Hospitalization In Older Adults Research Articles

Risk Factors for Hospitalizations Among Older Adults with Gastrointestinal Cancers.

BackgroundOlder adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in older adults with GI cancers have been limited. This study sought to identify GA-based risk factors for chemotherapy toxicity–related hospitalization among older adults with GI cancers.Patients and MethodsWe performed a secondary post hoc subgroup analysis of two prospective studies used to develop and validate a GA-based chemotherapy toxicity score. The incidence of unplanned hospitalizations during the course of chemotherapy treatment was determined.ResultsThis analysis included 199 patients aged ≥65 years with a diagnosis of GI cancer (85 colorectal, 51 gastric/esophageal, and 63 pancreatic/hepatobiliary). Sixty-five (32.7%) patients had ≥1 hospitalization. Univariate analysis identified sex (female), cardiac comorbidity, stage IV disease, low serum albumin, cancer type (gastric/esophageal), hearing deficits, and polypharmacy as risk factors for hospitalization. Multivariable analyses found that patients who had cardiac comorbidity (OR 2.48, 95% CI 1.13-5.42) were significantly more likely to be hospitalized.ConclusionCardiac comorbidity may be a risk factor for hospitalization in older adults with GI cancers receiving chemotherapy. Further studies with larger sample sizes are warranted to examine the relationship between GA measures and hospitalization in this vulnerable population.

Effects of game-based interventions on functional capacity in acutely hospitalised older adults: results of an open-label non-randomised clinical trial

Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. To assess the effect of gamified interventions on functional capacity in hospitalised older adults. A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n = 21), a technology-based gamification group (TGG) (n = 23) or a control group (CG) (n = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. Seventy patients (mean age 86.01 ± 4.27years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15-2.80 points) and 2.69 points (95%CI, 1.32-4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70-9.76 points) in the Barthel Index and 2.03kg (95%CI, 0.33-3.72kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (β = 1.30; 95%CI, 0.45-2.14; indirect effect 0.864; 95%CI, 0.09-1.90) significantly mediated the TGG effect on the SPPB score. The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults.

Maoto plus neuraminidase inhibitor versus neuraminidase inhibitor alone for reducing hospitalization in older adults with seasonal influenza.

Maoto is a Japanese Kampo formula used for treating febrile illnesses. However, researchers have not yet clarified its effect in preventing severe influenza among older adults. We evaluated the association between the addition of maoto to a neuraminidase inhibitor in older adults and reduced hospitalization following influenza. Using a prefecture-wide health insurance claims database, we identified outpatients aged ≥60 years who were diagnosed with influenza between September 2012 and August 2017. We performed one-to-one propensity score matching between patients who received maoto in addition to a neuraminidase inhibitor and those who received a neuraminidase inhibitor alone. Hospitalization within 7 days of influenza diagnosis was compared using the McNemar's test. We performed subgroup analyses based on sex, age, and other characteristics. We identified 57,366 eligible patients with influenza. Maoto was used in 8.1% of these patients. In 4,630 matched pairs, the 7-day hospitalization rate was 1.77% (n = 82) and 1.62% (n = 75) for patients with and without maoto, respectively; the difference between the groups was insignificant (P = 0.569). Subgroup analysis showed a tendency toward more hospitalizations within 7 days among patients aged 90 years or older who were prescribed maoto than those who were not (9.7% vs. 6.6%, P = 0.257). Maoto use was not associated with decreased hospitalization rates in older adults with influenza. This warrants further research to evaluate the safety and effectiveness of maoto in different patient groups, particularly the oldest-old population.

Recombinant Adjuvanted Zoster Vaccine and Reduced Risk of Coronavirus Disease 2019 Diagnosis and Hospitalization in Older Adults.

