Piloting the global capacity education e-tool: can capacity be taught to health care professionals across different international jurisdictions?

Determining decision-making capacity is part of everyday business for health care professionals working with older adults. We used a modified Delphi approach to develop an inclusive curriculum for a capacity education e-tool with global application and clinical relevance to a range of disciplines. The tool comprised: (i) 25 questions forming a "pre-test" for the adaptive and personalized e-Learning platform; (ii) a learning module based on the participant's response to the "pre-test"; (iii) a "post-test" (the same baseline 25 questions) to test knowledge translation. The tool was tested on 31 health care professionals across Israel (8), Canada (15), and Australia (8) from the following disciplines: General Practitioners (GP) (19), Internal Medicine (1), Palliative Care GP (2); Palliative Care Physician (2), Geriatrician (2); and one of each: Psychologist, Occupational Therapist, Psychiatrist, Aged Care Researcher, and Aged Care Pharmacist. The mean baseline pre-test score was 19.1/25 (S.D. =1.61; range 15-22) and post-test score 21.7/25 (S.D.= 1.42; range 18-24); with a highly significant improvement in test scores (paired t-test P < 0.0001; t=10.81 on 30 df). This is the first such pilot study to demonstrate that generic capacity principles can be taught to health care professionals from different disciplines regardless of jurisdiction.

The Relationship Between Caregiver Burden and Emotion Recognition Deficits in Persons With MCI and Early AD: The Mediating Role of Caregivers' Subjective Evaluations.

OBJECTIVES: Emotion recognition (ER) abilities change in people with early Alzheimer disease (AD) and mild cognitive impairment (MCI) and can influence their caregivers' lives and experiences. The aims of this study were: (1) to assess caregivers' awareness of ER deficits in care-receivers with early AD or MCI; (2) to examine the mediating role of caregivers' subjective evaluations on the relationship between caregiver burden and ER deficits in persons with MCI and early AD. METHODS: Persons with MCI (N=29) and with early AD (N=26) performed an ER task (objective emotion recognition, OER) of watching short clips of dynamic bodily and dynamic facial expressions of 6 basic emotions. In addition, their family caregivers (N=55) were interviewed to measure their evaluation of their relatives' ER ability (subjective emotion recognition, SER) as well as their own experience of burden. RESULTS: Two thirds of the caregivers either underestimated or overestimated the care-receivers' ER deficits. Regression results yielded a significant positive relationship between OER and SER, as well as a significant negative relationship between SER and caregiver burden. Moreover, SER was found to mediate the relationship between OER and caregiver burden. CONCLUSION: Caregivers' better awareness of ER deficits in people with MCI and early AD might mitigate the deleterious consequences of caregiving for persons with cognitive deterioration and might therefore allow better chances for people with dementia to age in a homecare setting.

Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights.

BACKGROUND: Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study. METHODS: Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness. RESULTS: Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear. CONCLUSIONS: Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

[Length and outcome of acute inpatient rehabilitation for hospital-associated deconditioning in the elderly].

