Functional, cognitive, and nutritional decline in 435 elderly nursing home residents after the first wave of the COVID-19 Pandemic.

PURPOSE: Many institutionalized older people have died during the first wave of COVID-19. Other related consequences have not yet been described objectively. The aim of this study was to compare functional, cognitive, and nutritional status before and after the first wave among nursing home residents, in both COVID-19 and non-COVID-19 patients. METHODS: Older adults institutionalized in four nursing homes were assessed from May to June 2020, by a geriatric multidisciplinary team in collaboration with the nursing homes staff. Comprehensive geriatric assessment was performed including functional, cognitive, and nutritional variables before and after the first wave of the pandemic. Data from residents with positive results for microbiological testing for SARS-CoV-2 were compared with those who did not. RESULTS: 435 nursing home residents were included. The median age was 86.77 ± 8.5 years, 78.4% were women. 190 (43.9%) tested positive for coronavirus. Functional decline after the first wave was detected in 20.2% according to the Barthel Index and in 18.5% according to functional ambulation categories, p < 0.001. Cognitive status worsened by 22 and 25.9% according to the global deterioration scale (p < 0.001) and Lobo's Mini-Examen Cognoscitivo (p 0.01), respectively. Onset of depressive symptoms was found in 48% (p < 0.001). The prevalence of malnutrition increased by 36.8 and 38.4% lost weight. When comparing the functional, cognitive, and nutritional decline between COVID-19 and non-COVID-19 patients no clinical or statistically significant differences were found except for the presence of prior malnutrition, higher in the COVID-19 group. CONCLUSION: We observed a significative functional, cognitive, and nutritional decline in institutionalized elderly after the first wave of COVID-19. These results may be caused by the lockdown itself, since no differences have been found between COVID-19 and non-COVID-19 patients. According to these results, interventions are necessary during social isolation or confinement to prevent systemic decline in the elderly.

Development of a new comprehensive preoperative risk score for predicting 1-year mortality in patients with hip fracture: the HULP-HF score. Comparison with 3 other risk prediction models.

PURPOSE: The aim of this study was to develop a new comprehensive preoperative risk score for predicting mortality during the first year after hip fracture (HF) and its comparison with 3 other risk prediction models. METHODS: All patients admitted consecutively with a fragility HF during 1 year in a co-managed orthogeriatric unit at a university hospital were assessed and followed for 1 year. Factors independently associated with 1-year mortality were used to create the HULP-HF (Hospital Universitario La Paz - Hip Fracture) score. The predictive validity, discrimination and calibration of the HULP-HF score, the American Society of Anesthesiologists (ASA) scale, the abbreviated Charlson comorbidity index (a-CCI) and the Nottingham Hip Fracture score (NHFS) were compared. Discriminative performance was assessed using the area under the curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit-test. RESULTS: 509 patients were included. 1-year mortality was 23.2%. The 8 independent mortality risk factors included in the HULP-HF score were age >85 years, baseline functional and cognitive impairment, low body mass index, heart disease, low hand-grip strength, anaemia on admission, and secondary hyperparathyroidism associated with vitamin D deficiency. The AUC was 0.79 in the HULP-HF score, 0.66 in the NHFS, 0.61 in the abbreviated CCI and 0.59 in the ASA scale. The HULP-HF score, the NHFS and the abbreviated CCI all presented good levels of calibration (p > 0.05). CONCLUSIONS: The HULP-HF score has a predictive capacity for 1-year mortality in HF patients slightly superior to that of other previously existing scores.

Eficiencia de las unidades de agudos de geriatría frente al resto de servicios hospitalarios. Análisis de la casuística de 5 años ajustada por GRD / Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group

Introducción: La ocupación hospitalaria por pacientes mayores es elevada y lo será aún más en los próximos años. Sus estancias suelen ser más prolongadas, por lo que es importante que los hospitales desarrollen estructuras con la mayor eficiencia posible. Método: En un complejo hospitalario de 1.200 camas con dos unidades de geriatría de agudos (UGA), una en el hospital general (HG) y otra en un hospital de apoyo (HA), se analizaron las altas de los 15 grupos relacionados con el diagnóstico (GRD) más frecuentes en geriatría durante 5años y se compararon las estancias de los pacientes mayores de 75años en ambas UGA con las del resto de servicios de sus respectivos centros. Resultados: Se incluyeron 14.948 altas, cuyas estancias fueron 2,9días (25% de la estancia) inferiores en las UGA que en el resto de servicios. Las diferencias en la unidad del HG fueron del 22% (9,2 vs 11,7días) en 2011, del 16% (9,3 vs 11,1días) en 2012, del 21% (9,3 vs 11,1días) en 2013, del 34% (7,4 vs 11,1días) en 2014 y del 25% (8,3 vs 11días) en 2015. Las diferencias en la unidad del HA fueron del 18% (10,4 vs 12,7días) en 2011, del 19% (9,5 vs 11,7días) en 2012, del 25% (8,8 vs 11,7días) en 2013, del 24% (8,8 vs 11,6días) en 2014 y del 32% (9 vs 13,1días) en 2015, todas las diferencias con p<0,05. Conclusiones: Las UGA son un 25% más eficientes que el resto de servicios en el ingreso de pacientes mayores de 75años

Introduction: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible. Method: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments. Results: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05. Conclusions: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years

[Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group]. / Eficiencia de las unidades de agudos de geriatría frente al resto de servicios hospitalarios. Análisis de la casuística de 5 años ajustada por GRD.

INTRODUCTION: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible. METHOD: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments. RESULTS: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05. CONCLUSIONS: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years.