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Sample records for hospitalized elderly medical

  1. Relationship of in-hospital medication modifications of elderly patients to postdischarge medications, adherence, and mortality.

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    Mansur, Nariman; Weiss, Avraham; Beloosesky, Yichayaou

    2008-06-01

    Medication regimens are constantly modified and updated during a patient's hospitalization. These modifications and those made after discharge might increase the risk for nonadherence, polypharmacy, and poor outcomes among elderly patients. To investigate the extent of in-hospital modification of medication regimens of elderly patients and its relationship to medication adherence as well as one-month postdischarge drug regimen modifications and to examine the relationship of the modifications, adherence, and polypharmacy to mortality and readmissions 3 months postdischarge. Clinical and demographic data, postdischarge medication modifications, and adherence were prospectively obtained in 212 elderly patients. Inhospital drug regimen modifications were retrospectively recorded. The average +/- SD in-hospital medication regimen modification rate was 49.8% +/- 28.4. No modifications were found in 9.7% of the patients. Using demographic and clinical parameters, we performed regression analysis and found that patients who were admitted with polypharmacy, discharged home, and cognitively normal experienced fewer medication modifications (p medication regimen modification rate was 37.5% +/- 25.4. In- and posthospital modifications were directly correlated (p = 0.047). Three months postdischarge, 17 patients had died and 50 had been readmitted. The independent risk factors for mortality were in-hospital modification rate of 50% or greater (OR 6.4; 95% CI 1.3 to 29.7), impaired cognition (OR 4.2; 95% CI 1.4 to 12.3), and each chronic disease (OR 1.2; 95% CI 1 to 1.5). No relationships were found between in-hospital medication regimen modifications and readmissions or with postdischarge modifications, adherence, and polypharmacy to mortality and readmissions. Hospitalization of elderly patients is characterized by extensive medication regimen modifications, which are directly correlated with postdischarge modifications and may indicate an increased risk of mortality.

  2. A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly.

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    Helvik, Anne-Sofie; Engedal, Knut; Skancke, Randi H; Selbæk, Geir

    2011-10-01

    Few psychometric studies of the Hospital Anxiety and Depression Scale (HADS) scale have been performed with clinical samples of elderly individuals. The participants were 484 elderly (65-101 years, 241 men) patients in an acute medical unit. The HADS, the Montgomery-Aasberg Depression Rating Scale (MADRS) and questionnaires assessing quality of life, functional impairment, and cognitive function were used. The psychometric evaluation of the HADS included the following analyses: 1) the internal construct validity by means of principal component analysis followed by an oblique rotation and corrected item-total correlation; 2) the internal consistency reliability by means of the alpha coefficient (Cronbach's) and 3) concurrent validity by means of Spearman's rho. We found a two-factor solution explaining 45% of the variance. Six of seven items loaded adequately (≥0.40) on the HADS-A subscale (item 7 did not) and five of seven items loaded adequately on the HADS-D subscale (items 8 and 10 did not). Cronbach's alpha for the HADS-A and HADS-D subscale was 0.78 and 0.71, respectively. The correlation between HADS-D and the MADRS, a measure of the concurrent validity, was 0.51. The HADS appears to differentiate well between depression and anxiety. The internal consistency of the HADS in a sample of elderly persons was as satisfactory as it is in samples with younger persons. In contrast to younger samples, item 8 ("I feel as if I have slowed down") did not load adequately on the HADS-D subscale. This may be attributed to the way elderly people experience and describe their symptoms.

  3. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria.

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    Momin, Taufik G; Pandya, Rushi N; Rana, Devang A; Patel, Varsha J

    2013-01-01

    To detect the prevalence and pattern of use of Potentially inappropriate medications (PIMs) in hospitalized elderly patients of a tertiary care teaching hospital using Beers 2012 criteria and to compare the same with Beers 2003 criteria. Prescriptions of the elderly patients aged 65 years and above were collected from the medicine ward and analyzed. PIMs were identified with help of Beers 2003 and Beers 2012 criteria and comparison was made between the two criteria. Predictors associated with use of PIM were identified using bivariate and multivariate logistic regression analysis. A total of 210 patients received 2,267 drugs. According to Beers 2003 criteria, 60 (28.57%) elderly patients received at least one PIM and 2.9% drugs were prescribed inappropriately. According to Beers 2012 criteria, 84 (40%) elderly received at least one PIM while 22 (10.47%) received multiple PIMs and about 5% drugs were prescribed inappropriately. The most commonly prescribed PIM was mineral oil-liquid paraffin (30, 14.3%) followed by spironolactone (25, 11.9%), digoxin (19, 9%), and benzodiazepines (14, 6.7%). There was a significant association between the number of patients receiving more than six drugs and the use of PIMs (P PIMs in the elderly. The study shows high prevalence of prescribing PIMs in hospitalized elderly patients. Beers 2012 criteria are more effective in identifying PIMs than Beers 2003 criteria.

  4. Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials.

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    Martínez-Velilla, N; Cadore, L; Casas-Herrero, Á; Idoate-Saralegui, F; Izquierdo, M

    2016-01-01

    To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. Systematic review of the literature. A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.

  5. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

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    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  6. Inappropriate Medication Prescriptions among Elders Surviving an Intensive Care Unit (ICU) Hospitalization

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    Morandi, A; Vasilevskis, EE; Pandharipande, PP; Girard, TD; Solberg, LM; Neal, EB; Koestner, T; Torres, RE; Thompson, JL; Shintani, AK; Han, JH; Schnelle, JF; Fick, DM; Ely, EW; Kripalani, S

    2013-01-01

    Background Elderly patients admitted to intensive care units (ICU) are at risk of receiving potentially (PIMs) and actually inappropriate medications (AIMs). Objectives To determine types of PIMs and AIMs, which PIMs are most likely to be considered AIMs, and risk factors for PIMs and AIMs at hospital discharge in elderly ICU survivors. Design Prospective cohort study Setting Tertiary care, academic medical center Participants 120 patients ≥ 60 years old who survived an ICU hospitalization Measurements PIMs were defined according to published criteria; AIMs were adjudicated by a multidisciplinary panel. Medication lists were abstracted at the time of pre-admission, ward admission, Intensive Care Unit (ICU) admission, ICU discharge, and hospital discharge. Poisson regression was used to examine independent risk factors for hospital discharge PIMs and AIMs. Results Of 250 PIMs prescribed at discharge, the most common were opioids (28%), anticholinergics (24%), antidepressants (12%), and drugs causing orthostasis (8%). The three most common AIMs were anticholinergics (37%), non-benzodiazepine hypnotics (14%), and opioids (12%). Overall, 36% of discharge PIMs were classified as AIMs, but the percentage varied by drug type. Whereas only 16% of opioids, 23% of antidepressants, and 10% of drugs causing orthostasis were classified as AIMs; 55% of anticholinergics, 71% of atypical antipyschotics, 67% of non-benzodiazepine hypnotics and benzodiazepines, and 100% of muscle relaxants were deemed AIMs. The majority of PIMs and AIMs were first prescribed in the ICU. Pre-admission PIMs, discharge to somewhere other than home, and discharge from a surgical service predicted number of discharge PIMs, but none of the factors predicted AIMs at discharge. Conclusions Certain types of PIMs, which are commonly initiated in the ICU, are more frequently considered inappropriate upon clinical review. Efforts to reduce AIMs in elderly ICU survivors should target these specific classes of

  7. Inappropriate medication prescriptions in elderly adults surviving an intensive care unit hospitalization.

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    Morandi, Alessandro; Vasilevskis, Eduard; Pandharipande, Pratik P; Girard, Timothy D; Solberg, Laurence M; Neal, Erin B; Koestner, Tyler; Torres, Renee E; Thompson, Jennifer L; Shintani, Ayumi K; Han, Jin H; Schnelle, John F; Fick, Donna M; Ely, E Wesley; Kripalani, Sunil

    2013-07-01

    To determine types of potentially (PIMs) and actually inappropriate medications (AIMs), which PIMs are most likely to be considered AIMs, and risk factors for PIMs and AIMs at hospital discharge in elderly intensive care unit (ICU) survivors. Prospective cohort study. Tertiary care, academic medical center. One hundred twenty individuals aged 60 and older who survived an ICU hospitalization. Potentially inappropriate medications were defined according to published criteria; a multidisciplinary panel adjudicated AIMs. Medications from before admission, ward admission, ICU admission, ICU discharge, and hospital discharge were abstracted. Poisson regression was used to examine independent risk factors for hospital discharge PIMs and AIMs. Of 250 PIMs prescribed at discharge, the most common were opioids (28%), anticholinergics (24%), antidepressants (12%), and drugs causing orthostasis (8%). The three most common AIMs were anticholinergics (37%), nonbenzodiazepine hypnotics (14%), and opioids (12%). Overall, 36% of discharge PIMs were classified as AIMs, but the percentage varied according to drug type. Whereas only 16% of opioids, 23% of antidepressants, and 10% of drugs causing orthostasis were classified as AIMs, 55% of anticholinergics, 71% of atypical antipyschotics, 67% of nonbenzodiazepine hypnotics and benzodiazepines, and 100% of muscle relaxants were deemed AIMs. The majority of PIMs and AIMs were first prescribed in the ICU. Preadmission PIMs, discharge to somewhere other than home, and discharge from a surgical service predicted number of discharge PIMs, but none of the factors predicted AIMs at discharge. Certain types of PIMs, which are commonly initiated in the ICU, are more frequently considered inappropriate upon clinical review. Efforts to reduce AIMs in elderly ICU survivors should target these specific classes of medications. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  8. Study of Inappropriate Medication Prescribed to Elderly Hospitalized Patients Using the Screening Tool to Alert Doctors to Right Treatment

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    Mahya Mirzaei

    2016-07-01

    Conclusion: Since issues relating to the appropriate medications prescribed among the elderly can have serious implications, the drugs prescribed for the elderly are very important. Supervising the prescription, supply, and rational use of drugs is very vital and effective and acts as an integral part of the health budget allocated to the drug. Therefore, hospitals need to readily consult with the trained physicians and consider the expert opinions of clinical pharmacists in handling this problem.

  9. Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients

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    Ana Fajreldines

    2018-01-01

    Full Text Available Together, potentially inappropriate prescribing of medications (PIP and appropriate prescribing omission (APO constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE. This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment. The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

  10. Pneumonia and hospitalizations in the elderly

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    Francesco Cacciatore

    2017-05-01

    Full Text Available Pneumonia in the elderly is a common and severe problem. In this review we analyze the state of the art for pneumonia in the elderly. Several aspects are discussed: i how common is the disease; signs and symptoms in the elderly; ii the elderly must always be hospitalized and which is the best place - Intensive Care Unit or medical ward?; iii the role of comorbidities; iv etiology and pathogenesis; medical treatment - when and how to start; v antibiotic resistance; vi antibiotics in hospital acquired and ventilator related pneumonia; vii assisted non-invasive ventilation; viii the treatment in the terminally ill elderly patient.

  11. Potentially inappropriate medication use in elderly patients: A study of prevalence and predictors in two teaching hospitals

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    Harugeri A

    2010-01-01

    Full Text Available Background: Geriatrics is an emerging clinical specialty in India. Information about the appropriateness of prescription medication use among the elderly in India is limited. Aims: To determine the prevalence and predictors of potentially inappropriate medication (PIM use, and assess the relationship between PIM use and adverse drug reactions (ADRs in the hospitalized elderly. Settings: Medicine wards at two teaching hospitals. Design: Prospective observational study. Materials and Methods: Patients aged > 60 years admitted to medicine wards between January 2008 and June 2009 were included and reviewed for PIM use according to the Beers Criteria 2003 (BC. Severity of PIM use was classified as per BC as ′high′ or ′low′. ADRs observed in the study patients were also recorded. Statistical Analysis: Association between ADRs and PIM use was assessed using Chi Square test. Bivariate analysis and subsequently multivariate logistic regression was used to identify predictors of PIM use. Results: PIM use was observed in 191 of 814 enrolled patients. At least one PIM at admission and during hospital stay was received by 2.4% (20 and 22.1% (180 patients respectively. High-severity PIM use showed a higher prevalence compared to low severity [26.8% (218 vs. 5.5% (45]. Amongst the patients who received polypharmacy (> 5 concurrent medications, 1.4% (5/362 and 22.1% (163/736 patients received PIMs at admission and during hospital stay respectively. Use of aspirin/clopidogrel/diclofenac in the presence of blood clotting disorder or anticoagulant therapy (8.3% was the most commonly encountered PIM use. Medications not listed in BC were associated with increased occurrence of ADRs compared to medications listed in BC (349 vs. 11 (χ2 =98.4, P<0.001. Increased number of concurrent medications′ use (≥9 during the stay in medicine wards was identified as an influential predictor of PIM use [Odds ratio: 1.9, 95% Confidence Interval: 1.34-2.69, P<0.001 in

  12. A high-protein diet during hospitalization is associated with an accelerated decrease in soluble urokinase plasminogen activator receptor levels in acutely ill elderly medical patients with SIRS

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    Tavenier, Juliette; Haupt, Thomas Huneck; Andersen, Aino L

    2017-01-01

    Acute illness and hospitalization in elderly individuals are often accompanied by the systemic inflammatory response syndrome (SIRS) and malnutrition, both associated with wasting and mortality. Nutritional support and resistance training were shown to increase muscle anabolism and reduce...... inflammation in healthy elderly. We hypothesized that nutritional support and resistance training would accelerate the resolution of inflammation in hospitalized elderly patients with SIRS. Acutely admitted patients aged >65 years with SIRS were randomized to an intervention consisting of a high-protein diet...... accelerate recovery in acutely ill elderly medical patients....

  13. Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

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    Jui-Chen Tsai

    2012-09-01

    Conclusion: Although the initial resuscitation success rate was not affected by age, a longer time interval between the last medical staffs’ visit and the onset of resuscitation did result in a worse success rate in elderly patients. Our data suggest that more frequent staff visits to the elderly population during hospitalization could alter initial resuscitation results.

  14. Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case-control study

    National Research Council Canada - National Science Library

    Goldberg, Amanda; Straus, Sharon E; Hamid, Jemila S; Wong, Camilla L

    2015-01-01

    Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence...

  15. Pattern of medication use among older inpatients in seven hospitals in Italy: results from the CRiteria to assess Appropriate Medication use among Elderly complex patients (CRIME) project.

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    Tosato, Matteo; Settanni, Silvana; Antocicco, Manuela; Battaglia, Miriam; Corsonello, Andrea; Ruggiero, Carmelinda; Volpato, Stefano; Fabbietti, Paolo; Lattanzio, Fabrizia; Bernabei, Roberto; Onder, Graziano

    2013-04-01

    Prescribing pharmacological treatment for hospitalized older patients represents a challenge for physicians. In particular, hospitalized older adults present with acute and chronic diseases, which may require multiple treatments and increase their susceptibility to adverse drug reactions. Patterns of drugs use have rarely been investigated in these patients. To describe patterns of drugs use among hospitalized older adults participating in the CRiteria to assess Appropriate Medication use among Elderly complex patients (CRIME) project. We performed a cross-sectional multicentre study based on data from the CRIME project, a study performed in geriatric and internal medicine acute care wards of 7 Italian hospitals. The only two exclusion criteria were: age < 65 years old and unwillingness to participate in the study. Participants were assessed at hospital admission and followed until discharge. Mean (Standard Deviation) age of 1123 participants was 81.5 (7.4) years, with 629 (56%) being women and 572 participants (51%) were admitted from Emergency Room. Mean length of stay was 11.2 (6.7) days. Mean number of drugs used greatly varied before (6.2, SD 3.2), during (10.6, SD 5.6) and after (7.1, SD 3.1) hospitalization. No difference in the number of drugs used during hospital stay was observed across age groups. During hospital stay, drugs for acid related disorders (77.9%) and antithrombotic agents (76.8%) were the most commonly used drugs, followed by drugs acting on the renin-angiotensin system (58.0%) and diuretics (57.1%). Very common was the use of psycholeptics (34.3%) and psychoanaleptics (22.4%). Use of multiple drug treatments is common in hospitalized older adults and hospitalization is associated with a substantial increment in the number of drugs used, with no differences across age groups.

  16. Frequency and nature of adverse drug reactions in elderly in-patients of two Indian medical college hospitals

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    A Harugeri

    2011-01-01

    Full Text Available Background : Adverse drug reactions (ADRs are a major public health problem in the elderly. Although the Indian elderly represent 12.8% of the entire global elderly population, data on prevalence and predictors of ADRs in elderly Indians is extremely limited. Aim : To determine the prevalence, severity, preventability, length of hospital stays, and risk factors for ADRs in hospitalized Indian elderly. Setting : Medicine wards of two tertiary care teaching hospitals. Design : Prospective study was conducted between July 2007 and December 2009. Materials and Methods : In-patients of either sex and aged ≥60 years were included and monitored for ADRs throughout their hospital stay. Severity (Hartwig et al. scale, preventability (Shumock and Thornton criteria and increased length of stay (considering underlying disease, ADR, and discussion with clinicians were assessed. Statistical Analysis : Bivariate analysis and subsequently multivariate logistic regression were used to determine the risk factors for developing ADRs. Results : Over the study period, among the 920 patients monitored, 296 patients (32.2% experienced 419 ADRs. Among all ADRs, 48.4% (203 were preventable. Majority of ADRs [226 (53.9%] were moderate in severity. Therapeutic classes of drugs frequently associated with ADRs were the drugs used in diabetes [76 (18.1%] and antibacterials for systemic use [54 (12.9%]. ADRs increased the hospital stay in 5.9% (54 of patients. Female gender [Odds Ratio: 1.52, 95% Confidence Interval:1.04-2.22, P=0.03] was observed as the influential risk factor for ADRs. Conclusion : One third of hospitalized elderly experienced ADRs. Interventions focused at preventable ADRs should be developed and implemented to reduce their implications.

  17. Brief hospitalizations of elderly patients

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    Strømgaard, Sofie; Rasmussen, Søren Wistisen; Schmidt, Thomas Andersen

    2014-01-01

    BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less......, swollen or painful leg conditions, dyspnea, suspected parenchyma surgical disease and problems with the urinary system or catheters. The most common diagnoses given at hospital were chronic cardiovascular disease, bacterial infection, symptoms deriving from bone, muscle or connective tissue, liquid...

  18. Preventing hospital admissions by reviewing medication (PHARM) in primary care : an open controlled study in an elderly population

    NARCIS (Netherlands)

    Leendertse, A. J.; de Koning, G. H. P.; Goudswaard, A. N.; Belitser, S. V.; Verhoef, M.; de Gier, H. J.; Egberts, A. C. G.; van den Bemt, P. M. L. A.

    2013-01-01

    What is known and objective Limited and conflicting evidence exists on the effect of a multicomponent pharmaceutical care intervention (i.e. medication review, involving collaboration between general practitioners (GPs), pharmacists and patients) on medication-related hospitalizations, survival,

  19. Prevalence of Beers Criteria Medications Among Elderly Patients in a Military Hospital

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    Edward K. Osei CPT, PharmD

    2016-03-01

    Full Text Available Objective: This study aims to examine potentially inappropriate medication (PIM prevalence and factors that affect the use of PIMs in a military treatment facility. Method: Admission and discharge medication lists of 60 patients aged ≥65 years were retrospectively reviewed by a clinical pharmacist and a member of the study team for the presence of PIM using the 2012 Beers Criteria. Patients included were those discharged between December 2012 and September 2013 from the Womack Army Medical Center, Internal Medicine unit. Results: Among the 60 patients evaluated, 44 (73% were on at least one PIM at admission, whereas the prevalence of PIM at discharge (30 patients was 50% ( p 10 medications at admission (37, 62% were 4 times more likely to have a PIM ( p < .001. Conclusion: Data showed a high and a previously unknown PIM prevalence among older adults in a U.S. military treatment facility.

  20. Taste loss in hospitalized multimorbid elderly subjects

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    Toffanello ED

    2013-02-01

    Full Text Available ED Toffanello,1 EM Inelmen,1 A Imoscopi,1 E Perissinotto,2 A Coin,1 F Miotto,1 LM Donini,3 D Cucinotta,4 M Barbagallo,5 E Manzato,1 G Sergi11Department of Medical and Surgical Sciences, Geriatrics Division and University of Padova, Padova, 2Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy; 3Department of Medical Physiopathology (Food Science Section, University of Roma, La Sapienza, Roma, 4S Orsola Malpighi Hospital, Bologna, 5Geriatric Unit, Department of Internal Medicine and Emerging Diseases, University of Palermo, Palermo, ItalyBackground: Loss of the sense of taste is common among older people. Morbidities and polypharmacy may contribute to the age-related decline in gustatory function. The aims of the present study were to investigate taste perception in elderly hospitalized patients by comparing their taste recognition thresholds with those of healthy, free-living elderly individuals and to identify potential determinants of taste loss.Methods: The participants in this observational study were 55 elderly patients hospitalized in the acute geriatric section of the Department of Medical and Surgical Sciences at Padova University and 41 free-living individuals aged older than 65 years, randomly recruited from elderly people attending mild fitness programs at public gymnasiums in Padova. Data were collected on nutrition, health, cognitive, and functional status for all participants. Gustatory capabilities were assessed using aqueous solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride (representing sweet, salty, sour, and bitter stimuli, respectively, and taste recognition thresholds were measured in both groups.Results: In comparison with the free-living elderly subjects, those in hospital were significantly less able to recognize the taste of citric acid (P < 0.05. Low citric acid sensitivity was independently associated with advanced age (≥75 years; odds ratio [OR] 3

  1. Elder and Caregiver Solutions to Improve Medication Adherence

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    O'Quin, K. E.; Semalulu, T.; Orom, H.

    2015-01-01

    Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We…

  2. Potentially inappropriate medications among elderly Brazilian outpatients

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    Christine Grützmann Faustino

    Full Text Available CONTEXT AND OBJECTIVESIn Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed for elderly outpatients, identify the PIMs most commonly involved, and investigate whether age, sex and number of medications are related to prescription of such medications.DESIGN AND SETTINGObservational descriptive study developed in the Geriatrics Service of the Central Institute of Hospital das Clínicas (HC, Faculdade de Medicina da Universidade de São Paulo (FMUSP, São Paulo, Brazil.METHODSPrescriptions issued to 1,270 elderly patients (≥ 60 years were gathered from a database. These prescriptions had been written by geriatricians at a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. The prescriptions were divided according to sex and age group (60-69, 70-79 and ≥ 80. The Beers criteria were used to evaluate PIMs.RESULTSMost of the sample comprised women (77% and the mean age was 80.1 years. The mean prevalence of PIM prescriptions was 26.9%. Female sex and number of medications prescribed were associated with prescription of PIMs. The chance of having a PIM prescription was lower among patients ≥ 70 years.CONCLUSIONThe greater prevalence of PIMs was correlated with female sex. The chance of having a PIM prescription was lower among patients ≥ 70 years and became greater with increasing numbers of medications prescribed (≥ 7.

  3. Development and validation of the Thai version of the 4 ‘A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses

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    Kuladee S

    2016-02-01

    Full Text Available Sanchai Kuladee, Thanavadee Prachason Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: The English version of the 4 ‘A’s Test (4AT is a rapid screening tool for delirium with a high sensitivity and specificity among hospitalized elderly patients.Objective: To develop the Thai version of the 4AT (4AT-T and assess its validity.Subjects and setting: A total of 97 elderly patients aged 60 years or above who were admitted to the general medical wards were included.Methods: Both authors independently translated the English version of the 4AT into Thai and thereafter developed a single reconciled forward translation by consensus. Back translation was performed by a bilingual native English speaker and it was then reviewed to ensure its agreement with the original one. After 24 hours of admission, subjects were enrolled and clinical data collected. Definite diagnosis of delirium was made by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria and the 6-item Thai Delirium Rating Scale; the 4AT was then administered to participants by nurses within 30 minutes. A 4AT score ≥4 was considered positive for delirium screening. The optimal cut-off point of the 4AT-T was identified by Youden’s index.Results: In all, 24 out of 97 participants met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria for delirium. At a cut-off score of 4 or greater, the 4AT-T exhibited satisfactory diagnostic performance with a sensitivity of 83.3% (95% confidence interval (CI: 62.6%–95.3% and specificity of 86.3% (95% CI: 76.3%–93.2%. The area under the receiver operating characteristic curve was 0.92. The specified score provided maximal Youden’s index, suggesting an optimal criterion value for delirium screening.Conclusion: The 4AT-T is a valid delirium-screening instrument for hospitalized

  4. Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients.

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    Jørgensen, Lise Walther; Søndergaard, Kasper; Melgaard, Dorte; Warming, Susan

    2017-12-01

    Oropharyngeal dysphagia (OD) is prevalent among medical and geriatric patients admitted due to acute illness and it is associated with malnutrition, increased length of stay and increased mortality. A valid and reliable bedside screening test for patients at risk of OD is essential in order to detect patients in need of further assessment. The Volume-Viscosity Swallow Test (V-VST) has been shown to be a valid screening test for OD in mixed outpatient populations. However, as reliability of the test has yet to be investigated in a population of medical and geriatric patients admitted due to acute illness, we aimed to determine the interrater reliability of the V-VST in this clinical setting. Reporting in this study is in accordance with proposed guidelines for the reporting of reliability and agreement studies (GRRAS). In three Danish hospitals (CRD-BFH, CRD-GH, NDR-H) 11 skilled occupational therapists examined an unselected group of 110 patients admitted to geriatric or medical wards. In an overall agreement phase raters reached ≥80% agreement before data collection phase was commenced. The V-VST was applied to patients twice within maximum one hour by raters who administrated the test in an order based on randomization, blinded to each other's results. Agreement, Kappa values, weighed Kappa values and Kappa adjusted for bias and prevalence are reported. The interrater reliability of V-VST as screening test for OD in patients admitted to geriatric or medical wards was substantial with an overall Kappa value of 0.77 (95% CI 0.65-0.89) however interrater reliability varied among hospitals ranging from 0.37 (95% CI -0.01 to 0.41) to 0.85 (95% CI 0.75-1.00). Interrater reliability of the accompanying recommendations of volume and viscosity was moderate with a weighted kappa value of 0.55 (95% CI 0.37-0.73) for viscosity and 0.53 (95% CI 0.36-0.7) for volume. The overall prevalence of OD was 34.5%, ranging from 8% to 53.6% across hospitals. The prevalence and bias

  5. Prescribing Patterns and Inappropriate Use of Medications in Elderly ...

    African Journals Online (AJOL)

    Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary hospital in Nigeria. Methods: A retrospective study was carried out among elderly subjects (age 60 years) who were issued prescriptions in the outpatients department of ...

  6. Causes of mortality among the elderly in a Nigerian hospital ...

    African Journals Online (AJOL)

    Hospital (UPTH). Methods: The medical records of all patients aged 60 years and above admitted in the medical wards of UPTH from June 2002 to May 2006 were reviewed. Results: A total of 300 deaths occurred in the elderly during the period. Diseases of the cardiovascular system were responsible for 149 (49.6%)

  7. Managing personal integrity: the process of hospitalization for elders.

    Science.gov (United States)

    Jacelon, Cynthia S

    2004-06-01

    Although, in the United States of America (USA), 40% of people aged 75 years old and older are hospitalized each year, the literature does not provide insight into their perspectives on hospitalization. The study was designed to illuminate the experience and behaviours of hospitalized elders, discover the meaning of that experience for them, and develop a substantive theory that could explain the social processes in which elders engaged while hospitalized. Interviews and participant observation data were used to develop a grounded theory. Participants had to be at least 75 years old, speak English, have been admitted to the hospital for medical (non-surgical) reasons, and be able to give informed consent. The elder, a family member, and a registered nurse caring for the elder were interviewed. Two-hour periods of observation were conducted throughout the elder's hospital stay. Computer-assisted data analysis included open, axial and theoretical coding. Techniques to improve the trustworthiness of the research included persistent observation, participant checking, a peer research support group and an audit conducted by an expert gerontology nurse researcher. Hospitalization was characterized as a process beginning when an alteration in health is identified and continuing through to the process of adjusting to returning home. Personal integrity was found to be a dynamic, intrinsic quality of the self, composed of health, dignity and autonomy. During hospitalization, elders used strategies to manage their personal integrity. At first, elders focused on strategies relating to health and then moved on to dignity and, finally, autonomy. Hospitalized elders choose how they will interact with health care providers and the actions they will take to manage their health, dignity and autonomy. The findings have implications for developing nursing care and for further research.

  8. Factors affecting medication adherence in elderly people.

    Science.gov (United States)

    Jin, Hyekyung; Kim, Yeonhee; Rhie, Sandy Jeong

    2016-01-01

    Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants' FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher's exact test, and multiple regression analyses were used to analyze the data. The mean score of the total FHL was 7.72±3.51 (range 0-15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient's degree of satisfaction with the service (β=-0.215, P =0.022), sufficient explanation of medication counseling (β=-0.335, P =0.000), education level (β=-0.153, P =0.045), health-related problems (β=-0.239, P =0.004), and dosing frequency (β=0.189, P =0.018). In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients' individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient satisfaction with the counseling.

  9. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study)

    NARCIS (Netherlands)

    Stevenson, Jennifer; Parekh, Nikesh; Ali, Khalid; Timeyin, Jean; Bremner, Stephen; van der Cammen, T.J.M.; Allen, Jane; Schiff, Rebekah; Harchowal, Jatinder; Davies, Graham; Rajkumar, Chakravarthi

    2016-01-01

    Background: Medication related harm (MRH) is a common cause of morbidity and hospital admission in the elderly, and has significant cost implications for both primary and secondary healthcare resources. The development of risk prediction models has become an increasingly common phenomenon in

  10. Factors affecting medication adherence in elderly people

    Directory of Open Access Journals (Sweden)

    Jin HK

    2016-10-01

    Full Text Available Hyekyung Jin,1 Yeonhee Kim,2 Sandy Jeong Rhie1,3 1College of Pharmacy, 2Center for Excellence in Teaching & Learning, 3Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea Background: Little is known about the functional health literacy (FHL associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods: This was a cross-sectional survey. Participants (n=160 aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results: The mean score of the total FHL was 7.72±3.51 (range 0–15. The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=-0.215, P=0.022, sufficient explanation of medication counseling (β=-0.335, P=0.000, education level (β=-0.153, P=0.045, health-related problems (β=-0.239, P=0.004, and dosing frequency (β=0.189, P=0.018. Conclusion: In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists

  11. Medical implications of elder abuse and neglect.

    Science.gov (United States)

    Dong, XinQi

    2005-05-01

    Recognition of elder abuse and neglect among health care professionals has been a relatively recent phenomenon. Each year, millions of elderly persons suffer as the result of abuse and neglect. Their quality of life is severely jeopardized in the form of worsened functional status and progressive dependency, poorly rated self-health, feelings of helplessness, and from the vicious cycle of social isolation, stress and further psychologic decline. Other medical implications of abuse and neglect include higher health systems use in the form of frequent ER visits, higher hospitalization, and higher nursing home placement; most importantly, it is an independent predictor for higher mortality. Physicians are well situated in detecting and reporting suspected cases and taking care of the frail elders who are victims of abuse and neglect, but there are barriers on the individual level, and there is a broader need for system change. Through education, training, and reinforcement, there are strategies to get health care professionals more involved and provide effective management protocols and guidelines for us to advocate for our patients in the current epidemic of elder abuse and neglect.

  12. Assessing the nutritional status of hospitalized elderly.

    Science.gov (United States)

    Abd Aziz, Nur Adilah Shuhada; Teng, Nur Islami Mohd Fahmi; Abdul Hamid, Mohd Ramadan; Ismail, Nazrul Hadi

    2017-01-01

    The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. A literature search was performed on six databases using the terms "malnutrition", "hospitalised elderly", "nutritional assessment", "Mini Nutritional Assessment (MNA)", "Geriatric Nutrition Risk Index (GNRI)", and "Subjective Global Assessment (SGA)". According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future.

  13. Assessing the nutritional status of hospitalized elderly

    OpenAIRE

    Abd Aziz,Nur Adilah Shuhada; Teng, Nur Islami Mohd Fahmi; Abdul Hamid, Mohd Ramadan; Ismail, Nazrul Hadi

    2017-01-01

    Purpose The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. Methods A literature search was performed on six databases using the terms “malnutrition”, “hospitalised elderly”, “nutritional assessment”, “Mini Nutritional Assessment (MNA)”, “Geriatric Nutrition Ri...

  14. Sociodemographic profile and hospitalization process of elderly assisted at a emergency hospital

    Directory of Open Access Journals (Sweden)

    Maria Luciene Nobre Coutinho

    2015-12-01

    Full Text Available Objectives: to investigate the sociodemographic profile and the process of hospitalization of elderly assisted in an emergency hospital. Methods: descriptive epidemiological study conducted at an emergency hospital with 300 elderly patients using a form with hospitalization process and sociodemographic variables. Results: there was a predominance of females (56.0%, between 80 and 89 years old (45.4%, illiterate or with elementary education (86.7%, married or living in stable union (42.6%, with non-communicable chronic disease (54.7% and regular use of medications. The main reason for hospitalization was fall (54.7% at home and in the morning hours (42.4%, with admission in the afternoon, transported by ambulance. Conclusion: the findings contribute to the development of strategies directed to assist and care of the healthy elderly and in vulnerable situations.

  15. Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients

    DEFF Research Database (Denmark)

    Jørgensen, Lise Walther; Søndergaard, Kasper; Melgaard, Dorte

    2017-01-01

    Background: Oropharyngeal dysphagia (OD) is prevalent among medical and geriatric patients admitted due to acute illness and it is associated with malnutrition, increased length of stay and increased mortality. A valid and reliable bedside screening test for patients at risk of OD is essential...

  16. Clinical and epidemiological analysis of hospitalizations of elderly due to poisoning and adverse effects of medications, Brazil from 2004 to 2008.

    Science.gov (United States)

    de Paula, Tatiana Cruz; Bochner, Rosany; Montilla, Dalia Elena Romero

    2012-12-01

    The elderly are more susceptible to adverse drugs effects due to a variety of factors, such as excessive and concomitant use of several drugs, administration errors, physiological changes in the body that alter the pharmacodynamics and pharmacokinetics. In order to determine the main therapeutic classes involved in hospital admissions of elderly people due to intoxication and adverse drug effects, as well as major health problems related to these events, 9,793 hospitalizations of people aged 60 or over registered in the Hospital Information System of the Unified Health System (SIH-SUS) in the period of 2004 to 2008 were analyzed. Unspecified drugs, systemic antibiotics, psychotropics, psychoactives, antiepileptics, sedatives, hypnotics and antiparkinsonians accounted for 57% of the total of admissions analyzed. Injuries and falls were the main health problems related to intoxication and adverse drug effects. Hospitalizations due to injuries were associated with analgesic, antipyretic and antirheumatic non-opioid. Falls were associated with systemic antibiotics, contradicting studies which point out psychotropic drugs as the main drug involved in these events. The results reflect the growing trend of problems associated with drug use by elderly people. It was verified that the consumption profile alone is not sufficient to explain the concentration of cases of the major therapeutic classes. We suggest the adoption of more effective programs of pharmacovigilance, capable of intervening at different stages of drug use: prescribing, dispensing, marketing, administration and compliance.

  17. [Causes of death in hospitalized elderly patients].

    Science.gov (United States)

    Nakajima, Naoya; Aiba, Miyoji; Fukuda, Yukiko; Boku, Soushin; Isonuma, Hiroshi; Tsuda, Hiroshi; Hayashida, Yasuo

    2009-01-01

    The Juntendo Tokyo Koto Geriatric Medical Center (JTKGMC) is a community hospital catering for the health care needs of senior citizens, and 37.5% (120 beds) of its beds are psychiatric beds mostly for those with cognitive impairment. The purpose of this study was to analyze cause of death in a hospital like ours with its particular case mix. All patients who passed away in our hospital between June 1st 2002 and November 30th 2007 were surveyed with regard to their age distribution and causes of death were analyzed and compared with available national statistics. The over 65 age group accounted for 93.5% of the total and consisted of 815 patients, including 461 men (56.6%) and 354 women (43.4%). The most common cause of death was malignant neoplasm, followed by pneumonia, cardiovascular diseases, cerebrovascular accidents, and renal failure. Among those who died from the primary disease diagnosed on admission, malignancy was most common (288 cases, 61.3%), followed by pneumonia, cerebrovascular accidents, cardiovascular diseases and renal failure. As for those who died from non-primary diagnosis on admission (patients dying due to any condition, not the direct reason of their admission), pneumonia was the most common diagnosis on admission (95 cases, 27.5%), followed by cardiovascular diseases, malignant neoplasm, sepsis and renal failure. In the general wards, above half of those who died due to the primary cause of admission was malignant neoplasm. On the other hand, 1/4 of those who died from causes other than the primary diagnosis on admission was pneumonia. In the mental health wards the most common cause of death due to the primary diagnosis was malignant neoplasm, followed by dementia of Alzheimer's type. The most common cause of death other than the primary reason for admission was pneumonia. More non-primary diagnosis deaths occurred in the mental health wards than in the general wards. In our hospital, malignancy and pneumonia were the most common causes

  18. DYSELECTROLYTEMIA IN ELDERLY: A HOSPITAL BASED STUDY

    Directory of Open Access Journals (Sweden)

    Tanushree

    2016-03-01

    Full Text Available INTRODUCTION Dyselectrolytemia is a common problem affecting elderly hospitalised patients. Although hypo/hypernatremia is the most common electrolyte abnormality found in elderly, abnormalities in other electrolytes may also occur in various settings. Information regarding the pattern of electrolyte abnormalities in elderly is lacking in this part of the country. With this background the following case control study was taken up with the following aims and objectives. OBJECTIVES • To study the various patterns of dyselectrolytemia in elderly and compare them with young. • To evaluate and compare the various aetiological factors and comorbid conditions involved in the occurrence of electrolyte abnormalities in these groups of patients. RESULTS The mean age of the study population was 66.174 years (SD- 6.512 years and of the control group was 41.94 years (SD - 10.924 years. Hyponatraemia was the most common electrolyte abnormality encountered in both the groups (57% vs. 60%, p- 0.61. The incidence of hyperkalaemia was significantly higher in the older age group (19.5% vs. 11.5%, p-0.03. Also, in the elderly, the presence of abnormalities in more than one electrolyte level was significantly higher than the young (25.5% vs. 14%, p -0.005. The average length of hospital stay in the elderly was 10.05 days (SD- 4.40 days whereas in the young was 6.35 days (SD- 3.27 days, p <0.0001. The mortality rate was also significantly higher in the elderly group (16% vs. 3.5%, p<0.0001. CONCLUSION Dyselectrolytemia is a common pathological condition encountered in the elderly population which is associated with a very high morbidity and mortality when compared with the young. Hence, elderly patients particularly with associated comorbid conditions should be screened routinely for the presence of associated electrolyte disturbances.

  19. Assessing the nutritional status of hospitalized elderly

    Science.gov (United States)

    Abd Aziz, Nur Adilah Shuhada; Teng, Nur Islami Mohd Fahmi; Abdul Hamid, Mohd Ramadan; Ismail, Nazrul Hadi

    2017-01-01

    Purpose The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. Methods A literature search was performed on six databases using the terms “malnutrition”, “hospitalised elderly”, “nutritional assessment”, “Mini Nutritional Assessment (MNA)”, “Geriatric Nutrition Risk Index (GNRI)”, and “Subjective Global Assessment (SGA)”. Results According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. Conclusion It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future. PMID:29042762

  20. Attitudes and behaviors of hospital staff toward elders in an acute care setting.

    Science.gov (United States)

    Jacelon, Cynthia S

    2002-11-01

    This study was a grounded-theory approach to the social processes engaged in by elderly people while in the hospital. Staff behaviors were identified along two continua, attitude, which affected the elders' dignity and autonomy, and managing care, which affected the elders' health. Elders described the physicians' role as the director of their health care. The elders characterized the nurses' role to provide their medications and direct needs, whereas the nurses identified their role as providing education and emotional support. Implications and recommendations for practice are offered. Copyright 2002, Elsevier Science (USA). All rights reserved.

  1. The survival prognosis of elderly undernourished inpatients admitted to the internal medical department of an emergency hospital as assessed using the nutritional screening, tool CONUT (for CONtrolling NUTritional status).

    Science.gov (United States)

    Niwano, Mototaka

    2017-01-01

    CONUT, a tool for "CONtrolling NUTritional status" assesses the nutritional status of a subject by taking into account their serum albumin level, total cholesterol level and total lymphocyte count. Elderly undernourished inpatients admitted to the internal medical department were divided into two groups, those who left the hospital and those who died in the hospital. The goal of this study was to analyze whether or not the CONUT score, serum albumin level, total cholesterol level and total lymphocyte count could predict the survival prognosis of elderly undernourished inpatients and to show the ratio of patients discharged with artificial hydration and nutrition (AHN). We divided elderly undernourished inpatients into two groups, those who left the hospital (229 patients) and those who died in the hospital (363 patients), and examined the serum albumin level, total cholesterol level and total lymphocyte count within 10 days before discharge or death. Based on the degree of undernutrition as determined by CONUT, we further classified the patients 4-into four levels of nutrition status, normal, light undernutrition, moderate undernutrition and severe undernutrition. In addition, based on the serum albumin level, total cholesterol level and total lymphocyte count, the patients were also classified 4-into four levels of nutrition status, and we calculated the ratio of AHN patients in the discharged group. On comparing the discharge and death groups according to the degree of undernutrition, serum albumin level, total cholesterol level and total lymphocyte count, significant differences were found between the groups of all nutrition statuses except moderate undernutrition. Furthermore, the patients with moderate undernutrition status demonstrated no statistically significant difference in both groups, except the serum albumin level. Among the discharged patients, the ratio of AHN was 37.0% in those with a normal nutrition status and more than 50% in the patients with

  2. The hidden curriculum of the medical care for elderly patients in medical education: a qualitative study.

    Science.gov (United States)

    Meiboom, Ariadne; Diedrich, Chantal; Vries, Henk De; Hertogh, Cees; Scheele, Fedde

    2015-01-01

    Despite more attention being given to geriatrics in medical curricula, few new physicians are seeking training in this field. So far, there has been no exploration of factors in the hidden curriculum that could potentially influence the persisting lack of interest in this field of medicine. To study this hidden curriculum in medical education in relation to medical care of elderly patients, the authors used a qualitative research design including participant observations on two internal medicine wards in a teaching hospital and semistructured interviews. The results showed that elderly patients with multiple problems are seen as frustrating and not interesting. Medical students were not stimulated to go into the totality of medical problems of elderly patients. They picked up a lot of disparaging remarks about these patients. The mainly negative attitudes demonstrated by role models, in particular the residents, may potentially influence the development of future doctors and their choice of career.

  3. Medical and surgical complications of inflammatory bowel disease in the elderly: a systematic review.

    Science.gov (United States)

    Shung, Dennis L; Abraham, Bincy; Sellin, Joseph; Hou, Jason K

    2015-05-01

    The complications of therapy, hospitalization, and surgery related to inflammatory bowel disease (IBD) in the elderly are not well described. While multiple reviews have described the management and complications of elderly patients with IBD, none have been performed in a systematic fashion. We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the association between elderly patients with IBD and complications from therapy, hospitalizations, and surgery. Eligible studies were identified via structured keyword searches in PubMed and manual literature searches. A total of 5,644 publications were identified. Of these, fourteen studies met inclusion criteria, encompassing 963 elderly IBD patients (113 Crohn's disease and 850 ulcerative colitis patients), over 37,000 hospitalizations of elderly IBD patients and over 4,500 controls. Consistent associations were observed between increased age and higher nocturnal stool frequency post-ileal pouch anal anastomosis. Only two studies met inclusion criteria for medication-related complications, one observed an increased mortality and infection risk among elderly patients treated with tumor necrosis factor antagonists and the other observed increased hospital-related complications among elderly patients treated with steroids. Elderly patients with IBD are at an increased risk of hospital- and therapy-related complications. We found a paucity of high-quality studies evaluating outcomes in elderly patients with IBD. Further studies of elderly patients with IBD are needed to further evaluate the effect of age on medical and surgical complications.

  4. Malnutrition prevalence in hospitalized elderly diabetic patients.

    Science.gov (United States)

    Sanz París, Alejandro; García, José M; Gómez-Candela, Carmen; Burgos, Rosa; Martín, Ángela; Matía, Pilar

    2013-01-01

    Malnutrition prevalence is unknown among elderly patients with diabetes mellitus. Our objectives were to determine malnutrition prevalence in elderly in patients with diabetes, and to describe their impact on prognosis. An observational multicenter study was conducted in 35 Spanish hospitals. Malnutrition was assessed with the Mini Nutritional Assessment (MNA) tool. Patients were followed until discharge. 1,090 subjects were included (78 ± 7.1 years; 50% males). 39.1% had risk of malnutrition, and 21.2% malnutrition. A 15.5% of the malnourished subjects and 31.9 % of those at risk had a BMI ≥ 30 kg/m(2). In multivariate analysis, female gender (OR = 1.38; 95% CI: 1.19-1.11), age (OR = 1.04; 95% CI: 1.02-1.06) and presence of diabetic complications (OR = 1.97; 95% CI: 1.52-2.56) were associated with malnutrition. Length of stay (LOS) was longer in at-risk and malnourished patients than in well-nourished (12.7 ± 9.9 and 15.7 ± 12.8 days vs 10.7 ± 9.9 days; p elderly in patients with diabetes was observed, regardless of BMI. Malnutrition, albumin, and MNA score were related to LOS, mortality and home discharge. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

  5. Older people's perspectives on an elderly-friendly hospital environment: an exploratory study

    Directory of Open Access Journals (Sweden)

    Karki S

    2015-05-01

    Full Text Available Sushmita Karki,1 Dharma Nand Bhatta,1,2 Umesh Raj Aryal3 1Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal; 2Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand; 3Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal Background: Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people's perspectives on an "elderly-friendly" hospital. Methods: Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. Results: Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people's health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. Conclusion: Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that

  6. Agitation in the medically ill elderly

    African Journals Online (AJOL)

    Summary. Agitation is a common and significant problem in the medically ill elderly. It is responsible for diminished quality of life for not only the patient, but the caregivers as well as the patient's relatives. This paper will illustrate the concept of agitation and different modes of classification. The major emphasis will be placed ...

  7. Detecting Depression in Elderly Medical Inpatients.

    Science.gov (United States)

    Rapp, Stephen R.; And Others

    1988-01-01

    Used Research Diagnostic Criteria to assess base rate of detection of depression in 150 elderly medical inpatients by nonpsychiatric physicians, and evaluated psychometric properties of screening instruments to assess depression. Found detection of depression by house staff extremely low (8.7 percent). Beck Depression Inventory (BDI), BDI…

  8. HIV infection in elderly medical patients | Mtei | East African Medical ...

    African Journals Online (AJOL)

    HIV infection in elderly medical patients. L. N. Mtei, P. Pallangyo. Abstract. (East African Medical Journal: 2001 78(3): 144-147). Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/eamj.v78i3.9081 · AJOL African Journals Online.

  9. Ten ways to improve the care of elderly patients in the hospital.

    Science.gov (United States)

    Labella, Angelena Maria; Merel, Susan Eva; Phelan, Elizabeth Anne

    2011-01-01

    Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital. This article addresses these issues with 10 evidence-based pearls developed to help hospitalists provide optimal care for this expanding population. Copyright © 2011 Society of Hospital Medicine.

  10. Predictors of falling in elderly hospital patients.

    Science.gov (United States)

    Salgado, Raja I; Lord, Stephen R; Ehrlich, Frederick; Janji, Nabil; Rahman, Abdur

    2004-01-01

    A prospective study was conducted to determine whether a brief clinical assessment conducted soon after admission can accurately identify older people who fall while staying in an acute hospital. Eighty-eight non-bedfast patients aged 80-99 years took part in the study. Within 3 days of admission, these patients were assessed for the following measures: impaired orientation on the MMSE, psychoactive medication use, evidence of stroke, and impaired ability on the Get-Up-and-Go-test. The major presenting condition for each patient was also recorded. Patients were then followed up to determine whether they fell while in hospital. Impaired orientation on the MMSE, evidence of previous cerebrovascular accident, and major presenting conditions of falls and confusion were significantly associated with falls while in hospital. There was also a trend indicating that psychoactive medication use was elevated in the fallers. In contrast, there was no difference in the proportion of fallers and non-fallers who had impaired ability in the Get-Up-and-Go-test. Of the 15 patients who fell, 13 had two or more risk factors, and after controlling for possible confounding factors of age, sex and length of stay, the presence of two-plus risk factors remained strongly and significantly associated with falls (adjusted OR = 13.43; 95% CI = 1.91 - 94.40). The findings indicate that a simple screening protocol can accurately identify patients at risk of falling while in hospital.

  11. [Nursing experience with reducing delirium in a hospitalized elderly patient].

    Science.gov (United States)

    Wang, Shiao-Pei

    2006-10-01

    This article describes an experience of providing nursing care to an eighty year-old patient with urinary tract infection (UTI). The author cared for this patient in the role of clinical geriatric nurse specialist from May 11 to 23 in 2005. Through comprehensive assessment, careful review of medical records, contact with family and nursing home healthcare workers, it was determined that the patient's cognition and physical function declines were due to delirium resulting from the last time the patient had been hospitalized in the intensive care unit (ICU). In order to prevent incidents of delirium, three nursing goals were set: controlling infection, avoidance of delirium recurrence, and recovery of prior levels of physical function and self-care ability. Nursing interventions used included UTI control, tube and catheter removal as early as possible, control of environmental factors, and muscle strength and exercise training. After two weeks of care, the patient could take food orally and the nasogastric (NG) tube had been successfully removed. Physical function and self-care ability improved from "dependent" to "partial assistance". Although UTI was controlled, removal of the foley tube failed due to prostate hypertrophy. No delirious event occurred during hospitalization and cognitive functions improved. From this experience, early assessment and intervention should be conducted for high-risk elderly patients in order to prevent delirious events and declines in cognitive and physical functions. The author hopes this case report will prove a useful reference to nurses charged with caring for elderly patients at risk for delirium.

  12. Depression and associated factors in hospitalized elderly: a cross-sectional study in a Saudi teaching hospital.

    Science.gov (United States)

    Alamri, Sultan Hassan; Bari, Abdulaziz Ihsan; Ali, Abdulrahman Talal

    2017-01-01

    Depression in the elderly is a serious and often underdiagnosed psychiatric disorder that has been linked to adverse outcomes in the hospital setting. To determine the prevalence of depression and possible associated factors among hospitalized elderly. An analytical cross-sectional study. Medical and surgical wards of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study included 200 consecutively hospitalized patients aged 60 years and older. Participants were evaluated within 48 hours of admission using an interviewer-administered question-naire to provide basic demographic and clinical information. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) screening method and the Structured Clinical Interview for the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) mood disorder module. According to PHQ-9, 17% and 10.5% of the hospitalized patients were diagnosed with a major depressive disorder and other depressive disorders, respectively. The DSM-5 criteria identified 12% of elderly with major depression. Overall, the number of comorbidities associated with depression was signifi-cantly higher in the major depressive disorder group than in the no depression group (post hoc P=.022). Depression was also associated with female gender, unmarried status, lower income, and polypharmacy. In addition, cardiovascular disease and cancer were the most prevalent medical illnesses associated with depression among hospitalized elderly. Major depressive disorder was prevalent among hospitalized elderly, especially among those with comorbid conditions. Hospital physicians must, therefore, maintain a high index of suspicion to identify early and manage depressive symptoms in these patients. The small size of certain subgroups limits the statistical power to examine for associations of depression with particular conditions.

  13. Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

    Science.gov (United States)

    McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.

    2009-01-01

    This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a…

  14. Outcomes in elderly fall victims: what happens after hospital discharge?

    Science.gov (United States)

    Larson, Lance M; Sliter, Robert; Helmer, Stephen D; Reyes, Jared; Crawford, Greg; Haan, James M

    2016-12-01

    Falls are the leading cause of trauma-related death in the elderly, but postdischarge outcomes' data are lacking. The purpose of this study was to evaluate 12-month postdischarge mortality and causes of death. A retrospective review was conducted of patients 65 years and older admitted for a fall and discharged alive. Data collection included demographics, injury characteristics, hospitalization details, and outcomes. A state death database and hospital records were queried to identify patients who died within 12 months of hospital discharge. Of 347 patients meeting inclusion criteria, 74 (21.3%) died within 12 months postdischarge. These patients were older than those who survived (83.4 vs 79.1 years, P death, whereas several comorbidities were more common in those who died. Death was fall-related in 13 of 74 (17.6%) who died. Injury characteristics do not predict postdischarge mortality. However, pre-existing comorbidities, including advanced age were predictive of postdischarge mortality. Further study is needed to determine whether a focus on medical optimization can reduce 1-year postdischarge death. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Medication safety during your hospital stay

    Science.gov (United States)

    Five-rights - medication; Medication administration - hospital; Medical errors - medication; Patient safety - medication safety ... means there is less chance of a medicine error with electronic prescriptions. Your doctor can tell your nurse to write ...

  16. Eliminating US hospital medical errors.

    Science.gov (United States)

    Kumar, Sameer; Steinebach, Marc

    2008-01-01

    Healthcare costs in the USA have continued to rise steadily since the 1980s. Medical errors are one of the major causes of deaths and injuries of thousands of patients every year, contributing to soaring healthcare costs. The purpose of this study is to examine what has been done to deal with the medical-error problem in the last two decades and present a closed-loop mistake-proof operation system for surgery processes that would likely eliminate preventable medical errors. The design method used is a combination of creating a service blueprint, implementing the six sigma DMAIC cycle, developing cause-and-effect diagrams as well as devising poka-yokes in order to develop a robust surgery operation process for a typical US hospital. In the improve phase of the six sigma DMAIC cycle, a number of poka-yoke techniques are introduced to prevent typical medical errors (identified through cause-and-effect diagrams) that may occur in surgery operation processes in US hospitals. It is the authors' assertion that implementing the new service blueprint along with the poka-yokes, will likely result in the current medical error rate to significantly improve to the six-sigma level. Additionally, designing as many redundancies as possible in the delivery of care will help reduce medical errors. Primary healthcare providers should strongly consider investing in adequate doctor and nurse staffing, and improving their education related to the quality of service delivery to minimize clinical errors. This will lead to an increase in higher fixed costs, especially in the shorter time frame. This paper focuses additional attention needed to make a sound technical and business case for implementing six sigma tools to eliminate medical errors that will enable hospital managers to increase their hospital's profitability in the long run and also ensure patient safety.

