Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study.

Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.

Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department. / Perfil y resultados del paciente frágil valorado por la Enfermera de Práctica Avanzada en un servicio de urgencias.

OBJECTIVES: To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. MATERIAL AND METHODS: Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. RESULTS: 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). CONCLUSIONS: Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy.

[Continuity of care from the acute care hospital: Results]. / La continuidad de cuidados desde el hospital de agudos: resultados.

OBJECTIVE: To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. METHOD: A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. RESULTS: A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). CONCLUSIONS: Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions.

Perfil y resultados del paciente frágil valorado por la Enfermera de Práctica Avanzada en un servicio de urgencias / Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department

OBJETIVOS: Describir el perfil de pacientes valorados por la Gestora de Continuidad de Cuidados, en un servicio de urgencias e identificar el tipo de recurso asistencial alternativo asignado y los resultados de la práctica clínica. MATERIAL Y MÉTODOS: Estudio prospectivo de seguimiento al ingreso, en el servicio de urgencias de un hospital de agudos y al alta del recurso asistencial alternativo, de los pacientes valorados por la Gestora de Continuidad de Cuidados, de julio a diciembre de 2015. Se estudiaron las características de los pacientes, entorno social y resultados de la práctica clínica. RESULTADOS: Se incluyeron 190 pacientes, de los cuales reingresaron 13 (6,8%). Desde urgencias, 122 (59,8%) asistencias se derivaron a centros de atención intermedia, 71(34,8%) a hospitalización domiciliaria, 10 (4,9%) al hospital de agudos y un paciente (0,5%) falleció. Los pacientes derivados a atención intermedia eran más complejos, presentaban síndromes geriátricos como motivo de ingreso y diagnóstico de demencia. Los derivados a hospitalización domiciliaria presentaban más enfermedades respiratorias y cardiovasculares (p < 0,05). Los valores medios del índice de Barthel y la polifarmacia, antes del ingreso en urgencias fueron más altos que en el momento del alta del recurso alternativo (p < 0,05). CONCLUSIONES: Los pacientes presentan edad avanzada, complejidad, comorbilidad asociada, se derivan a atención intermedia o a hospitalización domiciliaria, no ingresan en el hospital de agudos y reingresan menos que el resto de los pacientes. Al alta al recurso alternativo, los pacientes pierden capacidad funcional y tienen menos polifarmacia

OBJECTIVES: To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. MATERIAL AND METHODS: Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. RESULTS: 190 patients were included of whom 13 were readmitted (6.8%).122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). CONCLUSIONS: Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other PATIENTS: After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy

Competencias avanzadas en las enfermeras de atención intermedia / Advanced competences in intermediate care nurses

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La continuidad de cuidados desde el hospital de agudos: resultados / Continuity of care from the acute care hospital: results

OBJETIVO: Describir los casos atendidos por la gestora de continuidad de cuidados en un hospital de agudos durante los primeros 6 meses de su actividad, así como el perfil de los pacientes atendidos y la asignación de recursos. MÉTODO: Estudio descriptivo transversal prospectivo de pacientes con necesidades de atención compleja que requirieron de enlace de continuidad asistencial y fueron atendidos por la gestora de continuidad de cuidados, en un centro de agudos, durante los meses de octubre de 2013 a marzo de 2014. Se estudiaron las características de los pacientes, su entorno social y la asignación de los recursos asistenciales. RESULTADOS: Se analizaron 1.034 casos de demanda que correspondieron a 907 pacientes (mujeres 55,0%; edad: 80,57 ± 10,1, crónicos 47,8%) de los cuales reingresaron el 12,2%. En el modelo multivariante se observó que las variables asociadas al reingreso eran la polifarmacia (OR: 1,86; IC: 1,2-2,9) y el historial de caídas previo al ingreso (OR: 0,586; IC: 0,36-2,88). CONCLUSIONES: Los pacientes atendidos por la GCC son mayores de 80 años, con comorbilidades, síndromes geriátricos, necesidades de atención complejas y de final de vida, a los que se les asigna un recurso alternativo a la hospitalización que evita reingresos

OBJECTIVE: To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource alLOCATION: Method: A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. RESULTS: A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57 ± 10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). CONCLUSIONS: Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions