Health-services utilisation amongst older persons during the last year of life: a population-based study.

BACKGROUND: Accurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia. METHODS: Data from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included. Several measures of hospital-based service utilisation during the last year of life were assessed from retrospectively linked data comprising data for all registered deaths, cause of death, hospital care during the last year of life (NSW Admitted Patient Data Collection [APDC] and Emergency Department [ED] Data Collection [EDDC]), and the NSW Cancer Registry. RESULTS: Amongst 34,556 decedents aged ≥70 years, 82% (n = 28,366) had ≥1 hospitalisation during the last year of life (median 2), and 21% > 3 hospitalisations. Twenty-five percent (n = 5485) of decedents attended ED during the last week of life. Overall, 21% had a hospitalisation > 30 days in the last year of life, and 7% spent > 3 months in hospital; 79% had ≥1 ED attendance, 17% > 3. Nine percent (n = 3239) spent time in an intensive care unit. Fifty-three percent (n = 18,437) died in an inpatient setting. Hospital records had referenced palliative care for a fifth (7169) of decedents. Adjusting for age group, sex, place of residence, area-level socioeconomic status, and cause of death, having > 3 hospitalisations during the last year of life was more likely for persons dying from cancer (35% versus 16% non-cancer deaths, adjusted odds ratio [aOR] 2.33), 'younger' old decedents (29% for age 70-79 and 20% for age 80-89 versus 11% for 90+, aOR 2.42 and 1.77 respectively) and males (25% versus 17% females, aOR 1.38). Patterns observed for other hospital-based service use were similar. CONCLUSIONS: This population-based study reveals high use of hospital care among older persons during their last year of life, although this decreased with increasing older age, providing important data to inform health services planning for this population, and highlighting aspects requiring further study.

Sensory impairment, use of community support services, and quality of life in aged care clients.

OBJECTIVE: To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients. METHOD: The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits. RESULTS: After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0-7.8). CONCLUSION: Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

Are sensory and cognitive declines associated in older persons seeking aged care services? Findings from a pilot study.

INTRODUCTION: To assess the association between sensory and cognitive function, and the potential influence of visual function on cognitive function assessment, in a sample of clients accessing aged care services. MATERIALS AND METHODS: We recruited 260 non-institutionalised, frail, older individuals who sought aged care services. Visual acuity was assessed using a LogMAR chart and hearing function was measured using a portable pure-tone air conduction audiometer. Visual impairment was defined as visual acuity (VA) <6/12 (<39 letters read correctly in the better eye), moderate-to-severe hearing impairment as hearing thresholds >40 decibels (better ear) and cognitive impairment as Mini-Mental State Examination (MMSE) score <24. RESULTS: Vision and hearing assessments were randomly performed in 168 and 164 aged care clients, respectively. Visual acuity correlated weakly with MMSE scores, either including (r = 0.27, P <0.001) or excluding (r = 0.21, P = 0.006) vision-related MMSE items. After partialling out the effect of age, the association remained (r = 0.23, P = 0.013 including, or r = 0.18, P = 0.044 excluding vision-related items). No correlation was found between MMSE scores and hearing thresholds (r = -0.07, P = 0.375). After adjusting for age, sex and stroke, mean MMSE scores were lower in persons with visual impairment than those with normal vision (25.2 + 0.5 versus 26.8 + 0.4 including, or 18.2 + 0.5 versus 19.2 + 0.3 excluding vision-related items), but were similar between subjects with none or mild and those with moderate-to-severe hearing loss (26.3 + 0.4 versus 26.0 + 0.4). CONCLUSIONS: In this study sample, visual and cognitive functions were modestly associated, after excluding the influence of visual impairment on the MMSE assessment and adjusting for age. Hearing thresholds were not found to be associated with cognitive function.

Oral Health Status Is Associated with Common Medical Comorbidities in Older Hospital Inpatients.

OBJECTIVES: To investigate oral health status and abnormalities in older adults admitted acutely to the hospital and explore the association with common medical comorbidities. DESIGN: Cross-sectional study. SETTING: Hospital. PARTICIPANTS: All individuals aged 70 and older (mean age 84.4, 61.4% female) admitted to a geriatric service over 3 months (N = 202). MEASUREMENTS: In-person assessment using the Oral Health Assessment Tool (OHAT) (range 0-2, 2 = poorest) for lips, tongue, gums and soft tissue, saliva, teeth, dentures, oral cleanliness, and dental pain. Comorbidities and medications were also recorded. RESULTS: One hundred twenty-eight (63%) participants had full or partial dentures, and 31 (15%) were edentulous. Median OHAT score was 6 (interquartile range 5-8). Of the eight domains, saliva scored worst, with 53% scoring 2. On univariate analysis, the highest (poorest) tertile of OHAT (score ≥8) was associated with dementia (odds ratio (OR) = 2.41, 95% confidence interval (CI) = 1.13-5.12, P = .02), moderate to severe renal impairment (estimated glomerular filtration rate <30 mL/min per 1.73 m(2) at discharge) (OR = 5.52, 95% CI = 1.54-19.69, P = .009), recent anticholinergic medication burden (P = .02), and low oral pH (P = .05). On multivariate analysis adjusted for oral pH and anticholinergic medication burden, dementia (OR = 2.29, P = .02) and moderate to severe renal impairment (OR = 5.64, P = .01) were independently associated with the highest tertile of OHAT. Charlson Comorbidity Index (includes renal disease, dementia) was associated with OHAT on univariate analysis (Spearman rho = 0.19, P = .01) but not when adjusted for oral pH (P = .10). CONCLUSION: Poorer oral health was not uncommon and was associated with dementia and renal impairment even after adjustment for anticholinergic medication and oral pH. Oral health screening should be considered for vulnerable populations.

Cerebral nocardiosis characterized by magnetic resonance spectroscopy in vivo.

We describe a patient with multiple cerebral lesions that initially were believed to be tumor metastases but were later found to be caused by Nocardia asteroides, after magnetic resonance spectroscopy (MRS) findings suggested that the lesions were infective in origin. This case report demonstrates the ability of MRS, a noninvasive imaging modality, to aid in the diagnosis of brain infection.