It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. L E et al. However, because of the relevant amount of missing data regarding GIC in patients hospitalized in geriatric units, we restricted the analysis of the present study to patients admitted to the medical units (and discharged alive). The Pro.Di.Ge. Acute Disease*/rehabilitation; Aged; Bed Rest/adverse effects* H Elderly patients who have symptomatic chronic mesenteric ischemia are at very high risk of developing acute on chronic mesenteric ischemia. Mehta It can be postulated that prehospital functional decline and HAD occur more frequently in frail older persons accumulating abnormalities in multiple domains, including subthreshold neuromuscular impairments or initial disability, cognitive dysfunction, comorbidities, depressive symptoms, a lack of social support, and others. See the full list here. M GIC 3–4 patients were not significantly older than GIC 1–2 patients (83.1±8.2 vs 82.4±8.3 years), but they had longer LOS (9.1±6.3 in GIC 3–4 vs 6.4±5.1 days in GIC 1–2) and lower preadmission BI (77.2±26 vs 89.6±18.7). Rozzini The PROgetto DImissioni in GEriatria Study, Impact of functional change before and during hospitalization on functional recovery 1 month following hospitalization, Recovery of activities of daily living in older adults after hospitalization for acute medical illness, Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care, A clinical index to stratify hospitalized older adults according to risk for new-onset disability, Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization, Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization, Influence of cognitive impairment and comorbidity on disability in hospitalized elderly patients, Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity, Development and testing of a new index of comorbidity, Geriatrics index of comorbidity was the most accurate predictor of death in geriatric hospital among six comorbidity scores, Prospective comparison of 6 comorbidity indices as predictors of 1-year post-hospital discharge institutionalization, readmission, and mortality in elderly individuals, Comorbidity and prognostic indices do not improve the 5-year mortality prediction of components of comprehensive geriatric assessment in hospitalized older patients, Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness, Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors, A systematic literature review of factors affecting outcome in older medical patients admitted to hospital, Association of the clinical frailty scale with hospital outcomes, Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. Z E As described earlier, this is an expected finding, due to the immediate disabling effect of acute cerebrovascular diseases. Rudberg et al. Call for Applications for Editor-in-Chief, Copyright © 2021 The Gerontological Society of America. Frisoni When older patients undergo HAD, they are at increased risk of postdischarge negative outcomes, including death, nursing home placement, short-term rehospitalization, and prolonged disability (3,5,9). Nov-Dec 2009;49(3):409-12. doi: 10.1016/j.archger.2008.12.008. CI = confidence interval; GIC = Geriatric Index of Comorbidity; LOS = length of stay; n = number; OR = odds ratio. We found a strong association between poor functional outcomes and LOS, which was a significant correlate of HAD even after controlling for prehospital functional decline. Sepsis – Fever is less common as a presentation of sepsis in the elderly. et al. These factors are expected to strongly interact with the relationship between comorbidity and HAD (21). The severity of illnesses was strongly associated with adverse functional outcomes around hospitalization, but frailty, intended as functional vulnerability to the acute disease before hospitalization, was a stronger predictor of HAD than illness severity and age. L Sinoff N E Barbisoni ( Log Out / Acute mental illness in the elderly:Acute mental illness in the elderly is a general term which can be used to describe a range of symptoms involving problems with feelings, behaviors, emotions and thoughts. Bueno Also, the study protocol did not include any change in the model of care usually provided by each unit to elderly patients. This study has limitations. Covinsky Wall 1,2 In the United States, there are 25.5 million persons aged 65 years and older. Wang R This phenomenon is termed “hospitalization-associated disability” (HAD) and is recognized as a geriatric syndrome (2,3). Factors causing this include decreased immune response, blunted rise in heart rate, co-morbid diseases and polypharmacy. Items in the BI relate to self-care (feeding, grooming, bathing, dressing, bowel and bladder continence, and toilet use) and mobility (ambulation, transferring, and climbing stairs). Arch Gerontol Geriatr. PMID: 19200611 [Indexed for MEDLINE] Publication Types: Clinical Trial; MeSH terms. GIC was constructed as follows (15). Further research is warranted for better identifying premorbid subclinical abnormalities which may herald prehospital functional decline and HAD (2,3). MA Ferrucci The scale ranges from 0, representing a totally dependent, bedridden state, to 100, indicating full independence. All rights reserved. Logistic Regression Analysis