Hospitalization In Older Patients Research Articles

Multilevel factors influencing falls of older patients in hospital: The risk of hospital-induced delirium and the impact of nurse staffing

ObjectiveThis study aimed to explore the individual and organizational factors influencing falls among older inpatients, with a particular focus on the risk posed by hospital-induced delirium and the effect of nurse staffing levels. MethodsThis retrospective cohort study utilized data from a national healthcare database to examine falls in hospitalized older adults, applying a mixed-effect logistic regression model ResultsData from 391,902 patients across 580 hospitals revealed that 1.2 % of older inpatients experienced falls. Influential factors for falls included advanced age, the use of multiple medications and treatments, impaired mobility, and hospital-induced delirium. Nurse staffing levels markedly influenced the reduction of fall risks among older patients. ConclusionFalls among hospitalized older adults are a frequent consequence of multifaceted risk components, highlighting the need for comprehensive fall prevention strategies and adequate.

Increased risk of rehospitalisation and death in older hospital patients at risk of malnutrition: A cohort study.

The aim of the study was to investigate associations between risk of malnutrition and risk of rehospitalisation and death in older hospital patients, and whether the possible associations were modified by age, gender, comorbidity or Ambulatory Care Sensitive Conditions (ACSCs). Prospective cohort study. Somatic hospital in Western Norway. 9,768 hospital admissions for patients aged ≥65 years. Information on the risk of malnutrition was based on nutritional risk screening data from 34 point prevalence surveys conducted between 2008 and 2018. Risk of malnutrition was assessed using Nutritional Risk Screening 2002 (NRS 2002) during the initial hospital admission. Outcomes and possible effect modifiers were obtained from the hospital's patient administration systems. The short-term outcome was the length of initial hospital stay. Long-term outcomes included total number of days in hospital, number of hospital stays and risk of death within one year following nutritional risk screening. Statistical analysis involved negative binomial and Cox regression models with adjustment for age, sex and number of diagnoses at time of nutritional risk screening. Overall, 34% of the patients were classified as being at risk of malnutrition. A higher proportion of the initial admissions were related to ACSCs for patients at risk of malnutrition than for those not at risk. Risk of malnutrition was associated with longer initial hospital stay (adjusted hazard ratio (95% confidence intervals) 1.31 (1.25, 1.37)), more days in hospital (adjusted risk ratio 1.25 (1.18, 1.32)) and a higher risk of having more than two hospital admissions the year following nutritional risk screening (adjusted risk ratio 1.16 (1.07, 1.26)). Patients at risk of malnutrition also had an increased risk of death within one year (adjusted hazard ratio 2.45 (2.25, 2.67)). All associations were more pronounced in the '65-69' and '70-79' age groups compared to the 80+ years age group, and in patients with fewer than four diagnoses compared to patients with four or more diagnoses. No significant interaction was detected between sex and risk of malnutrition with regard to patient outcomes. Older patients at risk of malnutrition have a higher risk of rehospitalisation and death during the first year after nutritional risk screening compared with those not at risk. Among patients at risk of malnutrition, the initial hospital admissions were more often due to ACSCs. The impact of the risk of malnutrition on outcomes appears stronger in patients aged 65-79 years and in patients with less comorbidity. These findings underline the importance of nutritional risk screening and subsequent nutritional support in all groups of older patients.

What Do Nurses Think of Their Role in the Hospital's Restorative Care and Rehabilitation Services for Older Patients?: A Qualitative Systematic Review.

To examine rehabilitation nurses' perspectives on their roles in caring for older patients in hospitals, emphasising how they fulfil these roles and their significance in geriatric rehabilitation (GR). The need for rehabilitation services was rising with an aging population. Rehabilitation nurses provided evidence-based care to older patients and encouraged them to participate in their rehabilitation goals. Rehabilitation nurses were vital to recovery; their contributions needed to be appreciated and valued. A qualitative systematic review. A systematic review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative evidence and a PROSPERO protocol CRD42023435728 published beforehand. From inception to 9 October, 2023, a comprehensive database search was developed using Medline and translated into five databases, including CINAHL, Web of Science, Scopus, ProQuest and Ageline. Thirty-three studies were reviewed, identifying six key themes, including decision-making, nursing role gaps, care coordination, communication, nursing skills and gender preference. This review examined rehabilitation nurses' experiences working with older patients in rehabilitation services. It highlighted gaps in their recognition and decision-making involvement despite being care coordinators, caregivers and advocates who were undervalued as rehabilitation team members. The review highlighted the importance of valuing nurses' contributions and re-evaluating the rehabilitation model. Interviewing rehabilitation nurses can validate the findings, potentially improving rehabilitation nursing practices for older patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Not applied since it was a systematic review.

