Type 2 Diabetes Correlates with Comorbidity and Nutritional Status but Not with Functional Health in Geriatric Ward Patients: A Cross-Sectional Study in Poland.

PURPOSE: The study aimed to assess the comorbidity profile, functional, and nutritional health in geriatric ward patients depending on their type 2 diabetes (DM) status. PATIENTS AND METHODS: We performed a cross-sectional study of 416 patients - median age 82 years (IQR 77-86), 77.4% female, 96.9% community-dwelling - consecutively admitted to the geriatric ward at the turn of 2014 and 2015. Comprehensive geriatric assessment results were analyzed (including self-care and instrumental activities of daily living, cognitive abilities, emotional health, risk of falls, frailty status, dynapenia, nutritional health, morbidity, biochemical parameters, and pharmacotherapy). RESULTS: DM was observed in 126 (30.3%) patients hospitalized in the study period; 4% of DM cases were newly diagnosed. In comparison to patients without DM, older adults with type 2 DM were significantly more frequently burdened with multimorbidity (61.1% versus 39.7%, P<0.001), polypharmacy (88.9% versus 74.7%, P=0.001), obesity (59.8% versus 34.5%, P<0.001), abdominal obesity (94.4% versus 75.5%, P<001), chronic kidney disease (61.1% versus 48.6%, P=0.02) and cardiovascular diseases: ischemic heart disease (66.7% versus 47.9%, P<0.001), congestive heart failure (50.0% versus 34.1%, P=0.002), atrial fibrillation (30.2% versus 20.7%, P=0.04) and peripheral arterial disease (24.6% versus 11.4%, p<0.001). There were no significant differences in all functional parameters evaluated. CONCLUSION: Type 2 DM patients were significantly more often burdened with multimorbidity, polypharmacy, obesity, and had an unfavorable profile of cardiovascular diseases than patients without DM, but - contrary to our expectations - they did not differ in any functional characteristic assessed. However, this may be due to the geriatric ward patients' specificity of health problems in the advanced, more complex disablement process phases.

Characteristics and outcome of elderly patients admitted for acute Cholecystitis to medical or surgical wards.

BACKGROUND: Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards. METHODS: This retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016. Data were retrieved from the electronic health records. RESULTS: A total of 187 patients were detected, 54 (29%) in medical departments and 133 (71%) in surgical wards. The mean age (±SD) was 80 ± 7.5 and was higher among those in medical than surgical wards (84 ± 7 versus 79 ± 7, p <  0.05). Patients hospitalized in medical departments had more comorbidity, disability and mental impairment. However, there was no difference in mortality between the two groups, 1 (2%) and 6 (4%) respectively. Independent predictors for hospitalization in medical departments were chronic obstructive pulmonary disease (OR = 9.8, 95% C. I 1.6-59) and the Norton Scale score (NSS)(OR = 0.7, 95% C. I 0.7-0.8). Impaired mental condition was the only predictor for hospitalization > 1 week. The strongest predictor for having cholecystostomy was admission to the surgical department (OR = 14.7, 95% C. I 3.9-56.7). Linear regression showed a negative correlation between NSS and length of hospitalization (LOH; Beta = - 0.5). CONCLUSION: Elderly patients with acute cholecystitis who require conservative management, especially those with severe functional and mental impairment can be safely hospitalized in medical departments. Outcome was not inferior in terms of mortality and LOH. These results have practical policy implications for the placement of elderly patients with acute cholecystitis in medical rather than surgical departments.

[Impact of psychiatric disorders on the outcome of acute geriatric inpatient treatment: an exploratory investigation]. / Die Bedeutung psychischer Störungen für den stationär akutgeriatrischen Behandlungsverlauf: eine explorative Untersuchung.

