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Acute care for elders

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https://www.readbyqxmd.com/read/27914968/segmenting-high-cost-medicare-patients-into-potentially-actionable-cohorts
#1
Karen E Joynt, Jose F Figueroa, Nancy Beaulieu, Robert C Wild, E John Orav, Ashish K Jha
BACKGROUND: Providers are assuming growing responsibility for healthcare spending, and prior studies have shown that spending is concentrated in a small proportion of patients. Using simple methods to segment these patients into clinically meaningful subgroups may be a useful and accessible strategy for targeting interventions to control costs. METHODS: Using Medicare fee-for-service claims from 2011 (baseline year, used to determine comorbidities and subgroups) and 2012 (spending year), we used basic demographics and comorbidities to group beneficiaries into 6 cohorts, defined by expert opinion and consultation: under-65 disabled/ESRD, frail elderly, major complex chronic, minor complex chronic, simple chronic, and relatively healthy...
November 30, 2016: Healthcare
https://www.readbyqxmd.com/read/27911313/challenges-in-screening-and-recruitment-for-a-neuroimaging-study-in-cognitively-impaired-geriatric-inpatients
#2
Ivayla Apostolova, Catharina Lange, Anna Roberts, Hans Joachim Igel, Anja Mäurer, Stephanie Liese, Melanie Estrella, Vikas Prasad, Elisabeth Stechl, Gernot Lämmler, Elisabeth Steinhagen-Thiessen, Ralph Buchert
BACKGROUND: Neuroimaging-based biomarkers have the potential to improve etiological diagnosis of cognitive impairment in elderly inpatients. However, there is a relative lack of studies on neuroimaging-based biomarkers in hospitalized geriatric patients, as the vast majority of neuroimaging studies in dementia have focused on memory clinic outpatients. An important aspect of study planning is a priori estimation of the rate of screen failures. OBJECTIVE: To report on the rate and causes of screen failures in a prospective study on the utility of neuroimaging (PET, MRI) for the etiological diagnosis of newly manifested cognitive impairment in acutely hospitalized geriatric patients...
November 28, 2016: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/27911143/factors-predicting-life-threatening-infections-with-respiratory-syncytial-virus-in-adult-patients
#3
Se Yoon Park, Taeeun Kim, Young Rock Jang, Min-Chul Kim, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jun Hee Woo, Sung-Han Kim
BACKGROUND: Respiratory syncytial virus (RSV) is a significant cause of acute respiratory illness with a clinical spectrum ranging from self-limiting upper respiratory infection to severe lower respiratory infection in elderly persons as well as young children. However, there are limited data on risk factors for life-threatening infections that could guide the appropriate use of antiviral agents in adult patients with RSV. METHODS: We conducted a retrospective cohort study from October 2013 to September 2015...
December 2, 2016: Infectious Diseases
https://www.readbyqxmd.com/read/27898697/risk-of-death-influences-regional-variation-in-intensive-care-unit-admission-rates-among-the-elderly-in-the-united-states
#4
Colin R Cooke
RATIONALE: The extent to which geographic variability in ICU admission across the United States is driven by patients with lower risk of death is unknown. OBJECTIVES: To determine whether patients at low to moderate risk of death contribute to geographic variation in ICU admission. METHODS: Retrospective cohort of hospitalizations among Medicare beneficiaries (age > 64 years) admitted for ten common medical and surgical diagnoses (2004 to 2009)...
2016: PloS One
https://www.readbyqxmd.com/read/27896949/sarcopenia-predicts-readmission-and-mortality-in-elderly-patients-in-acute-care-wards-a-prospective-study
#5
Ming Yang, Xiaoyi Hu, Haozhong Wang, Lei Zhang, Qiukui Hao, Birong Dong
OBJECTIVES: The aim of this study is to assess the prevalence of sarcopenia and investigate the associations between sarcopenia and long-term mortality and readmission in a population of elderly inpatients in acute care wards. METHODS: We conducted a prospective observational study in the acute care wards of a teaching hospital in western China. The muscle mass was estimated according to a previously validated anthropometric equation. Handgrip strength was measured with a handheld dynamometer, and physical performance was measured via a 4 m walking test...
November 28, 2016: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/27896468/evaluation-of-major-trauma-in-elderly-patients-a%C3%A2-single-trauma-center-analysis
#6
Samo Kocuvan, Drago Brilej, Domen Stropnik, Rolf Lefering, Radko Komadina
BACKGROUND: The objective of the study was to gather information about elderly major trauma patients admitted to one particular Slovenian trauma centre in Celje and examine this group of polytrauma patients, specifically with respect to mechanisms of injury, injury severity and distribution of injuries. Further on, to identify morbidity and mortality rates and compare these to the younger population and, finally, to determine the factors that have the most impact on treatment results...
