Relationship between traits and sleep quality of hospitalized elderly patients and sleep quality of family caregivers.

AIM: To understand whether the sleep quality of the caregivers of elderly inpatients is associated with their own characteristics and with the characteristics or sleep quality of the elderly inpatients. DESIGN: A cross-sectional study design that recruited participants from September to December 2020 was adopted, in which 106 pairs of elderly inpatients and caregivers were recruited. METHODS: Data collected from the elderly inpatients included demographic characteristics as well as the numerical rating scale (NRS) score, Charlson Comorbidity Index (CCI), Geriatric Depression Scale Short Form (GDS-SF) score, and Pittsburgh Sleep Quality Index (PSQI). Caregiver data included demographic characteristics and PSQI. RESULTS: In the regression analysis of caregiver characteristics and caregiver sleep quality, only caregiver age and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. In the regression analysis of elderly inpatient characteristics, caregiver characteristics, and caregiver sleep quality, only the PSQI of elderly inpatients and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. PATIENT OR PUBLIC CONTRIBUTION: Poor caregiver sleep quality was more likely to manifest when the elderly inpatients had poor sleep quality, when the caregivers themselves were older, and when the caregiver was the inpatient's spouse.

Association Between Sarcopenic Complications and Readmission in a Kaifukuki Rehabilitation Ward: A Retrospective Cohort Study.

Objectives This study investigated the association between sarcopenia and readmission to the Kaifukuki Rehabilitation Ward. Methods We conducted a retrospective observational study in a Kaifukuki Rehabilitation Ward in Japan. Muscle mass was evaluated using a body composition analyzer (InBody, Tokyo, Japan). Grip strength was measured using a grip dynamometer, and walking speed was measured using a 10-meter walk test. Sarcopenia was characterized based on the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. The presence or absence of readmission was calculated from the medical charts. This study used Rstudio for statistical analysis (Posit, Boston, USA). To examine the effect of sarcopenia on readmissions, we used the Kaplan-Meier method to estimate readmissions. Differences between curves were assessed using the log-rank test. Results A total of 131 patients were selected during the target period (March 1, 2020, to August 31, 2021). Of these, 12 (9%) were readmitted during the study period. The median patient age was 83 years. The study population consisted of 53 males (40%) and 78 females (60%). Sixty (50%) patients in the no-readmission group and seven (58%) patients in the readmission group had sarcopenia. For readmission, the presence of sarcopenia yielded an unadjusted hazard ratio of 1.37 (95% confidence interval: 0.41 to 4.56) and an adjusted hazard ratio of 1.74 (95% confidence interval: 0.52 to 5.83). Conclusions Sarcopenia may be a prognostic factor for readmission in Kaifukuki Rehabilitation Wards. Therefore, further evaluation is necessary.

Do neutrophil to lymphocyte ratio and platelet to lymphocyte ratio associate with frailty in elderly inpatient with comorbidity?

OBJECTIVE: Inflammation is one of the pathogenesis of frailty, Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are newly proposed inflammatory indicators. This study aimed to explore the relationship between NLR, PLR and frailty in elderly inpatient with comorbidity. METHODS: Inpatient elderly with comorbidity in our geriatric department from January 2015 to December 2018 were selected, and three groups, which included frailty, pre-frailty and robust, were divided by 5-item FRAIL scale. General data of the patients were collected, and comprehensive geriatric assessment was performed. NLR and PLR were calculated by neutrophil, lymphocyte and platelet in blood. SPSS24.0 software was used for analysis. RESULTS: CONCLUSION: Although results from the present study revealed associations between frailty and neutrophil and NLR in elderly inpatient with comorbidity, the potential role of these inflammation indicators on frailty needs further prospective investigation and researches involving larger population to improve its reliability.

Needs for nurses to provide spiritual care and their associated influencing factors among elderly inpatients with stroke in China: A cross-sectional quantitative study.

OBJECTIVES: To investigate the spiritual care needs and associated influencing factors among elderly inpatients with stroke, and to examine the correlations among spiritual care needs, spiritual well-being, self-perceived burden, self-transcendence, and social support. METHODS: A cross-sectional quantitative design was implemented, and the STROBE Checklist was used as the foundation of the study. A convenience sample of 458 elderly inpatients with stroke was selected from three hospitals in China. The sociodemographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being, the Self-Perceived Burden Scale, the Chinese Self-Transcendence Scale, and the Perceived Social Support Scale were used. Descriptive statistics, correlation, Student's t-test, ANOVA, non-parametric, and multiple linear regression analyses were used to analyze the data. RESULTS: The total score of spiritual care needs was 29.82 ± 7.65. Spiritual care needs were positively correlated with spiritual well-being (r = 0.709, p < 0.01), self-transcendence (r = 0.710, p < 0.01), and social support (r = 0.691, p < 0.01), whereas being negatively correlated with self-perceived burden (r = -0.587, p < 0.01). Religious beliefs, educational level, residence place, disease course, spiritual well-being, self-perceived burden, self-transcendence, and social support were found to be the main influencing factors. SIGNIFICANCE OF RESULTS: The spiritual care needs were prevalent and moderate. It is suggested that nurses should enhance spiritual care knowledge and competence, take targeted spiritual care measures according to inpatients' individual personality traits or characteristics and differences of patients, reduce their self-perceived burden and improve their spiritual well-being, self-transcendence and social support in multiple ways and levels, so as to meet their spiritual care needs to the greatest extent and enhance their spiritual comfort.

Chronic Kidney Disease (CKD) - A Brand Ambassador/Alarming Bell for Potentially Inappropriate Medication in Elderly Inpatients.

BACKGROUND: Since the past decade, prevalence of Potentially Inappropriate Medication (PIM) among elderly inpatients has increased drastically. However, limited data is available on PIM indicators and PIMs use among the elderly in patients suffering from Chronic Kidney Disease (CKD). OBJECTIVE: The objective of this study is to determine the prevalence of PIMs in elderly hospitalized patients with CKD. METHODS: A cross-sectional study was carried out on 102 patients in a tertiary care hospital. PIMs were identified using Beers criteria 2019. Chi-square test was used to identify the association between variables and PIMs use. RESULTS: PIMs, as assessed according to AGS updated Beers criteria 2019 was found to be in more than 68.6% of patients of median age 65 years and 3 diagnoses and 7 days median length of stay. Most of the patients (47.1%) had ≥4 diagnosis. The most common comorbidities in patient were diabetes mellitus (n=54) and hypertension (n=55). Most of the subjects (66.7%) were on polypharmacy (5-9 medications/day) and 25.5% were on a higher level of polypharmacy (>10 medicines/day). Approximately 90% of the patients were having very low CrCl < 21ml/min (calculated with the help of Cockcroft- Gault formula). A significant association between PIM use and an increased number of diagnoses, polypharmacy or high-level polypharmacy, was observed. CONCLUSION: The prevalence of PIMs in elderly inpatients suffering from CKD is quite high. The study clearly indicates negligence/ lack of awareness amongst physicians leading to increase in PIM use. Authors propose that the CKD patients should attract special attention of physician and should be treated as brand ambassadors/alarming bell for PIM use.

Initiation gait variability is higher in the morning in elderly inpatients.

OBJECTIVE: Although elderly inpatients are known to experience decreased physical activity in the morning, falls occur frequently during this time. Gait variability is an evaluation of gait instability and a risk factor for falls. Gait initiation requires complex processes, and it is important to evaluate gait variability not only during steady-state gait but also during gait initiation. However, the effect of the diurnal pattern on variability in gait characteristics is still unknown. The aim of this study was to investigate the effect of the diurnal pattern on initiation and steady-state gait variability in elderly inpatients. METHOD: Thirty-seven elderly inpatients (28 women; mean age, 79.7 ± 9.5 years) who could walk without support were sampled in this study. The quantitative measure of gait variability was evaluated using the coefficient of variation (CV) based on four consecutive stride durations determined using triaxial accelerometers. Gait characteristics were evaluated during initiation and steady-state gait and defined as initiation CV and steady-state CV, respectively. This measurement was performed at two time points, morning and daytime. RESULTS: There was no significant difference between initiation and steady-state gait characteristics in the daytime condition. However, in the morning condition, the initiation CV was higher than the steady-state CV. Furthermore, the initiation CV was higher in the morning than during daytime (p < 0.01). CONCLUSION: Our study revealed that the variability of initiation gait is higher in the morning. It may be important to assess the risk of falls, including initiation gait, in the morning.

