Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture.

BACKGROUND: Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality. METHODS: We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI). RESULTS: The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality. CONCLUSIONS: Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.

Molecular detection of SARS-CoV-2 from indoor air samples in environmental monitoring needs adequate temporal coverage and infectivity assessment.

The relevance of airborne exposure to SARS-CoV-2 in indoor environments is a matter of research and debate, with special importance for healthcare low-risk settings. Experimental approaches to the bioaerosol sampling are neither standardized nor optimized yet, leading in some cases to limited representativity of the temporal and spatial variability of viral presence in aerosols. Airborne viral viability moreover needs to be assessed. A study has been conducted collecting five 24-h PM10 samples in a COVID-19 geriatric ward in late June 2020, and detecting E and RdRp genes by RT-qPCR with a Ct between 36 and 39. The viral RNA detection at Ct = 36 was related to the maximal numerosity of infected patients hosted in the ward. Lacking a direct infectivity assessment for the collected samples an experimental model has been defined, by seeding twelve nasopharyngeal swab extracts from COVID-19 positive patients on Vero E6 cells; only the four extracts with a viral load above E+10 viral copies (approximately Ct<24) have been able to establish a persistent infection in vitro. Therefore, the cytopathic effect, a key feature of residual infectivity, could be considered unlikely for the environmental PM10 samples showing amplification of viral RNA at Ct = 36 or higher. A standardization of airborne SARS-CoV-2 long-term monitoring and of environmental infectivity assessment is urgently needed.

Constructional apraxia screening and oral health among hospitalized older adults: A cross-sectional study.

AIMS: Apraxia may hinder oral self-care and is associated with poor oral hygiene. Intersecting Pentagons Test (IPT) is a simple screening tool for constructional apraxia (CA) that tests the ability to copy a bidimensional figure. In this study we investigated whether IPT is useful to identify subjects that need interventions to support oral health in a cohort of geriatric inpatients. METHODS AND RESULTS: We assessed oral health through the decayed, missing or filled teeth index, plaque index, and periodontal screening and recording tool. We inquired about autonomy in oral hygiene activities through a standardized questionnaire. Among subjects with CA (273 out of 478 hospitalized subjects aged > 65 years) we found a higher prevalence of edentulism (P = 0.04), periodontal disease (PD) (P = 0.03), and dependence in oral hygiene activities (P < 0.001). Only 34.8% of nonautonomous apraxic patients had a caregiver that supplied oral care. In an age and sex-adjusted generalized linear model, IPT proved to be an independent predictor of dependence in oral care, reaching 61.5% sensitivity in identifying dependent patients. CONCLUSION: Among elderly inpatients, there is a significant association between IPT results, poor oral health status, and dependence in oral hygiene activities. Positivity to IPT should prompt proper device counseling and caregiver education.

Oral health status as predictor of 1-year mortality after discharge from an acute geriatric unit.

PURPOSE: Predicting mortality of older patients is a difficult, yet crucial task, which has lead to development of several prognostic tools. We hypothesized that the evaluation of oral health, which is often neglected, might be helpful to improve 1-year mortality prediction in a cohort of patients > 65 years admitted to an acute geriatric unit. METHODS: We assessed 200 patients using the Decayed, Missing or Filled Teeth tool, the Periodontal Screening and Recording tool and the Plaque Index. A comprehensive geriatric assessment was performed to measure functional, cognitive, nutritional and comorbidity status and to calculate the Multidimensional Prognostic Index (MPI). An age- and sex-adjusted regression model was used to identify independent predictors of 1-year mortality. Area under ROC curve (AUROC) was calculated to assess predictive accuracy of MPI risk groups before and after correction for dental examination results. RESULTS: Plaque Index and Periodontal Screening and Recording tool were associated with 1-year mortality. Participants with periodontal disease had a fivefold higher risk of death (p < 0.001). Conversely, absence of periodontal disease identified with high specificity (96.6%) participants who were still alive 1 year after discharge. Periodontal disease was an independent predictor of 1-year mortality in a regression model adjusted for age, sex and other variables of the comprehensive geriatric assessment. The correction of MPI according to results of Periodontal Screening and Recording tool significantly improved AUROC from 0.62 to 0.68 (p < 0.003). CONCLUSION: Oral health evaluation, if integrated in the comprehensive geriatric assessment, improves estimation of 1-year mortality in hospitalized patients.