Risk Factors for Mortality in Nursing Home Residents: An Observational Study.

Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults.

Delirium Predisposing and Triggering Factors in Nursing Home Residents: A Cohort Trial-Nested Case-Control Study.

BACKGROUND: Delirium is a common geriatric syndrome, with a prevalence of between 15-70% among older long-term care residents. It is associated with adverse outcomes, and its onset may prove imperceptible to health professionals. Few studies in institutionalized older people have analyzed the predictors of delirium. OBJECTIVE: The aim of the present study was to identify delirium predisposing and triggering factors, and develop a predictive model. METHODS: A cohort trial-nested case-control study covering a period of 12 consecutive months (April 2015 - March 2016) was carried out. Predisposing and triggering episodes of delirium were recorded. RESULTS: A total of 443 older persons were recruited, with a mean age of 85.73 (6.72) years and female predominance (78.3%; n = 374). The incidence of older people with delirium was 18.7% (n = 83). Dementia was the predisposing factor with the highest predictive capacity (OR = 2.74 [1.49-5.04]). In the presence of dementia, falls (OR = 2.45 [1.49-3.69]), neuroleptics (OR = 2.39 [1.23-4.65]) and anticholinergic drug use (OR = 1.87 [0.95-3.69]) were identified as triggering factors. The area under the curve (AUC) was 0.72 (95% CI: 0.66-0.78). CONCLUSIONS: Our findings suggest that interventions targeted to potentially preventable triggering factors could avoid the onset of delirium in older people with dementia. Knowledge of the predictive factors of delirium facilitates the screening of older people at increased risk, thereby allowing mental health service providers to prevent and identify the onset of a delirium episode. The decrease in delirium predictive factors should lead to a direct reduction in the occurrence of delirium and its consequences.

A Predictive Model of the Prevalence of Delirium in Elderly Subjects Admitted to Nursing Homes.

INTRODUCTION: Delirium is common in geriatric patients admitted to nursing homes, with an incidence of 22-79% among long-term residents. AIM: To establish a predictive model of the risk of delirium episodes in a sample of elderly people living in nursing homes. MATERIAL AND METHODS: A retrospective, cross-sectional case-control study covering a period of 12 consecutive months (April 2014 - March 2015) was carried out. The included cases had suffered at least one episode of delirium during the study period. Sociodemographic and clinical variables as well as risk factors predisposing to or triggering episodes of delirium were recorded. RESULTS: A total of 193 cases and 123 controls were recruited. The mean age of the cases was 89.6 years (SD 6.9), and 75.1% were women. The mean age of the controls was 84.7 years (SD 7.42), and 75.6% were women. The prevalence of delirium was 60.7%. The presence of infections (with the exception of urinary tract infections) was the variable offering the best predictive capacity (OR=7.08; 95% CI: 3.30-15.02; p<0.001). Other predictors of delirium were also identified, such as a previous diagnosis of dementia (OR=3.14; 95% CI: 1.81-5.45; p<0.001), the use of anticholinergic drugs (OR=2.98; 95% CI: 1.34-6.60; p=0.007), a diagnosis of depression (OR=1.92; 95% CI: 1.03-3.56; p=0.039), and urinary incontinence (OR=1.73; 95% CI: 0.97-3.08; p=0.065). The area under the curve (AUC) was 0.794 (95% CI: 0.74-0.84; p<0.001). CONCLUSIONS: The prevalence of delirium among elderly subjects admitted to nursing homes was 60.7%. Infections (with the exception of urinary tract infections), dementia, anticholinergic drug use, depression and urinary incontinence were predictive of the presence of delirium.

Detección de disfagia en mayores institucionalizados / Detection of dysphagia in the institutionalised elderly

Objetivo: Conocer la prevalencia de disfagia en mayores institucionalizados y la efectividad de un método clínico para su detección. Metodología: Estudio longitudinal prospectivo en una muestra aleatoria de residentes mayores. Se realizó una valoración de la deglución por un método clínico estandarizado con diferentes volúmenes y viscosidades (MECVV). Tras la valoración se aplicaron cuidados específicos y se realizó un seguimiento. Resultados: Se estudiaron 40 residentes. La prevalencia de disfagia no conocida fue del 42,5%, pasando tras la valoración por el MECVV de un 22,5% a un 65% (p = 0,012). La disfagia detectada por el MECVV se relacionó con el riesgo nutricional, medido por el Mini Nutritional Assessment (MNA) (p = 0,007) y la presencia de demencia (p = 0,028). Conclusiones: El diagnóstico de disfagia en esta muestra de ancianos institucionalizados aumenta cuando se aplica un método clínico para su detección, alcanzando una prevalencia elevada y similar a otros estudios(AU)

Objective: To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection. Methodology: A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment. Results: Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028). Conclusions: The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies(AU)

[Detection of dysphagia in the institutionalised elderly]. / Detección de disfagia en mayores institucionalizados.

OBJECTIVE: To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection. METHODOLOGY: A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment. RESULTS: Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028). CONCLUSIONS: The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies.