For example, a broken bone that might result from a fall must be treated by a doctor and will heal in time. E Guo In the interval between preadmission baseline and admission, 240 (34.5%) of these 696 patients declined in physical function (prehospital functional decline), 449 did not change their function, and the other 7 patients even improved their function. Acute mesenteric ischemia is an uncommon but often fatal cause of acute abdominal pain in older patients. LP © The Author 2016. 3 Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance Table 2. Studying the course and risks of ADL decli⦠P This result suggests that the individual susceptibility to develop new-onset disabilities in response to acute illnesses (ie, prehospital functional decline) is a stronger determinant of HAD than severity and number of diseases. Today the U.S. health care system faces a growing burden of chronic illness as the population ages. In conclusion, the severity of illnesses and advanced age were potent predictors of adverse functional dynamics around hospitalization in older medical patients, but the prehospital functional vulnerability to the acute disease (ie, frailty) was a stronger determinant of HAD than severity of illness and age. DG As a result of prehospital and in-hospital functional dynamics, about 30–40% of elderly patients are discharged from hospitals with new disabilities compared with the premorbid function, usually referring to 15 days before hospitalization and retrospectively measured at hospital admission (4,6,7). This section is divided into two subsections: acute minor illness and acute major illness. Cognitive disorders are on the rise. The association of each primary diagnosis (yes/no) with declining function between baseline and admission after adjustment for variables that were significant in the first logistic regression analysis (age, admission from emergency room or from other hospital units, and GIC) was evaluated in a series of logistic regression analyses. The study sample consisted of 696 patients hospitalized in internal medicine wards and discharged alive. et al. The use of therapeutic plasma exchange as adjunctive therapy in the treatment of coronavirus disease 2019: A critical appraisal of the current evidence. Older people often present atypically with acute illness. Their growing importance as a medical and psychiatric problem reflects the continued increase in the number of the elderly worldwide. Search for other works by this author on: Department of Laboratory Medicine, Università Tor Vergata, Unit of Geriatrics, Ospedale di Casteldelpiano, Azienda USL 9, Geriatric Agency Unit, Azienda Ospedaliera-Universitaria Careggi, Unit of Geriatrics, Azienda Ospedaliera S. Giovanni-Addolorata, Hospitalization, restricted activity, and the development of disability among older persons, Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure”, Patient and hospital factors that lead to adverse outcomes in hospitalized elders, Acute Care for Elders. (Related Pathway(s): Urinary tract infection (UTI): Empiric antibiotic selection for acute complicated UTI in adults.) Arch Gerontol Geriatr. Ferrucci HG (i) Interval preadmission baseline–admission: patients with declined function (decliners) versus nondecliners (unchanged or improved function); (ii) interval admission–discharge in the subgroup of patients with prior prehospital functional decline (decline between baseline and admission): patients with unchanged or declined function versus patients with improved function; and (iii) overall interval baseline–discharge: decliners (HAD) versus nondecliners (unchanged or improved function). . Exclusion criteria were dementia, delirium, and terminal state of medical illness. Resnick, Barbara PhD, CRNP, FAAN American Journal of Nursing: August 2001 - Volume 101 - Issue 8 - p 78 Covinsky Acute Illness Impacts Function In Elderly. T Romero-Ortuno Lamont CT, Sampson S, Matthias R, Kane R. The use of acute-care hospitals by the elderly is rising rapidly, particularly in the age group 75 and older. x There is a need for efficient, convenient, and inexpensive methods to accurately diagnose the clinical stage of lung cancer and evaluate the efficacy of chemotherapy in patients with lung cancer. KM Rudberg Illness severity (OR 1.9, 95% CI 1.2–3, p = .004) and older age were also predictive of HAD, even after adjustment for each coded primary discharge diagnosis. Pierluissi Rozzini MA This micro skills course examines how acute illness in the elderly may disguise other medical problems and considers the implications of this for presentation and examination. Lardi B Third, each patient was assigned to one of the four GIC classes considering two domains: (i) number of diseases and (ii) severity of diseases measured according to the Greenfield’s IDS score. AMDA - The Society for Post-Acute and Long-Term Care Medicine is the professional association of medical directors, attending physicians, nurses, social workers, nursing aides, and others practicing in the long term care