Hospitalization In Older Adults Research Articles

The combined effects of physical frailty and cognitive impairment on emergency department- versus direct-admission hospitalizations

BackgroundWe aimed to study whether physical frailty and cognitive impairment (CI) increase the risk of recurrent hospitalizations in older adults, independent of comorbidity, and disability.MethodsTwo thousand five hundred forty-nine community-dwelling participants from the National Health and Aging Trends Study (NHATS) with 3 + years of continuous Medicare coverage from linked claims data were included. We used the marginal means/rates recurrent events model to investigate the association of baseline CI (mild CI or dementia) and physical frailty, separately and synergistically, with the number of all-source vs. Emergency Department (ED)-admission vs. direct admission hospitalizations over 2 years.Results17.8% of participants had at least one ED-admission hospitalization; 12.7% had at least one direct admission hospitalization. Frailty and CI, modeled separately, were both significantly associated with risk of recurrent all-source (Rate Ratio (RR) = 1.24 for frailty, 1.21 for CI; p < .05) and ED-admission (RR = 1.49 for frailty, 1.41 for CI; p < .05) hospitalizations but not direct admission, adjusting for socio-demographics, obesity, comorbidity and disability. When CI and frailty were examined together, 64.3% had neither (Unimpaired); 28.1% CI only; 3.5% Frailty only; 4.1% CI + Frailty. Compared to those Unimpaired, CI alone and CI + Frailty were predictive of all-source (RR = 1.20, 1.48, p < .05) and ED-admission (RR = 1.36, 2.14, p < .05) hospitalizations, but not direct admission, in our adjusted model.ConclusionsOlder adults with both CI and frailty experienced the highest risk for recurrent ED-admission hospitalizations. Timely recognition of older adults with CI and frailty is needed, paying special attention to managing cognitive impairment to mitigate preventable causes of ED admissions and potentiate alternatives to hospitalization.

A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies—ATS Brianza and ATS Bergamo—from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017–2019 and quantified differences using rate ratios (RRs). Overall, in 2017–2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017–2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run.

A National Analysis of Discharge Disposition in Older Adults with Burns-Estimating the Likelihood of Independence at Discharge.

Whereas older age predicts higher burn mortality, the impact of age on discharge disposition is less well defined in older adults with burns. This investigation assesses the relationship between older age and discharge disposition after burns in a nationally representative sample. We queried the 2007 to 2015 National Trauma Data Bank for non-fatal burn hospitalizations in older adults. Pre-defined age categories were 55 to 64 years (working-age comparison group), 65 to 74 years (young-old), 75 to 84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area, injury mechanism, and race/ethnicity. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression assessed the association between older age and discharge to non-independent living. There were 25,840 non-fatal burn hospitalizations in older adults during the study period. Working-age encounters comprised 53% of admissions, young-old accounted for 28%, middle-old comprised 15% and old-old comprised 4%. Discharge to non-independent living increased with burn TBSA and older age in survivors. Starting in young-old, the majority (65 %) of patients with burns ≥20% TBSA were discharged to non-independent living. Adjusted odd ratios for discharge to non-independent living were 2.0 for young-old, 3.3 for middle-old, and 5.6 for old-old patients, when compared with working-age patients (all P &lt; .001). Older age strongly predicts non-independent discharge after acute burn hospitalization. Matrix analysis of discharge disposition indicates a stepwise rise in discharge to non-independent living with higher age and TBSA, providing a realistic discharge framework for treatment decisions and expectations about achieving independent living after burn hospitalization.

Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis.