  17. Iatrogenia em pacientes idosos hospitalizados Iatrogeny in hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Eurico T. Carvalho-Filho

    1998-02-01

    Full Text Available Analisar as complicações iatrogênicas apresentadas por idosos hospitalizados. Estudo retrospectivo dos prontuários de 96 pacientes, 48 do sexo masculino e 48 do feminino, com idades variando de 60 a 93 anos (média: 75,7 anos, hospitalizados durante o ano de 1995 em enfermaria geriátrica. A análise da evolução dos pacientes durante o período de hospitalização permitiu evidenciar: 1 em 42 (43,7% pacientes ocorreram uma ou mais complicações iatrogênicas, num total de 56 episódios; 2 manifestações relacionadas aos procedimentos diagnósticos corresponderam a 17,9% das iatrogenias; 3 alterações relacionadas às medidas terapêuticas corresponderam a 58,9%, sendo 32,1% referentes à terapêutica farmacológica e 26,8% a outros procedimentos terapêuticos; 4 manifestações iatrogênicas não relacionadas diretamente às afecções (úlceras de decúbito, quedas e fraturas corresponderam a 23,2%; 5 a presença de manifestações iatrogênicas correlacionou-se com período mais prolongado de internação; 6 cinco pacientes faleceram em conseqüência direta de complicações iatrogênicas. A iatrogenia é freqüente em pacientes idosos hospitalizados, podendo determinar manifestações graves e mesmo fatais. Como uma significativa proporção dessas complicações pode ser evitada através de medidas adequadas, deve-se procurar identificar suas causas e desenvolver métodos para previni-la ou reduzir seus efeitos.PURPOSE: To evaluate the iatrogenic complications in hospitalized elderly patients. MATERIAL AND METHOD: Review of the medical records of 96 patients, 48 men and 48 women, aged 60 to 93 years (75.7 years on average, hospitalized in a geriatric ward during 1995. RESULTS: The study of the medical records of the patients showed: 1 forty-two (43.7% of the elderly had one or more iatrogenic illnesses, with a total of 56 occurrences; 2 complications due to diagnostic tests corresponded to 17.9% of the iatrogenic disorders; 3

  18. Urinary incontinence in the prediction of falls in hospitalized elderly

    Directory of Open Access Journals (Sweden)

    Hellen Cristina de Almeida Abreu

    2014-10-01

    Full Text Available Objective Analyzing the effect of urinary incontinence as a predictor of the incidence of falls among hospitalized elderly. Method Concurrent cohort study where 221 elderly inpatients were followed from the date of admission until discharge, death or fall. The Kaplan-Meier methods, the incidence density and the Cox regression model were used for the survival analysis and the assessment of the association between the exposure variable and the other variables. Results Urinary incontinence was a strong predictor of falls in the surveyed elderly, and was associated with shorter time until the occurrence of event. Urinary incontinence, concomitant with gait and balance dysfunction and use of antipsychotics was associated with falls. Conclusion Measures to prevent the risk of falls specific to hospitalized elderly patients who have urinary incontinence are necessary.

  19. Nutritional Assessment in Elderly Hospitalized Patients in Qazvin Teaching Hospitals in 2011

    Directory of Open Access Journals (Sweden)

    Azam Ghorbani

    2013-04-01

    Full Text Available Objectives: Nutritional status in the elderly is an important issue in developing countries has been little attention to it. It results from complex interaction between personal and environmental factors that have a considerable effect on mortality, morbidity and quality of life of elderly people especially the hospitalized ones. The aim of this study was to investigate nutritional status in elderly hospitalized patients in Qazvin Teaching Hospitals and know Influential factors to plan appropriate programs for improving their health. Methods & Materials: In this cross-sectional study 233 elderly (151 women and 171 men aging more than 60 years, hospitalized in two hospitals in Qazvin city were studied. Nutritional status were evaluated using Mini Nutritional Assessment, The nutritional status was classified into: malnourished, risk of malnutrition and without malnutrition (adequate. Results: Among the assessed elderly 29.8% were well nourish, 13.4% malnourished and 42.95 at risk of malnutrition. There was more malnutrition in females compared to males (25.8% vs 7.2 P=23(62.5% vs. 12.6% P<0.001, Statistical analysis of the studied variables showed that nutritional status were significantly associated with Age, BMI, WC and WHR Conclusion: This study confirms a high prevalence of malnutrition risk in hospitalized elderly patients. The assessment of nutritional status with MNA that can facilitate evaluation of the nutritional status of elderly individuals in hospitals

  20. Factors Affecting Mortality in Elderly Patients Hospitalized for Nonmalignant Reasons

    Directory of Open Access Journals (Sweden)

    Teslime Ayaz

    2014-01-01

    Full Text Available Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%. Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6% of the hospitalized patients were discharged, 85 (8.4% died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.

  1. Prevalence of Oral and Maxillofacial Trauma in Elders Admitted to a Reference Hospital in Northeastern Brazil.

    Directory of Open Access Journals (Sweden)

    Marcus Antonio Melo Carvalho Filho

    Full Text Available To know the prevalence and etiology of oral and maxillofacial trauma in elders.Analytical quantitative cross-sectional study conducted at a public trauma hospital located in Fortaleza-Ceará, Brazil. The study population comprised patients with trauma who were hospitalized from April to August 2014. Of these patients, patients with oral and maxillofacial trauma were chosen to be included in the research. A questionnaire was administered in order to obtain information on socio-demographics, systemic comorbidities, use of medication, deleterious habits (smoking and alcohol consumption, etiology of oral and maxillofacial trauma and type of pre-hospital care.Of the 280 elderly hospitalized with trauma, 47 had oral and maxillofacial trauma, with a prevalence of 16.8%. In this group, the age ranged from 60 to 88 years, with a mean age of 72.4 years (SD± 8.38. The elderly were mostly women (55.3%, self-declared pardos (53.2%, who presented with cardiovascular disorders (48.9%, and who received formal pre-hospital care (70.2%. Elderly who were in the 60-69 years age group, spent 6-9 years at school and drank alcohol were 2.64, 3.75, and 1.97, respectively, more likely to suffer oral and maxillofacial trauma. The main causes of trauma were physical aggression, traffic accidents, falls and domestic accidents. All of the physical aggressions resulted in oral and maxillofacial traumas, and the elderly who suffered traffic accidents were four times more likely to have oral and maxillofacial trauma.The prevalence of 16.8% and the lack of research on oral and maxillofacial traumas in the elderly is worrisome and should be included in the oral health indicators for the elderly population to support the importance of oral health.

  2. Prevalence of Oral and Maxillofacial Trauma in Elders Admitted to a Reference Hospital in Northeastern Brazil.

    Science.gov (United States)

    Carvalho Filho, Marcus Antonio Melo; Saintrain, Maria Vieira de Lima; Dos Anjos, Rita Edna da Silveira; Pinheiro, Solange Sousa; Cardoso, Luciana de Carvalho Pádua; Moizan, Jean André Hervé; de Aguiar, Andréa Silvia Walter

    2015-01-01

    To know the prevalence and etiology of oral and maxillofacial trauma in elders. Analytical quantitative cross-sectional study conducted at a public trauma hospital located in Fortaleza-Ceará, Brazil. The study population comprised patients with trauma who were hospitalized from April to August 2014. Of these patients, patients with oral and maxillofacial trauma were chosen to be included in the research. A questionnaire was administered in order to obtain information on socio-demographics, systemic comorbidities, use of medication, deleterious habits (smoking and alcohol consumption), etiology of oral and maxillofacial trauma and type of pre-hospital care. Of the 280 elderly hospitalized with trauma, 47 had oral and maxillofacial trauma, with a prevalence of 16.8%. In this group, the age ranged from 60 to 88 years, with a mean age of 72.4 years (SD± 8.38). The elderly were mostly women (55.3%), self-declared pardos (53.2%), who presented with cardiovascular disorders (48.9%), and who received formal pre-hospital care (70.2%). Elderly who were in the 60-69 years age group, spent 6-9 years at school and drank alcohol were 2.64, 3.75, and 1.97, respectively, more likely to suffer oral and maxillofacial trauma. The main causes of trauma were physical aggression, traffic accidents, falls and domestic accidents. All of the physical aggressions resulted in oral and maxillofacial traumas, and the elderly who suffered traffic accidents were four times more likely to have oral and maxillofacial trauma. The prevalence of 16.8% and the lack of research on oral and maxillofacial traumas in the elderly is worrisome and should be included in the oral health indicators for the elderly population to support the importance of oral health.

  3. HYPERNATREMIA AND COPEPTIN LEVELS IN THE ELDERLY HOSPITALIZED PATIENT.

    Science.gov (United States)

    Liber, Michal; Sonnenblick, Moshe; Munter, Gabriel

    2016-12-01

    Elderly patients have a high prevalence of hypernatremia. The aim of this study was to determine demographic and clinical characteristics of the elderly hypernatremic patient hospitalized in the internal medicine ward and to enhance understanding of the role of antidiuretic hormone (ADH) secretion in the pathogenesis of hypernatremia. Case-control study performed in an internal medicine ward in a university-affiliated hospital. Thirtythree elderly hypernatremic patients (admission sodium, >150 mEq/L; age, >70 years) were compared with 34 normonatremic patients. Demographic, functional (mental status and activities of daily living), clinical data (Acute Physiology and Chronic Health Evaluation [APACHE] II score), and serum copeptin levels as a marker of ADH secretion, were collected at admission. Mortality and change in the functional status were followed up to 30 days from discharge. Patients with hypernatremia presented with significantly lower baseline functional and cognitive states and higher APACHE II score (21.3 ± 8.6 vs. 15.4 ± 6.7; PHypernatremia in the elderly at admission is associated with a high mortality rate. Copeptin level in the elderly seems to be a good single disease severity marker. ADH is strongly secreted in elderly hypernatremic patients. ADH = antidiuretic hormone APACHE = Acute Physiology and Chronic Health Evaluation.

  4. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  5. A proposal of Occupational Therapy service to hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Mariana Boaro Fernandez Canon

    2014-09-01

    Full Text Available Introduction: The association between chronic diseases, functional dependency, and hospitalization represents a high risk for the elderly, because it contributes to decreased functional capacity. Objectives: This study aimed to describe an action protocol of Occupational Therapy with hospitalized elderly patients with diagnosis of chronic diseases, approaching sensory, cognitive, psychomotor and functional aspects, and to analyze whether this protocol maximizes the independence for the feeding activity. Methodology: Patients hospitalized in a Geriatric Ward, between December 2011 and February 2012, were selected according to inclusion criteria. After conduction of the intervention protocol, a functional evaluation, Functional Independence Measurement (FIM – motor part, was performed approaching sensory, cognitive, psychomotor and functional aspects. There were 10 sessions with average duration of 30 minutes, the first and the last ones for the assessment and orientation. Six (6 hospitalized elderly patients were selected: 5 females and 1 male, mean age of 88.8, 5.3 years of schooling. Results: The scoreboard mean for the feeding item of the FIM before hospitalization was 2.7 points, it dropped to 1.5 points in the first days of hospitalization, and then increased to 3.8 points after the intervention of Occupational Therapy. The scoreboard means for the motor part of the FIM before hospitalization, during the first days, and after the intervention were: 26.8, 16 and 23.2 points, respectively. Conclusions: All the elderly benefited from this protocol and started to perform more independently not only the activity of feeding, but also the other basic activities of daily living, when compared to the first days of hospitalization.

  6. Inadequate treatment for elderly patients: professional norms and tight budgets could cause "ageism" in hospitals.

    Science.gov (United States)

    Skirbekk, Helge; Nortvedt, Per

    2014-06-01

    We have studied ethical considerations of care among health professionals when treating and setting priorities for elderly patients in Norway. The views of medical doctors and nurses were analysed using qualitative methods. We conducted 21 in depth interviews and 3 focus group interviews in hospitals and general practices. Both doctors and nurses said they treated elderly patients different from younger patients, and often they were given lower priorities. Too little or too much treatment, in the sense of too many interventions and too much drugs, combined with too little care and comfort, was admitted as a relatively frequent yet unwanted consequence of the way clinical priorities were set for elderly patients. This was explained in terms of elderly patients not tolerating the same treatment as younger patients, and questions were raised about the quality of life of many elderly patients after treatment. These explanations were frequently referred to as medically sound decision making. Other explanations had little to do with medically sound decisions. These often included deep frustration with executive guidelines and budget constraints.

  7. The Mystery of Increased Hospitalizations of Elderly Patients

    Centers for Disease Control (CDC) Podcasts

    2008-04-15

    Pneumonia is a common illness that affects millions of people in the United States every year. In some people, particularly the elderly and those who are ill from pre-existing conditions, bacterial pneumonia may follow influenza or even a common cold. Dr. Martin Meltzer, discusses two articles in the May 2008 issue of Emerging Infectious Diseases journal about increased pneumonia-related hospitalizations of elderly patients in England.  Created: 4/15/2008 by Emerging Infectious Diseases.   Date Released: 4/30/2008.

  8. Medication in the elderly - considerations and therapy prescription guidelines

    Directory of Open Access Journals (Sweden)

    Josip Anđelo Borovac

    2015-11-01

    Full Text Available The aim of this study was to integrate and present pertinent findings from the literature dealing with the treatment of the elderly within a primary care setting. Medical care for the elderly is an integral part of a general practitioner’s (GPs everyday work and is challenging for many reasons. Older people often experience multiple chronic diseases concurrently (comorbidity, multimorbidity and they often have deteriorated organ function and decreased physiological reserves due to the natural aging process. The choice of appropriate medication for each particular disease is a complex process and can cause “therapeutic confusion”, especially among younger GPs in the field. Elderly people are prone to develop adverse side-effects to usual dosages of medications and the side-effects are even 7 times more frequent in elderly than in younger patients. Moreover, in therapy for elder patients, a responsible clinician always needs to think about potential drug to drug interactions and possible compromised pharmacokinetic dynamics in the aging body. Professional geriatric societies in many countries (USA, Germany, UK have developed lists of potentially inappropriate medications for the elderly, and they update them systematically. Lists such as The Beers Criteria list and STOPP/START criteria should always be consulted when administering therapy to elderly patients. In this paper we emphasized the importance of medication lists as an important practical support in a GP’s everyday work. Implementation of such therapeutic aids reduces the possibility of medical error and minimizes the chance of an inappropriate prescription for this vulnerable population stratum. Conclusion. When prescribing drugs for the elderly, GPs should take into account the specificities of the elderly, their biological and chronological framework and should always apply the principles of rational, conservative and evidence-based pharmacotherapy.

  9. Nutritional status and functional capacity of hospitalized elderly

    Science.gov (United States)

    2009-01-01

    Background The nutritional status of the aging individual results from a complex interaction between personal and environmental factors. A disease influences and is influenced by the nutritional status and the functional capacity of the individual. We asses the relationship between nutritional status and indicators of functional capacity among recently hospitalized elderly in a general hospital. Methods A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%. Results Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition. Conclusion There is an interrelationship between the nutritional status of the elderly and reduced functional capacity. PMID:19919711

  10. Malnutrition and associated factors in elderly hospitalized.

    Science.gov (United States)

    Lara-Pulido, A; Guevara-Cruz, M

    2012-01-01

    To investigate the frequency of malnutrition and associated factors in patients over 65 years of age in a hospital. We conducted an observational, crosssectional and descriptive study. Department of Nutritional Support, Hospital Medica Sur, Mexico, we evaluated patients over 65 years of age within the first 24 hours of admission. We evaluated 769 patients, 49% of whom were women and 51% were men, with an average age of 75.3 ± 7.7 years. Among the patients evaluated, 53.6% exhibited an altered nutritional state. In addition, 9% were diagnosed as obese and 15% as overweight. Their risk of malnutrition was determined to be 22.5%, and at the time of admission, 7% were malnourished. The prevalence of malnutrition in hospitalized patients over 65 years of age was high. Thus, the early diagnosis of patients who are at risk for malnutrition or who are malnourished is essential and allows for prompt treatment.

  11. Hospital Care for Frail Elderly Adults: From Specialized Geriatric Units to Hospital-Wide Interventions

    NARCIS (Netherlands)

    Bakker, F.C.; Olde Rikkert, M.G.M.

    2015-01-01

    Much of the acute care provided in hospitals is for elderly people. Frailty is a common clinical condition among these patients. Frail patients are vulnerable to undergoing adverse events, to developing geriatric syndromes and to experiencing functional decline during or due to hospitalization. The

  12. Mapping the elder mistreatment iceberg: U.S. hospitalizations with elder abuse and neglect diagnoses.

    Science.gov (United States)

    Rovi, Sue; Chen, Ping-Hsin; Vega, Marielos; Johnson, Mark S; Mouton, Charles P

    2009-10-01

    This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Few hospitalizations (nursing home rather than "routinely" discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92-4.59). Elder mistreatment-coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p neglect cases having the highest charges in 2003 ($29,389). Knowledge about EM is often likened to the "tip of the iceberg." Our study contributes to "mapping the EM iceberg"; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.

  13. Risk factors and clinical aspects of delirium in elderly hospitalized patients in Iran.

    Science.gov (United States)

    Foroughan, Mahshid; Delbari, Ahmad; Said, Said Ebn; AkbariKamrani, Ahmad Ali; Rashedi, Vahid; Zandi, Taher

    2016-04-01

    Recognition of the risk factors of delirium has been clearly advantageous in preventing and managing it as it occurs. The main aims of this study were to investigate the occurrence of delirium and identify the associated risk factors in a sample of hospitalized elderly in Southwestern Iran. A cross-sectional, hospital-based study was performed on a total of 200 elderly patients, admitted to a general hospital for various health reasons. Data were gathered over a 3-month period of time in 2010. Abbreviated Mental Test score (AMTs) used for delirium detection in post-admission days 1, 3, and 5, followed by clinical diagnostic confirmation according to the DSM-IV-TR criteria for delirium. Information regarding physical, cognitive, emotional, and functional states of the participants was collected, too. Delirium developed in 22 % of the participants. The demographic characteristics of the patients with delirium indicated that they were typically single, older men who lived alone and had a lower level of education and poorer functional status. Among other variables, the following were significantly associated with delirium: hemoglobin ≤12 (P decline (P < 0.001). Patients with more than six different categories of medications were at high risk for delirium as well. Delirium is a serious and common problem in people over 60 years of age who are admitted to hospitals. Understanding risk factors and clinical aspects of delirium in elderly hospitalized patients will provide us with a better delirium management strategy.

  14. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  15. The elderly mentally handicapped in hospital: a clinical study.

    Science.gov (United States)

    Day, K A

    1987-06-01

    In a study of 99 long-stay hospital residents aged 65 years and over, two thirds were functioning in the moderately to mildly handicapped range, two thirds were under the age of 75 years and there was an overall female to male ratio of 2:1. As in the general population, mobility problems, a tendency to falls and fractures, cardiorespiratory disease, deteriorating eyesight, and hearing and urinary incontinence were commonly found; all increased in frequency with age. A fifth exhibited psychiatric disorder: the commonest conditions, as expected, were the psychoses and dementia. It is suggested that retirement provision for the elderly mentally handicapped should be made within the mental handicap services and that the small group with significant geriatric problems would be most appropriately cared for within the generic geriatric services. A plea is made for evaluative studies before large scale implementation of resettlement programmes for the elderly mentally handicapped in hospital.

  16. Prediction of survival for older hospitalized patients: the HELP survival model. Hospitalized Elderly Longitudinal Project.

    Science.gov (United States)

    Teno, J M; Harrell, F E; Knaus, W; Phillips, R S; Wu, A W; Connors, A; Wenger, N S; Wagner, D; Galanos, A; Desbiens, N A; Lynn, J

    2000-05-01

    To develop and validate a model estimating the survival time of hospitalized persons aged 80 years and older. A prospective cohort study with mortality follow-up using the National Death Index. Four teaching hospitals in the US. Hospitalized patients enrolled between January 1993 and November 1994 in the Hospitalized Elderly Longitudinal Project (HELP). Patients were excluded if their length of hospital stay was 48 hours or less or if admitted electively for planned surgery. A log-normal model of survival time up to 711 days was developed with the following variables: patient demographics, disease category, nursing home residence, severity of physiologic imbalance, chart documentation of weight loss, current quality of life, exercise capacity, and functional status. We assessed whether model accuracy could be improved by including symptoms of depression or history of recent fall, serum albumin, physician's subjective estimate of prognosis, and physician and patient preferences for general approach to care. A total of 1266 patients were enrolled over a 10-month period, (median age 84.9, 61% female, 68% with one or more dependency), and 505 (40%) died during an average follow-up of more than 2 years. Important prognostic factors included the Acute Physiology Score of APACHE III collected on the third hospital day, modified Glasgow coma score, major diagnosis (ICU categories together, congestive heart failure, cancer, orthopedic, and all other), age, activities of daily living, exercise capacity, chart documentation of weight loss, and global quality of life. The Somers' Dxy for a model including these factors was 0.48 (equivalent to a receiver-operator curve (ROC) area of 0.74, suggesting good discrimination). Bootstrap estimation indicated good model validation (corrected Dxy of 0.46, ROC of 0.73). A nomogram based on this log-normal model is presented to facilitate calculation of median survival time and 10th and 90th percentile of survival time. A count of

  17. Medical tourism private hospitals: focus India.

    Science.gov (United States)

    Brotman, Billie Ann

    2010-01-01

    This article examines demand factors for sophisticated medical treatments offered by private hospitals operating in India. Three types of medical tourism exist: Outbound, Inbound, and Intrabound. Increased profitability and positive growth trends by private hospital chains can be attributed to rising domestic income levels within India. Not all of the chains examined were financially solvent. Some of the hospital groups in this sample that advertised directly to potential Inbound medical tourists appear to be experiencing negative cash flows.

  18. Strategic management of Public Hospitals' medical services.

    Science.gov (United States)

    Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua

    2016-01-01

    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

  19. Fasting hyperglycaemia and in-hospital mortality in elderly population.

    Science.gov (United States)

    Iglesias, P; Polini, A; Muñoz, A; Dardano, A; Prado, F; Castiglioni, M; Guerrero, M T; Tognini, S; Macías, M C; Díez, J J; Monzani, F

    2011-03-01

    Admission hyperglycaemia has shown to be a marker of poor clinical outcome. The prevalence of admission hyperglycaemia and its relationship with in-hospital mortality in elderly population has not been clearly defined. We assessed the prevalence and prognostic significance of admission fasting hyperglycaemia in aged patients. A total of 808 elderly patients were studied. Patients were classified into group I (serum glucose 180 mg/dl). Groups II and III were considered newly recognised fasting hyperglycaemia (NRFH) in non-diabetic patients. NRFH was present in 18.6%. After excluding diabetic patients (n = 206, 25.5%), the distribution of patients (n = 602, 74.5%) was as follows: group I (n = 452, 55.9%), group II (n = 122, 15.1%) and group III (n = 28, 3.5%). In the whole cohort, median fasting glucose was lower in patients who survived [105 mg/dl (88-135)] than in those who died [127 mg/dl (93-159), p population. Both low albumin and high glucose serum concentrations were the only independent risk factors for in-hospital all-cause mortality in non-diabetic patients. In non-diabetic elderly patients admitted for acute disease, serum glucose concentration is an important, simple and independent predictor of hospital mortality. © 2011 Blackwell Publishing Ltd.

  20. Racial disparities in hospitalized elderly patients with chronic heart failure.

    Science.gov (United States)

    Wheeler, Erlinda C; Klemm, Paula; Hardie, Thomas; Plowfield, Lisa; Birney, Margaret; Polek, Carolee; Lynch, Kevin G

    2004-10-01

    The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and number of procedures on elderly persons hospitalized with chronic heart failure (CHF). Secondary data analysis was used to obtain data on 99,543 hospitalized Medicare patients with CHF age 65 years or older. MANOVA was utilized to examine the effects of race, age, and total hospital charges on LOS, number of procedures, and diagnosis. Asian American Pacific Islanders had significantly higher number of procedures and LOS compared to Whites. The combined dependent variables were significantly affected by race, F(9, 99,543) = 121.95, p =.000; the covariates of age, F(3, 99,543) = 720.65, p =.000; and total charges F(3, 99,543) = 38,962.95, p =.000. LOS accounted for 50% of the variance. Studies that examine cultural variables and their effect on LOS and number of procedures are needed.

  1. Implementation of medication reviews in community pharmacies and their effect on potentially inappropriate drug use in elderly patients

    NARCIS (Netherlands)

    Teichert, M.; Luijben, S.N.; Wereldsma, A.; Schalk, T.; Janssen, J.; Wensing, M.; Smet, P. de

    2013-01-01

    BACKGROUND: In 2008 recommendations were launched to prevent medication-related hospital admissions in the Netherlands. Elderly patients using several drugs on a chronic basis were among the target group. Pharmacy-led medication reviews (MRs) were identified as having potential for improving patient

  2. A Well Elderly Program: An Intergenerational Model in Medical Education.

    Science.gov (United States)

    Adelman, R.; And Others

    1988-01-01

    Describes effort to dispel ageist attitudes in medical students in which medical students participated in weekly health seminars and provided health counseling for older adults living in community. Notes that exposing students to healthy elderly persons began to dispel stereotypical views engendered by previous exposure to only frail, acutely ill,…

  3. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    DEFF Research Database (Denmark)

    Andreasen, Jane; Lund, Hans; Aadahl, Mette

    2015-01-01

    INTRODUCTION: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences...... of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. METHODS: The qualitative methodological approach was interpretive description. Data were...... gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. RESULTS: Four main categories were identified: "The system," "Keeping a social life," "Being...

  4. Hospital Mortality of Septic Acute Kidney Injury Requiring Renal Replacement Therapy in the Postoperative Elderly

    Directory of Open Access Journals (Sweden)

    Wei-Lun Liu

    2012-06-01

    Conclusions: The hospital mortality of postoperative elderly patients with septic AKI was more than 60% and was not affected by age. Mechanical ventilator use was the major risk factor and prognostic factor for elderly patients in this clinical setting.

  5. An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Asher Maya

    2008-02-01

    Full Text Available Abstract Background The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations. Objectives To evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care. Methods A multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program. Results As a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%. The number of adjusted hospitalization days dropped from 132 to 82 (37.9% and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%. The adjusted hospitalization cost ($/1,000 patients dropped from $32,574 to $18,624 (42.8%. The overall clinic expense, for all age groups, dropped by 9.9%. Conclusion Implementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.

  6. Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis.

    Science.gov (United States)

    Oscanoa, T J; Lizaraso, F; Carvajal, Alfonso

    2017-06-01

    It is currently admitted that adverse drug reactions (ADRs) account for a great burden of disease. Of particular concern are ADR-induced hospital admissions, particularly in the elderly; they receive most of the medications and they are the most prone to develop ADRs. Therefore, our aim was to carry out a study of ADR-induced hospital admissions focused on the elderly population. For the purpose, a systematic review and meta-analysis was performed of those studies addressing ADR-induced hospital admissions in patients over 60 years of age. A computerized search of the literature was carried out in the main databases. The search spans from 1988 to 2015. A pooled prevalence figure was calculated with 95% CIs; heterogeneity was also explored. The final number of selected articles was 42; all of them were published between January 1988 and August 2015. The overall average percentage of hospital admissions was 8.7% (95% CI, 7.6-9.8%). NSAIDs are one of the medication classes more frequently related to these admissions (percentages range from 2.3 to 33.3%). Inappropriate medication as a risk factor was studied in nine studies, four found a statistically significant relationship between those medications and hospital admissions. Circa one in ten hospital admissions of older patients are due to ADRs. A great burden of disease is due to a few and identifiable medication classes; in most of the cases, the reactions are well known and probably preventable. A sense of purpose and determination is needed by health authorities to face this problem. Doctors, on their part, should be aware when prescribing some specific identifiable medications to these patients. 1. One in ten hospital admissions in older patients are due to ADRs; NSAIDs are the medications the most related with these admissions, followed by other common medications used in patients of this age, such as beta-blockers. 2. A great burden of disease is due to medications that are intended to cure or alleviate

  7. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

    Directory of Open Access Journals (Sweden)

    Mosam Phirke

    2015-01-01

    Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

  8. Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000.

    Science.gov (United States)

    Groeneveld, Peter W; Laufer, Sara B; Garber, Alan M

    2005-04-01

    Low rates of technology utilization in hospitals with high proportions of black inpatients may be a remediable cause of healthcare disparities. Our objective was to determine how differences in technology utilization among hospitals contributed to racial disparity and if temporal reduction in hospital procedure rate variation resulted in decreased racial disparity for these technologies. We identified 2,348,952 elderly Medicare beneficiaries potentially eligible for 1 of 5 emerging medical technologies from 1989-2000 and determined if these patients had received the indicated procedure within 90 days of their qualifying hospital admission. Initial multivariate regression models adjusted for age, race, sex, admission year, clinical comorbidity, community levels of education and income, and academic/urban hospital admission. The inpatient racial composition of each patient's admitting hospital and time-race interactions were added as covariates to subsequent models. Blacks had significantly lower adjusted rates (P 20% black inpatients were less likely to perform these procedures on both white and black patients than hospitals with < 9% black inpatients, and racial disparity was greater in hospitals with larger black populations. There were no temporal reductions in racial disparities. Blacks may be disadvantaged in access to new procedures by receiving care at hospitals that have both lower procedure rates and greater racial disparity. Policies designed to ameliorate racial disparities in health care must address hospital variation in the provision of care.

  9. Construction of an Occupational Therapy Screenings Assessment for elderly medical patients

    DEFF Research Database (Denmark)

    Holsbæk, Jonas

    there for demands a validated Occupational Therapy Screening Assessment, that fast and easy can tell if more Occupational Therapy is needed. Aim: The aim of the study is to develop a Screening Assessment which can be used in the Occupational Therapist practice screening Hospitalized Elderly medical inpatients......Background: Occupational Therapist working with Elderly Medical inpatients at hospitals in Denmark, are under pressure due to an increasing patients, demands for validated interventions and best practice and economically effectually solutions at the same time. Occupational Therapists in Denmark...... by means of the Content Validity Index (CVI) – Questionaire. Result: The result was a Screening Assessment and a Manual, which was built up using ICF and the ADL-Taxonomy as References. The Screening Instrument should be a support for the working Occupational Therapist in their Clinical Reasoning. CVI...

  10. Hospital Care for Frail Elderly Adults: From Specialized Geriatric Units to Hospital-Wide Interventions.

    Science.gov (United States)

    Bakker, Franka C; Olde Rikkert, Marcel G M

    2015-01-01

    Much of the acute care provided in hospitals is for elderly people. Frailty is a common clinical condition among these patients. Frail patients are vulnerable to undergoing adverse events, to developing geriatric syndromes and to experiencing functional decline during or due to hospitalization. The strategy for providing specialized geriatric care to these hospitalized frail elderly patients currently consists of care provision either by specialized departments or by specialized teams who adopt comprehensive geriatric assessment. Even so, financial and human resources are insufficient to meet the needs of all hospitalized frail elderly patients who require comprehensive geriatric assessment. New innovative and more efficient geriatric interventions, in which the priorities of the patients themselves should be the main focus, should be developed and implemented, and professionals in all specialties should be educated in applying the fundamentals of geriatric medicine to their frail elderly patients. In the evaluation of such interventions, patient-reported outcomes should play a major role, in addition to the more traditional outcome measures of effectiveness, quality of care and cost-effectiveness. 2015 S. Karger AG, Basel.

  11. Medical Professionals Designing Hospital Management Models

    DEFF Research Database (Denmark)

    Byg, Vibeke

    especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...... adapt, interpret and negotiate hospital management over time in relation to changing hospital management models in hospital organizations in the Nordic health system context, illustrated by the Danish health system....

  12. Potentially inappropriate medications prescribed for elderly patients through family physicians

    Directory of Open Access Journals (Sweden)

    Abdulaziz Al Odhayani

    2017-01-01

    Full Text Available The elderly population is increasing throughout the globe, resulting in higher healthcare costs. Potential inappropriate medication (PIM prescriptions are a major health problem affecting the elderly persons. Due to limited studies in PIM use in primary care and home healthcare in Saudi Arabia, we aim to examine the extent of PIM prescription for and use by elderly patients. This study was carried out with 798 elderly patients, arbitrarily selected from Prince Sultan Medical Military City through the patient register. The mean age of the patients were in the range of 75.2 ± 5.5; 37.8% were males and 62.2% were females. The elderly patients are affected majorly with diabetes (73.9%, hypertension (83.2% and lipid abnormalities (73.8%. The maximum patients involved in this study were affected with lower hemoglobin levels i.e. 99.2%. Renal impairment was found in 64% and iron supplements were the most commonly used in 23.1%, followed by analgesics and opioids (17%. The 52.5% of participants were using one or more PIMs. Kidney was the only functions and had influence on prescribed decisions. This study indicates PIM is a concern in elderly patients attending clinics and home residents and commonly prescribed ones are atypical antipsychotics, iron overdose, benzodiazepines and opioids. Prescription of drug–drug interactions, cascades and inappropriate drug doses results in preventable adverse effects.

  13. A retrospective observational study of mortality rates in elderly patients with shock in a New Zealand district hospital ICU.

    Science.gov (United States)

    Keet, Owen; Chisholm, Stephanie; Goodson, Jennifer; Browne, Troy

    2017-04-07

    Admitting very elderly, critically ill patients to ICU is controversial. We compared our mortality data in a subgroup of elderly patients to internationally published outcomes. Tauranga Hospital ICU retrospectively investigated their mortality outcomes for patients with septic shock. The ANZICS adult database (AORTIC), Tauranga Hospital computer records and medical records were used to identify the study cohort and provide information on demographics, admission times and shock types between January 2009 and December 2014. Patients were divided into groups; not old (85 years) to compare survival statistics at ICU discharge, hospital discharge, 28 days, six months and 12 months. Patients in the >85 year group at Tauranga ICU had a 38.5% survival. With careful selection, elderly patients with septic shock may have an acceptable outcome.

  14. Preinjury warfarin, but not antiplatelet medications, increases mortality in elderly traumatic brain injury patients.

    Science.gov (United States)

    Grandhi, Ramesh; Harrison, Gillian; Voronovich, Zoya; Bauer, Joshua; Chen, Stephanie H; Nicholas, Dederia; Alarcon, Louis H; Okonkwo, David O

    2015-03-01

    Previous studies of traumatic brain injury (TBI) outcomes in elderly patients on oral antithrombotic (OAT) therapies have yielded conflicting results. Our objective was to examine the effect of premorbid OAT medications on outcomes among elderly TBI patients with intracranial hemorrhage. We performed a retrospective analysis of elderly TBI patients (≥65 years) with closed head injury and evidence of brain hemorrhage on computed tomography scan from 2006 to 2010. Patient demographics, injury severity, clinical course, hospital and intensive care unit length of stay, and disposition were collected. Comparison of patients stratified by premorbid OAT use was performed using nonparametric Kruskal-Wallis and Fisher's exact tests. Multivariable logistic regression was used to compare groups and identify predictors of primary outcomes, including mortality, neurosurgical intervention, hemorrhage progression, complications, and infection. A total of 1,552 patients were identified: 543 on aspirin only, 97 on clopidogrel only, 218 on warfarin only, 193 on clopidogrel and aspirin, and 501 on no antithrombotic agent. Blood products were administered to reverse coagulopathy in 77.3% of patients on antithrombotic medications. After adjusting for covariates, including medication reversal, OAT use was associated with increased mortality (p = 0.04). Warfarin use was identified as a key predictor (odds ratio, 2.27; p = 0.05), in contrast to the preinjury use of antiplatelet medications, which was not associated with increased risk of in-hospital death. Rates of neurosurgical intervention differed between groups, with patients on warfarin undergoing intervention more frequently. Survivor subset analysis demonstrated that hemorrhage progression was not associated with preinjury antithrombotic therapy, nor were rates of complication or infection, hospital and intensive care unit lengths of stay, or ventilator days. Preinjury use of warfarin, but not antiplatelet medications, influences

  15. The prevalence of renal impairment in the elderly hospitalized population

    Directory of Open Access Journals (Sweden)

    Maneshveri Pather

    2009-06-01

    Full Text Available Maneshveri PatherFormerly of the Department of Medicine, Clayponds Hospital, London, UKAbstract: Renal impairment has already been cited as being under-reported. A retrospective cross-sectional study was carried out. The sample population consisted of 94 inpatients aged over 60 years at Clayponds Hospital in the UK who had been admitted for rehabilitation from acute hospitals. The glomerular filtration rate (GFR was calculated using the Cockcroft–Gault formula modified for SI units. Renal impairment was found in 95.7% (95% CI: 91.8–99.6 of the sample (GFR < 90 ml/min. The study confirms that undetected renal impairment is prevalent. What is significant is that all of the subjects in this study were admitted from acute hospitals to Clayponds Hospital for rehabilitation. It is recommended that more attention be paid to the identification of patients with renal failure in hospitals owing to its significant morbidity and mortality.Keywords: renal impairment, GFR, elderly

  16. [Hospitality for elderly patients in the emergency department].

    Science.gov (United States)

    Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas

    2015-12-09

    Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective.

  17. Ingestive Skill Difficulties are Frequent Among Acutely-Hospitalized Frail Elderly Patients, and Predict Hospital Outcomes

    DEFF Research Database (Denmark)

    Hansen, Tina; Faber, Jens Oscar

    2012-01-01

    patients were frequent and characterized by great complexity. This necessitates a broad range of management strategies related to the patients’ ability in positioning, self-feeding skills, as well as oropharyngeal sensorimotor skills. Read More: http://informahealthcare.com/doi/full/10.3109/02703181.2012.736019......Purpose : To examine the relationship between ingestive skill performance while eating and drinking and frailty status in acutely-hospitalized elderly patients and to examine whether there is a relationship between the proportion of ingestive skill difficulties and Length of Hospital Stay (LOS......) and discharge destination. Methods : Frail (n = 64) and robust (n = 40) acutely-hospitalized elderly patients were assessed using The McGill Ingestive Skills Assessment. Results : Forty-three ingestive skills were significantly more affected in frail patients (21.9% to 95.3%) versus robust patients (2.5% to 65...

  18. Admission of elderly medical patients to fast track or standard hospitalisation

    DEFF Research Database (Denmark)

    Strøm, Camilla; Rasmussen, Lars Simon; Rasmussen, Søren Wistisen

    2016-01-01

    :1 allocation between hospitalisation in an SSU (intervention) and the Department of Internal Medicine (standard care). The study is conducted at Holbaek Hospital, Denmark. Elderly patients are screened for inclusion if an emergency physician assesses that treatment in an SSU is possible. Eligible participants...... and change in instrumental activities of daily living. We aim at recruiting 430 patients based on an estimated effects size of reducing mortality by 10%. All outcome measures will be assessed in an intention-to-treat analysis. Recruitment started on 5 January 2015. By 16 October 2015, we have enrolled 203...... patients. An interim safety analysis is scheduled. CONCLUSION: In the ELDER trial, we explore benefits and harms related to treatment in an SSU for elderly medical patients compared with standard hospitalisation. FUNDING: Region Zealand's Forskningsfond, the Tryg Foundation and University of Copenhagen...

  19. Prevalence of depression and its associated factors among elderly patients in outpatient clinic of Universiti Sains Malaysia Hospital.

    Science.gov (United States)

    Imran, A; Azidah, A K; Asrenee, A R; Rosediani, M

    2009-06-01

    Depression among elderly primary care patients is a serious problem with significant morbidity and mortality. This is a cross sectional study to determine the prevalence of depression and its associated factors among the elderly patients attending the outpatient clinic, Universiti Sains Malaysia Hospital. This study utilized Malay version Geriatric Depression Scale 14 (M-GDS 14) to screen for elderly depression among Malaysian population. It also looked into associated risk factors for elderly depression using sociodemographic, family dynamics, and medically related questionnaires. Out of 244 subjects, 34 or 13.9% were found to have depression. Three variables were found to be significantly associated with depression. Elderly patient with any illness that limits the patient's activity or mobility has more risk of developing depression (OR 2.68 CI 1.15 - 6.24). Elderly patients who were satisfied with their personal incomes (OR 0.29 CI 0.10 - 0.85), and who had children or son/daughter-in-law to take care of them when they are sick (OR 0.10 CI 0.01 - 0.83) have a lower chance of having depression. Screening the elderly for depression, would help in diagnosing the elderly depression better and offer them the treatment needed.

  20. Mobility and Gender Aspects of Hospital Trips of the Urban Elderly in ...

    African Journals Online (AJOL)

    Accessibility to health care facilities is one characteristic that have the potential to impact the health and well-being of the elderly. Using data from a multistage sample survey of 378 elderly, this study examines intra- urban mobility and gender differences in hospital trips of elderly in the city of Ilesa, South-western, Nigeria.

  1. Medication Discrepancies at Pediatric Hospital Discharge.

    Science.gov (United States)

    Gattari, Theresa B; Krieger, Lauren N; Hu, Hsou Mei; Mychaliska, Kerry P

    2015-08-01

    The pediatric hospital discharge process presents significant challenges, and medication discrepancies remain an unsolved problem. The purpose of this study was to determine the discrepancy rates at the time of discharge when multiple sources of medication documentation exist, and to characterize the medication discrepancies into error type, medication category, and discharge summary authorship. A prospective study was performed on pediatric patients admitted to a general inpatient floor for >24 hours. After discharge, medication lists were obtained from the patients' parent/guardian, discharge summary, and Patient Summary List, a medication list that is part of the electronic medical record. These 3 medication lists were then compared with the pharmacy record to identify discrepancies, defined as any difference in medication name, dose, route, or frequency. Medication discrepancies were analyzed in terms of error type (dosage or addition/omission), category of medication, and final signers of the discharge summary. Sixty-nine patient charts were analyzed, and 8% of medications contained a documentation discrepancy between sources. Overall, 26% (18 of 69) of the charts contained ≥1 discrepant medication; the Patient Summary List had the highest rate of discrepancy at 29%. Allergy (27%) and seizure medications (25%) were the categories with the highest rates of discrepancy. Addition/omission errors were much more common than dosage errors. Medication discrepancies exist in inpatient documentation at the time of pediatric hospital discharge when multiple sources of documentation exist. Copyright © 2015 by the American Academy of Pediatrics.

  2. Comparative study of trauma in the elderly and non-elderly patients in a University Hospital in Curitiba.

    Science.gov (United States)

    Broska, César Augusto; de Folchini, Augusto Bernardo; de Ruediger, Ricardo Rydygier

    2013-01-01

    To compare and identify differences in the profile of elderly and non-elderly patients with trauma. We conducted a comparative, cross-sectional, retrospective, quantitative study with 3112 patients between November, 25th 2010 and February, 25th 2011; patients were classified into GI: elderly (60 years or older) and GA: non-elderly (13-59 years). We collected information on the mechanism of trauma, injuries and factors associated with the event, which were compared between groups by using chi-square, Student t and proportions tests. Falls were more frequent in GI, mostly from the standing height, while violence and traffic accidents (especially with motorcycles) were the most important in GA. Both groups possessed mild trauma (bruises, sprains) as the most frequent, followed by traumatic brain injury (TBI) and fractures. Femur fractures were more common in the elderly, and hand and wrist fractures in the nonelderly. The elderly were hospitalized fewer days and there was no difference as for complications, need for intensive care unit (ICU), or mortality between groups. Falls from the standing height are more frequent in the elderly, and motorcycle accidents and interpersonal violence in the non-elderly. Both groups had superficial injuries, head trauma and fractures as major injuries. The elderly were hospitalized for less time. There was no difference in the need for ICU, complications and mortality.

  3. Rotavirus Vaccine Cut Kids' Hospitalization, Medical Costs

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_167720.html Rotavirus Vaccine Cut Kids' Hospitalization, Medical Costs Virus a common ... the sustained impact and effectiveness of the rotavirus vaccine program," study author Dr. Eyal Leshem said in ...

  4. Electroconvulsive therapy in the elderly: Retrospective analysis from an urban general hospital psychiatry unit

    Directory of Open Access Journals (Sweden)

    Dimple D Dadarwala

    2017-01-01

    Full Text Available Introduction: The number of elder patients with severe psychiatric illnesses other than depression is increasing. Electroconvulsive therapy (ECT has a special role in the treatment of late-life depression and other psychiatric conditions in the elderly. Using ECTs in the elderly could be difficult. In an Indian setting, ECT in the geriatric population is used as last resort of treatment which is in contrast to Western countries. There is dearth of data available for the use of ECT in the elderly in India. Methodology: Retrospective data review was carried out to identify patients 55 years or older who had received ECT from January 2014 to June 2016 in tertiary care teaching hospital in a metropolitan city in India. Results: A total of 304 ECTs were administered to 25 elderly aged> 55 years with average of 12 ECTs per patient. Schizophrenia (56% was the most common diagnosis among patients who were considered for ECT, and this was followed by major depression without psychotic features (24% and major depression with psychotic features (8%. The most common indication to start ECT was nonresponsiveness to medications (92%. There was an increase in mean Mini-Mental State Examination (MMSE scores from baseline (23.42 to the end of the sixth (24.60 and last ECT (24.60. Duration of current used during ECT had positive correlation with MMSE. Patients with comorbid medical illness (20% received ECT without any complication. Conclusions: This study adds to scarce database on the use of ECT in old-age patients in India and adds to evidence that ECT is safe and effective treatment in old age with no negative impact on cognition.

  5. Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study.

    Science.gov (United States)

    Palleschi, Lorenzo; De Alfieri, Walter; Salani, Bernardo; Fimognari, Filippo Luca; Marsilii, Alberto; Pierantozzi, Andrea; Di Cioccio, Luigi; Zuccaro, Stefano Maria

    2011-02-01

    To investigate the characteristics of patients who regain function during hospitalization and the differences in terms of functional outcomes between patients admitted to geriatric and general medicine units. Multicenter, prospective cohort study. Acute care geriatric and medical wards of five Italian hospitals. One thousand forty-eight elderly patients hospitalized for acute medical diseases. Functional status 2 weeks before hospital admission (baseline), at admission, and at discharge, as measured using the Barthel Index (BI). Geriatric patients were older (P<.001) and had lower preadmission functional levels (P<.001) than medical patients. Between baseline and discharge, 43.2% of geriatric and 18.9% of medical patients declined in physical function. In the subpopulation of 464 patients who had declined before hospitalization (between baseline and admission), 59% improved during hospitalization (45% of geriatric and 75% of medical patients), whereas only approximately 1% declined further. High baseline function (odds ratio (OR)=1.03, 95% confidence interval (CI)=1.02-1.04, per point of BI) and greater functional decline before hospitalization (OR 0.95, 95% CI 0.94-0.97, per % point of BI decline) were significant predictors of in-hospital functional improvement; type of hospital ward and age were not. Although geriatric patients have overall worse functional outcomes, in-hospital functional recovery may be frequent even in geriatric units, particularly in patients with greater preadmission functional loss and high baseline level of function. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  6. Medication discrepancies and potentially inadequate prescriptions in elderly adults with polypharmacy in ambulatory care

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    Juan Víctor Ariel Franco

    2017-01-01

    Full Text Available Objectives: The objective of this study is to describe the frequency and type of medication discrepancies (MD through medication reconciliation and to describe the frequency of potentially inadequate prescription (PIP medications using screening tool of older persons' prescriptions criteria. Design: Cross-sectional comparison of electronic medical record (EMR medication lists and patient's self-report of their comprehensive medication histories obtained through telephone interviews. Inclusion criteria: Elderly individuals (>65 years old with more than ten medications recorded in their EMR, who had not been hospitalized in the past year and were not under domiciliary care, affiliated to a private community hospital. Outcome Measures: The primary outcomes were the proportion of patients with MD and PIP. Secondary outcomes were the proportion of types of discrepancies and PIP. We analyzed possible associations between these variables and other demographic and clinical variables. Results: Out of 214 randomly selected individuals, 150 accepted to participate (70%. The mean number of medications referred to be consumed by patients was 9.1 (95% confidence interval [CI] =8.6–9.6, and the mean number of prescribed medications in their EMR was 13.9 (95% CI = 13.3–14.5. Ninety-nine percent had at least one discrepancy (total 1252 discrepancies; 46% consumed at least one prescription not documented in their EMR and 93% did not consume at least one of the prescriptions documented in their EMR. In 77% of the patients, a PIP was detected (total 186, 87% of them were at least within one of the following categories: Prolonged used of benzodiazepines or proton pump inhibitors and the use of aspirin for the primary prevention of cardiovascular disease. Conclusions: There was a high prevalence of MD and PIP within the community of elderly adults affiliated to a Private University Hospital. Future interventions should be aimed at reducing the number of PIP to

  7. University Extension of Elderly Health and Potency for Medical Training

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    Kerle Dayana Tavares de Lucena

    2017-06-01

    Full Text Available Objective: To present the potential of university extension for medical training, based on the perception of extension workers. Method: This is an exploratory descriptive study, with a qualitative approach, carried out with medical students, former students of the university extension project of the elderly health. Wheels of conversations were made to base empirical production on a semi-structured interview script. The analysis was performed using Fiorin's speech analysis technique. Results: It was possible to verify, in this research, the power of the university extension in the medical training, the impact generated in the accompanied elderly people and the importance of the production of bond. It was also verified the importance of providing students with more projects that can give a return to society and foster in students the need not to stop only the pathology, but mainly to awaken the motivation for a humanized and integral care. Conclusion: The university extension provides an approximation with the community, through the bond and accountability between the academic and the elderly. In addition, it allows to contribute to improve and implant the sense of citizenship in the life of individuals. Key words: Health of the institutionalized elderly, Medicine, Collective Health.

  8. Fall prevention in the elderly: analysis and comprehensive review of methods used in the hospital and in the home.

    Science.gov (United States)

    Clyburn, Terry A; Heydemann, John A

    2011-07-01

    Falls in the elderly are a significant problem both in and out of the hospital. The Deficit Reduction Act of 2005 and the Fiscal Year 2009 Inpatient Prospective Payment System Final Rule, as outlined by the Centers for Medicare & Medicaid Services, placed on hospitals the financial burden of fall prevention for falls (ie, hospital-acquired conditions) that could have been prevented by following evidence-based guidelines. Multifaceted and individualized programs have been created to prevent falls in the elderly. Many of these interventions are based on expert opinion and statistical trends. Our review of the literature revealed that the risk of fall is only slightly greater in the hospital environment than in the home and that there is no medical evidence that evidence-based guidelines are effective in fall prevention.

  9. Implementing Medical Teaching Policy in University Hospitals

    Science.gov (United States)

    Engbers, Rik; Fluit, Cornelia Cornelia R. M. G.; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F. J. M.

    2017-01-01

    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

  10. [Outplacement of medical students in local hospitals].

    Science.gov (United States)

    Lindsetmo, R O; Fosse, L; Evensen, S A; Wyller, V B; Nylehn, P; Ogreid, D

    1998-02-28

    The organisation and content of the training of medical students in practical and clinical skills at Norwegian universities is presented and discussed. Based on experience from Tromsø University, an increased use of local hospitals for training medical students in practical and clinical skills is planned for all universities in Norway.

  11. Medical slang in British hospitals.

    Science.gov (United States)

    Fox, Adam T; Fertleman, Michael; Cahill, Pauline; Palmer, Roger D

    2003-01-01

    The usage, derivation, and psychological, ethical, and legal aspects of slang terminology in medicine are discussed. The colloquial vocabulary is further described and a comprehensive glossary of common UK terms provided in appendix. This forms the first list of slang terms currently in use throughout the British medical establishment.

  12. Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes.

    Science.gov (United States)

    Halvorsen, Kristin; Eide, Helene Kjøllesdal; Sortland, Kjersti; Almendingen, Kari

    2016-01-01

    Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patients' nutritional status when elderly patients are transferred between hospital and nursing homes. A qualitative study was conducted using a phenomenological-hermeneutic approach. Data was collected in focus group interviews with 16 nurses in one large university hospital, and 11 nurses and 16 undergraduate nurses in five nursing homes associated with the university hospital. Participants from the university hospital represented a total of seven surgical and medical wards, all of which transferred patients to the associated nursing homes. The catchment area of the hospital and the nursing homes represented approximately 10% of the Norwegian population in heterogenic urban and rural municipalities. Data were coded and analysed thematically within the three contexts: self-understanding, critical common sense, and theoretical understanding. The results were summarized under three main themes 1) inadequate documentation of nutritional status on hospital admission, 2) inadequate and unsystematic documentation of nutritional information during hospital stay, 3) limited communication of nutritional information between hospital and nursing homes. The three main themes included seven sub-themes, which reflected the lack of nutritional screening and unsystematic documentation on admission and during

  13. Does hospital admission provide an opportunity for improving pharmacotherapy among elderly inpatients?

    Directory of Open Access Journals (Sweden)

    Daniela Oliveira de Melo

    Full Text Available ABSTRACT The purpose of the work was to assess the incidence of potential drug interactions (pDDI, major pDDI, and the use of potentially inappropriate medication (PIM at hospital admission, during hospitalization, and at discharge to evaluate whether hospital admission provides an opportunity for improving pharmacotherapy in elderly patients at a University hospital that has a clinical pharmacist. A prospective cohort study was carried out using data from the medical records of patients admitted to an internal medicine ward. All admissions and prescriptions were monitored between March and August 2006. Micromedex(r DrugReax(r and Beers Criteria 2015 were used to identify pDDI, major pDDI, and PIMs, respectively. A comparison of admission and discharge prescriptions showed the following: an increase in the proportion of patients using antithrombotic agents (76 versus 144; p<0.001, lipid modifying agents (58 versus 81; p=0.024, drugs for acid-related disorders (99 versus 152; p<0.001, and particularly omeprazole (61 versus 87; p=0.015; a decrease in the number of patients prescribed psycholeptics (73 versus 32; p<0.001 and diazepam (54 versus 13; p<0.001; and a decrease in the proportion of patients exposed to polypharmacy (16.1% versus 10.1%; p=0.025, at least one pDDI (44.5% versus 32.8%; p=0.002, major pDDI (19.9% versus 12.2%; p=0.010 or PIM (85.8% versus 51.9%; p<0.001. The conclusion is that admission to a hospital ward that has a clinical pharmacist was associated with a reduction in the number of patients exposed to polypharmacy, pDDI, major pDDI, and the use of PIMs among elderly inpatients.

