Pre-admission Levels Research Articles

Long-Term Outcomes of Older Adults in Ireland after Geriatric Rehabilitation for COVID-19: A Prospective Cohort Study

Abstract Background COVID-19 is a contagious disease caused by the Sars-CoV-2 virus. Disease presentation and severity has evolved since its emergence in 2019. In May 2023, the World Health Organization declared the end of the COVID-19 pandemic but described it as an established and ongoing health issue. Studies to date have focused on disease presentation, prevalence and evolution and the immediate rehabilitation outcomes for older adults. There is a paucity of research reporting the long-term outcomes of older adults who have completed geriatric rehabilitation. The primary aim of this study was to describe the long-term functional outcomes of a cohort of older adults with acute COVID-19 who have completed inpatient geriatric rehabilitation. Methods This is a subgroup analysis of Irish data gathered as part of a pan-European prospective cohort study. Patients were recruited from two acute hospitals in the Republic of Ireland: Beaumont Hospital and University Hospital Limerick. Patients with a confirmed case of COVID-19 infection and accepted for geriatric rehabilitation in the hospital setting were eligible for recruitment. Functional ability, patient reported symptoms and quality of life were measured using the Barthel Index, the COVID-19 Yorkshire Rehabilitation Screen and the EQ-5D-5L respectively. Results Thirty patients were included in the subgroup analysis. The rate of mortality was 23.3% at six months after discharge from rehabilitation. Patients achieved a return to pre-admission functional ability but reported a significant increase in patient reported symptoms and their quality of life did not return to pre-admission levels when assessed at six months after discharge from rehabilitation. Conclusion Multidisciplinary rehabilitation for older adults with acute COVID-19 infection can assist patients to return to their premorbid functional ability. On discharge from rehabilitation, ongoing follow up of older adults is recommended to assist them to negotiate and manage ongoing symptomatology such as breathlessness or fatigue.

Long-term outcomes of older adults with acute COVID-19 following inpatient geriatric rehabilitation: a prospective cohort study from the Republic of Ireland

BackgroundThere is a paucity of research reporting the long-term outcomes of older adults who have completed geriatric rehabilitation following COVID-19.AimThe primary aim of this study is to describe the long-term functional outcomes of a cohort of older adults with acute COVID-19 who have completed inpatient geriatric rehabilitation.MethodsThis is a subgroup analysis of Irish data from a pan-European prospective cohort study. Functional ability, patient reported symptoms, and quality of life were measured using the Barthel index, the COVID-19 Yorkshire Rehabilitation Screen, and the EQ-5D-5L, respectively.ResultsThirty patients enrolled in the study. The rate of mortality was 23.3% at 6 months after discharge from rehabilitation. Patients achieved a return to pre-admission functional ability but reported a significant increase in patient reported symptoms and their quality of life did not return to pre-admission levels when assessed at 6 months after discharge from rehabilitation.ConclusionsMultidisciplinary rehabilitation for older adults with acute COVID-19 infection can assist patients to return to their premorbid functional ability. On discharge from rehabilitation, ongoing follow-up of older adults is recommended to assist them to negotiate and manage ongoing symptomatology such as breathlessness or fatigue.

Impact of Hospitalization on Patients Ability to Perform Basic Activities of Daily Living.

Functional independence is dictated by the ability to perform basic activities of daily living (ADLs). Although hospitalization is associated with impairments in function, we know less about patients' functional trajectory following hospitalization. We examined patients' ability to do basic ADLs across pre-admission, admission, and follow-up (discharge or two-weeks post-admission) and determined which factors predicted changes in ADLs at follow-up. A secondary analysis of a small prospective cohort study of older patients (n=83, 50 females, 81 ± 8 years) from the Emergency Department and a Geriatric Unit were included. ADL scores (dressing, walking, bathing, eating, in and out of bed, and using the toilet) and frailty level (via the Clinical Frailty Scale) were measured. Comparing follow-up to pre-admission, patients reported worse ADL scores for dressing (36% of patients), walking (31%), bathing (34%), eating (25%), in and out of bed (37%), and using the toilet (35%). Most patients (59%) had more difficulty with 1+ ADL at follow-up versus pre-admission, with one-fourth of patients having greater difficulty with 3+ ADLs. Older age and higher frailty level were associated with (all, p < .04) worse functional scores for eating, getting in and out of bed, and using the toilet (frailty only) at follow-up versus pre-admission. Here, most inpatients experienced worse difficulty performing multiple basic ADLs after hospital admission, potentially predisposing them for re-hospitalization and functional dependence. Older and frailer patients generally were less likely to recover to pre-admission levels. Hospitalization challenges patients' ability to perform ADLs in the short-term, post-discharge. Strategies to improve patients' functional trajectory are needed.