BACKGROUND: Systematic study results of geriatric inpatient treatment assessing the impact of psychiatric disorders on treatment outcome are so far missing. This exploratory study investigated the impact of dementia, depression and delirium on treatment outcome in a geriatric department, compared to those individuals without psychiatric symptoms at the beginning of treatment. METHOD: From January to June 2018 treatment data from geriatric inpatient records were retrospectively evaluated. Functional measurements (Barthel index, timed up and go test, Tinetti test and the De Morton mobility index) were assessed at the start of geriatric treatment and at discharge. A multivariate variance analysis (MANOVA) was used to calculate the possible impact of psychiatric disorders on functional improvement during treatment and to find out if there were significant differences between the four defined groups (dementia, depression, delirium and mentally sound). RESULTS: A total of 280 geriatric inpatients with an average age of 84 years, were included in this study and showed a noticeable prevalence of psychiatric disorders: dementia 29%, depression 27%, and delirium 15%. As expected, the patients in the sample showed a high level of multimorbidity and polypharmacy. Functional improvement was present in each of the defined groups and significant differences between all groups were found. The results of MANOVA showed that none of the possible confounding variables, e.g. age, mini mental status examination (MMSE), degree of care, cognitive impairment, social status, gender and comorbid illness, had an important influence on the group results. CONCLUSION: This study of an acute geriatric department demonstrated that psychiatric disorders in these multimorbid, aged patients did not prevent functional improvement by treatment, showed significant differences during the course of treatment and outcome and compared to inpatients without psychiatric symptoms.

Analysis of drug resistance and homology of 226 Acinetobacter baumannii in geriatric department / 中国基层医药

Objective Through statistical analysis of drug resistance and homology of Acinetobacter baumannii in geriatric department of our hospital,we can provide evidence for clinical experience in antibiotics use and nosocomial infection control.Methods The drug resistance of Acinetobacter baumannii isolated from the elderly rehabilitation department in Ningbo Kangning Hospital from January 2017 to December 2018 was analyzed by retrospective analysis. The homology of Acinetobacter baumannii isolated from clinical isolates was detected by PCR ERIC －PCR method and agarose gel electrophoresis method.Results The resistance rates of Acinetobacter baumannii to ciprofloxacin and levofloxacin were 41.6%and 35.4%,respectively.The resistance rates to cefepime ,ceftriaxone and ceftazidime were 40.3%,38.9%and 36.7%,respectively.The resistance rate to imipenem was 38.9%,and the sensitivity rates to cefoperazone／sulbactam,gentamicin and tobramycin were all over 70%.A total of 226 strains of Acinetobacter baumannii were genotyped by ERIC －PCR.They were mainly classified into A,B,C,D and E 5 types.Among them, 116 strains were type A,68 strains were type B,26 strains were type C,8 strains were type D and E.Conclusion The resistance rate of Acinetobacter baumannii to some antibiotics in geriatric rehabilitation department is still at a high level,so we should continue to strengthen the rational use of antibiotics ;at the same time,the strains are highly homologous,and there is likely to be clonal transmission in the department ,so we should take more effective measures to prevent and control its transmission in hospital.

Exploration of influencing factors for comprehensive geriatric assessment carried out in geriatric departments of comprehensive hospitals in Sichuan province / 中华老年医学杂志

Objective To investigate influencing factors for comprehensive geriatric assessment carried out in geriatric departments of comprehensive hospitals in Sichuan province and its influential factors ,in order to verify whether education affects CGA and to raise medicine quality of senile disease. Methods The self-designed questionnaires were distributed to 40 hospitals in difference downs and cities in Sichuan province. The data were collected ,including items of CGA carried out in each hospital ,structure of staff ,scale ,bed distribution ,numbers of bed in geriatric department ,etc. The correlations of CGA items with the related factors were analyzed by using multiple linear regression analysis. Results The items of CGA carried out was positively related with hospital grade (β= -5.4 ,P=0.03) ,the staff-attending three times or more of geriatric training course (β=0.2 ,P=0.05) , the number of nurses per bed(β=15.6 ,P=0.03) ,the number of physicians with master's degree(β=-0.2 ,P=0.04) ,and the lower average age of medical staff (β= -0.6 ,P=0.05). Conclusions The grade of hospital ,attending actively geriatric training course ,the number of the nurses per bed ,the number of physicians with master's degree ,and the younger average age of medical staff were positively associated with the items of CGA carried out in hospitals.

