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.

Clinical significance of anemia in frail elderly patients admitted to the acute elderly care unit / 대한내과학회지

BACKGROUND: Anemia is a common medical problem among the elderly; it is more frequent with advancing age. Anemia has been associated with adverse outcomes such as hospitalization, disability and mortality. However, the clinical significance of anemia in frail elderly patients, especially those admitted to acute care units, has not been investigated. METHODS: From May 2004 to April 2005, 308 patients 65 years of age or older, admitted to the Acute Elderly Care Unit at the Seoul National University Bundang hospital, were enrolled in the current study. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. Clinical and laboratory evaluations were carried out to determine the prevalence and etiology of the anemia. RESULTS: Anemia (Hb < 13 g/dL in male, < 12 g/dL in female) was identified in 149 patients (48.4%). The leading cause of anemia was anemia of chronic disease (N=75, 50.3%). Comparison between the anemic group and a control group was performed. Anemic patients were older, male, had an impaired functional status as well as a poor nutritional status. Moreover, the development of delirium was more frequent in the anemic group compared to the control group (11.0% vs 20.7%, p=0.021). In addition, the duration of hospitalization was significantly increased in patients with anemia (12.97+/-1.24 vs 18.07+/-1.77, p=0.019). However, in the multiple regression analysis, the presence of anemia did not affect the length of hospitalization as an independent factor. CONCLUSIONS: Anemia is common in frail elderly patients and has been associated with a poor clinical outcome. Although anemia was not an independent risk factor in the elderly patients, the anemia was associated with multiple co-morbidities, disability and frailty. Therefore, the presence of anemia in the elderly requires active investigation and management.

Clinical characteristics of elderly Korean patients with peptic ulcer / 대한내과학회지

BACKGROUND: The incidence of peptic ulcer has decreased in the general population, but it has increased for the geriatric patients worldwide. The aim of the study is to determine the age-related characteristics of peptic ulcer patients. METHODS: A total of 277 patients (195 men and 82 women), who were diagnosed with peptic ulcer from May 2003 to Dec 2004, were analyzed retrospectively. The clinical characteristics of peptic ulcer were compared between the two groups, that is, 138 elderly (= 65 yrs) and 139 non-elderly (= 50 yrs) patients. RESULTS: Peptic ulcer in the elderly were located more atypically (high body and the greater curvature side of the mid and low body), the lesions were large and healed slowly. In the elderly group, 50.7% of the ulcers were gastric and 36.2% were duodenal. On the other hand, in the non-elderly group, 30.2% and 57.6% of the ulcers were gastric and duodenal, respectively. There was no difference of the main symptoms between the two groups. For endoscopically bleeding ulcer, the use of NSAID was statistically significant (p=0.006) only for the elderly group. The presence of Helicobacter pylori was less common in the elderly group than in the non-elderly (57.7% vs 77%, respectively, p=0.001). In the case of gastric ulcer, the rate of H. pylori infection was similar between the two groups (62.9% vs 73.8%, respectively, p=0.233). In contrast, in the case of duodenal ulcer, H. pylori infection was less common for the elderly patients than in the non-elderly patients (51% vs 77.5%, respectively, p=0.002). CONCLUSIONS: For the elderly patients with peptic ulcer in Korea, the role of H. pylori was relatively less important that it was for the non-eldery group. On the contrary, NSAID, aspirin and combined chronic illness seem to contribute to ulcer. Bleeding peptic ulcer was discovered in both groups with no significant difference in the occurrence rate.

