Influencing Factors of Activity of Daily Living in Patients Admitted to the Acute Elderly Care Unit

OBJECTIVES: The purpose of this study is to investigate the clinical significance of activity of daily living(ADL) and to identify the influencing factors on ADL in elderly patients admitted to the hospital-based acute geriatric care unit. METHODS: We studied a total of 279 patients aged 65 years and older who admitted to the Acute Elderly Care Unit at Seoul National University Bundang Hospital between May, 2004 and April, 2005. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. RESULTS: Most of the patients need ADL(62.7%) and IADL(68.8%) assistance. Dependent ADL patients were older (p<0.01), admitted via emergency room(p<0.01), demented(p<0.01), and associated with depression(p<0.01), malnutrition(p<0.01), and stroke(p<0.05) compared to independent ADL group. The length of stay was also significantly increased in dependent ADL group(p<0.01) and six-month mortality rate was higher in dependent ADL group(p<0.01). In correlation analysis, MMSE-KC score(r=0.708, p<0.01), nutritional state(r=0.581, p<0.01), the length of stay(r=-0.433, p<0.01), depression(r=-0.309, p<0.01), the numbers of chronic disease(r=-0.287, p<0.01), age (r=-0.236, p<0.01) showed significant association with ADL. In multivariate analysis, cognitive impairment(OR=5.80), emergent admission(OR=4.33), over the 75 years old age(OR=3.33), malnutrition(OR=2.86), and depression(OR=2.61) were identified as the independent influencing factors on ADL dependency. CONCLUSION: ADL dependency is common in elderly inpatient and significantly associated with poor prognosis. Identifying and controlling the influencing factor on ADL decline may improve the patients' functional status and clinical outcome.

Incidence and Clinical Course of Implant Exposure after Hydroxyapatite Implantation in Anophthalmic Socket

We evaluated the incidence and clinical course of exposed hydroxyapatite implants in anophthalmic sockets. We retrospectively reviewed the charts of 157 patients who underwent hydroxyapatite implantation in anopthalmic socket and were followed up for more than 4 months. The number of the exposed hydroxyapatite implants was 13 of 157 eyes (8.28%). We found that the incidence of hydroxyapatite exposure following enucleation was 1 of 54 (1.85%), while was 9 of 68 eyes (13.24%) following evisceration, and following secondary implantation was 3 of 35 eyes (8.28%). The exposure of hydroxyapatite implants following evisceration was more frequent than that of following enucleation(P=0.02). 7 of 9 eyes (77.8%) of exposed hydroxyapatite implants following evisceration was late onset which was beyond postoperative 2 months. We believe that the rate of exposure following evisceration may be greater than that of following enucleation. Enucleation could be a good procedure in view of postoperative exposure. And many cases of exposed hydroxyapatite following evixceration were late onset.