Do hemoglobin and creatinine clearance affect hospital readmission rates from a skilled nursing facility heart failure rehabilitation unit?

OBJECTIVES: Cardio renal anemia syndrome is being increasingly recognized in patients with congestive heart failure (CHF) and is associated with increased mortality and rehospitalization rates. Our objective was to assess the relationship between hemoglobin (Hb), creatinine clearance (C(Cr)), and hospital readmission in elderly patients enrolled in a skilled nursing facility (SNF)-based CHF rehabilitation unit. METHODS: We retrospectively identified 127 consecutive patients admitted to an SNF-based CHF rehabilitation unit between July 2001 and September 2002. The patients were grouped into quintiles of hemoglobin and creatinine clearance (C(Cr)) The rate of hospital readmission between quintiles of above variables was compared using the chi-square test. RESULTS: We found a higher prevalence of anemia than reported earlier in the literature for CHF patients discharged from hospital. Rehospitalization rates were increased two- and fivefold in lower compared to higher quintiles of hemoglobin and creatinine clearance, respectively. Anemia predicted rehospitalization in patients with renal dysfunction. CONCLUSION: Our study suggests an association between anemia and rehospitalization rates in patients with renal dysfunction enrolled in an SNF-based CHF rehabilitation unit.

Low bone mass and postfall fracture risk among elderly nursing home men.

OBJECTIVE: To study postfall fracture risk in relation to bone mineral density. SETTING: The study was conducted in men residing in nursing homes. PARTICIPANTS: A total of 212 men above the age of 65 years were recruited, and of these, 172 satisfied the inclusion criteria of the study. Among them, 82 were less than 85 years old, and 90 were at least 85 years old. INTERVENTION: Bone mineral density (BMD) of the calcaneus was measured, using the Lunar PIXI Bone Densitometer (version 1.43) and charts were reviewed for age, falls, and fractures. MEASUREMENTS: The values of BMD were expressed as T-scores, and the Lunar criteria equivalents of T-scores were used (T-scores more than -0.6 for normal BMD, -0.6 to -1.6 for osteopenia, and below -1.6 for osteoporosis). RESULTS: The median age of all participants was 84 years (range 65 to 102 years), and their mean T-score at the calcaneus was -1.51. In about 51% of them, the T-score was in the osteoporotic range. For subjects less than 85 years old, the mean T-score was -1.19, and for those 85 years and older, the mean T-score was -1.81; the mean bone density of those in the older old group was significantly lower than those in the younger old group if there was a history of a fracture. Analysis by age quartiles showed a progressive decline in BMD with advancing age. About 53% of the subjects who fell (37.2%) sustained a nontraumatic fracture. Among them, 67.6% had osteoporosis. CONCLUSION: At any given age after age 65, men who sustained a postfall fracture had a significantly lower BMD than those who did not sustain a postfall fracture.

Training principles for elite senior athletes.

Despite the passage of time, masters athletes are still capable of incredible performances. Nevertheless, overuse injuries are the most common challenge in this escalating cohort. The incidence of exertion-related cardiovascular events is also greater among older athletes, especially men, highlighting the importance of a thorough preparticipation medical evaluation before entry into senior athletic training programs and competition. Accordingly, masters athletes with a moderate to high risk for coronary artery disease, who desire to enter vigorous competitive events, should undergo peak or symptom-limited exercise testing. Training programs for senior athletes should be individually tailored and focus on the predominant energy pathways and performance requirements for a given sport. Although competition and "personal bests" are important, protection against sickness and disability are increasingly listed as the primary participative motives of older athletes.

Eye care in the skilled nursing facility: a pilot study of prevalence and treatment patterns of glaucoma.

OBJECTIVE: The objective of this study was to determine the rates of ophthalmic examinations for glaucoma, prevalence rates of glaucoma, ongoing evaluation (follow-up) rates and rates of treatment for a population of residents in a skilled nursing facility. DESIGN: We conducted a retrospective evaluation and chart review of glaucoma-related ophthalmology services. SETTING: This study was conducted in a skilled nursing facility located in a large metropolitan area located in the Midwest. PARTICIPANTS: We studied all nursing home residents of the facility on October 1, 2002 (n = 160). METHODS: We conducted a retrospective evaluation and chart review of glaucoma-related ophthalmology services for 160 patients. The medical records used for review included admission records, physician history and physical records, hospital notes, nursing assessments, consultation notes, and medication reviews (including medications administered during hospital stays). Minimum data set (MDS) data and individual patient interviews were used to supplement and verify chart abstraction findings. RESULTS: Eighty-three residents (52%) had evidence of assessment for glaucoma. Thirty-three of these residents (40%) had documentation of a diagnosis of glaucoma; 25 (76%) had current treatment orders for a topical ophthalmic agent. Nine patients were using combination therapy; four used topical and oral beta-adrenergic-blocking agents. CONCLUSIONS: Visual impairment remains a serious problem for nursing facility residents. Assessment of visual abilities is infrequent or nonexistent. Education for nursing home personnel, discussion and activation among nursing home thought leaders, and guidelines for the evaluation and management of glaucoma in this care environment are needed.

The role of geriatricians and family practitioners in the treatment of overactive bladder and incontinence.

Although the prevalence of overactive bladder (OAB) and that of its symptoms (urinary urge incontinence, urgency, and frequency) increase with age, these conditions are not necessarily normal consequences of aging. Patients who present with urinary symptoms should be evaluated and treated, whether they are living on their own or in a residential, assisted-care, or long-term-care environment. Effective treatment for OAB and urinary incontinence (UI) is available and improves quality of life for the elderly. The primary care physician and geriatrician can accomplish a basic evaluation for UI using a systematic approach, as detailed in the following pages.

Cerumen, hearing, and cognition in the elderly.

OBJECTIVE: This investigation was performed to study the prevalence of cerumen impaction and evaluate its impact on hearing and cognition in elderly patients admitted to a skilled nursing facility (SNF). DESIGN: Prospective clinical trial using a pretest-posttest design. SETTING: A 160-bed skilled nursing facility. SUBJECTS: Twenty-nine English-speaking residents over the age of 65 who were new admissions to a SNF. INTERVENTION: Participants with cerumen that occluded 50% or more of the external auditory canal had cerumen removed with a cerumenolytic agent and tepid water irrigation. MEASUREMENTS: A standardized Folstein Mini-Mental Status Exam (MMSE)(1) and audiometric evaluation were administered to all participants before and after cerumen removal. Participants who did not have cerumen impaction served as controls. Hearing changes were scored as "+1" for an improvement, "0" for no change and "-1" for a loss at each frequency tested. Results were compared using 2-tailed paired t tests. RESULTS: Nineteen participants (65.5%) had cerumen in at least one ear. Following cerumen removal, hearing improved in 80% of impacted ears compared with 3% of nonimpacted ears (P < 0.001). The average change in hearing score following cerumen removal was 0.26 +/- 0.50 compared with an average change of 0 +/- 0.16 in the controls (P < 0.001). The average change in MMSE score was 1.05 +/- 1.6 for participants who had cerumen removed compared with -0.30 +/- 0.95 for the controls (P < 0.01). CONCLUSIONS: This study found a majority of residents admitted to the SNF had cerumen impaction. Evaluation of hearing and mental status following removal of cerumen resulted in a statistically significant improvement in hearing and cognition when compared with controls. Removal of cerumen is a relatively safe and easy procedure that can be done at minimal cost and provide a significant benefit to residents of a SNF.