An Inpatient Geriatrics Program with a Focus on Any Type of Cognitive Impairment Reduces Mortality.

BACKGROUND: No matter what type of cognitive impairment an older hospitalized patient has, the risk of mortality is increased. OBJECTIVES: To describe a hospital-based geriatrics program with a focus on any type of cognitive impairment and to determine whether this program was associated with reduced mortality over time. DESIGN, PARTICIPANTS AND SETTING: Retrospective chart review of all patients age 70+ admitted during a 3-year period (2017-2019, N=20,401), to a 500-bed community-based hospital (Level 1 Trauma Center and Stroke Center). INTERVENTION: A multicomponent geriatrics program was developed and implemented throughout 2018 and included: geriatric consultation, data collection, review of the data with hospital leaders, a geriatrics task force, clinician education and a Delirium Unit. MAIN OUTCOMES AND MEASURES: Monthly mortality rates for patients with and without cognitive impairment over the 3-year period. To control for other variables associated with mortality, pre-post implementation analyses were performed (2017 versus 2019). RESULTS: A linear regression analysis showed a significant downward trend in mortality over time for patients with cognitive impairment [R2=0.4, P<.0001, (correlation coefficient -0.6, 95% CI, -0.8 to -0.4)] but not among patients without cognitive impairment [R2=0.0, P=0.829, (correlation coefficient 0.0, 95% CI, -0.3 to 0.3)]. When controlling for other variables, there was still a decrease in mortality risk among patients with cognitive impairment. CONCLUSION: Although there are limitations to this study, a multicomponent geriatrics program with an emphasis on any type of cognitive impairment, may be associated with improved mortality.

A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people.

INTRODUCTION: The SARC-F scale is a newly developed tool to diagnose sarcopenia and obviate the need for measurement of muscle mass. SARC-F ≥ 4 is defined as sarcopenia. The questions of SARC-F cover physical functions targeting sarcopenia or initial presentation for sarcopenia. The aim of the study is to explore the application of SARC-F in the Chinese people. METHODS: Two hundred thirty Chinese people over 65 years old were assessed by the SARC-F scale, PSMS, Lawton IADL and the shortened version of the falls efficacy scale-international(the short FES-I). Hospitalization was investigated. Physical performance and strength were measured. The association of SARC-F with other scales or tests was analyzed. RESULTS: Poor physical performance and grip strength were associated with SARC-F ≥ 4 independently (P<0.005). The κ value for agreement of SARC-F ≥ 4 and cutoff points of tests were 0.391 to 0.635. The short FES-I were correlated to SARC-F scores (Spearman's coefficient 0.692). Poor PSMS and Lawton IADL scores were associated with SARC-F ≥ 4(P=0.000) and SARC-F ≥ 4 was associated with hospitalization in the past 2 years (P=0.000). CONCLUSION: The SARC-F scale can identify old Chinese people with impaired physical function who may suffered from sarcopenia. SARC-F judgment reflects fear of falling, indicates the hospitalization events and is associated with ability of daily life. Thus, SARC-F may be a simple and useful tool for screening individuals with impaired physical function. Further studies on SARC-F in Chinese people would be worthy.

Use of alternative therapies in older outpatients in the United States and Japan: prevalence, reporting patterns, and perceived effectiveness.

BACKGROUND: The purpose of this study was to determine the prevalence, patterns of reporting, and perceived effectiveness of alternative medical therapies (ATs) among older white American, African American, and Japanese outpatients. METHODS: This study used a questionnaire to interview participants (N = 593; age, >59 y), who were outpatients of geriatric outpatient clinics in Saint Louis, Missouri, and Tokyo, Japan (white Americans, n = 180; African Americans, n = 106; and Japanese, n = 307). RESULTS: Use of >1 AT was greatest among older Japanese (74.3%), followed by white Americans (61.1%) and African Americans (47.2%; p <.001). The most common ATs used among the Japanese (and significantly more than the white and African American groups) were lifestyle diet, herbal therapy, massage, acupressure, and acupuncture. The white and African American groups were more frequent users of relaxation techniques and spiritual healing compared with the Japanese group. Contrary to prior studies of the general population, the use of >1 AT did not correlate with any sociodemographic variables. Reported use of ATs to doctors was low but similar in all three groups (white Americans = 48%, African Americans = 42%, and Japanese = 46%). Perceived effectiveness was high but similar in all three groups (white Americans = 85%, African Americans = 92%, and Japanese = 84%). Although chronic conditions were common reasons for use of ATs, nonmedical reasons (e.g., general health or religious reasons) were also common. CONCLUSIONS: Use of ATs was greater in Japan than in the United States, but for both countries, use by older persons was greater than previous reports of the general population. Because sociodemographic variables do not predict use, and reported use to doctors is low and perceived effectiveness is high, increased awareness and understanding about ATs by health care professionals seems imperative.

