Effects of a Modified Hospital Elder Life Program on Frailty in Individuals Undergoing Major Elective Abdominal Surgery

Objectives To test the effects of a modified Hospital Elder Life Program (mHELP) on frailty. Design Matched and unmatched analyses of data from a before-and-after study. Setting Hospital, inpatient. Participants Participants aged 65 years and older ((N = 189) undergoing elective, major abdominal surgery at a medical center in Taiwan. Intervention The mHELP included three nursing interventions: early mobilization, oral and nutritional assistance, and orienting communication. Measurements Frailty rate and transitions between frailty states from hospital discharge to 3 months after discharge, using Fried's phenotype criteria categorized as: non-frail (0 or 1 criteria present), pre-frail (2 or 3 criteria present), and frail (4 or 5 criteria present). Results Among matched pairs, participants who received the mHELP interventions were significantly less likely to be frail at discharge (19.2% vs. 65.4% for controls; adjusted OR = .10, 95% CI = .02 to .39) than their matched controls. Transitions to states of greater frailty during hospitalization were more common for participants in the control group. At 3 months post-discharge, participants who received the mHELP intervention during hospitalization were less likely to be frail than the matched controls (17.3% versus 23.1%; adjusted OR = .73; 95% CI = .21 to 2.56), although this difference did not achieve statistical significance. Conclusion The mHELP intervention is effective in reducing frailty by hospital discharge but the benefit is diminished by 3 months post-discharge. Thus, the mHELP provides a useful approach to manage in-hospital frailty for older patients undergoing major abdominal surgery

Shared Risk Factors for Distinct Geriatric Syndromes in Older Taiwanese Inpatients.

[[abstract]]Background: Identifying shared common risk factors of geriatric syndromes is clinically useful in designing a unified approach to optimizing geriatric care. Objectives: The purpose of this study was to identify older Taiwanese inpatients' common shared risk factors among seven distinct geriatric syndromes: malnutrition, depression, cognitive impairment, functional dependence, incontinence, pressure ulcers, and dehydration. Method: A cross-sectional, hospital-wide survey was conducted to enroll inpatients (N = 455) older than 65 years and admitted to 24 medical and surgical units in a 2,200-bed urban academic medical center in northern Taiwan. Malnutrition was defined as a Mini-Nutritional Assessment score less than 17.5, depression was defined as a Geriatric Depression Scale score more than 10, cognitive impairment was considered a Mini-Mental State Examination score less than 20, and functional dependence was defined as a Barthel Index score less than 50. Incontinence, pressure ulcers, and dehydration were extracted from patients' medical records. Results: Participants had a mean age of 75.3 years (SD = 6.1 years, range = 65-92 years). The prevalence of geriatric syndromes ranged from 5% (pressure ulcers) to 33% (malnutrition). The selected geriatric syndromes were shown through logistic regression analysis to be predicted by female gender (odds ratio [OR] = 1.57-2.75), functional status (OR = 0.94-0.99), cognitive status (OR = 0.82-0.95), nutritional status (OR = 0.74-0.93), and depressive symptoms (OR = 1.07-1.26), supporting the notion of shared risk factors in geriatric syndromes. Conclusions: The findings support the theory that common geriatric syndromes have a shared set of risk factors-female gender, depressive symptoms, and functional, cognitive, and nutritional status. Revising care to target these shared risk factors in preventing common geriatric syndromes is theoretically sound.[[notice]]補正完