of Variables Associated With Functional Decline in the Transition From Preadmission Baseline to Hospital Admission (prehospital functional decline). C In all these logistic regression analyses, older age, LOS, emergency admission, admission from other hospital units, and GIC 3–4 were, again, significant predictors of HAD. When these logistic regression analyses were repeated by including only patients with baseline BI above 20, similar results were observed, with older age, emergency admission, admission from other hospital units, LOS, and GIC 3–4 (OR 1.99, 95% CI 1.2–3.1, p = .003), but also dementia (OR 2.7, 95% CI 1–7.3, p = .04), as significant predictors of HAD in Model 1 and with LOS and prehospital functional decline as significant predictors of HAD in Model 2 (number of valid cases = 655 for both the models). Acute Illness in Older Adults: Watch for subtle changes. Second, we did not examine the role of some important hospitalization processes, including continence and nutritional care, use of medications, and in-hospital mobility. Orsitto S JD A Landefeld When the latter association between GIC 3–4 and HAD was controlled for the occurrence of prehospital functional decline, however, GIC 3–4 was not significantly predictive of HAD anymore, while prehospital functional decline was the main determinant of HAD. This limits the generalizability of our results, which needs to be replicated in larger populations including patients hospitalized in geriatric wards. KE RH et al. Mudge Elective admission (directly from home) was intended as a planned hospitalization, due to a recent-onset medical disease, mainly after evaluation in an outpatient setting. In general, poor premorbid (15 days before hospitalization) function, older age, functional status at hospital admission, cognitive impairment, and depression have consistently proved to be prognostic factors for HAD (2,3). Acute diseases come on rapidly, and are accompanied by distinct symptoms that require urgent or short-term care, and get better once they are treated. These considerations warrant the need of a more “realistic” approach to the issue of hospitalization of older persons and the effective and timely transition of such patients to posthospital settings (25). Table 2 shows the results of the logistic regression analysis for the interval baseline–admission (before hospitalization). Although most of the functional decline occurs before hospitalization in response to the acute diseases, the role played by comorbidity in the functional trajectories around hospitalization is unclear. LP Denaro CS Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Accordingly, older age, a typical predictor of negative functional outcomes during hospitalization in prior studies (4), was no longer significantly associated with HAD after adjustment for prehospital functional decline. Clinical Phenotype in an Early-Onset French Pediatric Population: Charcot-Marie-Tooth's Disease Type 2A. When this logistic regression analysis was repeated by including only patients with baseline BI above 20 (thereby excluding patients with baseline BI ≤ 20, ie, with severe premorbid disability), we obtained similar results, with older age, emergency admission, admission from other hospital units, and GIC 3–4 (OR 2.2, 95% CI 1.5–3.3, p < .0001), but also low baseline BI (OR 0.989, 95% CI 0.981–0.99, p = .01), which emerged as independent predictors of prehospital functional decline (number of valid cases = 670). First, our database did not include some important variables, such as biological measures, body mass index, cognitive status measurements, history of falls, socioeconomic status, diagnosis of delirium or depression, and objective measures of physical performance, which might contribute to explain the relation between severity of illness and prehospital functional decline. Acute diseases and subsequent hospitalization are crucial events in the trajectory leading to disability in older people and account for about 50% of all new-onset disabilities in the general elderly population (1). Delirium is often a prominent feature; Blood Pressure can drop earlier than in most cases. The occurrence of prehospital functional decline was also accounted for as independent predictor of HAD after adjustment for other variables. G Patients were also grouped according to the primary coded ICD9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) discharge diagnosis in the following nine disease categories: valvular and organic cardiomyopathies, coronary artery disease, conduction disorders and arrhythmias, cerebrovascular diseases, neurological diseases, gastrointestinal diseases, pulmonary diseases, cancer, and other diseases. Myocardial Infarction – One third of elderly patients will have no chest pain in Myocardial Infarction. Ibáñez-Beroiz causes of Acute mental illness in the elderly, Symptom Checker, including diseases and ⦠âThe hospitalization, not the illness, may be the deciding factor in the functional ability of the frail, elderly at dischargeâ 1 As the number of older adults increases, it is our duty to provide them with comprehensive care, namely in the acute setting. Y With this regard, and based on a conceptual framework of hospital-related functional trajectories (2,3,5,10), we hypothesized