BackgroundMultimorbidity is defined as the presence of multiple chronic conditions in the same individual. Multimorbidity is more prevalent in older adults and can lead to several adverse health outcomes.MethodsWe systematically reviewed evidence from observational studies to verify the association between multimorbidity and hospitalization in older adults. Furthermore, we also aimed to identify whether it changes according to gender, advanced age, institutionalization, and wealth of the country of residence. We searched the PubMed, Embase and Scopus databases from December 2020 to April 2021. The analysed outcomes were as follows: hospitalization, length of stay and hospital readmission.ResultsOf the 6,948 studies identified in the databases, 33 were included in this review. From the meta-analysis results, it was found that multimorbidity, regardless of the country’s wealth, was linked to hospitalization in older adults (OR = 2.52, CI 95% = 1.87–3.38). Both definitions of multimorbidity, ≥2 (OR = 2.35, 95% CI = 1.34–4.12) and ≥3 morbidities (OR = 2.52, 95% CI = 1.87–3.38), were associated with hospitalization. Regardless of gender, multimorbidity was associated with hospitalization (OR = 1.98, 95% CI = 1.67–2.34) and with readmission (OR = 1.07, 95% CI = 1.04–1.09). However, it was not possible to verify the association between multimorbidity and length of stay.ConclusionsMultimorbidity was linked to a higher hospitalization risk, and this risk was not affected by the country’s wealth and patient’s gender. Multimorbidity was also linked to a higher hospital readmission rate in older adults. PROSPERO Registration (Registration number: CRD42021229328).

Developing Multicomponent Interest-Based Interventions to Prevent Delirium: A Quality Improvement Project for Hospitalized Older Adults

Abstract Date Presented 03/31/2022 Delirium is prevalent among hospitalized older adults. Interest-based activities and environmental cues can increase cognitive stimulation to prevent delirium. OTs have unique skills to create person-centered interventions to promote cognition and participation. The feasibility of providing multicomponent interest-based intervention in the acute care setting was explored. Promising patient engagement and high satisfaction were reported. Primary Author and Speaker: Qianwen Liu Contributing Authors: Elena Donoso Brown, Shauni Johnson, Autumn Moss-Corcoran

CO59 Polypharmacy and Risk of Fall-Related Hospitalization in Older Adults

This study assessed the association between the number of prescription drugs used, Fall-risk increasing drugs (FRIDs) use, and hospitalization due to falls in older adults.

Frailty, depression risk and 10-year hospitalization in older adults. The FRADEA study

ObjectivesTo determine whether the interaction between frailty status and depression risk is associated with hospitalization density in older adults. MethodsOngoing cohort study in 794 subjects aged over 70 years from Albacete (Spain). Data were collected on depression risk, frailty, hospitalizations, and covariates. Participants were categorized into six groups. ResultsAdjusted hospitalization risk was higher for groups of prefrail/-non depression risk (HR 1.48; 95% confidence interval (CI) 1.16-1.89), prefrail/depression risk (HR 1.73; 95% CI 1.29-2.30), frail/non depression risk (HR 1.79; 95% CI 1.22-2.62), and frail/depression risk (HR 2.12; 95% CI 1.49-3.02), compared with robust/non depression risk group (p<0.01). Frail and prefrail groups presented increased hospitalization density in the first four follow-up years. ConclusionsDepression risk changes the yearly probabilities of hospitalization in prefrail and frail groups, increasing them in the first years. Depression risk should be monitored in prefrail and frail older adults as an independent risk factor for hospitalization.

Effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization in older adults with cardiovascular diseases

ObjectivesThere is limited evidence on the effectiveness of influenza vaccination on hospitalization outcomes by cardiovascular disease (CVD) subtypes or comorbidities. MethodsThis study involved 713,488 records of hospitalization of adults ≥60 years with CVD from the Beijing Urban Employee Basic Medical Insurance database. Logistic regression with generalized estimating equations was conducted to estimate the effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization, adjusting for unmeasured confounders. ResultsThe coverage of influenza vaccination was only 13.3% among older adults hospitalized for CVD. Influenza vaccination was associated with 15% (odds ratios 0.85 [0.74, 0.99]) lower risk of in-hospital death among patients with CVD, with stronger associations in patients with stroke. Influenza vaccination was associated with 6% (0.94 [0.88, 0.99]) and 28% (0.72 [0.56, 0.93]) lower risks of recurrent hospitalization for ischemic heart disease (IHD) and respiratory disease in patients with IHD, but there were no clear associations in patients with stroke. For in-hospital death, the protective association of influenza vaccination was stronger in patients with fewer comorbidities and was similar to that of joint vaccinations of influenza and pneumococcal vaccinations. ConclusionThe protective association of influenza vaccination on CVD hospitalization outcomes serves as the evidence base to increase the uptake of influenza vaccination among older adults in China.

