DEMENTIA CARE ON MEDICAL AND MEDICINE FOR THE ELDERLY WARDS

Dementia is associated with increased health care resource utilisation and greater co-morbidity burden. Due to the psychophysiological and social demands of dementia, specific approaches to care, communication, environment and clinical treatment are needed. Timely diagnosis can greatly improve quality of life. Dementia is often not coded in hospitals as it is not considered the primary reason for admission. These missed opportunities have potential to serve as important checkpoints for proper diagnostic assessment. Upon discharge, adjustments can be made to manage these patients better. In April 2012, the dementia CQUIN was introduced with goals for early diagnosis of dementia at point of hospital admission. This study aims to investigate if the raised profile of dementia care has been generalised across the whole system, the impact on management and whether there is a difference in dementia care between geriatric and medical wards. There was excellent performance across the board for review of medication, prescription of anti-psychotics, ordering of routine bloods and neurological examinations. . Increased awareness is needed for dementia-specific blood tests, namely: thyroid function test, B12 and folate. Geriatric wards performed consistently better than medical wards for all aspects of clinical care examined. For medical wards, incorporating multi-disciplinary care would be useful in managing these patients more holistically

DEMENTIA CARE ON MEDICAL AND MEDICINE FOR THE ELDERLY WARDS

Dementia is associated with increased health care resource utilisation and greater co-morbidity burden. Due to the psychophysiological and social demands of dementia, specific approaches to care, communication, environment and clinical treatment are needed. Timely diagnosis can greatly improve quality of life. Dementia is often not coded in hospitals as it is not considered the primary reason for admission. These missed opportunities have potential to serve as important checkpoints for proper diagnostic assessment. Upon discharge, adjustments can be made to manage these patients better. In April 2012, the dementia CQUIN was introduced with goals for early diagnosis of dementia at point of hospital admission. This study aims to investigate if the raised profile of dementia care has been generalised across the whole system, the impact on management and whether there is a difference in dementia care between geriatric and medical wards. There was excellent performance across the board for review of medication, prescription of anti-psychotics, ordering of routine bloods and neurological examinations. . Increased awareness is needed for dementia-specific blood tests, namely: thyroid function test, B12 and folate. Geriatric wards performed consistently better than medical wards for all aspects of clinical care examined. For medical wards, incorporating multi-disciplinary care would be useful in managing these patients more holistically

Impact of exercise and leucine-enriched protein supplementation on physical function, body composition, and inflammation in pre-frail older adults: a quasi-experimental study

BackgroundExercise and a protein-enriched diet are essential for muscle protein synthesis, cellular growth, mitochondrial function, and immune function. The U.S. Food and Nutrition Board's current guideline on recommended dietary allowance for protein in older adults is 0.8 g/kg per day, which may not be sufficient in vulnerable pre-frail older adults.AimsThis study aimed to evaluate the impact of leucine-enriched protein supplementation with or without exercise over 3 months in pre-frail older adults who consumed ≤1 g/kg/day of protein on improving (i) physical function, (ii) body composition measures, and (iii) inflammatory biomarkers such as interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α).MethodsA non-randomized cluster quasi-experimental study guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist of 178 pre-frail older adults [112 control, 44 nutrition (Nu), and 22 in the nutrition with exercise (Nu+Ex) group] comparing the effect of Nu+Ex and Nu on physical function, body composition, and inflammation. At 0, 3, and 6 months, questionnaires on demographics, depression, perceived health, and cognition were administered. Physical function assessment (short physical performance battery [SPPB] test, gait speed, handgrip strength, 5× sit-to-stand [STS]) was conducted, and body composition analysis was performed using a bioelectrical impedance analysis machine. IL-6 and TNF-α were measured at 0 and 3 months.ResultsAt 3 months, there were significant improvements in gait speed, 5× STS, SPPB scores, depression, perceived health, fat-free mass, and appendicular skeletal muscle mass indices in the Nu+Ex group. Both Nu+Ex and Nu groups had improvements in body cell mass and reductions in IL-6 and TNF-α. The improvements were not sustained after 6 months.ConclusionOur study results need to be validated in future longitudinal randomized studies with a larger sample size focusing on populations at risk

Formulation of choline chloride/ascorbic acid natural deep eutectic solvent: Characterization, solubilization capacity and antioxidant property

In the present study, natural deep eutectic solvent composed of choline chloride and ascorbic acid (CHCL/AA NADES) was formulated for enhancing the solubility and antioxidant properties of antioxidant extracts from fruit wastes of Mangifera pajang. The solubilities of Mangifera pajang's antioxidant extracts in water and CHCL/AA NADES at different water contents (0–50 wt%) were investigated. It was observed that the antioxidant extracts were most soluble in the CHCL/AA NADES with 10 wt% of water, and the concentration of antioxidant was found to be approximately 15% and 4% as compared to water and pure CHCL/AA NADES, respectively. The positive effect of water on NADES can be related to the reduced viscosity of NADES, where the viscosity decreased up to 74% upon addition of water. Aside from that, all the tested CHCL/AA NADES enhanced the antioxidant capacity of antioxidant extracts by 1.3–14.64% compared to the antioxidant extracts in water. This finding highlights the role of CHCL/AA NADES as an antioxidant capacity enhancer. Noteworthy, the antioxidant extracts solubilized in the CHCL/AA NADES system formed a nano-scale cluster structure, as depicted by the TEM image, suggesting that the CHCL/AA NADES could potentially use in nanoformulation that provides protection to the antioxidant extracts

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

10.1186/s12877-020-01894-0BMC GERIATRICS20