Different effects of chronic omeprazole use on osteoporotic fractures rate in the elderly.

AIMS: To investigate the potential association of chronic use of omeprazole with the occurrence of osteoporotic fractures (OF) in community-dwelling elderly subjects. METHODS: The cohort consisted of community-dwelling residents aged >65 years registered with a large health maintenance organization in Israel between January 2002 and December 2016. Data were retrospectively collected from the electronic medical files on demographics, parameters known to be associated with OF, diagnoses of osteoporotic hip, wrist, and vertebral fractures, and chronic use of omeprazole (>11 prescriptions/year). Time to OF/death/end of study was calculated from the beginning of the study (2002). The risk of fractures in the chronic users of omeprazole was analyzed by multivariate Cox proportional hazard regression model. RESULTS: In total, 46 805 subjects were included (41% men), mean age 83.4±6.4 years, of whom 10 272 (21.9%) were chronic users of omeprazole. During 14 years of follow-up, OF were diagnosed in 414 (4.0%) omeprazole users and 1007 (2.8%) omeprazole nonusers (p < 0.001). In a Cox regression model adjusted for age and gender only, chronic use of omeprazole was associated with a 16% excess of OF. However, when parameters known to be associated with OF were entered into the multivariate Cox regression model, chronic use of omeprazole was not found to be an independent risk factor for OF, either overall (adjusted hazard ratio = 0.965, 95% confidence interval 0.86-1.08, P = .55) or specifically, in the ≥85 years age group (adjusted hazard ration = 0.780, 95% confidence interval 0.635-0.958, P < .05) in which an inverse correlation between omeprazole use and OF, was demonstrated. CONCLUSIONS: Chronic use of omeprazole was not associated with the occurrence of OF in elders.

Informal caregivers' negative affect: The interplay of caregivers' resilience, aging anxiety and burden.

OBJECTIVES: This study focused on the negative affect of informal caregivers of older adults. In a novel investigation, the interplay of aging anxiety, caregiving burden, and resilience as a protective factor was examined, suggesting that aging anxiety and caregiving burden are mediators for the link between resilience and negative affect. METHODS: In a cross-sectional design, 191 Israeli informal caregivers of older adults (65+) participated in the study. They completed questionnaires that assessed demographic and caregiving characteristics, resilience, aging anxiety, caregiving burden, and negative affect. RESULTS: The findings showed a serial mediation process in which higher resilience predicted lower caregiving burden, which subsequently predicted lower aging anxiety, which subsequently predicted lower negative affect. However, the indirect path from resilience to aging anxiety and negative affect was non-significant. CONCLUSION: Based on this study's findings, the aging anxiety of informal caregivers of older adults should be professionally addressed in the early stages of caregiving because it contributes to the caregiving burden and negative affect. Additionally, resilience should be enhanced by psycho-social interventions tailored to address informal caregiver challenges that often induce caregiving burden and negative affect.

Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis.

BACKGROUND/AIMS: The novel coronavirus SARS-CoV-2 has caused a pandemic threatening millions of people worldwide. This study aimed to describe clinical characteristics, outcomes, and risk factors of SARS-CoV-2-positive, asymptomatic, frail older adults. METHODS: A retrospective cohort study was conducted in 6 designated COVID-19 units, in skilled nursing homes. Subjects were severely frail older adults, positive for SARS-CoV-2, and asymptomatic at the time of their admission in these units. Residents' characteristics and symptoms were obtained via electronic medical records. The primary outcome was a composite of death or hospitalization by day 40. We looked at time to the primary outcome and used Cox regression for a multivariate analysis. RESULTS: During March-November 2020, 849 residents met inclusion criteria. Median age was 84 years. Most were completely dependent for basic activities of daily living and showed cognitive impairment. Six hundred forty-one (75.5%) residents were discharged after considered cured from COVID-19, 125 (14.7%) were hospitalized, and 82 (9.7%) died in the facilities. In survival analysis, 35% reached the primary outcome of death or hospitalization by day 40. Age (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.1-1.4), male gender (HR 1.41; 95% CI: 1.1-1.88), and COPD (HR 1.8; 95% CI: 1.23-2.67) were significant risk factors. CONCLUSIONS: In this large cohort, we report care and prognosis of asymptomatic older adults with major functional or cognitive impairments during the COVID-19 pandemic. Most presymptomatic patients do not develop severe infection, and age stays a predominant risk factor, even in the frailest older adults.

