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Elderly inpatients with coronavirus disease 2019 (COVID-19) are often at nutritional risk and at higher risk of critical disease. The standardized nutrition treatment could effectively improve the nutritional status, quality of life, and clinical outcomes of COVID-19 patients, and is an important component of the comprehensive management of COVID-19. The individualized nutrition diagnosis, treatment and monitoring should be conducted in compliance to standard procedures of medical nutrition therapy, with consideration of the clinical characteristics of elderly COVID-19 inpatients. The Department of Clinical Nutrition at Peking Union Medical College Hospital has integrated the latest clinical nutrition guidelines and clinical practice of nutrition support of COVID-19, with the aim to provide evidence-based, concise and practical recommendations on nutritional management for elderly inpatients with COVID-19. The recommendations here are to inform effective and standardized nutrition support practice.
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Objective:To analyze the hospitalization expenses of elderly patients with hypertension and its influencing factors, so as to provide reference for optimizing the medical service management of elderly patients with hypertension.Methods:Medical record home page data of all hypertension inpatients of elderly patients at two tertiary general hospitals in Jiangsu province from 2017 to 2020 were retrieved. These data were used to analyze the basic information, hospitalization expenses and their influencing factors. Descriptive analysis was used for all data, variance analysis was used for one-way analysis, and multiple linear regression was used for multivariate analysis.Results:A total of 20 596 elderly inpatients with hypertension were included in this study. The number of patients was increased from 1 476 in 2017 to 10 771 in 2020. Among them, the number of inpatients with≥2 diseases increased from 1 105(74.86%) to 10 564(98.08%); From 2017 to 2020, the average hospitalization expenses of elderly inpatients with hypertension were 11 500 yuan, 13 600 yuan, 13 800 yuan and 14 100 yuan respectively, increasing year by year; Gender, age, number of hospitalizations, hospitalization days and number of diseases were the influencing factors of hospitalization expenses( P<0.05), and the hospitalization expenses increased with the increase of hospitalization days, number of diseases and age. Conclusions:The number of elderly patients with hypertension, the incidence of comorbidity, and the average hospitalization cost in tertiary hospitals in Jiangsu province were increasing year by year. There were many factors affecting the hospitalization cost. The author suggested that the treatment of elderly patients with hypertension should be shifted to prevention, so as to reduce the economic burden of disease and improve their quality of life.
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OBJECTIVE To evaluate the effects of pharmaceutical interventio n led by clinical pharmacists on medication appropriateness of elderly inpatients. METHODS A non-randomized concurrent controlled trial was carried out. Elderly patients admitted to two treatment groups in the geriatric department of Yancheng First People ’s Hospital since June 2021 were selected as the research objects. According to the inclusion and exclusion criteria ，the first 40 patients were selected from each of the two treatment groups （according to the order of admission time ）and set as the control group or the intervention group. The control group received routine treatment and nursing services ，and the intervention group additionally received pharmaceutical intervention led by clinical pharmacists on the basis control group. Clinical pharmacists found potential inappropriate medication （PIM）and put forward suggestions on optimization of medication regimen. American Geriatrics Society 2019 Updated AGS Beers Criteria ® for PIM Use in Older Adults （hereinafter referred to as “Beers criteria ”）and the Criteria of PIMs for Older Adults in China 2017 Edition （hereinafter referred to as “Chinese criteria ”）were used as reference tools for drug use review. The medication appropriateness index （MAI）total scores （main evaluation indicator ），the number of PIMs ，the number of drugs used ，the length of hospital stay ，the number of drug-related adverse events during hospital stay ，the number of drug regimen optimization suggestions by pharmacists ， and implementation rate of E-mail：zhihuadou@163.com optimization suggestions adopted by clinicians were compared between 2 groups at admission and at discharge. RESULTS At admission ，there were no statistically differences in MAI total scores，the number of PIMs based on Beers criteria ，the number of PIMs based on Chinese criteria or the number of drugs used between 2 groups（P＞0.05）. At discharge ，there were no statistically differences in the number of PIMs based on Chinese criteria and the length of hospital stay between 2 groups（P＞0.05），but the MAI total scores ，the number of PIMs based on Beers criteria and the number of drugs used in the intervention group were lower than those in the control group （P＜0.05）. In the intervention group，the proportion of drugs recorded as “inappropriate medication ”at admission （34.5％）was significantly higher than that at discharge（19.5％）（P＜0.05）. The difference between the number of drugs discharged from hospital and the number of drugs admitted to hospital in the control group [ 3（1-4.8)] was significantly higher than that in the intervention group [ 1（0-2.8)]（P＝ 0.012）. Compared with admission ，the proportion of drugs recorded as “inappropriate medication ”in the intervention group at discharge was significantly decreased on the basis of “effectiveness”dimension and “course”dimension （P＜0.05）. During hospitalization，clinical pharmacists put forward 70 optimization suggestions of drug regimen for the intervention group ，among which 39 suggestions were adopted and implemented by clinicians ，with an implementation rate of 55.7％. CONCLUSIONS The pharmaceutical intervention led by clinical pharmacists can improve overall appropriateness of drug use in the elderly inpatients using MAI as main evaluation indicator.