Functional status recovery trajectories in hospitalised older adults with pneumonia.

Background and objectivesPneumonia is associated with significant mortality and morbidity in older adults. We investigated changes in functional status over 6 months after pneumonia hospitalisation by frailty status.Methods and measurementsThis single-centre prospective cohort study enrolled 201 patients (mean age 79.4, 37.3% women) who were hospitalised with pneumonia. A deficit-accumulation frailty index (range: 0–1; robust <0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, severely frail ≥0.45) was calculated on admission. Functional status, defined as self-reported ability to perform 21 activities and physical tasks independently, was measured by telephone at 1, 3 and 6 months after discharge. Group-based trajectory model was used to identify functional trajectories. We examined the probability of each trajectory based on frailty levels.ResultsOn admission, 51 (25.4%) were robust, 43 (21.4%) pre-frail, 40 (20.0%) mild-to-moderately frail and 67 (33.3%) severely frail patients. Four trajectories were identified: excellent (14.4%), good (25.4%), poor (28.9%) and very poor (31.3%). The trajectory was more strongly correlated with frailty level on admission than pneumonia severity. The most common trajectory was excellent trajectory (59.9%) in robust patients, good trajectory (74.4%) in pre-frail patients, poor trajectory (85.0%) in mild-to-moderately frail patients and very poor trajectory (89.6%) in severely frail patients. The risk of poor or very poor trajectory from robust to severely frail patients was 11.8%, 25.6%, 92.5% and 100%, respectively.ConclusionsFrailty was a strong determinant of lack of functional recovery over 6 months after pneumonia hospitalisation in older adults. Our results call for hospital-based and post-acute care interventions for frail patients.

Predictors of Functional Improvement, Length of Stay, and Discharge Destination in the Context of an Assess and Restore Program in Hospitalized Older Adults.

Assess and restore programs such as Humber’s Elderly Assess and Restore Team (HEART) provide short-term restorative care to prevent functional decline in hospitalized older adults. The aim of this retrospective observational study was to determine which HEART participant characteristics are predictive of functional improvement, decreased length of stay, return to home, and decreased readmission to hospital. Electronic health records were retrospectively examined to gather predictor data. Differences in functional status, excessive length of stay, discharge destination, and hospital readmissions were compared in 547 HEART patients and 547 matched eligible non-participants using ANOVAs, Mann–Whitney, and chi-square tests. The greatest functional improvements (percent Barthel change) were seen in those requiring a one-person assist (M = 39.56) and using a walker (M = 46.07). Difference in excessive length of stay between HEART and non-HEART participants was greatest in those who used a walker (Mdn = 3.80), required a one-person assist (Mdn = 2.00), had a high falls risk (Mdn = 1.80), and had either a lower urinary tract infection (Mdn = 2.25) or pneumonia (Mdn = 1.70). Predictor variables did not affect readmission to the hospital nor return to home. Predictive characteristics should be considered when enrolling patients to assess and restore programs for optimal clinical outcomes.

Patient outcomes related to receiving care on a dedicated Acute Care for Elders (ACE) unit versus with an ACE order set.

The Acute Care for Elders (ACE) unit model of care aims to reduce common complications of hospitalization in older adults through early involvement of allied health providers, changes to the care environment, elder-friendly care protocols, and proactive discharge planning. Our hospital established a dedicated 28-bed medical ACE unit. Because of capacity limitations, the number of eligible older medical patients often exceeds the available number of beds. Thus, some ACE unit-eligible patients are instead admitted to other medical or surgical units for their medical care. These "bed-spaced" ACE patients receive care by the same general internists and ACE order set that ACE unit patients are cared under. We sought to compare the health outcomes of ACE-designated patients admitted to the ACE unit versus bed-spaced peers cared for using a protocolized ACE order set. 3046 ACE-designated patient admissions were analyzed (1499 ACE unit and 1547 bed-spaced). The primary outcomes examined were discharge disposition and in-hospital mortality. Univariate and multivariate comparisons were performed. Propensity matching was used to adjust for case mix in a post-hoc analysis. The mean age of participants was 83.5 years for ACE unit patients and 82.6 for bedspaced patients. In adjusted models, ACE unit patients were more likely to be discharged home (OR 1.28 [1.08-1.50], p=0.003). In an unadjusted analysis, patients admitted to ACE unit were less likely to die in hospital, but this finding did not persist after adjustment for case mix. Care of older adults delivered on a dedicated ACE unit increases the likelihood of discharge to home when compared to care delivered with an ACE order set alone for general internal medicine patients.