BackgroundSome vaccines elicit nonspecific immune responses that may protect against heterologous infections. We evaluated the association between recombinant adjuvanted zoster vaccine (RZV) and coronavirus disease 2019 (COVID-19) outcomes at Kaiser Permanente Southern California.MethodsIn a cohort design, adults aged ≥50 years who received ≥1 RZV dose before 1 March 2020 were matched 1:2 to unvaccinated individuals and followed until 31 December 2020. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for COVID-19 outcomes were estimated using Cox proportional hazards regression. In a test-negative design, cases had a positive severe acute respiratory syndrome coronavirus 2 test and controls had only negative tests, during 1 March–31 December 2020. Adjusted odds ratios (aORs) and 95% CIs for RZV receipt were estimated using logistic regression.ResultsIn the cohort design, 149 244 RZV recipients were matched to 298 488 unvaccinated individuals. The aHRs for COVID-19 diagnosis and hospitalization were 0.84 (95% CI, .81–.87) and 0.68 (95% CI, .64–.74), respectively. In the test-negative design, 8.4% of 75 726 test-positive cases and 13.1% of 340 898 test-negative controls had received ≥1 RZV dose (aOR, 0.84 [95% CI, .81–.86]).ConclusionsRZV vaccination was associated with a 16% lower risk of COVID-19 diagnosis and 32% lower risk of hospitalization. Further study of vaccine-induced nonspecific immunity for potential attenuation of future pandemics is warranted.

Effects of Resistance Training Intervention along with Leucine-Enriched Whey Protein Supplementation on Sarcopenia and Frailty in Post-Hospitalized Older Adults: Preliminary Findings of a Randomized Controlled Trial

Resistance training and protein supplementation are expected to exert the greatest effect in counteracting muscle-wasting conditions. Myokines might play a key role, but this remains to be elucidated. The aim of this study (NCT03815201) was to examine the effects of a resistance training program with post-exercise leucine-enriched protein supplementation on sarcopenia and frailty status and on the plasma myokine concentrations of post-hospitalized older adults. A total of 41 participants were included in this 12-week resistance training intervention and randomized either to the placebo group or the protein group. Sarcopenia, frailty, body composition and blood-based myokines were measured at baseline and after 12 weeks. Both groups improved in terms of physical performance (p < 0.005) and frailty (p < 0.07) following the resistance training intervention, but without any difference between groups. Myokine concentrations did not change after the intervention in either group. Changes in myostatin concentrations were associated with greater improvements in appendicular skeletal muscle mass at the end of the intervention (p < 0.05). In conclusion, the implementation of resistance training programs after hospitalization in older adults should be prioritized to combat sarcopenia and frailty immediately. The results regarding myostatin should be taken as preliminary findings.

Source of information on COVID‐19 vaccine and vaccine hesitancy among U.S. Medicare beneficiaries

Source of information on <scp>COVID</scp>‐19 vaccine and vaccine hesitancy among U.S. Medicare beneficiaries

Social Work Graduates Entering the Field of Gerontology During COVID-19: Exploring Perceived Readiness and Needs

Gerontological social workers (GSW) are on the frontlines supporting the biopsychosocial needs of older adults in hospitals, communities, and long-term care settings. However, it is unclear whether social workers (SW) are trained to meet the emerging needs of older adults during COVID-19. This study describes training received, perceived readiness, and training needs of GSWs new to the field during 2020. A cross-sectional online survey was conducted with recent graduates from U.S. SW programs. Survey questions explored training received and ongoing needs, perceived self-efficacy (adapted from the Geriatric Social Work Competency Scale), demographics, and confidence in ability to work with populations 55+. A total of 15 recent SW graduates specializing in gerontology completed the survey. Fifty-three percent of the sample held MSWs and over half (53.3%) were licensed social workers or registered interns. Nearly all participants (73.3%) reported taking an introductory aging course, and almost half (46.7%) completed coursework in aging and diversity, aging policy, and end-of-life care/bereavement; 80% completed fieldwork in aging. Participants report moderate skill in assessing issues related to losses or transitions (46.7%), and physical functioning (53.3%), and advanced skill in assessing cognitive functioning (60.0%), and caregiver stress/needs (53.3%). Nearly half of respondents who rated their training as good-excellent indicate being very-extremely confident (42.8%) in their ability to practice with older adults. Training needs among participants include disaster preparedness, telehealth, and coordination of scarce resources. Curriculum development and continuing education are necessary to support emerging gerontological social workers in their practice during COVID-19 and other emergencies.

