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.

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.

[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.

[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.

[Treatment with antidepressants in geriatric departments. Occurrence and record keeping]. / Behandling med antidepressiva på geriatriske afdelinger. Forekomst og journalforing

INTRODUCTION: The aim of the present study was to describe the occurrence of antidepressant treatment in geriatric departments in Denmark and assess the notes of the patient records in connection with prescription. MATERIAL AND METHODS: Patient records for consecutively referred patients in seven geriatric departments were examined and basic information was noted. For users of antidepressants further information about the treatment was noted. RESULTS: A total of 1211 patients records were examined and out of these 338 patients were in treatment with antidepressants (29.7%). The users of antidepressants used more drugs on their discharge from the hospital. For 61.8% (209/338) of the users the treatment had started before the admission and in more than three-fourths the treatment remained unchanged at their discharge, in 9% the treatment was discontinued. 38.2% (129/338) started their treatment during the admission. Depression was stated as being the main reason in 54% of those who continued an ongoing treatment, and in 78% of those who started their treatment during admission. In 98.4%, the beginning of treatment with antidepressants was based upon the file notes. In 34.8% of the records of ongoing treatment no file notes were given. DISCUSSION: Treatment with antidepressants is common in geriatric departments and most often it is a question of continuation of a treatment that had started before the admission. The study shows that there is a need for an optimization of the file notes.