Rates Of Institutionalization Research Articles

The Integrated Care Team: A primary care based-approach to support older adults with complex health needs.

Many older adults have complex needs and experience high rates of acute care use and institutionalization. Comprehensive Geriatric Assessment (CGA) is a specialized multidimensional interprofessional intervention to prevent such outcomes, but access to CGA in the community is limited. The Integrated Care Team (ICT) is a proactive case-finding intervention to support older adults with complex needs in primary care. The ICT provides nurse practitioner-led shared-care supported by a pharmacist, family physician, and geriatrician. Patients undergo a CGA, and a person-centred plan of care is implemented. We conducted a mixed-methods evaluation of the ICT. Patients were 81 ± 9.2years old, 71% were women. Patients had a high burden of dementia and multimorbidity and received 12.8 ± 5.8 prescriptions daily. The ICT improved prescribing and reduced emergency department visits by 49.5% (P = 0.0001). Patients, care partners, and referring physicians reported high satisfaction with care. The ICT is currently being expanded to support additional primary care providers.

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

BackgroundThe aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay.Materials and methodsAn observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database.ResultsAmong 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals.ConclusionThis study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

A multicomponent personalized prevention program in the primary care setting: a randomized clinical trial in older people with noncommunicable chronic diseases (Primacare_P3 study)

BackgroundMulticomponent interventions based on a comprehensive geriatric assessment (CGA) could promote active aging and improve health status in older people with Noncommunicable Chronic Diseases (NCDs), but conflicting evidences are available.AimTo evaluate the efficacy of a CGA-based multicomponent personalized preventive program (PPP) in reducing unplanned hospitalization rates during 12-month follow-up in community-dwelling older people with NCDs.Materials and methodsIn this randomized clinical trial (RCT), 1216 older adults recruited by 33 general practitioners (GPs) will be randomly allocated to intervention group (IG) or usual care control group (CG). The IG will receive a multicomponent PPP developed on the findings of the CGA-based Multidimensional Prognostic Index short-form (Brief-MPI), including structured interventions to improve functional, physical, cognitive, and nutritional status, to monitor NCDs and vaccinations, and to prevent social isolation. Participants in the CG will receive usual care. Brief-MPI, resilience, and health-related quality of life will be assessed after 6 and 12 months. Moreover, saliva samples will be collected at baseline in IG to measure biomarkers of oxidative stress, inflammatory cytokines, and oral microbiome.Expected resultsThe CGA-based PPP might reduce unplanned hospitalization rates and potentially institutionalization rates, emergency department (ED) and unplanned GP visits, and mortality. Further outcomes explored in the IG will be the adherence to PPP, resilience, health-related quality of life, and multidimensional frailty as assessed by the Brief-MPI.ConclusionsResults will suggest whether the CGA-based multicomponent PPP is able to improve specific outcomes in a primary care setting.Trial registrationClinicalTrials.gov; identifier: NCT06224556; Registered January 25, 2024.

Societal Costs of Dementia: 204 Countries, 2000-2019.

Dementia prevalence is expected to increase as populations grow and age. Therefore, additional resources will be needed to meet the global demand for care for Alzheimer's disease and related dementias (ADRD). Estimate global and country-level health care spending attributable to ADRD and the cost of informal care for people living with ADRD. We gathered data from three systematic literature reviews and the Global Burden of Disease 2019 study. We used spatiotemporal Gaussian process regression to impute estimates for the many countries without underlying data. We projected future costs to 2050 based on past trends in costs, diagnosis rates, and institutionalization rate. We estimated that in 2019, the direct health care spending attributable to ADRD across 204 countries reached $260.6 billion (95% uncertainty interval [UI] 131.6-420.4) and the cost of informal ADRD care was $354.1 billion (95% UI 190.0-544.1). On average, informal care represents 57% (95% UI 38-75%) of the total cost of care. We estimated that direct health care spending attributable to ADRD will reach $1.6 trillion (95% UI 0.6-3.3) in 2050, or 9.4% (95% UI 3.9-19.6%) of projected health spending worldwide. We estimated the cost of informal care will reach $0.9 trillion (95% UI 0.3-1.7) in 2050. These cost estimates underscore the magnitude of resources needed to ensure sufficient resources for people living with ADRD and highlight the role that informal care plays in provision of their care. Incorporating informal care cost estimates is critical to capture the social cost of ADRD.