An Age- Friendly Campus Partnership for Hospitalized Older Adults in the COVID Era and Beyond

As hospitals isolate COVID-19 patients to prevent the spread of this highly contagious disease, patients and family are separated during times of critical illness. For many older adults inflicted with coronavirus it is not the fear of dying that matters the most, it is the fear of dying alone. Utilizing the 4Ms approach, University of Maryland, Baltimore (UMB) and University of Maryland Medical Center (UMMC) responded with several initiatives including intergenerational programs designed to shape and inform the development of future healthcare clinicians in addressing what matters the most to patients and leveraging technology to connect them with families, provide mobility opportunities, monitor medications, and reduce errors.

What you need to know about: delirium in older adults in hospital.

Delirium is a clinical syndrome characterised by a disturbance of perception, consciousness and/or cognitive function, with an acute onset, fluctuating course and a severe deterioration arising over hours or days. Delirium is usually triggered by a combination of influences including acute illness, surgery, drugs and environmental factors. It is commonly seen in older people presenting to hospital, but can also develop during hospitalisation. There are three types of delirium: hypoactive, hyperactive and mixed. All patients over 65 years old presenting to hospital should be screened for delirium using the '4AT' tool. An alternate method for diagnosing hospital-acquired delirium is described. This article outlines a 10-stage method for diagnosing, managing and preventing delirium, with emphasis on which areas of the history and examination should be prioritised, what the salient investigations are and both non-pharmacological and pharmacological approaches to preventing and treating delirium. Finally, this article explores which patients require specialist referrals or investigations and how to best follow up patients with delirium.

Delirium due to avoidable hospitalizations among older adults

AbstractBackgroundDelirium is a common complication during the course of acute care hospitalizations in older adults, particularly those with pre‐existing dementia. A substantial percentage of these admissions are for ambulatory care sensitive conditions (ACSCs) or avoidable hospitalizations – conditions that might be treated early in the outpatient setting to prevent hospitalization and its complications. We sought to examine the incidence of delirium among older adults hospitalized for ACSCs.MethodsWe examined admissions for 37,346 older adults 65 years of age admitted from January 1, 2015 to December 31, 2019 to the general inpatient (non‐ICU) units of a large regional Southeastern academic medical center. The primary outcome was delirium defined as a score 2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission. Generalized linear mixed models were used to compare rates of delirium between hospitalizations with a primary admission diagnosis for an ACSC, using standardized definitions, versus hospitalization for other non‐ACSC diagnoses, adjusting for covariates and repeated observations for individuals with multiple admissions.ResultsDelirium occurred in 30.1% of admissions for older adults. Rates were lower for those admitted for ACSCs versus those admitted for other conditions. Older age, higher number of comorbidities, presence of dementia, lower baseline cognitive scores, and lower baseline functional scores were all associated with increased risk of delirium. After adjustment for covariates, risk of delirium was 51% lower for admissions for ACSCs versus admissions for other conditions (odds ratio [OR] = 0.49; 95% CI 0.43, 0.57).ConclusionsRates of delirium among older adults hospitalized for ACSCs were lower than rates of delirium during hospitalization for other conditions, but were still substantial. This indicates that treatment of ACSCs in the outpatient setting could be an important component of efforts to reduce delirium.

Gait changes over time in hospitalized older adults with advanced dementia: Predictors of mobility change.

People with dementia are at risk of mobility decline. In this study, we measured changes in quantitative gait measures over a maximum 10-week period during the course of a psychogeriatric admission in older adults with dementia, with the aims to describe mobility changes over the duration of the admission, and to determine which factors were associated with this change. Fifty-four individuals admitted to a specialized dementia inpatient unit participated in this study. A vision-based markerless motion capture system was used to record participants’ natural gait. Mixed effect models were developed with gait measures as the dependent variables and clinical and demographic variables as predictors. We found that gait stability, step time, and step length decreased, and step time variability and step length variability increased over 10 weeks. Gait stability of men decreased more than that of women, associated with an increased sacrum mediolateral range of motion over time. In addition, the sacrum mediolateral range of motion decreased in those with mild neuropsychiatric symptoms over 10 weeks, but increased in those with more severe neuropsychiatric symptoms. Our study provides evidence of worsening of gait mechanics and control over the course of a hospitalization in older adults with dementia. Quantitative gait monitoring in hospital environments may provide opportunities to intervene to prevent adverse events, decelerate mobility decline, and monitor rehabilitation outcomes.