Is avoidable diabetes-related hospitalization in older patients with type 2 diabetes mellitus associated with increased health expenditure?: A nationwide retrospective cohort study in South Korea

Is avoidable diabetes-related hospitalization in older patients with type 2 diabetes mellitus associated with increased health expenditure?: A nationwide retrospective cohort study in South Korea

Association between all-cause mortality and diabetic avoidable hospitalization among older patients

Abstract Background In South Korea, the prognosis of avoidable hospitalization in diabetes has not been evaluated, even though the incidence rate is considerably high compared to the Organization for Economic Co-operation and Development average. This study investigated the association between diabetic avoidable hospitalization after the diagnosis of type 2 diabetes mellitus and short- and long-term all-cause mortality. Methods Participants were type 2 diabetes mellitus patients aged 60 years and older and gathered through the National Health Insurance Services Senior cohort data from 2008 to 2019. The outcome measures included five-year and overall period all-cause mortality. The main independent variable was the first-year experience of diabetic avoidable hospitalization after type 2 diabetes mellitus diagnosis. Regression analysis was performed using the Cox proportional hazard model. To enhance the robustness of the study results, a sensitivity analysis and inverse probability of treatment weighting method were conducted. Results Among 31 222 participants, 2343 (7.5%) died within 5 years of type 2 diabetes mellitus diagnosis and 5314 (17.0%) died in the overall study period after type 2 diabetes mellitus diagnosis. Participants who experienced diabetic avoidable hospitalization one year after being diagnosed with type 2 diabetes mellitus had a higher risk of all-cause mortality compared to those who did not (Five-year: hazard ratio 1.84, 95% confidence interval 1.54-2.21; Overall period: hazard ratio 1.81, 95% confidence interval 1.60-2.06). Conclusions Enhancing accessibility and quality of primary care to prevent avoidable hospitalization in older patients with type 2 diabetes mellitus is necessary. Key messages • Older patients with T2DM who experienced avoidable hospitalization exhibited higher all-cause mortality rates in both the short and long terms. • Enhancing the accessibility and quality of primary care to prevent avoidable hospitalization in older patients with type 2 diabetes mellitus is necessary.

Evaluation of sacral pressure ulcers of older long-term hospital patients for five or fewer years

This study aimed to examine the statuses of sacral pressure ulcer and treatment strategies for 135 elderly patients who were long-term hospital patients. Patients with sacral pressure ulcers were divided into two groups, the cured or non-cured, and the discharged or deceased.The mean age, length of hospital stay, diagnosis, bedridden degree, nutritional status pre and post ulcer development, nutritional administration method, presence on admission or development, depth on National Pressure Ulcer Advisory Panel and treatment duration were examined.The serum albumin levels, lymphocyte counts and hemoglobin levels were calculated, and malnutrition levels were categorized into normal, mild, moderate or severe according to the Controlling Nutritional Status variant scores. The mean age of men (n=62) and women (n=73) was 80.8±4.9 and 86.2±1.2 years, and the mean length of hospital-stay was 25.1±9.6 and 27.3±4.9 months, respectively, indicating a significant difference.The diagnoses did not vary significantly between the cured (n=43) or non-cured (n=92) patients, or in those discharged (n=53) or deceased (n=82) patients.Comparison of the groups revealed that pressure ulcers were difficult to heal in patients with advanced age, those brought to hospital, bedridden degree C2 (unable to turn over), depth level III, moderate to severe malnutrition and those whose Gr did not improve.The effectiveness of gastrostomy management and the ineffectiveness of central venous nutrition were determined. Bedridden degree C2, depth level III, presence on admission, malnutrition on admission and no improvement were the factors for interruption of the healing.

