The experience of a geriatric hospital at home service for acutely ill elderly patients with pressure ulcers: an observational study .

UNLABELLED:  Background. Pressure ulcers are an often underestimated problem affecting elderly patients. METHODS: An observational study was undertaken to evaluate patients admitted from January 2000 to December 2001 to a geriatric hospital affiliated at home service. RESULTS: Four hundred sixty-six patients (44.4% men and 55.6% women) were enrolled. Seventy-nine (16.9%) patients presented with a pressure ulcer upon admission. These patients were more functionally and cognitively impaired and had the poorest nutritional status. Anorexia and asthenia were significantly higher in patients with pressure ulcers (P < 0.001), and prevalence of constipation and dysphagia was significantly different between the two groups (P <0.05). Relative risk of new onset of pressure ulcers was significantly linked to age (1.09, CI 95% 1.02-1.15), to the number of functions lost (1.79, CI 95% 1.15-2.78), and to comorbidity (2.79, CI 95% 1.26-6.18). The relative risk of death during hospital admission was significantly linked to age (1.02, CI 95% 1.00-1.05), number of activities of daily living (ADL) functions lost (1.2, CI 95% 1.08-1.33), underweight (1.31, CI 95% 1.06-1.62), and the presence of pressure ulcers (1.59, CI 95% 1.23-2.05). CONCLUSION: Home treatment of acutely ill elderly patients with pressure ulcers is feasible and efficacious. .

Geriatric ward hospitalization reduced incidence delirium among older medical inpatients.

OBJECTIVES: Most strategies for delirium prevention in older hospitalized patients are common good clinical geriatric care. We investigated whether acute geriatric ward (AGW) hospitalization, compared with acute general medical ward (AGMW) hospitalization,is associated with reduced incident delirium in older medical inpatients. DESIGN: prospective observational study. SETTING: a tertiary care, university hospital in Torino. PARTICIPANTS: consecutive medical patients 70 years or older admitted from the emergency department to an AGW and to an AGMW were included. MEASUREMENTS: Baseline measures included demography, functional and psychocognitive status, comorbidity, physiological and clinical severity of acute illness. Incident delirium was evaluated by qualified psychiatrists according to the Confusion Assessment Method and the Delirium Rating Scale. RESULTS: Delirium occurred in 8 of 121 patients admitted to AGW (6.6%) and in 20 of 131 patients admitted to AGMW (15.2%). After adjustment for significant differences in baseline covariates between groups, AGW hospitalization remained independently associated with less incident delirium (relative risk 0.90, 95% confidence interval: 0.024-0.331, p <0.001). In a multivariable logistic model with delirium incidence as independent variable, AGW hospitalization was independently associated with lower delirium incidence (relative risk 0.039, 95% confidence interval: 0.007-0.214, p <0.001), whereas greater cognitive impairment (p <0.001), higher Acute Physiology and Chronic Health Evaluation II score (p 0.001) and recent stressful events (p <0.001) were associated with increased delirium incidence. CONCLUSION: AGW hospitalization is associated with less incident delirium among older medical inpatients. Despite inherent limitations of observational studies, these hypothesis-generating findings add to previous evidence of potential benefit in delirium prevention from geriatric consultation in several hospital settings.

Risk factors of functional decline during hospitalization in the oldest old.

BACKGROUND AND AIMS: The number of hospital admissions of the elderly is increasing and hospitalization often leads to functional decline. The aim of this study was to identify major risk factors for functional decline in the hospitalized oldest old. METHODS: Prospective, observational, non-randomized study of patients aged >/=80 years, admitted for at least two days to the University Department of Geriatric Medicine of Torino, Italy, between November 2003 and November 2004. For detection of functional decline, the ADL scale was used, referring to the number of dependent ADL. RESULTS: At discharge, ADL mean scores were significantly higher than on admission (2.5+/-2 vs 2.3+/-1.9, p<0.001). 23.9% of the sample lost at least one ADL function during hospitalization, and 19.2% were transferred to long-term care, compared with 5.4% of those with no functional decline. Length of hospitalization, neoplasm, low level of albumin and high number of drugs prescribed were associated with functional decline. At multivariate analysis, only in-hospital stay was an independent risk factor for functional decline (RR 1.1 per day of hospitalization, CI 1.03-1.14). CONCLUSIONS: Hospitalization of the oldest old increases the risk of functional decline, especially if prolonged. It is important to identify patients at high risk for functional decline after hospital admission.