Immigration enforcement and the institutionalization of elderly Americans

This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aides, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community.

Caring for patients in the terminal phase of Alzheimer’s disease

Regardless of the aetiology of dementia, its terminal phase has a similar clinical picture. This is when progressive multi-organ dysfunction and, ultimately, death occur. At this stage, the therapy of cognitive dysfunction loses its dominant role in favour of treatment that reduces the severity of behavioural disorders and, above all, efforts to intensify the care and ensure the comfort of the patient. Dementia usually coexists with other conditions, presenting a difficult and complex medical and care problem. In these patients, pharmacotherapy for all disorders should be limited to what is necessary, taking into account the multi-drug nature of the disease, as well as the short life expectancy of patients. The benefits versus side effects of therapy should be weighed very carefully, and unnecessary diagnostics, invasive procedures, unnecessary surgery, and burdensome therapeutic interventions classified as persistent therapy (futile care) should be eliminated. In terminal dementia, unnecessary hospitalisations should also be avoided due to the high risk of complications (infections, delirium, bedsores, thromboembolic complications, further deterioration of functional capacity, increased institutionalisation rates, and mortality). In Poland, the primary caregivers for patients with dementia are family members. As the disease progresses, care becomes round-the-clock, imposing a huge burden on the caregiver. At the same time, family caregivers receive little institutional support.

Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia.

Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30-60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09-1.26), previous institutionalization (29.1; 3.7-224.7), BI (1.09; 1.05-1.14), CCI (1.5; 1.1-2.1), and length of stay (1.1, 1.02-1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93-0.99) and length of stay (1.06; 1.00-1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20-51.21), BI (0.95; 0.92-0.98), and length of stay (1.12; 1.04-1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.

Using a systems perspective to examine child protection systems and practice: A scoping review on child abandonment and institutionalisation in the Maghreb

The Maghreb (Algeria, Libya, Mauritania, Morocco (including Western Sahara), Tunisia) has high rates of child maltreatment and child abandonment, leading to high rates of child institutionalisation. This review aims to provide an estimate of the prevalence of children in institutions in the countries of the Maghreb and to compare and contrast the child protection systems in the region. Using a scoping review approach, we identified 44 relevant studies from databases including Academic Search Premiere, Africa-Wide Information, Policy file Index, Google, and Google Scholar. Estimated children in institutions were as follows: Algeria 550,000, Libya 80–145,000, Mauritania 45,850, Morocco 471,006, and Tunisia 140,000. Common elements included limited child protection resources, lack of transparent databases, limited separation between religion and state, Shariah's influence on social and cultural norms, and a kafala system, an Islamically prescribed from of permanent guardianship for abandoned children. Mauritania and Tunisia had dedicated child protection codes, and all countries except Libya reported to the CRC. The literature indicates that components of the child protection systems in the countries of the Maghreb are fragmented with competing purposes, prioritising existing communitarian cultural mores over child protection. High rates of child abandonment and institutionalisation in the region result from inadequate child safeguarding structures and the stigmatisation of unmarried mothers and their children. Kafala, is a common element of Maghrebian child protection systems, with little alternative care provision, such as foster care. The scoping review highlights the opportunity to develop and adapt existing child safeguarding and alternative care structures and practice between countries of the Maghreb. Intra-regional research is urgently needed to facilitate changes and reduce rates of child abandonment and institutionalisation.

Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management – results of a randomized controlled trial

AbstractBackgroundThere is a need to examine whether evidence based collaborative care management can be beneficial to people with cognitive impairment transitioning from hospital to primary care.MethodWe conducted a longitudinal multisite randomized controlled trial with two arms (care as usual and care as usual + intersectoral care management) and two follow‐ups 3 and 12 months after hospital discharge. The sample under analysis consists of n = 401 participants from 3 different hospitals in Germany who were at least 70 years old, cognitively impaired and community‐dwelling.A comprehensive assessment of medical, nursing and psychosocial data at time of admission was analyzed using pre‐specified algorithms to develop an individualized treatment and care plan. After discharge, care managers visited participants at home, aligned the plan and supported participants for up to 3 months afterwards.Primary outcomes were the rate of re‐admission to hospital, and physical and instrumental functionality (activities of daily living, ADL) after 3 months and rate of institutionalization and ADL after 12 months. Secondary outcomes of interest were: health related quality of life, depressive symptoms, cognitive status and frailty. Statistical analyses include regression models controlled for various factors.ResultThere was no statistically significant effect on the re‐admission rate after 3 months, the activities of daily living, or the institutionalization rate. However, analyses show a significant effect of collaborative care management on health related quality of life 3 as well as 12 months after hospital discharge. Furthermore, depressive symptoms were significantly less likely in the intervention group 3 months after discharge. No effects on cognition or frailty were shown.ConclusionDementia care management has a positive effect on cognitively impaired older people during and after their hospital stay. There is an effect on quality of life and mental wellbeing. It is arguable why there is none on ADL. There is a need to discuss whether it is an appropriate primary outcome measure for a complex care intervention, as the intervention is targeting the needs associated with impaired functionality rather than functionality directly. Further limitations are discussed in more detail.

Sex differences in COVID-19 deaths in the early months of the pandemic in Canada: An examination with an immigration lens.

At the onset of the COVID-19 pandemic, there was an overrepresentation of males in COVID-19 deaths worldwide, with Canada reporting more female COVID-19 deaths. This paper examines the overrepresentation of female COVID-19 deaths in Canada, with an immigration lens. Data were extracted from the COVID-19 Sex-Disaggregated Data Tracker to compare the sex distribution of COVID-19 deaths in Canada with that of other countries. A linkage of deaths to the Longitudinal Immigration Database (IMDB) allows for the comparison of sex-specific COVID-19 death rates by immigrant status for age and geography, as well as by major employment sector among immigrants, using the tax data from the IMDB. While there were proportionately more female than male COVID-19 deaths in Canada in the early months of the pandemic, this trend was mainly a phenomenon among non-immigrants aged 85 and older. In addition, COVID-19-specific death rates for males were higher than those for females across age groups by immigrant status, except for those aged 85 and older among the non-immigrant population. Among immigrants, the death rate among health care and social assistance workers was higher among males than among females (10.7 vs. 2.9 per 100,000 population). The initially observed overrepresentation of female COVID-19 deaths to male COVID-19 deaths in Canada evened out in the summer of 2021. The higher proportion of female COVID-19 deaths was likely related to the high concentration of COVID-19 deaths in long-term care facilities, where a lower institutionalization rate for immigrants had been observed. Since the implementation of vaccination targeting long-term care facility residents in Canada, the overrepresentation of female COVID-19 deaths ceased.

