A Prospective Cohort Study of Geriatric Syndromes Among Older Medical Patients Admitted to Acute Care Hospitals
ABSTRACT To identify the prevalence of geriatric syndromes in the premorbid for all syndromes except falls (preadmission), admission, and discharge assessment periods and the incidence of new and significant worsening of existing syndromes at admission and discharge.
Prospective cohort study.
Three acute care hospitals in Brisbane, Australia.
Five hundred seventy-seven general medical patients aged 70 and older admitted to the hospital.
Prevalence of syndromes in the premorbid (or preadmission for falls), admission, and discharge periods; incidence of new syndromes at admission and discharge; and significant worsening of existing syndromes at admission and discharge.
The most frequently reported premorbid syndromes were bladder incontinence (44%), impairment in any activity of daily living (ADL) (42%). A high proportion (42%) experienced at least one fall in the 90 days before admission. Two-thirds of the participants experienced between one and five syndromes (cognitive impairment, dependence in any ADL item, bladder and bowel incontinence, pressure ulcer) before, at admission, and at discharge. A majority experienced one or two syndromes during the premorbid (49.4%), admission (57.0%), or discharge (49.0%) assessment period. The syndromes with a higher incidence of significant worsening at discharge (out of the proportion with the syndrome present premorbidly) were ADL limitation (33%), cognitive impairment (9%), and bladder incontinence (8%). Of the syndromes examined at discharge, a higher proportion of patients experienced the following new syndromes at discharge (absent premorbidly): ADL limitation (22%); and bladder incontinence (13%).
Geriatric syndromes were highly prevalent. Many patients did not return to their premorbid function and acquired new syndromes.
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ABSTRACT: Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine. © 2015 Society of Hospital Medicine.Journal of Hospital Medicine 04/2015; 10(5). DOI:10.1002/jhm.2356 · 2.08 Impact Factor
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ABSTRACT: This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.04/2015; 6(2):e0017. DOI:10.5041/RMMJ.10201
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ABSTRACT: The number of people with functional limitations, cognitive impairment and disability with unscheduled, unintended contact to emergency departments seeking acute medical care is increasing. With this, the problem of how to identify elderly people in need for acute geriatric care has evolved. The best solution to the problem would be to perform comprehensive geriatric assessment during the initial contact; however, comprehensive geriatric assessment is considered too complex and therefore not feasible for emergency departments. Instead, screening instruments have been developed and proposed. In this narrative review, selected screening instruments are discussed. The instrument best studied in various settings and countries is the Identification of Seniors At Risk (ISAR) screening tool which contains six simple questions that are easy to administer and can be assessed even in urgent situations. In recent years, several studies have examined the validity of ISAR in different European countries. Most of these studies, including one German study and a recent systematic review, confirmed the validity of ISAR. Unfortunately, evidence is conflicting, as some studies found only weak or even no association between ISAR and negative health outcomes. Other instruments have been investigated to a lesser extent and do not indicate obvious advantages over ISAR. Despite growing evidence in the field, there are still many uncertainties. Further research is needed to solve existing inconsistencies and to assess how elderly patients screened positive for acute geriatric care needs can best be managed further. Zusammenfassung Die Anzahl an Patienten mit funktionellen Einschränkungen, kognitiver Einschränkung oder Behinderung, die ungeplant in Kontakt mit der Notaufnahme eines Krankenhauses kommen und akutmedizinischer Versorgung bedürfen, nimmt zu. Damit stellt sich zunehmend das Problem, wie ältere Patienten mit Bedarf einer akut-geriatrischen Behandlung identifiziert werden können. Die Durchführung eines umfassenden geriatrischen Assessments bei Erstkontakt könnte eine Lösung sein. Allerdings gilt das umfassende geriatrische Assessment als zu aufwendig und komplex, um sinnvoll in der Notaufnahme umsetzbar zu sein. Deshalb wurden verschiedene Screening-Instrumente entwickelt und vorgeschlagen. Das in verschiedenen Versorgungszusammenhängen und unterschiedlichen Ländern am besten untersuchte Instrument ist derzeit das ‚Identification of Seniors At Risk‘ (ISAR) Screening Instrument. Es besteht aus sechs einfachen Fragen, die rasch angewendet und auch in dringlichen Situationen erhoben werden können. In den letzten Jahren wurde die Validität des ISAR-Instruments in verschiedenen europäischen Ländern getestet. Die meisten Studien, eine Studie aus Deutschland und eine aktuelle systematische Übersicht eingeschlossen, bestätigen die Validität. Die Ergebnisse sind aber nicht widerspruchsfrei. Einige Studien haben nur einen schwachen oder gar keinen Zusammenhang zwischen ISAR und negativen Gesundheitsfolgen gefunden. Andere Instrumente wurden deutlich weniger gut untersucht und scheinen keinen offensichtlichen Vorteil zu bieten. Trotz der zunehmenden Evidenz zum Thema bleiben etliche Unsicherheiten bestehen. Weitere Studien werden benötigt, um bestehende Inkonsistenzen aufzulösen und zu klären, wie im Screening positive Patienten am besten weiter behandelt werden können.Zeitschrift für Gerontologie + Geriatrie 01/2015; 48(1):4-9. DOI:10.1007/s00391-014-0852-1 · 1.02 Impact Factor