INTRODUCTION: Acute illness and prolonged bed rest might be associated with loss of muscle mass and significant decline in functional ability and mobility, regardless of a specific neurological or orthopedic insult. This condition is commonly termed hospital-associated deconditioning (HAD). To the best of our knowledge to date, acute inpatient rehabilitation length and outcome for HAD in the elderly have never been studied in Israel. AIM: To study which variables are independently associated with the length and mobility outcome of acute inpatient rehabilitation for HAD in the elderly. METHODS: A retrospective cross-sectional study was conducted during 2009 at the departments of Geriatric Medicine in the Tel-Aviv Medical Center The medical charts of consecutive elderly (< 65 years) patients admitted for rehabilitation due to HAD were studied for the following measurements: demographics, co-morbidities, causes of HAD, admission albumin serum levels, Mini-Mental Status Examination (MMSE) scores, admission transfer and walking Functional Independence Measure (FIM) scores, discharge transfer and walking FIM scores, and rehabilitation length. RESULTS: The cohort included 103 patients: 57 (55.3%) females and 46 (44.7%) males. The mean age for the entire cohort was 83.6 +/- 6.0 years. The three most common causes of HAD were pneumonia, craniotomy due to intracranial bleeding without neurological insults, and congestive heart failure exacerbation. The mean discharge transfer and walking FIM scores were 5.3 +/- 0.9 and 5.2 +/- 0.8, respectively. The mean length of rehabilitation was 20.4 +/- 13.9 days. Linear regression analysis showed that discharge transfer FIM scores, discharge walking FIM scores, and rehabilitation length were all independently associated with mobility upon admission to rehabilitation (p < 0.0001, p < 0.0001, p = 0.024, respectively). Rehabilitation length was also associated with admission albumin serum levels (p = 0.008). CONCLUSIONS: The length and mobility outcomes of acute inpatient rehabilitation for HAD in the elderly are associated with mobility upon admission to rehabilitation. Acute inpatient rehabilitation length is also associated with admission albumin serum levels.

Older patients with active cancer have favorable inpatient rehabilitation outcomes.

OBJECTIVES: To investigate the characteristics and rehabilitation outcomes of older patients with active cancer (OPAC) undergoing post-acute inpatient rehabilitation (IR), and to evaluate which clinical factors are associated with poor rehabilitation outcomes. MATERIALS AND METHODS: This is a retrospective study of patients aged ≥65 with active cancer undergoing IR following acute hospitalization at our tertiary hospital centre (N = 330). We collected data on patient, malignancy, and hospitalization characteristics, and IR outcomes including function, mobility, discharge destination, and mortality. Multivariate stepwise logistic regression was used to identify independent associations with the composite outcome of death within three months or discharge to long-term care (LTC). RESULTS: Patient mean age was 80.1 ± 7.2 years. The most common malignancies were colon (30.9%) and hematologic (16.1%). Most patients were hospitalized urgently (64.8%) and underwent surgery (72.4%). From IR admission to discharge, patients ambulating independently increased from 14.0% to 52.0%. Discharge destination was to the community (80.4%), to LTC (7.6%), and transfer to an acute ward (7.2%), while 4.8% died during IR. One-year survival was 62.1%. The composite outcome was met by 24.8% of patients with multivariate logistic regression revealing independent associations (p < 0.05) with high baseline dependency, metastatic disease, low mobility score on IR admission, complications during acute care, and ≥ 75th percentile values for lactate dehydrogenase and alkaline phosphatase. CONCLUSION: OPAC have favorable IR outcomes including high rate of community discharge, function and mobility gains, and lower mortality rates when compared with previously studied cancer rehabilitation populations. We identified several clinical markers associated with the composite outcome, which can guide post-acute discharge planning in patients with an unclear prognosis.

Efficacy of the I-SOCIAL intervention for loneliness in old age: Lessons from a randomized controlled trial.

Loneliness is common among older persons and is associated with adverse health and wellbeing outcomes. We investigated a theory-based intervention that addresses barriers to social contacts and aims at increasing social self-efficacy. Individuals that met pre-assessment criteria of cognitive function, physical health, and loneliness levels were randomly assigned either to the I-SOCIAL intervention that combined both individual and group sessions to address individuals' unique social challenges, or to the control group. Assessment was administered at baseline, after the completion of the intervention, and after a 3-month follow-up period. The intervention group showed significant decline in loneliness level compared to the control group, both after the intervention and after the follow-up period. This innovative combination of analysis of personal barriers, support provided by the counselors, group activities, and individualized suggestions for social activities in the participant's neighborhood, may account for the success of the intervention in decreasing participants' loneliness levels.

Risk Factors for Urinary Retention Following Surgical Repair of Hip Fracture in Female Patients.