Correlation of body weight with structure and function of left ventricle in elderly inpatients / 中华临床营养杂志

Objective To explore the relationship between the body weight and the structure and function of the left ventricle in the elderly inpatients,in order to emphasize the importance of body weight in the health management for elderly patients.Methods A total of 152 elderly inpatients meeting the enrollment criteria and providing informed consent were consecutively recruited.The height,body weight,body mass index (BMI),liver and kidney function,glycosylated hemoglobin,blood lipid,blood uric acid and structure and function of left ventricular were measured by anthropometry,biochemical examination and echocardiography respectively.The clinical characteristics,metabolic parameters,structure and function of left ventricular were compared among the low/normal weight,overweight and obesity groups.The correlation between left ventricular diastolic dysfunction (E/A ≤ 0.7) and the metabolic factors was analyzed.Results The incidences of lower/ normal weight,overweight and obesity in elderly inpatients were 29.6％ (45/152),52.6％ (80/152) and 17.8％ (27/152) respectively.Compared with the lower/normal weight group,the level of systolic blood pressure,glycosylated hemoglobin (P=0.005),left atrial diameter (P =0.000),left ventricular posterior wall dimension (P=0.010),left ventricular diastolic diameter (P=0.010),left ventricular mass (P=0.000),relative wall thickness and septal thickness increased significantly in overweight and obesity groups (all P＜ 0.05).A higher proportion of left ventricular diastolic dysfunction was observed in overweight and obesity groups in the patients aging 60-69 years (P=0.028).There was positive correlation between left ventricular diastolic dysfunction and BMI (P=0.022).Conclusions Overweight/obesity increases the risk of left ventricular diastolic dysfunction among elderly inpatients.The body weight management needs to be strengthened in health management for the elderly patients.

Relationships between Dietary Diversity and Nutritional Status in Elderly Inpatient / 肠外与肠内营养

Objective: To identify the relationship between Dietary Diversity and Nutritional Status in Elderly Inpatient. Methods: 136 elderly inpatients were selected in a tertiary hospital in Yunnan Provience. Food frequency questionnaire was used to collect dietary information and DDS9 was calculated; We used Mini Nutritional Assessment (MNA) to evaluate nutritional status, then analyzed the effect of Dietary Diversity on nutritional status in elderly inpatients. Results:① Patients at risk of malnutrition and with confirmed malnutrition in participants were 46. 3％, 33. 8％,, respectively. ② The incidence of insufficient diversity, moderate diversity and adequate diversity were 19. 9％, 77. 2％ and 2. 9％, respectively; the total scores of dietary diversity were (4. 68 ± 1. 27). However, apart from vegetables, the rest 8 kinds of food all showed lower scores of intra-group variety; while the consumption of beans, nuts and seafood was seriously inadequate. ③ The incidence of malnutrition risk and confirmed malnutrition in insufficient-diversity group and moderate-diversity group were 5. 109 times and 1. 094 times of adequacy group (P＜ 0. 05). Conclusion: Dietary diversity is strongly associated with putritional status in elderly inpatient. Improvement of dietary diversity status is potentially beneficial in the prevention of malnutrition.

What affects the subjective sleep quality of hospitalized elderly patients?

