Geriatric Hospital Patients Research Articles

Evaluation of potentially inappropriate medications among hospitalized geriatric patients in tertiary care referral hospital using STOPP/START criteria

ObjectivesTo evaluate potentially inappropriate medications (PIM) and potential prescribing omission (PPO) among hospitalized geriatric patients using STOPP and START criteria respectively, to study morbidity and drug use pattern and to collect feedback from the physicians to improve rational drug therapy. MethodOLOGY: A prospective observational study was carried out for a period of 12 months among patients aged ≥65 years. The study was conducted in three phases. During first phase, the patient's data were recorded in data collection form and analyzed using STOPP/START criteria. During second phase, the results of first phase were introduced to the physicians along with the criteria and feedback form. During third phase, the prescriptions were re-assessed to determine the acceptance of criteria. ResultsA total of 210 patients were included in the study during the entire study period with 108 patients in first phase and 102 patients in third phase. The prevalence of PIM detected using STOPP criteria during first and third phase were 43.5% and 40.2% respectively. Similarly the prevalence of PPO detected using START criteria during first and third phase were 52.8% and 53.9% respectively. ConclusionThe study shows that there is high prevalence of PIM and PPO among hospitalized geriatric patients which are unacceptable and there should be consensus for considering such evidence based screening tools while prescribing drugs to elder peoples.

Poor Sleep Quality of Hospitalized Geriatric Patients in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia

<p>Background: In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health. Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulation<br />Objective: To study the epidemiological (gender, age group) and health status (co-morbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia.<br />Materials and Methods: A hospital based cross sectional study was conducted from January to June 2014. A total of 92 subjects aged 60 years and above were selected consecutively from hospitalized geriatric patients for this study. The data was analyzed by means and proportions.<br />Results: The male and female subjects were 51.1% and 48.9%. Mean age was 66.79 + 5.448 years. The age group of 60 – 75 years and above 75 years was 92.4% and 7.6% consecutively. Subjects with diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were 30.4%, 62.0%, 18.5%, 21.7%, 21.7%, 20.7% consecutively and 63.0% with more than 2 co-morbidities. According to PSQI 72.8% subjects have poor sleep quality. Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes (RR= 3.208 [95% CI: 1.045 – 9.848], p = 0.022) and chronic kidney disease (RR= 6.247 [95% CI: 0.902 – 43.279], p = 0.017)<br />Conclusions: Seventy two percents of subjects have poor sleep quality, and associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.</p>

Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It?

To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. The study was performed in an Italian geriatric research hospital (INRCA, Ancona). Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses-linear and logistic regression-were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04-5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21-0.95). A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.

Management of urinary tract infection in geriatric hospital patients

As the elderly population increases, so does the prevalence of urinary tract infections in the elderly population in long-term care facilities and the associated medical costs. Screening tests and treatment for asymptomatic bacteriuria in elderly residents in the community or in long-term care facil...

Spectrum of the causes of lower gastrointestinal bleeding in geriatric patients in tertiary care hospital

Context: Lower gastrointestinal bleeding (LGIB) patients in geriatric are the common indication of hospital admissions, with marked geographic variation in the frequency of different etiologies. Colonoscopy is considered as first-line diagnostic procedure of choice in evaluation of patients with bleeding per rectum. Aims: This study aims to determine spectrum of LGIB in our region using lower gastrointestinal (GI) endoscopy. Settings and Design: A retrospective study of 2-year period from August 2010 to July 2012, 2 years study in tertiary hospital. Subjects and Methods: The clinical data of patients admitted with per rectal bleeding were collected including age, sex, site of bleeding and the underlying cause. In all cases proctoscopy was done and colonoscopy after preparation and stabilization of the patients. Statistical Analysis Used: SPSS analysis. Results: During 2-year follow-up study, 45 patients were admitted with LGIB with mean age of 67.5 years, the bleeding site was in the colorectal causes found in 33 (73.3%) cases, while perianal in 6 (13.3%) of cases. Carcinoma was the most common cause. Conclusions: Bleeding per rectum is a common cause in geriatric patients admitted to Gastroenterology Department. Carcinoma is the most common cause of bleeding per rectum. There is wide geographic variation regarding the etiologies of LGIB. Lower GI endoscopy is very useful tool in evaluating patients with bleeding per rectum.