Examining the effect of intervention to nutritional problems of the elderly living in an inner city area: a pilot project.

OBJECTIVE: To examine the effect of interventions provided to home-delivered meal service recipients living in an inner city neighborhood for the purpose of improving their nutritional conditions. DESIGN: Intervention study. SETTING AND PARTICIPANTS: Both the Study Group (42 seniors) and the Control Group (39 seniors), all of whom are over 60 years old, received home delivered meal services. In addition, only the Study Group received the following services through the trained neighborhood residents: 1) health education, 2) referrals to other community resources for unmet health needs, and 3) follow-up services to assure that the health problems were addressed appropriately. The nutritional condition, depression and cognitive status of the Study Group were assessed by medical staff before and after the six-month intervention. The same assessments were conducted to the Control Group with the same interval. Data was analyzed using ANOVA (repeated). MEASUREMENTS: MNA, GDS, and MMSE. RESULTS: Compared to the Control Group, the nutritional condition (p=0.052) and depression (p=0.02) of the Study Group were improved, while no significant difference was observed in their cognitive status. CONCLUSION: A combination of interventions by medical professionals and by trained neighborhood residents seemed to be an effective strategy to approach nutritional problems of seniors living in inner city areas.

A student-run Geriatric Home Health Care Program.

This paper describes how medical students developed, maintained, and received curriculum credit for a home health care program for senior citizens, and how both patients and students have benefited from the program.

Polypharmacy and hospitalization among older home care patients.

BACKGROUND: One of the major goals of home care is the prevention of hospitalization. The objective of this study was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization among home care patients older than 65 years. METHODS: A retrospective chart review of 833 discharged older home care patients was performed. These patients were consecutive discharges from a single home care agency who either (a) returned to independent self-care or care of the family (S/F Care group) or (b) were admitted to the hospital (Hospitalized group). Medication assessment within these two groups included total number of medications (prescription and nonprescription); degree of polypharmacy (percentage of patients taking 5 or more, 7 or more, and 10 or more medications); and prevalence for different types of medications, including different types of inappropriate medications. Inappropriate medications were designated according to a list that was previously developed through a modified Delphi consensus technique by a panel of 13 experts in geriatric pharmacology and has been utilized in other studies. Student's t test was used for continuous variables and chi-square test was used for categorical variables to evaluate for differences between the S/F Care group and the Hospitalized group (p <.05). For comparisons of types of medications, p < .01 was used for significant differences, because of the high number of comparisons made. RESULTS: Of 833 discharges, 644 (77.3%) returned to self-care or care of the Family (S/F Care group) and 189 (22.7%) were hospitalized. The Hospitalized group, compared with the S/F Care group, was taking a higher number of medications (mean +/- SD: 6.6+/-3.9 vs 5.7+/-3.4, p = .004), and had a higher percentage of patients taking 7 or more medications (46% vs 26%, p = .002) and 10 or more medications (21% vs 10%, p = .005), but not 5 or more medications. Only three types of medications were more commonly used among patients in the Hospitalized group than among patients in the S/F Care group: clonidine (4.2% vs 1.1%, p = .004); mineral supplements (23.8% vs 14.8%, p = .003); and metoclopramide (5.8% vs 2.0%, p = .006). The Hospitalized group had a lower percentage of patients taking inappropriate medications than did the S/F Care group (20% vs 27%, p = .040), but none of the types of inappropriate medications was used more often in either group. CONCLUSIONS: This study shows a relationship between high levels of polypharmacy and hospitalization. Although it cannot be determined from this study whether a higher number of medications was an indicator of sicker patients at risk for hospitalization, or whether a higher number of medications might have directly led to hospitalization, polypharmacy should still be considered a marker for older home care patients for whom prevention of hospitalization is the goal.

