Factors associated with prolonged length of stay in older patients

<p><b>INTRODUCTION</b>Prolonged stay in acute hospitals increases the risk of hospital-acquired infections in older patients, and disrupts patient flow and access to care due to bed shortages. We aimed to investigate the factors associated with prolonged length of stay (pLOS) among older patients (aged ≥ 78 years) in a tertiary hospital, to identify the potentially modifiable risk factors that could direct interventions to reduce length of stay (LOS).</p><p><b>METHODS</b>During a three-month period from January 2013 to March 2013, we identified 72 patients with pLOS (LOS ≥ 21 days) and compared their demographic and clinical variables with that of 281 randomly selected control patients (LOS < 21 days) using univariate and multivariate logistic regression analyses.</p><p><b>RESULTS</b>The mean age of the patients was 85.30 ± 5.34 years; 54% of them were female and 72% were of Chinese ethnicity. Logistic regression revealed the following significant factors for increased LOS: discharge to intermediate and long-term care services (odds ratio [OR] 9.22, 95% confidence interval [CI] 3.56-23.89; p < 0.001); increased severity of illness (OR 2.41, 95% CI 1.12-5.21; p = 0.025); and presence of caregiver stress (OR 3.85, 95% CI 1.67-8.91; p = 0.002).</p><p><b>CONCLUSION</b>Presence of caregiver stress and nursing home placement are potential modifiable risk factors of pLOS among older patients. Early identification and management of caregiver stress, as well as expediting discharge planning, may help to reduce the length of stay for this cohort.</p>

The Role of GPs in Helping Caregivers of Persons with Dementia

Caregiver interventions have been shown to reduce caregiver depression, burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers too need care. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic helpers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from having to deal with behavioural problems can lessen as the burden from coping with functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to work towards creating a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community.

Validity and reliability of the Zarit Burden Interview in assessing caregiving burden

<p><b>INTRODUCTION</b>This study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore.</p><p><b>MATERIALS AND METHODS</b>Adult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey.</p><p><b>RESULTS</b>A total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149).</p><p><b>CONCLUSION</b>The results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.</p>

Fast matching of sensor data with manual observations.

In systems and trials concerning wearable sensors and devices used for medical data collection, the validation of sensor data with respect to manual observations is very important. However, this is often problematic because of feigned behavior, errors in manual recording (misclassification), gaps in recording (missing readings), missed observations and timing mismatch between manual observations and sensor data due to a difference in time granularity. Using sleep activity pattern monitoring as an example we present a fast algorithm for matching sensor data with manual observations. Major components include a) signal analysis to classify states of sleep activity pattern, b) matching of states with Sleep Diary (SD) and c) automated detection of anomalies and reconciliation of mismatches between the SD and the sensor data.