Association Between Physical Functioning and Time Until a New Hospitalization in Community-Dwelling Older Adults: A Prospective Cohort Study.

Physical functioning refers to the ability to independently perform activities that require physical ability, and may be an important tool for predicting a higher risk of hospitalization. The objective of this study was to verify whether aspects of physical functioning are independently associated with the risk for new hospitalization in older adults seen in primary health care. This prospective cohort study consisted of 473 older adults 60 years and older who had not been hospitalized in the prior year. Hospitalization records were obtained with authorization from the hospital admission. Depending on physical functioning, the probability of a new hospital admission within the next 5 years was determined based on survival analysis and the Kaplan-Meier curve. Physical functioning was evaluated using 5 easy-to-administer tests: handgrip strength using a Jamar dynamometer, functional performance using the Short Physical Performance Battery, balance using the step test, mobility using the Timed Up and Go (TUG) test, and gait speed using the 4-m walk test. The association between poor physical functioning and new hospitalization was verified using a Cox regression model, adjusted for sex, age, number of comorbidities, number of medications, and BMI. Models were implemented separately for each physical functioning test. In the sample, 32% had been hospitalized at least once in 5 years. The Kaplan-Meier curve showed a decrease in the probability of nonhospitalization within the next 5 years. Cox regression analysis showed an association between hospitalization within the next 5 years and mobility on the TUG test of more than 12.4 seconds in the crude (hazard ratio [HR] = 1.33, 95% CI = 1.10-1.60) and adjusted models (HR = 1.26, 95% CI = 1.02-1.56), and balance using the step test of more than 7.5 seconds in the crude (HR = 1.27, 95% CI = 1.03-1.56) model. Physical functioning tests demonstrated that poor physical performance predicts new hospitalization, and reinforced the importance of their application in physical therapy practice in primary health care settings.

Surgical Hospitalization Is Not Associated With Cognitive Trajectory Over 6Years in Healthy Older Australians.

The aim was to investigate the association of cognitive trajectories and overnight surgical hospitalization in older adults, while controlling for and comparing to the association with acute medical hospitalizations. This is a secondary analysis of data from a population-based, longitudinal cohort study of older Australians. Cognition was assessed with 4 biennial waves of prospective neuropsychological data from 1026 Sydney Memory and Aging Study participants age 70 to 90years at baseline. Hospitalization exposure was obtained from 10years of electronically linked data from the New South Wales Admitted Patient Data Collection. Latent growth curve modeling estimated global cognition z-score baseline and slope over 6years, and the effects of contemporaneous surgical and medical hospitalization predictors while controlling for potential demographic and comorbidity confounders. After controlling for confounding variables, this analysis showed that overnight surgical hospitalizations were not associated with worse baseline global cognition or accelerated cognitive decline over 6years. This was despite this cohort having more surgeries and more complex surgeries compared with Australian data for overnight hospitalizations in over 70-year-olds. Conversely, recent medical hospitalizations were associated with accelerated cognitive decline. This analysis finds that surgery and anesthesia are unlikely to be risk factors for medium to long-term global cognitive decline in healthy older adults, while controlling for contemporaneous medical hospitalizations. These findings are contrary to prior conclusions from several surgical studies that may have been impeded by insufficient comparison groups. They are, however, consistent with recent population-based studies suggesting surgery has minimal association with cognitive decline in the medium to long-term. Future research needs to clarify the association of surgical hospitalization with the full spectrum of cognitive outcomes including subjective cognitive complaints and dementia, and importantly, how these cognitive outcomes correlate with clinically significant functional changes.

