Explanatory survival model for nursing home residents- a 9-year retrospective cohort study.

PURPOSE: There is a gap in the literature regarding the analysis of long-term survival and mortality risk factors among disabled and multimorbid institutionalized populations. The study aimed to analyze 9-year survival, investigate mortality factors, and develop an explanatory survival model for nursing home residents. MATERIALS AND METHODS: A retrospective cohort study with a 9-year follow-up (2009-2018) was conducted among 96 residents of a nursing home with Barthel index ≤ 40. The study was based on baseline measurements performed in 2009, which included results obtained on geriatric scales: Mini Nutritional Assessment Short-Form (MNA-SF) and Abbreviated Mental Test Score (AMTS). Information on demographics, comorbidities, pharmacotherapy, transfers and deaths came from medical records. Kaplan-Meier curves were used to estimate and present survival data. Factors associated with mortality were determined using Cox proportional hazard models. RESULTS: The median survival was 2.9 years. Mortality during the follow-up period was 83%. Kaplan-Meier curves showed that residents with normal nutritional status (p = 0.002) and taking aspirin (p = 0.005) had a better 9-year survival. The multivariable Cox regression model revealed that the risk of mortality (Hazard Ratio, HR) increased in older age (HR=1.04), male gender (HR=2.08), with risk of malnutrition (HR=3.91), malnutrition (HR=4.84), and presence of urinary incontinence (HR=2.14). The aspirin use was the strongest protective factor against death (HR=0.40). CONCLUSION: The aspirin use was associated with better long-term survival for nursing home residents. Factors associated with higher mortality among residents include older age, male gender, poor nutritional status, and urinary incontinence. BRIEF SUMMARY: We are the first to report the beneficial effects of a low-dose of aspirin on the long-term survival of disabled, institutionalized populations with multimorbidity. Furthermore, this study presents an explanatory model of survival for nursing home residents and identifies the long-term mortality risk factors among disabled residents with multimorbidity.

Cardiovascular and Pre-Frailty Risk Assessment during Shelter-In-Place Measures Based on Multimodal Biomarkers Collected from Smart Telemedical Wearables.

Wearable devices play a growing role in healthcare applications and disease prevention. We conducted a retrospective study to assess cardiovascular and pre-frailty risk during the Covid-19 shelter-in-place measures on human activity patterns based on multimodal biomarkers collected from smartwatch sensors. For methodology validation we enrolled five adult participants (age range: 32 to 84 years; mean 57 ± 22.38; BMI: 27.80 ± 2.95 kg/m2) categorized by age who were smartwatch users and self-isolating at home during the Covid-19 pandemic. Resting heart rate, daily steps, and minutes asleep were recorded using smartwatch sensors. Overall, we created a dataset of 464 days of continuous measurement that included 50 days of self-isolation at home during the Covid-19 pandemic. Student's t-test was used to determine significant differences between the pre-Covid-19 and Covid-19 periods. Our findings suggest that there was a significant decrease in the number of daily steps (-57.21%; -4321; 95% CI, 3722 to 4920) and resting heart rate (-4.81%; -3.04; 95% CI, 2.59 to 3.51) during the period of self-isolation compared to the time before lockdown. We found that there was a significant decrease in the number of minutes asleep (-13.48%; -57.91; 95% CI, 16.33 to 99.49) among older adults. Finally, cardiovascular and pre-frailty risk scores were calculated based on biomarkers and evaluated from the clinical perspective.

What factors influence the long-term survival of nursing home residents with severe disabilities?

B a c k g r o u n d / A i m: Factors influencing the survival of the nursing home population have not yet been clearly defined. The aim of the study was to investigate the impact of nutritional, mental, functional, disease and pharmacological factors on the survival of nursing home residents with severe disabilities. Material and Methods: A retrospective cohort study was conducted with a 9-year follow-up period among nursing home residents with a Barthel score ≤40. The initial assessment included the following scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), the Barthel Index, and blood pressure (BP) measurements. Comorbidities, medications and all-cause mortality were extracted from medical records. The analyzed cohort was divided into two groups: Deceased - residents who died ≤3 years and Survivors - those who survived >3 years of observation. R e s u l t s: Survivors (n = 40) and Deceased (n = 48) did not differ significantly in terms of age, sex, systolic and diastolic BP, the Barthel Index, number of diseases and medications used. Survivors had significantly higher scores in MNA-SF (p <0.001) and AMTS (p <0.003) than Deceased. Moreover, Survivors had hypertension significantly more often and took aspirin and ACE inhibitors (p <0.05). The multivariable logistic regression analysis showed that the MNA-SF score significantly affected mortality [OR = 0.62, (95%CI, 0.46-0.84), p <0.001]. C o n c l u s i o n: Higher MNA-SF scores were a factor that significantly affected the survival of nursing home residents, while functional status assessed using the Barthel Index had no effect on survival. MNA-SF was found to be a useful tool for assessing the risk of death in a nursing home.

Is treated hypertension associated with a lower 1-year mortality among older multimorbid residents of long-term care facilities?

INTRODUCTION: Long-term care facility (LTCF) residents are typically excluded from clinical trials due to multimorbidity, dementia, and frailty, so there are no clear evidence-based rules for treating arterial hypertension in this population. Moreover, the role of hypertension as mortality risk factor in LTCFs has not yet been clearly established. OBJECTIVES: The study aimed to investigate whether treated hypertension is associated with lower mortality among older LTCF residents with multimorbidity. PATIENTS AND METHODS: The study was performed in a group of 168 residents aged ≥ 65 years in three LTCFs. Initial assessment included blood pressure (BP) measurements and selected geriatric scales: MNA-SF, AMTS and ADL. Hypertension, comorbidities, pharmacotherapy, antihypertensive drugs and mortality during one-year follow-up were extracted from the medical records. The data was compared in groups: Survivors and Deceased. RESULTS: Survivors and Deceased revealed similar age, DBP, number of diseases, medications, and antihypertensive drugs. However, Deceased had significantly lower SBP (P <0.05) and presented significantly worse functional, nutritional and cognitive status than Survivors (P <0.001). Hypertension (P <0.001) and antihypertensive therapy (P <0.05) were significantly more frequent among Survivors. Significantly more of the hypertensive-treated than other multimorbid residents survived the follow-up (P <0.001). Logistic regression analysis showed that treated hypertension had a protective effect on mortality [OR = 0.11 (95% CI, 0.03-0.39); P <0.001]. CONCLUSIONS: One-year survival of LTCF residents with treated hypertension was significantly higher than the others. Appropriate antihypertensive therapy may be a protective factor against death in frail nursing home residents, even in short period of time.

What Features and Functions Are Desired in Telemedical Services Targeted at Polish Older Adults Delivered by Wearable Medical Devices?-Pre-COVID-19 Flashback.

The emerging wearable medical devices open up new opportunities for the provision of health services and promise to accelerate the development of novel telemedical services. The main objective of this study was to investigate the desirable features and applications of telemedical services for the Polish older adults delivered by wearable medical devices. The questionnaire study was conducted among 146 adult volunteers in two cohorts (C.1: <65 years vs. C.2: ≥65 years). The analysis was based on qualitative research and descriptive statistics. Comparisons were performed by Pearson's chi-squared test. The questionnaire, which was divided into three parts (1-socio-demographic data, needs, and behaviors; 2-health status; 3-telemedicine service awareness and device concept study), consisted of 37 open, semi-open, or closed questions. Two cohorts were analyzed (C.1: n = 77; mean age = 32 vs. C.2: n = 69; mean age = 74). The performed survey showed that the majority of respondents were unaware of the telemedical services (56.8%). A total of 62.3% of C.1 and 34.8% of C.2 declared their understanding of telemedical services. The 10.3% of correct explanations regarding telemedical service were found among all study participants. The most desirable feature was the detection of life-threatening and health-threatening situations (65.2% vs. 66.2%). The findings suggest a lack of awareness of telemedical services and the opportunities offered by wearable telemedical devices.

Assumptions of the European FRAILTOOLS project and description of the recruitment process for this study in Poland.

A i m: The main purpose of this article is to present the main assumptions of the FRAILTOOLS project and the characteristics of the recruitment process in the Polish part of the study. MATERIAL AND METHODS: The FRAILTOOLS project is a prospective observational study conducted in 5 European countries. The study included people aged 75 and older. Each participating center was required to recruit 388 patients, which corresponded to 97 subjects in each clinical setting by center. Recruitment took place in clinical settings (hospital geriatric acute care, geriatric outpatient clinic, primary health care) and in social conditions (nursing homes). The frailty syndrome was assessed among study participants using 7 different scales. The follow-up period was 18 months. RESULTS: In Poland, 268 elderly subjects took part in the study, which constituted 69.1% of planned recruitment. The majority of participants were acute care patients (108 participants). A high percentage of people successfully recruited for the study was seen in nursing homes (83.5% of predicted number). The lowest recruitment came from primary healthcare (53 participants) and geriatric outpatient clinic (26). About a quarter of recruited participants were lost during follow-up period. The poorest results of control visits were observed among patients from geriatric wards and geriatric outpatient clinic. CONCLUSIONS: The recruitment process for older people in Poland was satisfactory, mainly in hospitalized and institutionalized patients. The worst enrollment result was observed among outpatients. A detailed analysis of enrollment problems among the older Polish population is necessary to determine the optimal recruitment strategy and retain eligible study participants.

Treatment of Cardiovascular Diseases Among Elderly Residents of Long-term Care Facilities.

BACKGROUND: The prevalence of cardiovascular diseases among nursing home residents is high but little is known whether pharmacologic therapy recommended by actual medication guidelines is followed by facility's staff. AIM: To evaluate the adherence to actual guidelines for treatment of cardiovascular diseases among older adult residents of long-term care (LTC) facilities. MATERIAL AND METHODS: The cross-sectional study was performed from December 2009 to November 2010 among 189 elderly residents aged ≥60 years in 3 LTC facilities in Poland: 1 long-term care hospital (LTCH) and 2 nursing homes (NHs). The initial evaluation included analysis of medical documentation (all diagnosed diseases and used drugs), blood pressure (BP) measurements and performance of Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), Activities of Daily Living (ADL) score, and Barthel Index. Prescribed medication for hypertension (HT), heart failure (HF), and coronary heart disease (CHD) were compared to current European Cardiology Society (ESC), and European Society of Hypertension (ESH) medication guidelines. Residents were divided into 3 subgroups: with HT, HF, and CHD. Results were presented as means and standard deviation. Groups were compared using Mann-Whitney U test for nonparametric data and chi-square test to assess differences in distribution of categorical variables. P values <.05 were considered statistically significant. RESULTS: CHD was diagnosed among 114 residents (60.3%) but only 60.5% of them were treated with aspirin (ASA), 45.6% with beta-blockers (BBs), 60.5% with angiotensin-converting enzyme inhibitor (ACEI), and 24.6% with statins. HF observed in 75% of cases was treated by using ACEI (54.7%), BBs (45.3%), loop diuretics (LDs, 36%), mineralocorticoid-receptor antagonists (MRAs, 21.3%). HT was diagnosed among 98 study participants (51.9%) and in the majority of cases (76.6%) was well controlled (mean BP: 133.7 ± 17.6/73.8 ± 10.2 mmHg). The most popular antihypertensive drugs were ACEIs (77.6%), BBs (40.8%) and calcium channel blockers (CCBs, 26.5%) whereas thiazides, alpha-blockers (ABs), and angiotensin receptor blockers (ARBs) were used less frequently. CONCLUSION: In summary, the study showed that insufficient treatment of cardiovascular diseases among elderly residents of LTC facilities could be a potential risk factor of poor prognosis.

Nutritional and Functional Status in Newly Hospitalized Older Patients Who are Not Underweight.

Although malnutrition is commonly associated with being underweight, it occurs whenever nutrient intakes are inadequate, regardless of current body weight. The aim of the study was to determine nutritional status as a predictor of functional status among older patients without underweight according to body mass index (BMI) at hospital admission. This cross-sectional study enrolled 90 patients aged ≥65 years (mean age 78.1 ± 6.4). Assessments included basic and Instrumental Activities of Daily Living (bADL, IADL), Mini Nutritional Assessment (MNA), and BMI. Most of respondents were at risk of malnutrition (46%) or malnutrition (17%) according to MNA. Patients with/at risk of malnutrition had lower scores in bADL (p = 0.020), IADL (p = 0.010) and MNA (p < 0.001). Scores for bADL and IADL positively correlated with MNA (r = 0.34, r = 0.42, respectively) and negatively with age (r = -0.33, r = -0.21). MNA scores were also significant predictors of staying independence in bADL (ß = 0.53, p < 0.001) and IADL (ß = 0.45, p < 0.001) in regression analysis. Our findings indicated that most older patients with normal/elevated BMI were malnourished or at risk of malnutrition and experienced functional limitations in ADL at admission to hospital. In this population, nutritional status estimated by MNA appears to be one of the most important factors in predicting functional status of older adults who are not underweight.

Identification of Seniors at Risk scale as a simple tool of elderly patients' assessment in an acute hospital department.

INTRODUCTION: e aim of the study was to evaluate the usefulness of Identification of Seniors at Risk (ISAR) scale among elderly patients admitted to the department of internal medicine. MATERIAL AND METHODS: The ISAR score was performed among patients aged >59 years a er admission to the hospital ward. Data from medical history about diseases, taken medicines, falls, length of hospital stay and mortality were compared in patients with ISAR score of 0-1 and over 1 and in subjects with and without history of falls. Regression analysis was used to detect predictors of the length of hospital stay or death. RESULTS: The sample consisted of 102 subjects aged 80.9 ± 7.9 years, 45.5% of men, 34.6% had history of falls. The number of diseases was 11.3 ± 3.9 and number of medicines - 8.9 ± 3.7. The score of ISAR ≥2 was found in 90.2% of patients, length of hospital stay was 10.3 ± 8.4 days, mortality rate was 9.9%. Patients with ISAR score <2 were younger, showed a smaller number of diseases, used less drugs and had less frequency of falls than those with score ≥2. Patients with history of falls had higher mean ISAR score, higher number of diseases and medicines than the others. The increased number of diseases and higher ISAR score significantly influenced the length of hospital stay. None of the analyzed factors had any impact on mortality. CONCLUSION: The score of ISAR scale together with number of diseases have a positive impact on the length of hospital stay.