BACKGROUND/OBJECTIVES: Postoperative urinary retention (POUR) is a common event following surgical procedures. An increase in the number of elderly individuals who undergo hip fracture repair procedures is inevitable due to the aging of population. Postoperative urinary retention is associated with both early (infections, delirium) and late complications (urinary incontinence) of surgery. The objective of the current study is to direct attention to the less studied population of patients admitted to a geriatric rehabilitation ward following hip fracture repair who are at risk of POUR. DESIGN: Prospective single-center cohort study. SETTING: Academic tertiary hospital. MEASUREMENT: Postvoid bladder volume by ultrasonography (US). RESULTS: Postvoid bladder volume was measured by US in 88 consecutive female patients on the morning following their admission to the geriatric rehabilitation department. The mean age of the patients was 82.5 ± 6.5 years, and the frequency of POUR (defined as postvoid bladder volume ≥200 mL) was 37.5%. The POUR (n = 33) and non-POUR (n = 55) groups were similar with respect to most demographic and disease states. Multivariable stepwise logistic regression revealed a significant effect for opioid use (relative risk [RR] = 8.0, P < .001) and for treatment with anticholinergic medication (RR = 1.3, P = .046). There was an unexpectedly high proportion of patients with asymptomatic urinary retention (29 of the 33 patients, 88%). CONCLUSION: The high incidence of asymptomatic POUR in elderly patients calls for the need for improved screening tools for early identification and treatment.

Long-Term Outcomes of Medication Intervention Using the Screening Tool of Older Persons Potentially Inappropriate Prescriptions Screening Tool to Alert Doctors to Right Treatment Criteria.

OBJECTIVES: To compare 24-month outcomes of participants of a prospective randomized controlled trial (RCT) assigned to undergo a medication intervention of orally communicated recommendations based on Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) (intervention group) with outcomes of those assigned to undergo written medication review (control group). DESIGN: Retrospective cohort study. SETTING: Chronic care geriatric facility. PARTICIPANTS: Of 359 participants from a prospective RCT conducted between April 2012 and September 2013, 306 were evaluable for another 12-month follow-up. MEASUREMENTS: Outcomes at 24-month follow-up included quality of prescribing (assessed according to STOPP/START), hospitalizations, falls, costs of medications, and all-cause mortality. Outcomes were compared with those reported at the beginning (baseline) and end (12-month follow-up) of the RCT. RESULTS: There was a significant rise in potentially inappropriate prescriptions (PIPs) (P = .01) and potentially prescriptions omissions (PPOs) (P < .001) in the intervention group between 12 and 24 months, although the prevalence of PIPs was significantly lower in the intervention group (33.3%) than the control group (48.4%) at 24-month follow-up (P = .02). Costs of medications were significantly lower in the intervention group than the control group (P < .001) at 24-month follow-up. The average number of falls in both groups dropped significantly between baseline and study closure (P = .04 and P = .008, respectively). There was no significant difference in hospitalizations and mortality between the two groups at 24-month follow-up. CONCLUSION: The effect of an orally communicated medication intervention with the STOPP/START criteria on falls was maintained over time. Direct communication between pharmacists and prescribing physicians is more efficient than written medication review and is recommended every 6 months in geriatric facilities.

Characteristics and outcomes of ninth and tenth decade patients hospitalized in a sub-acute geriatric hospital.

BACKGROUND: Population structures are changing across the western world, with particularly rapid growth in the number of very old people. Life expectancy has been increasing gradually over years, resulting in a larger subpopulation of people aged 90 and over. OBJECTIVES: To describe the sociodemographic, medical and functional characteristics of people aged 80-90 and 90+ who were admitted to a sub-acute geriatric hospital and to compare the hospitalization outcomes between these subgroups. METHODS: We compared the demographic and clinical data (extracted by means of chart review) of two groups of elderly who were admitted to the Reuth Medical Center during 2001-2002: those aged 90+ and those 80-89. Among survivors, the main outcome measures at discharge were mortality rate, functional ability, and place of residence. RESULTS: The study included 108 patients who were admitted to different divisions of Reuth: 55 patients aged 90+ and 53 aged 80-90. The mortality rate was significantly elevated in the older age group (49.1% vs. 28.1% in the younger age group). On multivariate analysis, the most important prognostic factors for mortality were incontinence (odds ratio 3.45) and being dependent before admission (OR 4.76). Among survivors, an association was found between being incontinent and dependent before hospitalization, and being dependent on discharge. CONCLUSIONS: The main prognostic factors for mortality and functional outcome in patients admitted to a non-acute geriatric hospital are incontinence and functional state prior to admission, and not age per se.

