elderly and very elderly HF patients in terms of prevalence, associated clinical factors, burden of multimorbidity and functional status. Methods Overall cohort of the REgistro POliterapie SIMI (REPOSI) was used to assess study aims. REPOSI is an Italian Nationwide Registry of elderly hospitalized patients in Internal Medicine and Geriatric wards. HF diagnosis was assessed at hospital admission according to ICD-9 code 428.XX. Results Among the 7003 patients originally enrolled, a total of 1095 (15.6%) patients reported a diagnosis of HF at hospital admission. Prevalence of HF progressively increased according to age strata, up to 26.8% in patients ≥90 [Figure]. A logistic regression analysis found that increasing age, body mass index and total cumulative illness rating scale (CIRS) were associated with HF (Table). Moreover, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease and polypharmacy (≥5 drugs) were associated with HF, while liver disease and neoplasm were inversely associated (Table). According to CIRS severity index and comorbidity index quartile, HF patients reported more likely values in the highest quartile than those without HF (47.4% vs. 26.6%, p&lt;0.001 and 34.4% vs. 18.5%, p&lt;0.001 respectively). According to short blessed test, geriatric depression scale and Barthel index, patients with HF had significantly more cognitive impairment and dementia, depression and dependent from others in daily activities than those without HF (all p&lt;0.001). Prevalence of HF according to Age Strata Conclusions In a cohort of elderly patients hospitalized in Internal Medicine and Geriatric wards HF was highly prevalent, in particular in those very elderly. HF was associated with several clinical factors, emphasizing a stronger clinical complexity. HF patients were more burdened with multimorbidity and showed an impaired functional status. Acknowledgement/Funding None

Health and Functional Determinants of Orthostatic Hypotension in Geriatric Ward Patients: A Retrospective Cross Sectional Cohort Study

ObjectiveOrthostatic hypotension (OH) is a common problem in older people. Although it is indicated that OH can be a marker of frailty there are no studies that evaluate this relationship in hospitalized patients. The aim of the study was to assess the prevalence of OH in geriatric ward patients and its association with health and functional ability characteristics and patients’ frailty status.Design and settingA retrospective cross-sectional cohort study was conducted among patients aged 60 or over hospitalized in the geriatric ward.ParticipantsPatients’ medical records were analyzed and those with Active Standing Test (AST) results were included in the study.MeasurementsOrthostatic hypotension was defined by a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3minutes of standing up in AST. The database included sociodemographic characteristics, nutritional, functional and cognitive state, comorbidity and medical treatment. Frailty syndrome was diagnosed with Clinical Frailty Scale. Correlations with OH were counted and multivariable logistic regression models were built.Results416 patients were hospitalized in the study period and 353 (84.9%) were included, 78 (22.1%) men and 298 (84.4%) 75+ year-old. AST was not available in patients significantly more dependent in ADL and more frail. OH was diagnosed in 57 (16.2%) patients, significantly more frequently in men (systolic- 45,5%, systolic-diastolic-40,0%). The significant independent predictors of OH were lower diastolic blood pressure at admittance, nutritional risk in MNA-SF, Parkinson disease, α1-blockers, neuroleptics and memantine, and not the frailty syndrome diagnosed with Clinical Frailty Scale.ConclusionsOH affects a significant percentage of patients in the geriatric ward, although this problem may be underestimated due to limitations in the performance of AST in very frail and functionally dependent patients.

