A Prospective Cohort Study of Geriatric Syndromes Among Older Medical Patients Admitted to Acute Care Hospitals

The University of Queensland, Brisbane, Australia.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 10/2011; 59(11):2001-8. DOI: 10.1111/j.1532-5415.2011.03663.x
Source: PubMed


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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    • "Current practice in care settings generally focuses on continence containment rather than proactive management or identification of risk of incontinence (McCarthy, McCormack, Coffey, Wright, & Slater, 2009). For future practice Lakhan et al. (2011, p. 2007) recommend preventative interventions during hospitalisation, by way of ''better configuration of hospital systems to match patient's clinical needs.'' By ensuring timely ease of access, facilitation of independent toileting can occur and is a key component in continence promotion (Department of Health, 2012). "
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    • "Nevertheless, attention should be paid to the evolving gap between both age groups with respect to length of ED stay over time. This trend may reflect an emerging mismatch between the services offered by ED units and the complex needs of geriatric patients [16,22,23]. Furthermore, ED structures may be deleterious for these patients when, for instance, limited access to natural light promotes delirium in cognitively impaired patients and a cluttered environment may represent a fall hazard [24]. "
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    • "It is well known that older people are functionally worse and have poor quality of life following extended admissions to hospital [3,20,21]. However, it has not been known how much recovery has been possible. "
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