Risk factors for hospitalization among older persons.

The hospitalization of older patients involves, in addition to treating of acute illness or acute worsening of chronic disease, the risk of a number of age-specific complications. Deliria are one of the most common events at the onset of the hospital stay. As the ethiology of deliria in addition to the underlying disease we have to consider the deteriorated adaptability to environmental change. Another serious complication is the emergence of immobilization syndrome, which can start the irreversible unfavourable outcome. Infection complications with a high tendency to develop sepsis are a frequent primary cause of hospitalization, but also a frequent complication of hospitalization from originally different indications. The onset of the infection complication is usually accompanied by a slower increase of inflammatory parameters, but it does not mean slower progression of the condition. The basic problem is the choice of appropriate antibiotic treatment with regard to the high risk of Clostridium difficile selection in older age. Other risks, such as malnutrition, dehydration, thromboembolic disease are more frequent in hospitalized older patients and it is advisable to start as soon as possible with preventive measures against their occurrence. Key words: dehydration - deliria - immobilization syndrome - instability - malnutrition - respiratory infection - urinary infection.

Do the test results of cognitive function and activities of daily life of seniors correlate with the state of vitamin D supply to the organism?

INTRODUCTION: Till recently, the main effect of Vitamin D (calcitriol) was accounted for its role in regulation of calcium levels. But at the present time several other important functions of this vitamin have been unfolding in human organism, which currently ascribe to the properties of hormone. It also effects among other functions such as cognitive functions, immune system and muscle mass. In the resent past there are rising number of scientific publications on possible consequences of the long term deficit of Calcitriol, not only in the older generation. AIM: The aim of our study was to establish the relationship between the supply of Vitamin D to the organism and basic parameters of self-sufficiency, which are cognitive functions stipulated in the Mini Mental State Examination (MMSE) test and Barthels test for Activities of Daily Living (ADL) among seniors. MATERIALS AND METHODS: In our study we evaluated, 244 patients (65 men and 179 women) of average age 80,1 ± 7,4 (min. 65, max. 99) hospitalized at Department of Internal Medicine, Geriatrics, and General Practice of Faculty of Medicine, Masaryk University and Faculty Hospital Brno, from March 2012 to September 2012. The state of Vitamin D supply to the organism was evaluated with the help of serum Vitamin D total [1.25(OH)2D + 25(OH)D], the values of MMSE and ADL were taken from the third day of hospitalization till overcoming the acute stage. The characteristics of the patients were drawn with multimorbidity index CIRS - CI (cumulative Illness Rating Scale - Comorbidity Index). Furthermore, we observed the correlation of Serum Vitamin D levels to the season of the year. RESULTS:   In our patients average concentration of vitamin D levels, MMSE, and ADL was 37.9 ± 26.1 (8-142 nmol/l), 23.36 ± 6.91 (0-30 points), 80.66 ± 25.13 (0-100 points), and CIRS CI 4.7 + 1.9 points, respectively. The correlation of vitamin D serum level with MMSE was r = 0,289 (p 0.01), with ADL r = 0,292 (p 0.01), and CIRS CI r = -0.22 (p < 0.05). Using multivariation analysis proved the significance of correlations obtained, even after the exclusion of multimorbidity. There was no statistically significant correlation between seasons of the year and serum vitamin D total level. However, nonsignificant decreasing trend of serum vitamin D total level with rising age of patients was found (r = -0.149, NS). CONCLUSIONS: The values obtained for MMSE and ADL demonstrated a significant correlation with serum vitamin D total levels. Attention paid to maintain an adequate supply of serum vitamin D in the organism, helps to maintain quality bone remodeling and functioning of other processes with which it takes part. For supplementing elderly sick patients, apart from diet, it is suitable to choose partially or fully hydroxylated supplements and adequate exposure to sunlight. Key words:  ADL - cognitive function - MMSE - vitamin D.

Can we improve the therapy of Clostridium difficile infection in elderly patients?

BACKGROUND: Clostridium difficile infection (CDI) is becoming a serious problem predominantly in geriatric patients, who are a significant risk group. The goal of this study was to evaluate the risk factors for mortality in CDI patients and to construct a binary logistic regression model that describes the probability of mortality in geriatric patients suffering from CDI. METHODS: In this retrospective study, we evaluated a group of 235 patients over 65 years of age with confirmed diagnoses of CDI, hospitalized at the Department of Internal Medicine, Geriatrics and General Practice, Brno, from January 2008 to December 2013. The examined group comprised 148 women (63 %) and 87 men (37 %). For the diagnosis of CDI, confirmation of A and B toxins in the patients' stool or an autopsy confirmation was crucial. RESULTS: The impact of antibiotic therapy on the increased incidence of CDI was clearly confirmed in our study group when examining patients' histories. Other risk factors included cerebrovascular disease, dementia, the presence of pressure ulcers, and immobility. Our new model consisted of a combination of the following parameters: the number of antibiotics used (from patients' history), nutritional status (Mini Nutritional Assessment short-form test), presence of pressure ulcers, and occurrence of fever. CONCLUSION: Our logistic regression model may predict mortality in geriatric patients suffering from CDI. This could help improve the therapeutic process.