Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward

The relation between children's aerobic fitness and executive functions : a systematic review

A beneficial effect of physical activity on cognitive functioning is supposed, although to a certain extent, literature remains inconsistent. Furthermore, the mediating effect of aerobic fitness on this association remains unclear, especially in children. This review presents data from 26 articles on the relation between aerobic fitness and executive functions (i.e., inhibition, working memory, and cognitive flexibility) in prepubertal children (6-12 years). The qualitative synthesis was complicated by the use of diverse outcome measures to evaluate executive functions and the inconsistent inclusion of confounders. In general, cross-sectional studies reported enhanced executive functioning in children with higher aerobic fitness levels. Only three intervention studies with inconclusive results were retrieved. Whereas a beneficial effect of aerobic fitness on executive functioning in children is often supposed, the available research does not allow to draw a causal conclusion. Good quality randomized-controlled trials are necessary. Highlights This study reviewed the supposed mediating effect of aerobic fitness on the positive association between physical activity and executive functioning. Three intervention studies and 23 cross-sectional studies confirmed a positive correlation between aerobic fitness and certain measures of executive functioning. A causal conclusion about the beneficial effect of aerobic fitness on executive functioning cannot be drawn from this review

Palliative profile, one-year mortality and quality of life in older inpatients according to Be-PICT: a multicenter prospective cohort study.

A palliative care approach (PCA), including advanced care planning (ACP), should be considered for patients with limited life expectancy. The Belgian Palliative Care Indicators Tool (Be-PICT) has been released to help identify patients who may benefit from such approach. This study aimed at measuring 1-year mortality and describe the quality of life in older inpatients, according to baseline Be-PICT results. Prospective multicentre cohort study in older patients (≥ 75 years) admitted at geriatrics and cardiology wards of four Belgian hospitals. The palliative profile was defined as a positive Be-PICT.1, defined by the presence of its three criteria, i.e. a negative physician's answer to the surprise question '', ≥ 1 poor health indicator and ≥ 1 life-limiting condition. Of the 379 patients (50% aged ≥85 years; 51% female), 52 (14%) presented a palliative profile and 83 (23%) died within 1 year. Be-PICT.1 showed the following characteristics to predict 1-year mortality: sensitivity 0.54, specificity 0.83, positive and negative predictive values 0.48 and 0.86, positive and negative likelihood ratios 3.22 and 0.55. The patients with a palliative profile were at higher mortality risk (hazard ratio 4.79 p < 0.001) and 1-year mortality rate (45%). Not using the SQ allowed to improve sensitivity to include a larger number of patients who may benefit from ACP and PCA. Be-PICT.1 is a simple case-finding tool to identify older inpatients being at high mortality risk and candidates for ACP and PCA

Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study

Background An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. Aim To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients. Design Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed. Setting/participants Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals. Results In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only. The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs. Conclusions SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU

Use of STOPP & START in Belgium to screen elderly patient’s treatments: data of the Working Group Clinical Pharmacology, Pharmacotherapy and Pharmaceutical Care

info:eu-repo/semantics/publishedOlivia Dalleur on behalf of the Working Group Clinical Pharmacology Pharmacotherapy and pharmaceutical Care of the Belgian Society of Gerontology and Geriatric