Development and external validation of a prognostic model for time to readmission or death in multimorbid patients.

OBJECTIVE: To develop and externally validate a prognostic model built on important factors predisposing multimorbid patients to all-cause readmission and/or death. In addition to identify patients who may benefit most from a comprehensive clinical pharmacist intervention. METHODS: A multivariable prognostic model was developed based on data from a randomised controlled trial investigating the effect of pharmacist-led medicines management on readmission rate in multimorbid, hospitalised patients. The derivation set comprised 386 patients randomised in a 1:1 manner to the intervention group, i.e. with a pharmacist included in their multidisciplinary treatment team, or the control group receiving standard care at the ward. External validation of the model was performed using data from an independent cohort, in which 100 patients were randomised to the same intervention, or standard care. The setting was an internal medicines ward at a university hospital in Norway. RESULTS: The number of patients who were readmitted or had died within 18 months after discharge was 297 (76.9 %) in the derivation set, i.e. the randomized controlled trial, and 69 (71.1 %) in the validation set, i.e. the independent cohort. Charlson comorbidity index (CCI; low, moderate or high), previous hospital admissions within the previous six months and heart failure were the strongest prognostic factors and were included in the final model. The efficacy of the pharmaceutical intervention did not prove significant in the model. A prognostic index (PI) was constructed to estimate the hazard of readmission or death (low, intermediate or high-risk groups). Overall, the external validation replicated the result. We were unable to identify a subgroup of the multimorbid patients with better efficacy of the intervention. CONCLUSIONS: A prognostic model including CCI, previous admissions and heart failure can be used to obtain valid estimates of risk of readmission and death in patients with multimorbidity.

Effect of integrated medicines management on the quality of drug treatment in hospitalised multimorbid patients - a secondary endpoint analysis of a randomised controlled trial.

OBJECTIVES: To investigate the effect of integrated medicines management provided to hospitalised multimorbid patients on the quality of drug treatment at discharge measured as the mean number of potential prescribing omissions and potentially inappropriate medicines. METHODS: Multimorbid patients ≥18 years, using a minimum of four regular drugs from a minimum of two therapeutic drug classes, were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomised controlled trial; the difference between the intervention and control group at discharge in the mean number of potential prescribing omissions and potentially inappropriate medicines, measured with START-2 and STOPP-2 criteria, respectively. The difference between the groups was calculated using rank analysis. KEY FINDINGS: In total, 386 patients were analysed. Integrated medicines management reduced the mean number of potential prescribing omissions at discharge, compared to the control group, 1.34 versus 1.57, respectively (mean difference 0.23, 95% CI 0.07-0.38, P = 0.005, adjusted for values at admission). There was no difference in the mean number of potentially inappropriate medicines at discharge (1.84 versus 1.88, respectively; mean difference 0.03, 95% CI -0.18 to 0.25, P = 0.762, adjusted for values at admission). CONCLUSIONS: Integrated medicines management delivered to multimorbid patients during a hospital stay led to an improvement in undertreatment. No effect on deprescribing of inappropriate treatment was seen.

The Norwegian Directorate of Health recommends malnutrition screening tool (MST) for all adults.

BACKGROUND & AIMS: Malnutrition is underdiagnosed and undertreated in Norway. In a revision of a national guideline on malnutrition, the Norwegian Directorate of Health aimed for a harmonization and standardization of the malnutrition screening practice, including a recommendation of one malnutrition screening tool to be used among all adults in Norwegian health and care services. METHODS: A working group was appointed by the Norwegian Directorate of Health. Evidence-based practice, a pragmatic decision-making process based on a literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the DECIDE decision-making model was used as a guidance in order to convert evidence into recommendations. RESULTS: The criteria and properties of the four most frequently validated malnutrition screening tools were identified and ranked by the working group. The tools were prioritized in the following order: 1: Malnutrition Screening Tool (MST), 2: Malnutrition Universal Screening Tool (MUST), 3: Nutritional Risk Screening 2002 (NRS-2002), and 4: Mini-Nutritional Assessment short form (MNA). CONCLUSIONS: The Norwegian Directorate of Health recommends use of MST for screening for malnutrition among all adults (≥18 years), across all health care settings, and diagnoses or conditions in Norway.

Health literacy in medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway.

