Frontline nurses' experiences of managing visitor restrictions during the COVID-19 pandemic in a Danish university hospital - Lessons learned.

BACKGROUND: Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses' perspectives in a Danish context has yet to be assessed. AIM: The aim of this descriptive qualitative study was to explore frontline nurses' experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID-19 pandemic. METHODS: An online questionnaire, including open-ended questions, was developed. Data were analysed using descriptive statistics and content analysis. FINDINGS: 116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision-making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care. CONCLUSION: Restricting relatives' access challenged the nurses' professional values, and it seems to have affirmed their appreciation of relatives' role as important partners in contemporary hospital-based health care.

A Danish version of the MISSCARE survey: Translation and validation.

BACKGROUND: Measuring missed nursing care in clinical settings may serve as an important indicator for improving patient safety and nursing staff retention. Internationally, several tools exist, with the MISSCARE Survey being the most frequently used and validated; however, no tools are available in the Danish language. AIM: This study aimed at translating the MISSCARE Survey from US English to Danish and evaluate its psychometric properties. METHODS: The translation followed the recommended method, that is forward-and-backward translation, involving clinical experts and a professional, native English-speaking translator. The final version was approved by the survey's original developer. Face validity was tested among 10 nurses and 1 practical nurse. Nursing staff from 34 selected departments at Aarhus University Hospital's (n = 1241) were invited to participate in a pilot test in November 2020. The survey consisted of a demographic section, a section of 'nursing elements' (Part A) and section of 'reasons' (Part B). Acceptability was assessed on Part A and B. Reliability was tested by Cronbach's alpha, and psychometric properties were investigated using Confirmatory Factor Analysis (Part B). RESULTS: The face-validity test resulted in minor contextual changes and the addition of a 'not applicable' response option in Part A. The pilot test had a 42.6% response rate (n = 529). Acceptability was good, with 1-10 missing responses per item in Part A and 0-20 missing responses in Part B. The numbers of 'not applicable' responses ranged from 0 to 81. The overall Cronbach's alpha was 0.81. Factor-loading ranges were 0.62-0.48 for 'communication', 0.79-0.39 for 'materials and resources', and 0.50-0.35 for 'labour', suggesting an acceptable fit with the theoretical model. CONCLUSION: The MISSCARE Survey was successfully translated into Danish. The psychometric properties confirmed the questionnaire as a valid and reliable tool for measuring missed nursing care in Danish hospital settings.

Impact of involvement of relatives in early home visits by a hospital-led geriatric team.

OBJECTIVES: To evaluate whether the involvement of relatives in home visits by a geriatric team post-discharge is associated with unplanned readmissions in severely frail patients living alone. METHODS: A quality improvement project evaluating outcomes from routine care of patients who were severely frail, 65+ years, living alone, and visited at home by a geriatric team after discharge from acute hospital admission. We compared patients who did and did not have relatives attending the visit. Data were analyzed by logistic regression. RESULTS: Of 437 patients with a mean age of 85.0 (±7.8) years 73% had severe comorbidity, 68% had a low functional ability, and 100 patients (23%) had relatives attending. Attendance of relatives was associated with a lower unplanned 30-day readmission rate (10% vs. 18%, adjusted odds ratio: 0.48 (0.23-1.00) p=0.05). CONCLUSION: Results highlights the importance of involvement of relatives in care planning in the severely frail older patients living alone.

Single-bed rooms in a geriatric ward prevent delirium in older patients.

BACKGROUND: Few studies have investigated treatment environment risk factors for delirium in geriatric patients. In March 2017, a geriatric department was moved from old hospital buildings with multiple-bed rooms (old wards) to a new hospital with single-bed rooms (new wards), with no changes regarding uptake area, staff and admission criteria. AIMS: The aim of this study was to investigate the risk of delirium among patients in single-bed rooms compared with multiple-bed rooms. METHODS: An observational prospective study included patients aged ≥ 75 years admitted between 15 September 2016 and 19 March 2017 to the old wards and between 20 March and 19 December 2017 to the new wards. Exclusion criteria were terminal illness, somnolence at admission and inability to communicate in Danish. Delirium was assessed by trained nurses, nurse assistants, occupational therapists and physiotherapists every morning and evening using the Confusion Assessment Method (CAM). RESULTS: We included 1014 patients. Patients' characteristics were similar between patients admitted to the old wards and to the new wards. Delirium was present at admission in 105 patients, with no significant difference between the old and new wards. Patients in the new wards had a significantly reduced incidence of delirium during hospital stay compared with patients in the old wards; hazard ratio 0.66 (95% CI 0.48-0.93, p < 0.02). No difference between the old and the new wards was observed in the duration of the first delirium episode. CONCLUSION: We found evidence that the risk of delirium is reduced in single-bed rooms compared with multiple-bed rooms in geriatric wards.

Analgesic and psychoactive medications and the risk of falls in relation to delirium in single-bed rooms compared to multiple-bed rooms in geriatric inpatients.

BACKGROUND: Previously, we demonstrated a substantial reduction of delirium incidence among geriatric patients after relocating from old hospital buildings with multiple-bed rooms to a new hospital with single-bed rooms. AIMS: To investigate whether (1) the reduced incidence of delirium in single-bed rooms was associated with a simultaneous change in medication use, (2) the relocation had affected the incidence of falls, (3) the use of analgesics and psychoactive medications was associated with the risk of delirium and falls. METHODS: We included 461 admissions to the old wards and 553 admissions to the new wards. Delirium was assessed by the Confusion Assessment Method. Data on drug use and falls during hospitalization were extracted from medical records. RESULTS: There was no difference in drug use between the wards. In the new wards, patients who had experienced delirium had a much higher risk of falls than patients without delirium, while in the old wards this contrast was small. The risk of delirium was increased among patients who received antipsychotic drugs and anti-dementia drugs, Patients who received these drugs had an insignificantly increased risk of falls. CONCLUSION: Medication of analgesics and psychoactive drugs was similar in the old and new wards. In single-bed rooms, but not in multiple-bed rooms there was a much higher risk of falls among inpatients that developed delirium than among other patients. Patients who had used antipsychotics and anti-dementia drugs during hospitalization had increased risk of developing delirium and an insignificantly higher risk of falls.

Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis.

INTRODUCTION: The management of patients with a hip fracture is affected by the use of oral anticoagulants. A cross-sectional analysis was undertaken to investigate health outcome differences in those anticoagulated compared to those not anticoagulated. METHODS: Patients aged 50 years and over presenting to a large university hospital with hip fractures were identified from the service registry. Patient characteristics and health outcomes between those not anticoagulated were compared with those anticoagulated (warfarin and direct oral anticoagulants, DOAC). RESULTS: 200/2307 (9%) patients were anticoagulated. 84% were on warfarin, and the rest a DOAC. Compared to those anticoagulated, there was a higher prevalence of dementia (25% vs. 18%, p = 0.02) and a lower prevalence of cardiovascular disease (54% vs. 78%, p < 0.01), atrial fibrillation (10% vs. 82%, p < 0.01), and polypharmacy (55% vs. 76%, p < 0.01). Renal function was lower in the anticoagulated group. Time to operation for those not anticoagulated and anticoagulated was a median (IQR) of 25 (15) and 27 (18) hours. There was no difference in blood transfusion and hospital mortality. Postoperative complications were similar except a higher rate of renal failure (14% vs. 19%, p = 0.04) and heart failure (1% vs. 5%, p < 0.01), and a longer length of stay [median (IQR): 14 (10) vs. 16 (12) days] in the anticoagulated group. This was no longer significant after adjustment of confounders. CONCLUSION: There was no statistically significant difference in health outcomes between those anticoagulated and those not after adjusting for patient characteristics. It was feasible to avoid significant delay in hip fracture surgery in those anticoagulated.

Frailty status but not age predicts complications in elderly cancer patients: a follow-up study.

OBJECTIVES: The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. MATERIAL: Patients aged ≥70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. METHODS: CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. PRINCIPAL RESULTS: Patients (N = 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.

Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial.

OBJECTIVES: To investigate whether a liberal blood transfusion strategy [Hb levels ≥11.3 g/dL (7 mmol/L)] reduces the risk of postoperative delirium (POD) on day 10, among nursing home residents with hip fracture, compared to a restrictive transfusion strategy [Hb levels ≥9.7 g/dL (6 mmol/L)]. Furthermore, to investigate whether POD influences mortality within 90 days after hip surgery. METHODS: This is a post hoc analysis based on The TRIFE - a randomized controlled trial. Frail anemic patients from the Orthopedic Surgical Ward at Aarhus University Hospital were enrolled consecutively between January 18, 2010 and June 6, 2013. These patients (aged ≥65 years) had been admitted from nursing homes for unilateral hip fracture surgery. After surgery, 179 patients were included in this study. On the first day of hospitalization, all enrolled patients were examined for cognitive impairment (assessed by MMSE) and delirium (assessed by CAM). Delirium was also assessed on the tenth postoperative day. RESULTS: The prevalence of delirium was 10 % in patients allocated to a liberal blood transfusion strategy (LB) and 21 % in the group with a restrictive blood transfusion strategy (RB). LB prevents development of delirium on day 10, compared to RB, odds ratio 0.41 (95 % CI 0.17-0.96), p = 0.04. Development of POD on day 10 increased the risk of 90-day death, hazard ratio 3.14 (95 % CI 1.72-5.78), p < 0.001. CONCLUSION: In nursing home residents undergoing surgery for hip fracture, maintaining hemoglobin level above 11.3 g/dL reduces the rate of POD on day 10 compared to a RB. Development of POD is associated with increased mortality.

Reliability of the Danish Abbey Pain Scale in severely demented and non-communicative older patients.

AIM: To validate a Danish version of the observational Abbey Pain Scale (APS) in a geriatric ward. MATERIAL AND METHODS: The study population consisted of 50 old patients (70+ years), consecutively admitted to the geriatric wards of Aarhus University Hospital, Denmark, and fulfilling one of the following inclusion criteria: Mini Mental State Examination (MMSE) < 5, delirium, non-communicative aphasia, or unconsciousness. APS has six subscales and ranges from 0 (no pain) to 18 (worst pain). Criterion validity was assessed by using Verbal Rating Scale (VRS) as the gold standard. Cohen's kappa (k) was the measure of agreement. Inter-rater reliability was measured by two independent ratings of the same patient at the same time and assessed by Intraclass Correlation Coefficient (ICC). Internal consistency between the subscales was analysed by Cronbach's Alpha. Responsiveness was tested if the first APS score was positive for pain. 'Before' and 'after' sum scores were compared by paired t-test. RESULTS: We found poor agreement between APS and VRS (k=0.42). The inter-rater reliability was good (ICC=0.84). Cronbach's Alpha was 0.52 (fair agreement). In 66% of the patients, pain was observed and re-tested when an expected effect of analgesics had occurred. Of these, 88% reached a reduction on the APS sum-score (p<0.001). CONCLUSION: Our assessment of the Danish version of APS shows that this pain assessment scale should be considered as qualified and usable in severely demented and non-communicative older patients admitted to a geriatric ward.

Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture: the TRIFE randomized controlled trial.

BACKGROUND AND PURPOSE: Hip fracture (HF) in frail elderly patients is associated with poor physical recovery and death. There is often postoperative blood loss and the hemoglobin (Hb) threshold for red blood cell (RBC) transfusions in these patients is unknown. We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery. PATIENTS AND METHODS: We enrolled 284 consecutive post-surgical HF patients (aged ≥ 65 years) with Hb levels < 11.3 g/dL (7 mmol/L) who had been admitted from nursing homes or sheltered housing. Allocation was stratified by residence. The patients were randomly assigned to either restrictive (Hb < 9.7 g/dL; < 6 mmol/L) or liberal (Hb < 11.3 g/dL; < 7 mmol/L) RBC transfusions given within the first 30 days postoperatively. Follow-up was at 90 days. RESULTS: No statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group (where 27% died) and the liberal group (where 21% died). Per-protocol 30-day mortality was higher with the restrictive strategy (hazard ratio (HR) = 2.4, 95% CI: 1.1-5.2; p = 0.03). The 90-day mortality rate was higher for nursing home residents in the restrictive transfusion group (36%) than for those in the liberal group (20%) (HR = 2.0, 95% CI: 1.1-3.6; p = 0.01). INTERPRETATION: According to our Hb thresholds, recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival.

