Identification of hospitalized elderly patients at risk for adverse in-hospital outcomes in a university orthopedics and trauma surgery environment

Gronewold, Janine; Dahlmann, Christian; Jäger, Markus

doi:10.1371/journal.pone.0187801

Cited by 22 publications

(32 citation statements)

References 41 publications

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“…Specifically, trauma patients experience increased incidence of mood disorders, psychotic disorders and anxiety disorders that often last beyond the acute phase of physical recovery . It is also well documented that mental health outcomes such as depression and PTSD contribute to negative outcomes of trauma patients such as increased hospital length of stay , increased healthcare utilization and increased medical symptoms and complications . Further, depression and symptoms of post‐traumatic stress among trauma patients in the first year following injury are significantly higher compared to the general population, with an estimated prevalence ranging from 28% to 42% .…”

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confidence: 99%

Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre

et al. 2018

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The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service ≥24 h, medically stable, spoke English or Spanish and ≥18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients' height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 ± 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.

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Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre

et al. 2018

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“…Since the number of such patients at risk is expected to increase due to demographical changes, attempts have been made to identify these patients using screenings and assessments [9,10]. By now the ISAR screening tool is one of the most commonly used tools to predict the risk of functional decline in older patients [6,11,12]. For high-risk patients with positive ISAR screening a comprehensive geriatric assessment (CGA) is recommended as a second diagnostic step.…”

Section: Introductionmentioning

confidence: 99%

“…A study conducted by Sousa et al found that nursing hours in intensive care patients were predicted by higher age and severity of illness and it were higher in surgical patients than in patients in internal medicine wards [21]. In patients admitted to surgery wards, comorbidities, the ISAR score, mobility impairment, ADL impairment and cognition impairment were predictors of nursing hours [6]. Evidence for the prediction of nursing hours in internal medicine in-patients is still missing as is evidence for the prediction of physiotherapy, which reflects mobility impairment and also contributes to functional recovery, in internal medicine inpatients.…”

Section: Introductionmentioning

confidence: 99%

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Scharf

Gronewold

Dahlmann

et al. 2020

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Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: 242 in-patients (57.4% male) aged 78.4±6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β=-0.19, 95% confidence interval (CI)=-0.66;-0.13), number of admission diagnoses (β=0.28, 95%CI=0.16;0.41), ADL impairment (B=6.66, 95%CI=3.312;10.01), and signs of depression (B=6.69, 95%CI=1.43;11.94) independently predicted length of hospital stay. ADL impairment (B=1.14, 95%CI=0.67;1.61), cognition impairment (B=0.57, 95%CI=0.07;1.07) and ISAR score (β =0.26, 95%CI=0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)=1.06, 95%CI=1.04;1.08), ADL impairment (RR=3.54, 95%CI=2.29;5.47), cognition impairment (RR=1.77, 95%CI=1.20;2.62) and signs of depression (RR=1.99, 95%CI=1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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“…In Europe, the proportion of people 65 years and older increased from 16.6% in 2005 to 18.9% in 2015, with Germany, Italy and Greece having the highest share of people 65 years and older in the total population. The median age of the total population also increased by about 4 years from 2005 to 2015 so that the proportion of older people will increase strongly in the future.…”

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confidence: 99%

“…We for the first time evaluated ISAR screening followed by standardized comprehensive geriatric assessment in a German university orthopedics and trauma surgery environment [16]. ISAR consists of 6 questions with dichotomized yes/no answers assessing functional dependence (premorbid and acute change), recent hospitalization, impaired memory and impaired vision and polymedication (≥ 6 medications) [12].…”

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Supporting Elderly Patients at Risk in Hospital Environments

Gronewold¹,

Hermann²

2017

J Alzheimers Dis Parkinsonism

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Identification of hospitalized elderly patients at risk for adverse in-hospital outcomes in a university orthopedics and trauma surgery environment

Cited by 22 publications

References 41 publications

Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre

Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Supporting Elderly Patients at Risk in Hospital Environments

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