November 28, 2016: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/27896467/audit-of-geriatric-hip-fracture-care-a%C3%A2-slovenian-trauma-center-analysis
#7
Dejan Krušič, Drago Brilej, Colin Currie, Radko Komadina
BACKGROUND: The aim was to describe an audit of hip fracture patient care and outcomes in a Slovenian healthcare setting prior to the implementation of the Geriatric Fracture Center (GFC) model of care. METHODS: The Fragility Fracture Network (FFN) hip fracture audit database was used to collect data on hip fracture care in elderly patients. Epidemiological data were submitted as well as fracture type, prefracture residence and mobility prior to the fracture. The timeline of events and acute care data were also collected...
November 28, 2016: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/27896466/early-hemodynamic-assessment-and-treatment-of-elderly-patients-in-the-medical-icu
#8
Gorazd Voga, Lucija Gabršček-Parežnik
BACKGROUND AND OBJECTIVES: The aim of this retrospective study was to analyze differences in the initial hemodynamic assessment and its impact on the treatment in patients aged 80 years or older compared to younger patients during the first 6 h after admission to the medical intensive care unit (ICU). RESULTS: We analyzed 615 consecutive patients admitted to the medical ICU of which 124 (20%) were aged 80 years or more. The older group had a significantly higher acute physiology and chronic health evaluation (APACHE II) score, an overall mortality in the ICU and a presence of pre-existing cardiac disease...
November 28, 2016: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/27874977/relationship-between-age-and-trajectories-of-rehospitalization-risk-in-older-adults
#9
Kumar Dharmarajan, Angela Hsieh, Rachel P Dreyer, Jack Welsh, Li Qin, Harlan M Krumholz
OBJECTIVES: To characterize the magnitude and duration of risk of rehospitalization according to age after hospitalization for heart failure (HF), acute myocardial infarction (AMI), or pneumonia. DESIGN: Retrospective cohort study. SETTING: U.S. hospitals (n = 4,767). PARTICIPANTS: All Medicare fee-for-service beneficiaries aged 65 and older surviving hospitalization for HF, AMI, or pneumonia between October 2012 and December 2013...
November 22, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27868320/predictors-of-rehospitalization-among-older-adults-results-of-the-crime-study
#10
Federica Sganga, Francesco Landi, Stefano Volpato, Antonio Cherubini, Carmelinda Ruggiero, Andrea Corsonello, Paolo Fabbietti, Fabrizia Lattanzio, Ester Manes Gravina, Roberto Bernabei, Graziano Onder
AIM: To assess the predictors of readmission among older adults hospitalized in acute care wards. METHODS: A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics...
November 21, 2016: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/27866869/clinical-characteristics-and-outcomes-of-yemeni-patients-with-acute-heart-failure-aged-50years-or-younger-data-from-gulf-acute-heart-failure-registry-gulf-care
#11
A-Nasser Munibari, Ahmed Al-Motarreb, Nora Al-Sagheer, Hana Abu Hadi, Ali Othman, Nawar Al-Wather, Abdu Hamoud, Mutae Alawlagy, Salem Almehdar, Abdulkarim Alhammadi, Mohammed Almogayed, Giorgio Caretta, Anees Al Jabri, Luciano Agati
AIMS: There is a shortage of data about acute heart failure (AHF) in the young, including its underlying causes, clinical presentation and outcomes. We aim to describe clinical characteristics, causes and outcomes of AHF in Yemeni patients aged 50years or younger. METHODS AND RESULTS: we evaluated Yemeni patients with AHF enrolled in Gulf CARE registry. Patients were divided into two groups: young patients (≤50years) and older patients (>50years). A total of 1536 patients with AHF were enrolled, of whom 635 (41...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27860143/ageing-acute-surgical-population-the-auckland-experience
#12
Hannah Linkhorn, Li Hsee
BACKGROUND: This study provides data supporting the supposition that more elderly patients are requiring surgical care and illustrates the risks associated with acute surgical illness in elderly patients. METHODS: The clinical records database was accessed to identify all patients discharged from general surgery and acute surgical unit (ASU) during 2013 and 2014. These groups were stratified by age (over 80 years). Data were collected on number of patients discharged per year, length of stay, number of intensive care unit admissions and number of procedures and mortality rates...
November 15, 2016: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/27853872/-effects-of-psychosomatic-treatment-for-the-elderly-on-cognition-and-quality-of-life-naturalistic-study-at-the-psychosomatic-day-care-hospital-for-the-elderly-in-nuremberg
#13
Christina Wunner, Corinne Reichhart, Bernhard Strauss, Wolfgang Söllner
BACKGROUND AND OBJECTIVE: In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition. MATERIAL AND METHODS: Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD)...