continuum. Loures Valle Impact of systemic corticosteroids on mortality in older adults with critical COVID-19 pneumonia, Impaired cognitive flexibility induced by chronic cerebral hypoperfusion in 5XFAD transgenic mouse model of mixed dementia, Sarcopenic obesity and amino acids: Concord Health and Ageing in Men Project, Reduced Physical Activity Alters the Leucine-Stimulated Translatome in Aged Skeletal Muscle, Updating and Validating the Veterans Affairs Frailty Index: Transitioning from ICD-9 to ICD-10, The Journals of Gerontology, Series A (1995-present), About The Journals of Gerontology, Series A, About The Gerontological Society of America, Receive exclusive offers and updates from Oxford Academic, Establishing a Hierarchy for the Two Components of Restricted Activity, Thyroid Hormones as Predictors of Short- and Long-term Mortality in Very Old Hospitalized Patients, A biomarker-based biological age in UK Biobank: composition and prediction of mortality and hospital admissions, Biological Aging Predicts Vulnerability to COVID-19 Severity in UK Biobank Participants. The 15 Most Common Health Concerns for Seniors. Mehta and colleagues, however, studied only patients without overt disabilities at baseline (11), whereas we addressed a heterogeneous group including both patients who were not disabled prior to the acute illness and patients with different severity of premorbid disability; furthermore, we measured disability by the BI, a more sensitive tool than the Katz index (7). Thus, longer LOS is presumably a consequence of disability, severity of illness, and frailty, being unlikely that longer LOS per se may play a causative role in worsening in-hospital functional dynamics (5,20–23). N After adjustment for the occurrence of prehospital functional decline, however, illness severity and older age were not predictive of HAD anymore. C E ADEM has been described in adult patients, but the incidence in the adult and especially elderly population is low. Elective admission (directly from home) was intended as a planned hospitalization, due to a recent-onset medical disease, mainly after evaluation in an outpatient setting. *Reference category: admission from home (elective admission). Acute Disease Aged Aphasia / diagnosis* Appendicitis / complications Appendicitis / diagnosis Humans P Change ), You are commenting using your Facebook account. The following differential diagnoses have to be discerned: pseudodementia in acute depressive states, depression as a risk factor for dementia, and a depressive episode in the early stage of dementia. These and other differences between the two studies may account for the partially different results. Shadmi Orsitto Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial December 2016 Wang These findings are congruent with the conceptual framework of hospital-related functional trajectories described earlier (2,3,5,10) and confirm the role of premorbid vulnerabilities in determining functional dynamics around hospitalization for an acute illness. . Z G Further research is warranted for better identifying premorbid subclinical abnormalities which may herald prehospital functional decline and HAD (2,3). This study was specifically designed to investigate the potential independent role played by comorbidity, and particularly the severity of diseases at admission, in the functional trajectories around hospitalization for acute medical diseases in older patients. Zisberg In all these logistic regression analyses, older age, LOS, emergency admission, admission from other hospital units, and GIC 3–4 were, again, significant predictors of HAD. Counsell Certain medical conditions, such as cancer, heart disease, and obesity can also increase risk for severe illness. Thus, “prehospital” and “in-hospital” functional changes are distinct processes, with the former indicating the functional response to the acute disease and the latter reflecting a mix of factors, such as quality of and individual response to hospital care and processes, disease severity, age, frailty, length of hospital stay, and others (4–8). It is believed that this condition is due to the decline in their bodyâs ability to use insulin. In addition, to our knowledge, the association between severity of illness and functional trajectories was never studied by distinguishing the prehospital from the hospital phase. In the present study, cognitive function was significantly associated with recovery after prolonged bed rest. . First, clinicians identified 15 diseases that are recognized as the most prevalent in hospitalized patients: heart disease of ischemic or organic origin, primary arrhythmias, other heart disease (cardiomyopathies, myocarditis, cor pulmonale due to chronic pulmonary embolism, primary pulmonary hypertension or chronic obstructive lung disease), hypertension, stroke, peripheral vascular disease, diabetes mellitus, anemia, gastrointestinal diseases, hepatobiliary diseases, renal diseases, respiratory diseases, parkinsonism and nonvascular neurologic