Blood transfusion and risk of infection in frail elderly after hip fracture surgery: the TRIFE randomized controlled trial.

OBJECTIVES: It is still under debate that red blood cell (RBC) transfusions might increase the risk of healthcare-associated infections after hip fracture surgery. Previously, we found that a liberal RBC transfusion strategy improved survival in nursing home residents. Our aim, therefore, was to investigate whether a more liberal RBC transfusion strategy was associated with a higher infection risk in frail elderly hip fracture patients. DESIGN: Prospective, assessor-blinded, randomized and controlled trial. SETTINGS: Orthopedic ward, Geriatric ward, and Hospital-at-home. PATIENTS: 284 consecutively hospital-admitted elderly with hip fracture from nursing homes or sheltered housing facilities were included. INTERVENTION: A restrictive RBC transfusion strategy (hemoglobin <9.7 g/dL; 6 mmol/L) compared with a liberal strategy (hemoglobin <11.3 g/dL; 7 mmol/L) administered within 30 days after surgery. MAIN OUTCOME MEASUREMENTS: Leukocytes and C-reactive protein (CRP) in repeated blood samples within 30 days, and number of all infections (pneumonia, urinary tract infection, and other infections) within 10 days. RESULTS: 88 % of the patients received a RBC transfusion. A median of 1 RBC unit (interquartile range (IQR): 1-2) was transfused for the restrictive strategy group versus 3 RBC units (IQR: 2-5) for the liberal group. Leukocytes and CRP measurements were similar for both groups. Rates of infection were 72 % for the restrictive group compared to 66 % for the liberal group (risk ratio 1.08; 95 % confidence interval 0.93-1.27, p value 0.29). CONCLUSIONS: A more liberal RBC transfusion strategy was not associated with higher risk of infection among residents from nursing homes or sheltered housing undergoing hip fracture surgery.

Prevalence of missed nursing care and its association with work experience: A cross-sectional survey.

Background: Nurses faced with multiple demands in hospitals are often compelled to prioritize nursing care. Knowledge of missed nursing care provides insight into whether necessary nursing care is delivered, what is missed, and the reasons for missed nursing care. This insight is essential to support evidence-based policy and practice to improve patient care, enhance nursing practice, and optimize the work environment. Research on factors influencing missed nursing care is imperative to implement targeted strategies. However, studies investigating work experience as a predictor are inconclusive, and no identified studies have examined how nurses' work experience is associated with different elements of missed nursing care. Objectives: To investigate the prevalence and reasons for missed nursing care and whether nurses' work experience was associated with missed nursing care. Design: The design was cross-sectional, using the Danish version of the MISSCARE survey. Setting: The study was conducted at a public Danish university hospital with 1,150 beds and approximately 10,350 employees. Participants: Across 34 surgical, medical, and mixed bed wards for adults, 1,241 nurses were invited by email to respond anonymously to the Danish MISSCARE survey. Of these nurses, 50.3% responded, and 42.6% fully completed the questionnaire. Methods: A total score mean and a mean score were calculated and then compared between experience (≤5 years/>5 years) in a linear regression model adjusting for unequally distributed variables. Results: More than two thirds of the nurses reported that emotional support, patient bathing, ambulation, mouth care, interdisciplinary conferences, documentation, and assessing effectiveness of medication were frequently missed elements of nursing care. The most significant reasons for missed nursing care were an inadequate number of nurses, an unexpected rise in patient volume, urgent patient situations, heavy admission, and discharge activity. Nurses with work experience of less than 5 years reported more missed nursing care, especially within fundamental care. Conclusions: Nursing elements to avoid potentially critical situations and nursing related to treatment observations were rarely missed, while nursing care elements visible only to the patient and the nurse were most often missed. By increasing transparency and explicitness within nursing care, the results enable critical evaluation of prioritization of nursing care elements. The number of staff not balancing the number and acuity of patients was the main reason for missed nursing care. The perception of missed nursing care was most pronounced in less experienced nurses. The study contributes to the global research community to achieve a broader understanding of missed nursing care. Tweetable abstract: Nursing to avoid potentially critical situations and treatment observations are prioritized over fundamental care, perceived mainly by less experienced nurses.

Prevalence of factors contributing to unplanned hospital readmission of older medical patients when assessed by patients, their significant others and healthcare professionals: a cross-sectional survey.

OBJECTIVE: To describe the prevalence of factors contributing to readmission of older medical patients perceived by patients, significant others and healthcare professionals and to examine the agreement of factors contributing to readmission. METHODS: This cross-sectional survey was conducted at Horsens Regional Hospital from September 2020 to June 2021. Patients aged ≥ 65 years and who were readmitted within 30 days were included. The questionnaire covered eight themes: disease; diagnosing, treatment and care; network; organisation; communication; skills and knowledge; resources; and practical arrangements. Response groups were patients, significant others, GPs, district nurses and hospital physicians. Outcomes were the prevalence of factors contributing to 30-day readmission and inter-rater agreement between respondents. RESULTS: In total, 165 patients, 147 significant others, 115 GPs, 75 district nurses and 165 hospital physicians were included. The patients' median age was 79 years (IQR 74-85), and 44% were women. The following were the most prevalent contributing factors: (1) relapse of the condition that caused the index admission, (2) the patient could not manage the symptoms or illness, (3) worsening of other illnesses or conditions, (4) the patient was not fully treated at the time of discharge and (5) the patient's situation was too complex for the medical practice to handle. Kappas ranged from 0.0142 to 0.2421 for patient-significant other dyads and 0.0032 to 0.2459 for GP-hospital physician dyads. CONCLUSION: From the perspectives of the included respondents, factors associated with the disease and its management were the most prevalent contributors to readmission for older medical patients. Agreement on the contributing factors was generally low. TRIAL REGISTRATION: Clinical trial number NCT05116644. Registration date October 27, 2021.

Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study.

PURPOSE: To evaluate the effect of a transitional care intervention (TCI) on readmission among older medical inpatients. METHODS: This non-randomised quasi-experimental study was conducted at Horsens Regional Hospital in Denmark from 1 February 2017 to 31 December 2018. Inclusion criteria were patients ≥ 75 years old admitted for at least 48 h. First, patients were screened for eligibility. Then, the allocation to the intervention or control group was performed according to the municipality of residence. Patients living in three municipalities were offered the hospital-based intervention, and patients living in a fourth municipality were allocated to the control group. The intervention components were (1) discharge transportation with a home visit, (2) a post-discharge cross-sectorial video conference and (3) seven-day telephone consultation. The primary outcome was 30-day unplanned readmission. Secondary outcomes were 30- and 90-day mortality and days alive and out of hospital (DAOH). RESULTS: The study included 1205 patients (intervention: n = 615; usual care: n = 590). In the intervention group, the median age was 84.3 years and 53.7% were females. In the control group, the median age was 84.9 years and 57.5% were females. The 30-day readmission rates were 20.8% in the intervention group and 20.2% in the control group. Adjusted relative risk was 1.00 (95% confidence interval: 0.80, 1.26; p = 0.99). No significant difference was found between the groups for the secondary outcomes. CONCLUSION: The TCI did not impact readmission, mortality or DAOH. Future research should conduct a pilot test, address intervention fidelity and consider real-world challenges. TRIAL REGISTRATION: Clinical trial number: NCT04796701. Registration date: 24 February 2021.

Computer habits and digital literacy in geriatric patients: A survey.

Objective: Among hospitalised geriatric patients, only half are computer users. However, many of them refrain from using telehealth solutions. This study aimed to investigate geriatric patients' computer and Internet habits and digital literacy and their associations with stress levels and frequency of Internet use. Methods: Inpatients and outpatients aged 65 years or older, all computer users, were consecutively surveyed. Besides information about computer and Internet habits, computer support, and computer stress, the survey also collected information about digital literacy using the electronic Health Literacy Assessment toolkit. Results: A total of 124 computer users with a mean age of 80.6 ± 7.4 years participated in the study from 1 October to 1 December 2019. Most patients received computer support from their children and grandchildren, whereas 6% did not seek support. They found themselves 'most familiar with using a keyboard' (79%), 59% 'were unfamiliar with the Copy Paste function', and only one-third 'were open to new ways of using computers'. Digital literacy was associated with the frequency of Internet use (P = 0.001), and higher digital literacy was associated with less computer stress (P = 0.01). Conclusions: Geriatric computer users are challenged by their basic computer skills, which may influence their choice of participation in telehealth solutions. If telehealth solutions are to succeed among geriatric patients, individualised computer support based on their basic computer skills and user-friendly computer devices are a prerequisite. For ongoing support, it is also necessary to introduce people close to the patient to telehealth solutions.