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Objective:To explore the effect of nurse-led multi-disciplinary team management on postoperative gastrointestinal function and nutritional status in elderly colon cancer inpatients.Methods:A total of 75 elderly inpatients after colon cancer operation who met eligibility criteria and signed informed consent form were randomized into study (n=37) or control group (n=38), receiving nurse-led multi-disciplinary team management or routine nursing for 6 months, respectively. The gastrointestinal function, days of postoperative hospital stay, body weight, body composition and dietary intake were compared between the two groups.Result:Compared to the control group, time to defecation (t=14.79, P<0.01), time to initiation of liquid diet intake (t=6.80, P<0.01), time to initiation of semi-liquid diet intake (t=10.78, P<0.01) and days of postoperative hospital stay (t=8.76, P<0.01) in the study group were significantly shortened; and body weight [(59.44±6.12)kg vs. (62.54±6.41)kg, P=0.004], BMI [(19.02±4.13)kg/m 2 vs. (19.98±3.98)kg/m 2, P=0.025], body fat percentage [(20.03±3.55)% vs. (21.34±3.68)%, P<0.01], lean body mass [(19.63±3.44)kg vs. (21.45±3.16)kg, P<0.01], grip strength [(21.65 ± 3.56) kg vs. (22.48 ± 3.81) kg, P=0.011], attainment rate of 75% target energy intake (65.8% vs. 86.5%, P=0.036) and attainment rate of 75% target protein intake (57.9% vs. 83.8%, P=0.014) were significantly improved in study group 6 months after operation. Conclusion:The nurse-led multi-disciplinary team management can effectively improve the postoperative recovery of gastrointestinal function and the long-term nutritional status in elderly patients with colon cancer.
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Embora o índice de envelhecimento da população mundial venha crescendo, isso não implica, necessariamente, longevidade saudável. Estudos que apontem as variáveis que interferem nos resultados em saúde de pessoas idosas são relevantes nesse contexto. Com base nos referenciais da Psicologia da Religião sobre envelhecimento e sobre coping espiritual/religioso, foi empreendido um estudo junto a essa população com o objetivo de evidenciar o funcionamento da espiritualidade/religiosidade (E/R) nesse contexto de saúde ameaçada. A metodologia utilizada foi de abordagem quantitativa, descritiva, de corte transversal. Os instrumentos utilizados foram: escala breve de coping espiritual/religioso (CER), escala da centralidade da religiosidade e um questionário para levantamento dos dados sociodemográficos. Participaram do estudo 51 pessoas, com média de idade de 71,76 anos, baixa renda econômica (86,3%), predominantemente católicos (68,6%); seguidos dos evangélicos (23,5%). Os idosos são altamente religiosos (M = 4,3) e 80,4% fazem utilização alta/altíssima de CER Positivo. A despeito da relevância da E/R, 87,3% deles nunca foram abordados sobre questões ligadas à E/R e 41,2% afirmam que gostariam de ter sido. Os resultados confirmam as teorias sobre o papel da E/R nessa fase da vida e indica ser essa uma dimensão relevante a ser integrada na terapêutica por toda a equipe de saúde.