Association of Anemia with Dementia and Cognitive Decline among Community-Dwelling Elderly.

INTRODUCTION: The association of anemia with dementia in elders is controversial. We examined the potential association of anemia with dementia in a large population of elders. METHODS: Historical-prospective registry-based study. Included 36,951 community-dwelling elders (65-113 years) that were followed during 2002-2012. Anemia of all kinds was defined according to Clalit Health Services (CHS) definitions: hemoglobin (HGB) <14 g/dL men, <12 g/dL women; and World Health Organization (WHO): HGB <13 g/dL men, <12 g/dL women. Anemia was categorized as mild (HGB 11-13 g/dL men, 11-12 g/dL women) or moderate-severe (HGB <8-10.9 g/dL men and women). Background data, laboratory values, and diagnosis of dementia and cognitive decline (DCD) were reviewed. RESULTS: During the 10-year follow-up period, DCD was newly diagnosed in 7,180 subjects (19.4%). Subjects with DCD had a higher rate of anemia than those without DCD. Time to development of DCD was 1.5 years shorter in those with than without anemia. On multivariate Cox regression analysis adjusted for age and sex, the hazard ratio (HR) for DCD was 1.45 (95% CI: 1.37-1.54) by CHS and 1.51 (95% CI: 1.41-1.61) WHO anemia criteria. The more severe the anemia, the greater the risk of DCD development (HGB 13-14 g/dL [men only], HR = 1.20 [95% CI: 1.09-1.32]; mild anemia, HR = 1.38 [95% CI: 1.28-1.49]; moderate-severe anemia, HR = 1.64 [CI: 1.41-1.90]). Every decrease in 1 standard deviation of HGB (1.4 g/dL) increased the DCD risk by 15%. A competing risk model has weakened the association of anemia with DCD risk. CONCLUSIONS AND IMPLICATIONS: Anemia in community-dwelling elders appears to be associated with an increased DCD risk in a dose-response manner. Application of the WHO anemia criteria in men may miss patients with mild anemia that places them at DCD risk. Further research should look at anemia as a cause of reversible dementia.

Use of proton pump inhibitors is associated with lower rates of first-time ischemic stroke in community-dwelling elderly.

AIM: Data on cardiovascular outcomes in elderly using proton pump inhibitors (PPI) are scant. We aimed to test the association between PPI use and the occurrence of first-time ischemic stroke (FTIS) among elderly. METHODS: The electronic database of a centrally located district branch of a large health maintenance organization in Israel was retrospectively screened (2002-2016) for community-dwelling individuals (≥65-95 years) for demographics and co-morbidities. Follow-up was until FTIS, death or end of study. Findings were analyzed by PPI use and occurrence of FTIS. RESULTS: 29,639 subjects (without history of stroke and use of antiplatelet aggregation drugs) mean age of 82.2 ± 5.5 years (range: 65-95 years, 38% male) were analyzed: 8,600 (29%) used PPIs. Mean follow up was 10.58 years (SD ± 5.44). Similar total and annual occurrence rates of FTIS were depicted in PPI users and non-users (20.9% vs. 21% and 2% vs. 2.1%, respectively). On a Cox regression analysis, upon adjustment for age, gender and cardiovascular disease related risk factors, PPI use was significantly associated with lower rates of FTIS (HR 0.73, 95% C.I. 0.69-0.77, p < 0.001). The risk for FTIS was significantly lower in subjects using PPI at any dose and for any time period compared to non-users (HR 0.9, 95% C.I. 0.85-0.96 for 7-48 yearly prescriptions and HR 0.51, 95% C.I. 0.46-0.55 for ≥49 yearly prescriptions). CONCLUSIONS: PPI use was associated with lower rates of FTIS in community-dwelling elders. Prospective large-scale studies are needed to fully elucidate the effect of PPI in this aging population.