Well-being right before and after a permanent nursing home admission.

Permanent nursing home (NH) admissions are a frequent and major life event aimed at maintaining quality of life in old age. Yet, insights into the impact of a NH admission on well-being are scarce and inconclusive. We evaluate the effect of a NH admission on domains of well-being among those who are admitted using event study methodology for cross-sections combined with inverse probability weighting. We apply this doubly robust approach to Dutch survey data on well-being linked to extensive administrative data on NH admissions, health, and socio-economic status. We find that a NH admission leads to a temporary increase in loneliness, the risk of anxiety and depression, and a loss of control over one's life. However, these scores revert to pre-admission levels after 6months. These findings may contribute to better-informed individual-level and policy decisions about potential NH entry and aging in place policies.

Insulin therapy associated relative hypoglycemia during critical illness.

In critically ill diabetes patients, relative hypoglycemia (RH) (a decrease in glucose ≥30% below pre-admission levels, as estimated by HbA1c) is associated with greater mortality and absolute hypoglycemia. We investigated the epidemiology and outcomes of RH when it was associated with insulin therapy. We performed retrospective analysis of a cohort of critically ill patients with diabetes who received insulin in the intensive care units (ICUs) of a tertiary hospital. The primary outcome was 28-day mortality with respect to insulin therapy associated relative hypoglycemia (ITARH). ITARH occurred in 184 (42%) of insulin-treated patients. ITARH was associated with a higher HbA1c (8.6% vs 6.6%, p < 0.001), a higher glycemic variability index (121 vs 75.1 mmol2/L2/h/week, p < 0.001) and more absolute hypoglycemia (18.5% vs 3.94%, p < 0.001). Its frequency peaked about 5 h after initiation of insulin therapy. ITARH was associated with a greater risk of subsequent hypoglycemia (adjusted HR 3.5, 95% CI 1.7-6.8) but not mortality (HR 1.2, 95% CI 0.7-2.2). ITARH is common in insulin treated critically ill diabetes patients and associated with poorer glycemic control. Unlike reports of RH in general, it is not associated with mortality, suggesting that the prognostic implications of RH differ according to its context.

COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

BackgroundAcute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre.MethodsWe analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020.ResultsOf the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months.ConclusionsThis large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.

Trajectory of Quality of Life Before and After Entering a Nursing Home: A Longitudinal Study.

The objective of this longitudinal study was to compare the trajectory of subjective quality of life in 2 groups of older adults: those who entered a nursing home and those who remained living in the community with similar clinical conditions. PAQUID is a prospective population-based study. It included, at baseline, 3777 community-dwelling participants aged 65 years and over. Participants were followed-up for up to 27 years. Among people living at home at baseline, 2 groups were compared: participants who entered a nursing home over a 20-year follow-up (n = 528) and those who remained community dwellers (n = 2273). We used latent process mixed models to estimate the relationship between mean trajectory of subjective quality of life and admission into a nursing home. We computed univariate and multivariate models taking into account potential confounders (age, gender, education, income, comorbidities, dementia, disability and depression). Nursing home placement was significantly associated with a drop in quality of life between the last visit before and after institutionalization. Nevertheless, we found no difference in quality of life trajectory after this initial drop. Older adults exhibit an acute drop in quality of life after nursing home admission, probably reflecting the associated psychological distress. Even though their quality of life does not go back to pre-admission levels, the residents do not show a steeper decline when compared to the "natural" evolution of quality of life in older adults living in the community, which suggests a relative adaptation to their new living conditions.

Double non-contiguous fractures in a patient with spondylo-epiphyseal dysplasia with spinal ankylosis treated with open and percutaneous spinal fixation technique: a case report

BackgroundPatients with ankylosing spines are susceptible to developing spinal fractures even with minor trauma and can develop early or late neurological injuries. These fractures require early and aggressive surgical management to enable spinal stability and/or neural decompression. Being highly unstable by nature, they require relatively long segment instrumentation and fusion, which can increase paravertebral soft tissue damage and perioperative bleeding. The purpose of this report is to describe a rare case of traumatic double fractures at the cervico-thoracic and thoraco-lumbar transition zones in ankylosing spine with spondylo-epiphyseal dysplasia (SED) of unknown cause, which were successfully treated with a combined open and percutaneous spinal fusion procedure.Case presentationA 46-year-old woman who was diagnosed with non-contiguous fractures in cervico-thoracic and thoraco-lumbar junction zones among multiple injuries sustained in a traffic accident was treated with hybrid techniques for posterior instrumentation with an open approach using a computed tomography (CT)-based navigation system and percutaneous pedicle-screwing method. She regained mobility to pre-admission levels and started walking on crutches 3 months postoperatively. Genetic testing for the cause of SED revealed no mutation in the COL2A1 or TRPVR4 genes. The union of fractured spine was confirmed on CT scan 1 year postoperatively.ConclusionThis is the first report of double spinal fractures in an ankylosing spine with genetically undetermined spondyloepiphyseal dysplasia. A long-segment posterior instrumentation procedure incorporating the invasive treatment of spinal fractures in ankylosing spondylitis or diffuse idiopathic hyperostosis was effective.

ICU survivors show no decline in health-related quality of life after 5years.

Severe critical illness requiring treatment in the intensive care unit (ICU) may have a serious impact on patients and their families. However, optimal follow-up periods are not defined and data on health-related quality of life (HRQOL) before ICU admission as well as those beyond 2years follow-up are limited. The aim of our study was to assess the impact of ICU stay up to 5years after ICU discharge. We performed a long-term prospective cohort study in patients admitted for longer than 48h in a medical-surgical ICU. The Short-Form 36 was used to evaluate HRQOL before admission (by proxy within 48h after admission of the patient), at ICU discharge, and at 1, 2, and 5years following ICU discharge (all by patients). Changes in HRQOL were assessed using linear mixed modeling. We included a total of 749 patients (from 2000 to 2007). At 5years after ICU discharge 234 patients could be evaluated. After correction for natural decline in HRQOL, the mean scores of four dimensions-physical functioning (p<0.001), role-physical (p<0.001), general health (p<0.001), and social functioning (p=0.003)-were still significantly lower 5years after ICU discharge compared with their pre-admission levels, although effect sizes were small (<0.5). After correction for natural decline, the effect sizes of decreases in HRQOL were small, suggesting that patients regain their age-specific HRQOL 5years after their ICU stay.

Marked Direct Hyperbilirubinemia due to Ceftriaxone in an Adult with Sickle Cell Disease.

Drugs are a significant cause of liver injury. Drug-induced liver injury (DILI) can cause acute hepatitis, cholestasis, or a mixed pattern. Ceftriaxone is a commonly used antibiotic and has been associated with reversible biliary sludge, pseudolithiasis, and cholestasis. A 32-year-old male with sickle cell disease was admitted to the hospital for acute sickle cell crisis. On the second day of hospitalization, he developed cough and rhonchi with chest X-ray revealing right middle lobe infiltrates. Ceftriaxone and azithromycin were initiated. Subsequently, he developed conjugated hyperbilirubinemia and mild transaminitis. His total bilirubin trended upwards from 3.3 mg/dL on admission to 17 mg/dL. It was predominantly conjugated bilirubin, with preadmission bilirubin levels of 3-4 mg/dL. His transaminases were mildly elevated as well compared to previous levels. Extensive workup for bilirubin elevation was unremarkable. Ceftriaxone was switched to levofloxacin and the hyperbilirubinemia improved. On ambulatory follow-up, his bilirubin remained below 4 mg/dL. Ceftriaxone may be associated with marked direct hyperbilirubinemia particularly in sickle cell patients with chronic liver chemistry abnormalities. In the case of elevated bilirubin with concomitant ceftriaxone use, elimination of the offending agent should be considered.

