Ward round communication with older patients.

OBJECTIVES: Ward round communication is essential to patient care. While communication in general with older patients is well described, little is known about how communication with older patients and their relatives at ward rounds can be optimised. Hence, this scoping review aims to provide an overview of ward round communication with older patients. Furthermore, the review investigates barriers to the optimal communication. Such an overview would provide a point of departure for developing future health care professionals' education in ward round communication training. METHOD: A scoping review was performed by searching CINAHL, Embase, MEDLINE, and PubMed databases. The search strategy included terms synonymous with "ward rounds" and "older patients." We included studies regarding communication with patients above 65 years during ward rounds. Thematic analysis was applied. RESULTS: Seven of the 2322 identified papers were included in the present review. Thematic analysis revealed three overall themes: Communication strategy, frailty and patient participation, and organisational and age norm challenges. Barriers included frailty-related patient characteristics and imbalance of power between physicians and patients. Papers focused mainly on what the optimal ward round communication should include rather than how it should be performed. CONCLUSION: Characteristics of frail older patients and organisational barriers challenge effective and safe ward round communication. Little is known about how ward round communication with frail older patients and their relatives can be optimised.

Clinical presentation and outcomes of COVID-19 in older hospitalised patients assessed by the record-based multidimensional prognostic index, a cross-sectional study.

PURPOSE: Older people are the most frequently hospital admitted patients with COVID-19. We aimed to describe the clinical presentation of COVID-19 among frail and nonfrail older hospitalised patients and to evaluate the potential association between frailty and clinical course, decision of treatment level with outcomes change in functional capacity and survival. METHODS: We performed a multi-center, retrospective cross-sectional cohort study examining data on clinical presentation and frailty-related domains for hospitalised people aged 75 + years with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test. Frailty was assessed at admission using record-based MPI (rMPI) and Clinical Frailty Scale (CFS). Decision on treatment level about invasive ventilation and cardiopulmonary resuscitation (CPR), change in CFS-score from admission to discharge, changed need of home care, and in-hospital, 30-day and 90-day mortality were registered. RESULTS: 100 patients (median age 82 years (IQR 78-86), 56% female) with COVID-19 were included. 54 patients were assessed moderately or severely frail (rMPI-score = 2 or 3) and compared to non-frail (rMPI-score = 1). At admission, frail patients presented more frequently with confusion. At discharge, functional decline measured by change in CFS and increased home care was more prevalent among frail than the non-frail. Decisions about no invasive ventilation or CPR were more prevalent among frail older patients with COVID-19 than non-frail. Ninety-day mortality was 70% among frail patients versus 15% in non-frail. CONCLUSION: Frailty seems to be associated with confusion, more frequent decisions about treatment level, larger functional decline at discharge and a higher mortality rate among older patients with COVID-19.

Non-surgically treated older women with operable early breast cancer in Denmark.

INTRODUCTION: Women ≥ 70 years of age, especially women with co-morbidity, have not achieved the same increase in survival as younger women with early breast cancer. Older patients with and without co-morbidity do not receive primary surgical treatment as often as younger women do. The primary aim of this study was to describe older women with operable early breast cancer who are not surgically treated. Secondarily to evaluate if there is a need for further research to clarify if the women may potentially benefit from comprehensive geriatric care (CGC) according to receiving surgery. METHODS: This was a descriptive cross-sectional study including 781 women ≥ 70 years of age with biopsy-verified early breast cancer in Denmark 2012-2017. Data were retrieved from the Danish Breast Cancer Cooperative Group registry and medical record reviews. RESULTS: Women ≥ 70 years of age with early breast cancer who did not receive surgical treatment represent a group of frail patients with the characteristics of a geriatric population. Among older women with early breast cancer, 14% had no primary surgical treatment. CGC may identify relevant health issues and interventions that could increase the possibility of surgical treatment in this group of patients. CONCLUSIONS: Women ≥ 70 years of age with early breast cancer who do not receive surgery represent a group of frail patients that may potentially benefit from special geriatric care. CGC may be a way to provide this special care. Further research is needed. FUNDING: none. TRIAL REGISTRATION: not relevant.

Statins and Risk of Intracerebral Hemorrhage in Individuals With a History of Stroke.

Background and Purpose- It has been suggested that statins increase the risk of intracerebral hemorrhage in individuals with a history of stroke, which has led to a precautionary principle of avoiding statins in patients with prior intracerebral hemorrhage. However, such prescribing reticence may be unfounded and potentially harmful when considering the well-established benefits of statins. This study is so far the largest to explore the statin-associated risk of intracerebral hemorrhage in individuals with prior stroke. Methods- We conducted a population-based, propensity score-matched cohort study using information from Danish national registers. We included all individuals initiating statin treatment after a first-time stroke diagnosis (intracerebral hemorrhage, N=2728 or ischemic stroke, N=52 964) during 2002 to 2016. For up to 10 years of follow-up, they were compared with a 1:5 propensity score-matched group of statin nonusers with the same type of first-time stroke. The difference between groups was measured by adjusted hazard ratios for intracerebral hemorrhage calculated by type of first-time stroke as a function of time since statin initiation. Results- Within the study period, 118 new intracerebral hemorrhages occurred among statin users with prior intracerebral hemorrhage and 319 new intracerebral hemorrhages in users with prior ischemic stroke. The risk of intracerebral hemorrhage was similar for statin users and nonusers when evaluated among those with prior intracerebral hemorrhage, and it was reduced by half in those with prior ischemic stroke. These findings were consistent over time since statin initiation and could not be explained by concomitant initiation of other medications, by dilution of treatment effect (due to changes in exposure status over time), or by healthy initiator bias. Conclusions- This large study found no evidence that statins increase the risk of intracerebral hemorrhage in individuals with prior stroke; perhaps the risk is even lower in the subgroup of individuals with prior ischemic stroke.

Statins and Risk of Intracerebral Haemorrhage in a Stroke-Free Population: A Nationwide Danish Propensity Score Matched Cohort Study.

BACKGROUND: Statins may increase the risk of intracerebral haemorrhage (ICH) in individuals with previous stroke. It remains unclear whether this applies to individuals with no history of stroke. This study is the first to explore the statin-associated risk of ICH in stroke-free individuals while considering the timing of statin initiation. METHODS: We conducted a population-based, propensity score matched cohort study using information from five Danish national registers. We included all stroke-free individuals initiating statins in 2004-2013 and a propensity score matched group of non-users. Adjusted hazard ratios (aHRs) for ICH risk among statin users compared to non-users were calculated as a function of time since statin initiation. FINDINGS: 519,894 stroke-free individuals initiating statins and their 1:5 matched stroke-free reference subjects were included and followed for up to ten years. During this period, 1409 ICHs occurred in statin users. Statin users had an overall aHR of 0.85 (95% confidence interval: 0.80-0.90) compared to non-users, but this risk was modified by time since statin initiation. Statin users and non-users had similar ICH risk during the first six months after statin initiation. Hereafter, statin users had a 22-35% lower risk throughout the study period. INTERPRETATION: Statin users had lower ICH risk than non-users from six months after statin initiation. This finding could not be explained by healthy initiator bias or differences between users and non-users in terms of sociodemographic characteristics, comorbidity, or parallel treatment regimens. Our study suggests that statin use in stroke-free populations is associated with reduced ICH risk. FUNDING: The Novo Nordisk Foundation.

Autoimmune diseases and breast cancer recurrence: a Danish nationwide cohort study.

Autoimmune diseases (ADs) comprise a large group of heterogeneous diseases in which the immune system attacks healthy organs. Both intrinsic changes in the body and AD treatment can compromise immune function. Impaired immune function could increase the risk of recurrent cancer. We aimed to investigate this hypothesis in a population-based epidemiological study. We examined the risk of breast cancer (BC) recurrence associated with an AD diagnosis among patients with incident stages I-III BC diagnosed during 1980-2007. Data were obtained from Danish population-based medical registries. ADs were categorized dichotomously and according to organ system of origin. Follow-up was up to 10 years or until 31 December 2009. Multivariate Cox proportional hazard regression was used to compute hazard ratios (HRs) and associated 95 % confidence intervals (95 % CIs) to evaluate the association between AD diagnosis and BC recurrence. 78,095 women with stages I-III BC were identified. Median age-at-diagnosis was 61 years (19-102 years), median follow-up was 5.7 years, and 13,545 women had a recurrence during follow-up. 6,716 women had at least one AD. In adjusted models, the association between ADs and BC recurrence was near null: HRadjusted 0.96 (95 % CI 0.89, 1.04). These results held in all AD subcategories, except for central nervous/neuromuscular system ADs, with HRadjusted 0.56 (95 % CI 0.40, 0.78). Among women with BC, a history of at least one AD diagnosis was not associated with BC recurrence, with the possible exception of ADs of the central nervous/neuromuscular system.

Survival of women with breast cancer in central and northern Denmark, 1998-2009.

OBJECTIVE: Breast cancer is the most common cancer among women worldwide. The Nordic countries have relatively high survival, but Denmark has a lower survival than neighboring countries. A breast cancer screening program was introduced in 2007 and 2008 in the northern and central regions of Denmark respectively. We aimed to examine possible changes in survival of Danish breast cancer patients in central and northern Denmark in the period 1998-2009. MATERIALS AND METHODS: From the northern and central Denmark regions, we included all women (n = 13,756) with an incident diagnosis of breast cancer, as recorded in the Danish National Registry of Patients during the period January 1, 1998 through December 31, 2009. We calculated age-stratified survival and used Cox proportional hazard regression to estimate mortality rate ratios (MRRs) for all breast cancer patients. RESULTS: Median age was 62 years (21-102 years). The overall 1-year survival improved steadily over the period from 90.9% in 1998-2000 to 94.4% in 2007-2009, corresponding to a 1-year age adjusted MRR of 0.68 in 2007-2009 compared with the reference period 1998-2000. We estimated the 5-year survival to improve from 70.0% in 1998-2000 to 74.7% in 2007-2009, corresponding to a 5-year age adjusted MRR of 0.82 in 2007-2009 compared with the reference period 1998-2000. For middle-aged women (50-74 years) 1-year survival increased from 92.8% in 1998-2000 to 96.6% in 2008-2009, and 5-year survival was expected to increase from 73.9% in 1998-2000 to 80.2% in 2007-2009. Among younger women (15-49 years) and elderly women (>75 years), 1-year survival and 5-year predicted survival did not change over the two time periods. CONCLUSION: Survival of breast cancer patients has improved in Denmark over the period 1998-2009, and this change was most distinct in women aged 50-74 years. Survival improved even before the implementation of a formal breast cancer screening program.