Hospitalization In Older Adults Research Articles

Effectiveness and safety of exercise training and rehabilitation in elderly patients after heart valve intervention: A systematic review and meta-analysis of randomized controlled trials

ObjectiveTo investigate the effectiveness and safety of exercise rehabilitation in older adults undergoing intervention for heart valve disease. MethodPubMed, Embase, Cochrane Library, CINAHL, Ovid Medline, SPORTDiscus, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang were systematically searched until January 2024. Risk-of-bias assessments were performed using the Cochrane risk-of-bias tool. A meta-analysis of the following indexes was performed using RevMan 5.4 software. ResultsNine trials involving 631 patients were ultimately included. Exercise rehabilitation significantly reduced the risk of adverse events, increased the 6-minute walk distance, improved the physical component of quality of life, and shortened the length of postoperative hospitalization. However, exercise rehabilitation did not affect all-cause mortality, left heart ejection fraction, or peak oxygen uptake. ConclusionsExercise rehabilitation may enhance exercise capacity, reduce the incidence of adverse events, and shorten the length of postoperative hospitalization in older adults undergoing intervention for heart valve disease.

Effect of high-dose vs. standard-dose quadrivalent influenza vaccine on death and hospitalizations in older adults with cardiovascular disease: a prespecified analysis of the DANFLU-1 study

Abstract Background The results of the DANFLU-1 trial indicated that high-dose quadrivalent influenza vaccines (HDQIV) as compared to standard-dose quadrivalent influenza vaccines (SDQIV) may reduce the incidence of death and hospitalization with pneumonia or influenza in older adults. Whether this effect differs by the presence of cardiovascular disease is unknown. Purpose To conduct a prespecified analysis aimed at assessing whether the presence of cardiovascular disease at baseline modified the effect of HDQIV vs SDQIV on clinical outcomes in the DANFLU-1 trial. Methods DANFLU-1 was a pragmatic, open-label trial randomizing 12,477 adults aged 65-79 years 1:1 to HDQIV vs SDQIV during the 2021/2022 influenza season. The trial used the Danish nationwide registers to collect both baseline and outcome data. Participants were included in October and November of 2021 and follow-up ended on May 31, 2022. In this prespecified analysis, we assessed the effectiveness of HDQIV vs SDQIV on clinical endpoints according to the presence of cardiovascular disease at baseline and across different cardiovascular subgroups including ischemic heart disease, heart failure and atrial fibrillation. Effectiveness was assessed with Cox proportional hazards regression. In addition, hospitalizations were also assessed with recurrent event analysis using negative binomial regression. Results The mean age of the 12,477 participants in the DANFLU-1 trial was 71.7 years (SD 3.9) and 6600 (53%) were male. During a median follow-up of 237 days (interquartile range 232-239 days), 62 participants died (0.5%), 38 (0.3%) were hospitalized with pneumonia or influenza, 220 (1.8%) were hospitalized with a cardiorespiratory diagnosis, and 192 (1.5%) were hospitalized with a cardiovascular diagnosis. HDQIV was associated with a lower incidence of death during follow-up as compared with SDQIV (HR 0.51 [95% CI 0.30-0.86], p=0.012), and this effect was consistent in participants with CVD and without CVD and across cardiovascular subgroups (Figure 1). HDQIV was also associated with a lower incidence of hospitalization with pneumonia or influenza (IRR 0.30 (95% CI 0.14-0.64, p=0.002), and this effect was consistent irrespective of CVD (subgroup estimates were inestimable due to low power) (Figure 2). There was no difference in the incidence of cardiorespiratory or cardiovascular hospitalization between the HDQIV and SDQIV group. No significant effect modification by the presence of CVD or cardiovascular subgroups was observed (Figure 1 and 2). Conclusions In this prespecified analysis of the DANFLU-1 randomized trial, high-dose influenza vaccine was associated with a reduced rate of death and hospitalization with influenza or pneumonia and this effect was consistent in participants with CVD and across cardiovascular subgroups.Figure 1:Time to event analysisFigure 2:Recurrent event analysis

Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults

Abstract Background Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’. Methods Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded. Results Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases. Conclusion FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.

