Subject(s)
Blood Pressure Determination/statistics & numerical data , Blood Pressure/physiology , Hypertension/physiopathology , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Blood Pressure Determination/standards , Female , Humans , Hypertension/drug therapy , Male , Practice Guidelines as Topic , Reference ValuesABSTRACT
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
Subject(s)
Geriatric Assessment/methods , Geriatrics/trends , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Patient Care/trends , Aged , Aged, 80 and over , Congresses as Topic , Female , Geriatrics/methods , Humans , Hypertension/diagnosis , Hypertension/therapy , Long-Term Care/methods , Male , Patient Care/methods , Pressure Ulcer/diagnosis , Pressure Ulcer/therapy , Prognosis , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Risk Assessment , Terminal Care/methods , Terminal Care/trends , Treatment Outcome , United StatesABSTRACT
This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.
Subject(s)
Delivery of Health Care , Nursing Homes , Polypharmacy , Aged , Dementia/drug therapy , Dementia/physiopathology , Female , Geriatric Assessment , Humans , Hypotension/drug therapy , Hypotension/physiopathology , Male , Renal Insufficiency, Chronic/drug therapy , Renal Insufficiency, Chronic/physiopathology , Transitional CareABSTRACT
OBJECTIVES: To validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a cohort of medical patients discharged to skilled nursing facilities (SNFs). DESIGN: Retrospective cohort. SETTING: Cleveland Clinic Main Campus. PARTICIPANTS: Cleveland Clinic Main Campus medicine services patients who were admitted between January 1, 2011, and December 31, 2012, and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital. MEASUREMENTS: Thirty-day all-cause readmissions to any hospital in the Cleveland Clinic Health System and the HOSPITAL score. RESULTS: During the study period, 4208 medical patients were discharged to 110 SNFs; 30-day all-cause readmission rates were 40.9% for high-risk patients, 28.1% for intermediate-risk patients, and 15.4% for low-risk patients. Compared to intermediate- and low-risk patients, high-risk patients had more hospitalizations in the past year (3.6 vs 1.1 vs 0.8; P < .0001), longer hospital stays (12.0 days vs 9.9 days vs 4.9 days; P < .0001) and more comorbidities, including end-stage renal disease (18.5% vs 9.3% vs 2.5%; P < .0001), congestive heart failure (39.9% vs 33.1% vs 26.1%; P < .0001), chronic obstructive pulmonary disease (26.9% vs 21.5% vs 20.2%; P < .0001), and diabetes (46.5% vs 38.6% vs 35.3%; P < .0001). The c--statistic for the HOSPITAL score was 0.65. CONCLUSIONS: Among patients discharged to an SNF, the HOSPITAL score may be used to identify those at highest risk of readmission within 30 days.
Subject(s)
Causality , Patient Discharge , Patient Readmission/trends , Skilled Nursing Facilities , Aged , Aged, 80 and over , Databases, Factual , Female , Humans , Male , Middle Aged , Ohio , Risk AssessmentABSTRACT
This is the ninth yearly update on clinical care in the nursing home. Topics covered this year are disease management in frail elders, heart failure, pneumonia, mild cognitive impairment, meaningful activities in the nursing home, atrial fibrillation, and anticoagulation.
Subject(s)
Nursing Care , Nursing Homes , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Atrial Fibrillation/nursing , Cognitive Dysfunction/nursing , Frail Elderly , Heart Failure/nursing , Humans , Leisure ActivitiesABSTRACT
This paper discusses recent developments and recommendations for elderly patients concerning immunizations, heart failure, lipid therapy, blood pressure control, and dementia.
Subject(s)
Geriatrics/standards , Heart Failure/therapy , Aged , Female , Frail Elderly , Guidelines as Topic , Humans , Immunization/standardsABSTRACT
About one-third of community-dwelling adults age 65 and older fall each year, and some suffer fractures, traumatic brain injury, and even death. Therefore, it is important to identify older adults at risk and recommend helpful interventions.