OBJECTIVE: When discharged from hospital patients are often assumed to have sufficient health literacy (HL) to participate in their medical treatment and manage medical self-care after discharge. However, limited HL is a widespread concern and patient participation during discharge is lacking. In this study, we explore how HL influences medication communication during hospital discharge. DESIGN: A qualitative case study, comprising unstructured observations of patient-healthcare personnel (HCP) encounters followed by semistructured interviews. Data were analysed using content analysis. SETTING: An internal medicines ward at a university hospital in Norway. PARTICIPANT: Fifteen patients aged 40-89 years were included close to the day of discharge. RESULTS: The following themes describing dimensions of HL emerged: (1) access, (2) understand, (3) appraise and (4) apply. Most patients sought access to medication information from HCP, while some felt dependent on HCP to provide it. However, their abilities to understand, evaluate and make informed decisions were challenged, partly because HCPs' ability to adapt their communication to the patient's knowledgebase varied. CONCLUSION: The results give a broader understanding of how HL influences medication communication during hospital discharge. To consider central dimensions of HL is important to achieve optimal medication communication, as the communication only can be exercised within the frames of the patient's HL. The findings in this study support that HL should be described as a shared responsibility between the patients and HCP. Attention should be focused to the HCP's responsibility to adapt the communication to the patient's knowledgebase.

Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway.

OBJECTIVE: Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients' knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge. DESIGN: This is a qualitative case study. Data collection was done through qualitative observations of patient-HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis. SETTING: An internal medicines ward at a university hospital in Norway. PARTICIPANTS: Nine patients aged 49-90 years were included close to the day of discharge. RESULTS: The analysis revealed the following themes: (1) patient-centred care (PCC), which included 'understanding and involvement in the patient-as-person', 'establishment of a therapeutic alliance', and 'sharing power and responsibility'; and (2) biomedical (conventional) care, including the subthemes 'HCPs in power and control' and 'optimising medical outcomes, following guidelines'. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued. CONCLUSIONS: The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.

Discharge processes and medicines communication from the patient perspective: A qualitative study at an internal medicines ward in Norway.

BACKGROUND: Patients are expected to participate in the hospital discharge process, assume self-management after discharge and communicate relevant information to their general practitioner; however, patients report that they are not being sufficiently empowered to take on these responsibilities. The aim of this study was to explore and understand the discharge process with a focus on medicines communication, from the patient perspective. METHODS: Patients were included at a hospital ward, observed during health-care personnel encounters on the day of discharge and interviewed 1-2 weeks after discharge. A process analysis was performed, and a content analysis combined data from observations and data from patient interviews focusing on medicines communication in the discharge process. RESULTS: A total of 9 patients were observed on the day of discharge, equalling 67.5 hours of observations. The analysis resulted in the following themes: (a) the observed discharge process; (b) patient initiatives; and (c) the patient role. The medicines communication in the discharge process appeared unstructured. Various patient preferences and needs were revealed. The elements of the best practice structured discharge conversation were observed; however, some patients did not have a discharge conversation at all. CONCLUSIONS: The study contributes to a broader understanding of the discharge process, how patients experience it, including their role. It is evident that the discharge process is not always tailored to meet the patients' needs. More focus on early patient involvement and communication, in order to better prepare patients for self-management of their medications, is important for their health outcomes.

Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial.

OBJECTIVE: To investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival. DESIGN: Parallel-group, randomised controlled trial. SETTING: Recruitment from an internal medicine hospital ward in Oslo, Norway. Patients were enrolled consecutively from August 2014 to the predetermined target number of 400 patients. The last participant was enrolled March 2016. Follow-up until 31 December 2017, that is, 21-40 months. PARTICIPANTS: Acutely admitted multimorbid patients ≥18 years, using minimum four regular drugs from minimum two therapeutic classes. 399 patients were randomly assigned, 1:1, to the intervention or control group. After excluding 11 patients dying in-hospital and 2 erroneously included, the primary analysis comprised 386 patients (193 in each group) with median age 79 years (range 23-96) and number of diseases 7 (range 2-17). INTERVENTION: Intervention patients received pharmacist-led medicines management comprising medicines reconciliation at admission, repeated medicines reviews throughout the stay and medicines reconciliation and tailored information at discharge, according to the integrated medicines management model. Control patients received standard care. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was difference in time to readmission or death within 12 months. Overall survival was a priori the clinically most important secondary endpoint. RESULTS: Pharmacist-led medicines management had no significant effect on the primary endpoint time to readmission or death within 12 months (median 116 vs 184 days, HR 0.82, 95% CI 0.64 to 1.04, p=0.106). A statistically significantly increased overall survival was observed during 21-40 months follow-up (HR 0.66, 95% CI 0.48 to 0.90, p=0.008). CONCLUSIONS: Pharmacist-led medicines management had no statistically significant effect on time until readmission or death. A statistically significant increased overall survival was seen. Further studies should be conducted to investigate the effect of such an intervention on a larger scale. TRIAL REGISTRATION NUMBER: NCT02336113.

Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward.

BACKGROUND: Knowledge of risk factors for drug-related hospitalizations (DRHs) is limited. AIM: To examine the prevalence of DRHs and the relationships between DRHs and various variables in multimorbid patients admitted to an internal medicine ward. METHODS: Multimorbid patients ≥ 18 years, using minimum of four regular drugs from minimum two therapeutic classes, were included from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016. Clinical pharmacists prospectively conducted medicines reconciliations and reviews to reveal drug-related problems (DRPs). Blinded for identified DRPs, an interdisciplinary group retrospectively made comprehensive, clinical assessments of each patient case to classify hospitalizations as drug-related (DRH) or non-drug-related (non-DRH). Age, sex distribution, Charlson Comorbidity Index (CCI), renal function, aberrant genotype frequencies, body-mass index, number of drugs, proportion of patients which received assistance for drug administration from the home care service, and/or through multidose-dispensed drugs, and occurrence of specific DRP subgroups, were compared separately between patients with DRHs versus non-DRHs, followed by multiple logistic regression analysis. RESULTS: Hospitalizations were classified as drug-related in 155 of the 404 included patients (38%). Factors significantly associated with DRHs were occurrence of adverse effect DRPs (adjusted odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4-8.0), adherence issues (OR 2.9, 1.1-7.2), home care (OR 1.9, 1.1-3.5), drug monitoring DRPs (OR 1.9, 1.2-3.0), and CCI score ≥6 (OR 0.33, 0.14-0.77). Frequencies of aberrant genotypes did not differ between the patient groups, but in 41 patients with DRHs (26.5%), gene-drug interactions influenced the assessments of DRHs. CONCLUSION: DRHs are prevalent in multimorbid patients with adverse effect DRPs and adherence issues as the most important risk factors.

Effects of nutritional intervention upon bone turnover in elderly hip fracture patients. Randomized controlled trial.

BACKGROUND AND AIM: Hip fracture patients are at great risk of malnutrition, but documentation of the effect of nutrition supplementation in this group is sparse and inconclusive. The aim of this study was to examine if personalized nutrition advice combined with vitamin K1, Ca and vitamin D could improve bone turnover 4 months after hip fracture. DESIGN: This is a preplanned sub study of a randomized controlled trial of orthogeriatric care. The intervention group received orthogeriatric care, including nutrition advice and supplementation. The control group received usual care at the orthopedic ward. Blood was drawn for measurements of a number of vitamins and of bone turnover markers upon admission and at four months follow up. RESULTS: 71 patients (31 in the intervention group and 40 controls) had available data at 4 months as well as at baseline. After four months, vitamin K1 and 25(OH)D were higher in the intervention group compared with controls; vitamin K1: 1.0 ± 1.2 vs 0.6 ± 0.6 ng/ml, p = 0.09, 25(OH)D: 60 ± 29 vs 43 ± 22 nmol/L, p = 0.01 when adjusted for baseline differences. In a secondary, unadjusted analysis, comprising all patients with available four months data (n = 136), the differences were statistically significant for vitamin K1 as well as 25(OH)D (p = 0.03 and p < 0.001, respectively). There was a non-significant increase in 25(OH)D in the intervention group from baseline to 4 months follow up, and a significant decrease in the control group. There was no difference in bone turnover markers between the two groups at 4 months follow up. A substantial loss of weight and physical function was found in both groups. CONCLUSIONS: The supplementation of 25(OH)D and vitamin K1 improved serum concentrations of these vitamins, but this did not translate into any improvement in the bone turnover markers. The RCT is registered in ClinicalTrials.govNCT01009268 and NCT01738776.

Changes in nutritional care after implementing national guidelines-a 10-year follow-up study.