The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division.

BACKGROUND: Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) have been increasingly used to evaluate potentially inappropriate prescriptions (PIPs) and potentially prescription omissions (PPOs). The impact of hospitalization on PIPs/PPOs has not been investigated in depth. OBJECTIVE: To compare the prevalence of PIPs/PPOs in elderly patients on hospital admission and discharge and to identify associated risk factors. SETTING: An acute medical geriatric division of the Tel Aviv Medical Center (Israel). METHOD: This retrospective cross-sectional study included patients admitted from 12/2011 to 12/2012 aged ≥65 years. Data from patients' records included demographic details, diagnoses and medications at admission and discharge. STOPP/START criteria were applied to each patient's record. MAIN OUTCOME MEASURE: Prevalence of PIPs/PPOs on hospital admission and discharge. RESULTS: Three hundred patients were included (mean ± SD age 81.9 ± 7.2 years). Admission PIPs prevalence was 39.3 % (118 patients, 172 PIPs) and it increased to 46.0 % (138 patients, 209 PIPs) at discharge (P = 0.009). Admission PPOs prevalence was 41.0 % (123 patients, 153 PPOs) and it decreased to 28.3 % (85 patients, 99 PPOs) at discharge (P < 0.001). Having at least one PIP/PPO at discharge but not at admission was associated with length of hospital stay (OR 1.02, 95 % CI 1.001-1.03). History of falls increased the risk of being a "new PIP patient" (OR 2.25, 95 % CI 1.03-4.9), whereas diabetes increased the risk of being a "new PPO patient" (OR 3.86, 95 % CI 1.2-12.5). CONCLUSION: Hospitalization in a geriatric division resulted in an increase in PIPs and a decrease in PPOs. Strategies to reduce PIPs need to be implemented, especially for patients with longer hospital stay and a history of falls.

[Cerebral paraplegia due to blunt head injury].

Cerebral paraplegia due to traumatic brain injury is a very rare condition. We present a case study of a man who sustained a blunt head injury, sub-dural hematoma of the falx and dorsal paraplegia. Eventually, he recovered almost completely neurologically and functionally.

Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial.

OBJECTIVES: To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) medication intervention on clinical and economic outcomes. DESIGN: Parallel-group randomized trial. SETTING: Chronic care geriatric facility. PARTICIPANTS: Residents aged 65 and older prescribed with at least one medication (N = 359) were randomized to receive usual pharmaceutical care or undergo medication intervention. INTERVENTION: Screening medications with STOPP/START criteria followed up with recommendations to the chief physician. MEASUREMENTS: The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls, Functional Independence Measure (FIM), quality of life (measured using the Medical Outcomes Study 12-item Short-Form Health Survey), and costs of medications. RESULTS: The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year (P < .001). The average drug costs in the intervention group decreased by 103 shekels (US$29) per participant per month (P < .001). The average number of falls in the intervention group dropped significantly (P = .006). Rates of hospitalization, FIM scores, and quality of life measurements were similar for both groups. CONCLUSION: Implementation of STOPP/START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended.

Potentially inappropriate prescribing among older residents in a geriatric hospital in Israel.

