Geriatric Events among Older Adults Undergoing Nonelective Surgery are Associated with Poor Outcomes

2019 ◽  
Vol 85 (10) ◽  
pp. 1089-1093 ◽  
Author(s):  
Jill Q. Dworsky ◽  
Christopher P. Childers ◽  
Timothy Copeland ◽  
Melinda Maggard-Gibbons ◽  
Hung-Jui Tan ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Admissions ◽  
Skilled Nursing Facility ◽  
Failure To Thrive ◽  
Small Bowel Resection ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Prolonged Length ◽  
Poor Outcomes ◽  
The Impact

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55–64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure ( P < 0.001). After adjustment, the probability of any GE increased with age category ( P < 0.001); having any GE was associated with higher probability of all outcomes ( P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose–response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.

scholarly journals 1206. Association of Aging, Frailty and Place of Residence with Skin, Oral and Gut Microbiome Characteristics and Pathogenicity Reservoirs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S625-S625
Author(s):  
Peter J Larson ◽  
Julia Oh ◽  
Julie Robison ◽  
James Grady ◽  
George Kuchel
Keyword(s):  
Older Adults ◽  
Gut Microbiome ◽  
Skilled Nursing Facility ◽  
Antibiotic Resistance Genes ◽  
Community Dwelling ◽  
Colonization Resistance ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Cutibacterium Acnes ◽  
Control And Prevention

Abstract Background Despite their elevated risk for morbidity and mortality from infections, the microbiota of older adults remain understudied. While colonization resistance from resident microflora is a promising means to prevent infections, little is known about pathogenicity reservoirs and colonization resistance in this vulnerable population. Here we study the skin, oral, and gut microbiome dynamics of older adults in both community and Skilled Nursing Facility (SNF) settings, investigating relationships between age, frailty, environment, microbiota, and pathogenicity reservoirs. Methods We conducted a longitudinal metagenome survey of 47 adults age 65+ years of age; 22 residents of 3 different SNFs and 25 community dwelling individuals. We performed metagenomic whole genome shotgun sequencing on stool, oral, and skin samples from 8 sites, 1421 total. To correlate clinical and behavioral variables, we measured frailty, collected medical records, and interviewed participants on diet and lifestyle. We also draw comparisons with previous younger cohorts. Results • Compared to younger adults, the skin microbiota of older adults was characterized by ◦ High heterogeneity ◦ Decreased stability over time, suggesting increased susceptibility to colonization and pathogenicity ◦ Compositional differences including significantly lower levels of Cutibacterium acnes, with reciprocal increases in Staphylococci, Corynebacteria, and Malassezia • In older adults, Frailty (Rockwood) was found to have linear correlation with relative abundance of species relevant to infection risk including acnes, staphylococci, streptococci, E. coli, Akkermansia mucinophila, and Enterococcus faecalis. • The skin, oral, and gut microbiota of SNF residents had substantially elevated virulence factor and antibiotic resistance genes. Conclusion To the best of our knowledge, this is largest report to date of the skin metagenome in older adults. We demonstrate distinct and significant differences between cohorts with clinically relevant implications. We believe these results may inform infection control and prevention by increasing our understanding of colonization resistance and pathogenicity reservoirs, as well as advance our knowledge of the relationship between aging, the microbiome, and infections. Disclosures All Authors: No reported disclosures

The effects of telehealth use for post-acute rehabilitation patient outcomes

2016 ◽  
Vol 24 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Stephanie A Hicks ◽  
Verena R Cimarolli
Keyword(s):  
Cognitive Functioning ◽  
Patient Outcomes ◽  
Skilled Nursing Facility ◽  
Functional Independence ◽  
Emergency Department Visits ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Care ◽  
Acute Rehabilitation ◽  
The Impact

