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.

The Improvement of Hospital Food Service in Quality and Customer Satisfaction by Using 6-sigma Strategy

This study was performed to improve the hospital food service in quality and customer satisfaction by using 6-sigma strategy which was processed by DMAIC methods. The research procedure was as follows; analyzing the main causes of customer dissatisfaction of food service by using numerical method, and then finding out the standardized problem solving methods, and finally reforming food service process. The effectiveness of 6-sigma activity was measured by 'food service quality index', 'customer satisfaction index' and 'total food service satisfaction index'. Food service quality index was calculated by adding grade of soup temperature, food service, delivery time, and setting accuracy. Statistical data analyses were completed by using the Minitab Ver. 14. By performing 6 sigma activity, food service quality index was increased from 67 to 79 points (p<0.05) and customer satisfaction index also rise from 73 to 79points (p<0.05). Satisfaction of meals' taste, diverse menu, food setting accuracy, remove of food service, overall food service were significantly improved(p<0.05). The results of capability analysis in food service quality index, customer satisfaction index, and total food service satisfaction index were improved 2.11sigma to 2.49sigma , 1.88sigma to 2.43sigma, and 2.04sigma to 2.47sigma respectively (p<0.05). Therefore this study showed that subjective food service improving process could be measured by objective numerical value which might be used for financial value in hospital management.

Delirium in Acute Elderly Care Unit; Prevalence, Clinical Characteristics, Risk Factors and Prognostic Significance

OBJECTIVES: Delirium in elderly patients is thought as transient phenomenon, therefor often unrecognized by physicians. The aim of this study was to investigate incidence of delirium and to determine risk factors for delirium in elderly hospitalized patients METHODS: We studied 172 patients aged 65 years or older who had been admitted to the elderly medical service at geriatrics center from May 2004 to Sep 2004. Delirium was diagnosed by daily interviews according to the DSM-IV criteria for delirium and the CAM(Confusion Assessment Method). Comprehensive geriatric assessment after stabilization was performed by interdisciplinary team including geriatric nurse specialist. The parameters between delirium and non-delirium groups were investigated, that is laboratory variables, dehydration, infection, immobilization, indwelling foley catheter, sleep deprivation, depression, cognitive impairment, ICU stay, comorbidity(stroke, hypertension, diabetes, dementia) RESULTS: Delirium developed in 33 patients(19.2%). Of these, male was 16(26.2% of total male), female was 17(15.3% of total female). Mean onset of delirium just occurred 5 days later. Most of the patients(81.8%) occurred within day 6. Seventy percent of delirious patients were classified as hyperactive type, 18% as mixed type, 12% as hypoactive type. Forty five percent of delirious patients improved within 24hours. Patients who persisted symptom until in-hospital death or discharge were 13(39%). The mean length of stay for delirious patients was longer than non-delirious patients(p<0.05). This study show that 15 factors appeared to predict delirium significantly: age greater than 80 years, anemia, hyponatremia, infection, sleep deprivation, immobilization, indwelling foley catheter, cognitive impairment, dementia, hypertension, high BUN, low albumin, low cholesterol, low MMSE, low IADL. CONCLUSION: Delirium was recognized in 19.2% of patients in the elderly hospital setting and was also associated with longer hospital stay and increased mortality. By multiple logistic regression, three independent risk factors for delirium was dementia, sleep deprivation, immobilization.

Nutritional Status of Hospitalized Geriatric Patients Using by the Mini Nutritional Assessment / 대한지역사회영양학회지

The prevalence of undernutrition in hospital populations is known to be high. The presence of malnutrition is associated with depression, infections, sarcopaenia, falls, fractures, reduced autonomy and increased mortality. This study specifically examined the prevalence of malnutrition in patients aged 65 or older at the time of admission as determined by the Mini Nutritional Assessment (MNA) which has been a frequently used nutritional risk screening tools in detecting undernutrition in old people. This study was done for one hundred eight hospitalized geriatric patients in Seoul National University Bundang Hospital, Seoul, Korea. On admission baseline history, anthropometrics measurements, laboratory data and nutritional status by MNA were assessed. Length of hospital stay was obtained by reviewing medical charts. We used one-way analysis of variance to compare the differences in variables. Spearman's rank correlation coefficients were calculated for associations between MNA and variables. On admission, 22.3% of patients were malnourished and 40.7% were at risk of malnutrition according to the MNA. Percent of ideal body weight, anthropometrics data, albumin, and hemoglobin were lower in the malnourished patients (p < 0.05). The malnourished patients stayed in the hospital 7.3 days longer, as compared with well nourished patients (p < 0.05). Percent of ideal body weight, albumin, hemoglobin and total cholesterol were correlated inversely with nutritional status according to MNA (p < 0.05). MNA can be used for nutritional assessment in Korean old people, because MNA significantly correlated with other nutritional assessment parameters, such as, anthropometric and laboratory data in hospitalized geriatric patients. The high prevalence of malnutrition in the elderly was observed and the presence of malnutrition on admission predicted a significant increase in the length of hospital stay in this study. Therefore further studies are needed to determine whether nutritional interventions in old people with low MNA scores can improve clinical outcomes during the hospital course.