Although the rate of the world population aging is increasing, it does not imply healthy longevity. Studies that point out the variables that interfere in the health outcomes of the elderly are relevant in this context. Based on the framework of Psychology of Religion on aging and spiritual/religious coping, a study among elderly inpatients was carried out with the objective of showing the functioning of spirituality/religiosity (S/R) in the context of threatened health. The methodology used was quantitative in nature, descriptive and cross-sectional. The instruments used were: Brief Spiritual/Religious Coping Scale, Centrality of Religiosity Scale, and the Sociodemographic Questionnaire. Fifty-one elderly inpatients participated in the study, at an average age of 71,76 years old, low economic income (86.3%), predominantly Catholics (68.6%), followed by Evangelicals (23.5%). The elderly is highly religious (M = 4.3) and 80.4% make high/ higher use of Positive Spiritual Religious Coping. Despite the relevance of S/R, 87.3% of them were never asked about S/R issues and 41.2% said they would like to be approached with these issues. The results confirm the theories about the role of S/R in this phase of late life and indicate that this is a relevant dimension to be integrated in the practice of care by the multidisciplinary healthcare team.
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Objective@#To explore the effect of nutritional support based on clinical nursing pathway on nutritional status and quality of life among elderly inpatients with Alzheimer disease (AD).@*Methods@#A total of 101 elderly inpatients with AD who met the criteria of the protocol were consecutively enrolled and randomly divided to study group receiving nutritional support based on clinical nursing pathway for two months (n=51) and control group receiving routine nutritional management for 2 months (n=50). Nutritional risk and quality of life were measured by nutritional risk screening 2002 (NRS 2002) and Quality of Life-Alzheimer's Disease Scale (QOL-AD) respectively before and after nutritional support.@*Results@#Baseline data were comparable between the two groups (all P>0.05). After 2-month nutritional support, compared to the control, the incidence of nutritional risk (36.0% vs 17.6%, P=0.037) and undernutrition (26.0% vs 9.8%, P=0.033) decreased significantly in study group. The score of quality of life in study group were significant higher than that of control group (35.73±5.85 vs 30.76±6.14, P=0.023).@*Conclusion@#The nutritional support based on clinical nursing pathway is helpful to improve the nutritional status and quality of life in elderly hospitalized patients with AD.
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Objective To explore the effect of nutritional support based on clinical nursing pathway on nutritional status and quality of life among elderly inpatients with Alzheimer disease (AD). Methods A total of 101 elderly inpatients with AD who met the criteria of the protocol were consecutively enrolled and randomly divided to study group receiving nutritional support based on clinical nursing pathway for two months (n = 51) and control group receiving routine nutritional management for 2 months (n =50). Nutritional risk and quality of life were measured by nutritional risk screening 2002 (NRS 2002) and Quality of Life-Alzheimer's Disease Scale (QOL-AD) respectively before and after nutritional support. Results Baseline data were comparable between the two groups (all P>0. 05). After 2-month nutritional support, compared to the control, the incidence of nutritional risk (36. 0％ vs 17. 6％, P = 0. 037) and undernutrition (26. 0％ vs 9. 8％, P = 0. 033) decreased significantly in study group. The score of quality of life in study group were significant higher than that of control group (35. 73±5. 85 vs 30. 76±6. 14, P = 0. 023). Conclusion The nutritional support based on clinical nursing pathway is helpful to improve the nutritional status and quality of life in elderly hospitalized patients with AD.
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Objective To evaluate the effectiveness of family-centered educational intervention on fall prevention knowledge and attitude,compliance and fall incidence of elderly inpatients. Methods A total of 300 elderly inpatients were selected in a first-class grade A hospital in Beijing and divided into the experiment group and the control group equally.The intervention group was given family-centered educational intervention for 6 months,while the control group was given conventional treatment and care in ward.The knowledge and attitude,compliance and the incidence of falls of elderly inpatients were evaluated at discharge and 3 months,6 months after discharge. Results The knowledge and attitude, compliance of elderly inpatients in the intervention group were significantly better than that in the control group (P<0.05).The incidence of falls in the intervention group was significantly lower than that in the control group at discharge and 3 months,6 months after discharge (P<0.05). Conclusions The family-centered educational intervention can enhance the fall prevention knowledge, attitude and compliance of elderly inpatients effectively and reduce the incidence rate of falls.The long-term effect is relatively obvious.