Absorbent incontinence pad use and the association with urinary tract infection and frailty: A retrospective cohort study.

Background: Up to 40% of adults over 65 years are full-time users of absorbent incontinence pads due to urinary incontinence. Simultaneously, urinary tract infection is amongst the most common hospital-acquired infection in older patients. Objectives: To explore the association between (1) full-time use of absorbent incontinence pads and urinary tract infection at acute hospital admission, (2) state of frailty and becoming a pad user during hospitalization, and (3) becoming a pad user and acquiring a urinary tract infection during hospitalization in older patients. Design: A retrospective cohort study. Setting: Admissions in an emergency department with transfers to geriatric, cardiac, infectious, or endocrinological wards from September 7th, 2017 to February 18th, 2019. Patients: 1,958 patients aged 65 years or more, having daily homecare or moderate comorbidity, hospitalized due to acute illness, and living in the municipality of Aarhus. Methods: The study was conducted by two researchers reviewing the patients' electronic health records combined with data on frailty status from a geriatric quality database. In the electronic health records, data on baseline characteristics, absorbent incontinence pad use at admission and during the hospital stay, and urinary tract infection were obtained. Results: Full-time users of absorbent incontinence pads had a higher probability of being admitted with urinary tract infection (Odds Ratio=2.00 (95% Confidence Interval: 1.61-2.49); p<.001). Patients identified as severely frail had a higher probability of becoming pad users during hospitalization (Odds Ratio=1.57 (95% Confidence Interval: 1.45-1.71); p<.001) compared to non/mild/moderate frail patients. Patients who became pad users during hospitalization had a higher risk of a hospital-acquired urinary tract infection (Odds Ratio=4.28 (95% Confidence Interval: 1.92-9.52); p<.001). Conclusions: There was an association between the use of absorbent incontinence pads and the development of urinary tract infections in older hospitalized patients, both in full-time users and those who were frail and became pad users during hospitalization. These findings emphasize the need for further research on preventing urinary tract infections and unnecessary pad use in older patients.

Geriatric assessment may prevent readmission in frail medical inpatients.

INTRODUCTION: Frailty is common in older adults. Many approaches exist to care of hospitalised older medical inpatients. The objectives of this study were to 1) describe frailty occurrence and 2) explore associations between frailty, type of care, 30-day readmission and 90-day mortality. METHODS: In a cohort of 75+-year-old medical inpatients with daily homecare or moderate comorbidity, frailty was graded as moderate or severe using the record-based Multidimensional Prognostic Index. The emergency department (ED), internal medicine (IM) and geriatric medicine (GM) were compared. Estimates of relative risk (RR) and hazard ratios were calculated in binary regression and Cox regression models. RESULTS: Analyses included 522 patients (61%) with moderate frailty and 333 (39%) with severe frailty. A total of 54% were females, and the median age was 84 years (interquartile range: 79-89). In GM, the distribution of frailty grade differed significantly from that of the ED (p less-than 0.001) and IM (p less-than 0.001). GM had the highest occurrence of severely frail patients and the lowest readmission rate. Compared with GM, the adjusted RR for readmission in ED was 1.58 (1.04-2.41), p = 0.032; and in IM: 1.42 (0.97-2.07), p = 0.069. Between the three specialities, no differences were seen in 90-day mortality hazard. CONCLUSION: In a regional hospital, frail older patients were discharged from all medical specialities. Admission to geriatric medicine was associated with a lower readmission risk and no increase in mortality. Comprehensive Geriatric Assessment may explain the observed differences in readmission risk. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Frailty level at discharge predicts mortality in older patients with Clostridioides difficile more accurately than age or disease severity.

