Functional changes during hospital stay in older patients admitted to an acute care ward : a multicenter observational study

Objectives: Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods: The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged >= 65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score >= 18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Results: Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04 +/- 0.20 m/s, p<0.001; grip strength improvement: 0.43 +/- 5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusion: Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge

The long-term effect of smoking on 10 years’ survival and success of dental implants : a prospective analysis of 453 implants in a non-university setting

Background: The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers. Material and Methods: All patients referred for implant treatment between November 2004 and 2007 were scrutinized. All implants were placed by the same surgeon (B.C.). The single inclusion criterion was a follow-up time of at least 10 years. Implant survival, health, and bone loss were evaluated by an external calibrated examiner (S.W.) during recall visits. Radiographs taken at recall visits were compared with the post-surgical ones. Implant success was based on two arbitrarily chosen success criteria for bone loss (<= 1 mm and <= 2 mm bone loss after 10 years). Implant survival in smokers and non-smokers was compared using the log-rank test. Both non-parametric tests and fixed model analysis were used to assess bone loss in both groups. Results: A total of 453 implants in 121 patients were included for survival analysis, and 397 implants in 121 patients were included for peri-implant bone-loss analysis. After a mean follow-up time of 11.38 years (SD 0.78; range 10.00-13.65), 33 implants out of 453 initially placed had failed in 21 patients, giving an overall survival rate of 92.7% and 82.6% on the implant and patient level, respectively. Cumulative 10 years' survival rate was 81% on the patient level and 91% on the implant level. The hazard of implant loss in the maxilla was 5.64 times higher in smokers compared to non-smokers (p = 0.003). The hazard of implant loss for implants of non-smokers was 2.92 times higher in the mandible compared to the maxilla (p = 0.01). The overall mean bone loss was 0.97 mm (SD 1.79, range 0-17) at the implant level and 0.90 mm (SD 1.39, range 0-7.85) at the patient level. Smokers lost significantly more bone compared to non-smokers in the maxilla (p = 0.024) but not in the mandible. Only the maxilla showed a significant difference in the probability of implant success between smokers and non-smokers (<= 1 mm criterion p = 0.003, <= 2 mm criterion p = 0.007). Taking jaw into account, implants in smokers experienced a 2.6 higher risk of developing peri-implantitis compared to non-smokers (p = 0.053). Conclusion: Dental implants with a fluoride-modified surface provided a high 10 years' survival with limited bone loss. Smokers were, however, more prone to peri-implant bone loss and experienced a higher rate of implant failure, especially in the upper jaw. The overall bone loss over time was significantly higher in smoking patients, which might be suggestive for a higher peri-implantitis risk. Hence, smoking cessation should be advised and maintained after implant placement from the perspective of peri-implant disease prevention

A multicomponent approach to identify predictors of hospital outcomes in older in-patients : a multicentre, observational study

Background: The identification of older patients at risk of poor hospital outcomes (e.g. longer hospital stay, in-hospital mortality, and institutionalisation) is important to provide an effective healthcare service. Objective: To identify factors related to older patients’ clinical, nutritional, functional and socio-demographic profiles at admission to an acute care ward that can predict poor hospital outcomes. Design and Setting: The CRiteria to assess appropriate Medication use among Elderly complex patients project was a multicentre, observational study performed in geriatric and internal medicine acute care wards of seven Italian hospitals. Subjects: One thousand one hundred twenty-three consecutively admitted patients aged 65 years or older. Methods: Hospital outcomes were length of stay, in-hospital mortality, and institutionalisation. Results: Mean age of participants was 81 years, 56% were women. Median length of stay was 10 (7–14) days, 41 patients died during hospital stay and 37 were newly institutionalised. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Total dependency in activities of daily living and inability to perform grip strength test were independent predictors of inhospital mortality. Malnutrition and total dependency in activities of daily living were independent predictors of institutionalisation. Conclusions: Our results confirm that not only diseases, but also multifaceted aspects of ageing such as physical function and malnutrition are strong predictors of hospital outcomes and suggest that these variables should be systematically recorded

The FNIH-criteria for sarcopenia predict 15-year mortality in ambulatory older men

Objectives: The Foundation for the National Institutes of Health [FNIH] Sarcopenia Project recently developed new criteria for diagnosis of weakness and low muscle mass in older adults. These criteria were associated with increased likelihood for incident mobility impairment. However, mortality risk patterns were inconsistent and further validation of their cut-off points in other populations seems needed (McLean et al., 2014 Journals of Gerontology). In this study, we aimed to evaluate the FNIH cut-off points for weakness and low muscle mass in a sample of community-dwelling older men in Belgium. Methods: This community-based cohort study included 200 ambulatory men aged ≥74, living in the community of Merelbeke (municipality of Ghent, Belgium). Grip strength was measured twice consecutively using a Jamar type dynamometer. Weakness was defined as low grip strength (<26kg) and low grip strength-to-body mass index[BMI] ratio (<1.00). Low muscle mass (dual-energy x-ray absorptiometry) was categorized as low appendicular lean mass[ALM] (<19.75kg) and low ALM-to-BMI ratio (<0.789). Results: Mean age was 78.5(±3.5) years. Combined weakness and low muscle mass was present in 4 to 9% of men, depending on the criteria applied. After 12 years of follow-up, 134 men (67%) had died. Low grip strength (HR=1.59,95%CI=1.06–2.28), low grip strength-to-BMI ratio (HR=1.65,95%CI=1.03–2.65) and low ALM-to-BMI ratio (HR=1.68,95%CI=1.18–2.41), but not low ALM, were associated with all-cause mortality in older community-dwelling men. Conclusions: These findings confirm the FNIH cut-off points for low grip strength and low ALM-to-BMI ratio as candidate criteria for clinically relevant weakness and low muscle mass in men

Persistent decline over 3 years in physical function predicts 15-year mortality in ambulatory older men

Objectives: Physical function measurements can predict important adverse outcomes in older persons, but little is known about the predictive value of longitudinal changes in these measurements. This study evaluated the effects of transient and persistent decline over three years from baseline in physical function on 12 year mortality. Methods: This community-based cohort study included ambulatory men aged ≥71, living in the community of Merelbeke (municipality of Ghent, Belgium). Participants’ physical function and decline from baseline were assessed annually over three years using the following measurements and cut-off points: Timed Up and Go (2 sec), Chair Rise (1 sec), Balance (1 point), Grip strength (6kg), General Health (Short Form-36 item; 15 points), Physical Function (Short Form-36 item; 20 points) and Activities of Daily Living (ADL; Rapid Disability Rating Scale-2 questions; 2 points). Decline was considered persistent or transient based on whether the decline was still present at the end of year three. Results: Of 162 older men with complete annual physical function assessments from 1997 until 2000, 107 (66%) died within the subsequent 12 years. Mortality risk increased with persistent decline in Timed Up and Go (HR=2.15, 95%CI=1.24–3.73), Grip strength (HR=3.39, 95% CI=1.45–7.93), Physical Function (HR=2.51, 95%CI=1.43–4.41), General Health (HR=3.07, 95%CI=1.69–5.60), and ADL score (HR=3.30, 95%CI=1.43–7.63), compared with no decline. Decline in the last year in Chair Rise time (HR=2.63, 95%CI=1.39–4.98) and Balance (HR=2.39, 95%CI=1.10–5.18) also predicted death. Conclusions: Persistent decline in physical function affects mortality risk in ambulatory older men