Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial.

BACKGROUND: Ageing populations and health-care staff shortages encourage efforts in primary care to recognise and prevent health deterioration and acute hospitalisation in community-dwelling older adults. The PATINA algorithm and decision-support tool alerts home-based-care nurses to older adults at risk of hospitalisation. The study aim was to test whether use of the PATINA tool was associated with changes in health-care use. METHODS: An open-label, stepped-wedge, cluster-randomised controlled trial was done in three Danish municipalities, covering 20 area teams providing home-based care to around 7000 recipients. During a period of 12 months, area teams were randomly assigned to an intervention crossover for older adults (aged 65 years or older) who received care at home. The primary outcome was hospitalisation within 30 days of identification by the algorithm as being at risk of hospitalisation. Secondary outcomes were hospital readmission and other hospital contacts, outpatient contacts, contact with primary care physicians (PCPs), temporary care, and death, within 30 days of identification. This study was registered at ClinicalTrials.gov (NTC04398797). FINDINGS: In total, 2464 older adults participated in the study: 1216 (49·4%) in the control phase and 1248 (50·6%) in the intervention phase. In the control phase, 102 individuals were hospitalised within 30 days during 33 943 days of risk (incidence 0·09 per 30 days), compared with 118 individuals within 34 843 days of risk (0·10 per 30 days) during the intervention phase. The intervention was not associated with a reduction in the number of first hospitalisations within 30 days (incidence rate ratio [IRR] 1·10 [90% CI 0·90-1·40]; p=0·28). Furthermore it was not associated with reduced rates of other hospital contacts (IRR 1·10 [95% CI 0·90-1·40]; p=0·28), outpatient contacts (1·10 [0·88-1·40]; p=0·42), or mortality (0·82 [0·58-1·20]; p=0·25). The intervention was associated with a 59% reduction in readmissions within 30 days of hospital discharge (IRR 0·41 [95% CI 0·24-0·68]; p=0·0007), a 140% increase in contacts with PCPs (2·40 [1·18-3·20]; p<0·0001), and a 150% increase in use of temporary care (2·50 [1·40-4·70]; p=0·0027). INTERPRETATION: Despite having no effect on the primary outcome, the PATINA tool showed other benefits for older adults receiving home-based care. Such algorithms have the potential to shift health-care use from secondary to primary care but need to be tested in other home-based care settings. Implementation of algorithms in clinical practice should be informed by analysis of cost-effectiveness and potential harms as well as the benefits. FUNDING: Innovation Fund Denmark and Region of Southern Denmark. TRANSLATIONS: For the Danish, French and German translations of the abstract see Supplementary Materials section.

Older patients acutely admitted and readmitted to the same geriatric department: a descriptive cohort study of primary diagnoses and health characteristics.

PURPOSE: Advancing age is associated with increased risk for acute admissions and readmissions. The societal challenges of ageing populations have made the prevention of readmissions come into focus. Readmission may be perceived as the result of inadequate treatment during index admission but may also be caused by the onset of new disease following a generally impaired health of geriatric patients. We aimed at comparing the diagnoses at index and readmission to illuminate this issue. METHODS: This is a descriptive, retrospective cohort study of patients acutely admitted and readmitted (within 30 days from discharge) to the same geriatric ward (November 1, 2017-April 30, 2018). Electronic medical records were scrutinised manually for discharge diagnoses and patient characteristics. RESULTS: Readmission rate was 10.7% (98 of 918 unique admissions). Mean age was 85.6 (men 56%). About 75% were readmitted with a new acute disease unrelated to index admission, most commonly pneumonia (27%), other infections (22%), and dehydration (14%). The health characteristics were long index length-of-stay (median 7; IQR 5-11), high Charlson Comorbidity Index (CCI ≥ 3, n = 49 (50%), polypharmacy (≥ 5 prescriptions) (94%), and hospitalisations 12 months prior to index admission (57%). KEY CONCLUSIONS: The majority of readmitted geriatric patients have contracted a new acute condition. Although being characterised by several adverse health characteristics, prospective studies comparing readmitted and non-readmitted geriatric patients are needed. Still, increasing the awareness of early recognition of acute disease onset in geriatric patients is warranted.

Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study.

INTRODUCTION: Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes. OBJECTIVE: We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF). DESIGN: A retrospective single-centre before-and-after cohort study. SETTING AND PARTICIPANTS: Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016-25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed. INTERVENTION: OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (-OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT). MAIN OUTCOME MEASURES: Unplanned hospital readmission between 4 hours and 30 days following initial discharge. RESULTS: Totally 847 patients were included (440 -OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in -OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with -OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period. CONCLUSION: Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.

The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.

OBJECTIVES: The aim was to investigate if oncologic treatment decision based on G8 screening followed by comprehensive geriatric assessment (CGA) and a multidisciplinary team conference in patients with G8 ≤ 14 was better than treatment decision based on standard assessment. ClinicalTrials.gov Identifier: NCT02671994. MATERIALS AND METHODS: From January 2016 to June 2018, 96 patients with cancer, aged ≥70 years, were included. Patients were randomized to treatment decision based on the oncologist's clinical judgement (control) or based on screening with G8. If G8 > 14 treatment decision was made as in the control group and if G8 ≤ 14, patients were referred to CGA including intervention as needed and treatment decision after a multidisciplinary team conference (MDT). RESULTS: The study was closed early. 47 patients were randomized to the control group and 49 to the intervention group; 28 had a G8 ≤ 14, 24 of whom attended CGA. In the intervention group 48% completed treatment as planned compared to 54% in the control group (p = .208). Thirty-eight percent experienced grade 3-4 toxicity in the control group compared with only 20% in the intervention group (p = .055). Median overall survival (OS) was 14.2 months in the control group and 19.1 months in the intervention group (p = .911). Median progression-free survival (PFS) was 9.0 months in the control group and 7.8 months for the intervention group (p = .838). CONCLUSION: Treatment decision based on G8 screening followed by CGA had no impact on completion rate of planned oncologic treatment, OS or PFS, but resulted in a borderline significant lower incidence of grade 3-4 toxicity.

Impact of Age, Comorbidity, and FIGO Stage on Treatment Choice and Mortality in Older Danish Patients with Gynecological Cancer: A Retrospective Register-Based Cohort Study.

BACKGROUND: The number of older patients with cancer is increasing in general, and ovarian and endometrial cancer are to a large extent cancers of the elderly. Older patients with cancer have a high prevalence of comorbidity. Comorbidity and age may be predictive of treatment choice and mortality in older patients with cancer along with stage and performance status. OBJECTIVES: The aim of this study was to describe comorbidity in a population of older Danish patients with gynecological cancer, and to evaluate the predictive value of comorbidity and age on treatment choice and cancer-specific and all-cause mortality. MATERIALS AND METHODS: In this retrospective study, we included 459 patients aged ≥ 70 years. Patients were diagnosed with cervical, endometrial, or ovarian cancer from 1 January, 2007 to 31 December, 2011 and were evaluated and/or treated at Odense University Hospital. Comorbidity was assessed using the Charlson Comorbidity Index. Treatment was classified as curative intended, palliative intended, or no treatment. RESULTS: Age, International Federation of Gynecology and Obstetrics (FIGO) stage, and performance status were found to be significant predictors of treatment choice, while comorbidity was not. Multivariate analyses showed that both cancer-specific and all-cause mortality were significantly associated with treatment choice, FIGO stage, and performance status. Age was not associated with mortality, with the exception of ovarian cancer, where age was associated with all-cause mortality. Comorbidity was not an independent predictor of treatment choice or mortality. CONCLUSIONS: In our population of older Danish patients with gynecological cancer, age, FIGO stage, and performance status were predictors of treatment choice, while comorbidity was not. Treatment choice, FIGO stage, and performance status were significantly associated with both cancer-specific and all-cause mortality. Age was only associated with mortality in ovarian cancer, while comorbidity was not associated with mortality.

Impact of comprehensive geriatric assessment on quality of life, overall survival, and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy.

OBJECTIVES: Overall survival ï´¾OSï´¿ for patients with localized non-small cell lung cancer ï´¾NSCLCï´¿ treated with stereotactic body radiotherapy ï´¾SBRTï´¿ is poorer than for patients undergoing surgery. Patients who undergo SBRT are often ineligible for surgery due to significant comorbidities that can impact their mortality. A comprehensive geriatric assessment (CGA) that identifies and treats aging related comorbidities could improve OS and quality of life (QoL). This randomized study investigated if a CGA added to SBRT impacts QoL, survival, and unplanned admissions. MATERIALS AND METHODS: From January 2015 to June 2016, 51 patients diagnosed with T1-2N0M0 NSCLC treated with SBRT were enrolled. The patients were randomized 1:1 to receive SBRT +/- CGA. EuroQoL Group 5D (EQ-5D) health index and visual analogue scale (VAS) scores were assessed at start of SBRT, at five weeks, and every third month for a year after SBRT. RESULTS: There were 26 and 25 patients randomized to receive ± CGA, respectively. The repeated measures one-way analysis of variance (ANOVA) test of the EQ-5D health index and VAS scores did not show statistically significant differences between groups. For the EQ-5D VAS scores at twelve months follow-up there was a small difference between the groups although not statistically significant. Even though more patients deceased in the no-CGA group, no statistically significant difference in survival rates and unplanned admission rate was observed between groups. CONCLUSION: In patients with localized NSCLC treated with SBRT, a CGA did not impact the overall QoL, the prevalence/length of unplanned admissions, or survival. There was an indication of small differences in QoL and survival in the data, but such differences can only be validated in larger studies.

Physical, mental, and social functioning in women age 65 and above with and without a falls history: An observational case-control study.

OBJECTIVES: There is a lack of knowledge about how falls are associated with the older person's physical, mental, and social functioning which would help find effective methods for identifying rehabilitation needs in the older population to ensure appropriate follow-up. The aim was to investigate and compare functioning in women with and without a falls history. METHODS: This was an observational case-control study. Study participants were fallers aged ≥65 years recruited consecutively from a hospital; age matched randomly selected community controls (fallers without contact with the healthcare system due to falls and non-fallers). Fallers were classified as once only fallers and recurrent fallers. RESULTS: The sample constituted a group of older women with and without a falls history; 117 fallers from the Falls Clinic, and 99 fallers and 106 non-fallers community controls, median age 80 years. Both fallers from the clinic and the community had significantly lower functioning compared to non-fallers in all three domains. Recurrent fallers had poorer functioning compared to once only fallers. CONCLUSION: This study contributes to knowledge about older people's functioning and disability in conjunction with a high fall-risk and highlights the importance of rehabilitation and prevention strategies that focus on early identification of disability in the older population regardless of falls history.

How to measure energy and protein intake in a geriatric department - A comparison of three visual methods.

BACKGROUND & AIMS: Sufficient energy and protein intake are essential to treatment and recovery of hospitalized older adults. The food intake should be assessed in order to detect patients in need of nutritional intervention. The aim of this study was to compare the accuracy of three visual methods for assessing energy and protein intake as compared to weighing food items. METHODS: We conducted assessment of 103 lunch meals served to geriatric inpatients. Lunch meals were assessed by the nursing staff using three visual methods: 1. Meal Portions (MP): Consumption of each meat/fish, vegetables, potatoes, and sauce 2. Plate Method (PM): Consumption of 100%, 75%, 50%, 25%, or 0% 3. Reduced Plate Method (RPM): All, half, quarter, or nothing Separate weighing of all food items pre- and post-serving was used as reference method. Wilcoxon Signed Rank Test was used comparing the accuracy of the three visual methods. Bland-Altman analysis was used to test the degree of agreement. Results are given as median estimates [25%>, 75%> percentiles]. The Alpha level was set to 0.05. RESULTS: The total energy served pr. lunch meal was 893.6 kJ [830.4, 1034.3] and the weighed intake 676.6 kJ [421.4, 870.0]. The median intake was 663.0 kJ [389.0, 873.0] (p = 0.044), 636.0 kJ [436.5, 873.0] (p < 0.001), and 487.8 kJ [316.5, 873.0] (p < 0.001) assessed by MP, PM, and RPM respectively. The weighted protein content pr. served meal was 13.0 g [11.4, 15.4] with a weighted intake of 10.3 g [5.3, 13.1]. The median intake was 10.7 g [5.3, 11.7] (P = 0.045), 9.3 g [5.8, 11.7] (p < 0.001), and 8.0 g [4.8, 11.7] (p < 0.001) assessed by MP, PM, and RPM respectively. CONCLUSIONS: All visual methods underestimated energy intake. PM and RPM underestimated protein intake whereas MP overestimated protein intake. However, visual assessment by MP was found to be most accurate.

Questionnaire-based survey suggests that the majority of Danish geriatricians are against euthanasia.

INTRODUCTION: Euthanasia (EU) and/or physician-assisted suicide (PAS) is legal in some countries and being considered in others. Attitudes to EU/PAS among Danish geriatricians were studied. METHODS: An online questionnaire with 12 questions was e-mailed to all members of the Danish Geriatric Society. RESULTS: The response rate was 46% (120/261). A total of 55.8% (67/120) disagreed that EU is ethically justifiable, whereas 22.5% (27/120) found that EU is justifiable. Furthermore, 13.3% (16/120) agreed that EU should be offered as an alternative to palliative treatment, 73.4% (88/120) disagreed. A total of 64.2% (67/120) disagreed that PAS is ethically justifiable, whereas 19.2% (23/120) found that PAS is justifiable. In all, 15% (18/120) agreed that PAS should be offered as an alternative to palliative treatment, whereas 76.6% (92/120) disagreed. The impact of legalisation of EU/PAS on the relationship between physician and patient was believed to be negative by 62.2% (74/119), positive by 12.6% (15/119) and without implications by 25.2% (30/119). Younger physicians tended to be more positive towards EU/PAS. CONCLUSIONS: The majority of Danish geriatricians are opposed to EU and PAS. FUNDING: none. TRIAL REGISTRATION: none.

Trends in cancer in the elderly population in Denmark, 1980-2012.

BACKGROUND: Age is the strongest risk factor for developing cancer. The aim of the present analysis is to give an overview of the trends in cancer incidence, mortality, prevalence, and relative survival in Denmark from 1980 to 2012 focusing on age, comparing persons aged 70 years or more with those aged less than 70 years. MATERIAL AND METHODS: Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries. The Danish data originate from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS: Incidence and mortality rates of all sites, but non-melanoma skin cancer, were higher and relative survival was lower among persons aged 70 years or more than those aged less than 70 years. The age distribution (age group-specific percentages of total number of incident cases) remained constant over time while the percentage of persons dying from cancer decreased with time up to the age of 79 years but increased for those aged 80 years or more, in whom about a third of all cancer deaths occurred in 2012. In 2003-2007, the five-year relative survival was 48% for men aged 70-79 years, 38% for men aged 80-89 years, and 29% for men aged 90 years or more and the corresponding figures for women were 46%, 39%, and 36%, respectively. There was a substantial increase in the number of prevalent cancer cases aged 70 years or older, especially among those aged 90 years or more. CONCLUSION: An increase in elderly cancer patients is expected over the coming 20 years due to an increasing elderly population. Healthcare providers need to focus on developing specific strategies for treatment of elderly cancer patients in the future.

Choice of osteoporosis guideline has important implications for the treatment decision in elderly women referred to a fall clinic.

INTRODUCTION: Different guidelines are used worldwide to make decisions on treating osteoporosis. Some are based on fracture risk calculations, whereas others use criteria based on bone mineral density (BMD) T-scores, risk factors, or fragility fractures. The aim of this study was to explore how osteoporosis treatment decisions in a group of elderly women with falls would be affected if fracture risk-based guidelines were used as compared to guidelines based on BMD T-scores. METHODS: We studied 88 women attending a falls clinic. Dual energy X-ray absorptiometry and vertebral fracture assessment were performed and clinical risk factors were identified. We calculated the percentage of women recommended for treatment using five guidelines: Danish Bone Society (DBS-DK), UK National Osteoporosis Guideline Group (NOGG-UK), US National Osteoporosis Foundation (NOF-US); and we applied a 20% cut-off to fracture risk calculations by the Garvan Fracture Risk Calculator and Q-fracture 2012. Agreement was calculated using kappa statistics. RESULTS: The median age (interquartile range) was 81 years (75-85.5 years). The proportion of women (95% confidence interval) recommended for treatment was DBS-DK 56% (44.7-66.3%), NOGG-UK 51% (40.1-62.1%), NOF-US 88% (78.5-93.5%), Garvan 91% (82.9-96.0%), Q-fracture 58% (47.0-68.4%). The guidelines agreed on treatment recommendations for 23 (26%) of the 88 women studied. The kappa score was 0.13 (p < 0.0001). CONCLUSION: This study showed that the choice of guideline has a major impact on the treatment decisions in elderly women with falls. FUNDING: not relevant. TRIAL REGISTRATION: ClinicalTrial.gov (NCT01600547).

Calcaneal quantitative ultrasound and phalangeal radiographic absorptiometry alone or in combination in a triage approach for assessment of osteoporosis: a study of older women with a high prevalence of falls.

BACKGROUND: The objective of this study was to investigate if application of United Kingdom National Osteoporosis Society (UK-NOS) triage approach, using calcaneal quantitative ultrasound (QUS), phalangeal radiographic absorptiometry (RA), or both methods in combination, for identification of women with osteoporosis, would reduce the percentage of women who need further assessment with Dual Energy X-ray Absorptiometry (DXA) among older women with a high prevalence of falls. METHODS: We assessed 286 women with DXA of hip and spine (Hologic Discovery) of whom 221 were assessed with calcaneal QUS (Achilles Lunar), 245 were assessed with phalangeal RA (Aleris Metriscan), and 202 were assessed with all three methods. Receiver operator characteristics (ROC) curve for QUS, RA, and both methods in combination predicting osteoporosis defined by central DXA were performed. We identified cutoffs at different sensitivity and specificity values and applied the triage approach recommended by UK-NOS. The percentage of women who would not need further examination with DXA was calculated. RESULTS: Median age was 80 years (interquartile range [IQR]) [75-85], range 65-98. 66.8% reported at least one fall within the last 12 months. Prevalence of osteoporosis was 44.4%. Area under the ROC-curve (AUC) (95% confidence interval (CI)) was 0.808 (0.748-0.867) for QUS, 0.800 (0.738-0.863) for RA, and 0.848 (0.796-0.900) for RA and QUS in combination. At 90% certainty levels, UK-NOS triage approach would reduce the percentage of women who need further assessment with DXA by 60% for QUS, and 43% for RA. The false negative and false positive rates ranged from 4% to 5% for QUS and RA respectively. For the combined approach using 90% certainty level the proportion of DXAs saved was 22%, the false negative rate was 0% and false positive rate was 0.5%. Using 85% certainty level for the combined approach the proportion of DXAs saved increased to 41%, but false negative and false positive values remained low (0.5%, and 0.5% respectively). CONCLUSIONS: In a two-step, triage approach calcaneal QUS and phalangeal RA perform well, reducing the number of women who would need assessment with central DXA. Combining RA and QUS reduces misclassifications whilst still reducing the need for DXAs.

[Video recordings can be used for easier and faster evaluations of the performances of postgraduate trainees]. / Videooptagelse kan bruges til nemmere og hurtigere evalueringer i uddannelsen af læger i klinisk basisuddannelse.

Evaluating post-graduate trainees under direct observation is troublesome, and there are concerns about rater-variability. The aim of this study was to explore if video recordings could be used for evaluation. The performances of five trainees were video recorded. The videos were assessed by six supervisors watching either the complete recording or approximately 20 min. Video recording was well tolerated by the patients and the supervisors, but not the trainees. Watching part of the videos was sufficient for assessment. Video recording seems to provide a feasible method of assessing postgraduate trainees.

Central nervous system medications and falls risk in men aged 60-75 years: the Study on Male Osteoporosis and Aging (SOMA).

INTRODUCTION: drugs acting on the central nervous system (CNS) increase falls risk. Most data on CNS drugs and falls are in women/mixed-sex populations. This study assessed the relationship between CNS drugs and falls in men aged 60-75 years. METHODS: a questionnaire was sent to randomly selected Danish men aged 60-75 years. Cross-sectional data on CNS drugs and falls in the previous year were available for 4,696 men. Logistic regression investigated the relationship between falls and CNS drugs. RESULTS: the median age was 66.3 (IQR = 63.1-70.0) years; 21.7% were fallers. The following were associated with fallers (OR; 95% CI): opiates (2.4; 1.5-3.7), other analgesics (1.7; 1.4-2.1), antiepileptics (2.8; 1.5-5.1), antidepressants (2.8; 1.9-4.1) and anxiolytics/hypnotics (1.5; 0.9-2.6). Effects of opiates interacted strongly and significantly with age, with a marked association with falls in the older half of the subjects only. No significant associations were found between antipsychotics and fallers. Selective serotonin reuptake inhibitors and tricyclics were significantly associated with fallers (3.1; 2.0-5.0 and 2.2; 1.0-4.7, respectively). CONCLUSION: several CNS drug classes are associated with an approximately 2-3-fold increase risk of falls in men aged 60-75 years randomly selected from the population. Further longitudinal data are now required to confirm and further investigate the role of CNS drugs in falls causation in men.

Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit.

BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients. Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission was studied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS: All first admissions of patients with age >65 years between January 1st 2005 and December 31st 2009 were included. Data on BI, sex, age, and discharge diagnoses were retrieved from the hospital patient administrative system, and data on survival until September 6th 2010 were retrieved from the Civil Personal Registry. Co-morbidity was measured with Charlson Co-morbidity Index (CCI). Patients were followed until death or end of study. RESULTS: 5,087 patients were included, 1,852 (36.4%) men and 3,235 (63.6%) women with mean age 81.8 (6.8) and 83.9 (7.0) years respectively. The median [IQR] length of stay was 8 days, the median follow up [IQR] 1.4 [0.3; 2.8] years and in hospital mortality 8.2%. Mortality was greater in men than in women with median survival (95%-CI) 1.3 (1.2 -1.5) years and 2.2 (2.1-2.4) years respectively (p < 0.001). The median survivals (95%-CI) stratified on BI groups in men (n = 1,653) and women (n = 2,874) respectively were: BI 80-100: 2.6 (1.9-3.1) years and 4.5 (3.9-5.4) years; BI 50-79: 1.7 (1.5-2.1) years and 3.1 (2.7-3.5) years; BI 25-49: 1.5 (1.3-1.9) years and 1.9 (1.5-2.2) years and BI 0-24: 0.5 (0.3-0.7) years and 0.8 (0.6-0.9) years. In multivariate logistic regression analysis with BI 80-100 as baseline and controlling for significant covariates (sex, age, CCI, and diseases of cancer, haematology, cardiovascular, respiratory, infectious and bone and connective tissues) the odds ratios for 3 and 12 months survival (95%-CI) decreased with declining BI: BI 50-79: 0.74 (0.55-0.99) (p < 0.05) and 0,80 (0.65-0.97)(p < 0.05); BI 25-49: 0.44 (0.33-0.59)(p < 0.001) and 0.55 (0.45-0.68)(p < 0.001); and BI 0-24: 0.18 (0.14-0.24)(p < 0.001) and 0.29 (0.24-0.35)(p < 0.001) respectively. CONCLUSION: BI is a strong independent predictor of survival in older patients admitted to an acute geriatric unit. These data suggest that assessment of ADL may have a potential role in decision making for the clinical management of frail geriatric inpatients.

Auscultatory versus oscillometric measurement of blood pressure in octogenarians.