BACKGROUND: STOPP/START ("screening tool of older persons potentially inappropriate prescriptions"/"screening tool to alert doctors to right treatment") criteria were formulated to identify potentially inappropriate prescriptions (PIP) and potential prescription omissions (PPO) in older people. OBJECTIVE: To determine the prevalence of PIP and PPO using STOPP/START criteria and to identify associated risk factors. METHOD: Data were prospectively collected from 382 residents' records in an Israeli geriatric hospital. The study population included subjects ≥ 65 years of age who were taking at least one medication. Data on demographics, medical histories, current diagnoses, current medications and biochemistry results were collected and analyzed. STOPP/START criteria were applied to each medical file. RESULTS: A total of 359 residents comprised the study group (mean age [± SD] 82.7 ± 8.7, 66.6 % females). STOPP identified 430 instances of PIP in 243 (67.7 %) residents, and START identified 151 PPO in 122 (34 %) residents. The number of medications (OR: 1.2, 95 % CI 1.11-1.3), falls (OR: 1.16, 95 % CI 1.021-1.32) and hospitalizations (OR: 1.25, 95 % CI 1.025-1.53) were identified as predictors for STOPP-defined PIP. The Charlson Comorbidity Index (OR: 1.4, 95 % CI 1.17-1.7) was associated with START-defined PPO. CONCLUSION: A high prevalence of PIP/PPO was found among geriatric patients and was associated with number of medications, falls, hospitalizations and Charlson Comorbidity Index score.

Symptomatic venous thromboembolism in elderly patients following major orthopedic surgery of the lower limb is associated with elevated vitamin B12 serum levels.

BACKGROUND: Elevated vitamin B12 serum levels are associated with systemic inflammation and mortality. Since venous thromboembolism (VTE) is associated with systemic inflammation and mortality as well, we have hypothesized that it is also associated with elevated vitamin B12 serum levels in elderly patients following major orthopedic surgery of the lower limb. METHODS: This is a retrospective study. Medical charts of consecutive elderly (≥65 years) patients admitted for rehabilitation following major orthopedic surgery of the lower limb during 2007-2009 were reviewed. The study group included symptomatic VTE patients. The control group included patients in whom VTE was excluded. Demographics, co-morbidities, VTE risk factors, vitamin B12 serum levels, and 1-year mortality were studied. RESULTS: The cohort included 197 elderly patients (median age: 82 years): 140 (71.1%) women and 57 (28.9%) men. Overall, 20 (10.2%) patients had VTE (study group) and in 177 (89.8%) patients VTE was excluded (control group). Vitamin B12 serum levels were higher in the study group compared with the control group (median: 634 vs. 409 pg/dL, p=0.024). The incidence of elevated vitamin B12 serum levels (≥500 pg/dL) was higher in the study group compared with the control group (odds ratio 3.1, p=0.031). Elevated vitamin B12 serum levels were associated with VTE (odds ratio 5.3, p=0.011) and with 1-year mortality (odds ratio 6.6, p=0.015) independent of demographics, co-morbidities, and VTE risk factors. CONCLUSIONS: Symptomatic VTE is associated with elevated vitamin B12 serum levels in elderly patients following major orthopedic surgery of the lower limb.

Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients with deconditioning.

We sought to determine if admission Norton scale scores (ANSS) used for evaluating pressure ulcer risk also correlate with rehabilitation outcome and length in elderly patients with deconditioning. This was a retrospective study conducted in a geriatric department between June 2008 and June 2010. The medical charts of consecutive elderly (≥65 years) patients admitted for rehabilitation due to deconditioning were studied for the following measurements: ANSS, admission albumin serum levels, mini-mental status examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, discharge transfer FIM scores, and rehabilitation length. The cohort included 152 patients: 79 (52%) females and 73 (48%) males. Mean age was 83.6±6.5 years. The three most common causes of deconditioning were pneumonia, congestive heart failure exacerbation, and falls. ANSS correlated with discharge walking FIM scores (r=0.32; p=0.003), discharge transfer FIM scores (r=0.30; p=0.005), and length of rehabilitation (r=-0.37; p<0.0001), following adjustment for age, albumin serum levels, and MMSE scores. Linear regression analysis showed that ANSS were independently associated with discharge walking FIM scores (p=0.004), discharge transfer FIM scores (p=0.006), and rehabilitation length (p<0.0001). We conclude that the Norton scoring system may be used for predicting the outcome and the length of rehabilitation in elderly patients with deconditioning.