A focus group interview with health professionals: establishing efficient transition care plan for older adult patients in Korea

Background Although transition care planning can affect the functional status and quality of life after acute hospitalization in older adults, little is known on problems associated with discharge planning in acute care hospitals in Korea. We aimed to investigate barriers and possible solutions on transfer planning of complex older patients in this study.MethodsWe used focus group interviews with the application of framework analysis. Twelve physicians providing inpatient care from 6 different institutions in Korea participated in the interview. Facilitating questions were extracted from 2 roundtable meetings prior to the primary interview. From transcribed verbatim, themes were constructed from corresponding remarks by participants.ResultsWe revealed two main domains of the barrier, which included multiple subdomains for each of them. The first domain was a patient factor barrier, a composite of misperception of medical providers’ intentions, incomprehension of the healthcare system, and communication failure between the caregivers or decision-makers. The second domain, institutional factors included different fee structures across the different levels of care, high barrier to accessing health service in tertiary hospitals or to be referred to, the hardship of communication between institutions, and insufficient subacute rehabilitation service across the country.ConclusionsThrough the interview, physicians in the field recognized barriers to a smooth transition care process from tertiary level hospitals to community care, especially for older adults. Participants emphasized both the patients and hospital sides of adjustment on behaviors, communication, and greater attention for the individuals during the transition period.

560 A National Analysis of Discharge Disposition in Older Adults with Burns Estimating Independence at Discharge

IntroductionWhereas older age strongly predicts higher burn mortality, the impact of age on discharge disposition is less well defined. Both providers and patients need a better understanding of the likelihood of discharge to non-independent living, as this factor may matter most to older patients. This investigation assesses the relationship between older age and discharge disposition after burns, in a nationally representative sample.MethodsWe queried the 2007-2015 National Trauma Data Bank (NTDB) for burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working age group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area (TBSA), injury mechanism, and race. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression was used to assess the association between older age and discharge to non-independent living, adjusting for covariables.ResultsThere were 25,840 burn hospitalizations in older adults with complete data during the study period. Working-age patients comprised 13,563 (53%) of admissions. Young-old accounted for 7,342 (28%), while middle-old comprised 3,876 (15%), and 1,059 (4%) were classified as old-old. Discharge to non-independent living steadily increased with burn TBSA and older age in survivors (Table). Beginning in the 65-74 age group (young-old), most patients with burns ≥20% TBSA were discharged to non-independent living. After adjusting for patient and injury factors, odd ratios for discharge to non-independent living were 2.1 for young-old, 3.5 for middle-old and 7.6 for old-old patients, when compared to working-age patients (all p< 0.001).ConclusionsOlder age is a strong predictor of discharge to non-independent living after burns. These findings provide a realistic discharge framework for providers and older adults with acute burns.

Development of an Electronic Frailty Index for Hospitalized Older Adults in Sweden.

Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults. EHRs were extracted for 18 225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from 9 geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modeled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression. Thirteen thousand one hundred and eighty-eight patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission. An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.

Prevalence, risk factors, and outcomes of subsyndromal delirium in older adults in hospital or long-term care settings: A systematic review and meta-analysis

BackgroundSubsyndromal delirium (SSD) refers to the presence of one or more delirium criteria without a diagnosis of delirium, and it is common in older patients. The prevalence, risk factors, and outcomes of SSD are explored herein. DesignA systematic review and meta-analysis. Data sourcesPubMed, Web of Science, OVID, PsycINFO, CINAHL, Cochrane Library, CNKI, CBM, Chongqing VIP, and Wanfang databases were searched for studies published from inception to 2021, without language restrictions. Independent reviewers performed quality assessments, data extraction and analysis for all included studies. ResultsA total of 2,426 titles were initially identified, and 22 studies (5,125 individuals) were included in the systematic review. The prevalence of SSD in older adults was 36.4% (95%CI:0.28 to 0.44). Significant risk factors were dementia (OR 5.061, 95%CI:2.320 to 11.043), lower ADL scores (OR 1.706, 95%CI:1.149 to 2.533), lower hemoglobin (SMD -0.21, 95%CI: -0.333 to -0.096), and advanced age (SMD 0.358, 95% CI:0.194 to 0.522), and SSD was associated with poor outcomes, including cognitive and functional decline, increased length of hospital stay, and a higher mortality rate. ConclusionsSSD has a high prevalence and is associated with many risk factors and poor outcomes. Clinical oversight of patients with SSD should be increased. RegistrationThe systematic review was registered on the International Prospective Register of Systematic Review (CRD42021276070). Tweetable abstractSubsyndromal delirium has a high prevalence and an association with many risk factors and poor outcomes.