Sleep disturbances after fast-track hip and knee arthroplasty

Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement with length of stay (LOS) <3 days. The primary endpoint was REM sleep duration on the first postoperative night compared with before operation. Ten subjects (≥60 yr) receiving spinal anaesthesia and multimodal opioid-sparing postoperative analgesia for total hip or knee arthroplasty were included. Ambulatory polysomnography was performed one night before operation at home, continuously during hospitalization, and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated. The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean of 18.2 (9.5-23.5)% of total sleep time to 1.2 (0-5.8)% on the first postoperative night (P=0.002); awake time increased from 19.1 (3.7-44.4)% to 44.3 (12.2-70.6)% (P=0.009); and sleep architecture on the first postoperative night was more disturbed than before operation. Sleep architecture normalized on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern. Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated on the first postoperative night after fast-track orthopaedic surgery but returned to pre-admission levels when at home on the fourth postoperative night.

The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes*

The relationship between hyperglycemia and mortality is altered by the presence of diabetes mellitus. Biological adjustment to preexisting hyperglycemia might explain this phenomenon. We tested whether the degree of preexisting hyperglycemia would modulate the association between glycemia and outcome during critical illness in patients with diabetes mellitus. Retrospective observational study. Two tertiary intensive care units. Four hundred fifteen critically ill diabetic patients with HbA1c levels measured within 3 months of intensive care unit admission. None. There were 9,946 blood glucose measurements in this study cohort (glucose measured 6.7 times per day; every 3.6 hrs on average). The median preadmission HbA1c level was 7.0%. There was no significant difference in HbA1c levels (p = .17) or time-weighted average of blood glucose concentrations (p = .49) between survivors and nonsurvivors. The time-weighted average of blood glucose concentrations during intensive care unit stay for nonsurvivors was lower than that of survivors when the HbA1c was >6.8%. In multivariate analysis, we found that there was a significant interaction between HbA1c and the time-weighted glucose level, indicating that the relationship between HbA1c and mortality changed according to the levels of time-weighted average of blood glucose concentrations (p = .008). As a consequence, in patients with higher (>7%) preadmission levels of HbA1c, the higher the time-weighted acute glucose concentration during intensive care unit stay (>10 mmol/L), the lower the hospital mortality compared with the lower HbA1c cohort (<7%). In patients with diabetes mellitus admitted to intensive care units, there was a significant interaction between preexisting hyperglycemia and the association between acute glycemia and mortality. These observations generate the hypothesis that glucose levels that are considered safe and desirable in other patients might be undesirable in diabetic patients with chronic hyperglycemia. Further studies are required to confirm or refute our findings.

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 residents diagnosed with dementia and 636 with no dementia for 1 year preadmission and 2 years postadmission. Multivariate analysis with generalized estimating equations was used to identify the source of Medicare cost differentials between the two groups. Medicare expenditures peaked in the month immediately preceding admission and dropped to preadmission levels by the third month in a nursing home. Adjusted PPM costs postadmission for the dementia group as a whole were 79% (p < .001) of the Medicare costs of treating residents without dementia. For the subgroup of residents admitted without a Medicare qualified stay (MQS), those with dementia had Medicare costs of just 63% (p < .001) of those without dementia. Overall Medicare costs PPM were insignificantly different between the two groups admitted with a MQS. Whether nursing home residents are admitted with a MQS is the single most important factor in assessing treatment cost differentials between residents admitted with and without dementia. Failure to consider this factor may lead researchers and policy makers to misdirect their attention from the true source of the differential-dementia patients admitted without a qualifying stay.