  14. Clinical outcomes of acute kidney injury developing outside the hospital in elderly.

    Science.gov (United States)

    Turgutalp, K; Bardak, S; Horoz, M; Helvacı, I; Demir, S; Kiykim, A A

    2017-01-01

    Although various studies have improved our knowledge about the clinical features and outcomes of acute kidney injury developing in the hospital (AKI-DI) in elderly subjects, data about acute kidney injury developing outside the hospital (AKI-DO) in elderly patients (age ≥ 65 years) are still extremely limited. This study was performed to investigate prevalence, clinical outcomes, hospital cost and related factors of AKI-DO in elderly and very elderly patients. We conducted a prospective, observational study in patients (aged ≥ 65 years) who were admitted to our center between May 01, 2012, and May 01, 2013. Subjects with AKI-DO were divided into two groups as "elderly" (group 1, 65-75 years old) and "very elderly" (group 2, >75 years old). Control group (group 3) consisted of the hospitalized patients aged 65 years and older with normal serum creatinine level. In-hospital outcomes and 6-month outcomes were recorded. Rehospitalization rate within 6 months of discharge was noted. Hospital costs and mortality rates of each group were investigated. Risk factors for AKI-DO were determined. The incidence of AKI-DO that required hospitalization in elderly and very elderly patients was 5.8 % (136/2324) and 11 % (100/905), respectively (p elderly patients (p elderly patients than elderly ones, especially in male gender. Use of ACEI, ARB, NSAID and radiocontrast agents is the main risk factors for the development of AKI-DO in the elderly.

  15. Implementing medical teaching policy in university hospitals.

    Science.gov (United States)

    Engbers, Rik; Fluit, Cornelia R M G; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F J M

    2017-10-01

    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.

  16. Hospitals as factories of medical garbage.

    Science.gov (United States)

    Hodges, Sarah

    2017-12-01

    Over the course of the twentieth century, as hospitals cleaned up, they came to produce more and more rubbish. Beginning in the 1970s and gaining pace in the 1980s and 1990s, single-use plastic items (syringes, blood bags, tubing) saturated everyday medical practice across the globe. This essay brings the question of plastic to bear upon the longer history of twentieth century sanitary science. The widespread adoption of single-use disposable medical plastics consolidated a century's worth of changes in medical hygiene. As strange as it may seem today, the initial uptake of medical plastics was not driven primarily by concerns about hygiene. Plastic began as a mid-century technology of convenience and durability. It was not until the end of the twentieth century that it morphed into a powerful symbol and instrument of medical hygiene. Today, both patients and practitioners have embraced plastic as an indispensable technology of clean medicine. The procession of single-use medical plastics through everyday medicine now comprises a constant, if disposable, infrastructure of medical hygiene. This new processional infrastructure of disposable hygiene has produced another, albeit unintended, consequence. This new regime has exponentially increased hospitals' material outputs. In so doing, plastic has refigured the ecologies of everyday medicine. Plastic hygiene has rendered hospitals factories of medical garbage.

  17. Prevalence and mechanisms of hyperhomocysteinemia in elderly hospitalized patients.

    Science.gov (United States)

    Salles-Montaudon, N; Parrot, F; Balas, D; Bouzigon, E; Rainfray, M; Emeriau, J-P

    2003-01-01

    Plasma homocysteine concentrations increase with age and remain an independent risk factor for vascular disease in the elderly. There are negative correlations between plasma homocysteine and serum folate and vitamin B12 concentrations. Two mechanisms, poor nutritional status, and chronic atrophic gastritis, could explain hyperhomocysteinemia. The purpose of the study was to determine prevalence and mechanisms of hyperhomocysteinemia in older hospitalized patients. During a 12-month period, all the consecutive hospitalized patients who underwent gastric endoscopy were recruited in this observational prospective study. Clinical, histological, and biological data concerning nutritional status, gastric analysis, homocysteine, vitamin B12, and folate concentrations were collected during the study for each included patient. One hundred and ninety six patients (132 women and 64 men, mean age: 85.3 5.7 years) were included. Hyperhomocysteinemia (>or= 18 mmol/l) was diagnosed in 45.4 %, cobalamin deficiency in 13.3 %, and folate deficiency in 11.7 % patients. Hyperhomocysteinemia was significantly correlated to cobalamin deficiency (r = - 0.21; p = 0.005). In a sub group of patients without hypothyroidism, or chronic renal impairment, univariate and multivariate analysis showed a significant association between hyper homocysteinemia and low MNA (OR: 0.92; 95% CI 0.85-0.99), and low albumin (OR: 0.92; 95% IC: 0.83-0.99; p = 0.04). No correlation was found between homocysteine concentrations and chronic atrophic gastritis or Helicobacter pylori infection. Hyperhomocysteinemia seems to be frequent in the elderly and is associated with poor nutritional status rather than chronic atrophic gastritis.

  18. [Predictive value of the VMS theme 'Frail elderly': delirium, falling and mortality in elderly hospital patients].

    Science.gov (United States)

    Oud, Frederike M M; de Rooij, Sophia E J A; Schuurman, Truus; Duijvelaar, Karlijn M; van Munster, Barbara C

    2015-01-01

    To determine the predictive value of safety management system (VMS) screening questions for falling, delirium, and mortality, as punt down in the VMS theme 'Frail elderly'. Retrospective observational study. We selected all patients ≥ 70 years who were admitted to non-ICU wards at the Deventer Hospital, the Netherlands, for at least 24 hours between 28 March 2011 and 10 June 2011. On admission, patients were screened with the VMS instrument by a researcher. Delirium and falls were recorded during hospitalisation. Six months after hospitalisation, data on mortality were collected. We included 688 patients with a median age of 78.7 (range: 70.0-97.1); 50.7% was male. The sensitivity of the screening for delirium risk was 82%, the specificity 62%. The sensitivity of the screening for risk of falling was 63%, the specificity 65%. Independent predictors for mortality within 6 months were delirium risk (odds ratio (OR): 2.3; 95% CI 1.1-3.2), malnutrition (OR: 2.1; 95% CI 1.3-3.5), admission to a non-surgical ward (OR: 3.0; 95% CI 1.8-5.1), and older age (OR: 1.1; 95%CI 1.0-1.1). Patients classified by the VMS theme 'Frail elderly' as having more risk factors had a higher risk of dying (p < 0.001). The VMS screening for delirium is a reasonably reliable instrument for identifying those elderly people with a high risk of developing this condition; the VMS sensitivity for fall risk is moderate. The number of positive VMS risk factors correlates with mortality and may therefore be regarded as a measure of frailty.

  19. Viability of gait speed test in hospitalized elderly patients.

    Science.gov (United States)

    Martinez, Bruno Prata; Batista, Anne Karine Menezes Santos; Ramos, Isis Resende; Dantas, Júlio Cesar; Gomes, Isabela Barboza; Forgiarini, Luiz Alberto; Camelier, Fernanda Rosa Warken; Camelier, Aquiles Assunção

    2016-01-01

    The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = -0.27 to 0.15). The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance. O teste de velocidade de marcha (TVM) é um teste físico que pode predizer quedas e auxiliar no diagnóstico de sarcopenia em idosos da comunidade. Entretanto, pelo que sabemos, não há estudos que avaliaram sua reprodutibilidade em idosos hospitalizados. O objetivo deste estudo foi avaliar a segurança e a reprodutibilidade do TVM de seis

  20. Prescription of potentially inappropriate medications to elderly hemodialysis patients: prevalence and predictors.

    Science.gov (United States)

    Kondo, Naoya; Nakamura, Fumiaki; Yamazaki, Shin; Yamamoto, Yosuke; Akizawa, Tadao; Akiba, Takashi; Saito, Akira; Kurokawa, Kiyoshi; Fukuhara, Shunichi

    2015-03-01

    In elderly hemodialysis (HD) patients, the risk of medication-related problems is particularly high. Thus, certain medications should generally not be prescribed to those patients. The Beers criteria for potentially inappropriate medications (PIMs) have been publicized. Still, with regard to elderly HD patients, the prevalence and risk factors for prescription of PIMs are unknown. This was a cross-sectional study of data from the Japan Dialysis Outcomes and Practice Patterns Study (2002-08). Patients were included if they were 65 years old or older and were currently receiving HD treatment at a hospital or clinic. We counted the number of patients who were prescribed at least one PIM, as defined by the modified Beers criteria. We used multiple logistic regression analysis to determine which patient characteristics and facility characteristics were associated with prescription of PIMs. Data from 1367 elderly patients were analyzed. More than half of the patients (57%) had been prescribed a PIM. The three most frequently prescribed PIMs were H2 blockers (33%), antiplatelet agents (19%) and α-blockers (13%). PIM prescriptions were less likely at facilities that conducted multidisciplinary rounds {adjusted odds ratio (AOR): 0.67 [95% confidence interval (CI): 0.48-0.93]} and at teaching hospitals [AOR: 0.59 (95% CI, 0.39-0.90)]. PIM prescriptions are more likely if more than one physician has clearance to alter the HD regimen [AOR: 1.65 (95% CI, 1.12-2.44)]. PIMs were prescribed to many elderly HD patients in Japan. Nephrologists should become more aware of PIMs. Multidisciplinary rounds could benefit patients by reducing the prescription of PIMs. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  1. Assessment of hospital inpatient discharge summaries, written for general practitioners, from a department of medicine for the elderly service in a large teaching hospital.

    Science.gov (United States)

    Mc Larnon, E; Walsh, J B; Ni Shuilleabhain, A

    2016-02-01

    The discharge document summarising an acute inpatient stay in hospital is often the only means of communication between secondary and primary care. This is especially important in the elderly population who have multiple morbidities and are often on many medications. This study aimed to assess if information important to general practitioners is being included in inpatient hospital discharge summaries for patients of the medicine for the elderly service in a large teaching hospital. After a thorough literature review, a "gold standard" letter was defined as having included a discharge diagnosis, medications on discharge and follow-up plans. Forty computerised discharge summaries were retrospectively assessed for inclusion of these parameters. The study group consisted of the first eight sequentially discharged patients under the care of each of the five consultants during a 1-month period (1 September 2011-30 September 2011). A discharge diagnosis was included in 37 of the 40 summaries (92.5 %), medications on discharge were included in 39 summaries (97.5 %) and follow-up was recorded in 35 summaries (87.5 %). This study showed that the information assessed was available in the vast majority of discharge summaries for patients admitted acutely under the care of this medicine for the elderly service. Improvements can be made, including documentation of follow-up plans.

  2. Anemia and functional capacity in elderly Brazilian hospitalized patients

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    Raquel de Macedo Bosco

    2013-07-01

    Full Text Available This study evaluated the association between anemia and physical functional capacity in a cross-sectional population-based sample of 709 hospitalized elderly patients aged 60 years and over admitted to the Madre Teresa Hospital, Belo Horizonte, State of Minas Gerais, Brazil. The Mann-Whitney or "t" test, and chi-square or Fisher exact test were used for quantitative and categorical variables, respectively, and hierarchical binary logistic regression was used to identify significant predictors. The presence of anemia was found in 30% of participants and was significantly associated with decreased functionality according to the two measures which were used - ADL (activities of daily living and IADL (instrumental activities of daily living. Anemia was also independently associated with older age. The results of this study demonstrate a strong association between the presence of anemia and lower levels of functional capacity. Further investigations are needed to assess the impact of anemia treatment on the functionality and independence of older people.

  3. Readmission to hospital of medical patients

    DEFF Research Database (Denmark)

    Gothardt Rasmussen, Mette; Ravn, Pernille; Molsted, Stig

    2017-01-01

    Introduction: The incidence of acute readmissions is higher among elderly medical patients than in the general population. Risk factor identification is needed in order to prevent readmissions. Objective: To estimate the incidence of acute readmissions among medical patients ≥ 65 years discharged.......00–1.15), receiving home care service (personal care) (HR: 1.33, 95%CI: 1.15–1.55), nursing home residency (HR: 1.30, 95%CI: 1.14–1.48), a previous admission within six months (HR: 1.59, 95%CI: 1.48–1.72), increased length of index admission (HR: 1.14, 95%CI: 1.11–1.17), and moderate or high level of comorbidities...

  4. Oral inflammation and infection, and chronic medical diseases: implications for the elderly.

    Science.gov (United States)

    Scannapieco, Frank A; Cantos, Albert

    2016-10-01

    Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Fall Injuries and Related Factors of Elderly Patients at a Medical Center in Taiwan

    Directory of Open Access Journals (Sweden)

    Li-Yun Tsai

    2014-12-01

    Conclusion: Fall injuries have a negative and serious impact on elderly patients to their health condition and quality of life. Nursing staff need to instruct fall prevention measures at an early stage of elderly patient hospitalization. This study should provide a reference for nursing staff in assessing fall risks and reducing resultant falls and injuries among elderly patients.

  6. Measuring and Comparing Hospital Accessibility for Palm Beach County's Elderly and Nonelderly Populations During a Hurricane.

    Science.gov (United States)

    Prasad, Shivangi

    2017-09-18

    To determine whether, during a hurricane, geographic accessibility to hospitals with emergency care is compromised disproportionately for the elderly than for the nonelderly. The locations of hospitals with emergency health care and a subset of those hospitals functional during a hurricane were compared with the distribution of the elderly population at the block group level in Palm Beach County, Florida. Geographic Information Systems (GIS) proximity analysis (minimum distance to closest hospital) and cumulative distribution functions were used to measure and compare hospital accessibility during normal and hurricane conditions for the elderly and nonelderly populations. Accessibility to closest functional hospital during a hurricane was compromised disproportionately for the elderly. Geographic accessibility to emergency health care is compromised disproportionately for the elderly in Palm Beach County. Compounding the risk is the likelihood of the elderly experiencing a greater health care need during a hurricane. This poses a community public health crisis and calls for effective and collaborative planning between health professionals and disaster planners to address the health care needs of the elderly. (Disaster Med Public Health Preparedness. 2017;page 1 of 5).

  7. Venous thromboembolism prophylaxis in hospitalized elderly patients: Time to consider a 'MUST' strategy.

    Science.gov (United States)

    Ho, Kwok M; Litton, Edward

    2011-06-01

    Venous thromboembolism (VTE) is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual's risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat ('MUST') VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional 'selective and single-modal' VTE prophylaxis approach, which often becomes 'hit or miss' or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.

  8. Drug use by elderly inpatients of a philanthropic hospital

    Directory of Open Access Journals (Sweden)

    Rômulo Moreira dos Santos

    2011-06-01

    Full Text Available The high incidence of chronic diseases in the elderly leads to increased intermittent drug therapies. The presence of concomitant diseases and prescriptions made out by various health professionals facilitate the practice of polypharmacy, the emergence of iatrogenic diseases, and therapeutic regimens that are inconvenient for patients. The present study was carried out among elderly patients hospitalized at the Hospital Care Foundation of Paraiba, Campina Grande, with the objectives of studying the consumption of drugs by these patients, noting the possible adverse drug reactions (ADR, drug interactions and the presence of high-risk drugs prescribed to this age group. The study had a descriptive and cross-sectional quantitative design and involved a sample of 65 patients accompanied by the Pharmacovigilance Centre of the hospital, from August 2009 to July 2010. Over 90% of the patients were on polypharmacy, and the possible ADR found were related to the gastrointestinal tract where the most frequent interactions were with cardiovascular drugs. Within the context of pharmacoepidemiology, pharmacists can contribute by improving the quality of life of patients and preventing unnecessary expense with erroneous and poorly evaluated treatments.A elevada incidência de doenças crônicas na terceira idade induz ao aumento de terapias medicamentosas intermitentes. A presença de patologias concomitantes e prescrições elaboradas por diversos profissionais de saúde facilitam a prática da polifarmácia, surgimento de doenças iatrogênicas e esquemas terapêuticos pouco cômodos para o paciente. O estudo foi realizado junto aos pacientes idosos internados no Hospital da Fundação Assistencial da Paraíba (FAP, Campina Grande, com objetivo de estudar o consumo de medicamentos por estes pacientes, observando as possíveis reações adversas a medicamentos (RAM, interações medicamentosas apresentadas e a presença de medicamentos de alto risco

  9. Factors associated with the difficulty in hospital acceptance among elderly emergency patients: A population-based study in Osaka City, Japan.

    Science.gov (United States)

    Matsuyama, Tasuku; Kitamura, Tetsuhisa; Katayama, Yusuke; Kiyohara, Kosuke; Hayashida, Sumito; Kawamura, Takashi; Iwami, Taku; Ohta, Bon

    2017-06-18

    We aimed to investigate prehospital factors associated with difficulty in hospital acceptance among elderly emergency patients. We reviewed ambulance records in Osaka City from January 2013 through December 2014, and enrolled all elderly emergency patients aged ≥65 years who were transported by on-scene emergency medical service personnel to a hospital that the personnel had selected. The definition of difficulty in hospital acceptance was to the requirement for ≥4 phone calls to hospitals by emergency medical service personnel before receiving a decision from the destination hospitals. Prehospital factors associated with difficulty in hospital acceptance were examined through logistic regression analysis. During the study period, 72 105 elderly patients were included, and 13 332 patients (18.5%) experienced difficulty in hospital acceptance. In the simple linear regression model, hospital selection time increased significantly with an increasing number of phone calls (R(2)  = 0.774). In the multivariable analysis, older age (P for trend Japan, which has a rapidly aging population, a comprehensive strategy for elderly emergency patients, especially for advanced age groups or nursing home residents, is required. Geriatr Gerontol Int 2017; ••: ••-••. © 2017 Japan Geriatrics Society.

  10. Potential clinical impact of medication discrepancies at hospital admission.

    Science.gov (United States)

    Quélennec, Baptiste; Beretz, Laurence; Paya, Dominique; Blicklé, Jean Frédéric; Gourieux, Bénédicte; Andrès, Emmanuel; Michel, Bruno

    2013-09-01

    Medication errors at the interfaces of care are highly prevalent. This study aims to identify unintentional medication discrepancies at hospital admission and to explore their potential clinical impact in elderly patients. The study was conducted in an Internal Medicine Department. Patients ≥ 65 years admitted through the emergency department were eligible. Best possible medication histories, obtained from different sources by pharmacists, were compared to admission medication prescriptions to identify and correct unintentional discrepancies. A three-category scale was used to rate errors for their potential to cause harm: Level (L) 1 "no potential harm", L2 "monitoring or intervention potentially required to preclude harm", and L3 "potential harm". This scale was also designed to take into account patient's clinical characteristics and high-risk drugs. 256 patients were included. Mean age was 82.2 ± 7.2 years old. 85 patients (33.2%) had ≥ 1 unintentional discrepancies. Overall, there were 173 unintentional discrepancies. The 3 most common drug classes involved in errors were nervous system (22.0%), gastrointestinal (20.0%) and cardiovascular (18.0%) medications. The most common types of errors were "omission" (87.9%) and "incorrect dose" (8.1%). Among the unintentional discrepancies, 20.8% had the potential to require increased monitoring or intervention to preclude harm (L2) and 6.4% had the potential to cause clinical deterioration (L3). More than 25% of the identified errors presented a potential clinical impact. These results show that a combined intervention of pharmacists and physicians in a collaborative medication reconciliation process has a high potential to reduce clinical relevant errors at hospital admission. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  11. Impact of Blunted Perception of Dyspnea on Medical Care Use and Expenditure, and Mortality in Elderly People

    Directory of Open Access Journals (Sweden)

    Satoru eEbihara

    2012-07-01

    Full Text Available Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment (CGA in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20 and 30 cmH2O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs and death through computerized linkage with National Health Insurance (NHI beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all cause mortality were 0.65 (95%CI 0.23-1.89 for intermediate perception group and 0.31(0.10-0.97 for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p=0.04. The blunted perception of dyspnea is related to hospitalization, large medical costs and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.

  12. The effect of one-dose package on medication adherence for the elderly care in Japan

    OpenAIRE

    Yamamoto N.; Kamei M; Fujita M; Nakai K.

    2009-01-01

    Deterioration of the medication adherence for elderly could result in wasteful medical expenditure in a long-term span as well as aggravating the patient's medical condition.Objective: This study surveyed the effect of one-dose package medication made up by a pharmacist on the patient's behavior towards medication, what is expected to be one of the measures to improve the medication adherence for elderly.Methods: With support activity of the Pharmacist Association in Ueda-city in Nagano Prefe...

  13. Prevalence of Oral and Maxillofacial Trauma in Elders Admitted to a Reference Hospital in Northeastern Brazil

    National Research Council Canada - National Science Library

    Carvalho Filho, Marcus Antonio Melo; Saintrain, Maria Vieira de Lima; Dos Anjos, Rita Edna da Silveira; Pinheiro, Solange Sousa; Cardoso, Luciana de Carvalho Pádua; Moizan, Jean André Hervé; de Aguiar, Andréa Silvia Walter

    2015-01-01

    To know the prevalence and etiology of oral and maxillofacial trauma in elders. Analytical quantitative cross-sectional study conducted at a public trauma hospital located in Fortaleza-Ceará, Brazil...

  14. Year in review: medication mishaps in the elderly.

    Science.gov (United States)

    Peron, Emily P; Marcum, Zachary A; Boyce, Richard; Hanlon, Joseph T; Handler, Steven M

    2011-02-01

    This paper reviews articles from 2010 that examined medication mishaps (ie, medication errors and adverse drug events [ADEs]) in the elderly. The MEDLINE and EMBASE databases were searched for English-language articles published in 2010 using a combination of search terms including medication errors, medication adherence, medication compliance, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failures, and aged. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional publications. Five studies of note were selected for annotation and critique. From the literature search, this paper also generated a selected bibliography of manuscripts published in 2010 (excluding those previously published in the American Journal of Geriatric Pharmacotherapy or by one of the authors) that address various types of medication errors and ADEs in the elderly. Three studies focused on types of medication errors. One study examined underuse (due to prescribing) as a type of medication error. This before-and-after study from the Netherlands reported that those who received comprehensive geriatric assessments had a reduction in the rate of undertreatment of chronic conditions by over one third (from 32.9% to 22.3%, P vs 12.3%, respectively; P vs 24.7%, respectively; P = 0.005). In multivariable analyses stratified by race, blacks who used CAM were more likely than those who did not to have low antihypertensive medication adherence (prevalence rate ratio = 1.56; 95% CI, 1.14-2.15; P = 0.006). The remaining two studies addressed some form of medication-related adverse patient events. A case-control study of Medicare Advantage patients revealed for the first time that the use of skeletal muscle relaxants was associated significantly with an increased fracture risk (adjusted odds ratio = 1.40; 95% CI, 1.15-1.72; P vs 36

  15. Analysis of 126 hospitalized elder maxillofacial trauma victims in central China.

    Science.gov (United States)

    Li, Rui; Zhang, Rui; Li, Wenlu; Pei, Fei; He, Wei

    2015-07-01

    The aim of this study was to analyzed the characteristics and treatment of maxillofacial injuries in the elder patients with maxillofacial injuries in central China. We retrospectively analyzed the characteristics and treatment of maxillofacial injuries in the patients over the age of 60 to analyze the trends and clinical characteristics of maxillofacial trauma in elder patients from the First Affiliated Hospital of Zhengzhou University (from 2010 to 2013) in central China and to present recommendations on prevention and management. Of the 932 patients with maxillofacial injuries, 126 aged over 60 years old accounting for 13.52% of all the patients (male:female, 1.74:1; mean age, 67.08 years old). Approximately 52% of the patients were injured by falls. The most frequently observed type of injuries was soft tissue injuries (100%), followed by facial fractures (83.05%). Of the patients with soft tissue injuries, the abrasions accounted the most, followed by lacerations. The numbers of patients of midface fracture (60 patients) were almost similar to the number of lower face fractures (66 patients). Eighty two patients (65.08%%) demonstrated associated injuries, of which craniocerebral injuries were the most prevalent. One hundred and four patients (82.54%) had other systemic medical conditions, with cardiovascular diseases the most and followed by metabolic diseases and musculoskeletal conditions. Furthermore, the study indicated a relationship between maxillofacial fractures and musculoskeletal conditions. Only 13 patients (10.32%) sustained local infections, of whom had other medical conditions. Most of the facial injuries (85.71%) in older people were operated including debridement, fixing loose teeth, reduction, intermaxillary fixation and open reduction and internal fixation (ORIF). Our analysis of the characteristics of maxillofacial injuries in the elder patents may help to promote clinical research to develop more effective treatment and possibly prevent

  16. Urinary incontinence in elderly inpatients in Japan: a comparison between general and geriatric hospitals.

    Science.gov (United States)

    Toba, K; Ouchi, Y; Orimo, H; Iimura, O; Sasaki, H; Nakamura, Y; Takasaki, M; Kuzuya, F; Sekimoto, H; Yoshioka, H; Ogiwara, T; Kimura, I; Ozawa, T; Fujishima, M

    1996-02-01

    This is the first multi-hospital epidemiological study to elucidate the prevalence and characteristics of urinary incontinence in elderly inpatients throughout Japan. Of the 2586 subjects to whom questionnaires were issued, 1563 (60.4%) (65 to 102 years old, 598 men, 965 women) were suitable for the study. A total of 817 patients were hospitalized in geriatric hospitals; that is, geriatric facilities under the regulation of the Department of Health and Welfare. All patients were evaluated by medical doctors for the following items: age, sex, duration of hospitalization, activities of daily living, medical diagnosis, presence or absence of urinary incontinence, type of urinary incontinence, and therapy for urinary incontinence. The prevalence of urinary incontinence in patients under 70, 70-79, 80-89, and over 90 years old was 59.3%, 67.7%, 79.8%, and 82.2%, respectively. Overall, 1142 patients (72.0%) suffered from urinary incontinence. Cerebrovascular disease was the major cause of admission to hospital in patients with urinary incontinence (37.0%). The most frequent type of urinary incontinence was functional urinary incontinence in patients who were mentally and/or physically unable to go to the bathroom without aid (21.5%). Specifically, 38.1% of patients in geriatric hospitals were diagnosed as having functional urinary incontinence, in contrast to only 3.9% of patients in non-geriatric units. In patients with dementia, 88.7% were incontinent, whereas in patients without dementia, the prevalence of urinary incontinence was much lower (51.5%, p incontinence was urinary tract infection. The prevalence of urinary incontinence in patients with and without urinary tract infection was 87.8% and 59.5%, respectively (p incontinence (98.5%). On the other hand, urinary incontinence was not so frequent in patients who could walk (26.9%). Pad (42.8%) and indwelling bladder catheter (18.3%) were the major means of management of incontinence, whereas behavioral therapy (4

  17. Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2017-08-01

    Full Text Available Niklas Ekerstad,1,2 Kristoffer Bylin,3 Björn W Karlson3,4 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhättan, 2Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, 3Department of Acute and Internal Medicine, NU (NÄL-Uddevalla Hospital Group, Trollhättan, 4Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Background and objective: Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early rehospitalizations. Patients and methods: This is a clinical, prospective, observational study on rehospitalizations within 30 days after an acute hospital episode for frail patients over the age of 75 years. To identify adverse drug reactions (ADRs, underuse of evidence-based treatment and avoidability of rehospitalizations, the Naranjo score, the Hallas criteria and clinical judgment were used. Results: Of 390 evaluable patients, 96 (24.6% were rehospitalized. The most frequent symptoms and conditions were dyspnea (n = 25 and worsened general condition (n = 18. The most frequent diagnoses were heart failure (n = 17 and pneumonia/acute bronchitis (n = 13. By logistic regression analysis, independent risk predictors for rehospitalization were heart failure (odds ratio [OR] = 1.8; 95% CI = 1.1–3.1 and anemia (OR = 2.3; 95% CI = 1.3–4.0. The number of rehospitalizations due to probable ADRs was 13, of which two were assessed as avoidable. The number of rehospitalizations probably due to underuse of evidence-based drug treatment was 19, all of which were assessed as avoidable. The number of rehospitalizations not due to ADRs or underuse of evidence-based drug treatment was 64, of which none was assessed as avoidable. Conclusion: One out of four

  18. Metadata - National Hospital Ambulatory Medical Care Survey (NHAMCS)

    Science.gov (United States)

    The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect information on the services provided in hospital emergency and outpatient departments and in ambulatory surgery centers.

  19. Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital.

    Science.gov (United States)

    Baek, Myoung-Ha; Heo, Young-Ran

    2015-12-01

    Malnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly. Elected medical records of 141 elderly patients (86 men and 55 women, aged 73.5 ± 5.2 years) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification. According to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index. MNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital.

  20. Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital

    Science.gov (United States)

    Baek, Myoung-Ha

    2015-01-01

    BACKGROUND/OBJECTIVES Malnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly. SUBJECTS/METHODS Elected medical records of 141 elderly patients (86 men and 55 women, aged 73.5 ± 5.2 years) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification. RESULTS According to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index. CONCLUSIONS MNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital. PMID:26634053

  1. Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases.

    Science.gov (United States)

    Park, Hwa Yeon; Seo, Sin Ae; Yoo, Hyeyoung; Lee, Kiheon

    2018-01-01

    The aim of this study was to assess medication adherence and its related factors among elderly people living alone with chronic diseases using a conceptual framework with the Belief about Medicines Questionnaire and the Adherence to Refills and Medication Scale-Korean version. This was a cross-sectional study conducted in 3,326 elderly people living alone, who were enrolled in Seongnam Center for Home Health Care in South Korea. They completed validated questionnaires assessing their adherence and beliefs about medication in general. In attitudinal analysis using Belief about Medicines Questionnaire, 37.0% of patients were accepting of medication (high necessity with low concerns), 49.7% were ambivalent (high necessity with high concerns), 1.9% were skeptical (low necessity with high concerns), and 11.4% were indifferent (low necessity and low concerns). In multivariable analysis, we found that adherence was related to patients' beliefs about medication; compared with patients who were accepting of medication, those in the other three attitudinal groups had significantly lower adherence (indifferent, p =0.003; skeptical, p =0.001; ambivalent, p adherence was associated with heavy burden of drug costs (β=0.109; 95% CI 0.03, 0.19), presence of drug side effects (β=0.431; 95% CI 0.11, 0.75), dissatisfaction with medication (β=-0.626; 95% CI -0.77, -0.48), perceiving health status as poor (β=-0.151; 95% CI -0.27, -0.03), and receiving medical aid (β=0.655; 95% CI 0.42, 0.89). Gender, age group, and number of prescribed medication were not associated with medication adherence. To improve medication adherence of elderly living alone, it is essential to identify barriers to adherence, including their concerns and attitudes toward medications. These factors associated with adherence should be considered in further intervention studies.

  2. Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study.

    Science.gov (United States)

    Wakabayashi, Hidetaka; Sashika, Hironobu

    2014-03-01

    To investigate the association between nutritional status and rehabilitation outcome in elderly inpatients with hospital-associated deconditioning. A prospective cohort study. One hundred sixty-nine consecutive elderly inpatients diagnosed with hospital-associated deconditioning. Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center. Body mass index, haemoglobin, albumin, total lymphocyte count, C-reactive protein, cause of malnutrition, and feeding route were also investigated. Primary outcome was Barthel Index score at discharge. A total of 148 patients (87.6%) were malnourished, and 21 were at risk for malnutrition. There were no patients with normal nutritional status. Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition. Chronic disease-related malnutrition, oral intake, and parenteral nutrition were associated with the Barthel Index score at discharge. There were significant correlations between the Barthel Index score at discharge and nutritional score, albumin, and total lymphocyte count. In multiple regression analysis, Mini Nutritional Assessment Short Form, albumin, and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge. Most elderly inpatients with hospital-associated deconditioning are malnourished. Nutritional status, albumin, and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning.

  3. Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders.

    Science.gov (United States)

    Brock, Felipe; Bettinelli, Luiz Antonio; Dobner, Taise; Stobbe, Júlio César; Pomatti, Gabriela; Telles, Cristina Trevizan

    2016-08-08

    to estimate the prevalence of hypoalbuminemia in hospitalized elders, related to socio-demographic variables, nutritional status and length of stay. crosscutting study with 200 patients hospitalized in a large hospital in the South of Brazil during three months. Evaluations, lab tests and interviews through questionnaires were performed. the average albuminemia was 2,9 ± 0,5g/dL. Hypoalbuminemia was diagnosed in 173 subjects (87%) and was absent in 27 (13%) that have normal albuminemia (p=0,000). After six days of hospitalization, the prevalence of low levels grew significantly to 90% (p=0,002), average 2,7 ± 0,5g/dL. Using the Mini Nutritional Assessment, it was observed that 41 patients were malnourished and from those, 40 had hypoalbuminemia. the prevalence of hypoalbuminemia proved to be high, in approx. nine in ten elders, and the nutritional status and the length of stay proved to be related to the decrease of serum albumin levels. Thus, it is suggested that monitoring albumin levels should be done to evaluate the risk that the patient has to develop malnutrition and other complications during hospital stays. estimar a prevalência de hipoalbuminemia em idosos hospitalizados, em relação às variáveis sociodemográficas, estado nutricional e tempo de internação. estudo transversal, com 200 pacientes internados em hospital de grande porte do sul do Brasil, durante o período de três meses. Foram realizadas avaliações, análise de exames laboratoriais e entrevista através de questionário. a média de albuminemia foi 2,9 ± 0,5g/dL. O diagnóstico de hipoalbuminemia, foi encontrado em 173 sujeitos (87%), e não revelado em 27 (13%), que apresentaram albuminemia normal (p=0,000). Constatou-se que após seis dias de internação a prevalência de níveis baixos aumentou significativamente para 90% (p=0,002), com média de 2,7 ± 0,5g/dL. Utilizando-se a Mini Avaliação Nutricional, observou-se que 41 pacientes estavam desnutridos, e que destes, 40

  4. Evaluation of hospital medication inventory policies.

    Science.gov (United States)

    Gebicki, Marek; Mooney, Ed; Chen, Shi-Jie Gary; Mazur, Lukasz M

    2014-09-01

    As supply chain costs constitute a large portion of hospitals' operating expenses and with $27.7 billion spent by the US hospitals on drugs alone in 2009, improving medication inventory management provides a great opportunity to decrease the cost of healthcare. This study investigates different management approaches for a system consisting of one central storage location, the main pharmacy, and multiple dispensing machines located in each department. Each medication has a specific unit cost, availability from suppliers, criticality level, and expiration date. Event-driven simulation is used to evaluate the performance of several inventory policies based on the total cost and patient safety (service level) under various arrangements of the system defined by the number of drugs and departments, and drugs' criticality, availability, and expiration levels. Our results show that policies that incorporate drug characteristics in ordering decisions can address the tradeoff between patient safety and cost. Indeed, this study shows that such policies can result in higher patient safety and lower overall cost when compared to traditional approaches. Additional insights from this study allow for better understanding of the medication inventory system's dynamics and suggest several directions for future research in this topic. Findings of this study can be applied to help hospital pharmacies with managing their inventory.

  5. Handgrip Strength Predicts Functional Decline at Discharge in Hospitalized Male Elderly: A Hospital Cohort Study

    Science.gov (United States)

    García-Peña, Carmen; García-Fabela, Luis C.; Gutiérrez-Robledo, Luis M.; García-González, Jose J.; Arango-Lopera, Victoria E.; Pérez-Zepeda, Mario U.

    2013-01-01

    Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79–0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and

  6. Prevalence of self-medication and associated factors in an elderly population: a systematic review.

    Science.gov (United States)

    Jerez-Roig, Javier; Medeiros, Lucas F B; Silva, Victor A B; Bezerra, Camila L P A M; Cavalcante, Leandro A R; Piuvezam, Grasiela; Souza, Dyego L B

    2014-12-01

    The aging of the world populat ion together with changes in the epidemiological profile of diseases have led to increases in both the consumption of medicines and health expenses. In this context, self-medication has gained importance as a rapid treatment that bypasses bureaucracy and, in some instances, delays in obtaining medical assistance. Verification of self-medication prevalence and associated factors in the elderly, as well as identification of the main categories of non-prescription drugs utilized. The following databases were utilized: Cochrane, PubMed, Scopus, LILACS, SciELO, PAHO, MedCarib and WHOLIS. Studies on the prevalence of self-medication in community-dwelling elderly were included. Review studies were excluded, as well as MSc dissertations, PhD theses and research with convenience sampling. Community-dwelling individuals aged 60 years or over. A systematic review of population-based articles published up until September 1, 2014, is presented. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was applied for critical assessment of the articles, and those with a minimum score of 60% were selected for inclusion in the review. Thirty-six articles were selected, of which 28 were included after critical reading. The prevalence of self-medication varied between 4 and 87%, and the majority of studies reported values between 20 and 60%. The mean prevalence reported in the articles was 38%, but several criteria were utilized to measure self-medication. The most commonly utilized non-prescription drugs were analgesics and antipyretics, followed by non-hormonal anti-inflammatories, cardiovascular agents, dietary complements and alternative medicine components. The variables that presented positive associations with self-medication were female sex, visits to pharmacists, depression, functional dependency, recent hospitalization, oral pain, restriction of activities and physical inactivity. The variables with negative

  7. Community-acquired hypernatremia in elderly and very elderly patients admitted to the hospital: Clinical characteristics and outcomes

    Science.gov (United States)

    Turgutalp, Kenan; Özhan, Onur; Oğuz, Ebru Gök; Yilmaz, Arda; Horoz, Mehmet; Helvacı, İlter; Kiykim, Ahmet

    2012-01-01

    Summary Background The clinical features, outcome and cost burden of community-acquired hypernatremia (CAH) in elderly and very elderly patients are not well known. Our aim was to investigate the etiologies, reasons for admission, clinical courses, outcomes, complications, and cost assessments of the elderly patients with CAH. Material/Methods We conducted a retrospective study in our tertiary hospital. Elderly and very elderly patients evaluated in the emergency department (ED) from January 1, 2010 to December 31, 2010 (n=4960) were included. Totally, 102 patients older than 65 years and diagnosed with CAH were evaluated. The patients were divided into 2 main groups according to their age: elderly (65–74 years old) (group 1) (n=38), and very elderly (>74 years) (group 2) (n=64). Results Our overall observed prevalence of CAH was 2.0% (n=102, 102/4960). In particular, the prevalences of CAH in group 1 and group 2 were 1.0% (38/3651) and 4.8% (64/1309), respectively (p<0.001). Totally, 62 patients had been treated by renin-angiotensin system (RAS) blockers (ie, ACE-inhibitors). Alzheimer’s disease had been diagnosed in 46.1% of the subjects. The mean Katz scores at the time of admission were 2.4±1.9 and 1.1±1.0 in group 1 and 2, respectively (p<0.001). The mean cost was higher in group 2 than in group 1 (2407.13±734.54 USD, and 2141.12±1387.14 USD, respectively) (p<0.01). The need for intensive care was significantly greater in group 2 as compared to group 1. Conclusions The important determinants of “CAH” in elderly subjects are accompanying Alzheimer’s disease, oral intake impairment, and concomitant treatment with RAS blockers. PMID:23197235

  8. Community-acquired hypernatremia in elderly and very elderly patients admitted to the hospital: clinical characteristics and outcomes.

    Science.gov (United States)

    Turgutalp, Kenan; Özhan, Onur; Gök Oğuz, Ebru; Yılmaz, Arda; Horoz, Mehmet; Helvacı, Ilter; Kiykim, Ahmet

    2012-12-01

    The clinical features, outcome and cost burden of community-acquired hypernatremia (CAH) in elderly and very elderly patients are not well known. Our aim was to investigate the etiologies, reasons for admission, clinical courses, outcomes, complications, and cost assessments of the elderly patients with CAH. We conducted a retrospective study in our tertiary hospital. Elderly and very elderly patients evaluated in the emergency department (ED) from January 1, 2010 to December 31, 2010 (n=4960) were included. Totally, 102 patients older than 65 years and diagnosed with CAH were evaluated. The patients were divided into 2 main groups according to their age: elderly (65-74 years old) (group 1) (n=38), and very elderly (>74 years) (group 2) (n=64). Our overall observed prevalence of CAH was 2.0% (n=102, 102/4960). In particular, the prevalences of CAH in group 1 and group 2 were 1.0% (38/3651) and 4.8% (64/1309), respectively (p<0.001). Totally, 62 patients had been treated by renin-angiotensin system (RAS) blockers (ie, ACE-inhibitors). Alzheimer's disease had been diagnosed in 46.1% of the subjects. The mean Katz scores at the time of admission were 2.4 ± 1.9 and 1.1 ± 1.0 in group 1 and 2, respectively (p<0.001). The mean cost was higher in group 2 than in group 1 (2407.13 ± 734.54 USD, and 2141.12 ± 1387.14 USD, respectively) (p<0.01). The need for intensive care was significantly greater in group 2 as compared to group 1. The important determinants of "CAH" in elderly subjects are accompanying Alzheimer's disease, oral intake impairment, and concomitant treatment with RAS blockers.

  9. [Significance of anti-aging medical checkups for the elderly].

    Science.gov (United States)

    Yonei, Yoshikazu

    2013-01-01

    The purpose of anti-aging medical checkups is to evaluate the functional age of the patient, aiming to prevent functional aging and rejuvenate the functional age. In this study, a comparison of the medical checkup results was conducted in elderly groups with different levels of activities of daily living (ADL). There were three groups of subjects; and an independent group that included 43 independently-living subjects (68.9±6.3 years) in the Kyoto Yurin area, a support-requiring group that included 31 subjects (77.8±7.2 years) routinely visiting a day care center and a nursing-requiring group that included 19 subjects (83.7±6.8 years) who were living in a medical care facility for the elderly. We conducted anti-aging medical checkups, and the following five factors were evaluated: muscle mass by the bioelectric impedance method (Physion MD), bone strength by an ultrasonic wave method (A-1000: Yokogawa, AOS-100NW: Aloka), fingertip pulse wave analysis (SDP-100: Fukuda), cognitive function (Wisconsin card sorting test) and the serum insulin-like growth factor-I and dehydroepiandrosterone-sulfate (DHEA-s) level. To calculate the functional age of the subjects, we used the Age Management Check (Ginga Kobo, Nagoya), and the Δage (functional age-chronological age) was analyzed and compared between the groups. The functional ages in the independent group were muscle age, 55.5±7.0; blood vascular age, 65.4±8.5; neural age, 63.6±14.8; hormone age, 70.4±7.6 and bone age, 60.2±14.6 years. As a result of an increase in 1,506 daily steps based on walking instruction with pedometer monitoring, the subjects significantly improved their body weight, BMI, waist size, fasting plasma glucose level and serum DHEA-s in six months. By showing them their functional age, their motivation to participate in the health promotion program was increased, and the compliance was high, with an omission rate of less than 20% in 2.5 years. The support- and nursing-requiring groups showed

  10. Medical costs of osteoporosis in the elderly Medicare population.

    Science.gov (United States)

    Blume, S W; Curtis, J R

    2011-06-01

    Prior national cost estimates of osteoporosis and fractures in the USA have been based on diverse sets of provider data or selected commercial insurance claims. Based on a random population-based sample of older adults, the US medical cost of osteoporosis and fractures is estimated at $22 billion in 2008. National cost estimates of osteoporosis and fractures in the USA have been based on diverse sets of provider data or selected commercial insurance claims. We sought to characterize prevalence and costs for osteoporosis using a random population-based sample of older adults. A cross-sectional estimate of medical cost was made with 2002 data from the Medicare Current Beneficiary Survey (MCBS). MCBS combines health interviews with claims information from all payers to profile a random sample of 12,700 Medicare recipients. Three cohorts aged 65 or over were defined: (1) patients experiencing a fracture-related claim in 2002; (2) patients with a diagnosis, medication, or self-report for osteoporosis or past hip fracture; and (3) non-case controls. The total cost of patient claims was compared to that of controls using multiple regression. Of 30.2 million elderly Medicare recipients in 2002, 1.6 million (5%) were treated for a fracture that year, and an additional 7.2 million (24%) have osteoporosis without a fracture. The estimated mean impact of fractures on annual medical cost was $8,600 (95% confidence interval, $6,400 to $10,800), implying a US cost of $14 billion ($10 to $17 billion). Half of the non-fracture osteoporosis patients received drug treatment, averaging $500 per treated patient, or $2 billion nationwide. The annual cost of osteoporosis and fractures in the US elderly was estimated at $16 billion, using a national 2002 population-based sample. This amount corroborates previous estimates based on substantially different methodologies. Projected to 2008, the national cost of osteoporosis and fractures was $22 billion.

  11. Identification of inappropriate medication use in elderly patients with frequent emergency department visits

    Science.gov (United States)

    Wong, Jeffrey; Marr, Patricia; Kwan, Debbie; Meiyappan, Soumia; Adcock, Lesley

    2014-01-01

    Objective: To determine the demographic and health care characteristics of elderly family health team patients who are frequent emergency department (ED) users, focusing on potentially inappropriate medications (PIMs) and access to primary care services. Design: Cross-sectional retrospective chart review. Setting: Academic family medicine clinic in Toronto, Ontario. Participants: A total of 46 elderly patients (age >65 years) with 4 or more visits to a University Health Network–affiliated ED between April 1, 2010, and March 31, 2011. Main outcome measures: Using the validated STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) criteria, PIMs were identified. The primary objective was to determine whether PIMs were associated with more frequent ED use. The secondary objective was to determine whether patients who had previously undergone a clinic pharmacist-led medication review had fewer PIMs. We also determined the health characteristics of these patients at the time of their last ED visit of the study period. Utilization of primary care resources, both prior to and after ED visits, was determined. Results: Sixty-five percent of patients were taking at least 1 PIM. The total number of PIMs in the study population was 71. Having more PIMs was significantly correlated with a higher number of ED visits (r = 0.32, p < 0.05). Patients with a previous medication review had a similar number of PIMs compared with those without a review. The mean number of concurrent medications was 12.1 and the mean Charlson Comorbidity Index score was 3.7. Significant delay between hospital discharge and primary care follow-up (median 13 days) was observed. Conclusion: Elderly patients who are more frequent ED users have a greater number of PIMs. Primary care resources appear to be underused in this population. PMID:25360151

  12. Elderly patient refractory to multiple pain medications successfully treated with integrative East–West medicine

    Directory of Open Access Journals (Sweden)

    Bill Tu

    2008-07-01

    Full Text Available Bill Tu, Michael Johnston, Ka-Kit HuiUCLA Center for East–West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USABackground: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence.Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL.Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.Keywords: polypharmacy, pain, osteoarthritis, acupuncture, complementary and alternative medicine, integrative medicine, adverse drug reaction, elderly

  13. Prevalence of malnutrition and associated factors among hospitalized elderly patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

    Science.gov (United States)

    Alzahrani, Sami H; Alamri, Sultan H

    2017-07-03

    Malnutrition is a nutritional disorder that adversely affects the body from a functional or clinical perspective. It is very often observed in the elderly population. This study aimed to estimate the prevalence of malnutrition among hospitalized elderly patients and its associated factors and outcomes in terms of length of stay and mortality in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. In a cross-sectional study, we evaluated the nutritional status of hospitalized elderly patients using the most recent version of the short form of Mini Nutritional Assessment (MNA-SF). A total of 248 hospitalized patients were included (70.0 ± 7.7 years; 60% female). According to the MNA-SF, a total of 76.6% patients were either malnourished or at risk of malnutrition. Malnourished patients had significantly lower levels of serum albumin (28.2 ± 7.7), hemoglobin (10.5 ± 1.8), and lymphocyte (1.7 ± 0.91). They had increased tendency to stay in the hospital for longer durations (IQR, 5-11 days; median = 7 days) and had a mortality rate of 6.9%. Malnutrition was highly prevalent among hospitalized elderly and was associated with increased length of stay and mortality.

  14. Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study.

    Science.gov (United States)

    Mori, Ana Luiza Pereira Moreira; Carvalho, Renata Cunha; Aguiar, Patricia Melo; de Lima, Maria Goretti Farias; Rossi, Magali da Silva Pacheco Nobre; Carrillo, José Fernando Salvador; Dórea, Egídio Lima; Storpirtis, Sílvia

    2017-04-01

    Background The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria is used to identify instances of potentially inappropriate prescribing in a patient's medication regimen. Objective To determine the prevalence and predictors of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients at hospital discharge. Setting A university hospital medical clinic in Brazil. Method Discharge prescriptions were examined using the STOPP/START criteria. Subjects were inpatients aged ≥60 years receiving at least one medication prior to hospitalization and with a history of cardiovascular disease. The prevalence of PIMs and PPOs was determined and a multivariable binary regression analysis was performed to identify independent predictors associated with PIMs or PPOs. Main outcome measure Prevalence of PIMs and PPOs. Results Of the 230 subjects, 13.9% were prescribed at least one PIM. The most frequently prescribed PIMs were glibenclamide or chlorpropamide prescribed for type 2 diabetes mellitus (31.0%), and aspirin at doses >150 mg/day (14.3%). Ninety patients had at least one PPO (39.1%). The most prevalent PPOs were statins (29.8%) and antiplatelet therapy (13.7%) for diabetes mellitus when coexisting major cardiovascular risk factors were present. No predictors for PIMs were found. In contrast, diabetes was a risk factor while dyslipidaemia was a protective factor for PPOs. Conclusion PIMs and PPOs commonly occur with elderly people at hospital discharge. Diabetes and dyslipidaemia were significantly associated with PPOs. Our findings show the need for interventions to reduce potentially inappropriate prescribing, such as a pharmacist medication review process at hospital discharge.

  15. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    Directory of Open Access Journals (Sweden)

    Jane Andreasen

    2015-06-01

    Full Text Available Introduction: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. Methods: The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. Results: Four main categories were identified: “The system,” “Keeping a social life,” “Being in everyday life,” and “Handling everyday life.” These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. Conclusion and discussion: Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.

  16. Patients’ priorities for ambulatory hospital care centres. A survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital

    Science.gov (United States)

    Albada, Akke; Triemstra, Mattanja

    2009-01-01

    Abstract Objective  This study established patients’ preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients’ choice to visit this centre instead of the regional hospital. Methods  A questionnaire survey among 1477 elderly and chronically ill people (response 72%) assessed patients’ expectations regarding (a) quality of hospital care, (b) facilities in centres for ambulatory hospital care, and (c) future use of these centres. Additionally, 75 patients participated in discrete choice experiments about their decision to visit a centre for ambulatory hospital care or the regional hospital. Results  Respondents prioritized facilities for examination and medical consultations in the ambulatory care centres. Half of the respondents also valued paramedic care, information desks and pharmacies as centre facilities. Most patients living near a future centre for ambulatory care would rather visit this centre than the regional hospital. However, they favoured seeing their familiar physician, short waiting lists and appointments scheduled consecutively on 1 day. If these aspects were not guaranteed at the adjacent centres, more patients chose to visit the hospital. Conclusions  Although patients value most facilities, they set clear priorities. Furthermore, this study showed three important conditions in the decision to visit an ambulatory care centre; (1) the possibility to see their familiar physician, (2) to have consecutive appointments, and (3) a short waiting list. These three factors were more important to patients than proximity. Thus, when choosing between a hospital and an adjacent centre for ambulatory care, quality aspects matter. PMID:19250155

  17. Patients' priorities for ambulatory hospital care centres. A survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital.

    Science.gov (United States)

    Albada, Akke; Triemstra, Mattanja

    2009-03-01

    This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital. A questionnaire survey among 1477 elderly and chronically ill people (response 72%) assessed patients' expectations regarding (a) quality of hospital care, (b) facilities in centres for ambulatory hospital care, and (c) future use of these centres. Additionally, 75 patients participated in discrete choice experiments about their decision to visit a centre for ambulatory hospital care or the regional hospital. Respondents prioritized facilities for examination and medical consultations in the ambulatory care centres. Half of the respondents also valued paramedic care, information desks and pharmacies as centre facilities. Most patients living near a future centre for ambulatory care would rather visit this centre than the regional hospital. However, they favoured seeing their familiar physician, short waiting lists and appointments scheduled consecutively on 1 day. If these aspects were not guaranteed at the adjacent centres, more patients chose to visit the hospital. Although patients value most facilities, they set clear priorities. Furthermore, this study showed three important conditions in the decision to visit an ambulatory care centre; (1) the possibility to see their familiar physician, (2) to have consecutive appointments, and (3) a short waiting list. These three factors were more important to patients than proximity. Thus, when choosing between a hospital and an adjacent centre for ambulatory care, quality aspects matter.