Improving Delirium Care: A Retrospective Audit of Early Detection and Management Practices

Abstract Background Delirium, an acute change in cognition, consciousness, attention, and perception, is prevalent among older adults in hospitals. Patients with delirium experience longer hospital stays, higher fall risks, increased mortality, and greater care needs upon discharge. However, delirium is under-recognized, with up to 50% of cases missed. With an aging population, the need for improved delirium recognition and management is critical. Methods We conducted a retrospective audit on the charts of 47 patients over the age of 65 on two General Medical Wards at an Irish Model 3 hospital. We assessed medical admission proformas and notes to evaluate delirium recognition and management within the first 24 hours. The audit measured compliance with the 4AT cognitive screening tool, documentation of delirium and risk factors, non-pharmacological management, and antipsychotic use against HSE National Guidelines. Data was analysed in Excel. Results 47 patients with a median age of 80 years, 51% (n=24) male and 49% (n=23) female, were captured. Cognitive screening within 24 hours was performed in 34% (n=16) of patients, with 75% (n=12) showing abnormal results. Delirium was documented in 8.5% (n=4) of patients, and 50% (n=2) of these had a 4AT score recorded. 15% (n=7) were prescribed new antipsychotics within 24 hours, with 57% (n=4) lacking a formal delirium diagnosis. Conclusion This audit reveals deficiencies in initial cognitive screening and delirium recognition among high-risk patients. Only 8.5% of the cohort was identified with delirium compared to national statistics that suggest up to 31% of older patients are affected upon admission. Compliance with cognitive screening and diagnostic tool use was poor. Antipsychotic prescribing without a documented delirium diagnosis was prevalent, highlighting the need for improved diagnostic accuracy and non-pharmacological management. We plan to introduce a “Delirium Tool” for 4AT assessments and “PINCH-ME” risk-factors, alongside regular education sessions. A re-audit will measure improvements in care and outcomes.

Optimising Delirium Pathways in Geriatric Care: The Impact of Consultant Led Old Age Psychiatry Liaison Service

Abstract Background Delirium is a common and severe condition affecting up to 50% of older adults in hospitals. Delirium is compounded by the noisy and frightening environment of medical wards, often leading to prescription of antipsychotics. There is often no clear plan to monitor effects of these medications. Delirium is also associated with increased rates of institutionalised care on discharge, readmission rates and mortality. Methods This QIP examines the effectiveness of interventions for patients with delirium in COE wards, focusing on involvement of consultant led old-age psychiatry liaison service. This 2-cycle process included 106 patients in the 1st cycle (Feb 2020-Sep 202, nurse-led), and 64 patients in the 2nd cycle (Nov 2022-Aug 2023, consultant-led). Outcome measures the number of patients assessed, new antipsychotic prescription, new nursing home placement, follow-up plans, readmission rate, and 1year mortality. Results The QIP revealed an increase in the number of inpatients reviewed by the POA team (330%) and planned out-patient POA follow-up (320%). There was an increase in the number of antipsychotics prescribed on discharge (61.5%) and discharge to a new appropriate placement (27.6%). The overall readmissions rates had slightly decreased (2.5%), and readmissions with delirium had further reduced (4%) (not significant, p=0.66). The overall mortality rate increased by 4% since the introduction of these measures (not significant, p=0.63), however, this is small and at a level expected with this population group. Conclusion These results suggest that the new consultant led liaison team resulted in an increased use of their expert opinion on challenging patients with delirium. Significantly, more patients received psychiatric follow-up crucial for antipsychotic monitoring. There is a slight reduction in the readmission rates. Although, the increase in the mortality rate is insignificant, this warrants a closer look as antipsychotics are associated with cardiovascular diseases. A larger study over a longer period of time would provide more useful data.

Does an Inpatient Rehabilitation Admission Via the Community Prevent Hospital Readmissions in Older Adults? An Integrated Care Initiative

Abstract Background Rehabilitation interventions are essential in supporting frail older adult’s recovery following periods of decompensation and preventing future hospitalizations. Previously patients (age > 65 years) could only access inpatient rehabilitation via an inpatient stay in an acute hospital. Within the ICT (Integrated Care Team) in Dublin North West (DNW) a community rehabilitation pathway to two inpatient rehabilitation units exists. We retrospectively evaluated patients that were admitted to rehabilitation units via this pathway and measured their 90-day readmission rate to their local acute hospital. Methods 17 referrals were received from three pathways: Primary Care, the Holly Day clinic and the Frailty Intervention Team (FITT). Clinical frailty score’s (CFS), Falls risk (as per the world falls guidelines) and sarcopenia status as per the European Consensus on the definition of sarcopenia (EWGSOP) were recorded prior to admission. Readmissions within 90 days were collected from the hospital electronic database. Results CFS scores ranged from 5 to 7. All patients were identified as a high risk of falls and sarcopenic. The 90-day readmission rate was 11%. 5.5% of these were due to falls and the other 5.5% was due to the exacerbation of a pre-existing condition. All had CFS score of >6. Conclusion Readmission to acute care is not common in our patient cohort and shows the involvement of the ICT Geriatrician and Physiotherapist in identifying and referring frail older adults for inpatient rehab is successful. Ongoing development of interagency pathways and further referrals is needed to further progress this pathway and measure its efficacy in preventing readmission to an acute hospital. A 90 day and 180 day follow up and falls risk outcome measure pre and post admission would further demonstrate the success of this initiative and help measure the efficacy of this initiative in reducing the risk of preventable hospitalizations in older adults.

Malnutrition and other factors associated with hospitalization in older adults treated at the naval medical center of Callao - Peru

Malnutrition and other factors associated with hospitalization in older adults treated at the naval medical center of Callao - Peru

Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study

Background13-valent pneumococcal conjugate vaccine (PCV13) has been part of publicly funded childhood immunisation programmes in Ontario and British Columbia (BC) since 2010. We assessed the indirect impact of infant PCV13...

Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2024.

Respiratory syncytial virus (RSV) is a major cause of respiratory illness and hospitalization in older adults during fall and winter in the United States. The 2023-2024 RSV season was the first during which RSV vaccination was recommended for U.S. adults aged ≥60 years, using shared clinical decision-making. On June 26, 2024, the Advisory Committee on Immunization Practices voted to update this recommendation as follows: a single dose of any Food and Drug Administration-approved RSV vaccine (Arexvy [GSK]; Abrysvo [Pfizer]; or mResvia [Moderna]) is now recommended for all adults aged ≥75 years and for adults aged 60-74 years who are at increased risk for severe RSV disease. Adults who have previously received RSV vaccine should not receive another dose. This report summarizes the evidence considered for these updated recommendations, including postlicensure data on vaccine effectiveness and safety, and provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years. These updated recommendations are intended to maximize RSV vaccination coverage among persons most likely to benefit, by clarifying who is at highest risk and by reducing implementation barriers associated with the previous shared clinical decision-making recommendation. Continued postlicensure monitoring will guide future recommendations.

Association Between Exercise Program Participation and Hospitalization of Older Adults

Government and insurance sponsored exercise programs have demonstrated decreased hospitalizations, but it is unclear if this is the case for self-referred programs. In this retrospective cohort study from 2013 to 2020, older adults who participated for at least three months at a community-based exercise center (participants) were compared with those who did not (non-participants). Each completed a baseline physical assessment and periodic reassessments thereafter. These data were paired with regional hospital data and a national mortality database. Statistical analysis and modeling were performed from 2020 to 2023. Survival to all-cause hospitalization was assessed with a priori subgroup comparison by gender and cox proportional hazard modeling by age, gender, and comorbidities. The cohort included 718 adults, mean age 69.5 years (SD 8.4), with 411 (57.2%) participants and 307 non-participants. Mean follow-up was 26.7 months. Participants had similar baseline measures of fitness (p>0.05) but were more likely to be retired and less likely to have diabetes or prior stroke than non-participants. Sustained participation was associated with a reduced rate of all-cause hospitalization (9.0% vs 12.7%, p = 0.02), even when adjusted (HR 0.54; 95% CI 0.34, 0.87, p = 0.01). This decrease was noted only in women (p = 0.03) but not in men (p = 0.49), gender was non-significant after adjustment for comorbidities (p = 0.15). Exercise program participation was independently associated with decreased risk of all-cause hospitalization, with possible differential effects by gender. Further randomized trials of the benefits of personalized exercise programs are warranted to assess sex- and gender- specific effects.

Patterns, outcomes, and preventability of clinically manifest drug-drug interactions in older outpatients: a subgroup analysis from a 6-year-long observational study in North India.