Incidence and risk factors of institutionalisation in Parkinson's disease and atypical parkinsonism

IntroductionThe basic epidemiology of institutionalisation (the need for long-term care in an institution) in parkinsonism is unclear. We aimed to identify the incidence of, and risk factors for, institutionalisation in Parkinson's disease (PD) and atypical parkinsonism (AP). MethodsWe analysed data from a prospective population-based incidence cohort of parkinsonism in North-East Scotland (the PINE study). 556 newly-diagnosed participants (PD, N = 200; AP, N = 98; controls, N = 258), recruited between 2002 and 2009, were prospectively followed life-long with data collection on place of residence. We determined the incidence and baseline predictors of institutionalisation using Cox regression. ResultsThe median follow-up time was 9.3, 4.4, and 10.8 years in PD, AP, and controls respectively. 70 (35 %) PD, 53 (54 %) AP, and 43 (16 %) controls became institutionalised. The incidence rates of institutionalisation in PD, AP, and controls were 5.1, 20.8, and 1.8 per 100 person-years respectively. The median time to institutionalisation was 11.8 years in PD and 3.5 years in AP. Multivariable Cox regression showed that AP (HR versus PD = 3.05 [95 % CI 1.90,4.91]), increasing age (HR for 10-year increase = 1.82 [95 % CI 1.40,2.36]), poorer cognition (HR for MMSE<24 versus MMSE>27 = 2.62 [95 % CI 1.45, 4.73]), more-severe parkinsonian impairment (UPDRS part 3) (HR for 10-point increase = 1.25 [95 % CI 1.05, 1.48]) were independently associated with higher hazards of institutionalisation. Sex, co-morbidity, smoking history, and living alone were not associated with institutionalisation. ConclusionInstitutionalisation is much more frequent in parkinsonism, particularly in AP, than in controls. AP, older age, severe parkinsonian impairment, and poorer cognition were independent baseline predictors of institutionalisation.

Phenotype validation of the Korean working group on sarcopenia guideline

BackgroundThis study aimed to validate the proposed Korean Working Group on Sarcopenia (KWGS) guideline, which introduces the concept of functional sarcopenia, in older Korean adults. MethodsData from the Aging Study of Pyeongchang Rural Area, a longitudinal cohort of community-dwelling older adults, were utilized to compare frailty status and institutionalization-free survival among participants according to sarcopenia status. Based on the KWGS guideline, severe sarcopenia was defined as low muscle mass and strength with slow gait speed; sarcopenia (not severe) was defined as low muscle mass with low muscle strength or slow gait speed; and functional sarcopenia was defined as low muscle strength and slow gait speed without low muscle mass. ResultsAmong the 1302 participants, 329 (25.3 %) had severe sarcopenia, 147 (11.3 %) had sarcopenia (not severe), and 277 (21.3 %) had functional sarcopenia. Frailty was significantly greater in participants with any phenotype of sarcopenia than in those without sarcopenia. Additionally, participants with functional sarcopenia were frailer than those with sarcopenia (not severe). Furthermore, the rates of institutionalization and mortality were higher in participants with any phenotype of sarcopenia than in those without sarcopenia. There was no statistical difference between the rates of sarcopenia (not severe) and those with functional sarcopenia. These findings remained consistent after adjusting for age and sex. ConclusionsEach phenotype according to the KWGS guideline was associated with significantly greater frailty and increased risk of institutionalization and mortality. Functional sarcopenia was associated with greater frailty and had comparable prognosis with sarcopenia (not severe).

Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data

We assess whether informal care receipt affects the probability of transitioning to a nursing home. Available evidence derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data from the Netherlands, we use the gender mix of children to retrieve exogenous variation in informal care receipt. We find that informal care increases the chance of an admission within a three-year period for individuals with severe functional limitations, and increases the costs incurred on formal home care. For individuals with mild limitations, informal care substantially decreases total care costs, whereas its effect on nursing home admission is unclear. Further, informal care results in lower post-acute care use and hospital care costs, and does not increase mortality. Promoting informal care cannot be expected to systematically result in lower institutionalization rate and care costs, but it may nonetheless induce health benefits for its recipients.

Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study – Part of the PROPOLIS Study)

IntroductionWith increasing life expectancy and the rising incidence of stroke in young adults, it is important to know the long-term prognosis of this condition. Post-stroke delirium and post-stroke dementia are common complications of stroke that negatively affect prognosis. The purpose of this study was to evaluate five-year mortality from stroke and to assess the influence of post-stroke delirium and post-stroke dementia on mortality and disability over the five-year period.MethodsConsecutive patients admitted to the stroke unit for acute stroke or transient ischemic attacks were screened for in-hospital delirium. At the three- and twelve-month follow-up, the same patients underwent neurocognitive testing. Diagnoses of in-hospital delirium and dementia after three and twelve months based on DSM-5 criteria. Five years after stroke surviving patients were reevaluated. Outcome assessment included place of stay, current functional status assessed by the modified Rankin Scale (mRS), or death.ResultsAt the five-years of follow-up, data were collected from 575 of 750 patients originally included in the study (76.67%). The mortality rate was 51.65%. In-hospital post-stroke delirium and post-stroke dementia diagnosed three and twelve months after stroke were independent risk factors for death and an increase in mRS score of ≥ 1 or ≥ 2 points. There was no significant association with institutionalization rate.ConclusionsMore than half of post-stroke patients die within five years of follow-up. Post-stroke delirium and post-stroke dementia are associated with an increased risk of death and disability.

Rehabilitation of Older Asian Traumatic Brain Injury Inpatients: A Retrospective Study Comparing Functional Independence between Age Groups.

Across traumatic brain injury (TBI) severities, a geriatric TBI tsunami has emerged. Mixed outcomes are reported for elderly TBI with positive functional improvements with acute inpatient rehabilitation. We studied the effect of age at TBI on discharge functional outcomes, levels of independence and length of stay. A retrospective analysis of Asian TBI patients during inpatient rehabilitation over a 4-year period was conducted. Independent variables included admission GCS, post-traumatic amnesia (PTA) duration and injury subtypes. Primary outcomes were discharge Functional Independence Measure (Td-FIM) and FIM gain. In total, 203 datasets were analysed; 60.1% (122) were aged ≥65 years (older), while 39.9% (81) were <65 years (younger). At discharge, older TBI had a significantly lower Td-FIM by 15 points compared to younger (older 90/126 vs. younger 105/126, p < 0.001). Median FIM gains (younger 27 vs. older 23, p = 0.83) and rehabilitation LOS (older 29.5 days vs. younger 27.5 days, p = 0.79) were similar for both age groups. Older TBIs had significantly lower independence (Td-FIM category ≥ 91) levels (49.4% older vs. 63.9% younger, p = 0.04), higher institutionalisation rates (23.5% older vs. 10.7% younger, p = 0.014) and need for carers (81.5% older vs. 66.4% younger, p = 0.019) on discharge. Although 77% of older TBI patients returned home, a significantly higher proportion needed care. This study supports the functional benefits of TBI rehabilitation in increasing independence regardless of age without incurring longer inpatient rehabilitation days.

Heart Failure in Elderly People: From Pathophysiology to Diagnosis and Management

As the older population increases, there is an increase in age-related chronic diseases, especially heart failure. It affects 25% of over 75-year-old outpatients and represents the leading cause of hospitalization and death in older people. This review aimed to point out the main characteristics concerning heart failure in older people, taking into account clinical symptoms, diagnosis, and treatment. An extensive search on heart failure was made on PubMed and Google, using the keywords older people, heart failure, epidemiology, diagnosis, clinical symptoms, and pharmacological approach. Our results underline how heart failure in older patients is a complex and multifaceted reality that requires a multidimensional assessment to frame the patient correctly, resolve the acute episode, and set a targeted therapeutic, pharmacological, and non-pharmacological approach, without neglecting the psychogeriatric aspect. The latter must be aimed at reducing the relapse rate and preserving functional autonomy and quality of life, decreasing the rate of re-hospitalization and institutionalization, the length of hospitalization, and improving predictive outcomes.

Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study.

After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand. This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery. A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis. The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001). The study's results provide valuable insights for nurses to target these modifiable factors to enhance patients' mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study.