diseases, musculoskeletal disorders, and malignancies. Accordingly, a great prehospital functional decline was found to predict 6-month mortality independently of age, basal comorbidity, and severity of illness at hospital admission (20). Accordingly, older age, a typical predictor of negative functional outcomes during hospitalization in prior studies (4), was no longer significantly associated with HAD after adjustment for prehospital functional decline. Our conclusion is that TCT has not proved to be a predictor of recovering ambulation in elderly patients. The severity of illnesses was strongly associated with adverse functional outcomes around hospitalization, but frailty, intended as functional vulnerability to the acute disease before hospitalization, was a stronger predictor of HAD than illness severity and age. Cambra-Contin Although most of the functional decline occurs before hospitalization in response to the acute diseases, the role played by comorbidity in the functional trajectories around hospitalization is unclear. SE Unit of Geriatrics, Azienda Ospedaliera di Cosenza. On the other hand, an acute illness is a disease that lasts a shorter time. It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. Such abnormalities predispose older persons to rapidly progress to overt disability or to worsen their baseline disability level when they undergo the stress of acute illnesses and hospitalization. In the entire Pro.Di.Ge. Elevated serum anticholinergic activity levels have been associated with delirium in cross-sectional studies of ill older persons. Loures Valle et al. The functional status was measured by a modified version of Barthel Index (BI), which provides a reliable and accurate description of autonomy in daily living activities and is sensitive even to small changes in functional capacity (7). Therefore, prehospital functional decline qualifies as a multidimensional clinical epiphenomenon of frailty, which incorporates and goes beyond the information provided by age and the severity of precipitating diseases. R Because the minimum change of BI is a 5-point variation (increase or decrease), we considered as change of function a decrease or an increase of at least 5 points of BI (7). Our main findings may be summarized as follows: comorbidity (the number and the severity of illnesses) and advanced age were closely associated with both prehospital functional decline and overall HAD, after adjustment for possible confounders; however, when the occurrence of prehospital functional decline was considered, illness severity and age were not significantly associated with HAD anymore. It has been reported to account for 0.1 percent of … Functional status of the elderly patients at 2 weeks before hospitalization (baseline), at hospital admission, and at discharge was measured by the Barthel Index. Elderly patients can be admitted to hospitals because of typically disabling conditions, such as stroke or hip fracture, but many seemingly nondisabling illnesses, including pneumonia and exacerbations of cardiorespiratory chronic conditions, often lead to acute functional deterioration in vulnerable, frail individuals (2,3). Identifying negative prognostic factors is crucial for adequately assessing patients at admission, elaborating effective preventive hospital strategies, and improving correct transitions to the posthospital settings. Furthermore, the inability to remain functionally stable after an acute illness (i.e., the loss of function) might be an evident epiphenomenon of frailty. et al. Tonkikh The association of each primary diagnosis (yes/no) with HAD (decline from baseline to discharge) after adjustment for variables that were significant in Model 1 (age, LOS, admission from emergency room or from other hospital units, and GIC) was tested in another series of logistic regression analyses which also included the presence of prehospital functional decline (vs no prehospital decline) among the independent variables. ( Log Out / Dementia and delirium, the main cognitive disorders, are most common among the elderly. Notes: Valid cases = 686; dependent variable (outcome): the group of patients who declined in function between baseline (15 days before admission) and hospital admission (n = 236). GIC Class 1 includes patients with one or more diseases with IDS = 1 or lower. Among these adverse outcomes, disability is the most common, and frailty should be differentiated from disability (10). Sepsis - Fever is less common⦠The patients who came from nursing homes were hospitalized after evaluation in the emergency department. O KE Table 1 shows the results of the bivariate analyses between two groups in each of the three time intervals around hospitalization (see Methods). GIC was constructed as follows (15). L Ibáñez-Beroiz The original study was performed in three acute geriatric units and two general medicine units of three Italian hospitals (7). Accordingly, we sought to measure SACA during acute illness in elderly medical inpatients carefully screened to ensure that