Insomnia among hospitalized elderly patients: prevalence, clinical characteristics and risk factors.

Insomnia can determine an increase in falls and accidents, hospitalization and nursing home placement. The aims of our study are to evaluate prevalence, clinical characteristics and predictors of sleep disorders in elderly inpatients admitted to a Geriatric Acute Care Ward. This longitudinal observational study consecutively recruited patients aged 65 and older admitted to a Geriatric Acute Care Unit between January the 1st 2007 and June 31st 2007. During the 3rd day of length of stay (LOS), patients were asked if they suffered with sleep disorders. Patients reporting sleep disturbances during the first 3 days of LOS were included in the study. Patients were evaluated for insomnia, comorbidity, self-rated health, functional status, cognitive impairment and pain. Of the 280 subjects investigated, 80 referred sleep disorders during LOS with a prevalence of 36.7%. Patients with sleep problems scored significantly worse on the cumulative index rating scale (CIRS) severity index (p=0.007), on the numeric rating scale (NRS) (p=0.01) and on the activities of daily living (ADL) scale (p<0.001). The CIRS severity index resulted the best predictor for insomnia related to hospitalization (OR 7.9, SE 0.85, p=0.01). The knowledge of insomnia predictors might help in planning preventive strategies to improve patients' global health status and quality of life.

Functional decline two weeks before hospitalization in an elderly population.

INTRODUCTION: The use of hospital care increases significantly with age. Older people coming to the emergency department have three to seven times higher rates of hospitalization than younger people. Hospitalization can lead to loss of independence and also need for long-term care at discharge. METHODS: A prospective observational non-randomized study of elderly patients admitted to the Department of Geriatric Medicine, University of Torino, Italy, between October 2006 and May 2007. RESULTS: The mean age of 123 subjects was 82.2±7.3 years. Among patients with dependence two weeks before admission, as reported by their caregivers, bathing, toileting and dressing were the most compromised ADL functions. In the same patients, shopping and transportation were reported as the most frequent IADL functions lost. Functional decline before hospitalization was significantly associated with a worsening in functional decline during the length of stay (RR 2.2, CI 1.05-4.66) and with discharge to a long-term facility (RR 2.1, CI 1.04-4.44). CONCLUSIONS: As functional decline two weeks before hospitalization influences hospital discharge and functional outcomes, it is certainly interesting to evaluate the impact of a dedicated early rehabilitation program for elderly patients. A well-structured program involving geriatricians, physiatricians and physiotherapists could be helpful for better short-term prognoses.

The experience of a geriatric hospital at home service for acutely ill elderly patients with pressure ulcers: an observational study .

UNLABELLED:  Background. Pressure ulcers are an often underestimated problem affecting elderly patients. METHODS: An observational study was undertaken to evaluate patients admitted from January 2000 to December 2001 to a geriatric hospital affiliated at home service. RESULTS: Four hundred sixty-six patients (44.4% men and 55.6% women) were enrolled. Seventy-nine (16.9%) patients presented with a pressure ulcer upon admission. These patients were more functionally and cognitively impaired and had the poorest nutritional status. Anorexia and asthenia were significantly higher in patients with pressure ulcers (P < 0.001), and prevalence of constipation and dysphagia was significantly different between the two groups (P <0.05). Relative risk of new onset of pressure ulcers was significantly linked to age (1.09, CI 95% 1.02-1.15), to the number of functions lost (1.79, CI 95% 1.15-2.78), and to comorbidity (2.79, CI 95% 1.26-6.18). The relative risk of death during hospital admission was significantly linked to age (1.02, CI 95% 1.00-1.05), number of activities of daily living (ADL) functions lost (1.2, CI 95% 1.08-1.33), underweight (1.31, CI 95% 1.06-1.62), and the presence of pressure ulcers (1.59, CI 95% 1.23-2.05). CONCLUSION: Home treatment of acutely ill elderly patients with pressure ulcers is feasible and efficacious. .

Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit.

We aimed to identify fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients. In 340 men and 280 women consecutively admitted to a Acute Geriatric Ward of a University Hospital the following variables were evaluated: demographics, clinical history, main disease responsible for hospitalization, comorbidity (cumulative illness rating scale: CIRS 1 and 2) gait and balance deficit (Tinetti's scales), cognition/function (short portable mental status questionnaire: SPMSQ); activities of daily living: ADL; instrumental activities of daily living: IADL; delirium (confusion assessment method: CAM), drugs administered during hospitalization. Overall 80 falls occurred in 70 patients. The incidence rate of falls was of 6.0 per 1000 patient-days with 2.0 falls per bed/year. Age (relative risk=RR=1.050; 95% confidence interval=CI=1.013-1.087), delirium (RR=3.577; 95% CI 1.096-11.672), diabetes (RR=5.913; 95% CI 1.693-20.644), balance deficit (RR=0.914; 95% CI 0.861-0.970) and polypharmacy (RR=1.226; 95% CI 1.122-1.340) were independently predictive of falling. Fallers had a prolonged length of stay (LOS) (35.5+/-47.8 days vs. 23.2+/-27.2; p=0.01) and more frequent nursing home placements (12.9% vs.5.6%; p<0.005). The knowledge of falling predictors might help in planning specific preventive strategies to improve the patients' global health status and to reduce the costs of medical care.