The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study

Seben, Rosanne van; Reichardt, Lucienne A.; Aarden, Jesse J; Schaaf, Marike van der; Esch, M. van der; Engelbert, Raoul; Twisk, Jos W. R.; Bosch, Jos A.; Buurman, Bianca M.; Kuper, Ingeborg M.J.A.; Jonghe, Annemarieke de; Leguit-Elberse, Maike; Kamper, A.M.; Posthuma, Nynke; Brendel, Nienke; Wold, J.F.H.

doi:10.1016/j.jamda.2018.08.003

Cited by 48 publications

(35 citation statements)

References 44 publications

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“…Functionality in performing ADLs at discharge was assessed using the Katz-ADL, and scores ranged from 0 (independent at all ADLs) to 6 (dependent on all ADLs). 27 Somatic geriatric syndromes (fear of falling, pain, fatigue, and mobility impairment), which are prevalent after discharge 36 and may impair physical activity, were assessed. 37 Fear of falling, pain, and fatigue were measured using the numeric rating scale, which is a continuous scale from 0 (no symptoms) to 10 (severe symptoms).…”

Section: Assessment Of Other Variablesmentioning

confidence: 99%

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Kolk

Aarden

Vroomen

et al. 2021

Journal of the American Medical Directors Association

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Objectives: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Design: Prospective observational cohort study conducted in 2015e2017. Setting and Participants: Older adults (!70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. Methods: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. Results: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250e1146] at the last day of hospitalization. This increased to 1750 (IQR 675e4114) steps 1 day postdischarge, and to 1997 (IQR 938e4098) steps 7 days postdischarge. Age [b ¼ À57.93; 95% confidence interval (CI) À111.15 to À4.71], physical performance (b ¼ 224.95; 95% CI 117.79e332.11), and steps in hospital (b ¼ 0.76; 95% CI 0.46e1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (b ¼ À1400; 95% CI e2380 to À420; P ¼ .005). Conclusions and Implications: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps

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Section: Assessment Of Other Variablesmentioning

confidence: 99%

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Kolk

Aarden

Vroomen

et al. 2021

Journal of the American Medical Directors Association

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“…These factors increase the risk of adverse events such as readmissions (Bell & Saraf, 2016; Vitale et al., 2019). In the phase in which patients are discharged, the risk of adverse events increases again (Naylor et al., 2011), while medication regimes and treatment advices are often not well understood or mixed‐up with previous advices (Schoonover et al., 2014), and signs of physical deterioration are often detected too late (van Seben et al., 2019). Lastly, older cardiac patients are often not referred to traditional cardiac rehabilitation programmes because they are too intensive, or, when patients are referred, they often do not participate due to the intensity, travel issues and hindering comorbidities (Ruano‐Ravina et al., 2016).…”

Section: Introductionmentioning

confidence: 99%

The Cardiac Care Bridge randomized trial in high‐risk older cardiac patients: A mixed‐methods process evaluation

Verweij

Spoon

Terbraak

et al. 2021

Journal of Advanced Nursing

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Aim To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design A mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.

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“…These patients felt reassured at discharge but started worrying when they were back home and needed proper follow-up. Moreover, many of these patients had common geriatric syndromes after hospital discharge [10,43]. Most patients had experienced functional decline before visiting the ED, and did not feel they had recovered to their baseline level after discharge.…”

Section: Discussionmentioning

confidence: 99%

Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

Kolk

Kruiswijk²,

Vroomen

et al. 2020

Preprint

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Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

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The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study

Cited by 48 publications

References 44 publications

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

The Cardiac Care Bridge randomized trial in high‐risk older cardiac patients: A mixed‐methods process evaluation

Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

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