Is There an Association between Norton Scale and Cognitive Impairment in Hip Fractured Elderly Patients?

<b><i>Introduction:</i></b> Geriatric assessment as an integrative part of assessment is a composite of a large number of scales. Sometimes it is difficult to transfer all of them. The Norton Scale Score (NSS) assesses the degree of risk to develop bedsores. In previous studies, a correlation between Norton Scale and function was found. A correlation between Norton Scale and cognitive assessments was not evaluated yet. The aim of this study was to determine if there is an association between Norton Scale Score and cognitive impairment. This association can further facilitate geriatric assessment in frail older patients, especially in older patients with communicative difficulties. <b><i>Methods:</i></b> We have performed an observational cohort study which included hip fractured older patients consecutively admitted to the rehabilitation ward of the Shmuel Harofe Geriatric Medical Center. The collected data included demographic data and data on chronic illnesses. Results of cognitive status assessment (Mini-Mental State Examination – MMSE) and Norton Scale assessment were received from the computerized patients’ charts. We evaluated the association between these 2 scales. <b><i>Results:</i></b> The study included 224 consecutive hip fracture patients with a mean age of 81.78 ± 7.19 years. Norton scores at admission, age, education, and previous stroke emerged as the only statistically significant parameters differing between those with cognitive decline and those without it. After adjusting for confounding variables, lower Norton scores at admission (OR 1.303, CI: 1.097–1.548, <i>p</i> = 0.003) were associated with an increased risk finding for cognitive impairment. <b><i>Conclusion:</i></b> Our findings suggest that there is an association between Norton Scale Scores and cognitive impairment. Norton score parameters, under certain circumstances, such as speech and other communication difficulties, can be used as a proxy measure for MMSE to indicate cognitive impairment. These findings can be even more helpful in the present time of “COVID-19,” when we have to evaluate older patients with facial masks and other defensive suits.

Impact of Nursing Methodology Training Sessions on Completion of the Virginia Henderson Assessment Record

The Virginia Henderson model, integrated in the computer application GACELA Care, helps to standardise the nursing assessment and establish precise and personalised nursing diagnoses. The aim was to determine the extent of completion of the initial patient assessment record after nurses following a training programme on nursing methodology. A quasi-experimental, retrospective, randomised, observational, single-group study was performed in two stages: pre-training and post-training. Voluntary training sessions were held for the nurses that work with GACELA Care. The completion of the initial patient assessment using the needs of Virginia Henderson and the Norton scale was evaluated before and after the training sessions. Completion of the needs of Virginia Henderson in the initial patient assessment increased from 94.2% to 100% (p = 0.014). Completion of “hygiene/skin” increased significantly from 83.3% to 95.8% (pre-training and post-training, respectively). The remaining needs did not show statistical significance. Recording of the Norton scale increased from 63.13% to 92.5% (p < 0.001). The training sessions on nursing methodology have improved the completion of records and inclusion of normal characteristics, defining characteristics and risk factors, and improving pressure ulcer risk assessment through the Norton scale.

Elderly patients with chronic heart failure have higher risk of geriatric syndromes: results of the nursing study

Background The prevalence of chronic heart failure (CHF) and geriatric syndromes increases with age, however the associations between these conditions have not yet been studied. Purpose To evaluate the associations between CHF and geriatric syndromes in elderly patients. Methods Four hundred and seventy-two in-patients (18% male) aged 75–100 (mean 81±4) years were included in the nursing study. Patients were examined by nurses with a specially designed nursing assessment algorithm that included Mini-Cog test, Morse Fall scale, Norton scale, Barthel Activities of daily living Index, Short Physical Performance Battery (SPPB) tests, Mini Nutritional Assessment (MNA) scale, Geriatric Depression Scale (GDS-15), and a number of other questionnaires. Results CHF was observed in 180 patients (38%). Functional class (FC) of II (NYHA) was diagnosed in 133 (74%) of them, FC of III – in 47 (26%). Patients with and without CHF did not differ by age and gender. CHF patients had lower points on Norton scale (17,6±2,0 vs 18,2±1,8; p&lt;0,001), Barthel Index (92,0±13,9 vs 95,0±9,1; p=0,009), SPPB (5,3±3,2 vs 6,0±3,3; p=0,018), and higher points on Morse Fall scale (44,3±19,9 vs 39,3±21,1; p=0,007) and GDS-15 (4,7±3,2 vs 4,2±3,3; p=0,041) compared to non-CHF patients. CHF patients had higher frequency of frailty (75% vs 65%; p=0,029), depression (47% vs 38%; p=0,041), and cognitive impairment (54% vs 41%; p=0,008). Univariate regression analysis showed that CHF presence increased the frailty risk by 1,6 times (OR 1,59; 95% CI 1,05–2,40; p=0,029), the depression risk – by 1,5 times (OR 1,48; 95% CI 1,02–2,16; p=0,041), and the cognitive impairment risk – by 1,7 times (OR 1,65; 95% CI 1,14–2,40; p=0,009). Among CHF patients, severity of CHF clinical manifestations correlated with severity of geriatric syndromes. CHF patients with FC of II had higher points of Norton scale (17,8±1,9 vs 16,9±2,1; p=0,005), Barthel Index (93,4±12,9 vs 88,3±15,8; p=0,005), SPPB (4,4±3,3 vs 3,9±3,0; p=0,001), walk speed (0,58±0,26 vs 0,45±0,22 m/s; p=0,002), and lower points of GDS-15 (4,4±3,3 vs 5,5±2,9; p=0,008) compared to CHF patients with FC of III. The frequency of depression was higher in CHF patients with FC of III (64% vs 41%; p=0,008). Univariate regression analysis showed that in CHF patients with FC of III the depression risk was higher by 2,5 times (OR 2,50; 95% CI 1,26–4,98; p=0,009) compared to CHF patients with FC of II. Conclusion Elderly CHF patients had higher risk of geriatric syndromes such as frailty, depression, and cognitive impairment. Among CHF patients, severity of CHF clinical manifestations correlated with severity of geriatric syndromes. Funding Acknowledgement Type of funding source: None

Assessment of pressure ulcers in physically handicapped patients

PurposeAssessment of pressure ulcers is an indicator of nursing care quality. In physically handicapped patients, the risk is elevated, due to the neuropathy and incontinence that frequently accompany paresis and paralysis. We conducted a systematic review of 4 assessment scales to assess their use and usefulness for these patients.Materials/methodsWe searched 5 databases for articles published between 2016 and 2018 that included terms related to the risk of pressure ulcers in physically handicapped patients, including the names of 4 assessment scales (Norton, Braden, Waterlow and Spinal Cord Injury Pressure Ulcer Scale). One hundred and three sources were returned, from which we selected 10. We also selected an earlier source, for a total of 11.ResultsThe Braden and Waterlow scales are popular in clinical practice. The Norton scale is used for scientific comparisons and in clinical practice only sporadically. Expert opinion suggests that acceptance of the Spinal Cord Injury Pressure Ulcer Scale could reduce the incidence of pressure ulcers in physically handicapped patients.ConclusionsIntroduction of a scale designed for handicapped patients, combined with better preventive measures, could result in the bedsore reduction of pressure ulcers. Research testing the effectiveness of the Spinal Cord Injury Pressure Ulcer Scale in the Czech population is needed to validate its use in clinical practice.