Persistent cognitive decline in older hospitalized patients in Taiwan

[[abstract]]Aim. This paper is a report of a study conducted to determine the prevalence and predictors of persistent and transient cognitive decline in older hospitalized patients over 6 months after hospital discharge. Background. Cognitive decline occurs in 16–35·5% of older hospitalized patients, but this decline may be persistent rather than transient. Distinguishing persistent from transient cognitive decline is clinically useful. Methods. For this prospective cohort study, 291 older patients were recruited from five medical and surgical units at a tertiary medical centre in Taiwan between 2004 and 2006. Participants were assessed for cognitive status by scores on the Mini-Mental State Examination at admission, discharge, 3 and 6 months postdischarge. Persistent cognitive decline was defined as continuing score reduction and ≥3-point reduction 6 months postdischarge. Transient decline was defined as ≥3-point reduction at some stage, with a total decline <3 points 6 months postdischarge. Findings. The cognitive status of the majority of participants (57·4%, n = 167) decreased ≥3 points during follow-up. Of these decliners, 59 (35·3%) had persistent cognitive decline, with an average 5·32-point reduction 6 months postdischarge. Forty-six (27·5%) participants experienced transient cognitive decline. After multiple adjustments in logistic regression analysis, persistent decline was predicted by no in-hospital functional decline (OR = 0·16, P = 0·002), more re-admissions after discharge (OR = 2·42, P = 0·020), and older age (OR = 1·09, P = 0·048). Conclusion. A new perspective is needed on discharge planning on patients at risk for persistent cognitive decline. Nurses can oversee the delivery of care, identify cognitive decline, refer patients, and educate families on strategies to enhance cognitive functioning for their aging relatives.[[journaltype]]國外[[incitationindex]]SCI[[booktype]]紙本[[countrycodes]]GB

Functional Trajectory 6 Months Posthospitalization: A Cohort Study of Older Hospitalized Patients in Taiwan.

[[abstract]]Background: Although it is well-recognized that hospitalization often precipitates functional decline in older patients, there have been few studies to examine these functional changes carefully over multiple points in time. Objective: To describe functional trajectory during and 6 months posthospitalization and to ascertain the predictors that signal different classes of functional trajectory, using latent class analysis. Methods: A cohort study was conducted on 286 older hospitalized patients who were admitted to five surgical-medical units at a tertiary medical center in Northern Taiwan. Results are reported of 241 participants who completed all four scheduled assessments during hospitalization (within 48 hr after admission and before discharge) and 3 and 6 months postdischarge. Functional trajectory was measured using the Barthel index over four time points, and decline was defined as a reduction on the Barthel index scores. Demographics, comorbidities, visual impairment, medications taken, cognitive status, nutritional status, oral health, depressive symptoms, social support, surgical diagnosis, and length of stay were assessed as the predictors of functional trajectory classes. Results: Most (74.3%) participants developed functional decline during hospitalization, and 32.0% had persistent functional impairment at 6 months posthospitalization. Three functional trajectory classes (good, moderate, and poor) were identified, and gender, age, comorbidities, cognitive status, nutritional status, oral health status, and length of stay were associated with different trajectory classes. Conclusion: Visualizing different classes of functional trajectory and studying predictors that signal such differences during and posthospitalization help practitioners understand how function changed and the possible ways to intervene.[[notice]]補正完

Prevalence of Geriatric Conditions: A Hospital-wide Survey of 455 Geriatric Inpatients in a Tertiary Medical Center.

[[abstract]]The aim of this study was to investigate the prevalence of common geriatric conditions in a tertiary medical center. We conducted a cross-sectional, hospital-wide survey of 455 inpatients, aged 65 and older, from 24 medical and surgical units of a 2200-bed urban academic medical center in Taiwan. Patients were screened in face-to-face interviews for 15 geriatric conditions. The prevalence of geriatric conditions was determined and compared by medical versus surgical services. Our sample of participants had a mean age of 75.3 ± 6.1 years (±S.D.), range = 65–92. The prevalence of geriatric conditions ranged from 5% (pressure ulcers) to 57% (polypharmacy; taking > 5 prescriptions). The majority was visually impaired (74%) and complained of sleep disturbance during their hospital stay (58%). Prevalence rates of certain geriatric conditions differed significantly between medical and surgical units, suggesting that care should address not only common conditions but also those with higher rates on different units. Furthermore, high rates of geriatric conditions indicate strong needs for care that does not fit into traditional disease models of medicine. Care should be better targeted to address different risks for geriatric conditions of medical versus surgical geriatric inpatients in acute care settings.[[notice]]補正完