AIM: The present study aimed to identify the factors affecting the subjective sleep quality in elderly inpatients. METHODS: The participants were 290 older adults admitted in three general hospitals. Data were collected using a structured questionnaire consisting of scales for general characteristics, sleep quality, activities of daily living, instrumental activities of daily living and depression. Collected data were analyzed by descriptive statistics, t-test, one-way anova, Scheffé post-hoc, Pearson's correlation coefficient and stepwise multiple regression. RESULTS: There were statistically significant differences in sleep quality according to age, education level, marital status, monthly income and number of cohabitants. The most powerful predictor of sleep quality was depression (P < 0.01, R2 = 0.30). Five variables, depression, perceived health status, diagnosis, number of cohabitants and duration of hospitalization; explained 43.0% of the total variance in sleep quality. CONCLUSIONS: Elderly inpatients suffered from low sleep quality, and depression affected their sleep. We should develop and apply hospital-tailored sleep interventions considering older adults' depression, and then hospitalized older adults' sleep could improve. Furthermore, it is useful to identify other sleep-related factors. Geriatr Gerontol Int 2017; 17: 471-479.

Trend and determinants of acute inpatient care for the elderly in Italy from 2001 to 2011.

BACKGROUND: The population over 64 years of age is the main user of acute hospital care services. The elderly admission rates represent a marker for the appropriateness of the model of care. The aim of this study was to assess trends and determinants of acute in-patient care among the elderly in Italy between 2001 and 2011. STUDY DESIGN: Retrospective analysis of data included in the Italian Hospital Discharge Form Database. METHODS: Data from the Italian Hospital Discharge Form Database, Italian Ministry of Health, for the years 2001, 2006 and 2011 were analyzed for individuals over 64 years of age. Inpatient admission (> 1 day) rates across Italian Regions were calculated and compared with demographic variables and out-of-hospital care indicators. Univariate and multivariate analysis were used to determine independent relationship among variables. RESULTS: From 2001 to 2011 the elderly hospital admission rate decreased from 302.1/1,000 in 2001, to 222.4 in 2011, accounting for an overall decrease of about 28%. The decline in admission rates was less pronounced among individuals > 74 y (26.4%) than among those 65-74 y (32.1%). Hospitalization rates decreased in all Italian administrative regions between 2001 and 2011, even if the hospitalization rates in 2011 were still very different through the different Italian regions, ranging from 180.3/1,000 in Piedmont to 278.1/1,000 in Molise for people > 64 y. The multivariate linear regression was statistically significant in explaining the variations in hospitalization rates among the different Italian administrative regions (F: 3.637; p = 0.024; adjusted R2 = 0.57) and pointed to the role played by the proportion of the elderly (as percentage of the total population, p=0.043) and the rate of variation of acute care beds from 2004 to 2011 (p=0.001). Variables related to community-based care did not show any association with the hospital admissions rate among the elderly. CONCLUSIONS: The trend toward decline in elderly inpatient admissions is still present in 2011 as it was in 2001. Determinants of elderly hospital care in Italy are related to the increased number of elderly individuals and the reduction of hospital beds. Out-of-hospital care does not correlate with the variation of in-patient care so the overall care appropriateness could be negatively affected.

Measurement and analysis of nursing time based on patients requirement in geratic treat-care model department / 中国实用护理杂志

Objective To measure the nursing time that the geriatric patients need daily in a large general hospital in Anhui province,thus to understand the direct and indirect nursing items and time.Methods Timing and recording nursing operations to meet the conditions of the geriatric patients for 7 consecutive days by field recording method were done.Results The average time of each nursing procedures was calculated.Direct nursing time was 146.10 min,accounting for 84.70％ of the total nursing time,including primary care (42.81％) and respiratory/drain management proportion (15.86％); Indirect nursing time was 26.39 min,accounting for 15.30％ of the total nursing time.The actual number of nurse needed was 158,the suitable bed protection ratio was 1 ∶ 0.68.Conclusions Direct nursing time of geriatric patients needed was longer than that of indirect nursing time.To increase direct nursing hours and reduce the indirect nursing time can satisfy the need of elderly patients.In addition,the current nursing staffing cannot satisfy the clinical needs of the elderly,thus,nursing resources allocation should be reasonable arranged as soon as possible.