Care home residents admitted to hospital through the emergency pathway: characteristics and associations with inpatient mortality.

BACKGROUND: Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. METHODS: This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes. RESULTS: 7.7% of 14,777 admissions were care home residents. They were older, frailer, more likely to be women and have cognitive impairment than those admitted from their own homes. Additionally, 42% presented with an Emergency Department Modified Early Warning Score above the threshold triggering urgent review, compared to 26% of older adults from their own homes. Admission from a care home was associated with higher 30-day inpatient mortality (11.1 vs 5.7%), which persisted after multivariable adjustment (hazard ratio: 1.42; 95% confidence interval: 1.09-1.83; p = 0.008). CONCLUSION: Care home residents admitted to hospital as an emergency have high illness acuity and inpatient mortality

The association between clinical frailty and walking speed in older hospitalized medical patients: A retrospective observational study

$\textbf{Introduction}$ This study aims to further evaluate the use of the clinical frailty scale (CFS) by assessing its correlation with usual walking speed (UWS) in older medical inpatients. $\textbf{Methods}$ Retrospective observational study in an English tertiary university hospital. We analysed all admission episodes of people admitted to the Department of Medicine for the Elderly wards during a 3-month period. We excluded those who died or had a CFS score of 9, indicating terminal illness. The CFS was recorded on admission and 6 meter UWS was measured on the day of hospital discharge. Other variables collected were: age, sex, the four-item version of the Abbreviated Metal Test (AMT4), and the Emergency Department Modified Early Warning Score. $\textbf{Results}$ There were 1022 patients admitted over the study period, of which 741 met inclusion criteria and had both CFS and walking speed data available. Five hundred and seventy were able to mobilise at least 6 m. The median UWS was 0.33 (0.21–0.50) m/s. Logistic ordinal regression showed that lower CFS, being male and higher score in the AMT4 were associated with higher odds of being in a higher walking speed category (odds ratio for CFS after covariable adjustment: 0.57 [95% CI, 0.50 to 0.65]). $\textbf{Conclusions}$ We observed a strong association between higher admission CFS and lower discharge UWS. This association was not explained by variation in age, sex, presence of cognitive impairment or illness acuity and provides further evidence that the CFS maybe a valid measure of frailty in acute clinical settings.The study was conducted during a research training fellowship for Peter Hartley funded by Addenbrooke's Charitable Trust and the Cambridge Biomedical Research Centre

Scaling Analysis of Multipulsed Turbidity Current Evolution With Application to Turbidite Interpretation

Deposits of submarine turbidity currents, turbidites, commonly exhibit upward‐fining grain size profiles reflecting deposition under waning flow conditions. However, more complex grading patterns such as multiple cycles of inverse‐to‐normal grading are also seen and interpreted as recording deposition under cycles of waxing and waning flow. Such flows are termed multipulsed turbidity currents, and their deposits pulsed or multipulsed turbidites. Pulsing may arise at flow initiation, or following downstream flow combination. Prior work has shown that individual pulses within multipulsed flows are advected forward and merge, such that complex longitudinal velocity profiles eventually become monotonically varying, although transition length scales in natural settings could not be predicted. Here we detail the first high frequency spatial (vertical, streamwise) and temporal measurements of flow velocity and density distribution in multipulsed gravity current experiments. The data support both a process explanation of pulse merging and a phase‐space analysis of transition length scales; in prototype systems, the point of merging corresponds to the transition in any deposit from multipulsed to normally graded turbidites. The scaling analysis is limited to quasi‐horizontal natural settings in which multipulsed flows are generated by sequences of relatively short sediment failures (10 km) sequences of breaches or where pulsing arises from combination at confluences of single‐pulsed flows, such flows may be responsible for the pulsing signatures seen in some distal turbidites, >100 km from source

Care home residents admitted to hospital through the emergency pathway: characteristics and associations with inpatient mortality

Background Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. Methods This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes. Results 7.7% of 14,777 admissions were care home residents. They were older, frailer, more likely to be women and have cognitive impairment than those admitted from their own homes. Additionally, 42% presented with an Emergency Department Modified Early Warning Score above the threshold triggering urgent review, compared to 26% of older adults from their own homes. Admission from a care home was associated with higher 30-day inpatient mortality (11.1 vs 5.7%), which persisted after multivariable adjustment (hazard ratio: 1.42; 95% confidence interval: 1.09–1.83; p = 0.008). Conclusion Care home residents admitted to hospital as an emergency have high illness acuity and inpatient mortality

Earlier Physical Therapy Input is Associated with a Reduced Length of Hospital Stay and Reduced Care Needs on Discharge in Frail Older Inpatients: An Observational Study

$\textbf{Background and Purpose}$: Pressures on hospital bed occupancy in the English National Health Service (NHS) have focused attention on enhanced service delivery models and methods by which physical therapists might contribute to effective cost savings, while retaining a patient-centered approach. Earlier access to physical therapy may lead to better outcomes in frail older inpatients, but this has not been well studied in acute NHS hospitals. Our aim was to retrospectively study the associations between early physical therapy input and length of hospital stay (LOS), functional outcomes and care needs on discharge. $\textbf{Methods}$: This was a retrospective observational study in a large tertiary university NHS hospital in the United Kingdom. We analyzed all admission episodes of people admitted to the Department of Medicine for the Elderly wards over 3 months in 2016. Patients were categorized into 2 groups: those examined by a physical therapist within 24 hours of admission and those examined after 24 hours of admission. The outcome variables were: LOS (days), functional measures on discharge (Elderly Mobility Scale and walking speed over 6 meters), and the requirement of formal care on discharge. Characterization variables on admission were: age, gender, existence of a formal care package, pre-admission abode, the Clinical Frailty Scale, Charlson Comorbidity Index, the Emergency Department Modified Early Warning Score, C-reactive protein level on admission, and the 4-item version of the Abbreviated Mental Test. The association between the delay to physical therapy input and LOS before discharge home was evaluated using a Cox proportional hazards regression model. $\textbf{Results and Discussion}$: There were 1022 hospital episodes over the study period. We excluded 19 who were discharged without being examined by a physical therapist. Of the remaining 1003, 584 (58.2%) were examined within 24 hours of admission (early assessment), and 419 (41.8%) after 24 hours of admission (late assessment). The median (interquartile range: IQR) LOS of the early assessment group was 6.7 (3.1–13.7) versus 10.0 (4.2-20.1) days in the late assessment group, P < 0.001. The early assessment group was less likely to require formal care on discharge: n=110 (20.3%) versus n=105 (27.0%), P = 0.016. No other statistically significant differences were seen between the 2 groups. In the unadjusted Cox proportional hazards model, the hazard ratio for early assessment compared to late assessment was 1.29 (95% confidence interval: 1.12-1.48, P < 0.001). Early assessment was associated with a 29% higher probability of discharge to usual residence within the first 21 days after admission, compared to late assessment. Adjustment for possible confounding variables increased the hazard ratio: 1.34 (1.16 – 1.55) P < 0.001. $\textbf{Conclusions}$: Early physical therapy input was associated with a shorter LOS and lower odds of needing care on discharge. This may be due to the beneficial effect of early physical therapy in preventing hospital-related deconditioning in frail older adults. However, causality cannot be inferred and further research is needed to investigate causal mechanisms