Calf circumference-albumin index significantly predicts the prognosis of older patients with cancer cachexia: A multicenter cohort study

ObjectivesThe aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years. MethodsThis multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models. ResultsA total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0–78.0 years) and a mean follow-up time of 55.0 months (range: 25.0–85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612–0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score). ConclusionsThe CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.

Disentangling Anemia in Frailty: Exploring the Role of Inflammation.

In older patients, frailty and anemia frequently coexist. However, only few studies have been conducted in older patients with multimorbidity and several overlapping causes of anemia, such as inflammation, inadequate nutrition, or certain pathologies. This analysis aims to decipher potential factors associated with anemia in older hospital patients with frailty. Patients (n = 208, age: 62-98 years) were categorized as prefrail (n = 68) and frail (n = 140) using the Fried frailty phenotype. We quantified serum concentrations of markers of iron metabolism (iron, ferritin, transferrin, soluble transferrin receptor, and hepcidin), inflammation (interleukin [IL]-6 and IL-10 C-reactive protein), and hematology (hemoglobin). Principal component analysis was conducted to evaluate biomarker patterns and associations with frailty were assessed with logistic regression analysis. Anemia prevalence was higher in patients with frailty (84.3% vs 70.6%, p = .021). Three principal components (PC1-3) were identified. PC1 was characterized by high factor loadings representing inflammation and factor scores differed between patients with prefrailty and frailty (-0.04 (interquartile range [IQR]: 1.45) vs -0.51 (IQR: 0.87), p < .001]. PC2 represents macrocytic anemia and thus vitamin B12 or folate deficiency, whereas PC3 indicates hematological pathologies. Only PC1 was associated with frailty status when controlled for age, sex, number of drugs, and comorbidities (OR: 2.018, 95% CI: 1.316; 3.094, p = .001). PC2 and PC3 were not associated with frailty. Our results suggest that anemia in patients with frailty is driven by inflammation rather than being disease-related or solely the result of micronutrient deficiencies.

Delirium Assessment And Documentation As Part Of An Acute Medical Admission

Abstract Background Delirium is a prevalent issue affecting older patients in acute hospitals. National guidelines mandate that all patients &amp;gt;65 years old admitted to an acute hospital setting are screened for delirium. Prompt assessment and management of delirium is vital in delivering optimal care to the older patient. In our institution, delirium can be under recognised and not assessed routinely as part of the medical admission. Our aim was to assess delirium documentation rates and utilising the 4AT as part of the acute medical admission in a service development project. Methods A retrospective assessment of patient demographics and documentation of delirium and 4AT in the medical admission was carried out for January, February and March 2023 and compared to the same 3-month period in 2024 post set up of a new specialist geriatric ward (SGW) as part of a service development project. This was in tandem to targeted interventions for improving delirium education and management. Results Mean age was 83 years in both groups. 11% (18/157) in the cohort pre SGW and 30% (40/134) post setup of the SGW had a diagnosis of dementia. 13% (20/157) in the pre SGW cohort had delirium documented in the admission note and 23% (31/134) post. 24% (32/134) had a 4AT documented in the admission note post SGW setup compared with 6% (10/157) previously. Conclusion There was suboptimal documentation of the 4AT and delirium in the acute medical admission note. An acute medical admission proforma is being developed and implemented in our institution which will include a 4AT delirium screening tool. We will reassess this in 6 months’ time to ascertain whether there is an improvement in delirium and 4AT documentation. We will also give education to the medical NCHD group carrying out the admissions to emphasise the importance of utilising the 4AT and delirium documentation.

Factors Affecting Recurrent Staphylococcus aureus Bacteremia Among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study.

Introduction Staphylococcus aureus bacteremia (SAB) poses a significant health risk, particularly among adults over 65 years old, due to age-related vulnerabilities and comorbidities. Recurrent SAB is associated with increased morbidity, prolonged hospitalizations, and higher healthcare costs, necessitating the identification of risk factors that contribute to these recurrent infections. Methods A retrospective cohort study was conducted at a rural community hospital to identify factors associated with recurrent SAB in older patients. Data were extracted from electronic medical records of patients diagnosed with SAB between April 2016 and December 2023. Multivariate logistic regression was employed to analyze the relationship between recurrent SAB and potential risk factors, including age, sex, BMI, dependency on Japanese long-term health insurance, and comorbidities. Results Among 99 patients with SAB, 36 (36.4%) experienced recurrence. Higher BMI was significantly associated with recurrent SAB (OR: 1.15, 95% CI: 1.01-1.31, p = 0.036), while dependency on long-term care was associated with a lower risk of recurrence (OR: 0.20, 95% CI: 0.06-0.64, p = 0.007). Age and sex did not show significant associations with recurrence. Conclusion This study identified higher BMI as a risk factor for recurrent SAB in older patients, while dependency on long-term care was protective. These findings highlight the need for targeted management strategies for patients with higher BMI to prevent recurrent SAB. Further research is needed to explore these associations and confirm their relevance in other clinical settings.