Abstract 9989: Safety of Neurohormonal Antagonist Initiation Among Older Adults Following a Heart Failure Hospitalization

Introduction: Heart Failure (HF) hospitalizations may be an opportunity for clinicians to initiate neurohormonal antagonists (NHAs), but there is concern that initiation of multiple NHAs during the post-hospitalization period could worsen outcomes in older patients. We examined the safety of starting multiple NHAs in older adults following a hospitalization for HF with reduced ejection fraction (HFrEF). Hypothesis: Number of NHAs initiated following HFrEF hospitalization is associated with higher mortality and readmissions. Methods: The study population included beneficiaries aged &gt;= 65 years with HFrEF from a random 40% national sample of Medicare Part A, B, and D discharged following a HF admission between 2008 and 2015. The exposure variable was the count of NHAs initiated within 90 days of discharge. NHAs included ACE inhibitors, Angiotensin II Receptor Blockers, Beta blockers, and Mineralocorticoid Receptor Antagonists. The primary outcomes were mortality and readmission at 90 days. We calculated the hazard ratios of number of NHAs initiated (0-3) for each outcome with 95% confidence intervals using probability weighting to account for group differences and generated cumulative incidence plots for both outcomes in each group. Results: We examined 211,885 patients, among whom 14% had 0 NHAs initiated, 33% had 1, 42% had 2, and 11% had 3. Mortality and readmission at 90 days were lowest among those with higher NHA initiation counts (Figures 1, 2). Conclusion: Greater NHA initiation following HFrEF hospitalization in older adults was associated with lower 90-day mortality and readmission rates. On average, the benefits of starting multiple NHAs may outweigh risks.

Trends in urinary tract infection hospitalization in older adults in Spain from 2000-2015.

To analyze trends in urinary tract infection hospitalization (cystitis, pyelonephritis, prostatitis and non-specified UTI) among patients over 65 years in Spain from 2000-2015. We conducted a retrospective observational study using the Spanish Hospitalization Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). We collected data on sex, age, type of discharge, main diagnosis, comorbid diagnosis, length of stay, and global cost. All the hospitalizations were grouped by age into three categories: 65-74 years old, 75-84 years old, and 85 years old and above. In the descriptive statistical analysis, crude rates were defined as hospitalizations per 1,000 inhabitants aged ≥65. To identify trends over time, we performed a Joinpoint regression. From 2000-2015, we found 387,010 hospitalizations coded as UTIs (54,427 pyelonephritis, 15,869 prostatitis, 2643 cystitis and 314,071 non-specified UTI). The crude rate of hospitalization for UTIs between 2000 and 2015 ranged from 2.09 in 2000 to 4.33 in 2015 Rates of hospitalization were higher in men than in women, except with pyelonephritis. By age group, higher rates were observed in patients aged 85 years or older, barring prostatitis-related hospitalizations. Joinpoint analyses showed an average annual percentage increase (AAPC) in incidence rates of 4.9% (95% CI 3.2;6.1) in UTI hospitalizations. We observed two joinpoints, in 2010 and 2013, that found trends of 5.5% between 2000 and 2010 (95% CI 4.7;6.4), 1.5% between 2010 and 2013 (95% CI -6.0;9.6) and 6.8% between 2013 and 2015 (95% CI -0.3;14.4). The urinary infection-related hospitalization rate in Spain doubled during the period 2000-2015. The highest hospitalization rates occurred in men, in the ≥85 years old age group, and in non-specified UTIs. There were increases in all types of urinary tract infection, with non-specified UTIs having the greatest growth. Understanding these changing trends can be useful for health planning.

Effectiveness of Pneumococcal Vaccination Against Pneumococcal Pneumonia Hospitalization in Older Adults: A Prospective, Test-Negative Study.