Older adults are vulnerable to adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Evidence on clinically manifest DDIs in older outpatients is scanty. The present study aims to report clinically manifest DDIs, their risk factors, and preventive measures. A subgroup analysis of a 6-year (2015-2021) long prospective study was conducted in a tertiary hospital in North India. Older outpatients with ADRs constituted the study participants. Among 933 ADRs reported in 10,400 patient registrations, clinically manifest DDIs were involved in 199 (21.3%). DDIs accounted for 29.9%, 26.5%, and 21.3% of drug-related metabolic, vascular, and nervous system disorders, respectively. Movement disorders (n = 18), hypotension (n = 16), and hypoglycemia (n = 15) were the most common manifestations. Eighty-six percent of DDIs were of the pharmacodynamic type, and 13.1% were immune-mediated. Around 35% of DDIs resulted in hospitalization, with hyponatremia, movement disorder, and renal impairment as the common reasons. Older adults with Parkinsonism, infection, coronary artery disease, neuropsychiatric disease, and diabetes mellitus, respectively, had 3.28, 2.85, 1.97, 1.76, and 1.80 times higher odds of DDIs. Those receiving ≥ 10 drugs had 5.31 times higher odds of DDIs compared to individuals receiving 1-4 drugs. "Avoiding the causative drug," "optimal monitoring of the patient," and "start-low and go-slow" policy together could prevent 85% of DDIs. In conclusion,every fifth case of ADRs and nearly one third of ADR-related hospitalizations in older adults are related to DDIs. Movement disorder, hypotension, and hypoglycemia are the common manifestations. A holistic approach with drug omission, optimal patient monitoring, and slow titration of therapy can prevent significant DDIs in older adults.

Effect of comprehensive geriatric assessment on hospitalizations in older adults with frailty initiating curatively intended oncologic treatment: The PROGNOSIS-RCT study

IntroductionFrailty constitutes a risk for unplanned hospitalizations in older adults with cancer. This study examines whether comprehensive geriatric assessment (CGA) as an add-on to standard oncologic care can prevent unplanned hospitalizations in older adults with frailty and cancer who initiate curative oncological treatment. Materials and MethodsThis randomized controlled trial included older adults aged ≥70 with frailty (Geriatric 8 [G8] ≤14), and solid cancers who initiated curative oncological treatment. Participants were randomized 1:1 to either standard oncologic care (control) or standard oncologic care supplemented with CGA-guided interventions (intervention). Baseline characteristics were retrieved prior to randomization. The primary endpoint, the between-group rate ratio of unplanned hospitalizations within six months of treatment initiation, was analyzed using negative binominal regression. Analyses were performed using an intention-to-treat approach, followed by per-protocol analysis, including participants receiving CGA within 30 days of randomization, and preplanned subgroup analyses based on treatment modality and Geriatric 8 screening. Secondary endpoints included acute hospital contacts, treatment adherence, and toxicity. ResultsFrom November 1, 2020 to May 31, 2023, 173 participants were enrolled. Median age was 75 (interquartile range 72–79), 51.5% were female, 58% had a G8 score > 12, and 84% had Eastern Cooperative Oncology Group performance status 0–1. The most common cancer sites were lung (23%), upper gastrointestinal (15%), and breast (13%). The rate (per person-years) of unplanned hospitalization was 1.32 in the intervention group and 1.81 in the control group, with a between-group rate ratio of 0.74 (95% confidence interval [CI] 0.45–1.23, P = 0.25) favoring the intervention. The between-group rate ratio increased in the per-protocol analysis (0.64 [95% CI 0.37–1.10, P = 0.10]). Similarly, no significant between group differences were found in treatment adherence, rate of acute hospital contacts, or toxicity. DiscussionIn this study, CGA did not significantly reduce the rate of unplanned hospitalizations. Furthermore, no between-group differences were found in treatment adherence, toxicity lead hospitalizations, or treatment completion in older adults with cancer and frailty. However, per-protocol analysis suggests that increasing adherence to CGA may improve the outcome. Larger studies ensuring higher CGA adherence are warranted to confirm our findings.

Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial

PurposeTo describe the longitudinal change of health-related quality of life (HRQoL) over 12 months from acute hospitalization in older adults ≥ 70 years (IMMENSE study), and associated factors, to investigate how a medication optimization intervention influenced this change.MethodsThe EQ-5D-3L was used at discharge and 1, 6 and 12 months after discharge during a randomized controlled trial including 285 participants. Multilevel logistic (EQ-5D-3L dimensions) and mixed model regression (EQ-5D-3L index scores, EQ-VAS) were used to explore the longitudinal change with/without the intervention, and associations with medications, comorbidities, and socioeconomic variables. Subgroup analyses were performed for non-long and long stayers with hospitalizations < or ≥ 14 days.ResultsEQ-5D-3L index scores significantly declined after 12 months (β −0.06 [95% confidence interval (CI:) −0.10–−0.02], p = 0.003). Non-long stayers showed significant improvement 1 month from discharge (β 0.05 [0.00–0.09], p = 0.040). The number of medications and receiving home-care services were the main factors associated with reduced HRQoL. Being home-dwelling was the main factor associated with higher HRQoL. Non-long stayers of the intervention group reported significantly higher EQ-VAS than the control group (β 4.02 [0.11–7.93], p = 0.044).ConclusionWe observed no significant difference in the longitudinal change in HRQoL between the two IMMENSE study groups over 12 months after hospitalization. However, the non-long stayer subgroup analysis indicates that the intervention may have had a long-term effect on HRQoL in some of intervention patients. The number of medications and the ability to live and care for oneself should be taken into consideration when planning future patient care and health-care services.Trial registrationThe trial was registered in clinicaltrials.gov on 28/06/2016 before enrolment started (NCT02816086).

A novel electronic health record-based, machine-learning model to predict severe hypoglycemia leading to hospitalizations in older adults with diabetes: A territory-wide cohort and modeling study.

Older adults with diabetes are at high risk of severe hypoglycemia (SH). Many machine-learning (ML) models predict short-term hypoglycemia are not specific for older adults and show poor precision-recall. We aimed to develop a multidimensional, electronic health record (EHR)-based ML model to predict one-year risk of SH requiring hospitalization in older adults with diabetes. We adopted a case-control design for a retrospective territory-wide cohort of 1,456,618 records from 364,863 unique older adults (age ≥65 years) with diabetes and at least 1 Hong Kong Hospital Authority attendance from 2013 to 2018. We used 258 predictors including demographics, admissions, diagnoses, medications, and routine laboratory tests in a one-year period to predict SH events requiring hospitalization in the following 12 months. The cohort was randomly split into training, testing, and internal validation sets in a 7:2:1 ratio. Six ML algorithms were evaluated including logistic-regression, random forest, gradient boost machine, deep neural network (DNN), XGBoost, and Rulefit. We tested our model in a temporal validation cohort in the Hong Kong Diabetes Register with predictors defined in 2018 and outcome events defined in 2019. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC) statistics, and positive predictive value (PPV). We identified 11,128 SH events requiring hospitalization during the observation periods. The XGBoost model yielded the best performance (AUROC = 0.978 [95% CI 0.972 to 0.984]; AUPRC = 0.670 [95% CI 0.652 to 0.688]; PPV = 0.721 [95% CI 0.703 to 0.739]). This was superior to an 11-variable conventional logistic-regression model comprised of age, sex, history of SH, hypertension, blood glucose, kidney function measurements, and use of oral glucose-lowering drugs (GLDs) (AUROC = 0.906; AUPRC = 0.085; PPV = 0.468). Top impactful predictors included non-use of lipid-regulating drugs, in-patient admission, urgent emergency triage, insulin use, and history of SH. External validation in the HKDR cohort yielded AUROC of 0.856 [95% CI 0.838 to 0.873]. Main limitations of this study included limited transportability of the model and lack of geographically independent validation. Our novel-ML model demonstrated good discrimination and high precision in predicting one-year risk of SH requiring hospitalization. This may be integrated into EHR decision support systems for preemptive intervention in older adults at highest risk.

Impact of a clinical pharmacist‐led COVID‐19 treatment consult service in two primary care seniors clinics