Hip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery. A population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization. A total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1-27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23-2.74; p = 0.003). Only POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.

Racialization and Reproduction: Asian Immigrants and California's Twentieth-Century Eugenic Sterilization Program.

During the twentieth century, state health authorities in California recommended sterilization for over 20,000 individuals held in state institutions. Asian immigrants occupied a marginalized position in racial, gender, and class hierarchies in California at the height of its eugenic sterilization program. Scholars have documented the disproportionate sterilization of other racialized groups, but little research exists connecting the racist, gendered implementation of Asian immigration restriction to the racism and sexism inherent in eugenics. This study examines patterns of coercive sterilization in Asian immigrants in California, hypothesizing higher institutionalization and sterilization rates among Asian-born compared with other foreign- and US-born individuals. We used complete count census microdata from 1910 to 1940 and digitized sterilization recommendation forms from 1920 to 1945 to model relative institutionalization and sterilization rates of Asian-born, other foreign-born, and US-born populations, stratified by gender. Other foreign-born men and women had the highest institutionalization rates in all four census years. Sterilization rates were higher for Asian-born women compared with US-born [Incidence Rate Ratio (IRR)=2.00 (95% CI: 1.61, 2.48)] and other foreign-born women (p<0.001) across the entire study period. Sterilization rates for Asian-born men were not significantly higher than those of US-born men [IRR 0.95 (95% CI 0.83, 1.10). However, an inflection point model incorporating the year of sterilization found higher sterilization rates for Asian-born men than for US-born men prior to 1933 [IRR 1.31 (95% CI 1.09, 1.59)]. This original quantitative analysis contributes to the literature demonstrating the health impact of discrimination on Asian-Americans and the disproportionate sterilization of racial minorities under state eugenics programs.

Total Hip Arthroplasty or Hemiarthroplasty for Displaced Femoral Neck Fractures?: Commentary on an article by Mina Tohidi, MD, FRCS(C), PhD, et al.: "Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture. A Propensity-Score-Matched Cohort Study".

Commentary This Canadian study involves a subject of continued controversy1,2. It describes the outcomes of a large matched group of patients ≥60 years old with a displaced femoral neck fracture treated with total hip arthroplasty (THA) or hemiarthroplasty (HA). The 2 groups had similar revision and readmission rates, but those treated with THA had higher dislocation rates. Patients treated with HA had higher mortality rates, but they tended to be older and had higher rates of dementia and institutionalization. These findings are not new or unexpected, so what are surgeons to take away from this study? The major strength of this study is the use of a well-matched cohort with a large sample size (9,224). Most previous studies involved far fewer patients or performed meta-analyses of such studies3. Its major weakness is that surgeon and technical factors could not be taken into account. Who performs the surgery and how it is done are very important but were not captured in the data. In clinical practice, a femoral neck fracture is a devastating but common injury. Treatment should be based on shared decision-making involving the surgeon and the patient, family, or individual who has the power of attorney. These other individuals will ultimately rely heavily on the surgeon’s recommendations. The surgeon should clearly explain why a particular treatment is being recommended, along with the specific risks and benefits involved with each treatment. There are also many confounding factors that can influence the surgeon’s recommendation. These can include surgeon experience and comfort with the procedure, as well as institutional support for performing it at less than convenient hours (holidays, weekends). Age, comorbidities, anticipated life expectancy, approach, femoral component head size, use of a dual-mobility construct, bone quality, and use of cement all need to be taken into account. An institutionalized patient with Parkinson disease will be treated very differently from an active 70-year-old who lives at home. Some studies have not found significant differences between these 2 treatments, or have questioned the clinical importance of better quality-of-life scores after THA than after HA4. However, the pendulum is clearly swinging toward the use of THA for this injury5,6. This study provides further evidence that THA is a reasonable treatment for many displaced femoral neck fractures, but reinforces the need to consider factors that will reduce dislocation rates.