The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Relationship Between Cognitive Appraisal of Control and Cardiac Vagal Regulation During an Unsupported Ski Crossing of Greenland

International audiencePurpose The aim of the present study was to investigate the relationships between Perceived Control (PC) and Heart rate variability (HRV) during a 27-day expedition, during which an unsupported crossing was made from the west coast to the east coast of Greenland (across the Ice Sheet); and that therefore a high PC represents a favourable factor for recovery and stress management. Methods Four subjects participated in the study. PC was measured on alternated days in the evening at the end of the day, using the Pearlin Mastery Scale; and the next day, upon waking, heart rate using a wrist heart rate monitor and a chest strap. Together with the PC, the perceived effort was measured through the CR-100 Borg scale and each subject was asked to indicate the most emotionally significant event of the day. Time and frequency domain indices for heart rate variability were calculated. Results Several correlations were observed between PC and HRV indices. In particular two indices in the time domain, standard deviation of all NN intervals (SDNN) (rrm = 0.51) and root mean square of successive (RMSSD) (rrm = 0.46), showed a significant and strong positive correlation. Conclusion The existence of a positive correlation between PC and cardiac vagal regulation is of great interest to individuals immerged into extreme situations, because it can affect performance or prevents maladaptive states or injuries. To improve stress management, it could be convenient for members of extreme expeditions to adopt forms of cognitive training that modify their cognitive appraisal in order to raise their perception of control

Alterations in spontaneous electrical brain activity after an extreme mountain ultramarathon

This study aimed to investigate the impact of an extreme mountain ultramarathon (MUM) on spontaneous electrical brain activity in a group of 16 finishers. By using 4-minute high-density electroencephalographic (EEG) recordings with eyes closed before and after a 330-km race (mean duration: 125±17hours; sleep duration: 7.7±2.9hours), spectral power, source localization and microstate analyses were conducted. After the race, power analyses revealed a centrally localized increase in power in the delta (0.5-3.5Hz) and theta (4.0-7.5Hz) frequency bands and a decrease in alpha (8.0-12.0Hz) power at the parieto-occipital sites. Higher brain activation in the alpha frequency band was observed within the left posterior cingulate cortex, left angular gyrus and visual association areas. Microstate analyses indicated a significant decrease in map C predominance and an increase in the global field power (GFP) for map D at the end of the race. These changes in power patterns and microstate parameters contrast with previously reported findings following short bouts of endurance exercises. We discuss the potential factors that explain lower alpha activity within the parieto-occipital regions and microstate changes after MUMs. In conclusion, high-density EEG resting-state analyses can be recommended to investigate brain adaptations in extreme sporting activities

The energetics during the world most challenging mountain ultramarathon: a case study

The energy requirements during ultra-endurance events are likely to be at the extremes ofhuman tolerance (Millet and Millet, 2012). This is of further importance for extreme mountain ultra-marathon (MUM), where the ultra-long distance performance is coupled to run and/or walk on mountain trails with considerable positive and negative elevation change. For instance, it was shown that after the world\u2019s most challenging MUM the energy cost of uphill running decreased, likely due to changes in the uphill-running step mechanics that lead to a \u2018smoother\u2019 and more economical running style (Vernillo et al., 2013). However, that study focused only on longitudinal (i.e., pre-post) changes. Thus, there are few data examining the physiological changes during a MUM with a high fatiguing potential in ecologically valid environments. Accordingly, we report the case of an experienced MUM runner who was participating in the world\u2019s most challenging MUM with the aim to provide the first data about the energy requirements as well as the physiological adaptations of MUM

An extreme mountain ultra-marathon decreases the cost of uphill walking and running

Purpose: To examine the effects of the world’s most challenging mountain ultramarathon (MUM, 330 km, cumulative elevation gain of +24000 m) on the energy cost and kinematics of different uphill gaits. Methods: Before (PRE) and immediately after (POST) the competition, 19 male athletes performed three submaximal 5-min treadmill exercise trials in a randomized order: walking at 5 km·h-1, +20%; running at 6 km·h-1, +15%; and running at 8 km·h-1, +10%. During the three trials, energy cost was assessed using an indirect calorimetry system and spatiotemporal gait parameters were acquired with a floor-level high-density photoelectric cells system. Results: The average time of the study participants to complete the MUM was 129 h 43 min 48 s (range: 107 h 29 min 24 s to 144 h 21 min 0 s). Energy costs in walking (-11.5 ± 5.5%, P < 0.001), as well as in the first (-7.2 ± 3.1%, P = 0.01) and second (-7.0 ± 3.9%, P = 0.02) running condition decreased between PRE and POST, with a reduction both in the heart rate (-11.3%, -10.0%, and -9.3%, respectively) and oxygen uptake only for the walking condition (-6.5%). No consistent and significant changes in the kinematics variables were detected (P values from 0.10 to 0.96). Conclusion: Though fatigued after completing the MUM, the subjects were still able to maintain their uphill locomotion patterns noted at PRE. The decrease (improvement) in the energy costs was likely due to the prolonged and repetitive walking/running, reflecting a generic improvement in the mechanical efficiency of locomotion after ~130 h of uphill locomotion rather than constraints imposed by the activity on the musculoskeletal structure and function

The Energetics during the World's Most Challenging Mountain Ultra-Marathon—A Case Study at the Tor des Geants®

Purpose: To provide insights into the energy requirements as well as the physiological adaptations of an experienced 50-year-old ultra-marathon male athlete during the world's most challenging mountain ultra-marathon (MUM).Methods: The international race supporting the study was the Tor des Geants®, characterized by 330 km with +24,000 m D+ to be covered within 150 h. Before the MUM, we assessed the peak oxygen uptake (V˙O2peak) by means of an incremental graded running test. During the MUM we monitored six ascents (once per race day) with a portable gas analyzer, a GPS and a finger pulse oximeter. We then calculated the net metabolic cost per unit of distance (C), the vertical metabolic cost (Cvert) and the mechanical efficiency of locomotion (Effmech) throughout the six uphills monitored. We further monitored the distance covered, speed, altimetry and D+ from the GPS data as well as the pulse oxygen saturation with the finger pulse oximeter.Results: Subject's V˙O2peak was 48.1 mL·kg−1·min−1. Throughout the six uphills investigated the mean exercise intensity was 57.3 ± 6.0% V˙O2peak and 68.0 ± 8.7% HRpeak. C, Cvert and Effmech were 11.4 ± 1.9 J·kg−1·m−1, 57.9 ± 15.2 J·kg−1·mvert−1, and 17.7 ± 4.8%, respectively. The exercise intensity, as well as C, Cvert, and Effmech did not consistently increase during the MUM.Conclusions: For the first time, we described the feasibility of assessing the energy requirements as well as the physiological adaptations of a MUM in ecologically valid environment settings. The present case study shows that, despite the distance performed during the MUM, our participant did not experience a metabolic fatigue state. This is likely due to improvements in locomotor efficiency as the race progressed

Standard postural parameters in EO and EC.

<p>R  =  Runners; C  =  Control Group;</p><p>*p<0.05 compared with PRE;</p><p>p<0.05 compared with MID;</p><p>^# p<0.05,</p><p>^## p<0.01, compared with RUNNERS.</p

Graphical evolution of Stabilogram-diffusion in the medio-lateral (ML) and antero-posterior (AP) plane for the two groups of subjects during the three sessions of measurements during the race.

<p>A: EO condition, B: EC condition.</p

Description of Stabilogram-diffusion slope.

<p>Description of Stabilogram-diffusion slope.</p