they had received no anticholinergic medications. N Briefly, patients were hospitalized through the emergency department, directly from home (elective admission), or were transferred to the study unit from other acute care units of the same or other hospitals. GIC and the Cumulative Illness Rating Scale (CIRS) proved to be the best predictors of death during hospitalization and in the postdischarge period, when compared with other comorbidity indices including the Charlson index (17–19). Salani Although growth/differentiation factor 15 (GDF)-15 has great potential as a tumor marker, supporting clinical evidence is still lacking. Volpato Thus, the cause–effect model should be replaced by the stimulus–response model, which takes into account the individual vulnerability (frailty) to functional loss in response to the stress generated by both diseases and hospitalization (10,15). One atypical presentation which you may see is Delirium. Although most of the functional decline occurs before hospitalization in response to the acute diseases, the role played by comorbidity in the functional trajectories around hospitalization is unclear. G Sabatini Ferrucci K CI = confidence interval; GIC = Geriatric Index of Comorbidity; LOS = length of stay; n = number; OR = odds ratio. O’Rourke In Model 1, older age, emergency admission, admission from other hospital units, GIC 3–4, and LOS were significantly associated with declining function between baseline and discharge (HAD); in Model 2, however, after adjustment for prehospital functional decline (between baseline and admission), only LOS and prehospital functional decline were significant correlates of HAD. As described earlier, this is an expected finding, due to the immediate disabling effect of acute cerebrovascular diseases. In the few days before admission to hospital, frail elderly people can experience functional decline in response to the disabling effect of the acute disease; after admission to hospital, some patients improve their function, others remain stable, whereas some other patients undergo functional decline (4,7). The outcome of hospitalization for acute illness in the elderly. The risk for severe illness with COVID-19 increases with age, and older adults are at highest risk. The functional trajectory around hospitalization is a complex phenomenon including two different time segments (4–8). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. People with COVID-19 and underlying health conditions could expect complications like acute respiratory failure, ARDs, liver or cardiac injury, among others. Comorbidity was measured at admission by the Geriatric Index of Comorbidity (GIC), a tool mostly based on illness severity. BH D The expected changes in CRP, WCC and Heart Rate may also not be seen. Campbell Acute illness and hospitalization are important events in the trajectory leading to disability in elderly people. Cavalieri In addition, we collapsed GIC classes into two categories (GIC 1–2 vs GIC 3–4), with illness severity being the only domain separating the two categories. CP Class 3 includes patients having one disease with IDS = 3, other diseases with IDS = 2 or lower. Logistic Regression Analysis of Variables Associated With Functional Decline in the Transition From Preadmission Baseline to Hospital Admission (prehospital functional decline). Myocardial Infarction – One third of elderly patients will have no chest pain in Myocardial Infarction. Denaro Details about the study protocol are described elsewhere (7). E Darer AM Reference category: the group of patients with unchanged or improved function from baseline to discharge (n = 542). When patients with severe premorbid disability, who could not worsen anymore (floor effect), were ruled out from the analysis, a poor baseline function (low baseline BI) and dementia emerged as significant predictors of, respectively, prehospital functional decline and HAD. CM Second, we did not examine the role of some important hospitalization processes, including continence and nutritional care, use of medications, and in-hospital mobility. ( Log Out / ( Log Out / Mehta and measured comorbidity by the Geriatric Index of Comorbidity (GIC), a measurement tool mostly based on illness severity. The association of GIC with changes in functional status before hospitalization (between baseline and admission), during hospitalization (between admission and discharge), and in the overall period between baseline and discharge was assessed by logistic regression analyses. Gill E-mail: filippo.fimognari@virgilio.it, Decision Editor: Stephen Kritchevsky, PhD, Filippo Luca Fimognari, Andrea Pierantozzi, Walter De Alfieri, Bernardo Salani, Stefano Maria Zuccaro, Andrea Arone, Giacomo Palleschi, Lorenzo Palleschi, The Severity of Acute Illness and Functional Trajectories in Hospitalized Older Medical Patients, The Journals of Gerontology: Series A, Volume 72, Issue 1, 1 January 2017, Pages 102–108, https://doi.org/10.1093/gerona/glw096.
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