Glucose-Insulin-Potassium as an Adjunctive Therapy in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Glucose-insulin-potassium (GIK) fluid infusion may improve the myocardial energy metabolism in the ischemic condition. A prospective randomized clinical trial was designed to determine whether a GIK fluid infusion can reduce the ventricular remodeling in acute myocardial infarction. SUBJECTS AND METHODS: For the patients with acute myocardial infarction, during thrombolytic therapy with urokinase, GIK fluid (26% glucose 1000 mL, 50 IU insulin, and 80 mmol KCl) was administered for 24 hours. The ventricular volumes and function were evaluated by echocardiography during the admission period, at 6 months and at 12 months following discharge. RESULTS: This trial was done prospectively for 2 years in 73 patients; the GIK group included 41 patients and the control group included 32 patients. The median value of "the pain to door time" was 195 minutes in the GIK group and it was 120 minutes in the control group (p=NS). The wall motion score was 1.52+/-0.39 in the GIK group and it was 1.39+/-0.35 in the control group. The left ventricular volumes, ejection fractions, cardiac indices and the globular indices showed no significant difference between the two groups. The side effects of the GIK fluid were mild phlebitis in 6 patients (14.6%) and congestive heart failure in 5 patients (12.2%). CONCLUSION: This trial could not verify the beneficial effects of administering GIK fluid on the ventricular remodeling after acute myocardial infarction. The limitations of this trial were as follows: "the pain to door time" was too long and the severity of the myocardial infarction was mild. Low rates for the echocardiogrphy follow-up and the randomization failure in a few patients were also noted.

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.

Analysis of Risk Factors in the Patients with Acute Renal Failure / 대한신장학회잡지

BACKGROUND: Acute renal failure(ARF) is characterized by rapid decline in glomerular filtration rate and retension of nitrogenous waste products. This syndrome occurs in approximately 5 percent all hospital admissions and up to 30 percent of admissions to intensive care units. ARF is diagnosed when screening of hospital patients reveals a recent increase in serum BUN(blood urea nitrogen) and creatinine. The mortality rate for ARF is approximate 40-60% and has changed little in past three decades. This lack of improvement in outcome, despite significant advances in medicine. The reasons of high mortality rate is not certain. This study intend to identify prognostic risk factors influencing survivals. METHODS: We retrospectively analyzed 60 patients with ARF during 2 years period from Oct. 1996 to Oct. 1998 at chosun university hospital. Multiple factors which may influence mortality were evaluated. RESULTS: 1)Of the 60 patients, 34 were male and 26 were female. The mean age was 55.8+/-15.9 years. 2)The cause of ARF is Drug, toxin, dehydration, infection, trauma, surgery, urinary tract obstruction, HFRS, rhabdomyolysis and bleeding. 3)Underline disease is observed in 52 case. DM, Hypertension, Malignancy, Pulmonary disease, Liver disease, Renal disease 4)The mortality rate is 31.7%. The major cause of deaths is DIC, infection and hepatic failure. 5)Based on the unpaired t-test, chi-squre analysis, albumin, total bilirubin, hemoglobin, thrombocytopenia, APACHE II score, serum sodium, urine creatinine, number of multiple organ failure, cause of acute renal failure, pH, vital sign on admission, sepsis, DIC, oilguria, and hemodialysis were significant factors between survivors and nonsurvivors(p< 0.05). 6)APACHE II score on admission is good prognostic factor for patients with acute renal failure (p<0.001). CONCLUSION: This results suggest that the evaluation of patients symptom, sign, laboratory data, APACHE II score is important for patients with acute renal failure. the discriminant score by multiple analysis and APACHE II score could relatively predict the mortality of ARF patients. however further evaluation and clinical apply of prognostic factors is required to confirm these results.

A Case of Cedecea davisae Peritonitis in a Liver Cirrhosis Patient / 감염

Cedecea davisae is a motile, Gram-negative rod in the family Enterobacteriaceae which is positive for lipase, DNase and catalase, and negative for gelatinase and oxidase. This bacterium is rarely isolated in the clinical specimens. We isolated C. davisae from the ascitic fluid of a 49-year old male patient with liver cirrhosis who was diagnosed as acute bacterial peritonitis. Bacterial identification was performed by API 20E and VITEK. Antimicrobial susceptibility test showed that the isolate was susceptible to cefotaxime, piperacillin, and imipenem. Peritonitis of this patient was improved by imipenem therapy. This is the first reported case of peritonitis caused by this organism.