BACKGROUND/OBJECTIVES: In 2004, a survey conducted in Scandinavia documented insufficient knowledge in nutrition care among doctors and nurses. The survey also revealed a significant discrepancy in nutritional practice, where Norway ranked lowest, thus leading to several actions including elaboration of national guidelines. The aim of this study was to evaluate potential changes in nutritional practice, as well as assessing barriers to nutrition therapy, 10 years after the former study. SUBJECTS/METHODS: In the first half of 2014, a total of 4000 doctors and nurses received a questionnaire, similar to the one used in 2004. The questions dealt with nutritional practice, routines, knowledge, barriers, and use of clinical dietitians (CDs) in the hospitals. RESULTS: The response rate was 22%. Routines in nutritional practice were significantly improved. The level of knowledge among respondents were increased, but lack of knowledge and lack of assignment of responsibility were still important barriers. The patients' contradiction could be a barrier to the use of enteral nutrition. CDs are used in a small amount of patients, and wards with good nutritional routines have a better cooperation with CDs than wards with insufficient routines. CONCLUSIONS: Routines in clinical nutrition have improved from 2004 to 2014. Barriers in the daily practice among health care workers like lack of knowledge and lack of assignment of responsibility are still important, and health care professionals seem to let the patient himself or herself be a barrier to the use of enteral nutrition.

A 1-year follow-up of a randomized clinical trial with focus on manual and electric toothbrushes' effect on dental hygiene in nursing homes.

OBJECTIVE: A 2-month randomized clinical trial (RCT) study comparing electric and manual toothbrushes used by residents in nursing homes showed significant reduction in plaque score for both groups. The aim of this follow up study was to study if the effect sustained in a longer perspective when toothbrushes were used according to resident's own preference. MATERIALS AND METHODS: One year after baseline of the RCT-study, 100 participants were re-examined. The simplified oral hygiene index (OHI-S) was used as outcome measure on dental plaque. RESULTS: The mean age was 86.6, 78.1% had three or more medical diagnoses and 52.2% had moderate to severe cognitive impairment. The mean number of natural teeth was 18.8. After 1 year, mean plaque scores was significantly reduced within the population, from 1.2 to 0.7 (p < .001). A total of 46 participants preferred to use an electric toothbrush and 54 preferred manual. No significant difference in plaque score was found between electric and manual toothbrushes. CONCLUSION: After 1 year, the improvement in dental hygiene from the RCT study sustained for users of both electric and manual toothbrush. Focus upon tooth brushing seems to be efficient and both manual and electric toothbrushes should be available in nursing homes.

Micronutrients and the risk of hip fracture: Case-control study.

BACKGROUND: Vitamin D, and possibly vitamin K, has an established association to fracture risk. Other vitamins are, however, less studied. AIM: To determine whether specific micronutrients other than 25(OH)D and vitamin K play a role in risk of hip fracture and bone turnover. METHODS: In this case-control study, blood was drawn for measurements of vitamins A, B6, B12, C, E, and folic acid as well as the bone turnover markers osteocalcin and bone-specific alkaline phosphatase upon admission for hip fracture in 116 patients and in 73 home-dwelling non fractured controls. Results for vitamin K1 and 25(OH)D from the same populations have been reported previously. RESULTS: Low vitamin A, C, and E concentrations were independently associated with a risk of hip fracture. The adjusted odds ratio (95% confidence interval) per 10 µmol/L increase in vitamin A concentration was 0.74 (0.65-0.84); for 1 µmol/L vitamin C and E: 0.94 (0.92-0.97) and 0.81 (0.74-0.89) respectively. The results were principally unchanged when 25(OH)D, vitamin K1, Body Mass Index, and other potential confounders were adjusted for. All vitamins except B12 and folic acid correlated positively with total osteocalcin and negatively with bone-specific alkaline phosphatase. CONCLUSIONS: Low vitamin A, C, and E concentrations are associated with an increased risk of hip fracture, possibly mediated through bone turnover mechanisms. This case-control study is registered at: ClinicalTrials.gov. NCT01738776. The patient related outcome is also registered at: ClinicalTrials.gov. NCT01009268.

Dental hygiene registration: development, and reliability and validity testing of an assessment scale designed for nurses in institutions.

