Association of cytomegalovirus and other pathogens with frailty and diabetes mellitus, but not with cardiovascular disease and mortality in psycho-geriatric patients; a prospective cohort study

Background: Studies about associations of infections with herpes viruses and other pathogens, such as Chlamydia pneumoniae (CP) and Helicobacter pylori (HP) with cardiovascular disease (CVD), diabetes mellitus (DM), frailty and/or mortality are conflicting. Since high levels of antibodies against these pathogens occur in the elderly, the role of these pathogens in morbidity and mortality of vulnerable elderly was explored.Results: Blood samples of 295 community dwelling psycho-geriatric patients were tested for IgG antibodies to herpes simplex virus type 1 and 2, varicella zoster virus, Epstein Barr virus (EBV), cytomegalovirus (CMV), human herpes virus type 6 (HHV6), CP and HP. Frailty was defined with an easy-to-use previously described frailty risk score. Relative risks (RR) with 95% confidence intervals were calculated to evaluate associations between CVD, DM, frailty and pathogens. Pathogens as a predictor for subsequent mortality were tested using Kaplan Meier analyses and Cox proportional hazard models. The mean age was 78 (SD: 6.7) years, 20% died, 44% were defined as frail, 20% had DM and 49% had CVD. Presence of CMV antibody titers was associated with frailty, as shown by using both qualitative and quantitative tests, RR ratio 1.4 (95% CI: 1.003-2.16) and RR ratio 1.5 (95% CI: 1.06-2.30), respectively. High IgG antibody titers of HHV6 and EBV were associated with DM, RR ratio 3.3 (95% CI: 1.57-6.49). None of the single or combined pathogens were significantly associated with mortality and/or CVD.Conclusions: Prior CMV infection is associated with frailty, which could be in line with the concept that CMV might have an important role in immunosenescence, while high IgG titers of HHV6 and EBV are associated with DM. No association between a high pathogen burden and morbidity and/or mortality could be demonstrated

Due modi di trattare le opinioni notevoli. La nozione di felicità in Aristotele

Background: To identify frail elderly individuals, several index or scoring systems have been developed for research purposes. The practical value of these scores for screening and diagnostic use is uncertain. Aim: The available scoring systems were reviewed to determine whether they can be used in daily practice. Methods: Literature study on relevant test instruments developed for the detection of frailty on the basis of theoretical views on the frailty concept. Data on sensitivity and specificity and predictive values were extracted. Results: Several (n = 6) frailty scores were described with respect to their value as a screening or diagnostic test. Outcome of the selected test instruments is presented as a risk of negative health outcome when a test is positive. The reported AUCs of ROCs varied from 0.55 for functional decline in people admitted to an accident and emergency department to 0.87 for prediction of mortality on the basis of a co-morbidity score. As the prevalence of frailty and resulting negative health outcomes in published reports was low (5-41%), presented sensitivity and specificity values lead to low positive predictive values (6-49%) but reasonable negative predictive values (73-96%). Conclusions: As the number of false positive values of most available tests is substantial, these frailty scores are of limited value for both screening and diagnostic purposes in daily practice. As diagnostic instruments they can best be used to exclude frailty. The false-positive rate of currently available tests is too high to allow major decisions on medical care to be made on the basis of a positive test

Unplanned readmissions in younger and older adult patients: the role of healthcare-related adverse events

BACKGROUND: Readmissions are a burden for patients and increase healthcare costs. In Europe, factors associated with readmissions have not yet been extensively investigated. This study aimed to discover factors associated with readmissions in both young and older adult internal medicine patients. Furthermore, we explored the role of healthcare-related adverse events (AEs) in readmissions. METHODS: All patients admitted through the emergency department to the internal medicine department in the last 2 weeks of each month (2011) were included. Information on index admissions and readmissions, defined as an unplanned admission within 30 days after discharge, was obtained from the electronic patient record system. Demographic, clinical, and organizational factors were evaluated for their association with readmissions. RESULTS: Of all patients (n = 940), 17.3 % were readmitted; 16.9 % of the younger (<65 years, n = 485), and 17.8 % of the older patients (≥65 years, n = 455). Dependency in activities of daily living (ADL) was the only factor associated with readmissions in both all ages (OR 2.43) and in older patients (OR 3.19), while age was associated with readmissions in younger patients (OR 1.03 per year). AEs leading to 35.4 % of all index admissions were not associated with readmissions. CONCLUSIONS: Readmissions are common in medical patients, and, thus, remain a reason for concern in terms of patient safety and quality of care. AEs, responsible for to the index admission, were not associated with readmissions. ADL dependency was the only factor associated with readmission in patients of all ages and older patients, indicating that determining which patients are at risk for readmissions is not easy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40001-016-0230-0) contains supplementary material, which is available to authorized users

MOESM1 of Unplanned readmissions in younger and older adult patients: the role of healthcare-related adverse events

Additional file 1: Table S1. (Part of) Standard information obtained by nurses at admission

Mortality in hip fracture patients after implementation of a nurse practitioner-led orthogeriatric care program:results of a 1-year follow-up

BACKGROUND: Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported. METHODS: An anonymised data set, of hip fracture patients (n = 300) who presented to Maastricht University Medical Centre, the Netherlands, a level-1 trauma centre, was used. NPOCP was implemented on one of two surgical wards, while the other ward received UC. Patient allocation to these wards was random. RESULTS: In total, 144 patients received NPOCP and 156 received UC. In the NPOCP, 3-month and 1-year mortality rates were 9.0% and 13.9%, compared to 24.4% and 34.0% in the UC group (P < 0.001). The adjusted hazard ratio (aHR) for 3-month (aHR 0.50 [95%CI: 0.26-0.97]) and 1-year mortality (aHR 0.50 [95%CI: 0.29-0.85]) remained lower in NPOCP compared to UC. Median LOS was 9 days [IQR 5-13] in patients receiving UC and 7 days [IQR 5-13] in patients receiving NPOCP (P = 0.08). Thirty-eight (27.5%) patients receiving UC and fifty-seven (40.4%) patients receiving NPOCP were discharged home (P = 0.023). CONCLUSION: Implementation of NPOCP was associated with significantly reduced mortality in hip fracture patients and may contribute positively to high-quality care and improve outcomes in the frail orthogeriatric population