Diabetes mellitus among ethnic seniors: contrasts with diabetes in whites.

Diabetes mellitus is one of the most common chronic diseases affecting older persons in the United States. It occurs in 18% of persons between 65 and 75 years of age and in as many as 40% of persons over 80 years of age. The prevalence of diabetes mellitus varies considerably by ethnic group and is higher among most minority groups in the United States than among non-Hispanic white persons. Published data also show increased complications and mortality rate from diabetes in the minority groups. In this article, we review the current literature on the prevalence, complications, and mortality-rate effects of diabetes mellitus and the results of interventions in three major minority groups in the United States, namely African Americans, Hispanic Americans, and Native Americans. Recent studies of diabetes mellitus in Mexican seniors also are described. Our review focuses primarily on patients with non-insulin-dependent diabetes mellitus, because by far this is the most prevalent type in older persons.

Psychotherapeutic agents in older adults. Commonly prescribed and over-the-counter remedies: causes of confusion.

Acute confusion is associated with significant morbidity and mortality among older persons. Among the common causes of confusion, medications are at the top of the list. Since virtually any drug can cause confusion, it is helpful for the clinician to know which patients are at risk and which medications are risky. At particular risk are patients with dementia and patients whose pharmacokinetics or pharmacodynamics have been impaired by the aging process or diseases. The list of medications that can cause confusion is a long one, yet it can be remembered by the mnemonic ACUTE CHANGE IN MS (mental status). In addition to recognizing the offending agent, it is prudent for clinicians to prevent the chance of drug-induced confusion. One of the safest ways to do this is to avoid too many medications since the risk of adverse drug events rises exponentially with the number of medications prescribed.

Decreasing hospitalization rates for older home care patients with symptoms of depression.

OBJECTIVE: To target medically ill older home care patients with symptoms of depression in order to reduce their rate of hospitalization. DESIGN: A case-control study. SETTING: A private, nonprofit home care organization, the Visiting Nurse Association of St. Louis. PARTICIPANTS: Home care patients 65 years of age and older with symptoms of depression who were participants of a Total Quality Management (TQM) intervention (n = 81) were compared with an historical control of home care patients 65 years of age and older with symptoms of depression (n = 69). INTERVENTION: Utilization of TQM principles to develop a plan including: (a) an educational seminar on depression for home care staff involved in the project; (b) letters to physicians introducing the TQM project; (c) use of the Geriatric Depression Scale (GDS) for screening; (d) recommendation to the primary physician of a home social service (SS) consultation for patients with a GDS of 10 to 14; (e) recommendation to the primary physician of three interventions for patients with a GDS > or = 15: home SS consultation + mental health (MH), or gerontological nurse (GN) consultation + antidepressant medication (a pharmacotherapeutic algorithm sent by facsimile to the primary physician upon request). OUTCOME MEASURES: Hospitalization rates of the control group compared with the TQM intervention group, the degree to which part (e) of the plan was implemented, and the effect this had on hospitalization rates. RESULTS: The TQM intervention patients had a higher mean age than the historical control patients but were not different in percent female, percent white race, percent with a caregiver in the home, functional status, and in 15 of 16 diagnostic categories. Overall, the TQM intervention group had a hospitalization rate of 23.5% (19/81) compared with a rate of 40.6% (28/69) for the historical control group (P = .024). For part (e) of the plan (56/81 patients had a GDS > or = 15), 29/56 (52%) received the recommended SS consultation, 50/56 (89%) received the recommended MH or GN consultation, and 32/56 (57%) received antidepressant medication. One type of intervention did not seem to lower hospitalization rates more than another although having received the MH or GN visits approached significance (12/50, 24%; P = .052) when compared with the control group. CONCLUSIONS: Utilization of TQM principles and the development of an intervention such as the one described here can decrease hospitalization rates for medically ill older home care patients with symptoms of depression.

Impact on caregivers of supporting urinary function in noninstitutionalized, chronically ill seniors.

In a multivariate study of 148 caregivers of chronically ill older persons, 22% of those caring for a continent senior reported that maintaining continence was a burden, and 75% of caregivers of incontinent seniors reported it as burdensome. The burden of maintaining urinary function was associated with lack of social support, time spent providing care, and care receiver's immobility. Caregivers' depressive symptoms were associated with perceived burden from providing care for urinary function, a confused care receiver, and post-stroke support.