scholarly journals Contributing Factors to Hospital Readmissions

2013 ◽  
Author(s):  
Susan Amalfitano
Keyword(s):  
Elderly Patients ◽  
Hospital Readmission ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
The Elderly ◽  
High Rate ◽  
Chronic Obstructive ◽  
Contributing Factors ◽  
Obstructive Pulmonary Disease ◽  
Care Of Elderly

Aims and objectives. To investigate the elderly patient’s perspective about the reasons for discharge to home being unsuccessful, resulting in rehospitalization. Background. Elderly patients have a high rate of readmission to the hospital within 30 days of discharge. Starting in October of 2013, hospitals having a high rate of readmission of patients with heart failure (HF), myocardial infarction (MI), and pneumonia (PNA) will face financial penalties. Evidence indicated that by utilizing risk prediction tools and incorporating transition interventions the risk of a hospital readmission may be reduced. Design. A qualitative, descriptive design was used. Methods. In 2013, a student investigator interviewed elderly patients over the age of 65 who were readmitted to the hospital with the diagnosis of HF, MI, PNA or chronic obstructive pulmonary disease (COPD) within 30 days of discharge. A total of six (N=6) patients and/or surrogates participated in the interviews. Data were collected using semistructured interviews and subjected to thematic content analysis. Results. Three major themes emerged: discharge readiness, communication, and education. Implications for the advanced practice registered nurse (APRN). Practicing in an APRN role provides the opportunity for the nurse to facilitate the appropriate transitional care of elderly patients placing them at less risk for hospital readmission within 30 days.

scholarly journals Chronic obstructive pulmonary disease in patients with coronary heart disease of elderly age groups

2020 ◽  
pp. 19-19
Author(s):  
G.P. Voinarovska ◽  
E.O. Asanov
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Elderly Patients ◽  
Old Age ◽  
Age Groups ◽  
The Elderly ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Obstructive Pulmonary Disease

Background. Among the combinations of comorbid conditions, a special role belongs to the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD). Because COPD is often associated with CHD, most authors believe that there is a direct link between COPD, progression of bronchial obstruction, and pathological conditions of the cardiovascular system, including mortality from myocardial infarction. In elderly patients, according to some researchers, the link between COPD and CHD is most pronounced. Objective. To establish the frequency of COPD in patients with CHD in older age groups. Materials and methods. The studies are based on the results of a comprehensive survey of 635 patients with CHD aged 60-89 years, who were observed for a long time of the State Institution “Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine”. Results and discussion. The share of patients with CHD in whom COPD was detected in the group of elderly people is 19.4 %. This is much more than the average population. The frequency of COPD in patients with CHD decreases significantly with further aging. The prevalence of COPD among elderly patients is much lower than among elderly patients. This can most likely be explained by the fact that a significant proportion of patients with CHD with COPD do not live to old age. The analysis revealed that in elderly patients there is bronchial obstruction of more severe stages. This is due to the fact that CHD patients with COPD who live to old age have worsening bronchial patency due to the longer duration of the disease. It has been established that the majority of patients with CHD with COPD, both elderly and senile, are male. This can be explained by the negative effects of smoking. Conclusions. The incidence of COPD in patients with CHD in the elderly is much higher than in the population. At the same time, the incidence of COPD among patients with CHD in the elderly is much lower than among the elderly. In patients of advanced age bronchial obstruction is more expressed.

Hospital Readmissions: Patient, Carer and Clinician Views

2006 ◽  
Vol 5 (3) ◽  
pp. 104-107
Author(s):  
Elinor Kirk ◽  
◽  
M K Prasad ◽  
Ahmed H Abdelhafiz ◽  
◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Medical Condition ◽  
Hospital Readmissions ◽  
Chronic Obstructive ◽  
Medical Patients ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome

Aim: To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission. Methods: A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles. Results: Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged ≥75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients ≥ 75 years was noted (7.2% vs 5.1%, p=0.1). Conclusion: Although the majority of discharges are appropriate, up to a third of readmissions may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.