Contextual Exploration of a New Family Caregiver Support Concept for Geriatric Settings Using a Participatory Health Research Strategy.

Family caregivers are the backbone of the long-term care support system within the home environment. Comprehensive caregiver support programs require collaboration and coordination within the system. A new public health concept, Vade Mecum, aims to harmonize and professionalize family caregiver support initiatives in geriatric care settings in the Euregion Maas-Rhine. Exploration of the new concept recently started in Germany to gain in-depth insight into current support and the needs of the geriatric care team and family caregivers. Within the context of an exploratory qualitative study, a participatory health research (PHR) strategy was applied to make optimal use of experience and knowledge from the system. Care professionals, engaged as co-researchers, were responsible for decisions about the research question, data collection methods and procedures of engaging family caregivers. A research team representing all professions within the geriatric department was formed. Research objectives were formulated and an appropriate mix of qualitative data collection methods consisting of interviews, focus groups and story-telling was chosen. Needs and expectations of the new concept, and practical solutions for involving family caregivers were discussed. A PHR strategy resulted in initiating a qualitative study in a geriatric care setting carried out by care professionals from the department. Knowledge was generated in a co-creative manner, and co-researchers were empowered. A comprehensive understanding of the system serves as a starting point for advancement of the new family caregiver concept.

Operating a Monitoring Unit in the Geriatric Department: Effects on Outcomes.

OBJECTIVES: To compare the effect of a five-bed geriatric monitoring unit (MU) on in-hospital mortality and length of stay with the effect of usual care in a geriatric hospital department and a medical MU. DESIGN: Prospective, case-control, noninterventional study. PARTICIPANTS: All individuals hospitalized for 24 hours or longer in the geriatric MU (n = 89, aged 53-101, mean age 82.2 ± 9.6) over a period of 5 months (January-May 2015); individuals admitted to the geriatric department (n = 178, aged 55-100, mean age 83.2 ± 9.8), matched at a ratio of 1:2 according to sex, age ±5 years, and need for mechanical ventilation; and individuals admitted to a similar five-bed medical MU (n = 95, aged 35-90, mean age 68.2 ± 14.4) during the same period. MEASUREMENTS: Primary outcome was in-hospital mortality. RESULTS: The predicted death rate was 49 ± 26 for participants in the geriatric MU, 39.6 ± 27 for those in the medical MU (P = .02), and 36.7 ± 27 for those in the geriatric department (P < .001). Observed in-hospital mortality was higher for geriatric MU participants (n = 40, 44.9%) than for the department control group (n = 48, 27%) (P = .002), although the mortality ratios (actual divided by predicted death rates) of these two groups were similar, indicating that the more severely ill participants in the geriatric MU did better than control participants in the departments, in particular those requiring hemodynamic pressure support and those with acute renal failure. CONCLUSION: For elderly, severely ill adults, care in a geriatric MU was associated with lower in-hospital mortality than care in the hospital geriatric ward and a longer stay and may be an alternative to medical MU admission.

Nosocomial Infections in Geriatric Department:Status and Intervention Strategy / 中华医院感染学杂志

OBJECTIVE To investigate the status and risk factors of nosocomial infections in geriatric department and to lay down the intervention strategy.METHODS Prospective monitoring and retrospective investigation were carried out to analyze 218 cases of nosocomial infection in geriatric department.RESULTS The lower respiratory tract infection was the main one in geriatric department(69.4%),which was followed by urinary tract infection(22.5%).The risk factors included old ages,prolonged hospitalization,using broad spectrum antibiotics widely,severe underlying illness,invasive operating manipulation and so on.CONCLUSIONS General intervention strategy should be adopted to control the nosocomial infections in geriatric department in order to cut down the infection rate and increase the rate of curing.