  18. Inappropriate medication use among the elderly: a systematic review of administrative databases

    Directory of Open Access Journals (Sweden)

    Guaraldo Lusiele

    2011-11-01

    Full Text Available Abstract Background Inappropriate medication use (IMU by elderly people is a public health problem associated with adverse effects on health. There are a number of methods for identifying IMU, some involving clinical judgment and others, consensually generated lists of drugs to be avoided. This review aims to describe studies that used information from insurance company and social security administrative databases to assess IMU among community-dwelling elderly and to present the risk factors most often associated with IMU. Methods The paper search was conducted in Medline and Embase, using descriptors combined with free terms in the title or abstract. The limits applied were: publication date from January 1990 to June 2010, species (human and publication type (excluding editorials, letters and reviews. Excluded were: case studies; studies in hospitals, nursing homes, or hospital emergency departments; studies of specific drugs or groups of drugs; studies exclusively of subgroups of ill, frail elderly or rural populations. Additional studies were identified from reference lists. Data were selected and extracted after independent reading by two of the authors, with disagreements resolved by a third author. The primary outcome assessed was prevalence of IMU, defined as the proportion of elderly who received at least one inappropriate medication. Results Of the 628 studies, 19 met the inclusion criteria, 78.9% of them conducted in the USA. All papers included used explicit criteria of inappropriateness, most commonly Beers criteria (73.7% in their three versions (1991, 1997 and 2002. Other methods used included Zhan, which is derived from on Beers criteria and was applied in 21% of the papers selected. The study found that prevalence of IMU ranged from 11.5% to 62.5%. Only 68.4% of the studies included examined inappropriate use-related factors, the most important being female sex, advanced age and larger number of drugs. Conclusions The results

  19. Prevalence and Covariates of Polypharmacy in Elderly Patients on Discharge from a Tertiary 
Care Hospital in Oman.

    Science.gov (United States)

    Al-Hashar, Amna; Al Sinawi, Hamed; Al Mahrizi, Anwar; Al-Hatrushi, Manal

    2016-11-01

    To evaluate the prevalence of polypharmacy in relation to gender, comorbidity, and age among elderly patients upon discharge from an academic tertiary care hospital in Muscat, Oman. This cross-sectional study was conducted at Sultan Qaboos University Hospital between February and July 2014. We reviewed the electronic medical records of elderly patients aged ≥ 60 years who were admitted to any of the hospital's medical wards during the study period and collected data on age, gender, and diagnoses. We also collected information on the medications prescribed on discharge. Polypharmacy was defined as the concurrent use of ≥ 5 medications. A total of 431 elderly inpatients were enrolled, of which approximately 50% were female. Polypharmacy was identified in 76.3% of discharge prescriptions. Gender (adjusted odds ratio (aOR), 1.17; 95% CI 0.73, 1.88, p = 0.502) and age (aOR, 0.98; 95% CI 0.95, 1.00, p = 0.075) had no impact on polypharmacy. On the other hand, a significant association between polypharmacy and comorbidity was observed (aOR, 1.31; 95% CI 1.12, 1.54, p = 0.001). Cardiovascular diagnosis on admission was also identified as being associated with polypharmacy (aOR, 2.66; 95% CI 1.49, 4.75, p = 0.001). More patients had cardiovascular diseases on admission (31.0%), followed by infections (23.0%), and gastrointestinal diseases (13.0%). The most commonly prescribed drugs on discharge were cardiovascular drugs (48.0%), followed by drugs acting on the gastrointestinal system (11.0%), endocrine system (9.2%), and nutrition and blood (7.5%). The prevalence of polypharmacy among elderly medical patients discharged from our hospital was high (76.3%) and was associated with a number of comorbidities and cardiovascular disease as a cause of admission, but not with age or gender. The prevalence of polypharmacy in our institution raises significant concerns over its potential impact on patients' health outcomes and requires further investigation. Raising physicians

  20. Prevalence of self-medication among the elderly in Kermanshah-Iran

    National Research Council Canada - National Science Library

    Jafari, Faranak; Khatony, Alireza; Rahmani, Elham

    2015-01-01

    .... Given the risks of self-medication, this study was carried out to assess the prevalence of self-medication and its related factors among the elderly in Kermanshah-Iran In this descriptive cross...

  1. Use of Anti-Asthmatic Medications in Elderly Taiwanese Patients

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    Chi-Yu Chen

    2003-06-01

    Full Text Available The aim of this study was to assess the use of anti-asthmatic medications in Taiwanese geriatric asthmatic patients. We used computerized prescription databases from the National Health Insurance Program, Taiwan, and classified drugs according to the Anatomical Therapeutic Chemical Classification System to analyze the patterns and extent of medication use in people aged over 65 years, and the influence of physician specialty on the prescription of anti-asthmatics. A total of 708,624 prescriptions for 226,018 patients were analyzed. Oral medications were most often prescribed. Only 3.94% and 7.79% of patients were treated with inhaled corticosteroids and inhaled short-acting b-agonists, respectively. Pulmonologists prescribed significantly more inhaled anti-asthmatics, except for cromolyn, than other types of physicians. More males than females were prescribed each category of anti-asthmatic medications, except for ketotifen. In conclusion, physicians in Taiwan do not prescribe as many inhaled anti-inflammatory agents for the treatment of asthma in the elderly as suggested in international treatment guidelines.

  2. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance

    OpenAIRE

    Malhotra, S; Karan, R; Pandhi, P; Jain, S

    2001-01-01

    BACKGROUND—Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed.
METHODS—A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, conse...

  3. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

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    Kara H

    2013-12-01

    Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury

  4. Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

    Directory of Open Access Journals (Sweden)

    Christine Grützmann Faustino

    2011-03-01

    Full Text Available Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80. The Beers criteria (2003 version were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6% with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%. The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0 and number of medications prescribed (p<0.001 were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7. The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001; this result was not age-dependent (p=0.285. Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a

  5. Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients.

    Science.gov (United States)

    Pareja Sierra, T; Bartolomé Martín, I; Rodríguez Solís, J; Bárcena Goitiandia, L; Torralba González de Suso, M; Morales Sanz, M D; Hornillos Calvo, M

    Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Identification of inappropriate medication use in elderly patients with frequent emergency department visits.

    Science.gov (United States)

    Wong, Jeffrey; Marr, Patricia; Kwan, Debbie; Meiyappan, Soumia; Adcock, Lesley

    2014-07-01

    To determine the demographic and health care characteristics of elderly family health team patients who are frequent emergency department (ED) users, focusing on potentially inappropriate medications (PIMs) and access to primary care services. Cross-sectional retrospective chart review. Academic family medicine clinic in Toronto, Ontario. A total of 46 elderly patients (age >65 years) with 4 or more visits to a University Health Network-affiliated ED between April 1, 2010, and March 31, 2011. Using the validated STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria, PIMs were identified. The primary objective was to determine whether PIMs were associated with more frequent ED use. The secondary objective was to determine whether patients who had previously undergone a clinic pharmacist-led medication review had fewer PIMs. We also determined the health characteristics of these patients at the time of their last ED visit of the study period. Utilization of primary care resources, both prior to and after ED visits, was determined. Sixty-five percent of patients were taking at least 1 PIM. The total number of PIMs in the study population was 71. Having more PIMs was significantly correlated with a higher number of ED visits (r = 0.32, p PIMs compared with those without a review. The mean number of concurrent medications was 12.1 and the mean Charlson Comorbidity Index score was 3.7. Significant delay between hospital discharge and primary care follow-up (median 13 days) was observed. Elderly patients who are more frequent ED users have a greater number of PIMs. Primary care resources appear to be underused in this population.

  7. The prevalence of potentially inappropriate medication prescribing in elderly patients with chronic kidney disease.

    Science.gov (United States)

    Jones, Sarah Amy; Bhandari, Sunil

    2013-05-01

    Potentially inappropriate medication (PIM) prescribing is a global problem. Limited data are available on the prevalence of PIMs in elderly patients with chronic kidney disease (CKD). We examined the PIM prevalence in elderly patients with CKD, the most common drugs implicated and the levels of polypharmacy in this group. A retrospective case record analysis of patients with CKD above the age of 70 years was carried out on 100 consecutive inpatients between January 2008 and June 2008 at a University Teaching Hospital. PIMs were defined using the modified Beers' criteria and latest British National Formulary (BNF) guidance for prescribing in patients with renal impairment using creatinine clearance calculated by the Cockroft-Gault formula. The mean age of the cohort was 80 years with a female predominance (62%). The mean estimated glomerular filtration rate (eGFR) was 17.2 ml/min/1.73 m(2). 56 patients had one or more PIMs prescribed during the acute admission period. 81 out of the 622 medications prescribed were 'inappropriate'; therefore, the prevalence of PIMs prescribed was 13%. Antibiotics and antihypertensives accounted for the majority of PIMs. Each patient received an average of six drugs. The prevalence of PIMs in elderly inpatients with CKD is high. Inclusion of drugs prescribed acutely and use of the BNF to identify PIMs as well as the Beers' criteria may account for this. Use of screening tools may lead to better identification of PIMs in this high risk group. Routine calculation and documentation of eGFR on the medication chart on admission may help reduce PIMs.

  8. Blood Transfusion Reactions in Elderly Patients Hospitalized in a Multilevel Geriatric Hospital

    Directory of Open Access Journals (Sweden)

    E. Lubart

    2014-01-01

    Full Text Available Background/Objectives. Blood transfusion is a critical issue for patients with chronic diseases such as heart failure, chronic kidney disease, and malignancy. However, side effects are not rare. The purpose of the study is to evaluate the frequency of adverse blood transfusion reactions in hospitalized elderly patients during a one-year period. Design/Setting/Participants. Blood transfusion reactions such as fever, chills, dyspnea, and others following blood transfusions in hospitalized geriatric patients during one-year period were examined. Results. 382 blood units (242 patients were administered during the study period. In 40 (11% cases, blood transfusion reactions occurred. Fever was the most common reaction in 29 cases (72%, four (10% had shortness of breath, and 3 (8% had vomiting and chills each. There were no lethal cases in the 24-hour period following blood transfusions. Conclusion. A relatively low rate of adverse blood transfusion reactions occurred in our geriatric patients. We may speculate that this is related to underreporting of minor symptoms due to the high percentage of demented patients in this population.

  9. Effects of Medical Insurance on the Health Status and Life Satisfaction of the Elderly.

    Science.gov (United States)

    Gu, Liubao; Feng, Huihui; Jin, Jian

    2017-09-01

    Population aging has become increasingly serious in China. The demand for medical insurance of the elderly is increasing, and their health status and life satisfaction are becoming significant issues. This study investigates the effects of medical insurance on the health status and life satisfaction of the elderly. The national baseline survey data of the China Health and Retirement Longitudinal Survey in 2013 were adopted. The Ordered Probit Model was established. The effects of the medical insurance for urban employees, medical insurance for urban residents, and new rural cooperative medical insurance on the health status and life satisfaction of the elderly were investigated. Medical insurance could facilitate the improvement of the health status and life satisfaction of the elderly. Accordingly, the health status and life satisfaction of the elderly who have medical insurance for urban residents improved significantly. The regression coefficients were 0.348 and 0.307. The corresponding regression coefficients of the medical insurance for urban employees were 0.189 and 0.236. The regression coefficients of the new rural cooperative medical insurance were 0.170 and 0.188. Medical insurance can significantly improve the health status and life satisfaction of the elderly. This development is of immense significance for the formulation of equal medical security.

  10. Medical and economic burden of influenza in the elderly population in central and eastern European countries.

    Science.gov (United States)

    Kovács, Gábor; Kaló, Zoltán; Jahnz-Rozyk, Karina; Kyncl, Jan; Csohan, Agnes; Pistol, Adriana; Leleka, Mariya; Kipshakbaev, Rafail; Durand, Laure; Macabeo, Bérengère

    2014-01-01

    Influenza affects 5-15% of the population during an epidemic. In Western Europe, vaccination of at-risk groups forms the cornerstone of influenza prevention. However, vaccination coverage of the elderly (> 65 y) is often low in Central and Eastern Europe (CEE); potentially because a paucity of country-specific data limits evidence-based policy making. Therefore the medical and economic burden of influenza were estimated in elderly populations in the Czech Republic, Hungary, Kazakhstan, Poland, Romania, and Ukraine. Data covering national influenza vaccination policies, surveillance and reporting, healthcare costs, populations, and epidemiology were obtained via literature review, open-access websites and databases, and interviews with experts. A simplified model of patient treatment flow incorporating cost, population, and incidence/prevalence data was used to calculate the influenza burden per country. In the elderly, influenza represented a large burden on the assessed healthcare systems, with yearly excess hospitalization rates of ~30/100,000. Burden varied between countries and was likely influenced by population size, surveillance system, healthcare provision, and vaccine coverage. The greatest burden was found in Poland, where direct costs were over EUR 5 million. Substantial differences in data availability and quality were identified, and to fully quantify the burden of influenza in CEE, influenza reporting systems should be standardized. This study most probably underestimates the real burden of influenza, however the public health problem is recognized worldwide, and will further increase with population aging. Extending influenza vaccination of the elderly may be a cost-effective way to reduce the burden of influenza in CEE.

  11. A cloud medication safety support system using QR code and Web services for elderly outpatients.

    Science.gov (United States)

    Tseng, Ming-Hseng; Wu, Hui-Ching

    2014-01-01

    Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients. The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated. The proposed system is composed of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system. The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly. This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety.

  12. [Medical students' knowledge about hospital infections].

    Science.gov (United States)

    Marković-Denić, Ljiljana; Maksimović, Jadranka; Sbutega-Milosević, Gorica; Sbutega, Isidora; Maksimović, Milos

    2010-01-01

    The aim of this study was to show the differences in the knowledge level about hospital infections between medical students having studied according to the old and new education programs. Two cross-sectional studies were conducted at the Faculty of Medicine in Belgrade, Serbia. The anonymous self-administrated questionnaires were distributed to all third year students. In 2000, the students followed the "old" system of education, and in 2007 they followed the new curriculum according to the Bologna Process. The questionnaires were answered and returned by 79.8% of students who had the "old" education program and by 71.9% of students having a "new" curriculum. The latter students knew more about the definition of hospital infections (p importance of endogenous reservoirs (p students studying according to the new program recognized that the contact was the most frequent mode of transmission (p students with the new program of studies knew more about hospital infections. This difference may be attributed to the previous course in epidemiology and earlier clinical practice that covered these topics. Although all of the students stated they knew which mode of transmission was the most frequent, when asked in specific terms about the hand hygiene, the "new" curriculum students stated to have intermediate knowledge, and the "old" curriculum students showed a substantial lack of knowledge. It is important to increase their knowledge level and compliance with the hand hygiene. The knowledge about hospital infections seems to have been improved by theoretical and practical sessions during early clinical training by the Bologna curriculum.

  13. Medicamentos potencialmente inapropriados para idosos Potentially inappropriate medications in elderly

    Directory of Open Access Journals (Sweden)

    Milton Luiz Gorzoni

    2012-08-01

    Full Text Available OBJETIVO: Comparar PRISCUS com Beers-Fick na detecção de medicamentos potencialmente inapropriados (MPI para idosos à primeira consulta ambulatorial geriátrica. MÉTODOS: Análise retrospectiva de prontuários por PRISCUS e Beers-Fick adaptados à farmacopeia brasileira, comparando-se o encontro de MPI à primeira consulta ambulatorial geriátrica pelos dois critérios. RESULTADOS: Idade média de 77,4 ± 7,7 anos, 64 mulheres e 36 homens, consumo médio de 3,9 ± 2,5 fármacos. Este estudo encontrou significância estatística no número de mulheres em uso de benzodiazepínicos e de homens quanto a salicilatos. Média de 0,5 ± 0,7 MPI/paciente por Beers-Fick e 0,7 ± 0,8 MPI/paciente pela PRISCUS. Medicamentos de Beers-Fick mais referidos: benzodiazepínicos, metildopa e derivados do ergot. Medicamentos de PRISCUS mais referidos: benzodiazepínicos, anti-hipertensivos e antidepressivos tricíclicos. Não houve significância estatística comparando-se o número de idosos com MPI pelos dois critérios. Constatou-se significância estatística (PRISCUS versus Beers-Fick no consumo de benzodiazepínicos de longa ação e laxantes. Ambos não incluem fármacos como vitaminas, fitoterápicos e colírios, relatados por percentual da casuística. CONCLUSÃO: Os dois critérios são úteis para a prevenção de MPI em idosos, sendo PRISCUS mais atualizada e abrangente, mas não são completos para a realidade ambulatorial brasileira.OBJECTIVE: To compare PRISCUS with Beers-Fick in detecting potentially inappropriate medication (PIMs in elderly at their first outpatient geriatric visit. METHODS: Retrospective medical record analysis by PRISCUS and Beers-Fick adapted to Brazilian pharmacopoeia, comparing the finding of PIMs at the first outpatient geriatric visit by both criteria. RESULTS: Cases had mean age of 77.4 ± 7.7 years (64 females and 36 males, and mean consumption of 3.9 ± 2.5 drugs. This study found statistical significance for the

  14. Effect of aromatherapy massage on elderly patients under long-term hospitalization in Japan.

    Science.gov (United States)

    Satou, Tadaaki; Chikama, Mizuki; Chikama, Yoshiko; Hachigo, Masato; Urayama, Haruna; Murakami, Shio; Hayashi, Shinichiro; Koikem, Kazuo

    2013-03-01

    To verify the effectiveness of aromatherapy massage on elderly patients under long-term hospitalization. Aromatherapy massage was performed twice a week for a total of eight times. Nursing home. Elderly women under long-term hospitalization. Questionnaire and measurement of stress marker levels (salivary amylase activity) before and after the first, fifth, and eighth aromatherapy massages. Questionnaire (Face scale, General Health Questionnaire-12 [GHQ-12]), measurement of salivary amylase activity. A decrease in stress after aromatherapy massage compared to before each massage was confirmed at all measurement times and with the stress marker. No marked reduction was observed in Face scale or saliva amylase activity as a whole over the long term, although decreasing tendencies were seen. Marked reductions in GHQ-12 were observed over the long term. Aroma massage appears likely to prove effective in reducing psychological stress among elderly patients under long-term hospitalization.

  15. Quality of life and fall risk in frail hospitalized elderly patients

    Science.gov (United States)

    Öztürk, Zeynel Abidin; Özdemir, Sedat; Türkbeyler, İbrahim Halil; Demir, Zeynep

    2017-11-13

    Background/aim: Frailty is a complex, multifactorial, and important geriatric syndrome characterized by decline in physiological reserves and functional deficiency in multiple systems. The aim of the current study is to investigate the prevalence of frailty and to determine the correlation between quality of life (QoL) and falling risk in geriatric hospitalized patients. Materials and methods: A total of 420 patients, aged 65 years and above, were enrolled in the study. All participants were hospitalized at a university hospital in the internal medicine clinics. The Cardiovascular Health Study (CHS) frailty scale, Health-Related Quality of Life Short Form (SF-36) scale, and Hendrich II Fall Risk Model were administered to the patients. Demographic data of patients, number of chronic diseases, and information on used medication were also collected.Results: The median age of patients was 71.9 ± 6.3 years and 49.5% of the patients were female. By applying the CHS frailty scale, the proportion of frail patients was determined to be 65.5%. There were statistically significant differences among quality of life mean scores of robust, prefrail, and frail patients (P patients had the lowest scores in all SF-36 subgroups. Eighty-three (19.8%) patients were in the low-risk group while 337 (80.2%) were high-risk according to the Hendrich II Fall Risk Model. The rate of patients with high falling risk and poor QoL reached a maximum in the frail group (96%).Conclusion: Frailty is an important geriatric syndrome in elderly hospitalized patients. Poor QoL and high falling risk are issues commonly experienced with frailty.

  16. Health Care Practices for Medical Textiles in Government Hospitals

    Science.gov (United States)

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  17. Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City Hospital.

    Science.gov (United States)

    Ukai, Katsuyuki; Mizuno, Yutaka

    2009-12-01

    In the present study, we investigated the physical complications of elderly patients with senile dementia in the Department of Psychogeriatrics, Imaise Branch, Ichinomiya City Hospital. Physical complications that occurred in our ward in the 12 months from April 2007 to March 2008 were recorded. Our ward has 50 beds and, over the 12 months, the average occupation rate was approximately 90%. We subdivided physical complications into two categories: (i) serious emergencies occurring in the ward with a possible high risk of mortality within a few days (e.g. pneumonia and upper airway obstruction); and (ii) life-threatening complications arising in the ward that required diagnosis and treatment by specialists from other medical departments (e.g. bone fracture and cancer). Serious emergencies with a high risk of mortality occurred 56 times. Six patients died. Life-threatening complications requiring diagnosis and treatment by specialists from other departments occurred 44 times. Both categories of physical complications in occurred at a high rate, with various types of diseases recorded. The present study confirms the high frequency of physical complications that require treatment in facilities for patients with senile dementia. It is necessary to diagnose and treat these various physical complications and to cooperate with specialists from other medical departments.

  18. Inappropriate prescribing in the hospitalized elderly patient: Defining the problem, evaluation tools, and possible solutions

    Directory of Open Access Journals (Sweden)

    Robert L Page II

    2010-03-01

    Full Text Available Robert L Page II1, Sunny A Linnebur2, Lucinda L Bryant3, J Mark Ruscin41Associate Professor of Clinical Pharmacy and Physical Medicine, Clinical Specialist, Division of Cardiology and Heart Transplantation, 2Associate Professor of Clinical Pharmacy, Clinical Specialist, Center on the Aging, Schools of Pharmacy and Medicine, 3Assistant Professor of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA; 4Professor, Department of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, USAAbstract: Potentially inappropriate medication (PIM prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. In the acute care setting, PIM prescribing can be even more problematic due to multiple physicians and specialists who may be prescribing for a single patient as well as difficulty with medication reconciliation at transitions and limitations imposed by hospital formularies. This article highlights critical issues surrounding PIM prescribing in the acute care setting such as risk factors, screening tools, and potential strategies to minimize this significant public health problem.Keywords: inappropriate prescribing, aged, elderly, adverse drug events, adverse drug reactions, Beers’ criteria, screening

  19. Are Nutritional Care Adequate for Elderly Hospitalized Patients? A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Helene Kjøllesdal Eide

    2016-12-01

    Full Text Available This article assesses nutritional care in identifying and treating nutritional risk in elderly hospitalized patients. A cross-sectional study was conducted at a large Norwegian University hospital in the period 2011 to 2013. Data on nutritional risk and care for elderly patients (≥70 years without dementia were collected at 20 wards by 173 second-year nursing students in acute-care clinical studies. A stratified sampling technique was utilized to improve the representativeness of the sample. In total, 508 patients (48.8% women with a mean age of 79.6 years participated. The internationally and nationally recommended nutritional care was not implemented at the hospital, suggesting that nutritional care for elderly hospitalized patients was not adequate. This implies that the majority of the elderly patients nutritionally at risk are neither identified nor treated according to their needs. The article highlights the importance of having systematic nutritional care practices to make it possible for the hospital ward staff to routinely identify nutritional risk and initiate appropriate nutritional treatment measures.

  20. Development of a comprehensive hospital-based elder abuse intervention: an initial systematic scoping review.

    Directory of Open Access Journals (Sweden)

    Janice Du Mont

    Full Text Available Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review.Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation.The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1 addressed a response (e.g., an intervention to elder abuse, 2 contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3 were available in English.The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics.649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser;physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations.To address the lack of evidence to

  1. Using a Geriatric Mentoring Narrative Program to Improve Medical Student Attitudes towards the Elderly

    Science.gov (United States)

    Duke, Pamela; Cohen, Diane; Novack, Dennis

    2009-01-01

    This study examined first-year medical student attitudes concerning the elderly before and after instituting a geriatric mentoring program. The program began and ended with a survey designed to assess students' attitudes toward the elderly. During the mentoring program, students visited the same senior for four visits throughout the academic year.…

  2. Trauma in elderly people: access to the health system through pre-hospital care1

    Science.gov (United States)

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543

  3. The elderly occupations in hospital of condition: what is the form and the meaning?

    Directory of Open Access Journals (Sweden)

    amila Rebeca Vieira de Almeida

    2017-03-01

    Full Text Available Introduction: Aging is a universal, complex, multidimensional phenomenon that causes numerous repercussions in the occupations and social participation of older people. The process of hospitalization at this stage of life can affect the routine and meaningful occupations, generating ruptures, changes and departures from occupational preferences of the daily routine. Objective: Considering the possible repercussions of illness and hospitalization in occupations, health and the elderly welfare, this research sought to understand the form and meaning of the nursing occupations in a hospital situation. Method: This is a qualitative, descriptive exploratory research. The survey was conducted in a public hospital clinic in the state of Pará, from May to July 2013. Twelve elderly participated of the research, using a semistructured interview. The interviews were analyzed by content analysis. Results: The survey revealed the occupational experiences of hospitalized elderly. The results showed changes in the occupational role, rhythms and preferences. We observed occupational losses and changes in the form and meaning of occupations. Conclusion: The research offered a space where older people could express how they perceived their occupations during hospitalization. Such accounts and records can help and contribute to the understanding of the occupational dimension of these people during hospitalization.

  4. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    Science.gov (United States)

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-07-01

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Diabetes Affects Length of Stay and Hospital Costs for Elderly Patients with Pneumonia: An Analysis of a Hospital Administrative Database.

    Science.gov (United States)

    Kabeya, Yusuke; Shimada, Akira; Tsukada, Nobuhiro; Atsumi, Yoshihito; Higaki, Megumu

    2016-12-20

    The present study investigated the association of having diabetes with length of stay and hospital costs for elderly patients with pneumonia who were admitted to an acute-care hospital in Japan. Based on the inpatient administrative claims database of an acute-care hospital in central Tokyo between 2010 and 2013, 753 patients aged ≥ 65 years who were admitted to the hospital presenting with pneumonia and discharged alive were analyzed. The association was analyzed using a negative binomial model, having adjusted for age, sex, body mass index, dyspnea grade, functional evaluation of feeding, use of mechanical ventilation, and use of renal replacement therapy. A log-linear regression model adjusted for the same variables was used in the analysis of hospital costs. Of the 753 patients (mean age, 82.5 years; men, 58.2%), 225 patients had diabetes. The negative binomial regression revealed that those with diabetes had a 1.19 times longer length of stay (95% CI = 1.06-1.33) compared to those without. The log-linear regression revealed that hospital costs were 1.14 times higher (95% CI = 1.04-1.25) in patients with diabetes. The presence of diabetes significantly correlated with longer length of stay and higher hospital costs for elderly patients with pneumonia.

  6. Knowledge of healthcare professionals about medication errors in hospitals

    OpenAIRE

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comp...

  7. Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: a prospective nonrandomized controlled trial

    NARCIS (Netherlands)

    L.E. Flinterman; K.J. Asmus-Szepesi; A.P. Nieboer; J.P. Mackenbach; E.W. Steyerberg; M.A. Koopmanschap; Dr. A.J.E.M. Bakker

    2015-01-01

    The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly.

  8. Effect of strength training on muscle function in elderly hospitalized patients

    DEFF Research Database (Denmark)

    Suetta, C; Magnusson, S P; Beyer, N

    2007-01-01

    . Given that reduced lower limb muscle strength and loss of skeletal muscle mass (i.e. sarcopenia) have been associated with functional impairments and disability with aging, attempts to counteract this process seem highly relevant. In recent years, strength training has emerged as an effective method...... to induce muscle hypertrophy and increase muscle strength and functional performance in frail elderly individuals. Furthermore, there is increasing evidence that strength training is an effective method to restore muscle function in post-operative patients and in patients with chronic diseases. Despite this......Immobilization due to hospitalization and major surgery leads to an increased risk of morbidity, disability and a decline in muscle function especially in frail elderly individuals. In fact, many elderly patients fail to regain their level of function and self-care before admission to hospital...

  9. eMedication - a smartphone-based e-medication system for hospitalized patients

    OpenAIRE

    Thapa, Sanjit Jung

    2015-01-01

    Purpose: The purpose of this research was to develop a smartphone based e-medication app for hospitalized patients at the University Hospital of North Norway (UNN). The app was expected to provide an overview of medication that the patient is given during hospitalization. Motivation: E-medication has become widely popular in many countries, and has replaced the paper-based prescription. This replacement has enhanced the quality of the medication process and reduced medication err...

  10. Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital

    OpenAIRE

    Söderström, Lisa; Thors-Adolfsson, Eva; Rosenblad, Andreas; Frid, Hanna; Saletti, Anja; Bergkvist, Leif

    2013-01-01

    Background & aims: Large-scale studies performed in hospitals with the validated Mini Nutritional Assessment tool (MNA) are scarce. However, factors associated with malnutrition are important for identifying individuals at risk. The aims of the present study were to estimate the prevalence of malnutrition and to examine the association between mealtime habits, meal provision, and malnutrition among elderly patients admitted to hospital. Methods: This cross-sectional study included patient...

  11. Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication

    NARCIS (Netherlands)

    Spaans, H.P.; Sienaert, P.; Bouckaert, F.; van den Berg, J.F.; Verwijk, E.; Kho, K.H.; Stek, M.L.; Kok, R.M.

    2015-01-01

    Background Severe depression can be a life-threatening disorder, especially in elderly patients. A fast-acting treatment is crucial for this group. Electroconvulsive therapy (ECT) may work faster than medication.

  12. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

    National Research Council Canada - National Science Library

    Vieira de Lima, Thaís Jaqueline; Garbin, Cléa Adas Saliba; Garbin, Artênio José Isper; Sumida, Dóris Hissako; Saliba, Orlando

    2013-01-01

    The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems...

  13. Antimicrobial-Resistant Bacteremia in the Elderly: Risk of Previous Hospitalization

    Directory of Open Access Journals (Sweden)

    Yung-Cheng Su

    2017-03-01

    Conclusion: Our study showed that the risk of CAB in elderly due to ESBLs-producing E. coli/K. pneumoniae was highly associated with history of recent hospital admissions, and the effect can be prolonged up to 360 days after discharge.

  14. Gut microbiota composition and Clostridium difficile infection in hospitalized elderly individuals

    NARCIS (Netherlands)

    Milani, Christian; Ticinesi, Andrea; Gerritsen, Jacoline; Nouvenne, Antonio; Andrea Lugli, Gabriele; Mancabelli, Leonardo; Turroni, Francesca; Duranti, Sabrina; Mangifesta, Marta; Viappiani, Alice; Ferrario, Chiara; Maggio, Marcello; Lauretani, Fulvio; Vos, de Willem M.; Sinderen, Van Douwe; Meschi, Tiziana; Ventura, Marco

    2016-01-01

    The gut microbiota composition of elderly hospitalized patients with Clostridium difficile infection (CDI) exposed to previous antibiotic treatment is still poorly investigated. The aim of this study was to compare the microbiota composition by means of 16S rRNA microbial profiling among three

  15. Ambient particle source apportionment and daily hospital admissions among children and elderly in Copenhagen

    DEFF Research Database (Denmark)

    Andersen, Zorana Jovanovic; Wahlin, P.; Raaschou-Nielsen, Ole

    2007-01-01

    period (01 January 1999 to 31 December 2004), we examined associations between urban background PM(10) in the presence of gaseous pollutants (CO, NO(2)) and hospital admissions due to cardiovascular and respiratory disease in the elderly (age>/=65), and asthma in children (age 5-18) in Copenhagen...

  16. The hospital meal - Feeding or treating the elderly

    DEFF Research Database (Denmark)

    Røjel, Terkel

    Geriatric malnutrition is a significant problem for hospital patients in affluent countries, and is associated with severe personal consequences and economic bearing. We need to facilitate interventions focused on the multisensory and psychosocial quality of the hospital meals along with enhanced...

  17. The Geriatric Nutritional Risk Index predicts hospital length of stay and in-hospital weight loss in elderly patients.

    Science.gov (United States)

    Cereda, Emanuele; Klersy, Catherine; Pedrolli, Carlo; Cameletti, Barbara; Bonardi, Chiara; Quarleri, Lara; Cappello, Silvia; Bonoldi, Alberto; Bonadeo, Elisa; Caccialanza, Riccardo

    2015-02-01

    Nutritional derangements are common in elderly patients, but how nutritional risk affects outcome in this subset of hospital inpatients deserves further investigation. We evaluated the impact of nutritional risk on length of stay (LOS) and in-hospital weight loss (WL) in elderly patients (>65 yrs). Nutritional risk was assessed by the Geriatric Nutritional Risk Index (GNRI) in a prospective multicentre hospital-based cohort study. The outcomes were LOS and in-hospital WL. In the whole sample (N = 667), the prevalence of high (GNRI nutritional risk were 33% and 25%, respectively. Patients with a high nutritional risk were more likely (OR = 1.89; 95%CI: 1.22-2.92) to stay longer in hospital (fourth quartile, LOS ≥ 20 days) compared to those without. Other factors associated with prolonged LOS were cancer diagnosis (OR = 2.52; 95%CI: 1.69-3.75), the presence of comorbidities (OR = 1.24; 95%CI: 1.11-1.40) and surgical setting (OR = 1.65; 95%CI: 1.10-2.47). In-hospital WL ≥ 5% was recorded in 75 ambulant patients from a representative subgroup (N = 583). It was independently associated with prolonged LOS (OR = 1.80; 95%CI: 1.03-3.06) and was more frequent among cancer patients (OR = 1.88; 95%CI: 1.09-3.24), in patients with a high nutritional risk (OR = 2.23; 95%CI: 1.20-4.14) or those admitted to surgical units (OR = 1.77; 95%CI: 1.02-3.05). Nutritional risk assessed by the GNRI on admission, predicts LOS and in-hospital WL in elderly patients. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  18. [The Mini Nutritional Assessment of the elderly in the practice of a hospital geriatrics service: inception, validation and operational characteristics].

    Science.gov (United States)

    Cuyac Lantigua, Magdalena; Santana Porbén, Sergio

    2007-09-01

    The results of the administration of the Mini Nutritional Assessment (MNA) of the Elderly to 197 patients (Women: 62.5%; Ages between 60-75 years: 55.4%; Older than 85 years: 9.7%; Whites: 73.7%) consecutively admitted to the Geriatrics Service of the "Hermanos Ameijeiras" Hospital (La Habana, Cuba) are presented. Sixty-nine percent of the patients had between 2 - 7 concurrent health problems. Neoplasms and lymphoproliferative processes (22.8%), heart and blood vessels diseases (15.7%), and infections (12.2%) were prevalent. The state of nutritional anthropometric and biochemical markers was as follows: Body Mass Index nutritional diagnosis independently done with anthropometric and biochemical markers used either separately or combined. Aging of the Cuban population, along with increased proportions of elder patients in hospital areas should lead to consider the nutritional status of patients older than 60 years as an important predictor of the success of medical interventions and the quality of medical assistance.

  19. Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

    Directory of Open Access Journals (Sweden)

    Simpkins D

    2016-10-01

    Full Text Available Daniel Simpkins,1 Carmelle Peisah,2,3 Irene Boyatzis1 1Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, 2School of Psychiatry, University of New South Wales, 3Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Aim: The management of severely agitated elderly patients is not easy, and limited guidelines are available to assist practitioners. At a Sydney hospital, an Aggression Response Team (ART comprising clinical and security staff can be alerted when a staff member has safety concerns. Our aims were to describe the patient population referred for ART calls, reasons for and interventions during ART calls, and complications following them.Methods: Patients 65 years and older referred for ART calls in the emergency department or wards during 2014 were identified using the Incident Information Management System database and medical records were reviewed. Demographic and clinical data were collected. Results: Of 43 elderly patients with ART calls, 30 had repeat ART calls. Thirty-one patients (72% had underlying dementia, and 22 (51% were agitated at the time of admission. The main reasons for ART calls were wandering and physical aggression. Pharmacological sedation was used in 88% of the ART calls, with a range of psychotropics, doses, and routes of administration, including intravenous (19% and, most commonly, midazolam (53%. Complications were documented in 14% of cases where sedation was used. Conclusion: We observed a high frequency of pharmacological sedation among the severely agitated elderly, with significant variance in the choice and dose of sedation and a high rate of complications arising from sedation, which may be an underestimate given the lack of post-sedation monitoring. We recommend the development of guidelines on the management of behavioral emergency in the elderly patients, including de-escalation strategies and standardized psychotropic guidelines. Keywords: aged, aggression

  20. Analysis of the Children's Hospital Graduate Medical Education Program Fund Allocations for Indirect Medical Education Costs.

    Science.gov (United States)

    Wynn, Barbara O.; Kawata, Jennifer

    This study analyzed issues related to estimating indirect medical education costs specific to pediatric discharges. The Children's Hospital Graduate Medical Education (CHGNE) program was established to support graduate medical education in children's hospitals. This provision authorizes payments for both direct and indirect medical education…

  1. [Application of HIS Hospital Management System in Medical Equipment].

    Science.gov (United States)

    Li, Yucheng

    2015-07-01

    To analyze the effect of HIS hospital management system in medical equipment. From April 2012 to 2013 in our hospital 5 100 sets of medical equipment as the control group, another 2013 in our hospital from April 2014 may 100 sets of medical equipment as the study group, comparative analysis of two groups of medical equipment scrap rate, usage, maintenance score and the score of benefit etc. Control group and taken to hospital information system, his research group equipment scrap rate, there was a significant difference, the research group of equipment maintenance score and efficiency scores were higher than those of the control group (P equipment maintenance score and efficiency scores were higher than those of the control group. HIS hospital management system for medical equipment management has positive clinical application value, can effectively improve the use of medical equipment, it is worth to draw and promote.

  2. Initiation of Benzodiazepines in the Elderly After Hospitalization

    Science.gov (United States)

    Fischer, Hadas D.; Gill, Sudeep S.; Zagorski, Brandon; Sykora, Kathy; Wodchis, Walter P.; Herrmann, Nathan; Bronskill, Susan E.; Lee, Phil E.; Anderson, Geoff M.; Rochon, Paula A.

    2007-01-01

    Objective To estimate the rate of new chronic benzodiazepine use after hospitalization in older adults not previously prescribed with benzodiazepines. Design Retrospective cohort study using linked, population-based administrative data. Setting Ontario, Canada between April 1, 1992 and March 31, 2005. Participants Community-dwelling seniors who had not been prescribed benzodiazepine drugs in the year before hospitalization were selected from all 1.4 million Ontario residents aged 66 years and older. Main Outcome Measures New chronic benzodiazepine users, defined as initiation of benzodiazepines within 7 days after hospital discharge and an additional claim within 8 days to 6 months. We used multivariate logistic regression to examine for the effect of hospitalization on the primary outcome after adjusting for confounders. Results There were 405,128 patient hospitalizations included in the cohort. Benzodiazepines were prescribed to 12,484 (3.1%) patients within 7 days of being discharged from hospital. A total of 6,136 (1.5%) patients were identified as new chronic benzodiazepine users. The rate of new chronic benzodiazepine users decreased over the study period from 1.8% in the first year to 1.2% in the final year (P benzodiazepine users. Older individuals had a lower risk for the primary outcome. Conclusion New benzodiazepine prescription after hospitalization occurs frequently in older adults and may result in chronic use. A systemic effort to address this risky practice should be considered. PMID:17453266

  3. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    LENUS (Irish Health Repository)

    Walsh, E K

    2010-09-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

  4. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    LENUS (Irish Health Repository)

    Walsh, E K

    2012-02-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

  5. Age-specific prognostication after out-of-hospital cardiac arrest - The ethical dilemma between 'life-sustaining treatment' and 'the right to die' in the elderly.

    Science.gov (United States)

    Sulzgruber, Patrick; Sterz, Fritz; Poppe, Michael; Schober, Andreas; Lobmeyr, Elisabeth; Datler, Philip; Keferböck, Markus; Zeiner, Sebastian; Nürnberger, Alexander; Hubner, Pia; Stratil, Peter; Wallmueller, Christian; Weiser, Christoph; Warenits, Alexandra-Maria; van Tulder, Raphael; Zajicek, Andreas; Buchinger, Angelika; Testori, Christoph

    2017-03-01

    While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm. In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled. Patients were stratified according to age as follows: young and middle-aged individuals (85 years). There was an increasing rate of 30-day mortality (+21.8%, p 85-year-olds. Frailty was directly associated with mortality (HR 1.22, 95% CI 1.01-1.51, p = 0.049), showing a 30-day survival of 5.6% and a favourable neurological outcome of 1.1% among elderly individuals. An initially shockable electrocardiogram proved to be a suitable tool for risk assessment and decision making in order to predict a successful outcome in elderly victims of out-of-hospital cardiac arrest. However, the outcomes of elderly patients seemed to be exceptionally poor in frail individuals and need to be considered in order to reduce unnecessary treatment decisions.

  6. Relationship of Cognitive Functions with Daily Living Activities, Depression, Anxiety and Clinical Variables in Hospitalized Elderly Patients.

    Science.gov (United States)

    Demir Akça, Ayşe Semra; Saraçli, Özge; Emre, Ufuk; Atasoy, Nuray; Güdül, Serdar; Özen Barut, Banu; Şenormanci, Ömer; Büyükuysal, M Çağatay; Atik, Levent; Atasoy, H Tuğrul

    2014-09-01

    Cognitive impairment in elderly patients, which may be a sign of dementia, depression, anxiety or medical diseases, has been determined as a risk factor for functional loss. In this study, we aimed to investigate the frequency of cognitive impairment and to investigate the relationship of cognitive status with sociodemographic variables, daily living activities, anxiety and depression in elderly inpatients. The sample of this cross-sectional and descriptive study consists of 243 patients aged 65 years and older who were hospitalized in Bülent Ecevit University Hospital. A sociodemographic questionnaire,, the Mini-Mental State Examination (MMSE), Activities of Daily Living Scale, Lawton-Brody Instrumental Daily Activities Scale, Geriatric Depression Scale (GDS) and the Beck Anxiety Inventory were used for data collection. One hundred and six (43.6%) patients were female and 137 (56.4%) were male. The patients were divided into two groups according to the Mini-Mental State Examination (MMSE) 23/24 cut-off score. The cognitive decline was statistically significantly more frequent in patients who were older, female, less educated, low socioeconomic status, and living in rural areas. There were more problems in the basic and instrumental activities of daily living and nutrition in patients with cognitive decline. Anxiety and depression scores were higher in this group. In our study, although the frequency of cognitive decline and depression according to GDS were 56% and 48%, respectively; we found that only 10.5% of patients applied to the psychiatrist, and 9.3% of patients received psychiatric treatment. Cognitive decline may cause deterioration in the daily living activities, nutrition and capacity for independent functioning. Older age, female, low education, low socioeconomic status and living in rural area are important risk factors for cognitive impairment. Cognitive decline in older age may be associated with depression and anxiety. We assume that when cognitive

  7. Prevalence of self-medication among the elderly in Kermanshah-Iran.

    Science.gov (United States)

    Jafari, Faranak; Khatony, Alireza; Rahmani, Elham

    2015-01-21

    Self-medication is consumption of one or several medications without the physician's prescription. Given the risks of self-medication, this study was carried out to assess the prevalence of self-medication and its related factors among the elderly in Kermanshah-Iran In this descriptive cross-sectional study, 272 elderly visiting the private offices in Kermanshah were selected through convenience sampling method. The instrument for data collection was a researcher made self-medication questionnaire. Data were analyzed using descriptive and analytic statistical methods (Chi-Square and Fisher exact test). The prevalence of self-medication was 83%. The most common reasons for self-medication were certainty of its safety (93%), prior consumption of the drug (87.6%), busy offices of physicians (82%), non-seriousness of the illness (77.8%) and prior experience of the disease (73%).The most common drugs used for self-medication were analgesics (92%), cold drugs (74%), vitamins (61%), digestive drugs (54%) and antibiotics (43%). There was a significant correlation between self-medication and gender (p=0.001), education level (p=008), drug information (p=0.01), marital status (p=0.002), and medical insurance (p=0.001) variables. considering the relatively high rates of self-medication among the elderly as well as its side effects, designing and performing educational programs are suggested for the elderly people.

  8. Mental Health Conditions and Medical and Surgical Hospital Utilization.

    Science.gov (United States)

    Doupnik, Stephanie K; Lawlor, John; Zima, Bonnie T; Coker, Tumaini R; Bardach, Naomi S; Hall, Matt; Berry, Jay G

    2016-12-01

    Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs. Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment. Copyright © 2016 by the American Academy of Pediatrics.

  9. Perceived barriers to healthcare and receipt of recommended medical care among elderly Medicare beneficiaries.

    Science.gov (United States)

    Kurichi, Jibby E; Pezzin, Liliana; Streim, Joel E; Kwong, Pui L; Na, Ling; Bogner, Hillary R; Xie, Dawei; Hennessy, Sean

    2017-09-01

    Many Medicare beneficiaries perceive barriers to receiving healthcare, although the consequences are unknown. Facilitators can aid in the receipt of healthcare services. The objective was to assess the relationship between perceived facilitators and barriers to healthcare and actual receipt of recommended medical care among elderly beneficiaries. A cohort study using data from the 2001-2008 entry panels of the Medicare Current Beneficiary Survey that included 24,607 community-dwelling beneficiaries 65 years of age and older. Surveys elicited perceptions of healthcare with respect to: care coordination and quality; access to medical care; getting or delaying healthcare because of financial reasons; transportation; and usual source of care. The outcome was receipt of recommended medical care, expressed as an aggregate of 38 indicators covering initial evaluation, diagnostic tests, therapeutic interventions, hospitalization follow-up, and routine preventive care. Multivariable survey logistic regression produced odds ratios (ORs) and 95% confidence intervals (CIs) for receipt of recommended medical care, adjusted for sociodemographics, insurance, comorbidities, and disability. Beneficiaries who reported having trouble getting or reported delaying healthcare because of financial reasons (barrier) (adjusted OR=0.79, 95% CI: 0.73-0.86) and those who reported having no usual source of care (facilitator) (adjusted OR=0.55, 95% CI: 0.48-0.63) were less likely to receive recommended medical care. Survey data that capture patient perceptions of facilitators and barriers to healthcare may be useful for identifying system factors that affect timely receipt of recommended medical care. This information can inform the design of policies and programs to improve the healthcare of older adults. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. [The development of hospital medical supplies information management system].

    Science.gov (United States)

    Cao, Shaoping; Gu, Hongqing; Zhang, Peng; Wang, Qiang

    2010-05-01

    The information management of medical materials by using high-tech computer, in order to improve the efficiency of the consumption of medical supplies, hospital supplies and develop a new technology way to manage the hospital and material support. Using C # NET, JAVA techniques to develop procedures for the establishment of hospital material management information system, set the various management modules, production of various statistical reports, standard operating procedures. The system is convenient, functional and strong, fluent statistical functions. It can always fully grasp and understand the whole hospital supplies run dynamic information, as a modern and effective tool for hospital materials management.

  11. [Multicenter epidemiological investigation of hospitalized elderly, young and middle-aged patients with severe burn].

    Science.gov (United States)

    Tang, Y; Wang, L X; Xie, W G; Shen, Z A; Guo, G H; Chen, J J; Han, C M; Ren, L C; Chu, Z G; Yin, M F; Wang, Y; Zhang, D X; Huang, Y S; Zhang, J P

    2017-09-20

    Objective: To compare and analyze the epidemiological characteristics of hospitalized elderly, young and middle-aged patients with severe burn in recent years, so as to provide reference for the prevention and treatment of elderly patients with severe burn. Methods: Relying on the entry system of epidemiological case data and biological sample of severe burn from multicenter in clinic, medical records of patients with severe burn, aged above 18, hospitalized in 8 burn wards from January 2012 to December 2015 were collected. Six hundred and fifteen patients who were more than 18 years old and less than or equal to 65 years old were included in young and middle-aged group (YM). Eighty-two patients aged more than 65 years old were included in elderly group (E). Data of age, gender, residence, education level, cause of injury, location of injury, season of injury, total burn area, occurrence and area of full-thickness burn injury, wound site, inhalation injury incidence and severity, post burn admission time, proportion of delayed resuscitation, proportion of escharectomy or tangential excision and skin grafting, preinjury systemic disease, system complication during hospitalization, length of hospital stay, outcome of treatment, and reason of abandoning treatment of patients were analyzed. Data were processed with chi-square test and Mann-Whitney U test. The odds ratios of preinjury systemic disease, system complication during hospitalization, and adverse outcome of patients in group YM were compared with those in group E. Results: (1) The majority of patients in the two groups were male, but the proportion of male patients in group YM was higher. There was statistically significant difference in gender distribution of patients between the two groups (χ(2)=18.727, Pgroups were from rural areas, but the proportion of rural patients in group E was higher. There was statistically significant difference in residence distribution of patients between the two groups (χ(2

  12. High prevalence of skin and wound care of hospitalized elderly in Brazil: a prospective observational study.

    Science.gov (United States)

    da Rosa Silva, Carleara Ferreira; Santana, Rosimere Ferreira; de Oliveira, Beatriz Guitton Renaud Baptista; do Carmo, Thalita Gomes

    2017-02-02

    Skin changes caused by aging increase the risk of skin damages, such as pressure ulcers, during hospitalization of elderly patients. There is few information about the cost of wound treatment in Brazil. Conversely, skin and wound problems are highly reported among hospitalized elderly patients and caregivers. The purpose is to analyze the socio-demographic and clinical profile associated with skin and wound care in hospitalized elderly. This is a prospective observational study. The sample consisted of 75 patients, aged 60 years or more, randomly selected in three hospitals in Rio de Janeiro, Brazil. Data extraction from nursing records of the sample, using cross mapping with Nursing Interventions Classification. Data Synthesis supported by SAS 6.11 (SAS Institute, Inc. Cary North Carolina) in association with SPSS version 14.0 and statistics analysis. The findings were: age standard deviation 7.8, with minimum as 60, and maximum as 91 years old. Prevalence of women and married seniors. High prevalence of long-term hospitalization. There were 21 Nursing Interventions in the nursing records and seventeen of them related to skin and wound care. They were described in 57 nursing activities, present during 376 evaluations and repeated 1756 times. A significant difference was obtained between age and the presence of the nursing interventions "Positioning" (p-0.004), Eye Care/Hygiene (p- < 0.0001) and Oral Health Maintenance (p-0.0003). The skin care to prevention and treatment of skin damages represented the major demand of nursing interventions in different clinical conditions of hospitalized elderly.

  13. [The study of medical supplies automation replenishment algorithm in hospital on medical supplies supplying chain].

    Science.gov (United States)

    Sheng, Xi

    2012-07-01

    The thesis aims to study the automation replenishment algorithm in hospital on medical supplies supplying chain. The mathematical model and algorithm of medical supplies automation replenishment are designed through referring to practical data form hospital on the basis of applying inventory theory, greedy algorithm and partition algorithm. The automation replenishment algorithm is proved to realize automatic calculation of the medical supplies distribution amount and optimize medical supplies distribution scheme. A conclusion could be arrived that the model and algorithm of inventory theory, if applied in medical supplies circulation field, could provide theoretical and technological support for realizing medical supplies automation replenishment of hospital on medical supplies supplying chain.

  14. A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress.

    Science.gov (United States)

    Tibaldi, V; Aimonino, N; Ponzetto, M; Stasi, M F; Amati, D; Raspo, S; Roglia, D; Molaschi, M; Fabris, F

    2004-01-01

    A Geriatric Home Hospitalization Service (GHHS) has been operating in Torino at S. Giovanni Battista Hospital since 1985. GHHS allows us to perform diagnostic and therapeutic interventions, which are usually made in hospital, also at home. GHHS team includes geriatricians, nurses, physiotherapists, social workers and counselors. Between February 1999 and April 2002, the GHH Service conducted a randomized controlled trial on 109 elderly, demented patients requiring admission to the Hospital Emergency Department (ED)for acute illnesses. Objective of the study was to identify the benefits of the care in a GHHScompared to a general medical ward (GMW) in reducing behavioral disturbances in elderly patients with advanced dementia and in lowering caregiver's stress. Patients were randomly assigned to GHHS (56 patients) or to GMW (53 patients). Both groups were examined using the same protocol and were evaluated on admission and on discharge. All patients had a severe form of dementia as shown by the clinical dementia rating (CDR) scale mean value (3.7 +/- 0.9) with an important functional impairment and a relevant degree of comorbidity.The main reasons for hospitalization were infections, cerebrovascular accidents and malnutrition. Mortality of total sample was 19.3 %, without significant differences in the two settings of care. On discharge, in GHHS patients there was a significant reduction of behavioral disturbances. The use of anti-psychotic drugs was significantly lower in GHHS patients compared to the GMW group (p < 0.001). The stress of caregivers on discharge was reduced only in GHHS group and not in the control ones. In conclusion, we can say that a GHHS continuous support allows us to reduce the family caregiver's stress. When treated at home, demented patients do not have to change their environment or routine and it is possible to have a better control on behavioral disturbances.

  15. Living arrangements, chronic diseases, and prescription drug expenditures among Korean elderly: vulnerability to potential medication underuse.

    Science.gov (United States)

    Park, Eun-Ja; Sohn, Hyun Soon; Lee, Eui-Kyung; Kwon, Jin-Won

    2014-12-16

    Insufficient social security combined with family structure changes has resulted in a poverty of the elderly. The objective of this study was to examine an association of living arrangements of the elderly with chronic disease prevalence and prescription drug use. 2008 Korea Health Panel Survey (KHPS) data were used in this study. Information on living arrangements, socio-demographics, health behaviors, chronic disease prevalence and healthcare expenditures including out-of-pocket (OOP) prescription drug expenditures for elderly aged 65 or older were collected from self-reported diaries and receipts. OOP prescription drug expenditure as a total cost that subject paid to a pharmacy for prescription drugs was examined. Logistic regression was used to identify differences in major chronic disease prevalence by living arrangements. The association of living arrangements with prescription drug use was analyzed using generalized linear model with a log link and a gamma variance distribution. Proportions of elderly living alone, elderly living with a spouse only, and elderly living with adults aged 20-64 were 14.5%, 48.3%, and 37.2%, respectively. Elderly living alone showed 2.43 odds ratio (OR) (95% confidence interval (CI) = 1.66-3.56) for having major chronic diseases prevalence compared to elderly living with adults. Despite a higher major chronic disease prevalence, elderly living alone showed lower OOP prescription drug expenditures (Cost Ratio = 0.80, 95% CI = 0.67-0.97) after adjusting for the number of major chronic diseases. Total OOP prescription drug expenditures were significantly lower in patients with a low income level versus high income level. Even though elderly living alone had a higher risk of chronic disease, they spent less on OOP prescription drug expenditures. Optimal drug use is important for elderly with chronic diseases to achieve good health outcomes and quality of life. Public health policies should be supplemented to optimize medical

  16. Access to palliative care services during a terminal hospital episode reduces intervention rates and hospital costs: a database study of 19 707 elderly patients dying in hospital, 2011-2015.