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<p><b>OBJECTIVE</b>To assess nutritional status and define gender- and age-specific handgrip strength (HGS) cut-point values for malnutrition or nutritional risk in elderly inpatients.</p><p><b>METHODS</b>A cross-sectional study of 1,343 elderly inpatients was conducted in the Chinese PLA General Hospital. Nutrition Risk Screening (NRS 2002) and Subjective Global Assessment (SGA) were administered. Anthropometric measurements and blood biochemical indicators were obtained using standard techniques. The gender- and age-specific receiver operating characteristic (ROC) curves were constructed to evaluate the HGS for nutritional status by SGA and NRS 2002. Sensitivity, specificity, and areas under the curves (AUCs) were calculated.</p><p><b>RESULTS</b>According to NRS 2002 and SGA, 63.81% of elderly inpatients were at nutritional risk and 28.22% were malnourished. Patients with higher HGS had an independently decreased risk of malnutrition and nutritional risk. The AUCs varied between 0.670 and 0.761. According to NRS 2002, the optimal HGS cut-points were 27.5 kg (65-74 years) and 21.0 kg (75-90 years) for men and 17.0 kg (65-74 years) and 14.6 kg (75-90 years) for women. According to SGA, the optimal HGS cut-points were 24.9 kg (65-74 years) and 20.8 kg (75-90 years) for men and 15.2 kg (65-74 years) and 13.5 kg (75-90 years) for women.</p><p><b>CONCLUSION</b>Elderly inpatients had increased incidence of malnutrition or nutritional risk. HGS cut-points can be used for assessing nutritional status in elderly inpatients at hospital admission in China.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Asian People , Hand Strength , Physiology , Inpatients , Nutritional Status , PhysiologyABSTRACT
<p><b>INTRODUCTION</b>The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.</p><p><b>METHODS</b>A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.</p><p><b>RESULTS</b>A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.</p><p><b>CONCLUSION</b>The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.</p>
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Aged , Female , Humans , Male , Middle Aged , Cognition , Physiology , Delirium , Diagnosis , Epidemiology , Diagnostic Errors , Follow-Up Studies , Inpatients , Neuropsychological Tests , Pilot Projects , Prevalence , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness Index , Singapore , EpidemiologyABSTRACT
PURPOSE: To investigate the difference of the epidemiological, microbiological, and clinical characteristics and risk factors of inpatients with infectious keratitis between an elderly group (group I > or = 60 years) and a younger group (group II < 60 years). METHODS: A retrospective chart review of 255 eyes (male/female: 158/97 eyes, I/II: 116/139 eyes) with infectious keratitis hospitalized at Yeungnam University Hospital between January 2004 and December 2008 was performed. RESULTS: The proportion of bacterial/fungal/herpes viral keratitis was 42/31/27% in group I and 74/8/17% in group II. The proportion of fungal keratitis in relation to bacterial keratitis was higher in group I, as compared to group II (p < 0.001). The ratio of Gram-positive/negative bacteria was 43/30% in group I and 48/46% in group II. The proportion of Gram-positive bacteria in relation to Gram-negative bacteria was higher in group I, as compared to group II (p = 0.025). The most commonly isolated microorganisms were Staphylococcus epidermidis (I/II: 9/10 eyes) among Gram-positive bacteria, Enterobacter species (I: 6 eyes) and Pseudomonas aeruginosa (II: 9 eyes) among Gram-negative bacteria, and Candida species (I: 6 eyes, II: 2 eyes) among fungi. Clinical aspects and treatment outcomes, such as previous ocular surgery (I/II: 23/9%), hypertension (26/7%), diabetes mellitus (17/7%), presentation at our clinic after 1 week (43/16%), initial visual acuity less than 0.1 (54/32%), hypopyon (28/15%), epithelial healing time (16/10 days), corneal perforation (18/5%), operative treatment (23/7%), and final visual acuity less than 0.1 (36/14%) were statistically significantly poorer in group I, as compared to group II. Risk factors for unimproved visual outcomes included fungal keratitis in group I and previous ocular surgery and ocular surface disease in group II. CONCLUSIONS: Considering that clinical aspects and treatment outcomes are poor in elderly inpatients with infectious keratitis, special efforts are necessary for a more accurate differential diagnosis and appropriate early treatment to achieve successful treatment outcomes.