Survey of Depression in the Elderly Patients with Chronic Obstructive Pulmonary Disease

2013 ◽  
Vol 52 (3) ◽  
pp. 163 ◽  
Author(s):  
Seung-Hwan Sung ◽  
Hwa-Young Lee ◽  
Se-Hoon Shim ◽  
Hee-Yeun Jeong ◽  
Jae-Sung Choi ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Elderly Patients ◽  
Pulmonary Disease ◽  
The Elderly ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

scholarly journals Deep-Vein Thrombosis in the Elderly

2007 ◽  
Vol 14 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Gregory Piazza ◽  
Ali Seddighzadeh ◽  
Samuel Z. Goldhaber
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Elderly Patients ◽  
The Elderly ◽  
Chronic Obstructive ◽  
Thromboembolism Prophylaxis ◽  
Obstructive Pulmonary Disease ◽  
Vein Thrombosis ◽  
Venous Thromboembolism Prophylaxis ◽  
Deep Vein

Venous thromboembolism, including deep-vein thrombosis and pulmonary embolism, is a major source of morbidity and mortality among elderly patients. To improve our understanding of elderly patients with deep-vein thrombosis, we compared 1932 patients with deep-vein thrombosis aged 70 years or older with 2554 nonelderly patients in a prospective registry of consecutive ultrasound-confirmed deep-vein thrombosis patients. The mean age of elderly patients was 78.9 ± 6.1 years compared with 51.8 ± 12.9 years in nonelderly ( P < .0001). Elderly patients were more likely to have prior recent hospitalization (49.2% vs 44.7%, P = .03), congestive heart failure (20.5% vs 9.9%, P < .0001), chronic obstructive pulmonary disease (18.2% vs 11.7%, P < .0001), and recent immobilization (50.5% vs 39.6%, P < .0001) than the nonelderly patients. Elderly patients were less likely to present with typical deep-vein thrombosis symptoms of extremity discomfort (44.4% vs 60.6%, P < .0001) and difficulty ambulating (8.4% vs 11.2%, P = .002). Only 41% of elderly patients subsequently diagnosed with deep-vein thrombosis had received any venous thromboembolism prophylaxis. In conclusion, elderly patients with deep-vein thrombosis represent a particularly vulnerable population with numerous comorbid conditions. Diagnosis can present a challenge because typical deep-vein thrombosis symptoms may be absent. Fewer than 50% of elderly patients with deep-vein thrombosis had received any venous thromboembolism prophylaxis.

scholarly journals Improvement in Subjective Symptoms and Tolerability in Response to Nintedanib Treatment in Elderly Patients with Idiopathic Pulmonary Fibrosis

2020 ◽  
Vol 9 (3) ◽  
pp. 755 ◽  
Author(s):  
Takayuki Takeda ◽  
Yusuke Kunimatsu ◽  
Nozomi Tani ◽  
Izumi Hashimoto ◽  
Yuri Kurono ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Elderly Patients ◽  
The Elderly ◽  
Subjective Assessment ◽  
Phase Iii ◽  
Disease Assessment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Phase Iii Trials

The efficacy of nintedanib treatment in patients with idiopathic pulmonary fibrosis (IPF) was demonstrated in phase III trials. However, there is limited data on the significance of nintedanib in elderly patients aged ≥75 years. We have retrospectively evaluated 54 newly nintedanib-treated patients including 32 elderly individuals. Potential changes in modified medical research council (mMRC) grade and COPD (chronic obstructive pulmonary disease) assessment test (CAT) score, as well as in forced vital capacity (FVC) were obtained 6 months before, at the time of, and 6 and 12 months after initiation of nintedanib treatment. Significant differences were observed in CAT scores between 6 months before treatment and baseline (p < 0.001), and between baseline and 6 months (p < 0.001) and 12 months (p < 0.001) after treatment. If subjective improvement is defined as an improvement in mMRC grade or CAT score by 1 or 3 points, respectively, 25 patients (46.3%) have significantly improved after 6 months of treatment. Out of these, all have improved in CAT score. The tolerability of nintedanib was similar in elderly and younger patients. These findings suggest that CAT scores could be useful in the subjective assessment during nintedanib treatment, and that nintedanib is safe and efficient for the treatment of the elderly population.