PURPOSE: Clostridioides difficile infection (CDI) has a high mortality among older patients. Identification of older patients with CDI in increased mortality risk is important to target treatment and thereby reduce mortality. The aim of this study was to investigate mortality rates and compare frailty levels at discharge, measured by the record-based Multidimensional Prognostic Index (MPI), with age and severity of CDI as mortality predictors in patients with CDI diagnosed during hospitalisation. METHODS: This was a population-based cohort study from Central Denmark Region, Denmark, including all patients ≥ 60 years with a positive CD toxin test without prior infection and diagnosed from 1 January to 31 December 2018. Frailty level, estimated from the electronic medical record, was defined as low, moderate, or severe frailty. CDI severity was graded according to international guidelines. Primary outcome was 90-day mortality. RESULTS: We included 457 patients with median age 77 years (interquartile range 69-84) and females (49%). Overall, 90-day mortality was 28%, and this was associated with age (hazard ratio (HR): 2.71 (95% confidence interval 1.64-4.47)), CDI severity (HR 4.58 (3.04-6.88)) and frailty (HR 10.15 (4.06-25.36)). Frailty was a better predictor of 90-day mortality than both age (p < 0.001) and CDI severity (p = 0.04) with a receiver operating characteristic curve area of 77%. CONCLUSION: The 90-day mortality among older patients with CDI in a Danish region is 28%. Frailty measured by record-based MPI at discharge outperforms age and disease severity markers in predicting mortality in older patients with CDI.

Preoperative dehydration identified by serum calculated osmolarity is associated with severe frailty in patients with hip fracture.

BACKGROUND & AIMS: Preoperative dehydration is a well-known predictor of in-hospital complications and poor functional outcomes in older patients with hip fractures. In an orthopedic and geriatric cooperative setting, we aimed to investigate whether preoperative dehydration was associated with frailty, prolonged hospital stays and short-term mortality in older patients with hip fractures. METHODS: This retrospective cohort study was conducted in a Danish university hospital. The study population consisted of patients 65+ years surgically treated for hip fracture. Dehydration was defined as serum calculated osmolarity above 295 mmol/L. Outcomes were frailty at discharge measured by the Multidimensional Prognostic Index, hospital stay of 7 days or more and 90-day mortality. RESULTS: In total, 214 patients were consecutively included in the study from March 11, 2018, to August 31, 2020. The mean age was 81.2 (SD: 7.6) and 69% of the patients were women. The prevalence of preoperative dehydration was 40%. It was associated with severe frailty (Odds Ratio (OR): 2.08 [95% confidence interval (CI): 1.11-3.90]; p = 0.02) and prolonged hospital stay (OR: 2.28 [95% CI: 1.29-4.04]; p = 0.02). Seven percent died when dehydrated compared to 5% in the non-dehydrated (p = 0.91). CONCLUSION: Prevalence of preoperative dehydration is high among older patients with hip fractures and is associated with severe frailty and length of hospital stay. Systematic screening for dehydration on admission is advisable and may contribute to more adequate fluid management in the perioperative phase.

Prevalence of Computer Use among Geriatric In- and Outpatients.

Objective: Despite its many benefits, tele-rehabilitation is not widely used by the older generations. This study aimed to investigate the opportunity to offer tele-rehabilitation in a geriatric population by determining the prevalence of computer use and to examine whether the patients' characteristics affect computer use. Design: Cross-sectional study. Patients: Cognitive well-functioning in- and outpatients aged 65 years or older. Methods: Patients were consecutively included and surveyed. Results: A total of 249 patients participated in the survey. Among them, 124 were computer users. Four of these never went online. Compared to non-users, computer users were younger OR: 0.91 (95% CI: 0.87; 0.94) p = 0.001, less frail OR: 0.37 (95% CI: 0.25;0.55) p = 0.001, had a higher functional capacity OR: 1.02 (95% CI 1.01; 1.03) p = 0.001 and more often had an education at high school level or higher OR: 1.7 (95% CI: 1.41; 2.40). Conclusion: Only half of the geriatric patients are computer users. If tele-rehabilitation is to be adopted by a wider geriatric population challenged by reduced mobility, long transportation times, or frailty, computer training, user friendly devices and computer support should be considered beforehand.