Fall prevention in hospitals and nursing homes: Clinical practice guideline.

BackgroundFalls and their consequences are particularly common in older adults in hospitals and long‐term care (LTC) facilities.AimTo avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed.MethodsThe development process included a systematic literature review to identify systematic reviews and primary studies on the topic of fall prevention, an assessment of the study quality, the preparation of meta‐analyses to summarize the results, and the application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grade the scientific literature. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions.ResultsA total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low‐floor beds in hospitals, or body exercise interventions in frail residents.Linking Evidence to ActionDuring the development of this guideline, particular attention was paid to collecting evidence‐based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling. Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low‐floor beds, alarm sensor systems, medication review, and staff education in hospitals.

802 CONCURRENT PATHOLOGIES OBSERVED IN OLDER ADULTS WITH COVID-19 INFECTION

IntroductionThis study aimed to look at the effect of frailty and multi morbidity on short-term outcomes in patients diagnosed with COVID-19 in a hospital setting, looking specifically at the variety of concurrent pathologies diagnosed during their admission and how these affected the course of their illness and mortality.MethodsThe study took place at Glasgow Royal Infirmary. We retrospectively collected data from 280 patients who were admitted to the medicine for the elderly department between the 1st October and 1st December 2020 and diagnosed with COVID-19.ResultsIn this cohort, 65% of older adults in hospital with COVID-19 had their admissions complicated by concurrent pathologies; most commonly delirium, acute kidney injury and pulmonary embolism, also increasing mortality in this group. It was also found that 39% of patients in this group had co-pathologies that were not necessarily associated with COVID-19 disease, for example AKI, AF and stroke/TIA. 35% of older adults in this group had no concurrent medical diagnoses during their admission, however this did not correlate with reduced mortality in this group.ConclusionThe data highlights the vulnerability of older adults with COVID-19 infection making them more susceptible to concurrent disease and contributing to further morbidity and mortality. We also found a large number of patients had co-pathologies not associated with COVID-19 disease, highlighting the importance of considering other diagnoses in frail elderly patients.

Real-world evaluation of the impact of two anti-SARS-CoV-2 monoclonal antibody regimens on COVID-19 hospitalizations in older adults.

Evidence from clinical trials suggest anti‐SARS‐CoV‐2 monoclonal antibodies (mABs) may reduce coronavirus disease 2019 (COVID‐19)‐related hospitalizations. The purpose of this study was to assess the real‐world impact of mAB administration on COVID‐19 hospitalization among patients 65 years or older. This was a retrospective, propensity‐matched cohort study that included patients aged 65 years and older who presented to the emergency department (ED) within 10 days of symptom onset of mild to moderate COVID‐19 infection. Outcomes were compared between those who did and did not receive mAB therapy. The primary endpoint was the rate of hospitalization for COVID‐19 within 30 days of index ED visit. A total of 137 patients receiving mABs were matched to 137 controls. Hospitalization occurred in 2.9% of mAB‐treated patients compared to 14.6% of patients of the standard of care (SOC) arm (odds ratio: 0.20 [95% CI: 0.07–0.59]). There were zero intubations and zero deaths compared to 3 (2.2%) and 2 (1.5%) in the SOC group. Among the 223 patients receiving mAB in the overall cohort, adverse drug events occurred in 10 (4.5%). Treatment with mAB therapy for mild to moderate COVID‐19 was associated with a substantially reduced risk of hospitalization among patients at least 65 years of age.