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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline.

ABSTRACT: BACKGROUND:The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. METHODS:Two hundred forty-two in-patients (57.4% male) aged 78.4?±?6.4?years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. RESULTS:The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (??=?-?0.19, 95% confidence interval (CI)?=?-?0.66;-0.13), number of admission diagnoses (??=?0.28, 95% CI?=?0.16;0.41), ADL impairment (B?=?6.66, 95% CI?=?3.312;10.01), and signs of depression (B?=?6.69, 95% CI?=?1.43;11.94) independently predicted length of hospital stay. ADL impairment (B?=?1.14, 95%CI?=?0.67;1.61), cognition impairment (B?=?0.57, 95% CI?=?0.07;1.07) and ISAR score (? =0.26, 95% CI?=?0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)?=?1.06, 95% CI?=?1.04;1.08), ADL impairment (RR?=?3.54, 95% CI?=?2.29;5.47), cognition impairment (RR?=?1.77, 95% CI?=?1.20;2.62) and signs of depression (RR?=?1.99, 95% CI?=?1.39;2.85) predicted receiving physiotherapy. CONCLUSION:Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

SUBMITTER: Scharf AC

PROVIDER: S-EPMC7035632 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline.

Scharf Anne-Carina AC Gronewold Janine J Dahlmann Christian C Schlitzer Jeanina J Kribben Andreas A Gerken Guido G Frohnhofen Helmut H Dodel Richard R Hermann Dirk M DM

BMC geriatrics 20200221 1

<h4>Background</h4>The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients.<h4>Methods</h4>Two hundred forty-two in-patients (57.4% male) aged 78.4 ± 6.4 years, who were consecutively admitted to i ...[more]

PMID: 32085737

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Project description:BackgroundThe Medicare Hospice Benefit increasingly serves people dying with dementia. We sought to understand characteristics, hospice use patterns, and last-month-of-life care quality ratings among hospice enrollees with dementia coexisting with another terminal illness as compared to enrollees with a principal hospice diagnosis of dementia, and enrollees with no dementia.MethodsWe conducted a pooled cross-sectional study among decedent Medicare beneficiaries age 70+ using longitudinal data from the National Health and Aging Trends Study (NHATS) (last interview before death; after-death proxy interview) linked to Medicare hospice claims (2011-2017). We used unadjusted and adjusted regression analyses to compare characteristics of hospice enrollees with coexisting dementia to two groups: (1) enrollees with a principal dementia diagnosis, and (2) enrollees with no dementia.ResultsAmong 1105 decedent hospice enrollees age 70+, 40% had coexisting dementia, 16% had a principal diagnosis of dementia, and 44% had no dementia. In adjusted analyses, enrollees with coexisting dementia had high rates of needing help with 3-6 activities of daily living, similar to enrollees with principal dementia (62% vs. 67%). Enrollees with coexisting dementia had high clinical needs, similar to those with no dementia, for example, 63% versus 61% had bothersome pain. Care quality was worse for enrollees with coexisting dementia versus principal dementia (e.g., 61% vs. 79% had anxiety/sadness managed) and similar to those with no dementia. Enrollees with coexisting dementia had similar hospice use patterns as those with principal diagnoses and higher rates of problematic use patterns compared to those with no dementia (e.g., 16% vs. 10% live disenrollment, p = 0.004).ConclusionsPeople with coexisting dementia have functional needs comparable to enrollees with principal diagnoses of dementia, and clinical needs comparable to enrollees with no dementia. Changes to hospice care models and policy may be needed to ensure appropriate dementia care.

Project description:BackgroundVascular risk factors, including inflammation, may contribute to dementia development. We investigated the associations between peripheral inflammatory biomarkers and cognitive decline in five domains (memory, construction, language, psychomotor speed, and executive function).MethodsCommunity-dwelling older adults from the Ginkgo Evaluation of Memory Study (n = 1,159, aged 75 or older) free of dementia at baseline were included and followed for up to 7 years. Ten biomarkers were measured at baseline representing different sources of inflammation: vascular inflammation (pentraxin 3 and serum amyloid P), endothelial function (endothelin-1), metabolic function (adiponectin, resistin, and plasminogen activating inhibitor-1), oxidative stress (receptor for advanced glycation end products), and general inflammation (interleukin-6, interleukin-2, and interleukin-10). A combined z-score was created from these biomarkers to represent total inflammation across these sources. We utilized generalized estimating equations that included an interaction term between z-scores and time to assess effect of inflammation on cognitive decline, adjusting for demographics (such as age, race/ethnicity, and sex), cardiovascular risk factors, and apolipoprotein E ε4 carrier status. A Bonferroni-adjusted significance level of .01 was used. We explored associations between individual biomarkers and cognitive decline without adjustment for multiplicity.ResultsThe combined inflammation z-score was significantly associated with memory and psychomotor speed (p < .01). Pentraxin 3, serum amyloid P, endothelin-1, and interleukin-2 were associated with change in at least one cognitive domain (p < .05).ConclusionOur results suggest that total inflammation is associated with memory and psychomotor speed. In particular, systemic inflammation, vascular inflammation, and altered endothelial function may play roles in domain-specific cognitive decline of nondemented individuals.

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline.

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline.

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