AbstractIntroductionHealthcare utilization due to COVID‐19 infection is more prevalent in the older adult population. Nirmatrelvir/ritonavir is an oral antiviral option that can decrease the hospitalizations in older adults but has many of drug–drug interactions that need evaluation.ObjectivesThe objective of this study was to evaluate the impact of a clinical pharmacist COVID‐19 treatment consult service.MethodsClinical pharmacists were consulted to assess and provide COVID‐19 therapy recommendations for adults 65 years and older who tested positive for COVID‐19 in two primary care clinics. Recommendations for the most appropriate COVID‐19 therapy were sent to the primary care provider for review and discussed with the patient. Healthcare utilization, reinfection with COVID‐19, and safety of COVID‐19 therapies were evaluated.ResultsOne hundred and twenty four patients, average age of 82 years, received clinical pharmacy assessment for COVID‐19 therapy. Pharmacists recommended treatment with nirmatrelvir/ritonavir in 80% of patients. Medication modifications due to drug–drug interactions were required in 88% of patients receiving nirmatrelvir/ritonavir. Thirteen patients were recommended or opted to receive alternative COVID‐19 treatment while 36 patients declined COVID‐19 treatment, despite provider and pharmacist recommendations. Nineteen patients had an emergency department visit or hospitalization related to COVID‐19 within 30 days of pharmacy consult; 15 of the patients had been treated with COVID‐19 therapy and 4 declined therapy (p = 0.58). Eight patients experienced reinfection with COVID‐19. Only one patient reported an adverse event of hives within 30 days of receiving nirmatrelvir/ritonavir therapy.ConclusionA pharmacist‐led consult service for evaluating and recommending COVID‐19 antiviral therapies resulted in successful triage, while balancing management of drug interactions in a high‐risk patient population. No significant difference was found in healthcare utilization or reinfection between patients who received a COVID‐19 therapy and those who did not.

The Epidemic of Immobility in Hospitalised Patients: How to Get Your Patient Up and Moving

The global population is ageing and with cardiovascular disease (CVD) prevalence also increasing, the face of the prototypical cardiology inpatient is changing, from a middle-aged man with cardiovascular risk factors, to an older adult with multimorbidity and frailty. Hospital care is inherently harmful, with immobilization and reliance on others causing functional decline to be the leading complication of hospitalization in older adults. It is imperative to reinvent hospital care, employing age-friendly health systems to maintain health and function in older adults, improving not only CVD outcomes, but patient-centered outcomes such as function and independence and preventing avoidable harms.

Preventing functional decline in hospitalized older adults in medical ward: a best practice implementation project.

Functional decline frequently occurs in older adults in hospitals. The aim of this project was to promote evidence-based strategies for physical activity to prevent functional decline in hospitalized older adults in a medical center in southern Taiwan. This project was guided by the JBI Evidence Implementation Framework. Seven audit criteria were derived from a JBI evidence summary and a baseline audit involving 25 nurses and 30 hospitalized older adults was conducted to compare current practice with best practice recommendations. The JBI Getting Research into Practice (GRiP) approach was used to identify barriers to implementation, and strategies were developed to overcome those barriers. A follow-up audit was conducted to measure any changes in compliance. After implementing the strategies, the pass rate of nursing staff improved in the physical activity knowledge test, rising from 56% to 88%. Compliance of nursing staff with providing physical activity instructions using evidence-based guidelines to hospitalized older adults reached 80%. The incidence of functional decline among hospitalized older adults decreased from 36.7% to 20%. The results of this best practice implementation project suggest that initiating physical activity as early as possible for hospitalized older adults once their medical condition has stabilized can help prevent functional decline. http://links.lww.com/IJEBH/A171.

Association of COVID-19 vaccination with duration of hospitalization in older adults in Hong Kong

IntroductionThe association between COVID-19 vaccination and length of hospital stay may provide further insight into vaccination benefits, but few studies have investigated such associations in detail. We aimed to investigate the association between COVID-19 vaccination and length of hospital stay in COVID-19 patients during Omicron waves in Hong Kong, and explore potential predictors. MethodsThis retrospective cohort study was conducted on local patients aged ≥60 years who were admitted due to COVID-19 infection in Hong Kong in 2022, from 1 February to 22 November, and with 28 days of follow-up since admission. The exposure was either not vaccinated; or having received 2/3/4 doses of CoronaVac (Sinovac); or 2/3/4 doses of BNT162b2 (BioNTech/Fosun Pharma/Pfizer). Length of stay in hospital was the main outcome. Accelerated failure time models were used to quantify variation in hospital stay for vaccinated compared with unvaccinated patients, accounting for age, sex, comorbidity, type of vaccine and number of doses received, care home residence and admission timing; stratified by age groups and epidemic waves. ResultsThis study included 32,398 patients aged 60 years and above for main analysis, their median (IQR) age was 79 (71–87) years, 53% were men, and 40% were unvaccinated. The patients were stratified by confirmation prior to or since 23 May 2022, resulting in a sample size of 15,803 and 16,595 in those two waves respectively. Vaccinated patients were found to have 13–39% shorter hospital stay compared to unvaccinated patients. More vaccine doses received were associated with shorter hospital stay, and BNT162b2 recipients had slightly shorter hospital stays than CoronaVac recipients. ConclusionVaccination was associated with reduced hospital stay in breakthrough infections. Increased vaccination uptake in older adults may improve hospital bed turnover and public health outcomes especially during large community epidemics.