Evidence database for deprescribing of antipsychotic drugs in elderly and senile patients

The review deals with the problem of polypragmasia and associated adverse drug reactions, which is very relevant for the elderly and senile age. Based on the frequent unjustified prescription of antipsychotic drugs in clinical practice and the serious consequences associated with it, especially in elderly people with cognitive impairment, the aim of this review was to analyze the current literature and an evidence base for antipsychotic therapy optimization in elderly. One of the most effective way to decrease drug-associated harm is deprescribing, the planned process of decreasing dose, discontinuation of drug or switching to another one aimed to improve quality of life of the patient. The article describes different types of deprescribing, presents the results of the analysis of literature on deprescribing of antipsychotics in long-term use in elderly patients with dementia. Central to this is the analysis of a systematic review of Cochrane E. Van Leeuwen and co-authors (2018), the leading research in the evidence base of deprescribing. Based on the available literature, the authors make the conclusion about the safety of deprescribing of antipsychotic drugs. The effect of abrupt discontinuation of treatment with antipsychotic drugs was evaluated in available literature. Most of the evidence relates only to residents of nursing homes or to patients in long-term psychogeriatric or geriatric wards (in-patient treatment). However, the evidence base of deprescribing of antipsychotic drugs is small, many studies have methodological limitations, the initial characteristics of the patients included in the study are extremely heterogeneous, methodologies for diagnosing and determining the severity of dementia, types and dosages of antipsychotic drugs, duration of observation periods differed greatly. Attention is drawn to the short duration of observation periods. All of the above dictates the need for specially planned randomized clinical trials, the results of which will develop detailed algorithms for deprescribing antipsychotics.

Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

Residents in long-term care facilities (LTCFs) are increasingly found to be an important reservoir of multidrug-resistant gram-negative (MRGN) bacteria. We aimed to determine colonization by MRGN bacteria over 6 months in LTCFs and geriatric wards in Graz, Austria, and to evaluate risk factors for such colonization. During August 2015, we conducted a point-prevalence survey at LTCFs and geriatric wards of the Geriatric Health Centers of the City of Graz. Inguinal and perianal swabs were taken from 137 patients and screened for MRGN using standard procedures. Six months after the initial investigation all colonized patients were sampled again and use of antibiotics, hospital admissions, and mortality was registered. Genetic relatedness of MRGN bacteria was evaluated. We detected 12 patients harboring MRGN isolates (prevalence, 8.7%). Overall inguinal colonization was 5.1%. After 6 months, only 2 out of 12 patients were still colonized. Presence of a urinary catheter was associated with a higher risk of MRGN colonization (odds ratio [OR], 17.5; 95% CI, 1.6-192). Chronic wounds and gastrostomy were also risk factors of MRGN colonization (OR, 10.7; 95% CI, 1.6-69.3 and OR, 18.3; 95% CI, 2.4-139.4, respectively). There was no difference in mortality between colonized and noncolonized patients. Prevalence of colonization with MRGN bacteria was low in patients in LTCFs and geriatric wards in Graz, Austria.

Improving comfort around dying in elderly people: a cluster randomised controlled trial

Over 50% of elderly people die in acute hospital settings, where the quality of end-of-life care is often suboptimum. We aimed to assess the effectiveness of the Care Programme for the Last Days of Life (CAREFuL) at improving comfort and quality of care in the dying phase in elderly people. We did a cluster randomised controlled trial in acute geriatric wards in ten hospitals in Flemish Region, Belgium, between Oct 1, 2012, and March 31, 2015. Hospitals were randomly assigned to implementation of CAREFuL (CAREFuL group) or to standard care (control group) using a random number generator. Patients and families were masked to interventaion allocation; hospital staff were unmasked. CAREFuL comprised a care guide for the last days of life, training, supportive documentation, and an implementation guide. Primary outcomes were comfort around dying, measured with the End-of-Life in Dementia-Comfort Assessment in Dying (CAD-EOLD), and symptom management, measured with the End-of-Life in Dementia-Symptom Management (SM-EOLD), by nurses and family carers. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01890239. 451 (11%) of 4241 beds in ten hospitals were included in the analyses. Five hospitals were randomly assigned to standard health care practice and five to the CAREFuL programme; 118 patients in the control group and 164 in the CAREFuL group were eligible for assessment. Assessments were done for 132 (80%) of 164 patients in the CAREFuL group and 109 (92%) of 118 in the control group by nurses, and 48 (29%) in the CAREFuL group and 23 (19%) in the control group by family carers. Implementation of CAREFuL compared with control significantly improved nurse-assessed comfort (CAD-EOLD baseline-adjusted mean difference 4·30, 95% CI 2·07-6·53; p<0·0001). No significant differences were noted for the CAD-EOLD assessed by family carers (baseline-adjusted mean difference -0·62, 95% CI -6·07 to 4·82; p=0·82) or the SM-EOLD assessed by nurses (-0·41, -1·86 to 1·05; p=0·58) or by family carers (-0·59, -3·75 to 2·57; p=0·71). Although a continuous monitoring of the programme is warranted, these results suggest that implementation of CAREFuL might improve care during the last days of life for patients in acute geriatric hospital wards. The Flemish Government Agency for Innovation by Science and Technology and the Belgian Cancer Society "Kom Op Tegen Kanker".

