| 1. |
- Jónsson, Pálmi V, et al.
(författare)
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Admission profile is predictive of outcome in acute hospital care.
- 2008
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Ingår i: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 20:6, s. 533-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: The purpose of this study is to describe predictors for discharge and one-year outcomes of acute-care hospital patients, 75 years of age or over, based on admission status information. We carried out a prospective study of a randomly selected patient population, from one urban acute-care hospital in each of the Nordic countries. 763 persons aged 75+ were randomly selected from acute admissions to the participating hospitals. 749 observations at discharge and 655 observations at one year were used in analyses. METHODS: Data were collected with the MDS-AC 1.1 instrument within 24 hours of admission, and at day 7 or discharge, whichever came first. Outcome information was collected either by interviewing the patient or from patient records or registers. Discharge and one-year outcome (home, institution, death) were modeled by multinomial logistic regression, with admission status variables as predictors. RESULTS: At discharge, 84% of subjects returned home, 11% went to an institution and 5.6% had died. At one year, 64% were still living at home, 24% had died, and 12% had moved to an institution. For discharge outcome, those having hospital admission due to a new problem or exacerbation of an old one had a higher risk of dying (OR 3.3) than returning home. Moderate to severe cognitive problems predicted death (OR 2.2) and institutionalization (OR 8.6) compared with discharge home. Problems in instrumental activities of daily living predicted death (OR 3.1) and institutionalization (OR 6.0). At one year, those with exacerbation of an old problem (OR 2.1) or with a new or exacerbated existing problem (OR 2.3) had a higher risk of dying than of institutionalization or discharge home. Having some cognitive problems (OR 2.8) or moderate to severe cognitive problems (OR 6.6) predicted institutionalization, but not dying or discharge home. Those with some problems in activities of daily living had a higher risk of both dying (OR 1.7) and of institutional care (OR 2.7). Those with moderate to severe problems in activities of daily living had also a higher risk of institutional care (OR 4.7) compared with those living at home. CONCLUSIONS: Evidence predictive of discharge and one-year outcomes in older acute hospital medical care patients seems to be visible from the beginning of the hospital stay. In order to increase the efficient use of health care services and quality of care, systematic standardized and streamlined assessment should be performed during the admission process.
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| 2. |
- Jónsson, Pálmi V, et al.
(författare)
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Co-morbidity and functional limitation in older patients underreported in medical records in Nordic Acute Care Hospitals when compared with the MDS-AC instrument
- 2006
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Ingår i: Age and Ageing. - Oxford : Oxford Univ. Press. - 0002-0729 .- 1468-2834. ; 35:4, s. 434-438
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Tidskriftsartikel (refereegranskat)abstract
- SIR—Older persons are characterised by age-related changes, multiple diseases, multiple drug use and functional deficits. For optimal care, a holistic approach is needed; however, the health care systems of today are still essentially organised to provide acute medical care to relatively younger populations with little or no co-morbidity [ 1]. Health systems will have to adapt to this new situation.The value of geriatric assessment has been proven, where targeting is the key to success [ 2]. With shorter hospital stays, it is of importance to do this targeting quickly and effectively. According to a systematic literature review in the older patients, the most important predictors for adverse outcomes of acute care (mortality, frequent readmissions, institutionalisation and long length of stay) are current illness, decline in physical functions and age. In addition, illness severity, co-morbidity, polypharmacy, cognitive decline, poor nutrition and gender are predictive for one or more of the outcomes [ 3].The Minimum Data Set for Acute Care (MDS-AC) instrument was developed to guide care within the hospital and to facilitate the transfer and sharing of information to the next provider of care, thus supporting integrated care. The MDS-AC instrument provides an opportunity to systematically collect information that is reliable on function and co-morbidity and could thus be a valuable addition to the future electronic medical record [ 4].The aim of this study is to investigate to what degree important predictors of adverse outcomes, if present according to the MDS-AC instrument during the first 24 h of care for older patients, were not documented in traditional hospital records in acute care wards in five Nordic countries. Hence, the MDS-AC information is assumed to be a gold standard. A secondary aim is to show that suspected deficient documentation is an international issue.
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| 3. |
- Grue, Else Vengnes, et al.
(författare)
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Vision and hearing impairments and their associations with falling and loss of instrumental activities in daily living in acute hospitalized older persons in five Nordic hospitals
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:4, s. 635-643
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many older people believe sensory problems are inevitably, a part of growing old, and avoid assessment and help. Such problems are often also overlooked by health professionals. The aim of this study was to find the prevalence of hearing and vision impairment and their associations with loss of instrumental activities in daily living (IADL) and risk of falling in patients aged 75 years or older, admitted to a medical ward in an acute hospital in each of the five Nordic countries. Method: The Minimum Data Set for Acute Care was used for data collection in 770 patients. Premorbid data, admission data and history of falls over 3 months were obtained on admission by interview and observation. Hearing impairment was present if the patient required a quiet setting to be able to hear normal speech. Vision impairment was defined as unable to read regular print in a newspaper. Results: Bivariate and logistic regression analyses were performed. Forty-eight per cent of the patients had a hearing impairment, 32.3% had vision impairment and 20.1% had both. Hearing impairment was associated with falling but not in the logistic regression model. Hearing and vision impairment were associated with loss of IADL but only combined impairment was independently. Conclusion: Hearing and vision impairments were frequent among older patients in the medical wards. Falling was associated with hearing loss and IADL loss with hearing, vision and combined impairments. Sensory loss was also associated with fear of falling. It is recommended routinely to screen sensory functions in older patients in a medical setting. Intervention studies are needed to determine whether improvements in hearing and vision can prevent falls and further loss of function in this patient population.
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