    Science.gov (United States)

    Ireland, Anthony W

    2017-05-01

    The burden of healthcare costs for persons approaching death is of increasing concern. This study examines cost savings associated with access to palliative care (PC) during a hospital episode ending in death for a large sample of elderly patients. A retrospective cohort study of administrative data for the Department of Veterans' Affairs clients identified patient demographics, hospital characteristics, utilisation data and component costs for the hospital terminal episode for patients aged ≥ 70 years who died in hospital between July 2011 and June 2015. Differences between patients with and without access to PC were analysed with descriptive statistics and negative binomial regression models. Access to PC service was reported for 33.2% of patients, 59.5% for those with a cancer diagnosis and 24.3% for other patients. Rates were significantly lower in private hospitals for all patient groups. For the complete sample, PC access was associated with significantly lower rates of admission into the intensive care unit (1.9% vs 10.6%, P terminal episodes was $10 801 for PC patients and $16 165 for those with no recorded PC access (P < 0.001). All differences remained significant after adjustment for patient age, comorbidity and hospital type. In a hospital episode ending in death, access to PC services was associated with significantly lower rates of medical interventions and total hospital costs. © 2017 Commonwealth of Australia Internal Medicine Journal © 2017 Royal Australasian College of Physicians.

  17. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

    Directory of Open Access Journals (Sweden)

    Gladman John RF

    2011-05-01

    Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of

  18. Markov Chain-Based Acute Effect Estimation of Air Pollution on Elder Asthma Hospitalization

    Directory of Open Access Journals (Sweden)

    Li Luo

    2017-01-01

    Full Text Available Background. Asthma caused substantial economic and health care burden and is susceptible to air pollution. Particularly, when it comes to elder asthma patient (older than 65, the phenomenon is more significant. The aim of this study is to investigate the Markov-based acute effects of air pollution on elder asthma hospitalizations, in forms of transition probabilities. Methods. A retrospective, population-based study design was used to assess temporal patterns in hospitalizations for asthma in a region of Sichuan province, China. Approximately 12 million residents were covered during this period. Relative risk analysis and Markov chain model were employed on daily hospitalization state estimation. Results. Among PM2.5, PM10, NO2, and SO2, only SO2 was significant. When air pollution is severe, the transition probability from a low-admission state (previous day to high-admission state (next day is 35.46%, while it is 20.08% when air pollution is mild. In particular, for female-cold subgroup, the counterparts are 30.06% and 0.01%, respectively. Conclusions. SO2 was a significant risk factor for elder asthma hospitalization. When air pollution worsened, the transition probabilities from each state to high admission states increase dramatically. This phenomenon appeared more evidently, especially in female-cold subgroup (which is in cold season for female admissions. Based on our work, admission amount forecast, asthma intervention, and corresponding healthcare allocation can be done.

  19. Longitudinal assessment of psychotherapeutic day hospital treatment for elderly patients with depression.

    Science.gov (United States)

    Canuto, Alessandra; Meiler-Mititelu, Corina; Herrmann, François R; Delaloye, Christophe; Giannakopoulos, Panteleimon; Weber, Kerstin

    2008-09-01

    Although previous studies suggested that psychiatric day hospital care is a valuable alternative to inpatient treatment, its effectiveness for elderly patients is disputed. Small number of cases, poor definition of the psychotherapeutic setting, and absence of systematic assessment at different time points may explain the observed discrepancies. We performed an assessment of a psychiatric day hospital treatment combining individual and group psychotherapy in a series of 122 elderly depressed outpatients. The Geriatric Depression Scale, Short Form Survey, as well as a Therapeutic Community Assessment Scale and Group Evaluation Scale were repeated at admission, 3, 6, 12 months and discharge. The day hospital program was based on psychotherapeutic treatment combining individual and group settings. All patients presented with major depression or a depressive episode of bipolar disease. Variables included severity of depressive symptoms, quality of life, adhesion to therapeutic community treatment and progress in groups of psychotherapy, art-therapy, and psychomotricity. There was a significant reduction of depressive symptoms, and improvement in mental quality of life across all time points studied. Adhesion to therapeutic community increased from admission to discharge. This was also the case for the progress in group therapy for all three groups used, yet the evolution of this parameter at intermediate time points was highly variable. Neither demographic characteristics, nor pharmacological treatment or presence of stressful life events predicted the clinical improvement. Psychotherapeutic care program in day hospitals may improve clinical status and quality of life in elderly depressed patients.

  20. Markov Chain-Based Acute Effect Estimation of Air Pollution on Elder Asthma Hospitalization.

    Science.gov (United States)

    Luo, Li; Zhang, Fengyi; Zhang, Wei; Sun, Lin; Li, Chunyang; Huang, Debin; Han, Gao; Wang, Bin

    2017-01-01

    Asthma caused substantial economic and health care burden and is susceptible to air pollution. Particularly, when it comes to elder asthma patient (older than 65), the phenomenon is more significant. The aim of this study is to investigate the Markov-based acute effects of air pollution on elder asthma hospitalizations, in forms of transition probabilities. A retrospective, population-based study design was used to assess temporal patterns in hospitalizations for asthma in a region of Sichuan province, China. Approximately 12 million residents were covered during this period. Relative risk analysis and Markov chain model were employed on daily hospitalization state estimation. Among PM2.5, PM10, NO2, and SO2, only SO2 was significant. When air pollution is severe, the transition probability from a low-admission state (previous day) to high-admission state (next day) is 35.46%, while it is 20.08% when air pollution is mild. In particular, for female-cold subgroup, the counterparts are 30.06% and 0.01%, respectively. SO2 was a significant risk factor for elder asthma hospitalization. When air pollution worsened, the transition probabilities from each state to high admission states increase dramatically. This phenomenon appeared more evidently, especially in female-cold subgroup (which is in cold season for female admissions). Based on our work, admission amount forecast, asthma intervention, and corresponding healthcare allocation can be done.

  1. Self-medication among the elderly in Iran: a content analysis study.

    Science.gov (United States)

    Mortazavi, Seyede Salehe; Shati, Mohsen; Khankeh, Hamid Reza; Ahmadi, Fazlollah; Mehravaran, Shiva; Malakouti, Seyed Kazem

    2017-09-01

    Self-medication is described as the use of drugs without a physician's prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon. This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior. Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: "patient's attitudes towards disease, treatment, and physicians", "living with disease", "unfriendly environments", "enabling health system", and "influential others". Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services.

  2. Medical Audit: A Nigerian Teaching Hospital's Preliminary Experience

    African Journals Online (AJOL)

    The definition, historical background, aims dimensions and the characteristics of medical audit as well as the indices to be measured in a medical audit exercise are highlighted. The preliminary experience of the University of Ilorin Teaching Hospital (UITH) in the planning, implementation and monitoring of a viable medical ...

  3. Medical Admissions and Outcomes at Saint Paul's Hospital, Addis ...

    African Journals Online (AJOL)

    2012-04-01

    Background: Globally, trends of medical admission have been changing. This study was carried out to assess the current trend of medical admissions and outcomes in Ethiopia. Methods: Retrospective review of 840 records of patients admitted to medical ward of Saint Paul hospital during April 1, 2012-March 31, 2013 was ...

  4. Effects of Grade, Gender, and Hospitalization on Children's Medical Fears.

    Science.gov (United States)

    Aho, Amy C.; Erickson, Marilyn T.

    1985-01-01

    First, fourth, and seventh graders (N=291) completed a medical fears questionnaire. Girls expressed significantly more frequent and more intense medical fears than boys. Fourth and seventh graders reported more medical fears than first graders. Previous hospitalization experience had no effect on frequency or intensity of fears. (Author/CL)

  5. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

  6. Unit Cost of Medical Services at Different Hospitals in India

    Science.gov (United States)

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  7. Seasonal screening for viral gastroenteritis in young children and elderly hospitalized patients: is it worthwhile?

    Science.gov (United States)

    Borrows, C L; Turner, P C

    2014-06-01

    Viral gastroenteritis is common, especially in young children. In adults, particularly amongst the elderly, it can lead to outbreaks at a time when demands on clinical services are at their peak. To evaluate seasonal screening of young children and elderly patients with suspected viral gastroenteritis using multiplex polymerase chain reaction (PCR) for enteric viruses within a general hospital setting. Stool samples from 200 children aged five years and under were screened for rotavirus, adenovirus, astrovirus, sapovirus and norovirus using multiplex PCR and a combined rotavirus/adenovirus immunochromatographic test (ICT) during the winter of 2012. Diarrhoeal samples submitted to the laboratory from 195 adults aged 65 years and over attending as inpatients were also evaluated by multiplex PCR. One or more enteric viruses were detected by PCR in 56% of children. Rotavirus was the most prevalent virus, found in 19% of samples. Enteric (diarrhoea-associated) adenovirus was detected in 5% of samples and non-enteric adenovirus was detected in 14% of samples. Astrovirus, norovirus and sapovirus were detected in 18%, 12% and 10% of samples, respectively. The ICT yielded a slightly lower rate for rotavirus and enteric adenovirus, but gave more rapid results. Norovirus, rotavirus and adenovirus were detected in 15%, 2.5% and 1% of elderly adults attending hospital as inpatients, respectively. Rapid screening of young children (for rotavirus, adenovirus and norovirus) and symptomatic, elderly adults (for norovirus) during winter months may help to limit nosocomial spread. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. Medication Discontinuation in Patients After Discharge From a Psychiatric Hospital.

    Science.gov (United States)

    Abdullah-Koolmees, Heshu; Gardarsdottir, Helga; Yazir, Dilek; Stoker, Lennart J; Vuyk, Judith; Egberts, Toine C G; Heerdink, Eibert R

    2015-10-01

    Patients discharged from psychiatric hospitals may be at risk for intentional or unintentional discontinuation of their medication. To describe and assess the discontinuation of, and changes to, psychiatric and/or somatic medication in patients after discharge from psychiatric hospitals. A retrospective follow-up study was conducted in patients discharged from 4 psychiatric hospitals in The Netherlands between 2006 and 2009. Patients' medication use during the last 2 days of hospitalization was compared with medication dispensed during the 3 months following discharge. Changes in psychiatric and somatic medication were investigated and defined as medication discontinuation, start, or switch. Patients were classified as continuing users, when there were no changes to the medication after discharge. Relative risks with 95% confidence intervals to measure differences in discontinuation were estimated using Cox regression analysis. This study included 1324 patients, 69.8% of whom discontinued medication, and 9.7% switched one or more medications. Nearly half (47.4%) of all patients started a medication other than that dispensed during the last 2 days of hospitalization, and 13.7% of all patients experienced no changes to their medication regimen. Approximately 40% of the patients discontinued one or more medications for chronic conditions. From these, 68% discontinued psychiatric medications and 49.4% discontinued somatic medications. A quarter (25.2%) of the 644 patients discontinued using antipsychotics. More than a quarter (28.4%) of the 292 patients using medications for cardiovascular problems discontinued. Patients using as-needed medication prior to discharge were more likely to discontinue their medication (relative risk = 1.85; 95% confidence interval = 1.55-2.20). Discharge from a psychiatric hospital led to medication discontinuation in approximately 70% of all patients. Approximately 40% of the patients discontinued medications for chronic conditions

  9. Cognitive function in community-dwelling elderly with chronic medical conditions

    NARCIS (Netherlands)

    Jelicic, M; Kempen, GIJM

    1997-01-01

    Objectives. The aim of this study was to examine the effect of chronic medical conditions on cognitive function in a sample of community-dwelling elderly (N = 4528). Methods. A checklist of 18 chronic medical conditions was used to determine whether respondents were suffering from specific disease

  10. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance.

    Science.gov (United States)

    Malhotra, S; Karan, R S; Pandhi, P; Jain, S

    2001-11-01

    Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed. A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, consequences, and predictors. Eighty three (14.4%) of the 578 admissions were drug related: 39 (6.7%) caused by adverse drug reactions and 44 (7.6%) caused by non-compliance with medication. One hundred ninety two (33.2%) patients had a history of non-compliance. Factors associated with an increased risk of admission because of an adverse drug reaction were patients with diabetes or neoplasms, and patients using numerous different medications. Factors associated with a higher risk of hospitalisation because of non-compliance were poor recall of the medication regimen, seeing numerous physicians, female sex, polypharmacy, drug costs, and switching over to non-conventional forms of treatment. Many elderly admissions are drug related, with non-compliance accounting for a substantial fraction of these. Elderly people at high risk of suffering a drug related medical emergency are identified and suitable interventions may be planned by the healthcare policymakers to target them.

  11. Attitudes of Medical Students and Residents toward Care of the Elderly

    Science.gov (United States)

    Muangpaisan, Weerasak; Intalapapron, Somboon; Assantachai, Prasert

    2008-01-01

    The research reported in this article examined attitudes toward the care of the elderly between and among medical students and residents in training. Data were collected with a 16-item attitude questionnaire. Participants were medical students in their introduction period (prior to clinical experience) and residents of the Department of Internal…

  12. Supporting medication intake of the elderly with robot technology : Poster and demonstration

    NARCIS (Netherlands)

    Cnossen, Fokeltje; Sweers, Nikie; Shantia, Amir

    2016-01-01

    Medication intake can prove a complicated task for the elderly. Since roughly 50% of all prescribed medication is taken incorrectly (MacLaughlin, et al., 2005), simplification of this task might have beneficial effects on this group’s general health and society’s healthcare costs. In response,

  13. Potentially Inappropriate Medications in Elderly Haemodialysis Patients Using the STOPP Criteria

    OpenAIRE

    Parker, Krystina; Stavem, Knut; Aasebø, Willy

    2016-01-01

    Background Polypharmacy is commonly applied to elderly haemodialysis patients for treating terminal renal failure and multiple co-morbidities. Potentially inappropriate medications (PIMs) in multidrug regimens in geriatric populations can be identified using specially designed screening tools. Objective The aims of this study were to estimate the prevalence of PIMs by applying the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria and the Beers criteria to elderly haemodialysi...

  14. Epidemiology of medication use among the elderly in an urban area of Northeastern Brazil.

    Science.gov (United States)

    Neves, Sabrina Joany Felizardo; Marques, Ana Paula de Oliveira; Leal, Márcia Carrera Campos; Diniz, Alcides da Silva; Medeiros, Tibério Silva; Arruda, Ilma Kruze Grande de

    2013-08-01

    To analyze medication use and associated factors among the elderly. A population-based cross-sectional study was carried out with a sample of 400 elderly people aged over 60 living in the urban area covered by the Family Health Strategy program in Recife, Northeastern Brazil in 2009. Individuals were selected by systematic random sampling and household data were collected. Demographic, socio-economic, lifestyle factors including nutrition practices and health variables were evaluated. Medication use was the independent variable. Univariate and multivariate statistical analysis were performed. The prevalence of medication use was 85.5%. Polypharmacy (> 5 drugs) occurred in 11% of cases. Of the 951 drugs reported, 98.2% were prescribed by doctors and 21.6% were considered unsafe for the elderly. The most commonly prescribed groups were: cardiovascular drugs (42.9%), central nervous system agents (20.2%) and drugs with an effect on the digestive tract and metabolism (17.3%). The use of polypharmacy was associated with education (p = 0.008), self-reported health (p = 0.012), self-reported chronic disease (p = 0.000) and the number of doctor appointments per year (0.000). The results of this study indicate a high proportion of medication use among the elderly, including of those considered unsuitable, and inequality among groups of elderly individuals regarding the use of medication, when education, number of doctor appointments and self-reported health are considered.

  15. Prevalence and covariates of polypharmacy in elderly patients on discharge from a tertiary care hospital in Oman

    National Research Council Canada - National Science Library

    Al-Hashar, Amna; Al Sinawi, Hamed; Al Mahrizi, Anwar; Al-Hatrushi, Manal

    2016-01-01

    Objectives: To evaluate the prevalence of polypharmacy in relation to gender, comorbidity, and age among elderly patients upon discharge from an academic tertiary care hospital in Muscat, Oman. Methods...

  16. The Risk of Malnutrition in Community-Living Elderly on Admission to Hospital for Major Surgery.

    Science.gov (United States)

    Geurden, B; Franck, E; Weyler, J; Ysebaert, D

    2015-01-01

    With prevalence rates varying from 10 to 60%, malnutrition in acute hospitals has been acknowledged as a persistent problem in older adults worldwide. This publication is to describe the nutritional condition and associated risk factors of malnutrition in free living elderly on admission to the hospital for major elective surgery. A cross sectional, multi-center study in eight surgical wards in three Belgian hospitals. A total of 204 free living elderly, aged 74.8 ± 6.6 years (Mean ± SD), on admission to the hospital for major elective surgery and requiring at least 3 days of hospitalization, were consecutively recruited to the study. The nutritional status was assessed on admission and before surgery using the recommended NRS-2002. Data on possible associated factors were collected during post-operative stay using a structured questionnaire. A total of 107 patients (51.4%) were at high risk of malnutrition. In patients older than 70 years (n 150) the risk of malnutrition increased up to 66%. None of the included patients reported preoperative referral to a dietician or nutritional advice nor any prescribed preoperative nutritional supplement. In a multivariate regression analysis it appeared that none of the possible associated factors were significantly associated with malnutrition. This study confirms the high risk of malnutrition in community living elderly on admission to hospital for elective surgery. According to the NRS-2002 these patients might benefit from nutritional support. However, it appears that nutritional support is not yet commonly implemented in preoperative care for this population at risk. © Acta Chirurgica Belgica.

  17. Medication quality and quality of life in the elderly, a cohort study

    Directory of Open Access Journals (Sweden)

    Runnamo Rebecka

    2011-11-01

    Full Text Available Abstract Background Modern drugs have made large contributions to better health and quality of life. Increasing proportions of negative side effects due to extensive pharmacological treatment are however observed especially among elderly patients who have multiple health problems. The aim of our study was to see if there is an association between medication quality and quality of life. Methods 150 patients discharged from hospital. Inclusion criteria were: living in ordinary homes, ≥ 75 years and ≥ 5 drugs. Home visits were performed to all, including prescription reviews and calculation of medication appropriateness index. The patients were divided into three groups depending on index score and followed for 12 months. The validated and recognized EQ-5D and EQ VAS instruments were used to assess quality of life. Results A lower medication quality was associated with a lower quality of life. EQ-5D index was statistically significantly different (declining for each group among the groups (p = 0.001 at study start, p = 0.001 at 6 months and p = 0.013 at 12 months as was EQ VAS (p = 0.026 at study start, p = 0.003 at 6 months and p = 0.007 at 12 months. Conclusions This study has shown the validity of the basic principle in prescribing: the more appropriate medication the better quality of life. Since drug quality is related to the patients' quality of life, there is immense reason to continuously evaluate every prescription and treatment. The evaluation and if possible deprescribing should be done as a process where both the patient and physician are involved.

  18. Nutritional and Functional Assessment of Hospitalized Elderly: Impact of Sociodemographic Variables

    Directory of Open Access Journals (Sweden)

    Emam M. M. Esmayel

    2013-01-01

    Full Text Available Background. This work was constructed in order to assess the nutritional and functional status in hospitalized elderly and to study the associations between them and sociodemographic variables. Methods. 200 elderly patients (>65 years old admitted to Internal Medicine and Neurology Departments in nonemergency conditions were included. Comprehensive geriatric assessments, including nutritional and functional assessments, were done according to nutritional checklist and Barthel index, respectively. Information was gathered from the patients, from the ward nurse responsible for the patient, and from family members who were reviewed. Results. According to the nutritional checklist, 56% of participants were at high risk, 18% were at moderate risk of malnutrition, and 26% had good nutrition. There was a high nutritional risk in patients with low income and good nutrition in patients with moderate income. Also, there was a high nutritional risk in rural residents (61.9% in comparison with urban residents (25%. Barthel index score was significantly lower in those at high risk of malnutrition compared to those at moderate risk and those with good nutrition. Conclusions. Hospitalized elderly are exposed to malnutrition, and malnourished hospitalized patients are candidates for functional impairment. Significant associations are noticed between both nutritional and functional status and specific sociodemographic variables.

  19. Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital.

    Science.gov (United States)

    Söderström, Lisa; Thors Adolfsson, Eva; Rosenblad, Andreas; Frid, Hanna; Saletti, Anja; Bergkvist, Leif

    2013-04-01

    Large-scale studies performed in hospitals with the validated Mini Nutritional Assessment (MNA) tool are scarce. However, factors associated with malnutrition are important for identifying individuals at risk. The aims of the present study were to estimate the prevalence of malnutrition and to examine the association between mealtime habits, meal provision, and malnutrition among elderly patients admitted to hospital. This cross-sectional study included patients aged ≥65 years admitted to internal medicine, surgical or orthopaedic wards. The MNA was used for their nutritional assessment, and factors potentially associated with malnutrition were recorded. Of 1771 patients (mean age 78 years), 35.5% were well-nourished, 55.1% were at risk of malnutrition and 9.4% were malnourished. Overnight fasts exceeding 11 h, fewer than four eating episodes a day, and not cooking independently were associated with both malnutrition and risk of malnutrition. The risk of malnutrition was high among elderly patients admitted to hospital, whereas the proportion with fully developed malnutrition was lower than expected. A long overnight fast, few eating episodes, and not cooking independently were associated with an increased risk of malnutrition. Knowledge of these factors when providing care to the elderly may assist health-care professionals to prevent malnutrition. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  20. Systematic literature review of hospital medication administration errors in children

    OpenAIRE

    Ameer A; Dhillon S; Peters MJ; Ghaleb M

    2015-01-01

    Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs) during this process have been documented and t...

  1. Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: a nationwide retrospective cohort study.

    Science.gov (United States)

    Alvarez, Carlos A; Mortensen, Eric M; Makris, Una E; Berlowitz, Dan R; Copeland, Laurel A; Good, Chester B; Amuan, Megan E; Pugh, Mary Jo V

    2015-01-27

    High-risk medication exposure in the elderly is common and associated with increased mortality, hospitalizations, and emergency department (ED) visits. Skeletal muscle relaxants and antihistamines are high-risk medications commonly prescribed in elderly patients. The objective of this study was to determine the association between skeletal muscle relaxants or antihistamines and mortality, hospitalizations, and emergency department visits. This study used a new-user, retrospective cohort design using national Veteran Affairs (VA) data from 128 hospitals. Veterans ≥65 years of age on October 1, 2005 who received VA inpatient/outpatient care at least once in each of fiscal year (FY) 2005 and FY 2006 were included. Exposure to skeletal muscle relaxants and antihistamines was defined by the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measures for high-risk medications in the elderly. Primary outcomes identified within one year of exposure were death, ED visit, or hospitalization; ED visits or hospitalizations due to falls and fracture were also assessed. Propensity score matching (1 to 1 match) was used to balance covariates between exposed patients and non-exposed patients. In this cohort of 1,807,404 patients 55,566 patients were included in the propensity-matched cohort for skeletal muscle relaxants and 60,058 patients were included in the propensity-matched cohort for anti-histamines. Mortality was lower in skeletal muscle relaxants-exposed patients (adjusted odds ratio [AOR] 0.87, 95% CI 0.81-0.94), but risk of emergency care (AOR 2.25, 95% CI 2.16-2.33) and hospitalization (AOR 1.56, 95% CI 1.48-1.65) was higher for patients prescribed skeletal muscle relaxants. Similar findings were observed for emergency and hospital care for falls or fractures. Mortality (AOR 1.93, 95% CI 1.82-2.04), ED visits (AOR 2.35, 95% CI 2.27-2.43), and hospitalizations (AOR 2.21, 95% CI 2.11-2.32) were higher in the antihistamine

  2. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

    Directory of Open Access Journals (Sweden)

    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  3. Old age and chronic disease: is the emergency medical system the appropriate provider for the elderly?

    Science.gov (United States)

    Mochmann, Hans-Christian; Arntz, Hans-Richard; Dincklage, Falk V; Rauch, Ursula; Schultheiss, Heinz P; Bobbert, Peter

    2014-04-01

    The use of emergency medical services increases with the age of patients. Some care providers hold on to the prejudice that these alarms are unnecessary or of a lower importance. We assessed the relation of age and age-dependent emergency characteristics, taking into consideration the ratings of emergency physicians on whether or not emergency cases were considered truly in need of emergency physician attendance. Emergency physicians dispatched by the Berlin Fire Department evaluated for each case the necessity of emergency physician attendance. Case characteristics such as the day of the week and location of the emergency as well as patient characteristics such as age, sex, prior status, and care dependency were recorded. In addition, whether or not the physician accompanied the patient to the hospital was recorded as a parameter for emergency severity. Analysis was performed using multiple logistic regression modeling. During the 6-month prospective study period, 2702 cases were evaluated. Emergency medical services are used more frequently by older individuals, especially octogenarians. Emergency cases in older individuals were significantly more often rated as in need of emergency physician attendance; however, the rate of patients accompanied by the emergency physician to the hospital did not differ between the age groups. The age of patients, the primary diagnosis, the day and location of the emergency, and the presence of pre-existing dementia showed a significant impact on the necessity of physician-attended emergency missions. Despite common prejudices, emergency cases in elder patients are rated more often as in need of emergency physician attendance compared with those involving younger patients.

  4. Elders

    National Research Council Canada - National Science Library

    Geller, Jeffrey L; Crandell, Allan E

    2014-01-01

    ... is a bildungsroman, a classic coming-of-age progression, although the two primary characters, Elder McLeod and Elder Passos, devise two very different solutions to the developmental question. In the process they are often seen as alienated and anxious as they traverse the anticipated territory of late adolescence, with its sexual energy, long...

  5. Medical Admissions and Outcomes at Saint Paul's Hospital, Addis ...

    African Journals Online (AJOL)

    kim

    %), and renal failure 46 (5.5%). Mean duration of ... acute febrile illnesses, gastrointestinal infections, pulmonary infections as the leading causes of medical admissions (5). The other study conducted at Gondar Teaching hospital from. 1971 to ...

  6. International travel as medical research: architecture and the modern hospital.

    Science.gov (United States)

    Logan, Cameron; Willis, Julie

    2010-01-01

    The design and development of the modern hospital in Australia had a profound impact on medical practice and research at a variety of levels. Between the late 1920s and the 1950s hospital architects, administrators, and politicians travelled widely in order to review the latest international developments in the hospital field They were motivated by Australia's geographic isolation and a growing concern with how to govern the population at the level of physical health. While not 'medical research' in the conventional sense of the term, this travel was a powerful generator of medical thinking in Australia and has left a rich archival legacy. This paper draws on that archive to demonstrate the ways in which architectural research and international networks of hospital specialists profoundly shaped the provision of medical infrastructure in Australia.

  7. A "Medical Physics" Course Based Upon Hospital Field Experience

    Science.gov (United States)

    Onn, David G.

    1972-01-01

    Describes a noncalculus, medical physics'' course with a basic element of direct hospital field experience. The course is intended primarily for premedical students but may be taken by nonscience majors. (Author/PR)

  8. [Serious medication order errors at hospitals].

    Science.gov (United States)

    Andersen, Mette Lehmann; Søndergaard, Jens; Hallas, Jesper; Pedersen, Anette; Hellebek, Annemarie

    2009-03-09

    Medication order errors are frequent in Denmark. It is necessary to know the reasons why these errors happen to be able to implement initiatives limiting medication order errors. In this study we analyzed 811 medications order errors, which were reported as unintended events. The medication order errors were associated with at total of 98 medicinal product; hence nine medicinal products caused 18 errors with severe or catastrophic harm to patients. 46.0% of the errors were incorrect medicinal product, 47.7% were incorrect dosage and 6.3% of the orders were double ordering. Penicillin and warfarin were the most frequently involved medicinal products. The products that most frequently caused severe or catastrophic patient harm were insulin and warfarin. The most frequent errors were "no medicinal product prescribed" and "incorrect medicinal product". The errors with the most severe consequences for the patients were due to "medication was not discontinued" (sevoflurane and warfarin) and "poor patient compliance" (warfarin and insulin). A common feature concerning the errors' origin was incorrect handling of information. Specific initiatives should be taken to counter the above-mentioned problems and reduce the occurrence of medication order errors. Such measures may comprise control, medication reconciliation and imposition of clinical decision support.

  9. Medical technology management in U.S. hospitals.

    Science.gov (United States)

    Baretich, Matthew F

    2002-01-01

    Medical technologies move from research and development through manufacturing and marketing into the healthcare delivery system. Within the healthcare delivery system, hospitals rely heavily on medical technologies (and the medical devices they enable) to provide diagnosis, treatment, and monitoring in patient care. Managing these devices from acquisition through application in patient care is a formidable task. Hospitals must act to maximize the benefits of medical devices while minimizing adverse side effects. They must do so within a highly regulated and cost-constrained environment. This paper describes the challenges hospitals face and the strategies they employ in their efforts to achieve cost-effective medical technology management. The role of clinical engineering is discussed.

  10. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Science.gov (United States)

    2010-07-01

    ... disability or death from hospitalization, medical or surgical treatment, examinations or vocational... Special Purposes § 3.358 Compensation for disability or death from hospitalization, medical or surgical... result of hospitalization, medical or surgical treatment, examination, or vocational rehabilitation...

  11. Elderly and Nonelderly Use of a Dedicated Ambulance Corps’ Emergency Medical Services in Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Chia Huang

    2016-01-01

    Full Text Available Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years and nonelderly (<65 years. Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05 fewer (28 (9.2% nontransport calls than did the nonelderly (136 (21.4%. In the transport calls, 276 (35.6% were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

  12. Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals.

    Science.gov (United States)

    van der Veen, Willem; van den Bemt, Patricia M L A; Wouters, Hans; Bates, David W; Twisk, Jos W R; de Gier, Johan J; Taxis, Katja

    2017-08-22

    To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

  13. The Combined Effect of High Ambient Temperature and Antihypertensive Treatment on Renal Function in Hospitalized Elderly Patients.

    Directory of Open Access Journals (Sweden)

    Iftach Sagy

    Full Text Available The aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular.Higher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs.We obtained health data of patients older than 65 who were admitted to a large tertiary center during the years 2006-2011, with a previous diagnosis of hypertension, and treated with thiazide, ACE-inhibitors/ARBs or both. We collected environmental data of daily temperature, available from collaborative public and governmental institutions. In order to estimate the effect of daily temperature on renal function we performed linear mixed models, separately for each treatment group and creatinine change during hospital admission.We identified 26,286 admissions for 14, 268 patients with a mean age of 75.6 (±6.9 years, of whom 53.6% were men. Increment in daily temperature on admission of 5°C had significant effect on creatinine increase in the no treatment (baseline creatinine adjusted 0.824 mg/dL, % change 1.212, % change 95% C.I 0.082-2.354 and dual treatment groups (baseline creatinine adjusted 1.032mg/dL, % change 3.440, % change 95% C.I 1.227-5.700. Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on hospital admission, revealed a significant association within patients admitted due to acute infection and treated with dual therapy.Whereas previous studies analyzed sporadic climate effects during heat waves and/or excluded older population taking anti-hypertensive medications, the present study is novel by showing a durable association of temperature and decreased renal function specifically in elderly patients taking anti-hypertensive medications.

  14. Frequency of medical errors in hospitalized children in khorramabad Madani hospital during six months in 2008

    Directory of Open Access Journals (Sweden)

    azam Mohsenzadeh

    2010-02-01

    Full Text Available Many hospitalized children are suffered from medical errors that may cause serious injuries. The aim of this study was to evaluate medical errors in hospitalized children in khorramabad Madani hospital in the first half of 2008. Materials and Methods: This study was a cross sectional that was performed for all medical errors in hospitalized children in khorramabad Madani hospital from 21/3/2008 to 21/9/2008. The sampling method was census. Studied variables included: age, sex, weight, kinds of errers, education of parents, job of parents. Data was collected by questionnaire and analyzed by SPSS software. Results: In this study out of 2250 records, 151 (6/3% had medical errors. 53%were girls and 47% were boys that there was a significant relation between sex and medical errors. 46/4%were related to age group lower than 2 years old. Most of the errors were occurred in weight group of 6kg. Types of medical errors included drug ordering 46/3% (involved incorrect dosage of drug (37%, frequency 28%, rout 19% and others 16%, transcribing10%, administering32/4%, dispensing11/3%. Most errors related to liquid therapy 76/2% and intravenous rout 85/4%. Most errors were occurred during night 47% and during weekend 56/6%. Conclusion: Medical errors are common in hospitalized patients, and in our study the rate of medical errors was 6/3%. So further efforts are needed to reduce them.

  15. Validation of the Photography Method for Nutritional Intake Assessment in Hospitalized Elderly Subjects.

    Science.gov (United States)

    Monacelli, F; Sartini, M; Bassoli, V; Becchetti, D; Biagini, A L; Nencioni, A; Cea, M; Borghi, R; Torre, F; Odetti, P

    2017-01-01

    The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients. this is a prospective observational study. hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy). 255 consecutive elderly hospitalized patients. assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation). The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; ptherapeutic interventions.

  16. Impact of urban atmospheric environment on hospital admissions in the elderly

    Directory of Open Access Journals (Sweden)

    Edelci Nunes da Silva

    2012-08-01

    Full Text Available OBJECTIVE: To analyze the impact of intra-urban atmospheric conditions on circulatory and respiratory diseases in elder adults. METHODS: Cross-sectional study based on data from 33,212 hospital admissions in adults over 60 years in the city of São Paulo, southeastern Brazil, from 2003 to 2007. The association between atmospheric variables from Congonhas airport and bioclimatic index, Physiological Equivalent Temperature, was analyzed according to the district's socioenvironmental profile. Descriptive statistical analysis and regression models were used. RESULTS: There was an increase in hospital admissions due to circulatory diseases as average and lowest temperatures decreased. The likelihood of being admitted to the hospital increased by 12% with 1ºC decrease in the bioclimatic index and with 1ºC increase in the highest temperatures in the group with lower socioenvironmental conditions. The risk of admission due to respiratory diseases increased with inadequate air quality in districts with higher socioenvironmental conditions. CONCLUSIONS: The associations between morbidity and climate variables and the comfort index varied in different groups and diseases. Lower and higher temperatures increased the risk of hospital admission in the elderly. Districts with lower socioenvironmental conditions showed greater adverse health impacts.

  17. Idosos asilados em hospitais gerais Long-term care elderly residents in general hospitals

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    Milton Luiz Gorzoni

    2006-12-01

    Full Text Available Instituições de longa permanência para idosos interagem periodicamente com hospitais gerais para internações de casos agudos ou dos que necessitam de métodos diagnósticos complexos e da atenção de várias especialidades simultaneamente. A decisão de indicar hospitalização é multifatorial, sendo influenciada por circunstâncias como a gravidade do quadro clínico e a infra-estrutura das instituições de longa permanência para idosos. Internações hospitalares apresentam benefícios e riscos, como o desenvolvimento de iatrogenias, delirium e declínios funcionais, podendo resultar em piora do estado geral e da qualidade de vida do idoso asilado durante e/ou após a hospitalização. O objetivo do estudo foi abordar aspectos peculiares na avaliação, tratamento e manejo de idosos asilados em internações hospitalares, particularmente quanto a cuidados que os auxiliem efetivamente nessas circunstâncias. Discutiram-se situações freqüentes como delirium, iatrogenias, desnutrição, declínio funcional e cuidados paliativos e características próprias de residentes em instituições para idosos durante internações em hospitais gerais.Long-term care facilities for the elderly have regularly to work together with general hospitals to provide care to acutely ill residents or when they require all together more complex diagnostic procedures and multi-specialty care. The decision to hospitalize a nursing home elderly resident is multifactorial and it is based on factors such as illness severity and care facility infrastructure. Hospitalizations have benefits and risks such developing iatrogenic diseases, delirium, and functional decline, which may deteriorate patients' general condition and their quality of life during and/or after hospitalization. This study aimed at addressing specific aspects of assessment, treatment and management of nursing home elderly who require to be hospitalized, especially focusing on their effective care

  18. Retention of Medical Records in Ghanaian Teaching Hospitals ...

    African Journals Online (AJOL)

    Retention of Medical Records in Ghanaian Teaching Hospitals: Some International Perspectives. ... The study revealed that the problems inherent in the retention of management of non-current medical records are due to the absence of formal guidelines and procedures, and to the fact that those that exist are not properly ...

  19. Determinants of effective medical intern training at a training hospital ...

    African Journals Online (AJOL)

    Determinants of effective medical intern training at a training hospital in North West Province, South Africa. N Sein, J Tumbo. Abstract. Background. Medical internship that entails training as a doctor and working in an accredited facility under supervision within the limits of a well-defined scope prepares the professional for ...

  20. The medication process in a psychiatric hospital

    DEFF Research Database (Denmark)

    Soerensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter

    2013-01-01

    Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits....... The observational unit: The individual handling of medication (prescribing, dispensing, and administering). Results: In total, 189 errors were detected in 1,082 opportunities for error (17%) of which 84/998 (8%) were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%); dispensing......, 18/189 (10%); administration, 142/189 (75%); and discharge summaries, 19/189 (10%). The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. Conclusion: Errors throughout the medication...

  1. The medication process in a psychatric hospital

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter

    2013-01-01

    PURPOSE: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. METHODS: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits....... THE OBSERVATIONAL UNIT: The individual handling of medication (prescribing, dispensing, and administering). RESULTS: In total, 189 errors were detected in 1,082 opportunities for error (17%) of which 84/998 (8%) were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%); dispensing......, 18/189 (10%); administration, 142/189 (75%); and discharge summaries, 19/189 (10%). The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. CONCLUSION: Errors throughout the medication...

  2. Frequency and risk factors associated with emergency medical readmissions in Galway University Hospitals.

    LENUS (Irish Health Repository)

    Gorman, J

    2010-06-01

    Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH).

  3. How trained volunteers can improve the quality of hospital care for older patients. A qualitative evaluation within the Hospital Elder Life Program (HELP)

    NARCIS (Netherlands)

    Bas Steunenberg

    2016-01-01

    Full text beschikbaar met HU-account. The aim of this study was to investigate, using a mixed-methods design, the added value of a trained Hospital Elder Life Program (HELP) volunteer to the quality of hospital care in the Netherlands. The trained volunteers daily stimulate older patients, at risk

  4. How trained volunteers can improve the quality of hospital care for older patients. A qualitative evaluation within the Hospital Elder Life Program (HELP)

    NARCIS (Netherlands)

    Steunenberg, Bas; van der Mast, Roos; Strijbos, Marije J.; Inouye, Sharon K.; Schuurmans, Marieke J.

    2016-01-01

    The aim of this study was to investigate, using a mixed-methods design, the added value of a trained Hospital Elder Life Program (HELP) volunteer to the quality of hospital care in the Netherlands. The trained volunteers daily stimulate older patients, at risk of a delirium, to eat, to drink, and to

  5. Patients' priorities for ambulant hospital care centres: a survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital.

    NARCIS (Netherlands)

    Albada, A.; Triemstra, M.

    2009-01-01

    Objective: This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital. Methods: A questionnaire survey among 1477 elderly and

  6. [Counseling and preventive action in elderly population in hospitals and residences in Spain].

    Science.gov (United States)

    Maestre-Miquel, Clara; Figueroa, Carmen; Santos, Juana; Astasio, Paloma; Gil, Pedro

    2016-10-01

    To establish the profile of elderly patients, and to assess current preventive actions in hospitals, geriatric residences, and different health-care centres in Spain. Cross-sectional descriptive study, based on a questionnaire to be answered by doctors who treat the elderly population in Spain (2013). Health-care centres from different regions of Spain. A total of 420 practitioners from hospitals, residences and other community centres, with data from 840 geriatric clinics. Main outcome variables are: dependence, reason for assistance, comorbidity, professional consultation, and life style recommendations. Association factor, type of institution where patients have been attended. Analysis of prevalence and association using Chi-squared test. Two-thirds (66.7%) of the study population were shown to be dependent, with a higher percentage among women than men: 68.9% vs. 62.4% (P=.055). It was also found that among the population aged 85 or more, 88.6% of the women and 85.2% of the men suffered comorbidity. In spite of these results, only 6.6% of the patients suffering comorbidity received additional advice concerning healthy-lifestyle. A large majority (79.6%) of the patients treated in hospitals received advice concerning healthy lifestyle, while 59.62% of those treated in nursing homes received it (P<.001). It was observed that there is a lack of preventive action related to health promotion among the elderly, with differences between hospitals and geriatric residences. This suggests that it is time to put forward new specialised programs addressed to health professionals, in order to reinforce health promotion attitudes and preventive interventions in gerontology clinical practice. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  7. Collaboration between Hospital and Community Pharmacists to Improve Medication Management from Hospital to Home

    Directory of Open Access Journals (Sweden)

    Judith Kristeller

    2017-05-01

    Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days

  8. [Inter-hospital competition--from a medical director's perspective].

    Science.gov (United States)

    Schaffartzik, Walter

    2009-01-01

    On the basis of a model calculation the Federal Statistical Office--despite a decreasing overall population--predicts a rise in the number of patients requiring inpatient healthcare of approximately 12% because of the ageing of our society. The comparative publication of data about the range, the character, the quality and the success of medical treatment allows more transparency of the medical achievements of a hospital, and the patients have learned to expect a high quality of medical treatment and its outcomes. Therefore hospitals have to find ways to present themselves to the patient as a suitable and desirable institution. In the inter-hospital competition for patients an individual hospital can only be successful by recruiting excellent professional (both medical and nursing) staff. Hospitals seeking to secure their existence will have to develop strategies that allow them to succeed in the competition for patients and staff. This includes a verifiably high quality of their medical treatment while striving for an efficient way of managing the costs. At the same time a realistic approach to the recruitment and motivation of the medical staff is essential, which is especially true of physicians.

  9. Safety assessment of potentially inappropriate medications use in older people and the factors associated with hospital admission.

    Science.gov (United States)

    Varallo, Fabiana Rossi; Capucho, Helaine Carneiro; Planeta, Cleópatra Silva; Mastroianni, Patrícia de Carvalho

    2011-01-01

    Potentially Inappropriate Medications (PIM) use in elderly people may be responsible for the development of Adverse Drug Reaction (ADR) which, when severe, leads to hospital admissions. to estimate the prevalence of elderly who had used PIM before being admitted to hospital admission and to identify the risk factors and the hospitalizations related to ADR arising from PIM. A descriptive and cross-sectional study was performed in the internal medicine ward of a teaching hospital (Brazil), in 2008. With the aid of a validated form, patients aged ≥ 60 years, with length of hospital stay ≥ 24 hours, were interviewed about drugs taken prior to the hospital admission and the complaints/reasons for hospitalization. 19.1% (59/308) of older patients had taken PIM before hospital admission and in 4.9%; there were a causal relation between the PIM taken and the complaint reported. PIM responsible for admissions were: amiodarone, amitriptyline, cimetidine, clonidine, diazepam, digoxin, estrogen, fluoxetine, lorazepam, short-acting nifedipine and propranolol. 47.0% of the clinical manifestations of PIM-related ADR were: dizziness, fatigue, digoxin toxicity and erythema. Only polypharmacy was detected as a risk factor for the occurrence of ADR of PIM (p = 0.02). PIM use in elderly people is not a risk factor for ADR-related hospital admission. Probably, severe ADR, which lead to hospitalizations of older people, can be explained by idiosyncratic response or the predisposition of these patients to develop adverse drug events, whether or not drugs are classed as PIM.

  10. [Patient satisfaction with the work of the hospital medical personnel].

    Science.gov (United States)

    Miseviciene, Irena; Milasauskiene, Zemyna

    2002-01-01

    The article presents the data of patient's satisfaction with the work of nurses and physicians in the hospitals, which belong to Lithuanian Health promotion hospitals network. All nine hospitals of the Lithuanian health promotion hospitals network took part in this study. Altogether 1300 questionnaires were handed out. They have been completed and returned by 1271 patients, i.e. 97.8%. Patients were asked to complete uniform anonymous questionnaire and evaluate the work, behavior and educational activity of nurses and physicians. The majority of respondents assessed the work of nurses and physicians positively, respectively 96.1% and 95.5%. The evaluation of nurses' work depended on patients' sex and the size of the hospital in which they were treated. Male patients and the ones who were treated in big hospitals assessed the work of nurses better than females and patients in smaller hospitals. The evaluation of physicians' work was related to the patients' education and extra payment for health services. Patients, who had higher education and indicated that they had paid additionally, assessed the work of physicians more critically. The majority of patients assessed the behavior of nurses and physicians as very good or excellent, respectively 86.0% and 90.5%. The work of nurses was better evaluated by elderly people and patients treated in big hospitals and as well as in the departments of internal medicine. Patients' satisfaction with the behavior of physicians was associated with patients' education. Better-educated people were more critical in assessing the behavior of physicians. The results of this study have shown that patients' satisfaction depends on many factors. To improve the quality of health care services in hospitals it is necessary to study patients' needs, expectations and factors associated with patients' satisfaction.

  11. ASSESSMENT OF MEDICAL WASTE MANAGEMENT IN EDUCATIONAL HOSPITALS OF TEHRAN UNIVERSITY MEDICAL SCIENCES

    Directory of Open Access Journals (Sweden)

    M. H. Dehghani, K. Azam, F. Changani, E. Dehghani Fard

    2008-04-01

    Full Text Available The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past, medical waste was often mixed with municipal solid waste and disposed in residential waste landfills or improper treatment facilities in Iran. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better managing the wastes from healthcare facilities. This study was carried in 12 educational hospitals of Tehran University of Medical Sciences. The goals of this study were to characterize solid wastes generated in healthcare hospitals, to report the current status of medical waste management and to provide a framework for the safe management of these wastes at the considered hospitals. The methodology was descriptive, cross-sectional and consisted of the use of surveys and interviews with the authorities of the healthcare facilities and with personnel involved in the management of the wastes. The results showed that medical wastes generated in hospitals were extremely heterogeneous in composition. 42% of wastes were collected in containers and plastic bags. In 75% of hospitals, the stay-time in storage sites was about 12-24h. 92% of medical wastes of hospitals were collected by covered-trucks. In 46% of hospitals, transferring of medical wastes to temporary stations was done manually. The average of waste generation rates in the hospitals was estimated to be 4.42kg/bed/day.

  12. Hospitalization and catastrophic medical payment: evidence from hospitals located in Tehran.

    Science.gov (United States)

    Ghiasvand, Hesam; Sha'baninejad, Hossein; Arab, Mohammad; Rashidian, Arash

    2014-07-01

    Hospitalized patients constitute the main fraction of users in any health system. Financial burden of reimbursement for received services and cares by these users is sometimes unbearable and may lead to catastrophic medical payments. So, designing and implementing effective health prepayments schemes appear to be an effective governmental intervention to reduce catastrophic medical payments and protect households against it. We aimed to calculate the proportion of hospitalized patients exposed to catastrophic medical payments, its determinant factors and its distribution. We conducted a cross sectional study with 400 samples in five hospitals affiliated with Tehran University of Medical Sciences (TUMS). A self-administered questionnaire was distributed among respondents. Data were analyzed by logistic regression and χ(2) statistics. Also, we drew the Lorenz curve and calculated the Gini coefficient in order to present the distribution of catastrophic medical payments burden on different income levels. About 15.05% of patients were exposed to catastrophic medical payments. Also, we found that the educational level of the patient's family head, the sex of the patient's family head, hospitalization day numbers, having made any out of hospital payments linked with the same admission and households annual income levels; were linked with a higher likelihood of exposure to catastrophic medical payments. Also, the Gini coefficient is about 0.8 for catastrophic medical payments distribution. There is a high level of catastrophic medical payments in hospitalized patients. The weakness of economic status of households and the not well designed prepayments schemes on the other hand may lead to this. This paper illustrated a clear picture for catastrophic medical payments at hospital level and suggests applicable notes to Iranian health policymakers and planners.

  13. Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients

    Directory of Open Access Journals (Sweden)

    Bruno Prata Martinez

    2015-05-01

    Full Text Available OBJECTIVES: The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS: This cross-sectional study analyzed 68 elderly patients (≥60 years of age in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test. After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS: In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7% of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%, pneumonia (19.1% and abdominal disorders (10.2%. The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002. CONCLUSION: The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients.

  14. Medical directors' perspectives on strengthening hospital quality and safety.

    Science.gov (United States)

    Canaway, Rachel; Bismark, Marie; Dunt, David; Kelaher, Margaret

    2017-10-09

    Purpose The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance. Design/methodology/approach This qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction. Findings Varying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality. Research limitations/implications The findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data. Practical implications Lack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning. Social implications Variable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals. Originality/value The views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

  15. Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients.

    Science.gov (United States)

    Alkan, Ali; Yaşar, Arzu; Karcı, Ebru; Köksoy, Elif Berna; Ürün, Muslih; Şenler, Filiz Çay; Ürün, Yüksel; Tuncay, Gülseren; Ergün, Hakan; Akbulut, Hakan

    2017-01-01

    Due to more comorbidities, polypharmacy is common in elderly patients and drug interactions are inevitable. It is also challenging to treat an elderly patient with a diagnosis of cancer. Prevalence and clinical impacts of drug interactions and using potentially inappropriate medications (PIMs) have been studied in geriatric patients. However, these are not well defined in oncology practice. The purpose of this study is to define the prevalence of PIMs and severe drug interactions (SDIs) in elderly cancer patients and investigate the factors associated with them. Patients more than 65 years of age in both inpatient and outpatient clinics were evaluated. Patient, disease characteristics, and medications used were collected by self reports and medical records. Drug interactions were checked with Lexicomp® and PIM was defined with 2012 update of Beers criteria. Severe drug interactions are defined with category D or X DIs. Logistic regression was used to compute odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between SDIs, PIMs, and clinical parameters. Four hundered and forty-five elderly patients (286 outpatient, 159 inpatient), with a median age of 70 (65-89) were evaluated. SDIs were present in 156 (35.1 %) of patients, 81 (28.3 %), and 75 (47.2 %) for outpatient and inpatients, respectively (p patients, 40 (14.2 %), and 77(48.4 %) for outpatient and inpatients, respectively (p cancer were associated with severe DIs. Polypharmacy, inpatient status, and bad performance score (ECOG 3-4) were associated with PIMs. Nearly one third of the elderly cancer patients are exposed to severe drug interactions and PIMs. Clinicians dealing with elderly cancer patients should be more cautious when prescribing/ planning drugs to this group of patients. More strategies should be developed in this group of patients to minimize the medications prescribed and prevent severe DIs.

  16. Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals’ experiences

    Directory of Open Access Journals (Sweden)

    Unni Alice Dahl

    2014-04-01

    Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital.  Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.

  17. Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals’ experiences

    Directory of Open Access Journals (Sweden)

    Unni Alice Dahl

    2014-04-01

    Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews.Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients.Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.

  18. Nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards: A qualitative study

    DEFF Research Database (Denmark)

    Tove, Lindhardt; Hallberg, Ingalill Rahm; Poulsen, Ingrid

    2008-01-01

    . OBJECTIVE: To illuminate nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards, and of the barriers and promoters for collaboration. DESIGN AND SETTING: The design was descriptive. Three acute units in a large Danish university hospital participated...

  19. Hospital managers' attitude and commitment toward electronic medical records system in Isfahan hospitals 2014.

    Science.gov (United States)

    Jahanbakhsh, Maryam; Karimi, Saeed; Hassanzadeh, Akbar; Beigi, Maliheh

    2017-01-01

    Electronic medical record system (EMRS) is a valuable system for safe access to the patient's data and increases health care quality. Manpower is one of the requirements for EMRS, among which manager is the most important person in any hospital. Taking into account manager's positive attitude and good commitments, EMRS will be implemented successfully. As such, we decided to assess manager's attitude and commitment toward EMRS in Isfahan hospitals in the year of 2014. This article aimed to determine the hospital managers' attitude and commitment toward the implementation of EMRS. The present article is an applied analytic study. Research society consisted of the managers of all the hospitals in Isfahan that include hospitals affiliated to Isfahan University of Medical Sciences, private, and social security hospitals. This study was done in 2014. Data collection tools included a questionnaire for which reliability and validity were determined. Data were analyzed by means of SPSS 20. Average score for the managers' attitude toward EMRS in the city of Isfahan was 77.5 out of 100 and their average score for commitment was 74.7. Manager's attitude in social security hospitals was more positive than the private and governmental ones (83.3%). In addition, the amount of commitment by the managers in social security hospitals was higher than the same in private and governmental hospitals (86.6%). At present, managers' attitude and commitment in Isfahan hospitals toward EMRS are very high and social security hospitals show more readiness in this respect.

  20. Gait speed predicts post-operative medical complications in elderly gastric cancer patients undergoing gastrectomy.

    Science.gov (United States)

    Chandoo, Arvine; Chi, Chu-Huai; Ji, Weiping; Huang, Yingpeng; Chen, Xiao-Dong; Zhang, Wei-Teng; Wu, Rui-Sen; Shen, Xian

    2017-12-11

    Gait speed is a clinical outcome that can measure the physical performance of elderly gastric patients. The purpose of this study was to determine the importance of gait speed in predicting post-operative morbidities in elderly patients undergoing curative gastrectomy. We conducted a prospective study of 357 elderly patients (≥65 years old) undergoing curative gastrectomy. Preoperative gait speed was measured in a 6-m well-lit and unobstructed hallway. Patients were followed up for the post-operative clinical outcomes. Factors contributing to the post-operative morbidities were analysed using univariate and multivariate analyses. Slow gait speed was present in 95 out of 357 patients (26.61%) which was significantly associated with age (P operative medical complications (P = 0.022). In univariate analysis, age (P = 0.015) and slow gait speed (P = 0.029) were risk factors of post-operative complications. In multivariate analysis, we found that age (P operative medical complications. Slow gait speed is an independent predictor of post-operative medical complications in elderly patients undergoing curative gastrectomy. Those patients should be managed with appropriate perioperative nutritional support and physical exercise which can improve gait speed and reduce the risk of post-operative medical complications. © 2017 Royal Australasian College of Surgeons.

  1. Agitation in the medically ill elderly | Aloa | West African Journal of ...

    African Journals Online (AJOL)

    Agitation is a common and significant problem in the medically ill elderly. It is responsible for diminished quality of life for not only the patient, but the caregivers as well as the patient\\'s relatives. This paper will illustrate the concept of agitation and different modes of classification. The major emphasis will be placed on ...

  2. [Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment].