that, in the few days before hospitalization, the number and, particularly, the severity of illnesses may play a key role in precipitating disability in vulnerable, frail patients who exhibit at baseline a range of premorbid vulnerabilities, including older age, dementia, poor functional status, and others. It is believed that this condition is due to the decline in their bodyâs ability to use insulin. Ferrucci . A p value less than .05 was considered statistically significant. Functional decline after prolonged bed rest following acute illness in elderly patients: is trunk control test (TCT) a predictor of recovering ambulation? Anderson et al. In geriatric patients hospitalized for acute physical illness, depression is highly prevalent 1 but frequently undiagnosed or untreated. I No primary diagnosis was significantly associated with HAD, but cerebrovascular disease was a nearly-significant predictor (OR 1.77, 95% CI 0.93–3.37, p = .078). In contrast, when there are symptoms of cystitis in the absence of fever, flank pain, costovertebral angle tenderness, and other signs of systemic illness, we consider this acute … To our knowledge, this is the first study that has investigated the independent effect of illness severity on pre- and in-hospital functional trajectories in older patients. DM Myocardial Infarction - One third of elderly patients will have no chest pain in Myocardial Infarction. Acute diseases and hospitalization are associated with functional deterioration in older persons. Therefore, prehospital functional decline qualifies as a multidimensional clinical epiphenomenon of frailty, which incorporates and goes beyond the information provided by age and the severity of precipitating diseases. For patients hospitalized after evaluation in the emergency department, the assignment to geriatric or medicine wards by the emergency physicians (who had to be blinded about the study) was not dictated by specific criteria and was mostly based on the availability of beds. This study was specifically designed to investigate the potential independent role played by comorbidity, and particularly the severity of diseases at admission, in the functional trajectories around hospitalization for acute medical diseases in older patients. MA Identifying negative prognostic factors is crucial for adequately assessing patients at admission, elaborating effective preventive hospital strategies, and improving correct transitions to the posthospital settings. R Sometimes, an acute illness, such as the common cold, will just go away on its own. DC C Thus, the cause–effect model should be replaced by the stimulus–response model, which takes into account the individual vulnerability (frailty) to functional loss in response to the stress generated by both diseases and hospitalization (10,15). Boscardin We've put together a collection of detailed guides covering the 10 most comment elderly illnesses and ailments older peopl experience. et al. The Ethical Committee of Ospedale Israelitico, Rome, approved the study. We measured comorbidity by GIC, an assessment tool incorporating both the number and severity of diseases. Palleschi Acute mesenteric ischemia is a more common abdominal emergency than ruptured abdominal aneurysm and, in people older than 75, is a more common cause of acute abdomen than appendicitis. *Reference category: admission from home (elective admission). P Second, the severity of these conditions was graded according to the Greenfield’s Individual Disease Severity (IDS) (16) score on a 0–4 scale: 0 = absence of the disease; 1 = asymptomatic disease; 2 = symptomatic disease requiring medication but under satisfactory control; 3 = symptomatic disease uncontrolled by therapy; 4 = life-threatening disease or the most severe form of the disease. Such abnormalities predispose older persons to rapidly progress to overt disability or to worsen their baseline disability level when they undergo the stress of acute illnesses and hospitalization. et al. Change ), You are commenting using your Facebook account. Getting older can bring senior health challenges. Post-acute covid-19 (“long covid”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness.1 Clinical management requires a whole-patient perspective.2 This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital … et al. It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. In the entire Pro.Di.Ge. By being aware of these common chronic conditions, ⦠Tonkikh CP GIC Class 1 includes patients with one or more diseases with IDS = 1 or lower. Illness severity (GIC 3–4 vs 1–2: odds ratio [OR] 2.2, 95% CI [confidence interval] 1.5–3.3, p < .0001) and older age significantly predicted prehospital functional decline (between baseline and admission). . Boyd Oxford University Press is a department of the University of Oxford. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial December 2016 Change ), You are commenting using your Google account. First, clinicians identified 15 diseases that are recognized as the most prevalent in hospitalized patients: heart disease of ischemic or organic origin, primary arrhythmias, other heart disease (cardiomyopathies, myocarditis, cor pulmonale due to chronic pulmonary embolism, primary pulmonary hypertension or chronic obstructive lung disease), hypertension, stroke, peripheral vascular disease, diabetes mellitus, anemia, gastrointestinal diseases, hepatobiliary diseases, renal diseases, respiratory diseases, parkinsonism and nonvascular neurologic diseases, musculoskeletal disorders, and malignancies. ( Log Out / Covinsky When patients with severe premorbid disability, who could not worsen anymore (floor effect), were ruled out from the analysis, a poor baseline function (low baseline BI) and dementia emerged as significant predictors of, respectively, prehospital functional decline and HAD. Holford KE Details about the study protocol are described elsewhere (7). In this view, prehospital functional decline and HAD may be seen as a “post hoc” resultant of frailty. Allore BI = Barthel Index; GIC = Geriatric Index of Comorbidity; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; n = number. . From Dementia through to Incontinence. The association between functional status and LOS is expected and well recognized (5,20–22). L Hospitalization-associated disability (HAD) was defined as a functional decline between baseline and discharge. Sabatini Illness severity (OR 1.9, 95% CI 1.2–3, p = .004) and older age were also predictive of HAD, even after adjustment for each coded primary discharge diagnosis. Elashoff A Today the U.S. health care system faces a growing burden of chronic illness as the population ages. Treatment for acute illnesses can involve curing the disease. Volpato Certain medical conditions, such as cancer, heart disease, and obesity can also increase risk for severe illness. Search for other works by this author on: Department of Laboratory Medicine, Università Tor Vergata, Unit of Geriatrics, Ospedale di Casteldelpiano, Azienda USL 9, Geriatric Agency Unit, Azienda Ospedaliera-Universitaria Careggi, Unit of Geriatrics, Azienda Ospedaliera S. Giovanni-Addolorata, Hospitalization, restricted activity, and the development of disability among older persons, Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure”, Patient and hospital factors that lead to adverse outcomes in hospitalized elders, Acute Care for Elders. Zisberg For example, a broken bone that might result from a fall must be treated by a doctor and will heal in time. A bivariate analysis was performed using the t test, Mann–Whitney test, Chi-square test and Fisher’s exact test (2×2), as appropriate, to compare a series of variables between groups, as follows (Table 1): Bivariate Comparisons Between Functional Groups in the Two Time Periods (from baseline to admission and from admission to discharge) and in the Overall Perihospitalization Period (from baseline to discharge). KE Neuropsychological Phenotypes of Pediatric Anti-Myelin Oligodendrocyte Glycoprotein Associated Disorders: A Case Series. Zekry The risk for severe illness with COVID-19 increases with age, and older adults are at highest risk. People aged 65 years or older are more prone to heat-related health problems. Older age, emergency admission, admission from other hospital units, and GIC 3–4 were independently associated with declining function between baseline and admission (prehospital functional decline). Seymour . Acute Disease Aged Aphasia / diagnosis* Appendicitis / complications Appendicitis / diagnosis Humans It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. Class 4 includes patients with two or more diseases with IDS = 3 or one or more diseases with IDS = 4. DG SR population, which also included patients admitted to geriatric wards, the prevalence of HAD was 29% (7), that is, comparable with values observed in other studies (2–4,6,9,11). It characteristically presents with acute inflammation, resulting in demyelination, often following an infectious disease. Frail elders, especially those with cognitive impairment, are in need of interventions that reduce the long-term functional consequences of acute illness. In order to address this issue, we used data from the Progetto Dimissioni in Geriatria Study (Project Discharges in Geriatrics, Pro.Di.Ge.) BH TM x There is a need for efficient, convenient, and inexpensive methods to accurately diagnose the clinical stage of lung cancer and evaluate the efficacy of chemotherapy in patients with lung cancer. Cavalieri RW Shadmi The association of GIC with changes in functional status before hospitalization (between baseline and admission), during hospitalization (between admission and discharge), and in the overall period between baseline and discharge was assessed by logistic regression analyses. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Change ). Factors causing this include decreased immune response, blunted rise in heart rate, co-morbid diseases and polypharmacy. The following differential diagnoses have to be discerned: pseudodementia in acute depressive states, depression as a risk factor for dementia, and a depressive episode in the early stage of dementia. Methods. In addition, we collapsed GIC classes into two categories (GIC 1–2 vs GIC 3–4), with illness severity being the only domain separating the two categories. G ( Log Out / In this course, students focus on the complex healthcare and management needs of the frail elderly by advanced nurse practitioners in community settings.
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