[EVALUATION OF THE ELDERLY PATIENT WITH CANCER].

INTRODUCTION: In recent years, there has been a significant increase in the number of adult patients with malignant diseases. These patients are a major therapeutic challenge due to a high incidence of comorbidities, lower functional status and often a diagnosis of the disease at a relatively advanced stage. The preferred approach to the treatment of cancer is a multidisciplinary approach. In the last decade, we have witnessed the integration of geriatricians as part of the multidisciplinary team in order to better assess patients' ability to withstand oncological or surgical treatment and, if necessary, to prepare them better for these treatments. In this article we review the use of various geriatric tools, such as generalized geriatric assessment, fragility and sarcopenia, and their effect on the decision-making process of the treating physicians and on the outcomes of the various treatments, including the outcomes of the operations. We show that comprehensive geriatric assessment is the basis for the evaluation of the adult oncology patients, and proper preparation for treatment in order to improve the outcomes of the treatment and reduce its complications. The rapid growth rate of the elderly population in Israel, together with the continuous development of oncology and cancer treatments, indicate the need to allocate resources and efforts to treat this unique population. We recommend an integration of geriatricians in the multidisciplinary team that treats this population.

[ANEMIA IN PATIENTS AFTER HIP FRACTURE REPAIR SURGERY].

INTRODUCTION: Hip fractures (HF) are common among the elderly. The prevalence increases with age and occurs more frequently among females. Up to 30% mortality rates have been observed during the first year following HF, with or without surgery. Additional implications may include functional and cognitive decline and significant morbidity. Many factors are associated with morbidity and mortality after HF repair surgery, including anemia. Anemia is present in approximately 50% of these patients upon admission to the hospital and its incidence increases further following surgery. The mean reduction in the hemoglobin level after surgery is estimated at 0.7-2.5 g/dL. There are several causes of anemia, some are patient dependent and some are related to the type of fracture and surgery. Anemia has a significant effect on the elderly patient in general, and on the patient's condition post-HF in particular. Anemia on admission is associated with short and long-term mortality, in addition to the length of stay, amount of blood transfusions, repeated hospitalizations, post-operative complications, poor functioning and a reduced quality of life. The most common treatment for anemic patients before and after HF repair surgery is the administration of blood transfusions. It has been common practice to administer blood transfusions when hemoglobin reaches a level of 8g/dL, however the effectiveness of this approach in older patients is not conclusive. Regarding other modalities, i.e., iron, erythropoietin and tranexamic acid, there are currently no clear guidelines in the literature and their effectiveness has not been fully established. Further research is needed to address these issues.

Statins and Selective Serotonin Reuptake Inhibitors are Associated with Longer Survival in Nursing Home Residents.

BACKGROUND: Statins and selective serotonin reuptake inhibitors (SSRIs) have beneficial effects on health outcomes in the general population. Their effect on survival in debilitated nursing home residents is unknown. OBJECTIVES: To assess the relationships between statins, SSRIs, and survival of nursing home residents. METHODS: Baseline patient characteristics, including chronic medications, were recorded. The association of 5-year survival with different variables was analyzed. A sub-group analysis of survival was performed according to baseline treatment with statins and/or SSRIs. RESULTS: The study comprised 993 residents from 6 nursing homes. Of them, 285 were males (29%), 750 (75%) were fully dependent, and 243 (25%) were mobile demented. Mean age was 85 ± 7.6 years (range 65-108). After 5 years follow-up, the mortality rate was 81%. Analysis by sub-groups showed longer survival among older adults treated with only statins (hazard ratio [HR] for death 0.68, 95% confidence intervals [95%CI] 0.49-0.94) or only SSRIs (HR 0.6, 95%CI 0.45-0.81), with the longest survival among those taking both statins and SSRIs (HR 0.41, 95%CI 0.25-0.67) and shortest among residents not taking statins or SSRIs (P < 0.001). The survival benefit remained significant after adjusting for age and after conducting a multivariate analysis adjusted for sex, functional status, body mass index, mini-mental state examination, feeding status, arrhythmia, diabetes mellitus, chronic kidney disease, and hemato-oncological diagnosis. CONCLUSIONS: Treatment with statins and/or SSRIs at baseline was associated with longer survival in debilitated nursing home residents and should not be deprived from these patients, if medically indicated.

Increasing Serum Albumin Level Shortly After Gastrostomy Tube Insertion Predicts Longer Survival in Elderly Patients With Dementia.

GOAL: To identify factors influencing survival after percutaneous endoscopic gastrostomy (PEG) tube insertion in elderly patients with severe dementia. BACKGROUND: Use of PEG in patients with dementia raises medical and ethical questions. STUDY: The cohort included 189 patients aged ≥64 years with severe dementia who underwent PEG tube insertion in 2002 to 2011 at a tertiary hospital and were followed through 2014. Data were collected on background diseases, laboratory tests conducted 14 (±10) days before and 90 (±10) days after PEG, and date of death. Multivariate Cox regression analysis was performed and cumulative survival curves plotted. RESULTS: Mean baseline serum albumin level was significantly lower in patients who died ≤30 days after PEG (n=32, 16.9%) than patients who survived longer (2.9±0.5 vs. 3.3±0.5 g/dL, P<0.001), and significantly higher in patients who survived 1 year after PEG (n=96, 50.8%) than patients who died earlier (3.4±0.5 vs. 3.1±0.5 g/dL, P=0.002). No significant differences were found for the other laboratory parameters. After adjustment for background diseases, serum albumin level above the median (3.3 g/dL) was the only predictor of survival (hazard ratio 0.51; 95% confidence interval, 0.37-0.72; P<0.001). Patients with stable/increased serum albumin levels at 90 days after PEG (n=80, 42.3%) survived longer than patients with decreased levels. The only predictor of survival after adjustment for age and background diseases was a stable/increased albumin level at 90 days (hazard ratio 0.59; 95% confidence interval, 0.42-0.85; P=0.004). CONCLUSIONS: Survival after PEG tube insertion is associated with a higher serum albumin level at baseline and a stable/increased serum albumin level during follow-up.

High blood pressure variability predicts 30-day mortality but not 1-year mortality in hospitalized elderly patients.

BACKGROUND: The association of blood pressure (BP) variability (BPV) in hospitalized patients, which represents day-to-day variability, with mortality has been extensively reported in patients with stroke, but poorly defined for other medical conditions. AIM AND METHOD: To assess the association of day-to-day blood pressure variability in hospitalized patients, 10 BP measurements were obtained in individuals ≥75 years old hospitalized in a geriatric ward. Day-to-day BPV, measured 3 times a day, was calculated in each patient as the coefficient of variation of systolic BP. Patients were stratified by quartiles of coefficient of variation of systolic BP, and 30-day and 1-year mortality data were compared between those in the highest versus the lowest (reference) group. RESULTS: Overall, 469 patients were included in the final analysis. Mean coefficient of variation of systolic BP was 12.1%. 30-day mortality and 1-year mortality occurred in 29/469 (6.2%) and 95/469 (20.2%) individuals respectively. Patients in the highest quartile of BPV were at a significantly higher risk for 30-day mortality (HR =4.12, CI 1.12-15.10) but not for 1-year mortality compared with the lowest BPV quartile (HR =1.61, CI 0.81-3.23). CONCLUSIONS: Day-to-day BPV is associated with 30-day, but not with 1-year mortality in hospitalized elderly patients.

The Association in Elderly Hospitalized Patients, Between Psychotropic Drugs and Hip Fractures Resulting from Falls.