Admission Norton scale scores (ANSS) and postoperative complications following hip fracture surgery in the elderly.

We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with postoperative complications and in-hospital mortality following hip fracture surgery in the elderly. This was a retrospective cross-sectional study conducted in a tertiary medical center. The medical charts of consecutive elderly (≥ 65 years) patients admitted for hip fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, postoperative complications, the need for revision procedures, and in-hospital mortality. Except for pressure ulcers, postoperative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 269 patients: 198 (73.6%) females and 71 (26.4%) males. Mean age for the entire cohort was 82.8 ± 0.4 years. Most patients underwent an internal fixation (n=146; 54.3%) or hemiarthroplasty (n=92; 34.2%). Overall, 110 (40.9%) patients had low (<15) ANSS. Patients with low ANSS had significantly more postoperative complications relative to patients with high ANSS (0.77 ± 0.09 vs. 0.23 ± 0.04; p<0.0001). Among all postoperative complications, urinary tract infection was independently associated with low ANSS (p<0.0001). ANSS were independently associated with postoperative complications (p<0.0001), the need for revision procedures (p=0.019), and in-hospital mortality (p=0.016). We conclude that the Norton scoring system may be used for predicting postoperative complications and in-hospital mortality following hip fracture surgery in the elderly.

Admission Norton scale scores are associated with long-term mortality following rehabilitation in older adults.

OBJECTIVE: Low admission Norton scale scores (ANSS) are usually associated with high risk of pressure ulcer. The aim of this study was to determine whether low ANSS are also associated with long-term mortality following rehabilitation in older adults. DESIGN: A cross-sectional retrospective study. SUBJECTS: Consecutive older adults admitted during 2009 for rehabilitation following stroke (n = 110), hip arthroplasty (n = 201), and hospital-associated deconditioning (n = 96). METHODS: Patients were followed until January, 2011. Long-term mortality rates, i.e. within one year or more, were compared between patients with low (≤ 14) ANSS and patients with high (≥ 15) ANSS. RESULTS: The final cohort included 407 patients (67.8% females; mean age 82.2 years). Overall, 193 (47.4%) patients had low ANSS. Patients were followed for a mean period of 524 days. Overall, 66 (16.2%) patients died during this time. Patients who died had significantly lower mean ANSS compared with those who survived (13.9 vs 14.9; p = 0.001). Cumulative survival rates were significantly lower among patients with low ANSS compared with patients with high ANSS (p = 0.004). Regression analysis showed that ANSS were independently associated with mortality (p = 0.02), regardless of rehabilitation cause, age, gender, and chronic co-morbidities. CONCLUSION: ANSS may be used not only for evaluating pressure ulcer risk, but also for predicting long-term mortality, i.e. within one year or more, following rehabilitation in older adults.

Preliminary clinical evaluation of a noninvasive device for the measurement of coagulability in the elderly.