Subject(s)
Accidental Falls/prevention & control , Gait , Postural Balance , Risk Assessment/methods , Wounds and Injuries/prevention & control , Aged , Bone Density Conservation Agents/therapeutic use , Cognitive Dysfunction/epidemiology , Environment Design , Humans , Independent Living , Mass Screening , Nursing Homes , Osteoporotic Fractures/prevention & control , Peripheral Nervous System Diseases/epidemiology , Psychotropic Drugs/therapeutic use , Risk Factors , Sarcopenia/epidemiology , Urinary Incontinence/epidemiology , Vision Disorders/epidemiologyABSTRACT
The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and resources available to patients, caregivers, and health care providers.
Subject(s)
Activities of Daily Living/psychology , Firearms/legislation & jurisprudence , Frail Elderly/psychology , Public Health/legislation & jurisprudence , Aged, 80 and over , Humans , MaleABSTRACT
This is the eighth yearly update on clinical care in the nursing home. Topics covered this year are heart failure, delirium, nutrition, hospice, diabetes mellitus, frailty, and sarcopenia.
Subject(s)
Nursing Homes , Nursing Process , Aged , Aged, 80 and over , Delirium/nursing , Diabetes Mellitus/nursing , Frail Elderly , Heart Failure/nursing , Hospices/legislation & jurisprudence , Humans , Nutritional Support/nursing , Sarcopenia/nursingSubject(s)
Continuity of Patient Care , Long-Term Care , Skilled Nursing Facilities , Societies, Medical , Biomedical Research , Continuity of Patient Care/standards , Humans , Long-Term Care/standards , Models, Organizational , Organizational Objectives , Practice Guidelines as Topic , Quality Indicators, Health Care , Skilled Nursing Facilities/standards , United States , WorkforceABSTRACT
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
Subject(s)
Geriatrics , Nursing Homes , Aged , Aged, 80 and over , Anabolic Agents/therapeutic use , Anorexia/etiology , Anorexia/therapy , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents, Local/therapeutic use , Bandages , Bone Density Conservation Agents/administration & dosage , Bone Density Conservation Agents/adverse effects , Cachexia/etiology , Cachexia/therapy , Congresses as Topic , Dementia/psychology , Dementia/therapy , Depression/diagnosis , Depression/therapy , Diet, Sodium-Restricted , Frail Elderly , Hip Fractures/rehabilitation , Hip Fractures/surgery , Human Growth Hormone/therapeutic use , Humans , Hypertension/therapy , Malnutrition/etiology , Malnutrition/therapy , Osteoporotic Fractures/prevention & control , Pain Management , Postoperative Care , Sarcopenia/etiology , Sarcopenia/therapy , Skin Transplantation , Stockings, Compression , Varicose Ulcer/diagnosis , Varicose Ulcer/physiopathology , Varicose Ulcer/therapy , Weight LossSubject(s)
Antipsychotic Agents/therapeutic use , Delirium/drug therapy , Nursing Homes , Aged , Humans , Middle AgedABSTRACT
This article is the sixth in the series of clinical updates on nursing home care. The topics covered are management of hypertension, antidepressant medications in people with dementia, peripheral arterial disease, probiotics in prevention, and treatment of Clostridium difficile-associated diarrhea, frailty, and falls.
Subject(s)
Geriatrics , Nursing Homes , Accidental Falls/prevention & control , Aged , Aged, 80 and over , Antidepressive Agents/therapeutic use , Clostridioides difficile , Dementia/nursing , Depression/drug therapy , Depression/physiopathology , Diarrhea/drug therapy , Enterocolitis, Pseudomembranous/drug therapy , Geriatric Nursing/trends , Humans , Hypertension/drug therapy , Peripheral Arterial Disease/drug therapy , Probiotics/therapeutic useABSTRACT
Many new guidelines and studies of interest to the geriatric population have emerged in the areas of falls and fracture prevention, cardiovascular care, depression, and Alzheimer disease. Some of these guidelines and studies translate to immediate changes that should be made to clinical practice; others are new areas of controversy.
Subject(s)
Accidental Falls/prevention & control , Cognitive Dysfunction/diagnosis , Depression/drug therapy , Diphosphonates/adverse effects , Geriatrics/methods , Hypertension/therapy , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Citalopram/administration & dosage , Denosumab , Geriatrics/trends , Heart Valve Prosthesis Implantation/methods , Humans , Immunologic Factors/therapeutic use , Practice Guidelines as TopicABSTRACT
This represents the fifth article in the series on yearly updates of hot topics in long term care.