BACKGROUND/STUDY CONTEXT: Psychotropic drug treatment has been associated with increased risk for falls and hip fractures in elderly patients. The authors examined the association between drug treatment and hip fractures resulting from falls in elderly hospitalized patients, focusing on the medications' anticholinergic properties. METHODS: This retrospective case-control study was conducted in an acute geriatric ward in a general medical center. Medical records, including demographic, clinical, biochemical, and pharmacological variables, of elderly patients with hip fractures from falls (N = 185), admitted during a 2-year period, were reviewed and compared with a control group (N = 187) of patients matched for age and gender and without hip fractures. RESULTS: The usage rates of antipsychotics, antidepressants, mood stabilizers, and various nonpsychiatric medications were similar in the two groups, except for hypnotics-anxiolytics (higher rates in hip-fracture patients). The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and diastolic blood pressure constituted very modest predictors of falls (R(2) = .038, p = .004). There were no significant differences in the anticholinergic burden values, clinical dementia ratings, and comorbidity burden between the two groups. CONCLUSION: The rate of psychotropic drug use in general and their anticholinergic burden are similar in acutely admitted elderly patients with or without hip fractures. However, higher usage rate of anxiolytics found in the patients with hip fractures may indicate that this is a risk factor for hip fractures related to falls in elderly patients living in the community.

Systolic blood pressure during acute stroke is associated with functional status and long-term mortality in the elderly.

BACKGROUND AND PURPOSE: The prognostic value of blood pressure (BP) levels during acute stroke has not been adequately studied. Most studies do not use continuous BP measurements, and patients are followed only for a short period. We designed a study to assess, with 24-hour BP monitoring (24H BPM), the impact of BP levels during the first day of stroke, on the short-term functional status and long-term mortality in elderly patients. METHODS: We studied 177 patients with acute stroke (89 men), mean age 84±6 years. BP was measured on admission and 24H BPM was recorded within 24 hours of admission. After 7 days, patients were assessed for functional status according to the modified Rankin Scale and were subsequently followed up for mortality ≤5 years (mean, 2.07±1.48). RESULTS: After 7 days, functional status improved and modified Rankin Scale decreased from 4.2 to 3.7. Follow-up analysis disclosed that 71 patients (27 men and 44 women) had died. Mortality rate was higher in women (50% versus 30%; P<0.01) and in patients with a history of congestive heart failure. Only average systolic BP, recorded by 24H BPM, predicted short-term functional status and long-term mortality. Cox proportional hazards model analysis demonstrated that age, sex, congestive heart failure, and average systolic BP >160 mm Hg, recorded by 24H BPM, were associated with increased mortality. CONCLUSIONS: High systolic BP recorded by 24H BPM on the first day of stroke was found to be associated with unfavorable short-term functional status and long-term mortality in elderly patients.

Gastric cancer risk in the elderly is associated with omeprazole use and inversely associated with aspirin use.

BACKGROUND: The association between long-term omeprazole use and gastric cancer (GC) risk is controversial. The aim of this study was to investigate the incidence of GC in elderly community-dwelling omeprazole chronic users with/without aspirin compared to non-users. METHODS: The registry of a large health management organization was searched for all community-dwelling members aged ≥65 years from January 2002 to December 2016. Data on demographics, background parameters, and chronic omeprazole and aspirin use (>11 prescriptions/year) were retrieved. Those diagnosed with new-onset GC during the study period (from January 2003) were identified. RESULTS: Of 51 405 subjects who met the inclusion criteria, 197 were diagnosed with GC during a mean follow-up period of 8.74 ±â€…4.16 years. This group accounted for 0.7% of PPI chronic users (72/11 008) and 0.3% (125/40 397) of nonusers (P < 0.001). GC risk was directly associated with omeprazole chronic use [hazard ratio (HR) 2.03, 95% confidence interval (CI): 1.51-2.73, P < 0.001] and inversely associated with aspirin chronic use (HR 0.55, 95% CI: 0.40-0.75, P < 0.001). Each year of omeprazole use increased GC risk by 9%, and each year of aspirin use decreased GC risk by 10% among omeprazole chronic users. The lowest rate of GC was found in omeprazole nonusers/ aspirin chronic users, and the highest, in omeprazole chronic users/aspirin nonusers. CONCLUSION: Higher GC rate was associated with omeprazole chronic use and inversely associated with aspirin chronic use relative to omeprazole nonuse in community-dwelling elderly.

Chronic omeprazole use in the elderly is associated with decreased risk of dementia and cognitive decline.

BACKGROUND: The association between proton pump inhibitor (PPI) use and increased risk of dementia is controversial. AIM: Investigating this issue in a large population of community-dwelling elders. METHODS: Our database was retrospectively searched for all community-dwelling patients aged ≥65 years who newly diagnosed with dementia/cognitive decline (DCD) between January 2002 - December 2012. Receiving ≥11 prescriptions of PPIs/year was categorized as PPI users. Clinical data were collected from the medical files. Risk of DCD in PPI users was analyzed by Cox regression models. RESULTS: Included 48,632 elders of whom 8,848 were diagnosed with DCD (18.2%). PPI use was documented in 10,507, of whom 1,959 were subsequently diagnosed with DCD (18.6%). Among 38,125 non-PPI users, 6,889 (18.1%) were diagnosed with DCD. The hazard ratio for occurrence of DCD in PPI users compared to non-users was 0.85 (95% CI: 0.81-0.89, P <0.001) in an un-adjusted Cox regression model and 0.83 in a Cox regression model adjusted for age and sex (95% CI: 0.79-0.87, P <0.001). Multivariate Cox regression accounting for background diseases, marital status, and socioeconomic state yielded a hazard ratio of 0.77 (95% CI: 0.73-0.81, P <0.001). CONCLUSION: PPI use wasn't associated with DCD development in chronic PPI users.

Serum transforming growth factor beta-1 post hip fracture repair in elderly patients.

BACKGROUND: To determine the kinetics of serum transforming growth factor beta-1 (TGF-ß1) in aged hip fracture patients during a month post-op. and determine its relationship to complications and cognitive status. METHODS: Forty-one elderly patients were prospectively followed. Serum TGF-ß1 was obtained during the first 10h post-fracture (baseline) and pre-surgery, 48-60 h post-op., 7 and 30 days post-op. RESULTS: Mean age was 81.8±7.7, range 68-97 years. A significant increase in serum TGF-ß1 (from baseline) was observed on the seventh day post-op., lasting for at least 1 month (p = 0.004). Sixteen patients experienced post-op. complications. Serum TGF-ß1 of patients with complications was significantly higher compared to patients without complications (p = 0.039). More complications were found in impaired mental status (IMS) patients (9/12) compared to cognitively normal patients (10/29), (p = 0.037). However, no differences were found in serum TGF-ß1 between IMS and normal patients, nor was a correlation found between age and TGF-ß1 production. No differences were found between genders. CONCLUSIONS: There is a distinct increase in serum TGF-ß1, a week post hip fracture repair, lasting for at least a month, which is significantly higher in patients with post-op. complications. TGF-ß1 seems to be essential to the healing process post hip fracture repair; still its clinical applications have as yet to be determined.

Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study.

INTRODUCTION: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. METHODS: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. RESULTS: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. CONCLUSIONS: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. LEVEL OF EVIDENCE: Level IV.

Prediction of readmissions in the first post-operative year following hip fracture surgery.

PURPOSE: To define risk factors for rehospitalization following fragility hip fractures and to create a predictive model. METHODS: A retrospective cohort study of patients 65 years and older, who were treated operatively following fragility hip fractures between 01.2011 and 06.2016. Patients were allocated into two study groups based on the occurrence of recurrent hospitalizations in the year following surgery. Demographic information, comorbidities, and in-hospital characteristics were collected, as was information regarding 1-year readmissions. Multivariate analysis of factors predictive of rehospitalizations was performed, followed by a logistic regression using all predictors with p < 0.05. A stepwise backwards elimination method was used to create the predictive model. RESULTS: Eight hundred and fifty-one patients were included; 369 (43.4%) had recurrent hospitalizations within the first post-operative year. Patients who were rehospitalized were more likely to be males, to use a walking aid and to live dependently. They had a higher age-adjusted Charlson's comorbidity index (ACCI) score, a higher perveance of atrial fibrillation, lower hemoglobin, worse renal function, less platelets, and longer time to surgery. Prevalence of in-hospital complications was similar. Six variables were found to independently influence the chance for readmissions: male gender, the use of a walking aid, higher ACCI score, lower hemoglobin, atrial fibrillation, and a longer surgical delay. Only the first four were found to be adequate predictors and were added to the prediction formula. CONCLUSION: High 1-year readmission rates are seen following discharge in patients with fragility hip fractures. Addressing risk factors might aid to better rehabilitate patients and reduce morbidity.

Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer.

AIM: Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer. METHODS: Data of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014-2016 were collected retrospectively. Patients were divided into study group (age 80-89 y), and control group (age 60-69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI). RESULTS: The study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43±2.44 in those who died within six months from surgery compared to 7.07 ±1.61 in those who were alive after six months (p<0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95-1.98, p=0.013). CONCLUSION: Different screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.

Pulse pressure predicts mortality in elderly patients.

BACKGROUND: Pulse pressure (PP) values increase with age. The impact of PP on mortality in elderly patients has not been established. OBJECTIVES: To evaluate the effect of PP on mortality among very elderly hospitalized patients. DESIGN: A prospective clinical study. PARTICIPANTS AND MEASUREMENTS: The medical records of 420 inpatients aged >60 (187 males, mean age of 81.4 +/- 7 years) hospitalized in an acute geriatric ward were reviewed. Patients were followed up for a mean of 3.46 +/- 1.87 years. Mortality data were extracted from death certificates. Using relative operating characteristic (ROC) curves, we identified PP of 62.5 mmHg as a cutoff point. Subjects were categorized as having low PP (< or = 62.5 mmHg; N = 116) or high PP (>62.5 mmHg; N = 304). MAIN RESULTS: The mortality rate was greater in patients with high PP than in those with low PP. During the follow-up, 201 patients died, 155 patients (51%) in the high PP group and 46 patients (39.7%) in the low PP group (p = 0.038). Pulse pressure was associated with all-cause mortality (HR = 1.69, 95% CI = 1.19-2.38, p = 0.003) even after controlling for gender, age, diabetes mellitus, atrial fibrillation and heart rate. CONCLUSION: High PP is an independent predictor of mortality among elderly hospitalized patients.

Is there an association between inappropriate prescription drug use and adherence in discharged elderly patients?

BACKGROUND: Inappropriate prescription drug (IPD) use is very common among older patients. However, its impact on medication continuity and adherence after hospitalization has not been researched, with little known regarding readmissions and mortality. OBJECTIVE: To investigate the prevalence and clinical characteristics of patients discharged with IPDs and examine whether use of these drugs is related to medication continuity and adherence 1 month postdischarge as well as to readmissions and mortality 3 months postdischarge. METHODS: Clinical and demographic data, postdischarge medication modification, and adherence were prospectively obtained on interview of 212 unselected elderly (aged > or = 65 y) patients or, if necessary, their caregivers. Nonadherence was defined as the percentage of drug doses less than or equal to 70% or greater than or equal to 110%. Medication appropriateness was assessed retrospectively using the Beers' criteria. RESULTS: Use of IPDs occurred in 43.5% and 44.4% of patients on admission and discharge, respectively. At discharge, the numbers of IPDs and prescribed drugs were correlated (R = 0.39; p < 0.01). No relationship was found between IPDs at discharge and age, sex, functional and cognitive status, number of chronic diseases, and reason for admission. Sixty percent of patients who were nonadherent to at least one drug had at least one IPD, compared with 37.4% of the adherent patients (p = 0.008). Nonadherence to at least one drug increased as the number of IPDs on discharge increased (p = 0.004). No relationship was found between IPD use and postdischarge medication modifications, readmissions, and mortality. CONCLUSIONS: A high number of hospitalized elderly patients are discharged with IPDs that are directly correlated with the number of prescribed drugs at discharge and postdischarge nonadherence. Further studies are needed to assess the impact of postdischarge IPD use on health outcome, and healthcare providers should work to decrease its prevalence.