Despite use of the 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) over the last decade, the disease burden of pneumococcal pneumonia is still high. We evaluated the field effectiveness of PCV13, PPSV23, and sequential vaccination against pneumococcal pneumonia in older adults. This prospective multicenter study was conducted in adults aged ≥65 years hospitalized with community-acquired pneumonia (CAP) between September 2015 and August 2017. The case-control test-negative design was used to estimate vaccine effectiveness (VE) against pneumococcal CAP. Of 1525 cases with CAP hospitalization, 167 (11.0%) were identified as pneumococcal CAP. In the elderly aged ≥65 years, the adjusted VE of pneumococcal vaccines against pneumococcal CAP was statistically insignificant: 40.0% (95% confidence interval [CI], -10.8% to 67.5%) for PCV13 and 11.0% (95% CI, -26.4% to 37.3%) for PPSV23. However, in the younger subgroup (aged 65-74 years), sequential PCV13/PPSV23 vaccination showed the highest adjusted VE of 80.3% (95% CI, 15.9%-95.4%), followed by single-dose PCV13 (adjusted VE, 66.4% [95% CI, .8%-88.6%]) and PPSV23 (adjusted VE, 18.5% [95% CI, -38.6% to 52.0%]). Sequential PCV13/PPSV23 vaccination is most effective for preventing pneumococcal CAP among the elderly aged 65-74 years.

Impact of Relative Muscle Power on Hospitalization and All-Cause Mortality in Older Adults.

The purpose of this study was to evaluate the relationship of lower-limb muscle power with mortality and hospitalization. A total of 1 928 participants from the Toledo Study for Healthy Aging were included. Muscle power was assessed with the 5-repetition sit-to-stand test and participants were classified into different groups of relative power (ie, normalized to body mass) according to sex-specific tertiles and their inability to perform the test. Mean follow-up periods for hospitalization and all-cause mortality were 3.3 and 6.3 years, respectively. Compared to the high relative muscle power group, men with low (HR [95% CI] = 2.1 [1.2-3.6]) and women with very low and low (HR [95% CI] = 4.7 [3.0-7.4] and 1.8 [1.2-2.7]) relative power had an increased age-adjusted risk of hospitalization. After adjusting for several covariates (age, physical activity, body mass index education, depression, comorbidities, disability, and handgrip strength), these effects were attenuated (men and women with very low relative power: HR [95% CI] = 1.6 [0.9-2.9] and 2.8 [1.6-4.9]). The very low relative muscle power group had also an increased all-cause mortality risk (age-adjusted) in both men and women (HR [95% CI] = 2.3 [1.4-3.9] and 2.9 [1.6-5.3]). After adjusting for all the covariates, a significantly increased mortality risk was observed only in men (HR [95% CI] = 2.1 [1.1-3.8]; women HR [95% CI] = 1.6 [0.8-3.2]), with very low levels of relative power. Relative muscle power was independently and negatively associated with mortality and hospitalization in older adults. An augmented all-cause mortality risk was noted in the lowest group of relative muscle power.

Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults Aged ≥65 Years - COVID-NET, 13 States, February-April 2021.

Clinical trials of COVID-19 vaccines currently authorized for emergency use in the United States (Pfizer-BioNTech, Moderna, and Janssen [Johnson & Johnson]) indicate that these vaccines have high efficacy against symptomatic disease, including moderate to severe illness (1-3). In addition to clinical trials, real-world assessments of COVID-19 vaccine effectiveness are critical in guiding vaccine policy and building vaccine confidence, particularly among populations at higher risk for more severe illness from COVID-19, including older adults. To determine the real-world effectiveness of the three currently authorized COVID-19 vaccines among persons aged ≥65 years during February 1-April 30, 2021, data on 7,280 patients from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were analyzed with vaccination coverage data from state immunization information systems (IISs) for the COVID-NET catchment area (approximately 4.8 million persons). Among adults aged 65-74 years, effectiveness of full vaccination in preventing COVID-19-associated hospitalization was 96% (95% confidence interval [CI]=94%-98%) for Pfizer-BioNTech, 96% (95% CI=95%-98%) for Moderna, and 84% (95% CI=64%-93%) for Janssen vaccine products. Effectiveness of full vaccination in preventing COVID-19-associated hospitalization among adults aged ≥75 years was 91% (95% CI=87%-94%) for Pfizer-BioNTech, 96% (95% CI=93%-98%) for Moderna, and 85% (95% CI=72%-92%) for Janssen vaccine products. COVID-19 vaccines currently authorized in the United States are highly effective in preventing COVID-19-associated hospitalizations in older adults. In light of real-world data demonstrating high effectiveness of COVID-19 vaccines among older adults, efforts to increase vaccination coverage in this age group are critical to reducing the risk for COVID-19-related hospitalization.

A Survey of Nurses’ Knowledge of and Attitudes Toward Hospitalized Older Adults

Aim: To investigate the knowledge and attitudes of nurses towards older adults in the Taiwanese hospital.Design: A descriptive correctional study.Methods: A survey by random sampling of one teaching hospital for clinical nurses (N=80). The structural scales included demographic details, Palmore’s Facts on Aging Quiz (PFAQ) knowledge scale, and Kogan’s Old People (KOP) attitude scale. Lastly, we used Pearson’s correlation analyses to identify the correlates.Results: The rate of knowledge about aging was low at 55.76%. However, the subjects held more favorable attitudes towards older adults (KOP score was 66.91). We also found that subjects who had better knowledge about aging also had a more positive attitude towards older adults.The results can be used by nursing educators and managers to design courses on gerontology for nurses and nursing students, by providing data that can be utilized in decision-making regarding the effectiveness of nursing care provided to this growing group of older recipients.

What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol

IntroductionThe development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple...

American Diabetes Association Framework for Glycemic Control in Older Adults: Implications for Risk of Hospitalization and Mortality.

The 2021 American Diabetes Association (ADA) guidelines recommend different A1C targets in older adults that are based on comorbid health status. We assessed risk of mortality and hospitalizations in older adults with diabetes across glycemic control (A1C <7%, 7 to <8%, ≥8%) and ADA-defined health status (healthy, complex/intermediate, very complex/poor) categories. Prospective cohort analysis of older adults aged 66-90 years with diagnosed diabetes in the Atherosclerosis Risk in Communities (ARIC) study. Of the 1,841 participants (56% women, 29% Black), 32% were classified as healthy, 42% as complex/intermediate, and 27% as very complex/poor health. Over a median 6-year follow-up, there were 409 (22%) deaths and 4,130 hospitalizations (median [25th-75th percentile] 1 per person [0-3]). In the very complex/poor category, individuals with A1C ≥8% (vs. <7%) had higher mortality risk (hazard ratio 1.76 [95% CI 1.15-2.71]), even after adjustment for glucose-lowering medication use. Within the very complex/poor health category, individuals with A1C ≥8% (vs. <7%) had more hospitalizations (incidence rate ratio [IRR] 1.41 [95% CI 1.03-1.94]). In the complex/intermediate group, individuals with A1C ≥8% (vs. <7%) had more hospitalizations, even with adjustment for glucose-lowering medication use (IRR 1.64 [1.21-2.24]). Results were similar, but imprecise, when the analysis was restricted to insulin or sulfonylurea users (n = 663). There were substantial differences in mortality and hospitalizations across ADA health status categories, but older adults with A1C <7% were not at elevated risk, regardless of health status. Our results support the 2021 ADA guidelines and indicate that <7% is a reasonable treatment goal in some older adults with diabetes.

Measuring Processes of Integrated Care for Hospital to Home Transitions.

Background:Integrated care is a promising approach to improve transitions from hospital for older adults. Measures of integrated care tend to be survey-based or outcomes focused. This study determined the feasibility of using hospital chart data to measure integrated processes of care.Methods:This paper reports on two objectives: 1) the development of an integrated care transition framework and associated features of care; 2) a pilot study to test if the features could be applied to 214 hospital patient charts.Results:Twenty-four features were tested, and fifteen features could be reliably measured using chart review. Of these, the percent of patients classified as receiving integrated care varied widely across the items, from 0.05% to 84.1%.Discussion:The framework presented in this paper can guide measurement of system and clinical delivery of integrated care transitions. In combination with other tools, chart review can provide perspective on day-to-day care delivery not otherwise accessible, and highlight areas requiring practice change.Conclusion:Multiple measurement perspectives are needed to improve our understanding of how integrated care is being implemented. While chart review cannot address the full breadth of integrated care, it can help understand how processes of care are being implemented in routine daily care.