Consensus and controversies on post-acute care decision making and referral to geriatric rehabilitation: A national survey

BackgroundTransitioning older hospital patients to the appropriate type of post-acute care has become an urgent clinical issue within the context of changing demographics and limited duration of hospital stay. ObjectiveConsensus on assessments that guide post-acute care decision making would benefit potential patients and support cooperation between settings. DesignA national web-based questionnaire focusing on professional contributions, patient involvement and the use of triage items and measures. ParticipantsHospital and geriatric rehabilitation professionals in the Netherlands participated as respondent groups, representing ‘sending’ and ‘receiving’ professionals. MethodsA comprehensive questionnaire was used with open, multiple choice and closed questions, exploring in detail how assessment of hospital patients in need of a post-acute care decision was performed. Descriptive statistics were applied together with deductive coding of qualitative data. ResultsA total of 104 hospital liaison nurses (66.7 %) and 52 GR professionals (33.3 %) participated. Respondents were reasonably satisfied with the current triage practice. Hospital liaison nurses valued their operational responsibility for triage. Geriatric rehabilitation professionals wanted active involvement in decision making and deemed hospital paramedic expertise sub-optimally applied. ‘Too little involvement’ of patients and families was felt by 50.0 % of the GR respondents versus 15.5 % of hospital respondents. The importance of half (47.8 %) of the triage items was rated differently between respondent groups. When discussing complex cases between sending and receiving professionals, views were felt as complementary. ConclusionsBoth sending and receiving professionals expressed moderate satisfaction with post-acute care decision making, whereas their views on triage assessments differed according to setting and role. The patients’ voice may be insufficiently heard in triage decisions. Shared expertise and a consensual approach can develop when triage consultation is facilitated by both hospitals and PAC facilities. This study offers ingredients to reach a multi-professional view on post-acute care decision making and referral to geriatric rehabilitation.

Conception of a Recognized Accreditation for a Senior-Friendly Hospital: The Accreditation “Hospital Attentive to the Elder”

ObjectivesConsideration of the need to strengthen the commitment of professionals to the good care of the older population in hospitals has been emerging over the last several years. The steering committee of the geriatric sector of the hospitals of our Hospital Consortium (HC) has structured an accreditation project to promote the commitment of professionals to the good care of older adult patients in hospitals: the “Hospital Attentive to the Elder” (HAE) accreditation. This global approach aims to better adapt care to the needs of this population in the hospital and promote positive values (eg, kindness, attentive support). DesignThe creation of the HAE accreditation required the creation of an accreditation board, a referential framework, and an accreditation procedure. Setting and ParticipantsThe whole process was coordinated by the accreditation board, a multidisciplinary entity, representative of the hospitals of our HC. MethodsThe 5-step approach of the accreditation procedure includes a commitment to the HAE, with the support of the institutional board, and an internal self-assessment phase to guide the creation of action plans, followed by an accreditation cross-evaluation visit. The HAE accreditation is awarded to departments that meet the described criteria. This accreditation process was initially initiated by our HC. ResultsIn June 2021, 6 of 10 hospitals of our HC and 11 departments, which mobilized 28 medical, paramedical, and quality referents, initiated the process. All 11 departments fulfilled the criteria for the accreditation, and a ceremony to hand out the certificates was organized in December 2023. Conclusions and ImplicationsWe envisage that this accreditation process could be offered at the regional and national level to any hospital or group of hospitals with departments that receive patients aged >75 years, regardless of their specialty.

Multimorbidity in Older Adult Acute Care Hospital Patients: Impacts on Patient Flow, Medical Management, Care Transitions and Cost.

