Frailty assessment, hip fracture and long‐term clinical outcomes in older adults

2020 ◽  
Author(s):  
Monica Pizzonia ◽  
Chiara Giannotti ◽  
Luca Carmisciano ◽  
Alessio Signori ◽  
Gianmarco Rosa ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Clinical Outcomes ◽  
Frailty Assessment

scholarly journals Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chan Mi Park ◽  
Wonsock Kim ◽  
Hye Chang Rhim ◽  
Eun Sik Lee ◽  
Jong Hun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Outcome ◽  
Long Term Care ◽  
Functional Decline ◽  
Tube Feeding ◽  
Term Care ◽  
Pneumonia Severity ◽  
Frailty Assessment ◽  
Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

The Association Between Body Mass Index, Frailty and Long-term Clinical Outcomes in Hospitalized Older Adults

2021 ◽  
Author(s):  
Prarthna V. Bhardwaj ◽  
Vida Rastegar ◽  
Rohini Meka ◽  
Khalid Sawalha ◽  
Maura Brennan ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Hospitalized Older Adults

scholarly journals The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video‐Captured Falls in Long‐Term Care

2020 ◽  
Vol 35 (10) ◽  
pp. 1914-1922 ◽  
Author(s):  
Yijian Yang ◽  
Vicki Komisar ◽  
Nataliya Shishov ◽  
Bryan Lo ◽  
Alexandra MB Korall ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Hip Fracture ◽  
Long Term Care ◽  
Term Care

scholarly journals Optimal setting and care organization in the management of older adults with hip fracture: a narrative review

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Andrea Giusti ◽  
Antonella Barone ◽  
Monica Razzano ◽  
Rita Raiteri ◽  
Andrea Del Rio ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Fragility Fractures ◽  
Early Discharge ◽  
Models Of Care ◽  
Narrative Review ◽  
Care Organization ◽  
Beneficial Effects ◽  
Optimal Setting

Hip fracture (HF) is a common event in older adults and is associated with significant morbidity, mortality, reduction of quality of life and costs for the healthcare systems. The expected rise in the total number of HF worldwide, due to improvements in life expectancy, and the growing awareness of HF detrimental consequences have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to streamline hospital care, minimize inhospital complications, provide early discharge, improve short- and long-term functional and clinical outcomes, and reduce healthcare costs associated with hip and other fragility fractures. The main feature that distinguishes these models is the different healthcare professional that retains the responsibility and leadership during the acute and post-acute phases. This narrative review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential beneficial effects on the shortand long-term outcomes, and to define the strengths and limitations of these models. On the basis of available studies, it seems that the more complex and sophisticated services, characterized by a multidisciplinary approach with a co-leadership (geriatrician and orthopedic surgeon) or a geriatrician leadership demonstrated to produce better outcomes compared to the traditional or simplest models.

scholarly journals Care trajectories of chronically ill older adult patients discharged from hospital: a quantitative cross-sectional study using health insurance claims data

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yvonne de Man ◽  
Femke Atsma ◽  
Wilma Jonkers ◽  
Sophia E. J. A. de Rooij ◽  
Gert P. Westert ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Cross Sectional Study ◽  
Community Nursing ◽  
Sectional Study ◽  
Post Discharge ◽  
Cross Sectional ◽  
Term Care ◽  
First 90 Days

Abstract Background For older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions. This paper presents the 6-month post-discharge healthcare utilization of older adults and describes the numbers of readmissions and deaths for the most frequently occurring aftercare arrangements as a starting point in optimizing the post-discharge healthcare organization. Methods This cross-sectional study included older adults insured with the largest Dutch insurance company. We described the utilization of healthcare within 180 days after discharge from their first hospital admission of 2015 and the most frequently occurring combinations of aftercare in the form of geriatric rehabilitation, community nursing, long-term care, and short stay during the first 90 days after discharge. We calculated the proportion of older adults that was readmitted or had died in the 90–180 days after discharge for the six most frequent combinations. We performed all analyses in the total group of older adults and in a sub-group of older adults who had been hospitalized due to a hip fracture. Results A total of 31.7% of all older adults and 11.4% of the older adults with a hip fracture did not receive aftercare. Almost half of all older adults received care of a community nurse, whereas less than 5% received long-term home care. Up to 18% received care in a nursing home during the 6 months after discharge. Readmissions were lowest for older adults with a short stay and highest in the group geriatric rehabilitation + community nursing. Mortality was lowest in the total group of older aldults and subgroup with hip fracture without aftercare. Conclusions The organization of post-discharge healthcare for older adults may not be organized sufficiently to guarantee appropriate care to restore functional activity. Although receiving aftercare is not a clear predictor of readmissions in our study, the results do seem to indicate that older adults receiving community nursing in the first 90 days less often die compared to older adults with other types of aftercare or no aftercare. Future research is necessary to examine predictors of readmissions and mortality in both older adult patients discharged from hospital.

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