THE ROLE OF FUNCTIONAL AND INSTRUMENTAL RESEARCH METHODS IN THE DIAGNOSIS AND CONTROL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN THE ELDERLY

2021 ◽  
pp. 750-755
Author(s):  
Т.В. Таютина ◽  
А.В. Лысенко ◽  
Т.М. Казарян ◽  
Д.С. Лысенко
Keyword(s):  
Elderly Patients ◽  
Morphological Changes ◽  
Clinical Signs ◽  
High Specificity ◽  
The Elderly ◽  
Underlying Disease ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Obstructive Pulmonary Disease

Более чем у 500 пожилых пациентов с ХОБЛ оценивали частоту применения спиральной КТ легких и эхо-КГ сердца с диагностической целью и для контроля за течением болезни. Проведенное исследование показало, что, несмотря на высокую клиническую значимость показателя ОФВ(объем форсированного выдоха за 1-ю секунду), сам показатель при постановке диагноза ХОБЛ у пожилых пациентов является крайне неспецифичным. Высокая специфичность КТ легких обусловливает необходимость использования данного диагностического метода у пожилых пациентов для выявления морфологических изменений легких при наличии клинических признаков бронхиальной обструкции и отрицательных данных спирометрии. Необходимо усилить роль эхо-КГ при диагностике хронического легочного сердца и стратификации тяжести основного заболевания у пожилых больных ХОБЛ. In more than 500 elderly patients with COPD, the frequency of spiral computed tomography (SCT) of the lungs and echo-CG of the heart was evaluated for diagnostic purposes and to monitor the course of the disease. The study showed that despite the high clinical significance of the FEV indicator (the volume of forced exhalation in the first second), the indicator itself is extremely non-specific when diagnosing COPD in elderly patients. The high specificity of lung CT makes it necessary to use this diagnostic method in elderly patients to detect morphological changes in the lungs in the presence of clinical signs of bronchial obstruction and negative spirometry data. It is necessary to strengthen the role of echocardiography in the diagnosis of chronic pulmonary heart disease and stratification of the severity of the underlying disease in elderly patients with COPD.

Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach

2019 ◽  
Vol 77 (6) ◽  
pp. 574-583 ◽  
Author(s):  
Peter May ◽  
Melissa M. Garrido ◽  
Egidio Del Fabbro ◽  
Danielle Noreika ◽  
Charles Normand ◽  
...  
Keyword(s):  
Competing Risks ◽  
High Mortality ◽  
Hospital Readmission ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hospital Readmission Rate ◽  
Diagnosis Of Cancer

Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Eligible participants were adult inpatients admitted to an academic, safety-net medical center (2009-2015) with at least one diagnosis of cancer, heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure, AIDS/HIV, and selected neurodegenerative conditions. PC was associated with reduced 30-, 60-, and 90-day readmissions (subhazard ratios = 0.57, 0.53, and 0.52, respectively [all p < .001]). Hospital PC is associated with a reduction in readmissions, and this is not explained by higher mortality among PC patients. Performance measures only counting those alive at a given end point may underestimate systematically the effects of treatments with a high-mortality rate.

scholarly journals Hypoxia resistance among the agedpatients with chronic obstructive lung disease: possibilities of using hypoxic trains

2020 ◽  
Vol 1 (1) ◽  
pp. 12-18
Author(s):  
Iryna Dyba ◽  
Ervin Asanov ◽  
Seviliya Asanova ◽  
Juliya Holubova
Keyword(s):  
Elderly Patients ◽  
Chronic Obstructive Lung Disease ◽  
The Elderly ◽  
The Body ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Obstructive Pulmonary Disease ◽  
Resistance To Hypoxia ◽  
Functional Changes ◽  
Age Related

Age-related morphological and functional changes in the body lead to the development of arterial hypoxemia, tissue hypoxia and hypoxic changes, which reduces the body's resistance to hypoxia and contributes to the development of lung diseases, in particular chronic obstructive pulmonary disease (COPD) in the elderly. The aim of the study was to clarify the effect of interval normobaric hypoxic training (INHT) on hypoxia resistance in elderly patients with COPD. The survey showed that with an increase in bronchial obstruction, the shifts of blood saturation during hypoxia increase. The course of INHT leads to increased resistance to hypoxia, and also increases the ventilation response to hypoxia in elderly patients with COPD.

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