AIMS AND OBJECTIVES: To develop and test the dental hygiene registration, a dental hygiene assessment scale for nurses working in institutions. BACKGROUND: Removal of dental plaque is a key factor in preventing oral health-related diseases. A simple, but reliable dental hygiene assessment scale that enables nurses to monitor residents' dental hygiene on a daily basis, will improve monitoring oral hygiene status and quality of dental health care. DESIGN: Descriptive study on the development and evaluation of a dental hygiene registration instrument. METHODS: The dental hygiene registration was developed and tested over several stages during the period of 2011-2014. Dental hygiene registration consists of a five-point plaque score scale. The score indicates whether measures are needed. A reference group comprising both medical and dental personnel designed dental hygiene registration. Dental plaque was used as a measure of dental hygiene. A pictorial series of teeth with varying amounts of plaque was used to achieve intra-examiner agreement. Dental hygiene registration assessments were scored 50 times to assess interexaminer reliability between one dental hygienist and one clinical nurse. Dental hygiene registration was validated against the plaque index score of the Simplified Oral Hygiene Index. The Regional Ethics Committee approved the study (2011/915). RESULTS: Estimates for intra-examiner agreement on plaque score were good for the dental hygienist (κ = 0·7) and very good for the clinical nurse (κ = 0·8). Estimates for interexaminer reliability for dental hygiene registration between the dental hygienist and the clinical nurse were moderate (κ = 0·4). dental hygiene registration corresponded significantly with Simplified Oral Hygiene Index (Spearman's correlation coefficient = 0·8, p < 0·001) indicating good validity. CONCLUSION: The developed dental hygiene registration appears to be reliable and valid. RELEVANCE TO CLINICAL PRACTICE: Dental hygiene registration may contribute to the provision of daily oral care. Dental hygiene registration enables nurses to evaluate their own effort when assisting in dental hygiene and to register whether further effort is needed.

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

BACKGROUND: Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. OBJECTIVE: To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. METHOD: Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. RESULTS: 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). CONCLUSION: More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

Vitamin K1 and 25(OH)D are independently and synergistically associated with a risk for hip fracture in an elderly population: a case control study.

BACKGROUND & AIMS: The incidence of hip fractures in Oslo is among the highest in the world. Vitamin D, as well as vitamin K, may play an important role in bone metabolism. We examined if vitamin K1 and 25(OH)D were associated with an increased risk of hip fracture, and whether the possible synergistic effect of these two micronutrients is mediated through bone turnover markers. METHODS: Blood was drawn for vitamin K1, 25(OH)D, and the bone turnover marker osteocalcin upon admission for hip fracture and in healthy controls. RESULTS: Vitamin K1 and 25(OH)D were independently associated with a risk of hip fracture. The adjusted odds ratio (95% CI) per ng/ml increase in vitamin K1 was 0.07 (0.02-0.32), and that per nmol/L increase in 25(OH)D was 0.96 (0.95-0.98). There was a significant interaction between 25(OH)D and vitamin K1 (p < 0.001), and a significant correlation between total osteocalcin and vitamin K1 and 25(OH)D (rho = 0.18, p = 0.01; rho = 0.20, p = 0.01, respectively). CONCLUSIONS: Vitamin K1 and 25(OH)D are lower in hip fracture patients compared with controls. Vitamin K1 and 25(OH)D are independently and synergistically associated with the risk of hip fracture when adjusting for confounders. Intervention studies should include both vitamins.

Effect of electric toothbrush on residents' oral hygiene: a randomized clinical trial in nursing homes.

A single-blinded, randomized controlled clinical trial was performed to investigate the effect of electric toothbrushes (ET) compared with manual toothbrushes (MT) on residents in nursing homes and to evaluate the caregiver's opinion on ET. A sample of 180 nursing-home residents were given either a new ET or a new MT. Oral examinations were performed to measure dental hygiene, using the Oral Hygiene Index-Simplified (OHI-S). Both groups received the same instructions for use. After 2 months participants were re-examined. Questionnaires were then sent to their caregivers. Participants' mean age was 86.1 ± 7.7 yr, and the mean number of remaining teeth was 20 ± 5.6. No specific intervention effect was found for ET. Both groups showed identical improvements in the OHI-S, from 1.27 ± 0.63 at baseline (the mean value for all participants) to 1.01 ± 0.53 after 2 months. Of 152 caregivers who responded to the questionnaire, the majority evaluated ET to be beneficial and less time-consuming compared with MT, also for demented residents. In a frail population, no difference is found in the effect of ET compared with MT. However, the ET appears to be a useful aid for residents who receive assistance with dental hygiene.

Impaired taste and increased mortality in acutely hospitalized older people.