    Science.gov (United States)

    Li, Bin; Zheng, Yunxin; He, Dehua; Jiang, Ruiyao; Chen, Ying; Jing, Wei

    2012-03-01

    The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

  3. Impact of early in-hospital medication review by clinical pharmacists on health services utilization.

    Directory of Open Access Journals (Sweden)

    Corinne M Hohl

    . There was no significant effect on emergency department revisits, admissions, readmissions, or mortality.We were limited by our inability to conduct a randomized controlled trial, but used quasi-random patient allocation methods and propensity score modeling to ensure balance between treatment groups, and administrative data to ensure blinded outcomes ascertainment. We were unable to account for alternate level of care days, and therefore, may have underestimated the treatment effect in frail elderly patients who are likely to remain in hospital while awaiting long-term care.Early pharmacist-led medication review was associated with reduced hospital-bed utilization compared to usual care among high-risk patients under 80 years of age, but not among those who were older. The results of our evaluation suggest that medication review by pharmacists in the emergency department may impact the length of hospital stay in select patient populations.

  4. Responsibly managing the medical school--teaching hospital power relationship.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    2005-07-01

    The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship.

  5. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

    National Research Council Canada - National Science Library

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    .... To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD...

  6. [The revised system of hospitalization for medical care and protection].

    Science.gov (United States)

    Fukuo, Yasuhisa

    2014-01-01

    The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the

  7. Influenza Vaccination Reduces Hospitalization for Heart Failure in Elderly Patients with Chronic Kidney Disease: A Population-Based Cohort Study.

    Science.gov (United States)

    Fang, Yu-Ann; Chen, Chang-I; Liu, Ju-Chi; Sung, Li-Chin

    2016-05-01

    Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have reported the beneficial effects of the influenza vaccine in patients with CVD. However, the effects of influenza vaccination on the reduction of hospitalizations for heart failure (HF) in elderly patients with CKD remain unclear. This cohort study comprised elderly patients (≥ 55 years of age) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999 and December 31, 2008. Each patient was followed-up until the end of 2008. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the first HF hospitalization were analyzed. In addition, the patients were categorized into four groups based on their vaccination status (unvaccinated and total number of vaccinations: 1, 2-3, and ≥ 4). We found that elderly patients with CKD receiving influenza vaccination exhibited a lower risk of HF hospitalization (adjusted HR, 0.31; 95% CI, 0.26-0.39, p elderly patients with CKD receiving annual influenza vaccination are at a lower risk of HF hospitalization.

  8. Palliative care for the elderly - developing a curriculum for nursing and medical students

    Directory of Open Access Journals (Sweden)

    Bongartz Maren

    2010-09-01

    Full Text Available Abstract Background Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels. In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper. Methods In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages. We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found. Results The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum. Conclusions The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.

  9. Medical and mental disorders in elderly patients seen at the ...

    African Journals Online (AJOL)

    Cardiovascular diseases were the commonest occurring medical problems; degenerative, neoplastic and infectious diseases were also common. Mental disorders were diagnosed in only 2% of the patients with one case of Alzheimer's disease. No patient with mental disorder was given any second medical diagnosis nor ...

  10. An Update on the Management Of Hospital-Acquired Pneumonia in the Elderly

    Directory of Open Access Journals (Sweden)

    Chao-Hsien Lee

    2008-12-01

    Full Text Available Pneumonia is the leading cause of infection-related death and represents the fifth cause of mortality in the elderly. There are several reported risk factors for acquiring pneumonia at an older age, such as alcoholism, lung and heart diseases, nursing home residence, and swallowing disorders. Hospital-acquired pneumonia (HAP is reviewed, with an emphasis on multidrug-resistant (MDR bacterial pathogens, such as Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related comorbid disorders. Streptococcus pneumoniae is the pathogen most frequently responsible for pneumonia in the elderly with early HAP without risk factors for MDR; enteric Gram-negative rods should be considered in nursing home-associated pneumonia, as well as anaerobes in patients with aspiration pneumonia. Special attention should be given to preventive measures such as vaccination, oral care, and nutrition. The management of HAP should be instituted early with: appropriate use of antibiotics in adequate doses; avoidance of excessive use of antibiotics by de-escalation of initial antibiotic therapy, based on microbiologic cultures and the clinical response of the patient; and reduction of the duration of treatment to the minimum effective period.

  11. Impact of an Innovative Educational Strategy on Medication Appropriate Use and Length of Stay in Elderly Patients.

    Science.gov (United States)

    Corbi, Graziamaria; Gambassi, Giovanni; Pagano, Gennaro; Russomanno, Giusy; Conti, Valeria; Rengo, Giuseppe; Leosco, Dario; Bernabei, Roberto; Filippelli, Amelia; Ferrara, Nicola

    2015-06-01

    To evaluate the impact of an educational strategy on potentially inappropriate medications (PIMs) and length of stay in hospitalized elderly patients. An open study, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase), has been performed in order to compare the PIMs number before and after the introduction of an educational strategy. The study included 2 phases: PRE, in which patients were enrolled as control group; POST, in which an educational strategy on the PIMs use was introduced among physicians, and patients were enrolled as intervention group. Italian residential rehabilitation Centre. Inclusion criteria were ≥ 2 active chronic diseases and the current use of ≥ 4 medications. The educational strategy consisted of a 3-day course on strategies to prevent PIMs and a computerized tool running on a Personal Digital Assistant (PDA) device to check for PIMs. The primary was the PIMs number, the secondary the length of stay. A total of 790 patients, 450 controls and 340 cases, were enrolled. According to the Beers criteria, 52.3% of the study population received ≥ 1 PIMs, 18.73% ≥ 2, and 2.4% ≥ 4 PIMs. A significant reduction of PIMs (P = 0.020) and length of stay (P elderly with a high number of drugs and comorbidities.

  12. Medication Distribution in Hospital: Errors Observed X Errors Perceived

    Directory of Open Access Journals (Sweden)

    G. N. Silva

    2013-07-01

    Full Text Available Abstract: The aim of the present study was to compare errors committed in the distribution of medicationsat a hospital pharmacy with those perceived by staff members involved in the distributionprocess. Medications distributed to the medical and surgical wards were analyzed. The drugswere dispensed in individualized doses per patient, separated by administration time in boxes orplastic bags for 24 hours of care and using the carbon copy of the prescription. Nineteen staffmembers involved in the drug-dispensing process were also interviewed. In the observationphase, 1963 drugs dispensed in 259 prescriptions were analyzed, with a total of 61 dispensingerrors (3.2% of the medications. The most frequent errors were omission of the prescribedmedication (23% and distribution of non-prescribed medication (14.8%. In the interviews, themain errors perceived by the staff were medications dispensed at a concentration other thanthat prescribed (22% and the distribution of non-prescribed medication or medication differentfrom that prescribed (20%. Differences were found between the most frequent errors observedand those reported by staff members. Nonetheless, the views of the staff proved coherent withthe literature on this issue.Keywords: medication errors, hospital medication system.

  13. Hospital electronic medical record enterprise application strategies: do they matter?

    Science.gov (United States)

    Fareed, Naleef; Ozcan, Yasar A; DeShazo, Jonathan P

    2012-01-01

    Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance. This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses. A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics. The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy. This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward

  14. Depression in the hospitalized inpatient with various medical illnesses.

    Science.gov (United States)

    von Ammon Cavanough, S

    1986-01-01

    The amount of depressive symptomatology in the medical population is high. Most of the symptomatology is, however, mild and probably represents an adjustment disorder with depression as a result of illness and hospitalization. Routine screening for depression in the hospitalized medically ill patient appears to be useful, given poor physician recognition of not only mild, but severe depressive symptomatology. Affective and cognitive symptoms of depression are the most discriminating for severe depression. Patients with bone and connective tissue disease, gastrointestinal disease, neurological disease, respiratory disease, and cancer appear to be the groups of diseases at greatest risk for serious depression in a tertiary care setting in the United States.

  15. [Evaluation of the quality of hospital medical records in a hospital in Turin (Italy)].

    Science.gov (United States)

    Gianino, Maria Michela; Raciti, Ida Marina; Galzerano, Mario; Villata, Eugenia; Fonte, Gianfranco; Rapellino, Marco; Fiandra, Umberto

    2008-01-01

    The San Giovanni Battista Hospital in Turin validated a tool for evaluating the quality of hospital patient records. The tool defines the essential contents of patient records, indicators and weights as well as the standard score that must be reached. A pilot study was performed in 2007 to evaluate whether this tool adequately evaluates the quality of hospital patient records in both medical and surgical wards, and whether it can do so in a standardized and repeatable manner. A random sample of 206 medical charts of patients admitted to the San Giovanni Battista Hospital in 2007 was extracted and analysed. The instrument was found to adequately evaluate hospital patient records in a standardisd and repeatable manner.

  16. The impact of medical tourism on Thai private hospital management: informing hospital policy.

    Science.gov (United States)

    James, Paul T J

    2012-01-01

    The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualize the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand's health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology.

  17. [Localization Establishment of an Interdisciplinary Intervention Model to Prevent Post-Operative Delirium in Older Patients Based on 'Hospital Elder Life Program'].

    Science.gov (United States)

    Wang, Yan-Yan; Liao, Yu-Lin; Gao, Lang-Li; Hu, Xiu-Ying; Yue, Ji-Rong

    2017-06-01

    Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients. The authors adapted the original version of the Hospital Elder Life Program (HELP©) from the Hebrew Senior Life Institute for Aging Research of Harvard University by localizing the content using additional medical resources and translating the modified instrument into Chinese. Furthermore, the final version of this interdisciplinary intervention model for postoperative delirium was developed in accordance with the "guideline of delirium: diagnosis, prevention and management produced by the National Institute for Health and Clinical Excellence in 2010" and the "clinical practice guideline for postoperative delirium in older adults" produced by American geriatrics society in 2014. Finally, the translated instrument was revised and improved using discussions, consultations, and pilot study. The abovementioned procedure generated an interdisciplinary intervention model for preventing postoperative delirium that is applicable to the Chinese medical environment. The content addresses personnel structure and assignment of responsibility; details of interdisciplinary intervention protocols and implementation procedures; and required personnel training. The revised model is expected to decrease the occurrence of post-operative delirium and other complications in elderly patients, to help them maintain and improve their function, to shorten the length of their hospital stays, and to facilitate recovery.

  18. Aggression in elderly schizophrenia patients: a comparison of nursing home and state hospital residents.

    Science.gov (United States)

    Bowie, C R; Moriarty, P J; Harvey, P D; Parrella, M; White, L; Davis, K L

    2001-01-01

    This study examined the role of cognitive functioning, adaptive functioning, and symptomatology in predicting aggression in institutionalized geriatric schizophrenic patients residing in either a state institution (n=56) or a nursing home (n=113). Patients were assessed with a neuropsychological battery and rated for positive and negative symptoms, social functioning, and aggressiveness. Nursing home residents were older and more cognitively and functionally impaired than institutional residents. The prevalence of verbal, but not physical, aggression was similar to findings in younger, acutely hospitalized patients in previous studies. In the hospitalized group, severity of negative symptoms was predictive of physical aggression. In the nursing home group, severity of positive symptoms was predictive of verbal aggression and self-care deficit was predictive of physical aggression. Results indicate that verbal aggression, like positive symptoms, decreases little with aging in institutionalized schizophrenic patients, and that predictors of aggressive behavior are as difficult to identify in elderly patients as in younger ones.

  19. Elder

    National Research Council Canada - National Science Library

    Arroyo, Pedro; Gutiérrez-Robledo, Luis Miguel

    2016-01-01

    ...´s milk and dairy products intake in adults, with emphasis on the elderly. The role of milk and dairy products as part of the regular diet, as well as their contribution to a healthy diet for the aged population is described...

  20. Relationship between functional fitness, medication costs and mood in elderly people

    Directory of Open Access Journals (Sweden)

    Michelli Luciana Massolini Laureano

    2014-06-01

    Full Text Available Objective: to verify if functional fitness (FF is associated with the annual cost of medication consumption and mood states (MSt in elderly people. Methods: a cross-sectional study with 229 elderly people aged 65 years or more at Santa Casa de Misericórdia de Coimbra, Portugal. Seniors with physical and psychological limitations were excluded, as well as those using medication that limits performance on the tests. The Senior Fitness Test was used to evaluate FF, and the Profile of Mood States - Short Form to evaluate the MSt. The statistical analysis was based on Mancova, with adjustment for age, for comparison between men and women, and adjustment for sex, for comparison between cardiorespiratory fitness quintiles. The association between the variables under study was made with partial correlation, controlling for the effects of age, sex and body mass index. Results: an inverse correlation between cardiorespiratory fitness and the annual cost of medication consumption was found (p < 0.01. FF is also inversely associated with MSt (p < 0.05. Comparisons between cardiorespiratory fitness quintiles showed higher medication consumption costs in seniors with lower aerobic endurance, as well as higher deterioration in MSt (p < 0.01. Conclusion: elderly people with better FF and, specifically, better cardiorespiratory fitness present lower medication consumption costs and a more positive MSt.

  1. Results from three municipal hospitals regarding radical cystectomy on elderly patients

    Directory of Open Access Journals (Sweden)

    Matthias May

    2007-12-01

    Full Text Available OBJECTIVE: Radical cystectomy is the standard treatment for invasive bladder carcinoma in elderly patients at major surgical centers. As yet no data are available as to the question whether radical surgery on the genitourinary tract of patients over 75 can also be carried out at municipal hospitals with comparable intra and postoperative morbidity, and respective mortality. MATERIALS AND METHODS: 452 radical cystectomies and urinary diversions as ileum conduits or ileum neobladders due to transitional cell carcinoma were carried out at three municipal hospitals between 1992 and 2004. At the time of the surgery, 44 patients (9.7% were > 75 (75-84 (Group-1, by comparison 408 patients were younger than 75 (35-74 (Group-2. Comparisons are to be made between the groups for 30 day mortality, 30 day reoperation rate, early complication rate ( 3 months, progression-free survival, and overall survival. The results are to be discussed in view of the international literature. Mean follow-up was 49 months (median: 38 months. RESULTS: The perioperative mortality in Group-1 was 2.3% compared to 2.5% in Group-2 (p = 0.942. There was no significant difference in the perioperative mortality with regard to the different case load of the evaluated hospital. There were no significant group differences regarding the 30 day reoperation rate, early and late complications. Progression-free and overall survival of all patients after 5 years was 56.1% and 53.6% respectively; here again the differences between the age groups was not significant (p = 0.384 and p = 0.210. Our results for patients > 75 do not differ from the published data of large clinics with a high cystectomy frequency. CONCLUSIONS: Our data confirm that radical cystectomy on elderly patients can also be carried out in municipal hospitals with acceptable mortality and morbidity rates. Of prime importance is a careful patient selection based on comorbidity scores and possibly geriatric assessment.

  2. Effect of Long-Term Proton Pump Inhibitor Therapy on Nutritional Status in Elderly Hospitalized Patients.

    Science.gov (United States)

    Nakamichi, Mariko; Wakabayashi, Hidetaka

    2016-01-01

    The purpose was to investigate the association between proton pump inhibitor (PPI) therapy and nutritional status in elderly hospitalized patients. Participants were 190 elderly patients admitted to the long-term care wards, convalescence rehabilitation wards, and community integrated care wards in January 2015. Nutritional status was assessed using the mini nutritional assessment short-form (MNA-SF). The PPI use group was compared with the PPI non-use group regarding nutrition status. Logistic regression analysis was used to examine whether the period of PPI therapy was associated independently with malnutrition following adjustment for covariates including gender, age, and serum albumin level. Forty-one patients were male (22%) and 149 patients were female (78%), with a mean age of 85.4±8.4. Fifty-three patients (28%) took PPIs (with a median prescription period of 91 d, ranging from 51 to 227). With a MNA-SF score of 7 points or lower designated as malnutrition, there was no significant difference in nutritional status between the PPI and non-PPI groups (p=0.172). The median MNA-SF scores in the PPI and non-PPI groups were 9 vs 7 points, respectively. Logistic regression analysis showed that long-term PPI therapy (odds ratio, 0.994; 95% confidence interval 0.990-0.999) was significantly associated with improved nutritional status. The presence or absence of PPI therapy is not associated with malnutrition in elderly hospitalized patients. Longer-term PPI therapy may improve nutritional status.

  3. Adverse Health Events Related to Self-Medication Practices Among Elderly: A Systematic Review.

    Science.gov (United States)

    Locquet, Médéa; Honvo, Germain; Rabenda, Véronique; Van Hees, Thierry; Petermans, Jean; Reginster, Jean-Yves; Bruyère, Olivier

    2017-05-01

    Older adults often resort to self-medication to relieve symptoms of their current illnesses; however, the risks of this practice are multiplied in old age. In particular, this age group is more vulnerable to adverse drug events because of the physiological changes that occur due to senescence. The aim of the study was to obtain an overview of the adverse health events related to self-medication among subjects aged 60 years and over through a systematic review of the literature. A study of relevant articles was conducted among databases (MEDLINE, PsycINFO, and EBM Reviews-Cochrane Database of Systematic Reviews). Eligibility criteria were established and applied by two investigators to include suitable studies. The results and outcomes of interest were detailed in a descriptive report. The electronic search identified 4096 references, and the full texts of 74 were reviewed, of which four were retained in the analysis: three had a cross-sectional design and one prospectively followed elderly subjects. The first study showed a 26.7% prevalence of adverse drug reactions (ADRs) among elders, the second study found a 75% prevalence of side effects, and, finally, a prospective study showed an ADR incidence of 4.5% among self-medicated elders. These studies showed that adverse health events related to self-medication are relatively frequently reported. They also highlighted that analgesics and anti-inflammatory drugs are the most self-medicated products, while vitamins and dietary supplements also appear to be frequently self-administered, but by older individuals. Studies on self-medication in the elderly and its adverse health effects are clearly lacking. There is a need to perform prospective studies on this topic to gain a clear understanding of the extent of this problem and to enhance the awareness of health professionals to better inform seniors.

  4. E-learning to improve the drug prescribing in the hospitalized elderly patients: the ELICADHE feasibility pilot study.

    Science.gov (United States)

    Franchi, C; Mari, D; Tettamanti, M; Pasina, L; Djade, C D; Mannucci, P M; Onder, G; Bernabei, R; Gussoni, G; Bonassi, S; Nobili, A

    2014-08-01

    E-learning is an efficient and cost-effective educational method. This study aimed at evaluating the feasibility of an educational e-learning intervention, focused on teaching geriatric pharmacology and notions of comprehensive geriatric assessment, to improve drug prescribing to hospitalized elderly patients. Eight geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control. Clinicians of the two groups had to complete a specific per group e-learning program in 30 days. Then, ten patients (aged ≥75 years) had to be consecutively enrolled collecting clinical data at hospital admission, discharge, and 3 months later. The quality of prescription was evaluated comparing the prevalence of potentially inappropriate medications through Beer's criteria and of potential drug-drug interactions through a specific computerized database. The study feasibility was confirmed by the high percentage (90 %) of clinicians who completed the e-learning program, the recruitment, and follow-up of all planned patients. The intervention was well accepted by all participating clinicians who judged positively (a mean score of >3 points on a scale of 5 points: 0 = useless; 5 = most useful) the specific contents, the methodology applied, the clinical relevance and utility of e-learning contents and tools for the evaluation of the appropriateness of drug prescribing. The pilot study met all the requested goals. The main study is currently ongoing and is planned to finish on July 2015.

  5. Medication safety infrastructure in critical-access hospitals in Florida.

    Science.gov (United States)

    Winterstein, Almut G; Hartzema, Abraham G; Johns, Thomas E; De Leon, Jessica M; McDonald, Kathie; Henshaw, Zak; Pannell, Robert

    2006-03-01

    The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

  6. The management of hospital medical waste. How to increase efficiency through a medical waste audit.

    Science.gov (United States)

    Studnicki, J

    1992-01-01

    Medical waste is a nightmare for hospital administrators, cutting across department boundaries and incorporating legal, financial, and community concerns. In this two-part article the author provides a stepwise approach to effective waste management. The first part gives background information on waste generation, storage, and disposal and delineates the framework of a medical waste audit. This audit is put to the test in the second part, where data from a pilot trial at an actual hospital are presented and discussed.

  7. Spreading a medication administration intervention organizationwide in six hospitals.

    Science.gov (United States)

    Kliger, Julie; Singer, Sara; Hoffman, Frank; O'Neil, Edward

    2012-02-01

    Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals. INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions. From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%. With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.

  8. Website design: technical, social and medical issues for self-reporting by elderly patients.

    Science.gov (United States)

    Taylor, Mark J; Stables, Rod; Matata, Bashir; Lisboa, Paulo J G; Laws, Andy; Almond, Peter

    2014-06-01

    There is growing interest in the use of the Internet for interacting with patients, both in terms of healthcare information provision and information gathering. In this article, we examine the issues in designing healthcare websites for elderly users. In particular, this article uses a year-long case study of the development of a web-based system for self-reporting of symptoms and quality of life with a view to examine the issues relating to website design for elderly users. The issues identified included the technical, social and medical aspects of website design for elderly users. The web-based system developed was based on the European Quality of Life 5-Dimensions health-status questionnaire, a commonly used tool for patient self-reporting of quality of life, and the more specific coronary revascularisation outcome questionnaire. Currently, self-reporting is generally administered in the form of paper-based questionnaires to be completed in the outpatient clinic or at home. There are a variety of issues relating to elderly users, which imply that websites for elderly patients may involve different design considerations to other types of websites.

  9. Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto

    2013-12-01

    Full Text Available In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO. Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.

  10. [Medical treatment of hyperammoniemia in the elderly. Controlled clinical study].

    Science.gov (United States)

    Marchina, M M; Renzi, G; Serofilli, S

    1979-03-03

    After considering the physiopathological mechanisms of ammoniac metabolism and the different causes of hyperammonaemia in subjects whose organisms present the weak biological equilibrium of the elderly, the antiammonaemic activity of gamma-ethylester of glutamic acid and that of arginine have been compared in a controlled double-blind trial. 45 old patients suffering from hepatic insufficiency characterized by hyperammonaemia and correlated neurological symptomatology have been treated. The subjects, subdivided at random into groups of 15, were treated for an average of 8.8 days with gamma-ethylester of glutamic acid, arginine and placebo presented in identical 500 ml bottles. The posology of the active ingredients ranged form a maximum of 25 g to a minimum of 10 g. The results obtained show that gamma-ethylester of glutamic acid and arginine has significantly greater antiammonemic activity than placebo and that gamma-ethylester of glutamic acid is significantly more effective than arginine. As regards the improvement in neuropsychic symptomatology, the clear superiority of gamma-ethylester of glutamic acid versus both arginine and placebo non evident.

  11. Analysis of medication information exchange at discharge from a Dutch hospital

    NARCIS (Netherlands)

    van Berlo-van de laar, Inge R. F.; Driessen, Erwin; Merkx, Maria M.; Jansman, Frank G. A.

    Background At hospitalisation and discharge the risk of errors in medication information transfer is high. Objective To study the routes by which medication information is transferred during discharge from Deventer Hospital, and to improve medication information transfer. Setting Eight hospital

  12. Medical Admissions and Outcomes at Saint Paul's Hospital, Addis ...

    African Journals Online (AJOL)

    kim

    2012-04-01

    Methods: Retrospective review of 840 records of patients admitted to medical ward of Saint Paul hospital during. April 1, 2012-March 31, .... permission, records were reviewed since patient consent was not .... *Others: Bronchial asthma/COPD (2), Other CV disorders (3), other neurologic disorders (4),. Haematology and ...

  13. A comparison of medical admissions Kamuzu Central Hospital ...

    African Journals Online (AJOL)

    Diagnosis recorded in patients admitted to the adult medical wards of Jane Furse Memorial. Hospital, Lebowa, South Africa, from I November. 1982 - 31 October 1983. Disease Category. Number. Ofo of Patients Total No. Respiratory. 489. 49.0. TB alone. 273. 27.4. Cardiovascular. 147. 14.8. Hepatic. 24. 2.4. Diabetes. 43.

  14. Hospital exclusion clauses limiting liability for medical malpractice ...

    African Journals Online (AJOL)

    In 2002 the Supreme Court of Appeal ruling in Afrox Healthcare Beperk v. Strydom held that the common law allows hospitals to exclude liability for medical malpractice resulting in death or physical or psychological injury – except in the case of gross negligence. The effect of this judgment has now been superseded by the ...

  15. Self-Medication and Memory in an Elderly Canadian Sample.

    Science.gov (United States)

    Palmer, Heather M.; Dobson, Keith S.

    1994-01-01

    Investigated predictive value of three aspects of memory potentially related to success or failure in self-medication program. Results showed that combination of memory measures successfully discriminated between those subjects who advanced in program and those who did not. Results provide information that will aid in improving selection process…

  16. Movement disorders in the elderly | Carr | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 31, No 10 (2013) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your ...

  17. Medical and mental disorders in elderly patients seen at the ...

    African Journals Online (AJOL)

    Forty-one patients had more than one disease occurring in an individual. Cardiovascular diseases were the commonest occurring medical problems; degenerative, neoplastic and infectious diseases were also common. Mental disorders were diagnosed in only 2% of the patients with one case of Alzheimer's disease.

  18. Potentially Inappropriate Medications in Elderly Haemodialysis Patients Using the STOPP Criteria.

    Science.gov (United States)

    Parker, Krystina; Aasebø, Willy; Stavem, Knut

    2016-09-01

    Polypharmacy is commonly applied to elderly haemodialysis patients for treating terminal renal failure and multiple co-morbidities. Potentially inappropriate medications (PIMs) in multidrug regimens in geriatric populations can be identified using specially designed screening tools. The aims of this study were to estimate the prevalence of PIMs by applying the Screening Tool of Older Persons' Prescriptions (STOPP) criteria and the Beers criteria to elderly haemodialysis patients and to assess the association of some risk factors with the presence of PIMs. Fifty-one elderly haemodialysis patients participated; their median age was 74 (range 65-89) years, and 77 % of them were male. Demographic data, co-morbidity and medication lists were collected from the electronic medical records of the patients. The STOPP criteria were applied by two physicians independently to identify PIMs. The association of some risk factors with PIMs were assessed using Fisher's exact test. The patients used a median of 13 (range 7-21) medications per day. The overall prevalence of PIMs using the STOPP criteria was 63 %, and using the Beers criteria was 43 %. The most prevalent PIMs were proton-pump inhibitors. Benzodiazepines and first-generation antihistamines were related to side effects such as falls in the previous 3 months, and calcium-channel blockers were associated with chronic constipation. The number of PIMs was not significantly associated with number of medications, age, sex and co-morbidity. The STOPP criteria revealed a high prevalence of PIMs in a population of elderly patients receiving haemodialysis.

  19. Frail elderly patients’ experiences of information on medication. A qualitative study

    Directory of Open Access Journals (Sweden)

    Modig Sara

    2012-08-01

    Full Text Available Abstract Background Older patients generally have only poor knowledge about their medicines. Knowledge is important for good adherence and for participating in decisions about treatment. Patients are entitled to be informed on an individual and adequate level. The aim of the study was to explore frail elderly patients’ experiences of receiving information about their medications and their views on how the information should best be given. Methods The study was qualitative in design and was carried out in 2011. Twelve frail elderly (aged 68–88 participants taking cardiovascular medications participated in semi-structured interviews covering issues related to receiving information about prescribed medicines. The interviews were recorded, transcribed and subjected to content analysis, in which the text was analysed in five steps, inspired by Graneheim and Lundman. Results The results revealed that the experiences which the elderly participants had regarding the receiving of medical information fell into two main categories: “Comfortable with information” or “Insecure with information”. The elderly felt comfortable when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. Conclusions Factors that frequently caused insecurity about information and anxiety were too short consultations, lack of availability of someone to answer questions or of the opportunity to contact the physician if adverse effects are suspected. These factors could easily be dealt with and there must be improvements in the clinics if the patients´ feelings of security are to be increased.

  20. Performance of TOTAL, in medical patients attending a resource-poor hospital in sub-Saharan Africa and a small Irish rural hospital.

    Science.gov (United States)

    Opio, M O; Nansubuga, G; Kellett, J; Clifford, M; Murray, A

    2013-01-01

    Recently a very simple, easy to remember early warning score (EWS) dubbed TOTAL has been reported. The score was derived from 309 acutely ill medical patients admitted to a Malawian hospital and awards one point for Tachypnea >30 breaths per minute, one point for Oxygen saturation <90%, two points for a Temperature <35°C, one point for Altered mental status, and one point for Loss of independence as indicated by the inability to stand or walk without help. TOTAL has an area under the receiver operator characteristic curve (AUROC) for death within 72 hours of 78%. We compared the performance of the TOTAL score in 849 medical patients attending a resource poor hospital in Uganda and 2935 patients admitted to a small rural hospital in Ireland. TOTAL's AUROC for death within 24 hours was the same in both hospital populations: 85.1% (95% CI 78.6 - 91.6%) for Kitovu Hospital patients and 84.7% (95% CI 77.1 - 92.2%) for Nenagh Hospital patients. The discrimination of TOTAL is exactly the same in elderly Irish patients as it is in young African patients. The score is easy to remember, easy to calculate, and works over a broad range of patients.

  1. [New initiatives to improve medication safety in hospitals].

    Science.gov (United States)

    Otero López, María José

    2004-01-01

    Medication errors constitute a significant public health problem and are recognised as such nowadays among healthcare professionals, societies, authorities and international organizations. This has led to seeking and implementing effective practices focused on improving medication use safety. This article briefly describes some of the most recent initiatives promoted to prevent medication errors in the hospital setting. These safety improvement initiatives are based upon progressively developing an institutional culture of safety and on establishing practices designed to reduce errors or detect them in time, thus avoiding adverse effects to patients. Among these recent initiatives are the safety practices approved by the National Quality Forum, and the National Patient Safety Goals that the Joint Commission on Healthcare Accreditation has required since 2003. Also mentioned are several strategies that have been offered to facilitate the application of these practices, among which are the Pathways to Medication Safely, the development of collaborative projects among hospitals and organizations of experts, and the inclusion of a medication safety specialist in hospitals as a support figure overseeing the application of safety measures. Finally, the challenges inherent in putting these preventive measures into real patient's care are discussed. The barriers confronting this step must obviously be faced if improvements in patient safety are truly to be achieved.

  2. Pedagogical and professional compromises by medical teachers in hospitals.

    Science.gov (United States)

    Barrett, Jenny; Scott, Karen

    2014-08-01

    Following research about workplace constraints reducing the effectiveness of teaching and the motivation to teach, this study sought to understand how medical teachers in hospitals respond to the institutional context for their teaching of medical students. Through purposive sampling, younger and older male and female teachers in a range of medical and surgical paediatrics subspecialties participated in this qualitative study. We drew on ethnographic methods in interviews so that answers to the questions came from the teachers' own emphases. The systematic coding and categorising procedures used in the inductive analysis of the interview transcripts reflect the constant comparison approach of grounded theory, locating features, patterns and conceptual categories. We identified four main concepts: teachers' goals and motivations; their approaches to teaching; teachers' preferences; and, finally, as discussed in this article, the teachers' perceptions of contextual and institutional pressures in hospital-based medical teaching and related compromises. The teachers perceive constraints resulting from the various mismatches that they experience, a loss of autonomy, and the paucity of acknowledgement and resources. They suggest that the compromises they make in response are both pedagogical and institutional. We conclude that professional development is not enough to address these issues: the conditions for medical teaching and teachers in hospitals require workplace responses to enable a more productive connection between the students, curriculum and pedagogy. In particular, teachers' responsibilities in teaching and curriculum development need to be acknowledged, and practising teachers need to be supported and included in the education mission. © 2014 John Wiley & Sons Ltd.

  3. Evaluation and comparison of medical records department of Iran university of medical sciences teaching hospitals and medical records department of Kermanshah university of medical sciences teaching hospitals according to the international standards ISO 9001-2000 in 2008

    Directory of Open Access Journals (Sweden)

    maryam ahmadi

    2010-04-01

    Conclusion: The rate of final conformity of medical records system by the criteria of the ISO 9001-2000 standards in hospitals related to Iran university of medical sciences was greater than in hospitals related to Kermanshah university of medical sciences. And total conformity rate of medical records system in Kermanshah hospitals was low. So the regulation of medical records department with ISO quality management standards can help to elevate its quality.

  4. Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

    Science.gov (United States)

    Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

    2009-01-01

    Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

  5. Prevalence of Clostridium difficile infection and colonization in a tertiary hospital and elderly community of North-Eastern Peninsular Malaysia.

    Science.gov (United States)

    Zainul, N H; Ma, Z F; Besari, A; Siti Asma, H; Rahman, R A; Collins, D A; Hamid, N; Riley, T V; Lee, Y Y

    2017-10-01

    Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

  6. Análise clínica e epidemiológica das internações hospitalares de idosos decorrentes de intoxicações e efeitos adversos de medicamentos, Brasil, de 2004 a 2008 Clinical and epidemiological analysis of hospitalizations of elderly due to poisoning and adverse effects of medications, Brazil from 2004 to 2008

    Directory of Open Access Journals (Sweden)

    Tatiana Cruz de Paula

    2012-12-01

    concomitant use of several drugs, administration errors, physiological changes in the body that alter the pharmacodynamics and pharmacokinetics. In order to determine the main therapeutic classes involved in hospital admissions of elderly people due to intoxication and adverse drug effects, as well as major health problems related to these events, 9,793 hospitalizations of people aged 60 or over registered in the Hospital Information System of the Unified Health System (SIH-SUS in the period of 2004 to 2008 were analyzed. Unspecified drugs, systemic antibiotics, psychotropics, psychoactives, antiepileptics, sedatives, hypnotics and antiparkinsonians accounted for 57% of the total of admissions analyzed. Injuries and falls were the main health problems related to intoxication and adverse drug effects. Hospitalizations due to injuries were associated with analgesic, antipyretic and antirheumatic non-opioid. Falls were associated with systemic antibiotics, contradicting studies which point out psychotropic drugs as the main drug involved in these events. The results reflect the growing trend of problems associated with drug use by elderly people. It was verified that the consumption profile alone is not sufficient to explain the concentration of cases of the major therapeutic classes. We suggest the adoption of more effective programs of pharmacovigilance, capable of intervening at different stages of drug use: prescribing, dispensing, marketing, administration and compliance.

  7. Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery.

    Directory of Open Access Journals (Sweden)

    Seong Eun Hong

    Full Text Available Hip fracture is a common health problem in the elderly that is associated with increased mortality. Acute kidney injury (AKI is a frequent complication in elderly patients undergoing surgery and is associated with the clinical outcome. We evaluated the incidence and risk factors of AKI in elderly patients undergoing hip fracture surgery and the impact of AKI on short- and long-term clinical outcomes.We performed a retrospective cohort study of 450 elderly patients who underwent hip fracture surgery between January 2010 and December 2012. We defined AKI according to the Acute Kidney Injury Network (AKIN criteria and investigated the effect of AKI on the duration of hospital stay and in-hospital and long-term mortality.Of the 450 patients, 95 (21.1% developed AKI during hospitalization and 178 (39.6% died, with a mean follow-up of 3.6 ± 1.0 years. The baseline serum creatinine level, use of angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists, red blood cell transfusion volume, and history of coronary artery disease were independent risk factors for AKI. Patients with AKI during hospitalization had significantly longer hospital stays and higher in-hospital and long-term mortality than those without AKI. Multivariate analysis revealed that age, history of coronary artery disease, serum albumin level, and AKI were independent predictors of long-term mortality.AKI is a frequent complication in elderly patients undergoing hip fracture surgery and is independently associated with increased in-hospital and long-term mortality.

  8. Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

    NARCIS (Netherlands)

    K.J.E. Asmus-Szepesi (Kirsten); L.E. Flinterman (Linda); M.A. Koopmanschap (Marc); A.P. Nieboer (Anna); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); E.W. Steyerberg (Ewout)

    2015-01-01

    textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled

  9. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-centre study.

    Science.gov (United States)

    Vanderwee, Katrien; Clays, Els; Bocquaert, Ilse; Gobert, Micheline; Folens, Bert; Defloor, Tom

    2010-08-01

    In Belgium, general data on the prevalence of malnutrition are lacking. Prevalence rates are necessary to gain insight into the magnitude of malnutrition and to establish a nutrition policy that takes the limited health care resources into account. This study aimed to obtain insight into the prevalence of malnutrition in Belgian elderly hospital wards and to identify factors associated with the malnutrition prevalence. A cross-sectional, multi-centre study in elderly wards of Belgian hospitals. The nutritional status was assessed using the Mini Nutritional Assessment. A standardised questionnaire was used to record demographic data and data on potential factors associated with malnutrition. Out of 2329 elderly patients, 33% suffered from malnutrition. Almost 43% of the patients were at risk of malnutrition and 24% were well-nourished. Having swallowing difficulties, taste difficulties, and being transferred from a nursing home were strongly associated with being malnourished. The malnutrition prevalence in Belgian elderly hospitals wards is similar to international figures. Elderly who have swallowing difficulties, taste difficulties, or coming from a nursing home may need adequate nutritional care. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy. Copyright 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Analysis of the medication reconciliation process conducted at hospital admission

    Directory of Open Access Journals (Sweden)

    María Beatriz Contreras Rey

    2016-07-01

    Full Text Available Objective: To analyze the outcomes of a medication reconciliation process at admission in the hospital setting. To assess the role of the Pharmacist in detecting reconciliation errors and preventing any adverse events entailed. Method: A retrospective study was conducted to analyze the medication reconciliation activity during the previous six months. The study included those patients for whom an apparently not justified discrepancy was detected at admission, after comparing the hospital medication prescribed with the home treatment stated in their clinical hospital records. Those patients for whom the physician ordered the introduction of home medication without any specification were also considered. In order to conduct the reconciliation process, the Pharmacist prepared the best pharmacotherapeutical history possible, reviewing all available information about the medication the patient could be taking before admission, and completing the process with a clinical interview. The discrepancies requiring clarification were reported to the physician. It was considered that the reconciliation proposal had been accepted if the relevant modification was made in the next visit of the physician, or within 24-48 hours maximum; this case was then labeled as a reconciliation error. For the descriptive analysis, the Statistics® SPSS program, version 17.0, was used. Outcomes: 494 medications were reconciled in 220 patients, with a mean of 2.25 medications per patient. More than half of patients (59.5% had some discrepancy that required clarification; the most frequent was the omission of a medication that the patient was taking before admission (86.2%, followed by an unjustified modification in dosing or way of administration (5.9%. In total, 312 discrepancies required clarification; out of these, 93 (29.8% were accepted and considered as reconciliation errors, 126 (40% were not accepted, and in 93 cases (29,8% acceptance was not relevant due to a change in

  11. The stomatognathic system in the elderly. Useful information for the medical practitioner

    Directory of Open Access Journals (Sweden)

    Anastassia E Kossioni

    2008-01-01

    Full Text Available Anastassia E Kossioni1, Anastasios S Dontas21Department of Prosthodontics, Dental School, University of Athens, Greece; 2Hellenic Association of Gerontology and Geriatrics, Athens, GreeceAbstract: Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class. Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.Keywords: stomatognathic system, elderly, oral disease, general health, xerostomia

  12. Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry.

    Science.gov (United States)

    Gullón, Alejandra; Suárez, Carmen; Díez-Manglano, Jesús; Formiga, Francesc; Cepeda, José María; Pose, Antonio; Camafort, Miguel; Castiella, Jesús; Rovira, Eduardo; Mostaza, José María

    2017-03-03

    The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies. Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments. We evaluated 804 patients with a mean age of 85 years (range 75-101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favoured the use of anticoagulants. Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  13. Correlation between the use of 'over-the-counter' medicines and adherence in elderly patients on multiple medications

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Harbig, Philipp; Barat, Ishay

    2014-01-01

    Medication adherence is a multifaceted issue that is influenced by various factors. One factor may be the concurrent use of over-the-counter (OTC) medicines. The use of OTC medicine has been reported as common amongst elderly patients. Objective To determine if a correlation exists between the use...... of OTC medicines and adherence to prescribed medications in elderly patients. Setting Non-institutionalised elderly patients in Denmark. Methods Elderly unassisted patients aged ≥65 prescribed five or more prescription drugs were included in the study. Information on the use of concurrent OTC medications...... made where adherence was defined different. Main outcome measure Medication adherence based on pill-count. Results A total of 253 participants included 72 % who used OTC medicines and 11 % who did not adhere to their prescriptions. Users of OTC medicines, however, were significantly more likely...

  14. Efficacy and safety of silodosin in the treatment of lower urinary tract symptoms in elderly men taking antihypertensive medications

    Directory of Open Access Journals (Sweden)

    Woo Suk Choi

    2017-09-01

    Conclusion: Silodosin is an effective and safe agent in elderly men who are taking antihypertensive medications. Silodosin has an advantage in the treatment of LUTS in this population, even if the patients have orthostatic hypotension before treatment.

  15. Medical economic impact of tracheotomy patients on a hospital system.

    Science.gov (United States)

    Altman, Kenneth W; Banoff, Karen Merl; Tong, Charles C L

    2015-04-01

    Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system. A retrospective review of the health system's hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated. There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was ∼ 18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed. There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.

  16. Clinical and etiological profile of epilepsy in elderly: a hospital-based study from rural India.

    Science.gov (United States)

    Verma, Archana; Kumar, Alok

    2017-03-01

    To determine the clinical profile and etiology of epilepsy in elderly patients in rural population of India which is in a phase of demographic transition with steadily growing geriatric population. A cross-sectional, prospective, hospital-based clinicoepidemiological study was performed from October 2014 to November 2015. Patients having onset of epilepsy after 60 years were incorporated in the study. We excluded the acute symptomatic seizures. One hundred and ten patients were enrolled and were divided into three standard subgroups: subgroup A (aged 60-70), subgroup B (aged 71-80), and subgroup C (aged 81-90). Out of 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. The most common etiology was cerebrovascular disease (46.36%), followed by focal cerebral calcifications single or multiple (11.81%), tumors (9.09%), trauma (6.36%) dementias (6.36%) and unknown (16.63%). In our study, the frequency of epilepsy decreases with advancing age which was 77.27% in group A (less than 70 years), 16.36% in group B and 6.36% in group C (70-90 years).The most common type of seizure in the group studied was focal 59.09% followed by generalized seizures 37.27%. Hypertension was the most common co-morbidity found in 40 (36.36%) patients. The present study proposes that epilepsy in the elderly patients have etiological relationship with stroke, focal cerebral calcifications, tumors and dementias. CNS infections account for a significant number of cases of remote symptomatic epilepsy in elderly in our region where neurocysticercosis is endemic.

  17. Risk assessment - hospital view in selecting medical technology.

    Science.gov (United States)

    David, Yadin; Jahnke, Ernest; Blair, Curtis

    2004-01-01

    Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively direct their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for mitigating patient safety issues and costs of ownership. Clinical engineers identify technological solutions based on the matching of new medical equipment with hospital's objectives. They review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with consistent assessment methodology and evaluation analysis, will objectively guide the capital assets decision-making process. At Texas Children's Hospital we integrated engineering simulation, bench testing and clinical studies with financial information to assure the validity of risk avoidance practice and the promotion of medical equipment and supplies selection based on quantitative measurement process and product comparison practice. The clinical engineer's skills and expertise are needed to facilitate the adoption of an objective methodology for implementing the program, thus improving the match between the hospital's needs and budget projections, equipment performance and cost of ownership. The result of systematic planning and execution is a program that assures the safety and appropriateness of inventory level at the lowest life-cycle costs at the

  18. Polypharmacy and potentially inappropriate medication use among community-dwelling elders with dementia.

    Science.gov (United States)

    Lau, Denys T; Mercaldo, Nathaniel D; Harris, Andrew T; Trittschuh, Emily; Shega, Joseph; Weintraub, Sandra

    2010-01-01

    This cross-sectional study examines the association between total prescription medication use and potentially inappropriate medication use (PIRx) among community-dwelling elderly patients with and without dementia. Data (September 2005 to September 2007) were from the National Institute on Aging-funded National Alzheimer's Coordinating Center Uniform Data Set. The study analyzed the Uniform Data Set initial visits of 4518 community-dwelling subjects aged 65 years and above with and without dementia (2665 and 1853, respectively). PIRx was defined using a partial list of the 2003 Beers criteria. Generalized linear mixed models were applied to estimate the association between PIRx and polypharmacy. In both groups (with and without dementia), subjects who received PIRx on average took more medications than those taking no PIRx. As the total number of medications used increased, the odds of having PIRx also increased, controlling for dementia diagnosis and other subject characteristics. Our key findings were consistent after considering 2 definitions of PIRx (with or without oral estrogens) and accounting for missing data. In summary, the total number of medications used is associated with PIRx among Alzheimer's Disease Centers community-dwelling elderly patients with and without dementia, with polypharmacy increasing the risk of PIRx. Ensuring appropriate medication use in this population is clinically important because of the significant risks for institutionalization.

  19. Prescribing of potentially inappropriate medications for the elderly: an analysis based on the PRISCUS list.

    Science.gov (United States)

    Amann, Ute; Schmedt, Niklas; Garbe, Edeltraut

    2012-02-01

    The PRISCUS list of potentially inappropriate medications (PIM) for the elderly was published in 2010 and is the first systematically constructed list of this type in Germany. The aim of the present study is to estimate the baseline prevalence of the prescribing of PIM, as defined by the PRISCUS list. Pseudonymized claims data from three statutory health insurances in Germany, which together covered more than 8 million insurants, for the year 2007 were used to determine the age- and sex-standardized one-year period prevalence of PIM among the elderly, as well as the frequency of PIM prescribing per person. The study population included all insurants who were at least 65 years old and were continuously insured throughout the year 2007 or died during that year. Of the 804 400 elderly persons in the study population, 201 472 (25.0%) received at least one PIM prescription in 2007. The PIM prevalence was higher in women than in men (32.0% vs. 23.3%) and increased with age. The most commonly prescribed PIM were amitriptyline (2.6%), acetyldigoxin (2.4%), tetrazepam (2.0%), and oxazepam (2.0%). 8.8% of all elderly persons received the same PIM drug four or more times in 2007. These data show that PIM were frequently prescribed to elderly persons in Germany before the PRISCUS list was published. Medications on the PRISCUS list are not necessarily absolutely contraindicated, and this study contained no information about the individual risk/benefit analyses that may have been carried out before these drugs were prescribed; thus, no conclusion can be drawn about the prevalence of inappropriate prescribing. Further research is needed to validate the PRISCUS list, which was generated by expert consensus, as a basis for therapeutic guidelines in geriatric medicine.

  20. The use of shared medication record as part of medication reconciliation at hospital admission is feasible

    DEFF Research Database (Denmark)

    Munck, Lars K; Hansen, Karina R; Mølbak, Anne Grethe

    2014-01-01

    INTRODUCTION: Medication reconciliation improves congruence in cross sectional patient courses. Our regional electronic medical record (EMR) integrates the shared medication record (SMR) which provides full access to current medication and medication prescriptions for all citizens in Denmark. We...... studied whether our SMR integration could facilitate medication reconciliation. MATERIAL AND METHODS: Patients admitted to the emergency department for hospitalization were randomised to consultation using EMR with or without the integrated SMR access. Observed time used for medication reconciliation...... medical training each participated with a median of three consultations (range 1-9). Time expenditure for medicine reconciliation was 5:27 min.:sec. (range: 2:00-15:37) with access to SMR integration and 4:15 min.:sec. (1:15-12:00) without SMR access. The number of active medicine prescriptions was eight...

  1. High prevalence of pelvic floor muscle dysfunction in hospitalized elderly women with urinary incontinence.

    Science.gov (United States)

    Talasz, Helena; Jansen, Stephan C; Kofler, Markus; Lechleitner, Monika

    2012-09-01

    The purpose of this study was to determine pelvic floor muscle (PFM) function in hospitalized elderly women with urinary incontinence (UI). A cross-sectional study was performed using data of 704 patients, routinely collected by means of a clinical UI assessment. Only 25.5% of the patients were able to perform normal PFM contractions (Oxford grading scale score ≥3); 74.5% were unable to contract their PFM or showed weak PFM activity without circular contraction or elevation of the vagina. Vulvovaginal mucosal dystrophy was noted in 84% of the patients. A significant positive correlation of PFM function was found to cognitive status (MMSE score), mobility (Tinetti performance score), and history of previous PFM training; a negative correlation of PFM function was found to patients' age and vulvovaginal mucosal dystrophy, and no significant correlation to body mass index, parity, or history of hysterectomy. Targeted clinical UI assessment including digital vaginal palpation should be performed in all incontinent elderly women in order to detect PFM dysfunction and to optimize therapeutic measures.

  2. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Science.gov (United States)

    2010-07-01

    ... medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for outpatient medical services and inpatient hospital care. In scheduling appointments for outpatient medical...

  3. Systematic literature review of hospital medication administration errors in children

    Directory of Open Access Journals (Sweden)

    Ameer A

    2015-11-01

    Full Text Available Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child's weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients. Methods: Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria. Key findings: A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588. It was also identified in a mean of 29% of doses observed (n=8,894. The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration. Conclusion: This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to

  4. Compliance and Cognitive Function: A Methodological Approach to Measuring Unintentional Errors in Medication Compliance in the Elderly.

    Science.gov (United States)

    Isaac, Lisa M.; And Others

    1993-01-01

    Assessed multiple aspects of cognitive performance, medication planning ability, and medication compliance in 20 elderly outpatients. Findings suggest that aspects of attention/concentration, visual and verbal memory, and motor function which are untapped by simple mental status assessment are related to medication access, planning, and compliance…

  5. 24-hour pattern of falls in hospitalized and long-term care institutionalized elderly persons: A systematic review of the published literature.

    Science.gov (United States)

    López-Soto, Pablo Jesús; Manfredini, Roberto; Smolensky, Michael H; Rodríguez-Borrego, María Aurora

    2015-05-01

    Falls are common among the elderly > 65 years of age and can result in both serious trauma and costly medical care. The epidemiology of falls in the elderly typically focuses on identifying contributory exogenous environmental and endogenous age-related physical, cognitive and other health status factors; however, one potentially important variable seldom considered is time of fall. We sought to determine if falls in hospitalized/institutionalized elderly persons exhibit 24 h and other temporal patterns, since knowledge of such could be useful in their prevention. We conducted a systematic review of the published literature to critically appraise and synthesize the methods and findings of previous reports addressing clock-time, day-of-week and month-of-year fall patterns of institutionalized elderly cohorts. Medline, SCOPUS, Ovid SP and Web of Knowledge were systematic assessed, entering search terms of "accidental fall", "circadian rhythm", "biological clocks", "circadian clocks", "activity cycles", "periodicity", and with databases accepting an age limiter, "age of 65(+) years". Methodological quality was assessed by STROBE and CONSORT checklists, respectively, in observational and clinical studies. Publications were reviewed if meeting inclusion criteria of: (i) being an empirical study, (ii) adopting circadian and/or other period rhythmicity as a fall risk, and (iii) focusing on hospitalized/institutionalized falls in those ≥ 65 years of age; plus exclusion criteria of: (i) cohort < 65 years of age and (ii) reports as dissertations or editorials. The search retrieved 170 publications; however, only nine met all inclusion/exclusion criteria. Typically, past studies disregarded the temporal aspects of fall incidents; the few that did varied in quality, institutional setting, and patient type, i.e. medical diagnoses. Overall, findings suggest a single or double-peak 24 h pattern of fall incidence, with time of greatest incidence seemingly associated

  6. Delirium subtype identification and the validation of the Delirium Rating Scale--Revised-98 (Dutch version) in hospitalized elderly patients

    NARCIS (Netherlands)

    de Rooij, Sophia E.; van Munster, Barbara C.; Korevaar, Johanna C.; Casteelen, Gerty; Schuurmans, Marieke J.; van der Mast, Roos C.; Levi, Marcel

    2006-01-01

    BACKGROUND: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the

  7. Hospitalizations of the elderly in the United States for non-specific gastrointestinal diseases: A search for etilogical clues

    Science.gov (United States)

    Nonspecific gastrointestinal (GI) disease is a common cause of GI-related hospitalizations in U.S. elderly (82.9% of all cases) and it peaks concurrently with viral enteritis, suggesting a lack of diagnostic testing. The lack of etiological specificity in the current coding syste...

  8. Life experiences of elderly people with suicide ideation at the long-term care hospitals in South Korea.

    Science.gov (United States)

    Kim, Ok Sun; Sok, Sohyune R

    2017-10-05

    To understand the life experiences of elderly people who are living in long-term care hospitals and are afflicted with suicide ideation. A phenomenological qualitative methodology based on Colaizzi's method was used for the study. Participants included 9 elderly people who are 65 years old or older with suicidal ideas and were admitted in any of the 3 long-term care hospitals in D City, Gyeonggi-do, South Korea. Data were collected from July to December 2014. Seven categories, 15 theme categories, 30 themes, and 88 significant items were identified as parts of their life experiences. The 7 categories were identified as "being a slave to one's disease", "sadness as a result of being far away from one's family", "vain care and consolation for me", "continued life in a hospital, which feels like living abroad", "plunging life", "moving toward the end of life", and "sad relief from death". The findings from this study provide a deep understanding of the lives of elderly people who were staying in long-term care hospitals, and these will help improve their quality of life. Additionally, they can be used as references in implementing high-quality nursing practices for such elderly people. © 2017 John Wiley & Sons Australia, Ltd.

  9. Benefits of a vesicle re-education program on elderly hospitalized patients

    Directory of Open Access Journals (Sweden)

    Silvia del Rey Contreras

    2007-05-01

    Full Text Available Urinary incontinence is a geriatric syndrome of high prevalence in elderly people, which very frequently is not diagnosed and many times appears when suffering a sharp incapacitate Pathology.The aim of the research is to discover the response to the treatment of vesicle re-education in patients with various pathologies and to observe if the benefit is permanent.A group of 372 patients of the “Middle-Stay Unit” of the Red Cross Hospital were evaluated from October 1, 2001 to December 31, 2002 using objective instruments of physical and mental evaluation. The results showed that the prevalence of the incontinence at patients’ admission was very high and the vesicle re-education was proved to be very effective since the continence was recovered in a significant number of patients permanently.

  10. Adjunctive osteopathic manipulative treatment in the elderly hospitalized with pneumonia: a pilot study.

    Science.gov (United States)

    Noll, D R; Shores, J; Bryman, P N; Masterson, E V

    1999-03-01

    To evaluate the benefit of osteopathic manipulative treatment in the elderly with pneumonia, the authors recruited 21 individuals older than 60 years who were hospitalized with acute pneumonia. Eleven patients were randomly assigned to the treatment group and ten to the control group. The treatment group received specific osteopathic manipulative treatment for somatic dysfunction and a standardized treatment protocol. Both groups received conventional therapy, and the attending physician was blind to group assignments. No significant difference existed between groups for age, sex, or severity of illness. Although the mean duration of leukocytosis, intravenous antibiotic treatment, and length of stay were shorter for the treatment group, these measures did not reach statistical significance. However, the mean duration of oral antibiotic use did reach statistical significance at 3.1 days for the treatment group and 0.8 day for the control group. Osteopathic manipulative treatment may reduce antibiotic use and length of stay; however, a larger study is needed to clarify this outcome.

  11. [Comparative study of two enteral feeding formulas in hospitalized elders: casein versus soybean protein].

    Science.gov (United States)

    García-Talavera Espín, N V; Gómez Sánchez, M B; Zomeño Ros, A I; Nicolás Hernández, M; González Valverde, F M; Gómez Ramos, M J; Sánchez Alvarez, C

    2010-01-01

    To compare the incidence of gastrointestinal side effects of two enteral feeding formulas with changes in the origin of protein (casein and isolated soy protein) in hospitalised elderly patients. A cross sectional survey was done among a sample of elderly patients carrying nasogastric tube admitted to the Reina Sofia General Hospital (Murcia) during a period of 6 months. A formula based on casein or soybean protein was randomly assigned. The variables studied were: age, sex, cause for indication of EN, duration of the EN and maximum amount of EN administered per day. Nutritional status at admission and discharge, mortality and gastrointestinal side effects (diarrhoea, constipation, vomits or regurgitation) were also collected. Statistical analyses were performed with the Student's T and chi 2 tests, with a significance of 95%. Sample conformed by 50 patients over 65 years (48% casein, 52% soybean) without statistically significant differences in age nor cause of indication of the EN. Either there were no differences in the nutritional status at the admission and discharge in both groups. Significant differences were observed in the incidence of diarrhoea (C: 45.83%, S: 7.69%, p = 0.009) and vomits (C: 41.66%, S: 15.38%, p = 0.05). A significant reduction in the incidence of gastrointestinal complications, a reduction in the incidence of ulcers by pressure and less mortality occurred on the group that took formula based on the soybean protein. The individualized nutritional evaluation must be performed routinely when the patient is admitted to the hospital for detection and treatment of early signs of malnutrition.

  12. Unexpectedly Higher Morbidity and Mortality of Hospitalized Elderly Patients Associated with Rhinovirus Compared with Influenza Virus Respiratory Tract Infection.

    Science.gov (United States)

    Hung, Ivan F N; Zhang, Anna Jinxia; To, Kelvin K W; Chan, Jasper F W; Zhu, Shawn H S; Zhang, Ricky; Chan, Tuen-Ching; Chan, Kwok-Hung; Yuen, Kwok-Yung

    2017-01-26

    Rhinovirus is a common cause of upper and lower respiratory tract infections in adults, especially among the elderly and immunocompromised. Nevertheless, its clinical characteristics and mortality risks have not been well described. A retrospective analysis on a prospective cohort was conducted in a single teaching hospital center over a one-year period. We compared adult patients hospitalized for pneumonia caused by rhinovirus infection with those hospitalized for influenza infection during the same period. All recruited patients were followed up for at least 3 months up to 15 months. Independent risk factors associated with mortality for rhinovirus infection were identified. Between 1 March 2014 and 28 February 2015, a total of 1946 patients were consecutively included for analysis. Of these, 728 patients were hospitalized for rhinovirus infection and 1218 patients were hospitalized for influenza infection. Significantly more rhinovirus patients were elderly home residents and had chronic lung diseases (p respiratory tract symptoms of cough and sore throat (p infection. Rhinovirus infection in the adults was associated with significantly higher mortality and longer hospitalization when compared with influenza virus infection. Institutionalized older adults were particularly at risk. More stringent infection control among health care workers in elderly homes could lower the infection rate before an effective vaccine and antiviral become available.

  13. Patients' knowledge concerning their medications on discharge from hospital.

    Science.gov (United States)

    Pullar, T; Roach, P; Mellor, E J; McNeece, J; Judd, A; Feely, M; Cooke, J

    1989-02-01

    Fifty patients were interviewed, on discharge from hospital, about their medications. Nine (18%) patients did not know, and a further four (8%) had inappropriate beliefs about why they were taking at least one of their discharge medications. Very few patients knew of significant side-effects which they might expect, or precautions which they should take, and over half did not know how long they were to continue taking their medicines. A small proportion was unable to read the bottle or open the container. Thus, even patients who, by virtue of an in-patient stay, have had a prolonged opportunity for education regarding their medicines have very little knowledge of their medicines upon discharge from hospital.

  14. Hospital Social Work and Spirituality: Views of Medical Social Workers.

    Science.gov (United States)

    Pandya, Samta P

    2016-01-01

    This article is based on a study of 1,389 medical social workers in 108 hospitals across 12 countries, on their views on spirituality and spiritually sensitive interventions in hospital settings. Results of the logistic regression analyses and structural equation models showed that medical social workers from European countries, United States of America, Canada, and Australia, those had undergone spiritual training, and those who had higher self-reported spiritual experiences scale scores were more likely to have the view that spirituality in hospital settings is for facilitating integral healing and wellness of patients and were more likely to prefer spiritual packages of New Age movements as the form of spiritual program, understand spiritual assessment as assessing the patients' spiritual starting point, to then build on further interventions and were likely to attest the understanding of spiritual techniques as mindfulness techniques. Finally they were also likely to understand the spiritual goals of intervention in a holistic way, that is, as that of integral healing, growth of consciousness and promoting overall well-being of patients vis-à-vis only coping and coming to terms with health adversities. Results of the structural equation models also showed covariances between religion, spirituality training, and scores on the self-reported spiritual experiences scale, having thus a set of compounding effects on social workers' views on spiritual interventions in hospitals. The implications of the results for health care social work practice and curriculum are discussed.

  15. A vision of long-term care. To care for tomorrow's elderly, hospitals must plan now, not react later.

    Science.gov (United States)

    Kodner, D L

    1989-12-01

    In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry.

  16. Suicide loss, changes in medical care utilization, and hospitalization for cardiovascular disease and diabetes mellitus.

    Science.gov (United States)

    Cho, Jaelim; Jung, Sang Hyuk; Kim, Changsoo; Suh, Mina; Choi, Yoon Jung; Sohn, Jungwoo; Cho, Seong-Kyung; Suh, Il; Shin, Dong Chun; Rexrode, Kathryn M

    2016-03-01

    The impact of suicide loss on family members' cardiometabolic health has little been evaluated in middle-aged and elderly people. We investigated the effect of suicide loss on risks for cardiovascular disease (CVD) and diabetes mellitus (DM) in suicide completers' family members using a national representative comparison group. The study subjects were 4253 family members of suicide completers and 9467 non-bereaved family members of individuals who were age and gender matched with the suicide completers in the Republic of Korea. National health insurance data were used to identify medical care utilization during the year before and after a suicide loss. A recurrent-events survival analysis was performed to estimate the hazard ratios (HRs) of hospitalizations for CVD, DM, or psychiatric disorders, after adjusting for age, residence, and socioeconomic status. Among subjects without a past history of CVD, DM, or psychiatric disorders, the increased risks of recurrent hospitalizations were observed for CVD [HR 1.343, 95% confidence interval (CI) 1.001-1.800 in men; HR 1.240, 95% CI 1.025-1.500 in women] and DM (HR 2.238, 95% CI 1.379-3.362 in men; HR 1.786, 95% CI 1.263-2.527 in women). In subjects with a past history of CVD, DM, or psychiatric disorders, the number of medical care visits decreased after a suicide loss, and suicide completers' family members showed lower rates of hospitalization for CVD and DM than the comparison group. Compared with non-bereaved family members, suicide completers' family members without a past history of CVD, DM, or psychiatric disorder showed a high risk of hospitalization for those conditions. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  17. [Choosing the right medications in elderly patients with chronic kidney disease].

    Science.gov (United States)

    Stucchi, Andrea; Gallieni, Maurizio

    2015-10-01

    With the aging of the population, the prevalence of chronic kidney disease (CKD) is increased. Measurement of glomerular filtration rate as a screening tool may over-diagnose CKD, especially when proteinuria is normal, but it can be very useful when considering drug metabolism. Renal dysfunction is a factor predisposing to potential adverse drug reactions, because drug can accumulate to toxic levels. In addition, some drugs are nephrotoxic and can more easily damage the kidneys in the elderly. Limited data are available on the risks of drugs in the elderly population with CKD. Drugs with no clear evidence-based indication, drugs with higher risks of adverse side effects compared to their benefits, and drugs which are not cost-effective, have been defined "potentially inappropriate medications" (PIMs). Even if criteria to evaluate PIMs and adverse drug reactions are available to clinical management, we strongly support the idea that the issue of PIMs in the elderly affected by CKD should be better studied and defined. The Italian website Slow Medicine, based on the US project "Choosing Wisely", opened a new strategy in this field, taking into consideration both economic issues and patients quality of life. The main goal of this initiative is avoiding wasteful or unnecessary medical tests, treatments and procedures.

  18. Outcome of elderly patients who receive intensive care at a regional hospital in Hong Kong.

    Science.gov (United States)

    Shum, H P; Chan, K C; Wong, H Y; Yan, W W

    2015-12-01

    To evaluate the clinical outcome (180-day mortality) of very elderly critically ill patients (age ≥80 years) and compare with those aged 60 to 79 years. Historical cohort study. Regional hospital, Hong Kong. Patients aged ≥60 years admitted between 1 January 2009 and 31 December 2013 to the Intensive Care Unit of the hospital. Over 5 years, 4226 patients aged ≥60 years were admitted (55.5% total intensive care unit admissions), of whom 32.8% were aged ≥80 years. The proportion of patients aged ≥80 years increased over 5 years. As expected, those aged ≥80 years carried more significant co-morbidities and a higher disease severity compared with those aged 60 to 79 years. They required more mechanical ventilatory support, were less likely to receive renal replacement therapy, and had a higher intensive care unit/hospital/180-day mortality compared with those aged 60 to 79 years. Nonetheless, 71.8% were discharged home and 62.2% survived >180 days following intensive care unit admission. Cox regression analysis revealed that Acute Physiology and Chronic Health Evaluation IV-minus-Age score, emergency admission, intensive care unit admission due to cardiovascular problem, neurosurgical cases, presence of significant co-morbidities (diabetes mellitus, metastatic carcinoma, leukaemia, or myeloma), and requirement for mechanical ventilation independently predicted 180-day mortality. The proportion of critically ill patients aged ≥80 years increased over a 5-year period. Despite having more significant co-morbidities, greater disease severity, and higher intensive care unit/hospital/180-day mortality rate compared with those aged 60 to 79 years, 71.8% of those ≥80 years could be discharged home and 62.2% survived >180 days following intensive care unit admission. Disease severity, presence of co-morbidities, requirement for mechanical ventilation, emergency cases, and admission diagnosis independently predicted 180-day mortality.

  19. [Effects of psychosomatic treatment for the elderly on cognition and quality of life : Naturalistic study at the psychosomatic day care hospital for the elderly in Nuremberg].

    Science.gov (United States)

    Wunner, Christina; Reichhart, Corinne; Strauss, Bernhard; Söllner, Wolfgang

    2016-11-16

    In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition. Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8‑month follow-up. A 5-week waiting time before admission to the 5‑week therapy was implemented as a control condition. In comparison with the waiting time, after treatment significant improvement (<0.05) was found in cognitive capacity and quality of life. Effect sizes were partly small and mostly moderate (ES 0.2-1.0) with larger effect sizes in the quality of life than in the cognitive domain. Improvements of cognition and quality of life remained stable at follow-up (admission to follow-up ES 0.1-1.0). No correlation was found between cognitive improvement and reduction of depressive symptoms. The results indicate that the psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.

  20. Geriatric forensics - Part 2 “Prevalence of elder abuse and their potential forensic markers among medical and dental patients”

    Science.gov (United States)

    Mattoo, Khurshid A.; Garg, Rishabh; Kumar, Shalabh

    2015-01-01

    Context: This study is a continuation of the earlier studies and has been extended to investigate the potential forensic markers of elder abuse. Aims: To determine the prevalence of elder abuse in various outpatient departments (OPDs). To study the associated parameters related to the abuser and the abused. To determine the existence of potential forensic markers of elder abuse. Settings and Design: The subjects were randomly selected from the medical and the dental OPDs of the university. Materials and Methods: Eight hundred and thirty two elderly subjects in the age range 40-60 years were interviewed using a questionnaire to determine the existence of elder abuse. The subjects were investigated and examined for weight, nutrition and hydration, vital signs, habits, existing visual and auditory capabilities, medications, disclosure of wills/deeds, signs of depression, and documented cleanliness. The mini-mental state examination, the Geriatric Depression Scale, the Clock drawing test, and the Brief Psychiatric Rating Scale were used to determine the potential forensic markers. Statistical Analysis Used: Mean values in percentage were determined by dividing the number of determined subjects by the total number of subjects for that parameter. Results: About 37% in medical and 41% in dental OPDs were found to have suffered from abuse, mostly in the age group 60-70 years. Females received more abuse and a combination of son and daughter-in-law constituted most abusers. Various potential markers of elder abuse and neglect investigated among the elder abuse victims included depression (89%), signs of improper feeding (83%), changes in personal hygiene (69%), need for medical/dental treatment (78%), medication misuse (67%), changes in wills/deeds (26%), decubiti (10%), bruises (17%), skin tears (27%), and confusion (23%). Conclusions: Elder abuse exists in one or more forms in both medical and dental OPDs among both males and females in all age groups. PMID:26816460

  1. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

    Directory of Open Access Journals (Sweden)

    Liao LY

    2015-08-01

    Full Text Available Lin-Yu Liao,1,2 Kuei-Min Chen,2 Wei-Sheng Chung,3 Jung-Yien Chien4 1Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, 2College of Nursing, Kaohsiung Medical University, Sanmin District, Kaohsiung, 3Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, 4Department of Medicine, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, Taiwan Clinical trials identifier: NCT02329873 Background: Acute exacerbation (AE of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed.Objective: To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD.Methods: A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31 were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10–30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration were assessed at the baseline and at the end of the fourth day.Results: All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05. Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth

  2. The relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan.

    Science.gov (United States)

    Yang, Ya-Ting; Iqbal, Usman; Ko, Hua-Lin; Wu, Chia-Rong; Chiu, Hsien-Tsai; Lin, Yi-Chieh; Lin, Wender; Elsa Hsu, Yi-Hsin

    2015-06-01

    The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey. Community-based study. A total of 4249 middle-aged and elderly subjects were recruited. None. Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively. Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with aged and elderly who perceived inconvenient to access health care tended to shop in pharmacy stores compared with those with perceived convenience. Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly who were facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation system for improving accessibility. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  3. [Evaluation of a medication self-management education program for elders with hypertension living in the community].

    Science.gov (United States)

    Lee, Jong Kyung

    2013-04-01

    The purpose of this study was to examine the effect of a medication self-management education program on medication awareness, communication with health care provider, medication misuse behavior, and blood pressure in elders with hypertension. The research design for this study was a non-equivalent control group quasi-experimental design. Participants were 23 elders for the control group, and 26 elders for the experimental group. The experimental group participated in the medication self-management education program which included the following, verbal education, 1:1 consultation, practice in medication self-management, and discussion over 5 sessions. Data were analyzed using the SPSS 18.0 program. There were statistically significant differences between the experimental and control group for medication awareness, medication misuse behavior, and communication with health care providers. However, no significant difference was found between the two groups for blood pressure. The results indicate that the education program is effective in improving medication awareness and communication with health care providers and in decreasing medication misuse behavior. Therefore, it is recommended that this education program be used as an effective intervention for improving medication self-management for elders with hypertension.

  4. MEDICAL AND SOCIAL ISSUES OF OCCUPATIONAL REHABILITATION IN ELDERLY PATIENTS WITH VASCULAR OPHTHALMOPATHY

    Directory of Open Access Journals (Sweden)

    A. M. Razumovskaya

    2015-01-01

    Full Text Available Aim: To assess medical and social issues of occupational rehabilitation in elderly patients with vascular eye diseases. Materials and methods: The results of examination of 572 patients and disabled persons after acute occlusion of central retinal artery, central retinal vein or optic nerve ischemia with sequelae were analyzed. Results: The majority of patients (> 70% with history of acute occlusion of central retinal artery, central retinal vein or optic nerve ischemia were elderly and had extensive professional background. Frequency of acute vascular eye diseases-related disability was as follows: 12.7% after occlusion of central retinal artery, 60.1% after acute occlusion of central retinal vein and 27.2% after acute optic nerve ischemia. Conclusion: Key determinants of occupational abilities in patients with vascular eye diseases are: visual function, positive motivation for work, compensation status of background vascular condition and adequate working environment.

  5. Contribution of renal impairment to potentially preventable medication-related hospital admissions.

    NARCIS (Netherlands)

    Leendertse, A.J.; Dijk, E.A. van; Smet, P.A.G.M. de; Egberts, T.C.; Bemt, P.M. van den

    2012-01-01

    BACKGROUND: Medication errors and renal impairment contribute to severe adverse drug events, which may lead to hospital admission. OBJECTIVE: To determine whether medication errors and renal impairment contribute to hospital admission and examine these errors for strategies to prevent admissions.

  6. Religious attitudes and spiritual health among elderly inpatient adults in Shahrekord hospitals

    Directory of Open Access Journals (Sweden)

    Raziye Sadat hosseiny

    2016-06-01

    Full Text Available Background and Objectives: Human is a multidimensional creature and spiritual domain is the central dimension which has an undeniable effect on gaining health. The most important part of nursing care with family based approach is to help people in achieving optimal level of health. On the other hand, religious attitudes and spiritual health is an important domain of life in ageing period. Therefore, this study was conducted to assess the religious attitudes and spiritual health among elderly inpatients in Shahrekord hospitals. Methods: This descriptive correlational study was conducted in 1392 in Shahrekord hospitals. A total of 308 geriatric patients who were admitted to a surgical ward, were recruited through random sampling. Two sets of questionnaires regarding religious and spiritual health were used as the instruments. After collecting the data, descriptive (frequency, mean, variance, standard deviation and analytical (independent t test, Pearson correlation statistics were used by SPSS statistical software. Results: The results showed that 68.8% of patients possessed large religious attitude with an average of 140.68 ±30.14. Spiritual health in 51.3 percent of samples was described to be low while the obtained average score was 86.18 ± 16.61. However, Pearson test showed that there is a positive significant correlation between religious attitudes and spiritual health (r =0.83, P =0.05. Conclusions: The present study revealed that there is a significant relationship between religious attitudes and spiritual health and people with high religious attitudes have high spiritual health.

  7. Collaboration between relatives of elderly patients and nurses and its relation to satisfaction with the hospital care trajectory

    DEFF Research Database (Denmark)

    Lindhardt, Tove; Nyberg, Per; Hallberg, Ingalill Rahm

    2008-01-01

    BACKGROUND: Relatives are often involved in the care of frail elderly patients prior to admission and are thus important collaborative partners for nurses. They hold valuable knowledge, which may improve care planning for the benefit of the patient and the hospital care trajectory. Satisfaction...... among relatives may be an indicator of this. Aim: To investigate collaboration between relatives and nurses among those relatives reporting high versus low satisfaction with the hospital care trajectory. Further, the aim was to investigate the relationship between satisfaction with the hospital care...

  8. [MALNUTRITION IN THE ELDERLY PATIENT TO HOSPITAL ADMISSION, AN OLD PROBLEM UNSOLVED].

    Science.gov (United States)

    Rentero Redondo, Lorena; Iniesta Navalón, Carles; Gascón Cánovas, Juan Jose; Tomás Jimenez, Cristina; Sánchez Álvarez, Carmen

    2015-11-01

    to determine the prevalence of malnutrition in patients aged 65 years or more at admission and factors associated with its presence. Analyze excess hospital stay (EHS), economic impact and premature readmission rate associated with hospital malnutrition in elderly patient. retrospective study conducted at the University Hospital Reina Sofía. All patients aged 65 years or older admitted to internal medicine in 2011. The sample size was calculated taking into account the income of the previous year, and considering a prevalence of malnutrition of 50% with a 95% and included error of 5%. To define the degree of malnutrition nutritional control tool (CONUT), which establishes a score based on albumin, total cholesterol and lymphocyte determination was used. To determine the factors associated with the presence of moderate to severe malnutrition analysis of multivariate logistic regression was performed. For each patient the EHS, premature readmissions and the associated cost to EHS was calculated. A threshold of statistical significance of 0.05 was used for all analyzes and were performed with SPSS v15.0. 310 patients, of whom 54.2% were women were included, the mean age was 80.1 years (SD: 6.8), ranging between 65 and 95 years. Regarding diagnosis at admission 27.4% were respiratory diseases, 22.6% of the circulatory and digestive 11.6%. The median Charlson index was 2.0, found that 36.8% of patients had high comorbidity. The most prevalent chronic diseases were diabetes mellitus (44.2%), chronic kidney disease (25.2%) and dementia (10.6). Regarding the CONUT, 75.8% of patients met the criteria of malnutrition: 42.6% mild, 28.7% moderate and severe 4.5%, of which only 46.6% had some nutritional support during admission. Factors associated with the presence of moderate to severe malnutrition were female gender (OR: 1.7; 95%: 1.1 - 2.8), age over 80 years (OR: 2.0, IC 95%: 1.2 - 3.5), and dementia (OR: 2.4; IC 95%:1.2 - 5.2). No association with comorbidity or with

  9. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    Science.gov (United States)

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  10. Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes.

    Science.gov (United States)

    Cerri, Anna Paola; Bellelli, Giuseppe; Mazzone, Andrea; Pittella, Francesca; Landi, Francesco; Zambon, Antonella; Annoni, Giorgio

    2015-08-01

    Data about the prevalence of sarcopenia among hospitalized patients is lacking and it is unclear whether the diagnostic criteria commonly used in community-dwellers is applicable in acutely ill subjects. The aims of this report are: (i) to assess the prevalence of sarcopenia among hospitalized patients; (ii) to assess whether the European Working Group on Sarcopenia in Older People (EWGSOP) criteria are applicable in an acute care setting; and (iii) to assess the mortality rate at 3 months. 103 patients admitted to the Acute Geriatric Clinic were enrolled. Inclusion criteria were: age ≥65 years and malnutrition or risk of malnutrition, according to the Mini Nutritional Assessment Short Form. Sarcopenia was diagnosed using the EWGSOP criteria by means of bioimpedance analysis, handgrip strength and gait speed, within 72 h of admission. Information on deaths was obtained by telephone interview at 3 months following discharge. Sarcopenia was diagnosed in 22 patients (21.4%). Twenty-three patients (22.3%) were not able to perform the gait speed and/or the handgrip strength because bedridden or requiring intensive treatments. In this group, a definite diagnosis of sarcopenia was not possible, lacking at least one EWGSOP criteria. Eleven (10.7%) patients died within the 3 months post-discharge period. Kaplan-Meier survival curves showed that sarcopenic patients died significantly more frequently than others (log-rank p ≤ 0.001). In a population of hospitalized elderly malnourished or at risk of malnutrition, sarcopenia is highly prevalent and associated with an increased risk to die in the short-term. Furthermore, the EWGSOP criteria cannot be satisfactorily applied in a relevant proportion of patients. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  11. The stigma of low opioid prescription in the hospitalized multimorbid elderly in Italy.

    Science.gov (United States)

    Marengoni, Alessandra; Nobili, Alessandro; Corli, Oscar; Djade, Codjo Djignefa; Bertoni, Diana; Tettamanti, Mauro; Pasina, Luca; Corrao, Salvatore; Salerno, Francesco; Marcucci, Maura; Mannucci, Pier Mannuccio

    2015-04-01

    The primary aim of this study was to evaluate the prevalence of opioid prescriptions in hospitalized geriatric patients. Other aims were to evaluate factors associated with opioid prescription, and whether or not there was consistency between the presence of pain and prescription. Opioid prescriptions were gathered from the REgistro POliterapie Societa` Italiana di Medicina Interna (REPOSI) data for the years 2008, 2010 and 2012. 1,380 in-patients, 65+ years old, were enrolled in the first registry run, 1,332 in the second and 1,340 in the third. The prevalence of opioid prescription was calculated at hospital admission and discharge. In the third run of the registry, the degree of pain was assessed by means of a numerical scale. The prevalence of patients prescribed with opioids at admission was 3.8% in the first run, 3.6% in the second and 4.1% in the third, whereas at discharge rates were slightly higher (5.8, 5.3, and 6.6%). The most frequently prescribed agents were mild opioids such as codeine and tramadol. The number of total prescribed drugs was positively associated with opioid prescription in the three runs; in the third, dementia and a better functional status were inversely associated with opioid prescription. Finally, as many as 58% of patients with significant pain at discharge were prescribed no analgesic at all. The conservative attitude of Italian physicians to prescribe opioids in elderly patients changed very little between hospital admission and discharge through a period of 5 years. Reasons for such a low opioid prescription should be sought in physicians' and patients' concerns and prejudices.

  12. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.

    LENUS (Irish Health Repository)

    Grimes, Tamasine C

    2011-03-01

    Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation.

  13. Medication Discrepancies Associated With a Medication Reconciliation Program and Clinical Outcomes After Hospital Discharge.

    Science.gov (United States)

    Shiu, Jennifer R; Fradette, Miriam; Padwal, Raj S; Majumdar, Sumit R; Youngson, Erik; Bakal, Jeffrey A; McAlister, Finlay A

    2016-04-01

    To identify the frequency of unintended medication discrepancies 30 days postdischarge from medicine wards with interprofessional medication reconciliation processes and clinical import. Prospective cohort study of adults discharged between October 2013 and November 2014 from two teaching hospitals in Edmonton, Canada. The Best Possible Medication Discharge Plan (BPMDP) was prepared for all patients. Patients were called 30 days postdischarge to determine the medication discrepancy rate from the BPMDP and whether this was intentional or unintentional; three clinicians used standardized criteria to determine if the discrepancy was inconsequential. Electronic health records and patient contact were used to ascertain death, hospital readmissions, and emergency department (ED) visits at 90 days. Of 433 patients (mean age 64 yrs, 52% female, median discharge prescriptions 6 [interquartile range 4-9]), 168 (38.8%) had at least one unintentional medication discrepancy at 30 days (325 total discrepancies; median one [interquartile range 1-2 discrepancies per patient]). Patients with unintentional medication discrepancies were older (65.9 vs 61.9 yrs, p=0.03) with more discharge medications (7 vs 6, p=0.03). Most unintentional discrepancies (91.1%) were judged inconsequential. The presence of an unintentional medication discrepancy was not associated with 90-day readmission or death (42/167 [25.1%] vs 64/263 [24.3%], adjusted odds ratio 0.96 [95% confidence interval 0.60-1.54]) or ED visits (69 [41.3%] vs 101 [38.4%], adjusted odds ratio 1.11 [95% confidence interval 0.74-1.67]. Despite the presence of an interprofessional medication reconciliation process, over one-third of patients had a medication discrepancy within 30 days of discharge, although most were inconsequential and there was no association between unintended medication discrepancies and risk of readmission, ED visit, or death 3 months after discharge. © 2016 Pharmacotherapy Publications, Inc.

  14. Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

    Directory of Open Access Journals (Sweden)

    Chen Y

    2014-06-01

    Full Text Available Ying Chen,1 Ling-Ling Zhu,2 Quan Zhou3 1Liaison Office of Geriatric VIP Patients, 2First Geriatric VIP Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods: Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results: Fall-risk-increasing drugs (FRIDs include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer’s agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class and

  15. Iatrogenic risk factors associated with hospital readmission of elderly patients: A matched case-control study using a clinical data warehouse.

    Science.gov (United States)

    Schwab, C; Korb-Savoldelli, V; Escudie, J B; Fernandez, C; Durieux, P; Saint-Jean, O; Sabatier, B

    2018-02-14

    Hospital readmission within 30 days of patient discharge has become a standard to judge the quality of hospitalizations. It is estimated that 14% of the elderly, people over 75 years old or those over 65 with comorbidities, are at risk of readmission, of which 23% are avoidable. It may be possible to identify elderly patients at risk of readmission and implement steps to reduce avoidable readmissions. The aim of this study was to identify iatrogenic risk factors for readmission. The secondary objective was to evaluate the rate of drug-related readmissions (DRRs) among all readmissions and compare it to the rate of readmissions for other reasons. We conducted a retrospective, matched, case-control study to identify non-demographic risk factors for avoidable readmission, specifically DRRs. The study included patients hospitalized between 1 September 2014 and 31 October 2015 in an 800-bed university hospital. We included patients aged 75 and over. Cases consisted of patients readmitted to the emergency department within 30 days of initial discharge. Controls did not return to the emergency department within 30 days. Cases and controls were matched on sex and age because they are known as readmissions risk factors. After comparison of the mean or percentage between cases and controls for each variable, we conducted a conditional logistic regression. The risk factors identified were an emergency admission at the index hospitalization, returning home after discharge, a history of unplanned readmissions and prescription of nervous system drugs. Otherwise, 11.4% of the readmissions were DRRs, of which 30% were caused by an overdose of antihypertensive. The number of drugs at readmission was higher, and potentially inappropriate medications were more widely prescribed for DRRs than for readmissions for other reasons. In this matched case-control retrospective study, after controlling for gender and age, we identified the typical profile of elderly patients at risk of

  16. Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record

    NARCIS (Netherlands)

    Opondo, Dedan; Visscher, Stefan; Eslami, Saeid; Verheij, Robert A.; Korevaar, Joke C.; Abu-Hanna, Ameen

    2015-01-01

    To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. We included patients 65 years and older who received NSAIDs between

  17. Does electronic medication reconciliation at hospital discharge decrease prescription medication errors?

    Science.gov (United States)

    Allison, Geneve M; Weigel, Bernard; Holcroft, Christina

    2015-01-01

    Medication errors are an important patient safety issue. Electronic medication reconciliation is a system designed to correct medication discrepancies at transitions in healthcare. The purpose of this paper is to measure types and prevalence of intravenous antibiotic errors at hospital discharge before and after the addition of an electronic discharge medication reconciliation tool (EDMRT). A retrospective study was conducted at a tertiary hospital where house officers order discharge medications. In total, 100 pre-EDMRT and 100 post-EDMRT subjects were randomly recruited from the study center's clinical Outpatient Parenteral Antimicrobial Therapy (OPAT) program. Using infectious disease consultant recommendations as gold standard, each antibiotic listed in these consultant notes was compared to the hospital discharge orders to ascertain the primary outcome: presence of an intravenous antibiotic error in the discharge orders. The primary covariate of interest was pre- vs post-EDMRT group. After generating the crude prevalence of antibiotic errors, logistic regression accounted for potential confounding: discharge day (weekend vs weekday), average years of practice by prescribing physician, inpatient service (medicine vs surgery) and number of discharge mediations per patient. Prevalence of medication errors decreased from 30 percent (30/100) among pre-EDMRT subjects to 15 percent (15/100) errors among post-EDMRT subjects. Dosage errors were the most common type of medication error. The adjusted odds ratio of discharge with intravenous antibiotic error in the post-EDMRT era was 0.39 (0.18, 0.87) compared to the pre-EDMRT era. In the adjusted model, the total number of discharge medications was associated with increased OR of discharge error. To the authors' knowledge, no other study has examined the impact of reconciliation on types and prevalence of medication errors at hospital discharge. The focus on intravenous antibiotics as a class of high-stakes medications

  18. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    DEFF Research Database (Denmark)

    Andreasen, Jane; Lund, Hans; Aadahl, Mette

    2015-01-01

    disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged...... gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. RESULTS: Four main categories were identified: "The system," "Keeping a social life," "Being...

  19. [The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

    Science.gov (United States)

    Park, H W

    1998-01-01

    Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

  20. Utilization Pattern of Potentially Inappropriate Medications in Geriatric Patients in a Tertiary Care Hospital: A Retrospective Observational Study

    Science.gov (United States)

    Bhandare, Nikhil Narayan; Gouveia, Jonathan Joaquim; Bhandare, Padma Narayan

    2017-01-01

    Introduction Geriatric population is on the rise throughout the world, hence the quality and the safety of prescribing in the elderly is a global healthcare concern. It is important for the healthcare providers to be aware of the limitations in prescribing certain drugs to the elderly. This study was an attempt to shed light on the utilization pattern of Potentially Inappropriate Medications (PIMs) in elderly patients admitted in the medicine wards in a tertiary care hospital in Goa. Aim To measure the percentage prevalence of PIMs prescribed in the admitted geriatric patients. Materials and Methods In this retrospective observational study, 150 case records of patients aged 60 years or more were analysed. All the prescribed medications, for each case record, were then analysed by referring to the American Geriatrics Society (AGS) Beers Criteria 2015. Data was analysed using Statistical Package for Social Sciences (SPSS) software. Results Of the 150 patients, 99 (66%) received at least one PIM according to the Beers Criteria 2015 (including drugs to be used with caution). However, after excluding the drugs to be used with caution, the prevalence of PIMs decreased to 44%. The most commonly prescribed PIMs were ranitidine (17.33%) and prazosin (8.66%) and the most commonly prescribed drug to be used with caution was furosemide (35.33%). Conclusion As the medication needs of the geriatric population are unique, it is essential that the healthcare professionals are aware of these needs and also follow the available guidelines and tools. Formulation of hospital policies and protocols in this regard would help to improve the scenario. Increased education, awareness and reporting of drug-related problems along with more doctor-patient interaction in these situations are some of the factors that could play an important role in promoting better and safer prescribing practices and a better quality of life to the older generations of our communities. PMID:28571163

  1. Management of chronic musculoskeletal pain in the elderly: opinions on oral medication use.

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    Kean, W F; Rainsford, K D; Kean, I R L

    2008-04-01

    The use of oral medication in the treatment of chronic musculoskeletal pain in the elderly requires careful selection of drugs to control pain with consideration for both the physiological state and the presence of disease(s). Recent advances have improved the understanding of biomolecular mechanisms of chronic pain. These include the production of powerful pro-inflammatory cytokines by glial and microglial cells, which then lead to activation of major pain pathways from the periphery through the dorsal horn and supra-spinal pathways to the somatosensory and other higher cortical centres. This has allowed better recognition for intervention with anti-inflammatory agents to control cytokine production (e. g. prednisolone, triamcinolone and other brain-penetrating corticosteroids). Advances in understanding of chronic pain have lead to recognition of neuronal PX2 puringergic receptors as potential sites for drugs to control pain by more selective actions. Pain control in the elderly involves extensive use of analgesics, among them the non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), and various narcotics. Each of these has its drawbacks, mostly related to potential toxicities. Attempts to reduce the serious gastro-intestinal (GI) adverse effects of the NSAIDs by the introduction of the highly selective COX-2 inhibitors (coxibs) have only had limited benefit in reducing these untoward actions. Moreover, the risks of serious cardiovascular (CV) and renal side-effects, though statistically infrequent, are none the less of major concern. Cardio-renal effects have been attributed to some (e. g. diclofenac), but not all (e. g. naproxen) conventional NSAIDs. Here we make recommendations for a selection of certain NSAIDs to be used for pain therapy in the elderly in consideration of their relative safety and pharmacokinetics. While newer formulations of narcotics have given some advance in pain control, the application of this group of drugs

  2. Medication pain management in the elderly: unique and underutilized analgesic treatment options.

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    Atkinson, Timothy J; Fudin, Jeffrey; Pandula, Abhinetri; Mirza, Maira

    2013-11-01

    By 2030, the US population of adults aged ≥65 years will increase by >80%, and these adults will account for nearly 20% of the US population. In this population, the decline of multiple physiologic processes and diseases collectively influence treatment options. Physiologic changes, drug-drug interactions resulting from polypharmacy, and drug-disease interactions combine to make elderly patients more sensitive to the adverse events (AEs) associated with medications, all of which must be considered in drug selection. This article focuses on select underutilized medication options for analgesia that may provide significant advantages in the elderly population above and beyond commonly prescribed conventional choices. We performed a complete review of the literature using the search terms pain management, elderly, opioids, NSAIDs, topical NSAIDs, levorphanol, buprenorphine transdermal, and tapentadol. Databases searched included PubMed, Google Scholar, Ovid, and Athens. Package inserts were utilized for approval dates, indications, and formulations available. We looked at reviews of agents to identify important studies for consideration that searches may have missed. Pharmacology and pharmacokinetic data were taken from randomized trials focusing in this area. Pivotal Phase III trials were utilized for discussion of clinical trial experience and to summarize efficacy and AEs. For purposes of validity, only peer-reviewed literature was included. There were limited data that specifically outlined analgesic drug selection and highlighted safer alternatives for the elderly patient based on polypharmacy risks, end-organ deterioration, and/or drug choices that presented less risk. We focused on unique opioid alternatives: levorphanol, which offers several therapeutic advantages similar to methadone but without the pharmacokinetic and drug-interaction pitfalls associated with methadone; tapentadol, associated with significantly less gastrointestinal distress and

  3. Frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan.

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    Waris Qidwai

    Full Text Available OBJECTIVE: To study frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan. METHODOLOGY: A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC, Aga Khan University Hospital (AKUH Karachi, Pakistan from September to November 2009. All individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent. RESULTS: A total of 400 elderly completed the interview. Majority were females, 65-69 years age, More than half of the individuals ie: 227 (85% had received Care Giver experience for assistance and among these 195(72% had care provided by an immediate family member. A large proportion of them stated that their Care Givers managed to provide less than four hours in a day for care giving. Around 37% showed substantial improvement in their relationship with the care givers. About 70% of the respondents stated that the care provided by the Care Giver improved their quality of life. CONCLUSION: Elderly care is provided by majority of the family members resulting in increased satisfaction level, however small number still not satisfied due to unfulfilled need of these older people. This demands that efforts should be made to strengthen the family support by increasing awareness regarding elderly care and arranging support system by the government.

  4. Identification and evaluation of potentially inappropriate medications (PIMs) in hospitalized geriatric patients using Beers criteria.

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    Danisha, Pattani; Dilip, Chandrasekhar; Mohan, Panakkal Linu; Shinu, Cholamugath; Parambil, Jaffer Chalil; Sajid, Muhammed

    2015-07-01

    The aim of the study was to identify and evaluate potentially inappropriate medication (PIM) in geriatric patients using Beers criteria and also to identify adverse drug events (ADEs) due to PIMs and various drug-drug interactions. The medications in the prescriptions of patients above 60 years of age, their dosage regimen respective of their diagnosis were analyzed. Each medication was then checked with Beers list tables, and any medication if mentioned in the Beers list, was noted along with its strength of recommendation and quality of evidence. Any adverse drug event (ADE) due to PIM was identified. Causality of the events was assessed by Naranjo's Scale. The number of drug-drug interactions per prescription and the severity of each interaction were also analyzed. The collected data from 200 subjects were subjected to statistical treatments using Statistical Package for Social Sciences (SPSS) software version 16.0 for WINDOWS. Based on the Beers criteria 2012, 106 out of 200 (53%) prescriptions had at least one PIM prescribed. A sum of 1690 medications was prescribed as a whole for the entire study subjects. Among which, 134 PIMs were identified. Most commonly prescribed PIMs were benzodiazepines (39, 19.5%), followed by sliding scale use of insulin (31, 15.5%), and prazosin at a rate of 11.5% (23). A total of 10 ADEs were identified during the study. The average number of drug interactions observed among total samples was found to be 3.0±6.0 with 0±5.0 serious interactions, 2±4.0 significant interactions requiring close monitoring, and 0±6.0 minor interactions. The study shows high prevalence of prescribing PIMs in hospitalized elderly patients; PIM also caused incidence of ADEs; and serious drug-drug interactions were scarce among the patients.

  5. The influence of frailty syndrome on medication adherence among elderly patients with hypertension

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    Jankowska-Polańska B

    2016-12-01

    Full Text Available Beata Jankowska-Polańska,1 Krzysztof Dudek,2 Anna Szymanska-Chabowska,3 Izabella Uchmanowicz1 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland Background: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.Aims: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and results: The study included 296 patients (mean age 68.8±8.0 divided into frail (n=198 and non-frail (n=98 groups. The Polish versions of the Tilburg Frailty Indicator (TFI for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028. Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117, psychological (rho =-0.183, and social domain (rho =-0.163 of TFI as well as the total score of the questionnaire (rho =-0.183. However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395 and satisfaction with the home environment (β=0.897 were found to be independent stimulants of adherence level.Conclusion: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty

  6. Unexpectedly Higher Morbidity and Mortality of Hospitalized Elderly Patients Associated with Rhinovirus Compared with Influenza Virus Respiratory Tract Infection

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    Ivan F. N. Hung

    2017-01-01

    Full Text Available Rhinovirus is a common cause of upper and lower respiratory tract infections in adults, especially among the elderly and immunocompromised. Nevertheless, its clinical characteristics and mortality risks have not been well described. A retrospective analysis on a prospective cohort was conducted in a single teaching hospital center over a one-year period. We compared adult patients hospitalized for pneumonia caused by rhinovirus infection with those hospitalized for influenza infection during the same period. All recruited patients were followed up for at least 3 months up to 15 months. Independent risk factors associated with mortality for rhinovirus infection were identified. Between 1 March 2014 and 28 February 2015, a total of 1946 patients were consecutively included for analysis. Of these, 728 patients were hospitalized for rhinovirus infection and 1218 patients were hospitalized for influenza infection. Significantly more rhinovirus patients were elderly home residents and had chronic lung diseases (p < 0.001, whereas more influenza patients had previous stroke (p = 0.02; otherwise, there were no differences in the Charlson comorbidity indexes between the two groups. More patients in the rhinovirus group developed pneumonia complications (p = 0.03, required oxygen therapy, and had a longer hospitalization period (p < 0.001, whereas more patients in the influenza virus group presented with fever (p < 0.001 and upper respiratory tract symptoms of cough and sore throat (p < 0.001, and developed cardiovascular complications (p < 0.001. The 30-day (p < 0.05, 90-day (p < 0.01, and 1-year (p < 0.01 mortality rate was significantly higher in the rhinovirus group than the influenza virus group. Intensive care unit admission (odds ratio (OR: 9.56; 95% confidence interval (C.I. 2.17–42.18, elderly home residents (OR: 2.60; 95% C.I. 1.56–4.33, requirement of oxygen therapy during hospitalization (OR: 2.62; 95% C.I. 1.62–4.24, and hemoglobin

  7. Analysis of Inappropriate Medication Use in Older Adults Discharged From Hospitals Affiliated With Tehran University of Medical Sciences (TUMS Using the Beers Criteria in 2010

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    Leila Vali

    2011-10-01

    Full Text Available Objectives: Studies demonstrate that chronic diseases are more frequent among the elderly than other age groups. Therefore, it is reasonable to assume that more pharmaceuticals are consumed by this age group than by others and that older patients are more prone to pharmaceutical side effects and complications due to such higher drug consumption rates. Changes in pharmacokinetics and pharmacodynamics, among others, are considered as major causes of medication related complications among the elderly. Another factor worth noting is the inappropriate choice of medications prescribed for such patients, who can benefit from the identification of such medications and better care in their prescription. These issues are among the well known factors discussed in recent and relevant literature and may inflict significant harm on the health and well-being of the elderly population. Methods & Materials: For the purpose of the present study 212 patients aged 60yr and over (mean age: 69.32 yr discharged from 4 (2 teaching and 2 non-teaching general hospitals affiliated with TUMS were selected. The Beers Criteria was employed to assess inappropriate use of pharmaceuticals by the sample population. Results: Findings reveal that there was a significant relation between the level of income and the inappropriate use of medications among the sample population (P=0.041. The most frequent inappropriate use of medications, in order of frequency, included alprazolam (16.66%, chlordiazepoxide (14.28%, fluoxetine (11.90%, and oxazepam (11.90%. The highest rate of drug interactions was observed for the drug clopidogrel (29.4%. Benzodiazepines were recognized as the most frequent class of pharmaceuticals consumed by the patients (49.98%. There was no significant relationship between income rates and the amount of inappropriate drug use (P=0.041. Conclusion: Inappropriate consumption of pharmaceuticals was relatively high among the study population, in comparison to similar

  8. Self-medication with over-the-counter drugs and complementary medications in South Australia's elderly population

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    Esterman Adrian

    2009-11-01

    Full Text Available Abstract Background A number of surveys have examined use of complementary and alternative medicines (CAM in Australia. However, there are limited Australian data on use of CAM and over-the-counter (OTC medicines in the elderly population. The main aims of this study were to examine self-medication practices with CAM and OTC medicines among older Australians and variables associated with their use. Methods The Australian Longitudinal Study of Ageing (ALSA is an ongoing multidisciplinary prospective study of the older population which commenced in 1992 in South Australia. Data collected in 4 waves of ALSA between 1992 and 2004 were used in this study with a baseline sample of 2087 adults aged 65 years and over, living in the community or residential aged care. OTC medicines were classified according to the World Health Organization Anatomical Therapeutic Chemical (ATC classification. CAM were classified according a modified version of the classification adopted by the Therapeutics Goods Administration (TGA in Australia. Results The prevalence of CAM or OTC use ranged from 17.7% in 2000-2001 to 35.5% in 2003-2004. The top classes of CAM and OTC medicines used remained relatively constant over the study period. The most frequent classes of CAM used were vitamins and minerals, herbal medicines and nutritional supplements while the most commonly used OTC were analgesics, laxatives and low dose aspirin. Females and those of younger age were more likely to be CAM users but no variable was associated with OTC use. Conclusion Participants seemed to self-medicate in accordance with approved indications, suggesting they were informed consumers, actively looking after their own health. However, use of analgesics and aspirin are associated with an increased risk of adverse drug events in the elderly. Future work should examine how self-medication contributes to polypharmacy and increases the risk of adverse drug reactions.

  9. Prescribing error at hospital discharge: a retrospective review of medication information in an Irish hospital.

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    Michaelson, M; Walsh, E; Bradley, C P; McCague, P; Owens, R; Sahm, L J

    2017-08-01

    Prescribing error may result in adverse clinical outcomes leading to increased patient morbidity, mortality and increased economic burden. Many errors occur during transitional care as patients move between different stages and settings of care. To conduct a review of medication information and identify prescribing error among an adult population in an urban hospital. Retrospective review of medication information was conducted. Part 1: an audit of discharge prescriptions which assessed: legibility, compliance with legal requirements, therapeutic errors (strength, dose and frequency) and drug interactions. Part 2: A review of all sources of medication information (namely pre-admission medication list, drug Kardex, discharge prescription, discharge letter) for 15 inpatients to identify unintentional prescription discrepancies, defined as: "undocumented and/or unjustified medication alteration" throughout the hospital stay. Part 1: of the 5910 prescribed items; 53 (0.9%) were deemed illegible. Of the controlled drug prescriptions 11.1% (n = 167) met all the legal requirements. Therapeutic errors occurred in 41% of prescriptions (n = 479) More than 1 in 5 patients (21.9%) received a prescription containing a drug interaction. Part 2: 175 discrepancies were identified across all sources of medication information; of which 78 were deemed unintentional. Of these: 10.2% (n = 8) occurred at the point of admission, whereby 76.9% (n = 60) occurred at the point of discharge. The study identified the time of discharge as a point at which prescribing errors are likely to occur. This has implications for patient safety and provider work load in both primary and secondary care.

  10. Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort

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    Bach, Veronika; Schruckmayer, Guenter; Sam, Ines; Kemmler, Georg; Stauder, Reinhard

    2014-01-01

    Background Anemia in later life is associated with increased morbidity and mortality. The purpose of this study was to evaluate the prevalence and possible causes of anemia in the elderly in a well defined hospital cohort. Methods Participants in this cross-sectional, retrospective analysis included all inpatients and outpatients aged ≥64 years with complete blood counts treated at Innsbruck Medical University Hospital between October 1, 2004 and September 29, 2005 (n=19,758, median age 73 years). Results According to World Health Organization criteria, 21.1% of these patients were anemic, ie, 30.7% and 37.0% at 80+ years and 90+ years, respectively. The prevalence of anemia was significantly correlated with advanced age (r=0.21; Panemia was multifactorial, with decreased renal function (glomerular filtration rate anemia subtypes. Cytopenias and morphologic alterations suggestive of underlying myelodysplastic syndromes were found in a substantial proportion of anemic patients, including thrombocytopenia (5.4%), leukopenia (8.26%), and macrocytic alterations (18.4%). Conclusion Anemia was frequently diagnosed in this series of elderly patients. Partly treatable nutritional deficiencies, such as iron or folate deficiency, were identified as possible causes. A complex and heterogeneous interplay of chronic inflammation, functional iron deficiency, and renal impairment was identified in a large proportion of patients. A hitherto undiagnosed myelodysplastic syndrome can be assumed in a relevant proportion of patients. Morphologic classification based on mean corpuscular volume is inadequate from the standpoint of pathogenesis. New parameters are needed to differentiate the multifactorial pathogenesis of anemia in the elderly. PMID:25092968

  11. Delirium assessment in hospitalized elderly patients: Italian translation and validation of the nursing delirium screening scale.

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    Spedale, Valentina; Di Mauro, Stefania; Del Giorno, Giulia; Barilaro, Monica; Villa, Candida E; Gaudreau, Jean D; Ausili, Davide

    2017-08-01

    Delirium has a high incidence pathology associated with negative outcomes. Although highly preventable, half the cases are not recognized. One major cause of delirium misdiagnosis is the absence of a versatile instrument to measure it. Our objective was to translate the nursing delirium screening scale (Nu-DESC) and evaluate its performance in Italian settings. This was a methodological study conducted in two sequential phases. The first was the Italian translation of Nu-DESC through a translation and back-translation process. The second aimed to test the inter-rater reliability, the sensibility and specificity of the instrument on a convenience sample of 101 hospitalized elderly people admitted to relevant wards of the San Gerardo Hospital in Monza. To evaluate the inter-rater reliability, two examiners tested Nu-DESC on 20 patients concurrently without comparison. To measure the sensibility and specificity of Nu-DESC, the confusion assessment method was used as a gold standard measure. The inter-rater reliability (Cohen Kappa) was 0.87-an excellent agreement between examiners. The study of the ROC curve showed an AUC value of 0.9461 suggesting high test accuracy. Using 3 as a cut-off value, Nu-DESC showed 100 % sensibility and 76 % specificity. Further research is needed to test Nu-DESC on a larger sample. However, based on our results, Nu-DESC can be used in research and clinical practice in Italian settings because of its very good and similar performances to previous validation studies. The value of 3 appears to be the optimal cut-off in the Italian context.

  12. Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality

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    Francisco José Tarazona-Santabalbina

    2012-01-01

    Full Text Available OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.

  13. Evaluation of the Prevention and Reactivation Care Program (PReCaP for the hospitalized elderly: a prospective nonrandomized controlled trial

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    Asmus-Szepesi KJ

    2015-03-01

    Full Text Available Kirsten J Asmus-Szepesi,1 Linda E Flinterman,1 Marc A Koopmanschap,2 Anna P Nieboer,2 Ton J Bakker,3 Johan P Mackenbach,1 Ewout W Steyerberg1 1Department of Public Health, Erasmus University Medical Center, 2Institute of Health Policy and Management, Erasmus University, 3Stichting Wetenschap Balans, Rotterdam, the Netherlands Background: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly.Methods: The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP, while two other hospitals providing usual care served as control settings. Within the PReCaP hospital we compared patients pre-implementation with patients post-implementation of the PReCaP (“within-hospital analysis”, while our nonrandomized controlled trial compared patients of the PReCaP hospital post-implementation with patients from the two control hospitals providing usual care (“between-hospital analysis”. Hospitalized patients 65 years or older and at risk of functional decline were interviewed at baseline and at 3 and 12 months using validated questionnaires to score functioning, depression, and health-related quality of life (HRQoL. We estimated costs per unit of care from hospital information systems and national data sources. We used adjusted general linear mixed models to analyze functioning and HRQoL.Results: Between-hospital analysis showed no difference in activities of daily living (ADL or instrumental activities of daily living (IADL between PReCaP patients and control groups. PReCaP patients did have slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI 0.2–0.6], lower depression (Geriatric Depression Scale 15; -0

  14. Hospital Staff and Patient Recognition Toward Opening of Medical Services Market, and Factors in Selecting a Foreign Hospital

    OpenAIRE

    Ryu, Hyang Jin; Park, Eun Cheol; Sohn, Tae Yong; Yu, Seung Hum

    2007-01-01

    Purpose The objectives of this study are to compare the hospital employees' and patients' recognition and attitudes toward the opening of the medical services market, to analyze the differences between hospital employees and patients on the factors in selecting a foreign hospital. Materials and Methods This study collected and analyzed data using systematic questionnaires that were self-administered by employees and outpatients to compare their recognition of the opening of the medical servic...

  15. Hospital-based health technology assessment for innovative medical devices in university hospitals and the role of hospital pharmacists: learning from international experience.

    Science.gov (United States)

    Martelli, Nicolas; Lelong, Anne-Sophie; Prognon, Patrice; Pineau, Judith

    2013-04-01

    Several models of hospital-based health technology assessment (HTA) have been developed worldwide, for the introduction of innovative medical devices and support evidence-based decision making in hospitals. Two such models, the HTA unit and mini-HTA models, are widespread in university hospitals and involve various stakeholders. The purpose of this work was to highlight the potential role of hospital pharmacists in hospital-based HTA activities. We searched for articles, reviews, and letters relating to hospital-based HTA, as defined by the Hospital-Based Health Technology Assessment Worldwide Survey published by the Health Technology Assessment International (HTAi) Society, in the Health Technology Assessment database, MEDLINE, EMBASE, and hospital pharmacy journals. The number of university hospitals performing hospital-based HTA has increased since the 2008 Hospital-Based Health Technology Assessment Worldwide Survey. Our own experience and international findings show that hospital pharmacists already contribute to hospital-based HTA activities and have developed study interpretation skills and a knowledge of medical devices. Promoting multidisciplinary approaches is one of the key success factors in hospital-based HTA. Hospital pharmacists occupy a position between hospital managers, clinicians, health economists, biomedical engineers, and patients and can provide a new perspective. In the future, hospital pharmacists are likely to become increasingly involved in hospital-based HTA activities.