Endoscopic sphincterotomy in adult hemophiliac patients with choledocholithiasis

Background The aim of this study was to investigate the risk of bleeding in adult hemophiliac patients undergoing endoscopic sphincterotomy for choledocholithiasis. Methods From 1983 to 2002, 7 patients with hemophilia A and two with hemophilia B were referred for endoscopic sphincterotomy and extraction of bile duct stones. The degree of hemophilia was mild in 4 patients, moderate in 3, and severe in two. Pre-admission levels of blood clotting factors ranged from less than 1% to 18%. Levels of the deficient factors were monitored carefully before and after sphincterotomy, and the relevant factor was replaced to achieve 100% activity before and for 24 hours after endoscopic sphincterotomy. Observations Seven patients had factor replacement every 8 hours, and two received continuous infusions. No patient developed bleeding after sphincterotomy. At discharge, 48 hours after the procedure, patients who had received continuous infusions had a factor level of greater than 90%; those who had received intermittent replacement had levels of greater than 50%. After discharge, the patients were treated with regular infusion of the deficient factor for 15 days. Conclusions With adequate preoperative and post-procedure monitoring of clotting factors, meticulous attention to hemostasis during sphincterotomy, careful post-procedure monitoring, and timely replacement therapy, patients with hemophilia can undergo endoscopic sphincterotomy without bleeding complications.

A retrospective evaluation of a therapeutic community for mentally disordered offenders

This paper reports a retrospective evaluation of a therapeutic community (TC) for mentally disordered offenders in a regional secure unit (RSU). All 85 patients who had passed through the TC since it opened in 1987 were eligible for the study. Information on 81 patients was available in clinical records, providing a descriptive profile of the population. Information on recidivism was collected from the Home Office Offenders Index for 53 patients, providing information on effectiveness of the TC in terms of its impact on crime. Those for whom post-discharge crime information was collected were split into assessment and treatment groups, and short- and long-stay groups. All patients significantly reduced their offending after discharge as compared with pre-admission levels. There was no significant difference between the assessment and treatment groups, or between short- and long-stay groups. Whilst there was a significant overall reduction in offending, this cannot be attributed to the TC programme. Programme design, selection criteria and pre-admission assessment all require further attention to optimize the effectiveness of group treatment for mentally disordered offenders.

Ethnic differences in pre-admission levels of physical activity in patients admitted with myocardial infarction

Background: Regular exercise is generally considered to reduce the risk of coronary heart disease. Reduced levels of physical activity in Indo-Asians may partly explain why patients from this ethnic group sustain so many heart attacks. Aim: To investigate ethnic differences in pre-admission levels of physical activity amongst patients admitted with myocardial infarction and triggers for the acute cardiac event. Design: Cross-sectional study using standard Baecke questionnaire, which provided a semi-quantitative work score, sport score, leisure score and total activity score of general daily activities, with additional questions on activity at the onset of chest pain. Setting: Coronary Care Unit, City Centre Teaching Hospital. Patients and results: We studied 100 consecutive patients (76 males, mean age 62.3 years, S.D. 12.5; 74 caucasians, 26 Indo-Asians) admitted with myocardial infarction. Most patients were engaged in sedentary activities, including lying in bed (25%), sitting (19%), watching television (14%) and sleeping (6%), whilst only 21% of patients were engaged in physical activity at chest pain onset; there were, however, no ethnic differences in activity at chest pain onset. There was a diurnal variation in chest pain onset, with the mode between 08:00 and 10:00 h. As the mean age of Indo-Asians was significantly lower than caucasians in the whole group (56.3 vs. 64.4 years; t-test, P < 0.002), the Baecke questionnaire analysis was confined to only male patients aged <70 years ( n = 56). Indo-Asian patients with myocardial infarction were found to have a significantly lower overall physical activity score (3.78 vs. 5.33; P = 0.003), leisure time physical activity (2.43 vs. 2.74; P < 0.05) and sporting score (0.14 vs. 0.82; P < 0.01) when compared to caucasians, despite a similar mean age and body mass index. Conclusion: The majority of myocardial infarction patients were engaged in sedentary activities at chest pain onset. Although there were no differences between caucasians and Indo-Asians in activity at symptom onset, Indo-Asian patients had a significantly lower overall physical activity score, leisure time physical activity and sporting score compared to caucasians. The lower general physical activity amongst Indo-Asians may in part contribute to the high prevalence of ischaemic heart disease amongst this ethnic group.

Functional Outcomes of Acute Medical Illness and Hospitalization in Older Persons

Short-stay hospitalization in older patients is frequently associated with a loss of function, which can lead to a need for postdischarge assistance and longer-term institutionalization. Because little is known about this adverse outcome of hospitalization, this study was conducted to (1) determine the discharge and 3-month postdischarge functional outcomes for a large cohort of older persons hospitalized for medical illness, (2) determine the extent to which patients were able to recover to preadmission levels of functioning after hospital discharge, and (3) identify the patient factors associated with an increased risk of developing disability associated with acute illness and hospitalization. A total of 1279 community-dwelling patients, aged 70 years and older, hospitalized for acute medical illness were enrolled in this multicenter, prospective cohort study. Functional measurements obtained at discharge (Activities of Daily Living) and at 3 months after discharge (Activities of Daily Living and Instrumental Activities of Daily Living) were compared with a preadmission baseline level of functioning to document loss and recovery of functioning. At discharge, 59% of the study population reported no change, 10% improved, and 31% declined in Activities of Daily Living when compared with the preadmission baseline. At the 3-month follow-up, 51% of the original study population, for whom postdischarge data were available (n=1206), were found to have died (11%) or to report new Activities of Daily Living and/or Instrumental Activities of Daily Living disabilities (40%) when compared with the preadmission baseline. Among survivors, 19% reported a new Activities of Daily Living and 40% reported a new Instrumental Activities of Daily Living disability at follow-up. The 3-month outcomes were the result of the loss of function during the index hospitalization, the failure of many patients to recover after discharge, and the development of new postdischarge disabilities. Patients at greatest risk of adverse functional outcomes at follow-up were older, had preadmission Instrumental Activities of Daily Living disabilities and lower mental status scores on admission, and had been rehospitalized. This study documents a high incidence of functional decline after hospitalization for acute medial illness. Although there are several potential explanations for these findings, this study suggests a need to reexamine current inpatient and postdischarge practices that might influence the functioning of older patients.

Ethnic differences in pre-admission levels of physical activity in patients admitted with myocardial infarction

Ethnic differences in pre-admission levels of physical activity in patients admitted with myocardial infarction

Changes in behaviour before and after nursing home admission

AbstractThe Psychogeriatric Dependency Rating Scale (PGDRS) behavior subscale was completed for 431 residents of eight nursing homes at three time points: the weeks preceding nursing home admission, 2 weeks and 2 months after nursing home admission. The mean PGDRS behaviour subscale score significantly decreased from before admission to 2 weeks after admission but returned to preadmission levels at 2 months after admission (p &lt; 0.01). There were significant temporary decreases after admission in the prevalence of interfering behaviour, difficulty understanding, self‐destructive behaviour, persecutory ideas and hallucinations. A decrease in behaviour problems after admission was associated with admission because of disruptive behaviour, possible Alzheimer's disease and expecting to live permanently in the nursing home. An increase in behaviour problems was associated with admission because of disruptive behaviour, dementia with stroke, delirium, being uneasy with other residents, unoccupied by activities, incontinence and physical dependence.

The Relationship Between Locus of Control, Amount of Pre‐Admission Analgesic/Ergot Overuse, and Length of Stay for Patients Admitted for Inpatient Treatment of Chronic Headache

This study was undertaken to assess the relationship between locus of control, medication overuse, and length of hospitalization for patients admitted for inpatient treatment of chronic headache with drug rebound. Thirty patients admitted for treatment using repetitive IV DHE were administered the Health Attribution Test (HAT). Two-thirds of these patients had profile scores representative of good health attitudes associated with favorable rehabilitation outcomes. There was a trend in the direction of predicting shorter lengths of hospital stay for those patients with "good" profiles, although the correlation did not reach statistical significance. The statistical relationship (r = .25; P = .09) found between the HAT's "Powerful Others" scale and preadmission levels of medication use was consistent with previously published control theory findings regarding high external locus of control in drug and alcohol abusers. The findings of this study suggest that analgesic/ergot abusing chronic headache patients may differ from street drug abusers. This may account, in part, for the high levels of success for these patients at two year follow-up after hospital discharge.