Dietary mineral intakes predict Coronavirus-disease 2019 (COVID-19) incidence and hospitalization in older adults

BackgroundThe aim of this study was to determine the association between dietary mineral intake and Coronavirus-disease 2019 (COVID-19) infection and its associated hospitalization.MethodsThis cohort study utilized the MASHAD study population, which comprised individuals aged 35–65. Upon recruitment in 2007, dietary intake was documented using a validated 65-item food frequency questionnaire (FFQ). Data on COVID-19 PCR test results was collected from all relevant medical centers in Mashhad between February 2020 and June 2022. The regression model included dietary minerals and employed the backward variable selection method, along with advanced data analysis techniques.ResultsThe final analysis involved 1957 participants, including 193 COVID-19-positive patients. The mean age was 49.71 and 50.28 years in the COVID-19-positive and negative groups, respectively (p = 0.12). Dietary intakes of magnesium, iron, and potassium were notably lower in COVID-19-positive patients (P < 0.05). Following adjustments for age and sex, dietary iron remained significantly associated with COVID-19 incidence (OR = 0.94, 95% CI: 0.90–0.98). Furthermore, a statistically significant relationship was observed between dietary zinc and hospitalization due to COVID-19 (OR = 0.69, 95% CI: 0.51–0.93). In dynamical system models, intakes of calcium, zinc, and iron below the cut-offs of 1138, 9.7, and 8.17 mg/day, respectively, were linked to an increased risk of COVID-19 incidence.ConclusionHigher dietary iron and zinc intake are associated with decreased risk of COVID-19 infection and hospitalization, respectively.

Prepandemic Physical Activity and Risk of COVID-19 Diagnosis and Hospitalization in Older Adults

Higher prepandemic physical activity (PA) levels have been associated with lower risk and severity of COVID-19. To investigate the association between self-reported prepandemic PA levels and the risk and severity of COVID-19 in older US adults. This cohort study combined cohorts from 3 ongoing prospective randomized clinical trials of US adults aged 45 years or older who provided prepandemic self-reports of baseline leisure-time PA and risk factors for COVID-19 outcomes using the most recent questionnaire completed as of December 31, 2019, as the baseline PA assessment. In multiple surveys from May 2020 through May 2022, participants indicated whether they had at least 1 positive COVID-19 test result or were diagnosed with or hospitalized for COVID-19. Prepandemic PA, categorized into 3 groups by metabolic equivalent hours per week: inactive (0-3.5), insufficiently active (>3.5 to <7.5), and sufficiently active (≥7.5). Primary outcomes were risk of COVID-19 and hospitalization for COVID-19. Multivariable logistic regression was used to estimate odd ratios (ORs) and 95% CIs for the association of COVID-19 diagnosis and/or hospitalization with each of the 2 upper PA categories vs the lowest PA category. The pooled cohort included 61 557 participants (mean [SD] age, 75.7 [6.4] years; 70.7% female), 20.2% of whom were inactive; 11.4%, insufficiently active; and 68.5%, sufficiently active. A total of 5890 confirmed incident cases of COVID-19 were reported through May 2022, including 626 hospitalizations. After controlling for demographics, body mass index, lifestyle factors, comorbidities, and medications used, compared with inactive individuals, those insufficiently active had no significant reduction in infection (OR, 0.96; 95% CI, 0.86-1.06) or hospitalization (OR, 0.98; 95% CI, 0.76-1.28), whereas those sufficiently active had a significant reduction in infection (OR, 0.90; 95% CI, 0.84-0.97) and hospitalization (OR, 0.73; 95% CI, 0.60-0.90). In subgroup analyses, the association between PA and SARS-CoV-2 infection differed by sex, with only sufficiently active women having decreased odds (OR, 0.87; 95% CI, 0.79-0.95; P = .04 for interaction). In this cohort study of adults aged 45 years or older, those who adhered to PA guidelines before the pandemic had lower odds of developing or being hospitalized for COVID-19. Thus, higher prepandemic PA levels may be associated with reduced odds of SARS-CoV-2 infection and hospitalization for COVID-19.