  16. Medication errors--an enduring problem for children and elderly patients.

    Science.gov (United States)

    Zakharov, Sergey; Tomas, Navratil; Pelclova, Daniela

    2012-08-01

    To analyze the types and reasons of medication errors, committed by health care professionals, which led to toxicological consultations at the Czech Toxicological Information Centre (TIC). Inquiries arising from medication errors for 2000-2010 were extracted and evaluated from the database of the TIC, recording the consultations of poisonings due to drugs, household products, plants, and mushrooms. From a total of 44,344 calls concerning pharmaceuticals, 215 (0.5%) were denoted by the caller as medication errors; 130 involved children (90 below 5 years of age) and 85 involved adults (30-60 years of age). The most common errors were: improper dosage (60.9%), wrong medication (19.3%), or erroneous route of administration (12.9%). The most frequent medication errors appeared using drugs affecting the nervous system (psycholeptics and antiepileptics), antibiotics, and drugs affecting the respiratory system. Nurses administering the drugs were responsible for 43.0%, physicians prescribing the drugs for 36.8%, and pharmacists dispensing the drugs for 20.2% of the errors. Of 25 patients with severe drug intoxications, 60.0% were children under 5 years of age treated with pharmaceuticals affecting the CNS, and 28.0% patients over 60 years of age with chronic application of theophylline, digoxin, or lithium. The trend in medication errors has remained relatively stable over the past 11 years. The analysis of medication errors shows two high-risk categories: children of less than 5 years of age, in whom the dose was not correctly adjusted, and elderly people with chronic medication and insufficient control of their medication level. Therefore, the measures for risk reduction should focus primarily on them.

  17. Medication incidents related to automated dose dispensing in community pharmacies and hospitals - a reporting system study

    NARCIS (Netherlands)

    Cheung, K.C.; Bemt, P.M. van den; Bouvy, M.L.; Wensing, M.J.; Smet, P.A. de

    2014-01-01

    INTRODUCTION: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may

  18. Medication incidents related to automated dose dispensing in community pharmacies and hospitals - A reporting system study

    NARCIS (Netherlands)

    Cheung, Ka Chun; Van Den Bemt, Patricia M L A; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A G M

    2014-01-01

    Introduction: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may

  19. Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures.

    Science.gov (United States)

    Lundström, M; Edlund, A; Lundström, G; Gustafson, Y

    1999-01-01

    The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.

  20. Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a “mission impossible”?

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    Carlsson, Per

    2009-02-01

    Full Text Available In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity, and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a a literature review, (b a register study, based on a unique population-based register of inpatient care in Sweden, and (c a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.

  1. Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

    Directory of Open Access Journals (Sweden)

    Lauren Lapointe-Shaw

    Full Text Available Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices.We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI, angiotensin-converting enzyme (ACE inhibitor or angiotensin receptor blocker (ARB following hospital admission from April 1(st 2008-March 31(st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class.The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47% for PPIs, $162 thousand (17% for ACE inhibitors and $14 thousand (4% for ARBs over the year following discharge.In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

  2. Pattern of biopsy-proven kidney disease in the elderly in a tertiary care hospital in India: a clinicopathological study.

    Science.gov (United States)

    Bagchi, Soumita; Mittal, Parmod; Singh, Geetika; Agarwal, Sanjay Kumar; Singh, Lavleen; Bhowmik, Dipankar; Mahajan, Sandeep; Dinda, Amit

    2016-04-01

    An aging population is an important demographic issue in India. The knowledge base about kidney diseases among the elderly Indians is inadequate. We aim to delineate the clinical profile and spectrum of biopsy-proven kidney disease in elderly patients. Records of all elderly patients (≥60 years) who had undergone kidney biopsy in the nephrology department from January 2010 to December 2014 were reviewed. Their clinical details and laboratory investigations at the time of biopsy were noted. Details of kidney biopsy were recorded from their biopsy reports. In total, 1728 patients underwent kidney biopsy during this period and 124 were elderly (7.2%). Their mean age was 64.9 ± 4.9 years, and they were predominantly males (63.7%). Mean serum creatinine was 3.0 ± 2.8 mg/dl, proteinuria was 4.0 ± 2.7 g/day, and 39.5% had microscopic hematuria. The most common indications for biopsy were nephrotic syndrome (NS)--39.5% and acute kidney injury/rapidly progressive glomerulonephritis (AKI/RPGN)--24.2%. Another 8.1% patients had NS with AKI. MN (39.0%) was the chief cause of NS, and pauci-immune crescentic glomerulonephritis (GN) (28.2%) was the leading cause of AKI/RPGN. MN, pauci-immune crescentic GN and acute on chronic tubulointerstitial nephritis (A/CTIN) and acute tubular injury (ATI) were more common in the elderly, while MCD, FSGS, IgA nephropathy and lupus nephritis were more frequent in the younger patients. 68.5% of the elderly patients biopsied were diagnosed with a renal disease which was potentially amenable to specific treatment. The spectrum of biopsy-proven kidney disease in the elderly Indians seen in our tertiary care hospital varies from the younger population. Kidney biopsy provides useful information with therapeutic and prognostic implications in these patients. The percentage of elderly patients among the total biopsied population is low in India, and these patients present late with renal dysfunction. Prospective studies are needed to assess the

  3. High-alert medications in a French paediatric university hospital.

    Science.gov (United States)

    Bataille, Julie; Prot-Labarthe, Sonia; Bourdon, Olivier; Joret, Perrine; Brion, Françoise; Hartmann, Jean-François

    2015-04-01

    High-alert medications (HAMs) are medications that are associated with a high risk of serious harm if used improperly. The objective of this study was to identify paediatric HAM used in our institution and to identify safety measures for their use. The list of HAM and the list of safety measures that were introduced in our department were based on (1) a literature search; (2) a survey of health care professionals in our department including doctors, head nurses, nurses and pharmacists; and (3) the drug steering committee. We found four lists of HAM based on a literature search, including 27 classes of pharmaceutical agents, and 63 common drug names. The response rate of the survey was 20.7% (230 of 1113). Some of the HAMs included in our list were not identified by the literature search. These included neuroleptic drugs, anti-malarial agents, antiviral agents, anti-retroviral agents and intravenous acetaminophen. The drug steering committee selected 17 HAM and highlighted 53 safety measures involving seven broad aspects of pharmacological management. This project was part of the new safety strategies developed in a paediatric hospital. We set out to make a list of HAM relevant to paediatrics with additional safety measures to prevent medication errors associated and a 'joker' system. The various safety measures, such as double-checking of HAM prescriptions, should be reviewed during the year following their implementation. This list, which was developed in our hospital specifically for use in paediatrics, can be adapted for use in other paediatric departments. © 2014 John Wiley & Sons, Ltd.

  4. Short-term effects of black smoke on cardiovascular hospitalization in elderly in Niš, Serbia

    Directory of Open Access Journals (Sweden)

    Stanković Aleksandra

    2012-01-01

    Full Text Available In past few years numerous epidemiological studies bring new evidence on the effects of particle air pollution on cardiovascular hospitalizations. The aim of our paper was to investigate the association between ambient concentrations of black smoke (BS and daily total non-accidental cardiovascular hospitalizations in elderly in Niš. The daily mean number of all age cardiovascular hospitalizations was 12.46±6.26 (0 to 38 and 5.92±3.29 (0 to 20 among person ≥ 65 yrs. Daily measurements for black smoke (BS and SO2, as well as the daily number of cardiovascular hospitalization among person ≥ 65 yrs of age, have been collected. BS (μg/m3 was measured by the refractometry method and SO2 (μg/m3 by spectrophotometer. Generalized linear model extending Poisson regression was applied. The effects of time trend, seasonal variations, day of week, temperature, relative humidity and barometric pressure were adjusted. Estimated OR of unipolutant regression model for among person ≥ 65 yrs was 1.00135 (95% CI: 0,97835 to 1,02489, and estimated OR of bipolutant model was 1,00975 (95% CI: 0,99457 to 1,02394 per 10μg/m3. The results do not support findings from previous studies that had shown an increase in the number of cardiovascular hospitalization in elderly in association with black smoke. [Projekat Ministarstva nauke Republike Srbije, br. 42008 i br. 43014

  5. Prognostic Factors of Fournier's Gangrene in the Elderly: Experiences of a Medical Center in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Feng Kuo

    2016-09-01

    Conclusion: The core principles to manage Fournier's gangrene in geriatric patients are early diagnoses, aggressive resuscitations, use of broad-spectrum antibiotics, and prompt and repeated surgical intervention. Medical teams can save their lives by applying aggressive treatment with longer hospitalization.

  6. [Socioeconomic inequalities in preventive services among the elderly: results from medical checkup, cancer check, and BP check].

    Science.gov (United States)

    Chun, Heeran; Kim, Il-Ho

    2007-09-01

    Due to the assumptions of homogeneity as well as challenges in the socioeconomic position of the elderly, they have been relatively neglected in studies of health inequalities. Therefore, this study was conducted to investigate the social inequalities in preventive services among elderly men and women. Data were obtained from a nationally representative sample of 342 men and 525 women aged 65 and over collected during the 2001 National Health and Nutrition Examination Survey. Age adjusted proportions and logistic regression were used to identify the social patterning of preventive services among elderly Koreans using various social position indicators. The findings of this study generally supported the presence of social gradients in preventive services among the Korean elderly. The likelihood of using the service becomes progressively higher with social position. Educational level, income, and self-rated living status were significantly associated with increased medical checkups and cancer checks. In addition, logistic regression detected educational inequalities only among older women receiving BP checks. After being stratified based on health status and chronic disease status, social disparities still existed when educational level and self-rated living status were considered. Among unhealthy individuals, place of residence was observed as a barrier to medical checkups. This study demonstrated strong and consistent associations between socioeconomic position and preventive services among the elderly in Korea. The results indicate that public health strategies should be developed to reduce the barriers to preventive services encountered by the elderly.

  7. Hospitals of the Future - Ubiquitous Computing support for Medical Work in Hospitals

    DEFF Research Database (Denmark)

    Bardram, Jakob Eyvind

    2003-01-01

    This paper describes the visions and on-going research within creating ubiquitous computing support for medical work in the hospitals of the future. Today, clinical computer systems seldom play any role in the execution of clinical work as such. Electronic Patient Records (EPR) are more often...... located in offices at a hospital rather than at patients' bedside, or in operating theaters. There are a number of challenges to the hardware and software design of contemporary computer systems that make them unsuitable for clinical work. It is, for example, difficult to operate a keyboard and a mouse...... while operating a patient. Research within UbiComp provides a range of new conceptual and technological possibilities, which enable us to move clinical computer support closer to the clinical work setting. An important barnce of the research at the Danish Center for Pervasive Healthcare is to design...

  8. Management of elderly patients with congestive heart failure--design of the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF).

    Science.gov (United States)

    Brunner-La Rocca, Hans Peter; Buser, Peter Theo; Schindler, Ruth; Bernheim, Alain; Rickenbacher, Peter; Pfisterer, Matthias

    2006-05-01

    Little is known about the management of elderly patients with congestive heart failure (CHF) although they represent the majority of the CHF population. Therefore, the TIME-CHF study was set up (1) to evaluate the medical management of very old patients (> or = 75 years) with CHF compared with younger patients (60-74 years), (2) to compare an intensified with a standard treatment approach, and (3) to differentiate between systolic and diastolic dysfunction (ejection fraction 45%). In a prospective single-blinded multicenter trial, 824 symptomatic patients, CHF hospitalization within the last year and elevated NT-BNP, are randomized to an intensified versus a standard medical therapy. Treatment strategies follow the published guidelines with the aim to reduce symptoms to NYHA class 45% in 26% and 10%, respectively. Significant comorbidities were present in 93% of patients. TIME-CHF will be the first prospective randomized trial to comprehensively study the management of elderly patients with CHF. It will provide unique information comparing two treatment strategies in two age groups irrespective of ejection fraction regarding prognosis, quality of life, as well as resource utilization and costs.

  9. Impact of medical treatment on lung diffusion capacity in elderly patients with heart failure. Baseline characteristics and 1-year follow up after medical treatment

    DEFF Research Database (Denmark)

    Petersen, Claus Leth; Kjaer, Andreas

    2005-01-01

    AIM: The aim of this investigation was (1) to study the effect of untreated chronic heart failure (CHF) on alveolar membrane diffusion capacity (transfer coefficient, K(CO)) in elderly patients and (2) to study the impact of the standard regime of medical treatment with diuretics and ACE-inhibito......AIM: The aim of this investigation was (1) to study the effect of untreated chronic heart failure (CHF) on alveolar membrane diffusion capacity (transfer coefficient, K(CO)) in elderly patients and (2) to study the impact of the standard regime of medical treatment with diuretics and ACE...... of multiple ECG-gated radionuclide ventriculography (MUGA). LVEF

  10. Medical leaders or masters?—A systematic review of medical leadership in hospital settings

    Science.gov (United States)

    Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.

    2017-01-01

    Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335

  11. Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

    Science.gov (United States)

    Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M

    2017-01-01

    Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

  12. Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

    Directory of Open Access Journals (Sweden)

    Mathilde A Berghout

    Full Text Available Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

  13. Effectiveness of nurse-delivered patient education interventions on quality of life in elders in the hospital: A systematic review.

    Science.gov (United States)

    Strupeit, Steve; Buss, Arne; Dassen, Theo

    2016-11-01

    Nurse-delivered education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. To our knowledge, no systematic review has addressed the effects of nurse-delivered education interventions on the quality of life in a general elderly inpatient population. To evaluate the effectiveness of nurse-delivered education interventions compared to usual care with regard to the quality of life in elders in the hospital. A systematic review was performed to identify randomized controlled trials examining the effects of nurse-delivered educational interventions on the quality of life in elders in the hospital. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p-values were extracted to determine the effectiveness of the interventions. Four studies were included in the review. One study testing multicomponent interventions showed positive effects on quality of life. Two studies showed no effect, and one study showed a negative effect of the intervention on quality of life. Methodological appraisal revealed single biases in most of the studies. Because of the scarcity of positive findings, methodological issues, and heterogeneity between studies, this review could not provide evidence of the effectiveness of nurse-delivered education interventions in elders in the hospital for improving quality of life. Nurse-delivered education may be more effective as a part of multifactorial interventions. Further studies should examine interventions that focus on quality of life using validated measures. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. [Terminal care for elderly patients with dementia in two long-term care hospitals].

    Science.gov (United States)

    Hirakawa, Yoshihisa; Masuda, Yuichiro; Kimata, Takaya; Uemura, Kazumasa; Kuzuya, Masafumi; Iguchi, Akihisa

    2004-01-01

    A byproduct of the aging of the population has been a dramatic rise in patients with dementia. The aim of the present study is to clarify the use of aggressive and palliative treatments, artificial nutrition and sedation in long-term care hospitals in Japan. We assessed 123 deaths in people aged 65 and older who died in two long-term care hospitals in and around Nagoya from January 2001 to December 2002. All deceased were divided into two groups according to their diagnosis of dementia. Data on the particular characteristics of the deceased, diagnosis of dementia, aggressive treatments (including CPR, intubation, mechanical ventilation, the use of systemic antibiotics and blood transfusion), palliative treatments (including oxygen, narcotic and nonnarcotic pain medication) artificial nutrition (including hyperalimentation and tube feeding) and sedation during the last six months of their lives were collected from medical charts. The prevalence of aggressive and palliative interventions did not vary significantly with the diagnosis of dementia except for the use of vasopressors. Artificial nutrition was prevalent and few patients received sedatives in either group. Patients with and without dementia received similar treatments in the end-stage. A greater understanding of the course of dementia is needed to further discussions on the terminal care of people with dementia. A national consensus on how to treat end-stage demented patients is also needed.

  15. Scoping medical tourism and international hospital accreditation growth.

    Science.gov (United States)

    Woodhead, Anthony

    2013-01-01

    Uwe Reinhardt stated that medical tourism can do to the US healthcare system what the Japanese automotive industry did to American carmakers after Japanese products developed a value for money and reliability reputation. Unlike cars, however, healthcare can seldom be test-driven. Quality is difficult to assess after an intervention (posteriori), therefore, it is frequently evaluated via accreditation before an intervention (a priori). This article aims to scope the growth in international accreditation and its relationship to medical tourism markets. Using self-reported data from Accreditation Canada, Joint Commission International (JCI) and Australian Council on Healthcare Standards (ACHS), this article examines how quickly international accreditation is increasing, where it is occurring and what providers have been accredited. Since January 2000, over 350 international hospitals have been accredited; the JCI's total nearly tripling between 2007-2011. Joint Commission International staff have conducted most international accreditation (over 90 per cent). Analysing which countries and regions where the most international accreditation has occurred indicates where the most active medical tourism markets are. However, providers will not solely be providing care for medical tourists. Accreditation will not mean that mistakes will never happen, but that accredited providers are more willing to learn from them, to varying degrees. If a provider has been accredited by a large international accreditor then patients should gain some reassurance that the care they receive is likely to be a good standard. The author questions whether commercializing international accreditation will improve quality, arguing that research is necessary to assess the accreditation of these growing markets.

  16. Patients’ satisfaction with diabetes medications in one hospital, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al-Aujan S

    2012-10-01

    Full Text Available Shiekha Al-Aujan,1 Sinaa Al-Aqeel,1 Abdulhaleem Al-Harbi,2 Emad Al-Abdulatief21Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2Department of Family Medicine, Security Forces Hospital, Riyadh, Saudi ArabiaObjectives: The main aim of this study was to evaluate diabetic patients’ satisfaction with their treatment. A secondary objective was to assess the relationship between treatment satisfaction scores and patient-related factors, if any.Methods: This cross-sectional study collected data from patients at a primary care clinic of a government hospital located in Riyadh, the capital of Saudi Arabia. Patients were recruited if they were ≥18 years of age, had type 2 diabetes, currently taking oral hypoglycemic agents or insulin or both, and able to read and write in Arabic. Satisfaction was measured using the Diabetes Medication Satisfaction (DiabMedSat questionnaire.Results: One hundred and twenty-three patients completed the questionnaire. The participant mean age was 46 years (standard deviation [SD] = 11.2 years; range 18–75 years, and mean duration of the disease was 7.8 years (SD = 6.9 years. Over half of respondents (63% reported that they were satisfied and only 16% were unsatisfied. Approximately 54% of respondents are interested in changing their diabetes medications. The overall satisfaction score was 59.56 (SD = 15.9. Mean scores for the burden, efficacy, and symptoms domains were 59.81 (SD = 15.7, 58.1 (SD = 22.6, and 60.77 (SD = 22.1, respectively. Treatment factors (eg, type of medication; P < 0.02 and adherence factors (eg, difficulty taking medications; P < 0.032 were independently associated with lower treatment satisfaction.Conclusion: Diabetes patients with difficulties in adherence to recommendations, as well as patients treated with insulin, require more attention in order to improve their treatment satisfaction.Keywords: diabetes mellitus, health status, patient satisfaction

  17. Epidemiology of hospital acquired urinary tract infections in a medical college hospital in Goa

    Directory of Open Access Journals (Sweden)

    Umesh S Kamat

    2009-01-01

    Full Text Available Background: Hospital Acquired Urinary Tract Infection (HAUTI is the commonest among the nosocomial infections, and hospital specific data concerning its magnitude and attributes is essential to its effective control. Materials and Methods: Prospective study was undertaken among 498 in-patients at the medical college hospital in Goa, employing the clinico-bacteriologic criteria of CDC, Atlanta, in the representative medicine and surgery wards. Antimicrobial sensitivity was tested using the Kirby-Bauer disc diffusion method. Statistical Analysis: Statistical significance of association was tested using the chi-square test and the unpaired t-test at 5% level of significance, while the strength of association was expressed as the Odd′s ratio with 95% confidence interval calculated by Wolff′s method. Results: While the overall infection rate was 8.03/100 admissions, 33.6% of the catheterized patients developed HAUTI. Effect of gender was found to remain restricted to the development of HAUTI among females at an earlier age and earlier in time series compared to males, but no overall difference in incidence in the two sexes. The factors significantly associated with HAUTI included: duration of hospitalization, per urethral catheterization and the duration of catheterization. E. coli, Pseudomonas, Kebsiella, and Candida accounted for over 90% of the isolates, and 73.5% of these were resistant to all the antibiotics for which sensitivity was tested. The remaining isolates demonstrated sensitivity to amikacin and/or cefoperazone-sulbactam. Conclusion: High infection rate coupled with widespread isolation polyantimicrobial resistant nosocomial pathogens emphasizes the importance of meticulous surveillance of nosocomial infections in the hospital, with due attention to antibiotic prescription practices.

  18. SUITABILITY OF MEDICATIONS USED BY THE ELDERLY PARTICIPANTS OF A SOCIAL GROUP, ACCORDING TO THE BEERS CRITERIA

    Directory of Open Access Journals (Sweden)

    Geysa Donária de Miranda Mascarenhas

    2014-09-01

    Full Text Available The dynamic process defined as aging progressively reduces the functional capacity of the elderly and added to the lifestyle, they can to testify to the high number of pathologies. Thus, pharmacotherapy for this age group requires special care, keeping in view its peculiarities. Given this need, a group of researchers has developed criteria that allowed the identification of inappropriate medications. Thus, the aim of this study was to investigate the suitability of medications used by the elderly participants of a social group, in Vitória da Conquista, BA, according to the Beers criteria. This research was an exploratory descriptive study and data collection conducted through semi - structured interviews. It was asked to bring all the elderly who were using medications and / or prescriptions. It was found that 12.7% of the drugs used by the elderly appeared in the list of inappropriate medicines and 42% of respondents make use of polypharmacy. Among the most prescribed inappropriate medications, there is acetylsalicylic acid, diclofenac, diazepam, piroxicam, ibuprofen and amitriptyline. The class of inappropriate drugs most used by seniors was anti - inflammatory drugs. Given this, all health professionals need to put into practice the criteria for selecting medications this age group as the reality of existing drugs in Brazil.

  19. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2.

    Science.gov (United States)

    Kimura, T; Ogura, F; Yamamoto, K; Uda, A; Nishioka, T; Kume, M; Makimoto, H; Yano, I; Hirai, M

    2017-04-01

    The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (stopp) criteria were updated in 2014 (stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications (PIMs), and the efficacy of hospital pharmacists' assessment and intervention based on stopp criteria ver.2. The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIMs based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIMs or not. The number of patients prescribed PIMs, the number and contents of PIMs, and the number of medications changed after pharmacists' intervention were calculated. Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0-80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIMs. Patients prescribed PIMs took significantly more medications than others: 10·0 (7·0-13·0) vs. 6·0 (4·0-9·0), P PIMs was 651%, 47·6% of which (n = 310) were recommended the doctors to change, and 292 of 651 PIMs (44·9%) were finally discontinued/changed after pharmacists' assessment and intervention

  20. [Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital].

    Science.gov (United States)

    Sánchez-Hernández, N; Sáez-López, P; Paniagua-Tejo, S; Valverde-García, J A

    2016-01-01

    To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway. The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  1. General medical and ethical problems of drug treatment in the elderly.

    Science.gov (United States)

    Wolf, R

    1996-01-01

    Drug treatment of the elderly raises important concerns regarding medical and ethical issues. Medical problems may arise from age-related changes in social and economic conditions. Furthermore, there is a complexity of influences on the physical and mental state by polymorbidity and polypharmacy, and by alterations in pharmacokinetics and pharmacodynamics. Ethical problems may arise from a conflict of interests between different parties, e.g., between the patient's goal to get the best available treatment and the physican's goal to improve medical knowledge about a certain drug. A central problem in medical ethics is the conflict between two ethical principles: e.g., the principle of respect for the patient's autonomy and the principle of beneficence. The usual solution to this ethical dilemma is to make use of the concept of competence, but it is debatable whether competence is a binary or graded concept. The model of informed consent is based on the patient's competence. But for the purpose of drug treatment of mentally impaired subjects a proxy consent of a legally authorized representative was claimed.

  2. The hidden curriculum of the medical care for elderly patients in medical education: a qualitative study.

    NARCIS (Netherlands)

    Meiboom, A.A.; Diedrich, C.; de Vries, H.; Hertogh, C.; Scheele, F.

    2015-01-01

    Despite more attention being given to geriatrics in medical curricula, few new physicians are seeking training in this field. So far, there has been no exploration of factors in the hidden curriculum that could potentially influence the persisting lack of interest in this field of medicine. To study

  3. Influence of Admission to a Tertiary Care Hospital after a Fall on Use of Potentially Inappropriate Medications among Older Patients.

    Science.gov (United States)

    Francis, Erin; Dyks, Derek; Kanji, Salmaan

    2014-11-01

    Each year, about one-third of individuals over the age of 65 years will experience a fall, and half of these will experience a subsequent fall in the following year. The use of potentially inappropriate medications (PIMs) is an important factor contributing to increased fall risk in geriatric patients. To determine the proportion of patients over the age of 65 admitted to orthopedics and general medicine services with diagnosis of a fall who experienced a change in the total number or dosage of PIMs, as defined by the Beers criteria, upon discharge from hospital. This retrospective observational study involved patients admitted to a tertiary care hospital with diagnosis of a fall between January 1 and December 31, 2011. Those aged 65 years or older with at least one PIM on admission were eligible for inclusion. Data analysis included χ(2) and Fisher testing, as well as multivariate analysis. A total of 148 patients were included, of whom 63 (43%) had an overall change in the dosage or number of PIMs during their hospital stay. Forty patients (27%) had an overall reduction in the dosage or number of PIMs upon discharge from hospital, whereas 23 (16%) experienced an overall increase in the dosage or total number of PIMs. The mean number (± standard deviation) of PIMs decreased during the hospital stay, from 1.6 ± 0.8 on admission to 1.4 ± 0.9 on discharge (p = 0.03). Benzodiazepines were the class of PIMs most frequently discontinued or reduced in dosage. One-quarter of patients admitted with falls had de-escalation of PIMs upon hospital discharge. Although dosage reduction or drug discontinuation may not be appropriate for all patients, a standardized approach to medication review during the hospital stay and improved prescriber education and awareness of PIM use among elderly individuals are warranted.

  4. Debates on Medical Quality and Safety in Wuwei people’s hospital

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    Xue-hua QI

    2014-06-01

    Full Text Available How to improve medical quality and reduce medical disputes has become a major issue in clinical and nonclinical departments at all levels of hospital. The paper puts forward a proposal of “Three lines of defense” concerning medical quality and safety, which plays a positive role in prevention of medical errors, in improvement of medical quality and patient safety.

  5. Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students, Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

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    Stanislaw Gorski

    2017-01-01

    Full Text Available Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students, targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards. Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization, received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

  6. Medical hospital materials processing: a literature review on sterilization effectiveness

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    Leonardo Mousinho Guerra

    2013-04-01

    Full Text Available Backgound and Objectives: Surgical instruments are widely reprocessed, mainly in developing countries, where the cost of using these materials is high. Scientifi c literature indicates the absence of validated cleaning and sterilization processes. The study aimed at evaluating, through a literature review, the evidence to support or not the practice of reprocessing and reuse of originally single-use, medical-hospital materials. Methods: A total of 27 articles in English and Portuguese were selected from journals indexed in the LILACS, Pubmed and Medline databases, as well as studies published in ScienceDirect website using the following key words: sterilization, single-use articles, hospital infection and surgical instruments. Articles that did not fi t the study subject were excluded. Results: There was a great variety of studied instruments and reprocessing methods. Most articles emphasize the sterilization ineffectiveness, identifying microorganisms at the end of the process. Conclusion: Based on the current knowledge, it is important to consider each case validating surgical materials reprocessing and reuse protocols based on scientific knowledge. Based on the analysis of the study articles, we concluded that this practice cannot be performed indiscriminately. KEYWORDS: Sterilization. Cross infection. Surgical Equipment. Public Health.

  7. Etiology and complications of thrombocytopenia in hospitalized medical patients.

    Science.gov (United States)

    Fountain, Eric M; Arepally, Gowthami M

    2017-05-01

    To determine incidence, risk factors, hematologic complications, and prognostic significance of thrombocytopenia in the general medicine population, we performed a single-institutional, retrospective study of all adult patients admitted to a general medical ward from January 1st, 2014 to December 31st, 2014 with hospital-acquired thrombocytopenia. Those with moderate thrombocytopenia, defined as a platelet count nadir of 50% relative decline, were compared to those with less severe thrombocytopenia. Of the 7420 patients admitted, 465 (6.3%) developed hospital-acquired thrombocytopenia. Infection and moderate thrombocytopenia were present in 56 and 23%, respectively. Severe sepsis and antibiotic use were both associated with moderate thrombocytopenia, and proton pump inhibitor use was statistically significant in both univariate and multivariate analysis. Hematologic complications were more frequent with moderate thrombocytopenia, including frequency of HIT testing and red blood cell transfusions. Outcome metrics including transfer to an intensive care unit (OR 6.78), death during admission (OR 6.85), and length of stay (10.6 vs. 5.1 days) were all associated with moderate thrombocytopenia. Thrombocytopenia is associated with poor prognosis, and the association between moderate thrombocytopenia and proton pump inhibitor use is relatively novel and should be validated in prospective studies.

  8. Pneumococcal infections in elderly patients attending hospital since PCV-13 authorization in Spain.

    Science.gov (United States)

    Payeras, Antoni; Peñaranda, Maria; Iñigo, Antonio; Garau, Margarita; Luis Pérez, José; Gallegos, Carmen; Riera, Melchor

    2017-01-01

    To study the characteristics and outcomes of pneumococcal infections in patients aged ≥65 years since the authorization of the 13-valent pneumococcal conjugate vaccine (PCV-13) in Spain. All pneumococcal pneumonias, empyemas or primary bacteraemias treated at two hospitals in Majorca from 2010 to 2015 were included. Clinical variables, serotypes, and antibiotic susceptibility were collected. Two hundred and forty-nine pneumonias, 11 primary bacteraemias, and 2 empyemas in 243 patients were studied; 181 (69.1%) men, median age 76 years (range: 66-99). Seven (2.6%) were pneumococcal-vaccinated. Bacteraemia was present in 127 (61.9%) cases and related to a higher severity, p= 0.02, and not having chronic lung disease, p = 0.002. Ninety-seven (37%) episodes involved complications and 30 (11.5%) patients died. Mortality was related with the presence of complications at admission, p < 0.001. Only septic shock was more frequent in patients ≥65 years during the period 2010-2015 compared to the period 2006-2010: 38 of 262 (14.5%) vs. 17 of 212 (8%), p = 0.02. Most infections (57.6%) were due to PCV-13 serotypes but were not related to a worse prognosis. The proportion of PCV-13 serotypes tended to decrease from 61% (non-invasive) and 80% (invasive) in 2010-2011 to 33% and 47% in 2014-2015. The antibiotic susceptibility remained stable. Rates of pneumococcal vaccination in elderly patients with pneumococcal infections were very low. Except for septic shock, the main outcome variables (including mortality) were similar to the ones observed in the period preceding PCV-13 authorization. PCV-13 serotypes were responsible for most infections although they showed a decreasing trend.

  9. Deterioro funcional en ancianos ingresados en un hospital sin unidades geriátricas Functional impairment in elderly inpatients in a hospital without geriatric units

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    Alfonso Jesús Cruz Lendínez

    2010-03-01

    ás influyen en la variación de la capacidad funcional durante la hospitalización. La hospitalización de ancianos en un hospital sin unidad geriátrica supone peores resultados en la capacidad funcional de los pacientes frente a los hospitales que cuentan con unidad de hospitalización geriátrica.Introduction: Increased population of elderly people is becoming more frequent admission to hospitals of people older than 65 years. Hospital stay in conventional units can lead to functional worsening in the elderly. Aim: To identify the profile of elderly patients treated in the Internal Medicine Hospital of Jaén. To analyze variation in functional ability of elderly people following admission to inpatient units of a public hospital. To identify variables that influence the changes in the functional ability of elderly inpatients in hospitals without geriatric units. Methods: Prospective observational study in 3 units of internal medicine units in a hospital belonging to the Andalusian Health Service. A sample of 190 hospitalized elderly patients has been included. Variables related to demographic, hospitalization and functional ability using Barthel Index, were reported. Results: Hospitalization in internal medicine units did not help to improve functional ability in older people; rather, they had a negative effect, promoting functional worsening in an important group of these patients. Depending on the age, among patients studied (65-85 and over, younger patients got better results on functional recovery at discharge, while those above 85 years got worst results. 16% under 85 years and 67.5% of those over 85 lose functional capacity. Conclusions: Most important factors affecting functional ability change during hospitalization were age, functional ability at admission, functional ability at discharge, the presence of companions during hospitalization and discharge destination. Hospitalization of elderly in a nongeriatric inpatient unit at hospital assumes no worse results in

  10. Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP)

    Science.gov (United States)

    2012-01-01

    Background Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. Methods/design To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented an innovative program (PReCaP), aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. Discussion This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the Prevention and Reactivation Centre (PRC); (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of future papers. Trial registration The Netherlands National Trial Register: NTR2317 PMID:22423638

  11. Suitability of an electronic reminder device for measuring drug adherence in elderly patients with complex medication.

    Science.gov (United States)

    Harbig, Philipp; Barat, Ishay; Damsgaard, Else M

    2012-09-01

    We evaluated an electronic reminder device for detecting non-adherence in elderly patients with complex medication regimens. Randomly selected, home-living elderly patients were studied. The patients were aged over 65 years and were taking more than four drugs. Patients received an electronic reminder device which contained a GSM communications module. They were visited three times over a one-year period by a nurse who counted their medicine supply. We compared the adherence measured by the electronic device with the actual adherence measured by the pill count. Almost half of the 315 patients dropped out of the study for various reasons, so the calculations were performed on 168 patients. The adherence measured by the electronic reminder system was 79% and was 92% measured by pill count (Padherence at morning/evening intake times with pill count adherence in the morning/evening only. For the pill count, there was almost no difference between morning and evening adherence rates (93%). For electronic measurement, adherence rates were lower in the evening (75%) than in the morning (81%). Electronic reminders were less reliable than the pill count in measuring adherence. However, the electronic system may be a useful supplement to other, more time consuming methods for measuring adherence.

  12. The contribution of a clinical pharmacist to the improvement of medication at a geriatric hospital unit in Norway.

    Directory of Open Access Journals (Sweden)

    Veggeland T

    2008-03-01

    Full Text Available The aim of the study was to use a clinical pharmacist in order to improve the medication of patients in a geriatric hospital unit. The hospital had no experience of using a clinical pharmacist before.Methods: A clinical pharmacist participated in the therapeutic team for 27 days during a 4-year period. Drug-related problems were recorded prospectively and discussed before and at the ward round. The results of the physician’s decisions on the current day about potential changes in medication proposed by the pharmacist were continuously recorded.Results: The pharmacist evaluated the medication of 250 patients. At least one drug- related problem was found in 188 (75% of the patients. For these patients, the physician made 606 decisions concerning potential changes in the medication (3.2 per patient. Thirty percent (184/606 of the decisions were connected to further measurements and to the follow-up of laboratory results, mainly (82%, 151/184 for cardiovascular drugs. Forty-two percent (255/606 of the decisions resulted in the discontinuation of drugs, dosage reduction or a decision to revise the assessment at a later stage during hospitalisation. Medicines with anticholinergic adverse effects were to a great extent withdrawn. Twenty-one percent (129/606 of the decisions were made on drugs with an addiction potential: hypnotics, anxiolytics, as well as analgesics containing tramadol and codeine. The result was often (71%, 91/129 dosage reduction, a change from fixed medication to medication on demand or to discontinuation. Conclusion: Even with a modest participation of once a month, the evaluation of a patient’s medication by a clinical pharmacist led to improved changes and the follow-up of the medication of the elderly.

  13. Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea.

    Directory of Open Access Journals (Sweden)

    Seung Ju Kim

    Full Text Available Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN care.We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery.We found that 150,256 (35.9% total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93-0.96compared to other hospitals Medical costs (0.74% and length of stay (1% in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57% in specialty hospitals compared with other hospitals.We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.

  14. [Historical origins between National Medical Association of China and Boji Hospital in Guangzhou].

    Science.gov (United States)

    Liu, Pinming

    2015-09-01

    In 2015, National Medical Association of China, now being called the Chinese Medical Association, celebrates its centennial and Boji Hospital in Guangzhou ( also known as Canton Hospital, or the Canton Pok Tsai Hospital, and now Sun Yat-sen Memorial Hospital of Sun Yat-sen University ) marks its 180th anniversary. Three major historical events establish the role of Boji Hospital in the founding and development of the National Medical Association of China during the last 100 years, viz.: ①hosting and participating in the establishment of the Medical Missionary Association of China and its official journal: the China Medical Missionary Journal; ②holding the 11th scientific sessions of the National Medical Association of China; ③nominating Dr. Wu Lien-teh as a candidate for the Nobel Prize in Physiology or Medicine in 1935 by William Warder Cadbury, the president of Boji Hospital.

  15. Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

    Science.gov (United States)

    Leonard, Maeve; McInerney, Shane; McFarland, John; Condon, Candice; Awan, Fahad; O'Connor, Margaret; Reynolds, Paul; Meaney, Anna Maria; Adamis, Dimitrios; Dunne, Colum; Cullen, Walter; Trzepacz, Paula T; Meagher, David J

    2016-01-01

    Objectives Differentiation of delirium and dementia is a key diagnostic challenge but there has been limited study of features that distinguish these conditions. We examined neuropsychiatric and neuropsychological symptoms in elderly medical inpatients to identify features that distinguish major neurocognitive disorders. Setting University teaching hospital in Ireland. Participants and measures 176 consecutive elderly medical inpatients (mean age 80.6±7.0 years (range 60–96); 85 males (48%)) referred to a psychiatry for later life consultation-liaison service with Diagnostic and Statistical Manual of Mental Disorders (DSM) IV delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with comparison of scores (including individual items) for the Revised Delirium Rating Scale (DRS-R98), Cognitive Test for Delirium (CTD) and Neuropsychiatric Inventory (NPI-Q). Results The frequency of neurocognitive diagnoses was delirium (n=50), dementia (n=32), comorbid delirium–dementia (n=62) and cognitively intact patients (n=32). Both delirium and comorbid delirium–dementia groups scored higher than the dementia group for DRS-R98 and CTD total scores, but all three neurocognitively impaired groups scored similarly in respect of total NPI-Q scores. For individual DRS-R98 items, delirium groups were distinguished from dementia groups by a range of non-cognitive symptoms, but only for impaired attention of the cognitive items. For the CTD, attention (p=0.002) and vigilance (p=0.01) distinguished between delirium and dementia. No individual CTD item distinguished between comorbid delirium–dementia and delirium. For the NPI-Q, there were no differences between the three neurocognitively impaired groups for any individual item severity. Conclusions The neurocognitive profile of delirium is similar with or without comorbid dementia and differs from dementia without delirium. Simple tests of attention and

  16. [White House Conference on Aging, 1981: Health-Related and Medical Care Issues of the Elderly. Eighteen Reports.

    Science.gov (United States)

    White House Conference on Aging, Washington, DC.

    This document contains the 18 papers on health-related and medical care issues of the elderly that were presented at the 1981 White House Conference on Aging. The materials focus on the following topics: physical mobility, death, heart disease, nutrition, injury, senile dementia, post-menopausaul women, gerontological nursing, learning and memory,…

  17. Status of Hepatitis B Immunization in Medical Stuffs at Children Medical Center Hospital-Tehran

    Directory of Open Access Journals (Sweden)

    M Najafi

    2014-04-01

    Full Text Available Introduction: Hepatitis B is a disease caused by the hepatitis B virus (HBV, which is transmitted through percutaneous (i.e., puncture through the skin or mucosal (i.e., direct contact with mucous membranes exposure to infectious blood or body fluids. HBV can cause chronic infection, resulting in cirrhosis of the liver, liver cancer, liver failure, and death. Persons with chronic infection also serve as the main reservoir for continued HBV transmission.   Material and Methods: This is a prospective cross sectional study was performed in Children Medical Center Hospital on 396 medical personals (including 172 students, 92 interns, 56 residents and 56 fellowships during September 2012 to October 2013.   Results: All of medical staff had done HB vaccination. In 93% of them the vaccination was complete. The others, 16% had only one, and 84% had two dose injections. 73% didn’t check HBsAb after vaccination.  Results showed in 21.4% of fellowships, 42.8% of residents, non of interns and 35% of students, had checked HBsAb.   Conclusion: Hepatitis B is a vaccine-preventable disease. HB is a serious world wide infection and medical staff are one of the most high risk groups. So Vaccinate their and HBS Antibody titer determination after complete vaccination is mandatory.    Keywords:Immunization, Hepatitis B, Medical Staff, Vaccination.  

  18. Pattern of pulmonary tuberculosis in elderly patients in Sohag Governorate: Hospital based study

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    Mona T. Hussein

    2013-04-01

    Conclusion: This study showed that elderly pulmonary TB patients had higher frequencies of atypically clinical, radiological presentations, co-morbidities, anti-tuberculosis drug adverse reactions and TB related mortality.

  19. Risk profile and in-hospital prognosis in elderly patients presenting for acute ST-elevation myocardial infarction in the Tunisian context

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    Walid Jomaa

    2016-11-01

    Conclusions: In the Tunisian context, elderly patients presenting with STEMI have higher prevalence of risk factors and a worse in-hospital course in comparison to younger patients. Clinical presentation on-admission has a strong impact on in-hospital prognosis.

  20. Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study.

    Science.gov (United States)

    Sung, Li-Chin; Chen, Chang-I; Fang, Yu-Ann; Lai, Chih-Hong; Hsu, Yi-Ping; Cheng, Tzu-Hurng; Miser, James S; Liu, Ju-Chi

    2014-06-24

    Elderly patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of hospitalization for cardiovascular complications, especially during respiratory infections. Previous studies showed that vaccination for influenza may reduce the risk of recurrent major cardiovascular events in patients with acute coronary syndrome (ACS). The purpose of this study was to evaluate the hypothesis that influenza vaccination could reduce hospitalizations for ACS in elderly patients with COPD. Using the Taiwan Longitudinal Health Insurance Database 1996-2008, this cohort study comprised elderly patients (≥ 55 years old) with a recorded diagnosis of COPD (n=7722) between January 1, 2000 and December 31, 2007. Each patient was followed until the end of 2007. A propensity score was derived by using a logistic regression model to reduce vaccine therapy selection bias. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS in elderly COPD patients was examined by Cox proportional hazards regression analysis. In addition, we categorized the patients into four groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2-3, and ≥ 4). We found that elderly patients with COPD receiving influenza vaccination had a lower risk of hospitalization for ACS (adjusted HR=0.46, 95% CI (0.39-0.55), p elderly patients with COPD receiving annual influenza vaccination. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Reporting of medication administration errors by nurses in South Korean hospitals.

    Science.gov (United States)

    Lee, Eunjoo

    2017-10-01

    To identify differences in what nurses consider as medication administration errors, to examine their willingness to report these errors and to identify barriers to reporting medication errors by hospital type. Cross-sectional, descriptive design. The questionnaire comprised six medication administration error scenarios and items related to the reasons for not reporting medication errors. Two tertiary and three general hospitals in a metropolitan area, and five general hospitals in K province, in South Korea. Registered nurses working at tertiary and general hospitals in South Korea (n = 467). Consideration of medication administration errors, intention to report medication errors and reasoning for not file an incident report. There were no significant differences in what nurses considered as medication administration errors between nurses working different in hospital types. The rate of incident reporting was very low; it ranged from 6.3% to 29.9%, regardless of hospital type. Korean nurses were more likely to report an error to a physician than file an incident report. The primary reason for not reporting medication errors was fear of the negative consequences of reporting the error and subsequent legal action. The rate of filing an incident report among nurses was very low, regardless of hospital type or whether nurses perceived the incident as a medication administration error. These results may have significant implications for improving medication safety in hospitals, and more efforts are needed at the organizational level to improve incident reporting by nurses.

  2. Bed blockers: A study on the elderly patients in a teaching hospital in India

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    Praveen Kumar N

    2010-07-01

    Full Text Available A cross-sectional study of in-patients over the age of 60 years was conducted at district McGann Hospital, Shimoga on patients who were classified as bed blockers. Level of dependency and cognitive function of these patients were assessed using Barthel scale and Abbreviated mental test (AMT respectively. Median age of the study population was 67 years; majority of them were men. Most of them were admitted in the medical ward and the median time to be labeled as bed blocker was 32 days. These bed blockers were a weak group of patients with an average 3.1 pathology per case. Majority of them suffered from neurological disorders and cardiovascular disease. High level of dependence was noted with a mean Barthel score of 29.68 (Range 0 -100. Low levels of cognitive function was also noted among these patients with a mean AMT of 4.76 (Range 0 -10.These findings demonstrate that the bed blockers in McGann hospital suffer not only from genuine health problems but also have a high dependency level in activities of daily living which hamper their discharge to the community. Community based rehabilitation using an intersectoral approach may help at least the less dependent to return home.

  3. Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study.

    Science.gov (United States)

    Wai, Abraham K C; Chor, C M; Lee, Allen T C; Sittambunka, Yuwares; Graham, Colin A; Rainer, Timothy H

    2009-04-08

    The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations. To investigate changes in ED presentations and care processes, and the relationship of patient demand and ED staff resources to waiting times and processing times. Retrospective analysis of prospectively collected administrative data from January 1999 to April 2005 in an emergency department in a university teaching hospital in Hong Kong. All patients attending the emergency department during the study period were included. Monthly attendance data were retrieved and analysed to determine both qualitative and quantitative changes in the patterns of presentation to the ED using prospectively gathered data. Total ED attendances decreased by 25% during the study with little seasonal variation. The admission rate and the use of ambulances increased steadily and significantly. Medical patients are increasing proportionately, but trauma patients are decreased in number. There have been major changes in the patterns of ED attendances and ED waiting times over the study period in this teaching hospital ED. Decreasing overall ED numbers are offset by an increasingly elderly population and a more complex case mix. Reducing clinical staff numbers appears to reduce the ED's capacity to provide timely assessments and care and to function as hospital gatekeepers. Restoring staff numbers to previous levels may improve the quality and timeliness of ED services. It is necessary to refine measures of ED complexity and workload to determine appropriate staffing levels in the future.

  4. Situation analysis of patients attending TU Teaching Hospital after medical abortion with problems and complications

    National Research Council Canada - National Science Library

    Ojha, Neebha; Bista, Kesang D B

    2013-01-01

    In Nepal medical abortion has been approved for use since 2009. There were many cases coming to Tribhuvan University Teaching Hospital coming with problems and complications following medical abortion...

  5. 城区老年健康服务需求医学社会学分析%Medical Sociology Analysis of Urban Elderly Health Service Demand

    Institute of Scientific and Technical Information of China (English)

    韩晓丹; 金新政

    2016-01-01

    目的:研究城市社区老年人的就医模式。方法采用问卷调查的方法对武汉市城区老年人的健康服务需求和行为进行调查,并用统计分析方法分析调查数据。结果自感病轻时超过80%的老年人选择就医,就医机构以社区、街道卫生服务中心为主,自感病重时约99%的老年人选择就医且绝大多数选择大型医院;影响老年人选择医疗机构的因素主要是“距离近,交通方便”(73.85%)、“医疗水平高”(65.23%)、“信誉好”(50.67%)、“医疗服务人员态度好”(46.09%)、“服务价格合理”(44.74%),等等;仍有接近20%的老年人在突发重病时无法获得及时的医疗救助;老年人患病未就医的主要影响因素是自感病情不严重(48.79%),其次是经济负担(25.70%)。结论建议加强政策性支持和指导,促进基础医疗机构发展,增强老年人健康意识。%Objective To research the treatment seeking mode of the urban community elderly. Method Adopt questionnaire survey to investigate the health service needs and behaviors of the urban community elderly in Wuhan, and analysis the data from questionnaire survey by statistical analysis methods. Results More than 80% of the elderly people go for medical treatment when self-induction disease condition is light and most of them give priority to community health service center, and about 99%of the elderly people choose go for medical treatment when self-induction disease condition is serious and most of them give priority to large-scale hospital;The influencing factors of the old to choose medical institutions are mainly as follows:‘the near distance, traffic is very convenient’(73.85%),‘Medical level is high’(65.23%),‘good credit’(50.67%),‘good service attitude’(46.09%),‘reasonable price’(44.74%), etc; There are still close to 20% of the old in sudden illness cannot get timely medical treatment; The main

  6. Twenty-Four-Hour Mobility During Acute Hospitalization in Older Medical Patients

    DEFF Research Database (Denmark)

    Pedersen, Mette Merete; Bodilsen, Ann Christine; Petersen, Janne

    2013-01-01

    BACKGROUND: Inactivity during hospitalization in older medical patients may lead to functional decline. This study quantified 24-hour mobility, validated the accelerometers used, and assessed the daily level of basic mobility in acutely admitted older medical patients during their hospitalization....... METHODS: This is a prospective cohort study in older medical patients able to walk independently (ambulatory patients) and those not able to walk independently (nonambulatory patients) on admission. The 24-hour mobility level during hospitalization was assessed by measuring the time in lying, sitting......%-100% with positions performed by older medical patients. CONCLUSIONS: Older acutely hospitalized medical patients with walking ability spent 17h/d of their in-hospital time in bed, and the level of in-hospital mobility seemed to depend on the patients' level of basic mobility. The accelerometers were valid...

  7. A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria.

    Science.gov (United States)

    Adamis, Dimitrios; Rooney, Siobhan; Meagher, David; Mulligan, Owen; McCarthy, Geraldine

    2015-06-01

    The recently published DSM-5 criteria for delirium may lead to different case identification and rates of delirium than previous classifications. The aims of this study are to determine how the new DSM-5 criteria compare with DSM-IV in identification of delirium in elderly medical inpatients and to investigate the agreement between different methods, using CAM, DRS-R98, DSM-IV, and DSM-5 criteria. Prospective, observational study of elderly patients aged 70+ admitted under the acute medical teams in a regional general hospital. Each participant was assessed within 3 days of admission using the DSM-5, and DSM-IV criteria plus the DRS-R98, and CAM scales. We assessed 200 patients [mean age 81.1±6.5; 50% female; pre-existing cognitive impairment in 63%]. The prevalence rates of delirium for each diagnostic method were: 13.0% (n = 26) for DSM-5; 19.5% (n = 39) for DSM-IV; 13.5% (n = 27) for DRS-R98 and 17.0%, (n = 34) for CAM. Using tetrachoric correlation coefficients the agreement between DSM-5 and DSM-IV was statistically significant (ρtetr = 0.64, SE = 0.1, p concept (delirium). Clarity of diagnosis is required for classification but also further research considering the relevance in predicting outcomes can allow for more detailed evaluation of the DSM-5 criteria.

  8. Medical insurance policy organized by Chinese government and the health inequity of the elderly: longitudinal comparison based on effect of New Cooperative Medical Scheme on health of rural elderly in 22 provinces and cities.

    Science.gov (United States)

    Liang, Ying; Lu, Peiyi

    2014-05-13

    The alarming progression of the aging trend in China attracts much attention in the country and abroad. In 2003, the Chinese central government launched the New Cooperative Medical Scheme (NCMS) to resolve the inequity problem of health in regions with inadequate infrastructure and relative poverty. The rural elderly are the main beneficiaries of this policy; the improvement of their health through the medical insurance policy require exploration. This study used data obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2005 and 2008. Elderly people living in rural areas and aged 60 and above were screened for the investigation. A total of 8658 and 9904 elderly people were selected from 2005 and 2008, respectively. By establishing models and employing multi-logistic analysis, stereotype logistic analysis, we examined the effect of NCMS organized by Chinese government on three domains of the health of the rural elderly. A total of 948 and 6361 elderly people participated in NCMS in 2005 (n = 8658) and 2008 (n = 9904), respectively. With regard to the independent variables, the number of participants in NCMS increased, whereas province distribution, gender, and years of education only slightly changed. As for the dependent variables, the rural elderly in 2005 had poor general health but good psychological health. Differences were found between different moods. Old people who engage in much outdoor activity can take care of themselves. After three-year promotion of NCMS, the differences between 2005 and 2008 indicate that the physical function of the rural elderly worsen, whereas the general health and psychological health improves. (1) In the 2005 data and 2008 data, result shows that NCMS participation can promote the self-rated quality and health change of the elderly. (2) After three years, the alleviation effect on anxiety and loneliness changed from insignificant to significant. Participants in NCMS have a stronger sense of

  9. The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors

    Directory of Open Access Journals (Sweden)

    Dijkgraaf Marcel G

    2011-05-01

    Full Text Available Abstract Background The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established. However, given the substantial incidence of preventable ADEs in Dutch hospitals found in recent studies, appears warranted. Therefore, "Ward-Oriented Pharmacy", an on-ward service tailored to the Dutch hospital setting, will be developed. This service will consist of multifaceted interventions implemented in the Internal Medicine wards by hospital pharmacists. The effect of this service on preventable ADEs in elderly inpatients will be measured. Elderly patients are at high risk for ADEs due to multi-morbidity, concomitant disabilities and polypharmacy. Most studies on the incidence and preventability of ADEs in elderly patients have been conducted in the outpatient setting or on admission to a hospital, and fewer in the inpatient setting. Moreover, recognition of ADEs by the treating physicians is challenging in elderly patients because their disease presentation is often atypical and complex. Detailed information about the performance of the treating physicians in ADE recognition is scarce. Methods/Design The design is a multi-centre, interrupted time series study. Patients of 65 years or older, consecutively admitted to Internal Medicine wards will be included. After a pre-measurement, a Ward-Oriented Pharmacy service will be introduced and the effect of this service will be assessed during a post-measurement. The primary outcome measures are the ADE prevalence on admission and ADE incidence during hospital stay. These outcomes will be assessed using structured

  10. The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

    Science.gov (United States)

    Hammer, Antje; Ommen, Oliver; Röttger, Julia; Pfaff, Holger

    2012-01-01

    The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a mu