Antipsychotic prescription patterns in the management of delirium symptoms in hospitalized elderly patients

Objective: The objective of this study was to study the pharmacological management of delirium in elderly hospitalized patients in acute geriatric medical wards. Method: We conducted a one-year retrospective cross-sectional study in patients 65 years of age or older who were admitted to an acute geriatric unit care at a teaching hospital with a delirium diagnosis. Results: A total of 133 subjects were included in the study. Delirium was prevalent in 78% of patients. The average length of delirium was 13 days. Antipsychotics were prescribed to 74% of patients with delirium. Patients with hyperactive, mixed and hypoactive delirium received antipsychotics regularly in a proportion of 68%, 54%, and 34% respectively. The length of antipsychotic prescription was of 11 days. Risperidone was the most commonly prescribed agent given on a regular basis while haloperidol was chosen for the as required prescriptions. Fifty-five percent of demented patients received a daily prescription of antipsychotics compared to 46% in the non-demented population. A shorter length of delirium episodes in subjects with acetylcholinesterase inhibitors was also observed. A higher mortality rate was observed in the group of subjects receiving benzodiazepine during the delirium episode. Conclusion: This study shows that antipsychotic treatment is widely, but not systematically prescribed in demented and non-demented patients in all types of delirium including hypoactive. Efforts should be made to increase appropriate antipsychotic prescription in this vulnerable population.

Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0-1 study according to the Medical Research Council Framework.

BackgroundThe effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the UK hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards.MethodsWe conducted a phase 0–1 study according to the Medical Research Council Framework. Phase 0 consisted of a review of existing LCP programmes from the UK, Italy, and the Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, we developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. The care programme was reviewed and refined by two nurses and two physicians working in an acute geriatric ward and by two experts from Italy and the Netherlands.ResultsPhase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation and a summary of the LCP concerns raised in the UK. Based on these findings we developed a new care programme consisting of (1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward, (2) supportive documentation, and (3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.ConclusionsBased on the existing LCP programmes and taking into account the key factors for successful LCP implementation as well as the concerns raised in the UK, we developed a care programme for the last days of life and modelled it to the acute geriatric hospital wards after gaining feedback from health professionals caring for older hospitalized patients.

Monitoring ambulation of patients in geriatric rehabilitation wards

The aim of this study is to determine whether clinicians' estimates of patients' walking time agree with those determined by accelerometer devices. The walking time was measured using a waist-mounted accelerometer device everyday during the patients' waking hours. At each weekly meeting, clinicians estimated the patients' average daily walking time in the previous week. Twenty-eight clinicians completed 176 estimates of the average daily walking time for 13 patients (78.5 ± 6.6 years old) over 31 weeks. The average daily walking time measured by the accelerometers was 36.4 ± 16.2 min and that estimated by clinicians was 61.3 ± 38.4 min. Clinicians overestimated the amount of walking time by 24.8 min on average (mean% error=165.8%). Most estimates were between an hour less to 2 h more than the accelerometer measurements. Only 38.6% of the estimates agreed with the accelerometer measurements. Therefore, clinician assessment of the level of patient activity in a rehabilitation setting is highly inaccurate and unreliable.