The healthcare system is wrestling with the impact of demographics on demand for care. We hear anecdotally of heightened patient acuity and increased prevalence of chronic disease. Southlake is a leading healthcare organization serving the northern York Region and southern Simcoe County. We have analyzed all in-patient data over the last four years and observed massive increases in multi-comorbidity levels in older in-patient cohorts. This article will review the analysis and highlight the impact of this phenomenon on critical areas of hospital operations such as patient flow, care transitions and cost. It will also review the medical management implications of increased chronic disease prevalence in this patient population. Finally, we share a series of initiatives that have been successful in helping the hospital respond to these challenges. We believe these are relevant for acute hospitals and their community-based partners across Canada.

Skin tears in older patients in intensive care units: A multicentre point prevalence study.

With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing-related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs). To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs. The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an "ST chart" to record patient demographic characteristics, clinical variables and skin assessment. STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals' average body mass index (BMI) (p = .043), age (p = .014), length of stay in the ICU (p = .004) and having ST. There was also a statistically significant relationship between skin temperature (p = .002), skin turgor (p = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness (p = .014), incontinence (p = .006), the Braden score (p = .004), the Itaki fall risk score (p = .006) and ST. In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified. Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.

Impact of a prospective feedback loop aimed at reducing non-beneficial treatments in older people admitted to hospital and potentially nearing the end of life. A cluster stepped-wedge randomised controlled trial.

To investigate if a prospective feedback loop that flags older patients at risk of death can reduce non-beneficial treatment at end of life. Prospective stepped-wedge cluster randomised trial with usual care and intervention phases. Three large tertiary public hospitals in south-east Queensland, Australia. 14 clinical teams were recruited across the three hospitals. Teams were recruited based on a consistent history of admitting patients aged 75+ years, and needed a nominated lead specialist consultant. Under the care of these teams, there were 4,268 patients (median age 84years) who were potentially near the end of life and flagged at risk of non-beneficial treatment. The intervention notified clinicians of patients under their care determined as at-risk of non-beneficial treatment. There were two notification flags: a real-time notification and an email sent to clinicians about the at-risk patients at the end of each screening day. The nudge intervention ran for 16-35weeks across the three hospitals. The primary outcome was the proportion of patients with one or more intensive care unit (ICU) admissions. The secondary outcomes examined times from patients being flagged at-risk. There was no improvement in the primary outcome of reduced ICU admissions (mean probability difference [intervention minus usual care] = -0.01, 95% confidence interval -0.08 to 0.01). There were no differences for the times to death, discharge, or medical emergency call. There was a reduction in the probability of re-admission to hospital during the intervention phase (mean probability difference -0.08, 95% confidence interval -0.13 to -0.03). This nudge intervention was not sufficient to reduce the trial's non-beneficial treatment outcomes in older hospital patients. Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).

Protocol for the Development and Analysis of the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-Electronic Patient Records (ORCHARD-EPR)

BackgroundHospital electronic patient records (EPRs) offer the opportunity to exploit large-scale routinely acquired data at relatively low cost and without selection. EPRs provide considerably richer data, and in real-time, than...

Body Weight and Composition Changes in Geriatric Rehabilitation Are Dependent on Sarcopenia and Malnutrition: RESORT

ObjectivesBody weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients. DesignRESORT is an observational, longitudinal cohort. Setting and ParticipantsGeriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital, Melbourne, Australia (N = 1006). MethodsChanges in body weight and body composition [fat mass (FM), appendicular lean mass (ALM)] from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ. ResultsA total of 1006 patients [median age: 83.2 (77.7–88.8) years, 58.5% female] were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia. Conclusions and ImplicationsIn geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients’ nutritional risk.

Factors impeding physical activity in older hospitalised patients: A qualitative meta-synthesis.