Introduction Previous research has shown that home telehealth services can reduce hospitalisations and emergency department visits and improve clinical outcomes among older adults with chronic conditions. However, there is a lack of research on the impact of telehealth (TH) use on patient outcomes in post-acute rehabilitation settings. The current study examined the effects of TH for post-acute rehabilitation patient outcomes (i.e. discharge setting and change in functional independence) when controlling for other factors (e.g. cognitive functioning). Methods For this retrospective study, electronic medical records (EMRs) of 294 patients who were discharged from a post-acute rehabilitation unit at a skilled nursing facility were reviewed. Only patients with an admitting condition of a circulatory disease based on ICD-9 classification were included. Main EMR data extracted included use of TH, cognitive functioning, admission and discharge functional independence, and discharge setting (returning home vs. returning to acute care/re-hospitalisation). Results Results from a regression analysis showed that although TH use was unrelated to post-acute rehabilitation care transition, it was significantly related to change in functional independence. Patients who used TH during their stay had significantly more improvement in functional independence from admission to discharge when compared to those who did not use TH. Discussion Findings indicate that TH use during post-acute rehabilitation has the potential to improve patient physical functioning.

scholarly journals Clinical Courses and Characteristics of Residents During a SARS-CoV-2 Outbreak at a Central Indiana Skilled Nursing Facility

2020 ◽  
Vol 3 ◽  
Author(s):  
Lauren Albert ◽  
Kristi Lieb ◽  
Laramie Mack ◽  
Kathleen Unroe
Keyword(s):  
Older Adults ◽  
Case Reports ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk ◽  
Symptom Load ◽  
Retrospective Case Study

Background/Objective: Older adults such as skilled nursing facility residents have increased risk of serious SARS-CoV-2 infection and comprise a large proportion of the COVID-19 pandemic’s deceased—the US Centers for Medicare & Medicaid Services report 232,831 cases and 38,518 resident deaths to date. Recent case reports reveal, as in other diseases, older adults may experience atypical symptomology, complicating identification of ill residents and efforts to slow transmission. While a few facility outbreaks have been characterized epidemiologically, little research exists regarding clinical timelines and trajectories which residents experience during COVID-19 illness.   Methods: From May 9, 2020-June 1, 2020, daily notes on each COVID-19 positive resident’s status (n = 69) were taken by the medical director of a central Indiana nursing facility. Combined with a retrospective resident chart review of this same period, these notes were examined for COVID-19 infection symptoms and illness timelines to descriptively categorize a number of common illness trajectories and symptoms seen in residents with SARS-CoV-2 infection.  Results: Residents fit four descriptive clinical timelines: concurrent symptom load with quick death (Avg 5.6 days) (n = 5), accumulating symptom load with gradual decline (Avg. 13.9 days) (n = 9), prolonged active symptom load with periods of stabilization and symptom reoccurrence (n = 42), and asymptomatic or atypical symptom load (n = 12). Most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. Of the 14 residents who died (20.3% of infected), 8 died in the facility and 6 died in the hospital.  Conclusion and Implications: This retrospective case study adds to literature describing the presentation and symptomology of SARS-CoV-2 infection in residents of skilled nursing facilities and aids efforts to evaluate resident presentation, prognosis, and disease course. Robust descriptions of expected clinical courses may support realistic expectations of disease progression for residents and their family members experiencing future outbreaks.

The Impact of a Skilled Nursing Facility on the Cost of Surgical Treatment of Major Head and Neck Tumors

2001 ◽  
Vol 127 (9) ◽  
pp. 1086 ◽  
Author(s):  
Hadi Seikaly ◽  
Karen H. Calhoun ◽  
Jana S. Stonestreet ◽  
Christopher H. Rassekh ◽  
Brian P. Driscoll ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Skilled Nursing Facility ◽  
Head And Neck Tumors ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Neck Tumors ◽  
The Cost ◽  
The Impact

scholarly journals Impaired Arousal in Older Adults Is Associated With Prolonged Hospital Stay and Discharge to Skilled Nursing Facility

2015 ◽  
Vol 16 (7) ◽  
pp. 586-589 ◽  
Author(s):  
Andrea M. Yevchak ◽  
Jin Ho Han ◽  
Kelly Doherty ◽  
Elizabeth G. Archambault ◽  
Brittany Kelly ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Stay ◽  
Skilled Nursing Facility ◽  
Prolonged Hospital Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Prolonged Hospital

scholarly journals POLICY AND QUALITY: THE IMPACT ACT OF 2014 AND DEVELOPMENT OF THE SKILLED NURSING FACILITY QUALITY REPORTING PROGRAM