The feasibility of the noninvasive assessment of blood 'coagulability' (the tendency to coagulate) has been tested by using a novel device, the Thrombo-Monitor. It monitors, by using the principles of near infra-red (NIR) dynamic light scattering, the tendency of blood to create clots. The Thrombo-Monitor observes the very initial changes of blood viscosity, which occurs due to the temporarily induced stasis of capillary blood of the finger. One hundred and fifteen patients aged >65 years (matched by age and sex) participated in the study. Patients were initially divided into four groups based on the patient's medical therapy. The study groups were: warfarin, enoxaparin, aspirin and/or clopidogrel, and a control group. The medications were given according to the patient's comorbidities (eg, atrial fibrillation [AF], status post pulmonary embolism [S/p PE], status post cerebrovascular accident [S/p CVA]). The Thrombo-Monitor Index (TMI) is a noninvasive index, derived on the basis of laboratory test results of international normalized ratio (INR) and prothrombin time (PT) values. For the group of patients who were treated only with warfarin, TMI was adjusted by using the jackknife statistical approach to create maximum correlation and linearity with INR and PT values that ranged from 1.1 to 5.0. For all warfarin patients (N = 35) the TMI was found to have a good correlation with INR and PT values (R(2) = 0.64, P < 0.00001); mean TMI = 1.86 (SD = 0.91); mean INR and PT = 2.3 (SD = 0.91). The calibration curve thus generated was used to calculate the TMI for all other groups: aspirin group, mean TMI = 1.3 (SD = 0.14, N = 23), corresponding approximately to INR and PT values of 1.036; enoxaparin group (N = 24), mean TMI = 1.34 (SD = 0.304), corresponding to mean INR and PT values of 1.07 (SD = 0.3); control group, INR and PT ≥ 1 (N = 32), mean TMI = 1.24 (SD = 0.32). R(2) of all control and warfarin patients (N = 67) was 0.55 (P < 0.00001). In summary, the newly introduced TMI index is significantly correlated with INR and PT values.

Admission Norton scale scores correlate with rehabilitation outcome and length in elderly patients following cerebrovascular accident.

AIMS: To determine whether Norton scale scores used for evaluating pressure sore risk also correlate with rehabilitation outcome and length following cerebrovascular accident (CVA) in elderly patients. METHODS: A retrospective study was conducted at a geriatric rehabilitation department in a tertiary medical center during 2009. The medical charts of consecutive elderly (≥65 years) patients admitted for rehabilitation after CVA were studied for the following measurements: admission Norton scale scores, admission albumin serum levels, mini-mental status examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, discharge transfer FIM scores, and rehabilitation length in days. RESULTS: The cohort included 110 patients, 64 (58.2%) women and 46 (41.8%) men. The mean age of the entire group was 80.5±7.4 years. Most patients had ischemic CVA (90.9%) and a first CVA (79.1%). The mean discharge walking FIM score was 4.7±1.4, the mean discharge transfer FIM score was 5.0±1.4, and the mean length of rehabilitation was 28.2±15.3 days. Admission Norton scale scores correlated with discharge walking FIM scores (r=0.51; p<0.0001), discharge transfer FIM scores (r=0.43; p<0.0001), and length of rehabilitation (r=-0.45; p<0.0001) after adjustment for age, albumin serum levels, and MMSE scores. Linear regression analysis showed that admission Norton scale scores were associated (p<0.0001) with the discharge walking FIM scores, the discharge transfer FIM scores and rehabilitation length, independent of age, gender, albumin serum levels, MMSE scores, type of CVA, and the appearance of pressure sores. CONCLUSIONS: The Norton scoring system may be used to predict the outcome and duration of rehabilitation in elderly patients after CVA.

Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients following hip arthroplasty.

We sought to determine if ANSS used for evaluating pressure sore risk also correlate with rehabilitation outcome and length following hip arthroplasty in elderly patients. This was a retrospective study conducted in a geriatric rehabilitation department during 2009. ANSS, admission albumin serum levels, mini-mental state examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, and rehabilitation length were studied. The final cohort included 201 patients: 160 (79.6%) females and 41 (20.4%) males. Mean age was 82.7±6.5 years. Mean discharge walking FIM score was 5.2±0.9. Mean length of rehabilitation was 19.9±7.8 days. ANSS correlated with discharge walking FIM scores (r=0.28; p=0.002), and with length of rehabilitation (r=-0.22; p=0.014) following adjustment for age, admission albumin serum levels, and MMSE scores. Linear regression analysis showed that ANSS were associated with the discharge walking FIM scores (p<0.0001) and rehabilitation length (p=0.027) independent of age, admission albumin serum levels, gender, type of hip surgery, and the appearance of pressure sores. We conclude that the Norton scoring system may be used for predicting the outcome and the duration of rehabilitation in elderly patients following hip arthroplasty.