Characteristics associated with recurrent falls among the elderly within aged-care wards …

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Prevalence of geriatric conditions: a hospital-wide survey of 455 geriatric inpatients in a tertiary medical center.
Arch Gerontol Geriatr. 2011 Jul-Aug;53(1):46-50
Authors: Chen CC, Yen CJ, Dai YT, Wang C, Huang GH
Ab…

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Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: A hospital-based study.
Arch Gerontol Geriatr. 2011 Aug 3;
Authors: Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK
Older people te…

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Prevalence of pain in elderly hospitalized patients.

Arch Gerontol Geriatr. 2010 Nov-Dec;51(3):273-6

Authors: Gianni W, Madaio RA, Di Cioccio L, D’Amico F, Policicchio D, Postacchini D, Franchi F, Ceci M, Benincasa E, Gentili M, Zuccaro SM

Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient’s recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.

PMID: 20031238 [PubMed - indexed for MEDLINE]

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Nutritional and hydration status in elderly subjects: clinical rating versus bioimpedance analysis.

Arch Gerontol Geriatr. 2010 May-Jun;50(3):e81-5

Authors: Rösler A, Lehmann F, Krause T, Wirth R, von Renteln-Kruse W

Malnutrition and dehydration are common in elderly. A simple, reliable instrument to assess nutritional and hydration status would be very helpful. Bioelectrical impedance analysis (BIA) has been promising in this context, but data of elderly persons and geriatric in-hospital patients are rare. Therefore, we first compared BIA measurements (resistance, reactance, phase angle and a resulting vectorgraph) with a clinical assessment in 31 community-dwelling women and 30 female nursing-home residents. The results of the BIA measurement correlated well to weight, hand grip strength, and calf circumference. We then compared BIA measurements with clinical judgement of hydration status in 103 acute geriatric hospital in-patients. Concordance between the results of clinical judgement and BIA measurements was only 43.7%. In assessing geriatric in-patients, there is little concordance between the clinical and the bioelectrical evaluation of the hydration status.

PMID: 19616321 [PubMed - indexed for MEDLINE]

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Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit.

Arch Gerontol Geriatr. 2009 Jul-Aug;49(1):142-5

Authors: Corsinovi L, Bo M, Ricauda Aimonino N, Marinello R, Gariglio F, Marchetto C, Gastaldi L, Fissore L, Zanocchi M, Molaschi M

We aimed to identify fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients. In 340 men and 280 women consecutively admitted to a Acute Geriatric Ward of a University Hospital the following variables were evaluated: demographics, clinical history, main disease responsible for hospitalization, comorbidity (cumulative illness rating scale: CIRS 1 and 2) gait and balance deficit (Tinetti's scales), cognition/function (short portable mental status questionnaire: SPMSQ); activities of daily living: ADL; instrumental activities of daily living: IADL; delirium (confusion assessment method: CAM), drugs administered during hospitalization. Overall 80 falls occurred in 70 patients. The incidence rate of falls was of 6.0 per 1000 patient-days with 2.0 falls per bed/year. Age (relative risk=RR=1.050; 95% confidence interval=CI=1.013-1.087), delirium (RR=3.577; 95% CI 1.096-11.672), diabetes (RR=5.913; 95% CI 1.693-20.644), balance deficit (RR=0.914; 95% CI 0.861-0.970) and polypharmacy (RR=1.226; 95% CI 1.122-1.340) were independently predictive of falling. Fallers had a prolonged length of stay (LOS) (35.5+/-47.8 days vs. 23.2+/-27.2; p=0.01) and more frequent nursing home placements (12.9% vs.5.6%; p<0.005). The knowledge of falling predictors might help in planning specific preventive strategies to improve the patients' global health status and to reduce the costs of medical care.

PMID: 18674824 [PubMed - indexed for MEDLINE]

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Efficacy and safety of two treatment combinations of hypertension in very elderly patients.

Arch Gerontol Geriatr. 2009 May-Jun;48(3):401-5

Authors: Fogari R, Zoppi A, Mugellini A, Corradi L, Lazzari P, Preti P, Derosa G

The study compared valsartan/amlodipine combination with irbesartan/hydrochlorothiazide (HCTZ) combination in very elderly hypertensives. After a 4-week placebo period, 94 hypertensives, aged 75-89 years were randomized to valsartan 160mg/amlodipine 5mg or irbesartan 300mg/HCTZ 12.5mg for 24 weeks according to a prospective, parallel group study. After 4 weeks amlodipine or HCTZ was doubled in non-responders. Patients were checked every 4 weeks. At each visit clinical sitting, lying and standing blood pressure (BP), systolic BP (SBP) and diastolic BP (DBP) were evaluated, and an electrocardiogram was performed. At the end of the placebo period and of the treatment period a non-invasive 24-h ambulatory BP monitoring (ABPM) was performed and electrolytes and uric acid were evaluated. Both combinations significantly reduced ambulatory BP. In the valsartan/amlodipine group the mean reduction (-29.9/-15.6 for 24h, -28.6/-14.5mmHg for day-time and -26.2/-17.4mmHg for night-time SBP/DBP) was similar to that of the irbesartan/HCTZ group (-29.6/-15.4 for 24h, -29.3/-14.9mmHg for day-time and -25.4/-16.9mmHg for night-time SBP/DBP). Both combinations significantly reduced clinical sitting and lying BP values with no difference between treatments. BP changes from lying to standing position were significantly greater in the irbesartan/HCTZ group (-17.2/-9.1mmHg) than in the valsartan/amlodipine group (-10.1/-1.9mmHg, p<0.05 for SBP and p<0.01 for DBP vs. irbesartan/HCTZ). Potassium significantly decreased and uric acid significantly increased (-0.4mmol/l, p<0.05 and +0.5mg/dl, p<0.05 vs. baseline, respectively) only in the irbesartan/HCTZ group. In conclusion, both combinations were similarly effective in reducing ambulatory and clinical BP in very elderly hypertensives. However, valsartan/amlodipine offered some advantages in terms of less pronounced BP orthostatic changes and absence of metabolic adverse effects.

PMID: 18457886 [PubMed - indexed for MEDLINE]

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