Perceptions and Intention of Nurses in Using Physical Restraints for Dementia Patients in Geriatric Hospitals

Purpose The purpose of this study was to investigate nurses' perceptions and intention to use physical restraints for geriatric hospital dementia patients. Methods A cross-sectional study design was used with 112 nurses recruited from 6 geriatric hospitals. Data on nurses' general characteristics as well as perceptions and intention to use physical restraints for dementia patients were collected. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient and standard multiple regression with SPSS/WIN 21.0. Results There were significant differences in perceptions of physical restraints for dementia patients according to type of restraint (wrist, lapboard with wheelchair, or alternative methods). Significant differences in intention were found for age, position, mobility decline, alternative methods, physical restraints guideline, and complaints from family. Factors affecting nurses' intention to use physical restraints included perceptions on physical restraint use, mobility decline, being a head nurse, and no alternative method available. These factors explained 51% of total variances in the regression model. Conclusion Findings show that nurses' perception of physical restraints for geriatric hospital dementia patients is significantly correlated with intention to use physical restraints. Therefore, provision of periodic training and education on alternatives are necessary to reduce indiscriminate use of physical restraints. 주요어: 인식, 의도, 간호사, 치매, ì‹ ì²´ì  ì–µì œëŒ€ Key Words: Perception, Intention, Nurses, Dementia, Physical restraints

요양병원 입원 노인을 위한 신체 억제대 프로토콜의 수용개작

요양병원 입원 노인을 위한 신체 억제대 프로토콜의 수용개작

Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series.

Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care.

Characteristics and Mortality Risk Factors in Geriatric Hospital Patients visiting One Region-wide Emergency Department

Characteristics and Mortality Risk Factors in Geriatric Hospital Patients visiting One Region-wide Emergency Department

MON-PP026: Cognitive Decline is an Independent Comorbidity Associated with Sarcopenia in Geriatric Hospital Patients

MON-PP026: Cognitive Decline is an Independent Comorbidity Associated with Sarcopenia in Geriatric Hospital Patients

Mo1493 EUS-Guided Intratumoral Injection of CHST15 Dsrna for Unresectable Pancreatic Cancer: an Investigator-Initiated Trial

Mo1493 EUS-Guided Intratumoral Injection of CHST15 Dsrna for Unresectable Pancreatic Cancer: an Investigator-Initiated Trial

The Correlation among Continence Function, Cognitive Function and ADL of Elderly Women Dementia Patients in Geriatric Hospitals in Yongin

본 연구는 노인병원에 입원 중인 여성 치매노인의 배설조절 기능과 인지기능 및 일상생활수행능력(Activities of daily living, ADL)과의 상관관계를 알아보는데 있다. 노인병원에 입원 중인 여성 환자 중 치매로 진단받은 65세 이상인 240명을 대상으로 하였다. 연구대상자들의 인지기능은 한국형 간이 정신상태 검사로 만든 설문지를 사용하였고, ADL과 배설조절 기능은 환자평가표를 활용하여 자료를 수집하였다. 상관관계 분석은 스피어만의 순위상관계수(Spearman"s rank correlation coefficient)를 사용하였다. 연구 결과를 보면 첫째, 배설조절 기능(대변조절, 소변조절)은 인지기능이 낮을수록 감소하는 것으로 나타났다. 둘째, 배설조절 기능에 어려움을 겪을수록 ADL의 의존도가 높은 것으로 나타났다. 셋째, 인지기능이 낮을수록 ADL의 의존도가 증가하는 것으로 확인되었다. 본 연구를 통하여 여성 치매노인의 배설조절 기능은 인지기능 및 ADL과 높은 상관관계가 있음을 알 수 있었다. 본 연구결과는 노인병원에 입원 중인 여성 치매노인의 관리 및 치료를 위한 기초자료로 활용 될 수 있을 것으로 사료된다.

Nurses' Experiences of the Death of Patients in Geriatric Hospitals

The purpose of this study was to identify and understand nurses' experiences of the death of patients in geriatric hospitals. Van Manen's hermeneutic phenomenological analysis was applied in the interpretation of experiential descriptions of seven nurses who had experienced the death of patients in a geriatric hospital. The essential subjects derived from the experience of the nurses on the death of patients in a geriatric hospital are covered in the following 7 themes. 'Placed in death site', 'Difficult repetition of death and farewell', 'Emotional waves that rushes in after farewell', 'Dilemmas in a place with no preparation to greet expected death', 'Getting dull from continually being struck with sorrow', 'Being together with living death', and 'Showing courtesy for a good farewell and living well'. The results of this research will contribute to the development of policy on all the deaths of patients in geriatric hospitals and suggest basic data that need to be applied in real practice and directions to introduce plans for realistic improvements in nursing care of deathbed patients in geriatric hospitals.

Prevalence and Types of Anemia and Associations with Functional Decline in Geriatric Inpatients.