November 16, 2016: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/27847759/analysis-of-the-outcome-and-prognostic-factors-of-decompressive-craniectomy-between-young-and-elderly-patients-for-acute-middle-cerebral-artery-infarction
#14
Byung Rhae Yoo, Chan Jong Yoo, Myeong Jin Kim, Woo-Kyung Kim, Dae Han Choi
OBJECTIVE: We compared the effect of decompressive craniectomy between patients < 65 and ≥ 65 years age and investigated prognostics factors that may help predict favorable outcome in acute stroke patients undergoing decompressive surgery. MATERIALS AND METHODS: 52 patients diagnosed with acute middle cerebral artery (MCA) territory infarction that underwent decompressive craniectomy were retrospectively reviewed. The outcome of all patients were evaluated by assessing the Glasgow coma scale, Glasgow outcome scale (GOS), and Modified Rankin scale (mRS) six months after the onset of the disease...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27846872/challenges-on-non-invasive-ventilation-to-treat-acute-respiratory-failure-in-the-elderly
#15
REVIEW
Raffaele Scala
Acute respiratory failure is a frequent complication in elderly patients especially if suffering from chronic cardio-pulmonary diseases. Non-invasive mechanical ventilation constitutes a successful therapeutic tool in the elderly as, like in younger patients, it is able to prevent endotracheal intubation in a wide range of acute conditions; moreover, this ventilator technique is largely applied in the elderly in whom invasive mechanical ventilation is considered not appropriated. Furthermore, the integration of new technological devices, ethical issues and environment of treatment are still largely debated in the treatment of acute respiratory failure in the elderly...
November 15, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27835920/-acute-myeloid-leukemia
#16
Jan Braess
Acute myeloid leukemia (AML) has been genetically characterized extensively and can now be subdivided into 9 to 11 pathogenetically different subtypes according to their profile of driver mutations. In clinical practice karyotyping and molecular analysis of NPM1, cEBPa and FLT3-ITD are required for treatment stratification and potentially genotype specific treatment. Some markers such as NPM1 not only offer prognostic information but can also serve as markers of minimal residual disease and thus have the potential to guide therapy in the future...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27830996/permanent-emergency-inequality-in-access-to-hospitalisation-among-urban-elderly-chinese
#17
Tim F Liao, Cuntong Wang
The phenomenon of elderly patients staying in hospital emergency department observation units for extended time in urban China poses a challenge to China's healthcare system and presents a social problem of inequality. In this paper, we analyse statistics collected from 16 major public hospitals in Beijing to assess the extent and intensity of the problem and examine interviews of medical professionals to understand the mechanisms linking the issue to the Chinese healthcare system. We study the issue with the literature on market transition theory and on China's recent healthcare reforms and view this age-based inequality as an outcome of the economic and social transformations in China...
November 10, 2016: Global Public Health
https://www.readbyqxmd.com/read/27828613/morbidity-utilization-of-curative-care-and-service-entry-point-preferences-in-metropolitan-centro-habana-cuba
#18
Armando Rodríguez, Addys Díaz, Susana Balcindes, René García, Pol De Vos, Patrick Van der Stuyft
First-line health services with a primary health care approach are a strong trigger for adequate health-care-seeking behavior. Research on the association between prevalence of chronic diseases and acute illnesses and use of health services emphasizes the importance of socioeconomic determinants in such patterns of utilization. In a cross-sectional study of 408 families in Centro Habana, Cuba, home interviews were conducted between April and June 2010 to analyze socio-demographic determinants of acute and chronic health problems and use of formal health services...
November 3, 2016: Cadernos de Saúde Pública
https://www.readbyqxmd.com/read/27825591/optimized-management-of-heart-failure-patients-aged-80-years-or-more-improves-outcomes-versus-usual-care-the-hf80-randomized-trial
#19
Charles Vorilhon, Frédéric Jean, Aurélien Mulliez, Guillaume Clerfond, Bruno Pereira, Vincent Sapin, Géraud Souteyrand, Bernard Citron, Pascal Motreff, Jean-René Lusson, Romain Eschalier
BACKGROUND: The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population. AIMS: To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months. METHODS: Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care)...
November 4, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27825182/practical-aspects-of-monitoring-of-antiplatelet-therapy
#20
Ljubica Jovanovic, Nebojsa Antonijevic, Tina Novakovic, Nebojsa Savic, Branka Terzic, Ivana Zivkovic, Nebojsa Radovanovic, Milika Asanin
Despite the application of new antiplatelet drugs (prasugrel and ticagrelor), dual antiplatelet therapy with clopidogrel and aspirin remains the standard for patients with acute coronary syndrome undergoing percutaneous coronary intervention, especially in countries of low socioeconomic status. Regardless of the proven benefits, numerous studies have shown that certain groups of patients who receive standard doses of clopidogrel and aspirin do not respond adequately, and many of them also exhibit adverse cardiovascular events...
November 8, 2016: Seminars in Thrombosis and Hemostasis
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