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 26-27
Author(s):  
A Ptaszek ◽  
A Deutsch ◽  
Q Li ◽  
A Cool ◽  
L Smith ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Quality Reporting ◽  
The Impact

Abstract P35: Mild or Improving Stroke is the Most Frequently Documented Reason for Not Giving rt-PA in Time-Eligible Acute Ischemic Stroke Patients: Findings From Get With the Guidelines-Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Eric E Smith ◽  
Gregg C Fonarow ◽  
Mathew J Reeves ◽  
Margueritte Cox ◽  
DaiWai Olson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
National Study ◽  
Stroke Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Poor Outcomes ◽  
Get With The Guidelines

Introduction: Previous studies suggest that mild or improving stroke is a frequently cited reason for not giving IV rt-PA and that some of these patients have poor outcomes. Methods: We examined the frequency of rt-PA use and contraindications among acute ischemic stroke patients arriving ≤2 hrs in the Get With The Guidelines-Stroke Program. Results: Between 4/1/2003-9/29/2009 there were 98,708 patients who arrived directly to the hospital within 2 hours. Among these patients 26.4% received IV rt-PA, 30.9% did not receive rt-PA solely because of mild/improving stroke, 28.6% had other contraindications, and 14.1% had no documented contraindications. From 2003-2009 rtPA use increased, the proportions not given rtPA despite no documented contraindications decreased, and the proportions with mild/improving stroke or other contraindications were similar (Figure). The initial NIH Stroke Scale (NIHSS) was recorded in 62.1% with mild/improving stroke and 82.3% given rt-PA; 75% of mild/improving stroke patients had NIHSS <5 while 90% of IV rt-PA-treated patients had NIHSS ≥5. Short-term outcomes in patients with mild/improving stroke were not always good: 1.1% died, 0.7% were discharged to hospice, 10.3% to a skilled nursing facility and 15.1% to an inpatient rehabilitation facility. Conclusion: In this large national study, mild/improving stroke is the most common reason for not giving rt-PA to early arriving patients. More patients are excluded because of mild/improving stroke than are treated with rt-PA. When deciding whether to withhold thrombolysis in patients with mild/improving stroke, clinicians should consider the risk of poor outcomes in this population.

scholarly journals Trends in inpatient discharges with drug or alcohol admission diagnoses to a skilled nursing facility among older adults, New York City 2008–2014

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Benjamin H. Han ◽  
Ellenie Tuazon ◽  
Hillary V. Kunins ◽  
Denise Paone
Keyword(s):  
Older Adults ◽  
New York ◽  
New York City ◽  
York City ◽  
Functional Limitations ◽  
Skilled Nursing Facility ◽  
Age Groups ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

Abstract Background Recent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults. However, no study examines trends in discharges to a skilled nursing facility (SNF) after a drug or alcohol-related hospitalization. Older adults are more likely to need post-hospital care in a SNF after a hospitalization due to an increased presence of chronic diseases and functional limitations. Therefore, the objective of this study was to estimate trends in drug or alcohol-related hospitalizations with discharge to a SNF among adults age 55 and older. Methods We analyzed data from New York State’s Statewide Planning and Research Cooperative System to calculate the number of cannabis, cocaine, opioid, and alcohol-related hospitalizations in New York City that resulted in discharge to a SNF from 2008 to 2014 among adults age 55 and older. Using New York City population estimates modified from US Census Bureau, we calculated age-specific rates per 100,000 adults. Trend tests were estimated using joinpoint regressions to calculate annual percentage change (APC) with 95% confidence intervals (CI) and stratified by adults age 55–64 and adults age 65 and older. Results During the study period, among adults age 55–64, there were significant increases in cocaine, cannabis, and opioid-related hospitalizations that resulted in discharge to a SNF. For adults ≥ 65 years, there were sharp increases across all substances with larger increases in opioids (APC of 10.66%) compared to adults 55–64 (APC of 6.49%). For both age groups and among the four substances, alcohol-related hospitalizations were the leading cause of discharge to a SNF. Conclusions We found an increase in hospital discharges to SNFs for patients age 55 and older admitted with alcohol or drug-related diagnoses. Post-acute and long-term care settings should prepare to care for an increase in older patients with substance use disorders by integrating a range of harm reduction interventions into their care settings.

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