Older hospitalised patients have low levels of physical activity and multiple impairing factors. To systematically evaluate the perceived barriers to physical activity among older patients during hospitalisation, and provide reference for future intervention programs. Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations. An exhaustive exploration was conducted across the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science from their inception until August, 2023 to identify qualitative research on obstacles to physical activity among older hospital patients. The quality of the literature was evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative research. Meta-synthesis method was used to integrate the results. In total, 8 literatures were included, 43 themes were extracted, and analogous research results were amalgamated to generate 10 categories and 3 syntheses: individual level, interpersonal influencing factors and hospital environment and resources level. Older inpatients are faced with multiple barriers to physical activity. Medical staff should pay attention to changes in physical activity during hospitalisation, identify barriers to physical activity in older inpatients and provide references for promoting physical activity programs for the older. This study is a meta-synthesis and does not require relevant contributions from patients or the public. Older patients are at low physical activity levels during hospitalisation. Older inpatients are faced with multiple barriers to physical activity. Factors of physical activity impairment in hospitalised older patients should be considered in the context of health status, psychological factors, motivation and social support. Disease-induced psychological fallout has a greater impact on physical activity in the older.

Socio-demographic characteristics and pharmacological treatment options in patients with delirium

IntroductionDelirium is common in hospital settings, with approximately 3% to 45% of older patients in hospitals developing delirium during their stay. Among the elderly and those with severe or advanced medical conditions, the reported percentage of patients with delirium is over 56%. The three motor subtypes of delirium are hyperactive, hypoactive, and mixed. Another way to characterize delirium is based on whether it is reversible, irreversible, or terminal.ObjectivesIdentifying appropriate pharmacological treatment options among antipsychotics and their correlation with various precipitating and predisposing factors in the in-hospital contextMethodsThis was a retrospective, cross-sectional, observational study that utilized a database created by the psychiatry department at the National Medical Center 20 de Noviembre, with data collected from April 2021 to April 2022. The database contains anonymized administrative and clinical data of patients who were seen in the psychiatry department for the diagnosis of any type of delirium, using the CAM scale for classification. The database includes records and data of hospitalized patients, encompassing all specialties at this medical centerResultsA total of 139 patients were included in the study, of which 39% were female and 61% were male, with a mean age of 67 and a median age of 68 years. It was observed that the average duration of delirium symptoms, from receiving the consultation to remission, was approximately 6 days (p &lt;0.005) (OR 5.12-6.62), and the average length of hospital stay was approximately 20 days (OR 17.3-22.09). Among the patients, 50.39% were overweight, 63% had hypertension (HTA), 29% had chronic kidney injury, 24% had a history of delirium, and 73% had recent surgical interventions. Patients with diabetes mellitus had a 3.1 times higher risk, those with HTA had a 2.8 times higher risk, and those with kidney injury had a 3.8 times higher risk of having a positive CAM result. It was observed that haloperidol, used in 84% of the patients, showed the highest percentage reduction in CAM scoresImage:Image 2:ConclusionsThe results of this study emphasize the importance of identifying risk factors associated with delirium and implementing effective treatment for this condition. It was observed that the average duration of delirium symptoms was approximately 6 days, which is relevant for understanding the course and management of this illness. Furthermore, it was found that the average hospital stay was 20 days, underscoring the burden that delirium can place on healthcare systems.In conclusion, this study highlights the importance of identifying risk factors and providing appropriate treatment, such as the use of haloperidol, to improve outcomes in patients with delirium.Disclosure of InterestNone Declared

More than a mouth to clean: Case studies of oral health care in an Australian hospital.

This study aimed to explore older patients' oral health status, their opinions about oral health care and their experiences with oral health care while in hospital. Improving older adults' oral health is considered an urgent priority at both the national and international levels, especially for hospitalised older patients who have been found to have poor oral health. However, a one-size-fits-all standardised approach to oral care delivery may not be the answer. This study was an embedded, multiple-case study, integrating qualitative and quantitative data. Seven patients were recruited from a geriatric ward of an acute hospital in Australia and participated in semi-structured interviews and oral health assessments using the Oral Health Assessment Tool (OHAT) in June-July 2022. Data were analysed descriptively and presented in case summaries. OHAT assessments identified oral health problems in all patients, but not all patients self-reported problems with their mouths. Each patient valued oral health care, but the reasons given varied. Patients had established, individualised oral health care routines, which they brought to hospital. Clinical observations of patient's oral health status might not match the patient's own judgement of their oral health and, if not explicitly addressed, may mask the need for oral health and hygiene intervention. Assessment and care planning needs to incorporate patients' own perceptions of their oral health and existing oral health care routines. Oral health histories may provide a means of facilitating this person-centred oral health care for older patients in hospital.