BACKGROUND: Auscultatory measurement using a sphygmomanometer has been the predominant method for clinical estimation of blood pressure, but it is now rapidly being replaced by oscillometric measurement. OBJECTIVE: To compare blood pressure by auscultatory and oscillometric measurements in patients ≥ 80 years. METHOD: 100 patients had blood pressure measured by auscultation with a sphygmomanometer and by an electronic device using the oscillometric method. For each patient the mean of two blood pressures with each method measured within 15 min were compared. RESULTS: The mean age of participants was 85.8 years; 55.8% were women. The correlation coefficient for systolic blood pressure was 0.88 and for diastolic 0.79. Differences between auscultatory and oscillometric values were less than 10 mmHg in 70.6% of systolic blood pressures and in 83.2% for diastolic. Arrhythmia and hypertension did not influence the results, and there was no correlation between the magnitude of the differences and the level of blood pressure. CONCLUSION: Agreement between oscillometric and auscultatory measurements of blood pressure in octogenarians was found to be less than required by validation protocols. However, semi-automatic equipment, which is observer-independent, may be used even in the very elderly, particularly if multiple readings are performed.

[Primary visitation of elective referred geriatric patients--a randomised study of home visits compared to day hospital visits]. / Primaer visitation af elektive geriatriske patienter. En randomiseret undersøgelse af hjemmebesøg kontra ambulantbesøg.

AIM: To compare the treatment, patient satisfaction, life quality and costs of elective referred patients seen by a geriatric team at home or in a geriatric day hospital. MATERIALS AND METHODS: Elective patients were randomised to primary contact by home visit (n=175) or to primary contact in the day hospital (n=176), median age 81 and 83 years, median Barthel - index 85 and 85, MMSE 25 and 25. 61% of elective referrals were randomised. RESULTS: There were no differences between the two groups' number of problems regarding referrals, treatment offered, number of blood tests, number of X-rays, number of outpatient contacts, number of admissions to hospital wards or number of diagnosis. The patient had to invest on average 99.5 min together with the geriatric team at the first visit at home and 57.7 min on following visits. The patient had to invest more time if seen in the day hospital: 159.0 min. at the first visit and 120 min. at the following visits. Despite this difference in time-consumption, no differences were found in patient satisfaction or life quality. Of the overall time used by the geriatric team for home visits 20% was used for transportation at the first visit and 30% at the following visits. On average the hospital costs were 3.50 hours/activity at home visits as compared to 1.55 hours/activity in the day hospital. CONCLUSION: Geriatric home visits are expensive and time-consuming.

[Geriatric home visits can prevent hospitalisation of subacute patients but is time-consuming. A randomised study]. / Geriatrisk teambesøg kan forebygge indlaeggelse af subakut henviste patienter, men er et tidskraevende tilbud. En randomiseret undersøgelse.

AIM: To study if geriatric home visits could prevent hospital admittance of geriatric patients referred subacute by general practitioners. MATERIALS AND METHODS: Patients were randomised to first contact by geriatric home visit (n=59), or to subacute admittance to a geriatric ward (n=43), median age 79.0 and 82.5 years, women 64% and 72%, Barthel-index 755 and 770 and MMSE 24,0 and 23,0. Only 30% of the total number of subacute referred patients were included. RESULTS: 53% (31/59) randomised to home visits were not admitted to hospital, 17% (10/59) were admitted at the first home visit and 12% (7/59) within the first 7 days. Patients admitted within the first 7 days were more often single, 84% (n=16/19) as compared to 52% (16/31) of those not admitted. The time used on home visits was on average 122 min, including 23 min (19%) for transportation. Among the 43 patients randomised to subacute admittance 16% (7/43) were sent home within 24 hours, and of these 73% were seen in the outpatient clinic, 26% (11/42) were sent home on day 2-7 and of these 27% were seen in the outpatient clinic. The overall median time in contact with the geriatric department was 27.1 days (n=59) in the home visit group and 15.0 days (n=43) in the admitted group (p<0.05). There were no significant differences in patient satisfaction or self-rated health. The average time used by the municipality for home service was reduced to 15 min/day in patients sent to hospital (p<0.01) and increased to 44 min/day in patients not admitted (p<0.05). CONCLUSION: Hospital admittance was avoided by geriatric home visits. However, time consumption was high. The municipality costs increased for non-admitted patients. The overall time in contact with the geriatric department was shortest for admitted patients.