The prevalence of anemia in hospitalized seniors has been linked to poor functional outcomes, increased mortality, and longer hospital stays, and has been associated with advancing age, male sex, and cognitive impairment. Despite the potential for complications, anemia often is undiagnosed and/or untreated in seniors. Examine (a) the distribution of anemia diagnosis and treatment in patients in a rehabilitation hospital, and (b) patients' cognitive and functional outcomes. Retrospective chart review of medical records of 132 patients. The presence and type of anemia were determined based on the World Health Organization criteria for adults and Smith's algorithm, respectively. The Mini-Mental State Exam (MMSE) was used to measure cognitive status. Functional impairment was assessed using the Functional Independence Measure (FIM). The mean age of the sample was 82.20 years, with 68% being female, the mean MMSE and FIM scores were 23.95 (SD = 4.3) and 82.82 (SD = 15.63), respectively. In total, 67% of males and 46% of females were anemic (P < 0.05). The majority of anemias were caused by nutritional deficiencies. The percent of anemic females receiving treatment for anemia was higher (71%) than the percent of anemic males (46%) (P < 0.05). The majority of the patients improved functionally regardless of anemia status. Results indicated that a substantial number of patients in a geriatric hospital were anemic, with significant percentage going untreated. The overall improvement in patients' functional abilities suggests that remedial rehabilitation of frail seniors has an impact on recovery during their hospital stay.

요양병원 입원노인의 건강이 수면과 삶의 질에 미치는 영향

본 연구는 실증적 검증을 통해 노인의 건강상태가 수면의 질과 삶의 질에 미치는 영향을 파악하여 요양병원에서 노인 간호의 질적인 개선을 위한 간호중재 방안을 제시하고자 하였다. 경기도와 부산광역시에 위치한 5개의 요양병원에 입원한 60세 이상의 노인 170명을 대상으로 2013년 5월 8일부터 28일까지 설문조사를 실시하였다. 요인 분석 결과 노인의 건강상태는 정서적 기능, 체력, 일상생활활동, 사회적 역할, 몸의 변화, 사회적 기능, 통증으로 구분되었으며, 정서적 기능과 통증은 수면의 질에 부적 영향을 미쳤고, 몸의 변화와 일상생활활동은 삶의 질에 긍정적인 영향을 미쳤다. 요양병원 노인 간호의 질적인 향상을 위해서는 입원한 노인의 통증과 정서적 문제를 조기에 발견하여 수면의 질을 향상시키기 위한 노력이 필요하며, 노화에 따른 몸의 변화와 일상생활 활동을 살펴 적절히 대처하기 위해서 요양병원 특성을 고려한 신체사정 및 건강증진 간호중재전략을 개발하는 것이 필요하다. The purpose of this study is to analyze the effect of health status on sleep quality and quality of life among elderly patients in geriatric hospitals. A survey was held to the elderly patient of 5 geriatric hospitals in Kyunggi-do and Busan from May 8 to May 28, 2013. As result of factor analysis, the health status divided to the 7 domain: Emotional function, Strength, Daily activity, social role, Change of body, Social function and pain. Pain and Emotional function revealed the negative effect on sleep quality and Change of body and Daily activity were positive effect on quality of life. In conclusion, it is need to improve sleep quality through finding pain and emotional problem in elderly patient, and in order to upgrade nursing in geriatric hospitals, it have to develop nursing strategies considering the geriatric hospital for health screening and health promotion to take care of daily activity and change of older's body.

The Correlation among Cognitive Function, ADL and Eliminative Function of Elderly with Dementia in Patients in Geriatric Hospitals

본 연구의 목적은 노인병원에 입원 중인 치매노인의 인지기능과 일상생활수행 및 배설기능과의 상관관계를 알아보는데 있다. 노인병원에 입원 중인 환자 중 치매로 진단받은 137명을 대상으로 하였다. 연구대상자들의 인지기능은 한국형 간이 정신상태 검사(K-MMSE)로 만든 설문지를 사용하여 측정하였고, 일상생활수행능력과 배설기능은 요양병원 환자평가표를 바탕으로 자료를 수집하였다. 그 결과 인지기능이 높을수록 일상생활수행능력의 의존도가 감소하고 대변기능을 조절할 수 있는 능력이 높은 것으로 나타났고(p<.001), ADL에서 화장실 사용하기가 어려울수록 소변기능을 조절하기가 어려운 것으로 나타났다(p<.001). 본 연구를 통하여 치매노인의 인지기능과 일상생활수행능력 및 배설기능에 상관관계가 있음을 알 수 있었다.

Teleconsultation in geriatrics: Impact on professional practice

Teleconsultations in medicine are encouraged by authorities and decision-makers to improve access to specialty services for isolated patients. For elderly patients in geriatric hospitals, they thus avoid trips to consult with specialists. However, teleconsultation can modify clinical practice and it may be abandoned for reasons not related to technical issues. Qualitative research on the impact of teleconsultation on medical practice and organisation are thus crucial for an understanding of the changes it can generate. MethodsWe used qualitative methods to analyse the impact on professional work practices and care organisation of an initially experimental and then permanent teleconsultation system using a video conference system set up between a geriatric hospital and a tertiary care hospital. Sixty-six teleconsultations (56 during the experimental phase and 10 when the system was in routine use) were observed and ten semi-structured interviews were carried out with the actors in the teleconsultations. ResultsOur study shows that the uses of teleconsultation affected work practices of both the consulted specialist and the geriatrician who participated in the consultation alongside the patient. The interactions of specialists with the patient were more difficult than in a face-to-face setting and delegation of the clinical examination of the patient depended on a specific form of cooperation and on trust in the person doing the examination. New kinds of relationships between health professionals contributed to sharing and transmission of knowledge between practitioners. While teleconsultations established alliances between geriatricians and specialists, they none-the-less called for a certain humility on the part of geriatricians. In order for these relationships to become routine and to facilitate interaction among participants, the project manager carried out important work during the experimental phase of the teleconsultations by organising these interactions. Finally, the teleconsultations went through several local reorganisations, especially within the geriatric hospital. These included changes in the geriatrician's schedule and the added presence of an assistant knowledgeable in telemedicine. ConclusionsSpecialists found the system used for teleconsultation between a geriatric hospital and a tertiary care hospital to be suitable for their consultations. The main advantage brought about by the teleconsultation system studied resulted from its collaborative nature, which created relationships between health professionals. This resulted in improved care for elderly patients. However, using the system required effort on the part of both the specialists and the geriatricians. Adapting to the system was facilitated by coordination work carried out by the project manager during the experimental phase that created a favourable context for cooperation between actors, allowing diagnoses to be made at a distance. Finally, teleconsultations do not appear suitable for all specialties, by reason of the limits imposed on the delegation of tasks, or to all situations. They require setting up new forms of organisation that must be encouraged by decision-makers.

Factors Influencing Depression among Elderly Patients in Geriatric Hospitals

[Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem scale, a social support scale, and a life satisfaction scale. Data were collected from April 20 to June 20, 2011. Data were analyzed using descriptive statistics, Pearson correlations, and multiple logistic regression analysis using SPSS 15.0 and Stata 11.0. [Results] The average GDSSF-K score of the participants was 8.94, indicating a moderate level of depression. About 78.4% of the elderly patients in this study were classified as predisposed toward depression. Significant predictors for depression included the patients’ perceived health status and life satisfaction. [Conclusion] The results indicate that elderly patients face a high risk of developing depression and that efforts should be made to address it wherever possible. Regular depression screening will be beneficial for early detection of depression in patients at community geriatric hospitals.

Cognitive function is associated with body composition and nutritional risk of geriatric patients.

Most patients with dementia lose body weight over the course of the disease. Yet it is not known whether this weight loss is predominantly in the form of fat-free mass (FFM) or fat mass (FM), the latter of which one would expect if the weight loss were caused simply by a chronic decrease of energy intake. To determine body composition and nutritional risk in geriatric patients and their association with cognitive function. A retrospective, cross-sectional single-center database analysis. We analyzed 4,095 consecutive geriatric hospital patients for body composition, nutritional risk, need of care and cognitive function using bioelectric impedance analysis, NRS 2002, Barthel Index and Mini Mental State Examination. Subjects with cognitive dysfunction showed significant lower body weight, body mass index (BMI), FM, fat mass index, FFM and fat-free mass index and a higher NRS score compared to cognitively intact subjects. Mean body weight decreased 10.2%, mean FM decreased 21.1%, mean FFM decreased 5.9% and mean NRS 2002 score increased from 2.1 to 3.0 points with increasing cognitive deterioration. A multivariate analysis revealed that cognitive dysfunction, age and female gender were all significant risk factors for a low body mass index and a low fat mass index. Age, male gender and need of care, but not cognitive dysfunction, were risk factors for a low fat-free mass index. Dementia patients seem to lose predominantly fat mass with weight loss. Female dementia patients are at a higher nutritional risk than male patients, presumably as a result of their different social situation in old age. That is why the nutritional state of female patients with dementia requires special attention.

Handgrip strength measurement as a predictor for successful dry powder inhaler treatment

More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed. In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer. A total of 87 (27%) men (mean age 81 ± 7 years) and 231 (73%) women (mean age 82 ± 8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively. A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.