Taste ability is known to be impaired in elderly and even more so in acutely hospitalized elderly people. To our knowledge, no study has investigated the association between taste impairment and mortality. Our aim was to examine this association in acutely hospitalized older people. In a prospective study, 200 acutely hospitalized elderly people ≥70 years of age were included between November 2009 and October 2010 at the Oslo University Hospital, Norway. Exclusion criteria were cognitive impairment, nursing home residency, and terminal diseases. Comorbidity was registered with the Cumulative Illness Rating Scale, in addition to recording of age, gender, smoking, education, and number of medications. Taste ability was assessed quantitatively with the "taste strips method" in 174 patients (mean age: 84 years). Mortality until 1 January 2012 was obtained from hospital records. Fifty-six patients died during the observation period. The relative risk of death in total taste score quartile 4 compared with total taste score quartile 1 was 0.31 (95% confidence interval [95% CI]: 0.14-0.69, P = 0.004), after adjusting for age, gender, smoking, education, and Cumulative Illness Rating Scale. Adjusted 1-year mortality decreased from 30% in total taste score quartile 1 to 9% in total taste score quartile 4. Thus, impaired taste appears to be strongly associated with mortality in acutely hospitalized elderly people.

Association between health-related quality of life, physical fitness, and physical activity in older adults recently discharged from hospital.

The purpose of this study was to determine the relationship among health-related quality of life (HRQOL), physical fitness, and physical activity in older patients after recent discharge from hospital. One hundred fifteen independent-living older adults (ages 70-92 years) were included. HRQOL (Medical Outcomes Study 36-item Short Form Health Survey), physical activity (Physical Activity Scale for the Elderly), and physical fitness (Senior Fitness Test) were measured 2-4 weeks after discharge. Higher levels of physical activity and physical fitness were correlated with higher self-reported HRQOL. Although cause and effect cannot be determined from this study, the results suggest that a particular focus on the value of physical activity and physical fitness while in hospital and when discharged from hospital may be important to encourage patients to actively preserve independence and HRQOL. It may be especially important to target those with lower levels of physical activity, poorer physical fitness, and multiple comorbidities.

Taste ability in hospitalised older people compared with healthy, age-matched controls.

OBJECTIVE: To investigate whether taste ability is reduced in acutely hospitalised older people compared with healthy, age-matched, non- hospitalised controls. BACKGROUND: Proper gustatory function in older people is important for quality of life and enjoyment of food. Impaired taste may contribute to weight loss in elderly. MATERIAL AND METHODS: Cross- sectional study. The participants comprised two groups with age ≥ 70 years. Older people hospitalised for acute disease, home-living prior to hospital admission and with adequate cognitive function (n = 174 with mean age = 84 years). The controls (n = 63, mean age 82 years) were home-living, and healthy by their own judgement. Whole mouth gustatory function was assessed with taste strips impregnated with sweet, sour, bitter and salty taste solutions in four different concentrations each. Correct identifications were summarized, and maximum total score was 16. RESULTS: Total taste score was reduced in the hospitalised group compared with the control group (p = 0.035). The difference was mainly due to reduced ability to detect sour and bitter taste qualities (p < 0.001 and p = 0.003). CONCLUSION: Acutely hospitalised older people had significantly reduced taste ability compared with non-hospitalised controls. Sour and bitter taste qualities were mostly affected. Hospital staff should pay attention to these findings when preparing food for hospitalised older people.

Nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome?

The aim of this study was to test the intervalidity of three different nutrition screening tools towards a broad population of elderly hospitalized patients. The association with risk factors and mortality was investigated. This is a prospective cohort study in three medical, surgical and geriatric settings, in Denmark and Sweden. Patients >65 years were consecutively included. Patients were screened by mini-nutritional assessment (MNA), malnutrition universal screening tool (MUST) and nutritional risk screening (NRS-2002). Anthropometrics, cognitive test (SPMSQ), as well as a questionnaire investigation regarding eating problems and life situation, were performed. Mortality within 12 months was investigated. In total, 233 patients mean (SD) age 81(7.64) years were included. A large variation in prevalence of nutritional risk was determined between the screening tools, MNA was 68% vs. MUST, 47% and NRS 54%, p < 0.0001. An overall agreement of 67% was seen (κ 0.52-0.55). Risk factors were associated with nutritional risk, including depressive mood. Only handgrip strength, fungus in mouth, serum albumin, CRP and cognitive function were associated with mortality. Fungus had the strongest association (OR 3.7; CI 1.19-11.30). The overall mortality rate was 27% during 12 months. However, none of the three screening tools predicted 12-month mortality. The findings show great variation in the prevalence of nutritional risk of under nutrition both between the tools and the settings. The level of agreement between the tools was moderate, and none of the three tools were capable of predicting 12-month mortality. A functional and psychological evaluation including oral health seems recommendable in elderly patients at nutritional risk.