Dynamics of Nutritional Health in a Community Sample of American Elders: A Multidimensional Approach Using Roy Adaptation Model

Nutritional health of community-dwelling elders has been shown to be one of the prime indices of health, influencing elders’ ability to live independently. However, little research has been directed towards understanding the dynamics of nutritional health in community-dwelling elders using a multidimensional theory approach. The purpose of this study was to evaluate the dynamics of nutritional health within the context of Roy Adaptation Model. Factors associated with nutritional health of community-dwelling elders were cross-examined. Depressive symptoms, functional status, oral health, and income emerged as independent predictors of nutritional health adjusting for confounders. This finding lends support to the notion that multidimensional biopsychosocial factors contribute to the dynamics of nutritional health

Functional Trajectory 6 Months Posthospitalization - a Cohort Study of Older Hospitalized Patients in Taiwan

Background. Although it is well-recognized that hospitalization often precipitates functional decline in older patients, there have been few studies to examine these functional changes carefully over multiple points in time. Objective: To describe functional trajectory during and 6 months posthospitalization and to ascertain the predictors that signal different classes of functional trajectory, using latent class analysis. Methods: A cohort study was conducted on 286 older hospitalized patients who were admitted to five surgical-medical units at a tertiary medical center in Northern Taiwan. Results: are reported of 241 participants who completed all four scheduled assessments during hospitalization (within 48 hr after admission and before discharge) and 3 and 6 months postdischarge. Functional trajectory was measured using the Barthel index over four time points, and decline was defined as a reduction on the Barthel index scores . Demographics, comorbidities, visual impairment, medications taken, cognitive status, nutritional status, oral health, depressive symptoms, social support, surgical diagnosis, and length of stay were assessed as the predictors of functional trajectory classes. Most (74.3%) participants developed functional decline during hospitalization, and 32. 0% had persistent functional impairment at 6 months posthospitalization. Three functional trajectory classes ( good, moderate, and poor) were identified, and gender, age, comorbidities, cognitive status, nutritional status, oral health status, and length of stay were associated with different trajectory classes. Conclusion: Visualizing different classes of functional trajectory and studying predictors that signal such differences during and posthospitalization help practitioners understand how function changed and the possible ways to intervene

Effects of a Modified Hospital Elder Life Program on Frailty in Individuals Undergoing Major Elective Abdominal Surgery

ObjectivesTo test the effects of a modified Hospital Elder Life Program (mHELP) on frailty. DesignMatched and unmatched analyses of data from a before-and-after study. SettingHospital, inpatient. ParticipantsParticipants aged 65 and older (n=189) undergoing major elective abdominal surgery at a medical center in Taiwan. InterventionThe mHELP included three nursing interventions: early mobilization, oral and nutritional assistance, and orienting communication. MeasurementsFrailty rate and transitions between frailty states from hospital discharge to 3months after discharge using Fried's phenotype criteria categorized as nonfrail (0 or 1 criteria present), prefrail (2 or 3 criteria present), and frail (4 or 5 criteria present). ResultsIn matched pairs, participants who received the mHELP interventions were significantly less likely to be frail at discharge (19.2%) than matched controls (65.4%) (adjusted odds ratio (AOR)=0.10, 95% CI=0.02-0.39). Transitions to states of greater frailty during hospitalization were more common for participants in the control group. Three months after discharge, participants who received the mHELP intervention during hospitalization were less likely to be frail (17.3%) than matched controls (23.1%) (AOR=0.73, 95% CI=0.21-2.56), although this difference did not achieve statistical significance. ConclusionThe mHELP intervention is effective in reducing frailty by hospital discharge, but the benefit is diminished by 3months after discharge. Thus, the mHELP provides a useful approach to manage in-hospital frailty for older adults undergoing major abdominal surgery