Reducing “iatrogenic disability” in the hospitalized frail elderly.
J Nutr Health…

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How to manage recurrent falls in clinical practice: guidelines of the French Society of Geriatrics and Gerontology.
J Nutr Health Aging. 2011;15(1):79-84
Authors: Beauchet O, Dubost V, Revel Delhom C, Berrut G, Belmin J,
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Early markers of prolonged hospital stay in demented inpatients: a multicentre and prospective study.

J Nutr Health Aging. 2010;14(2):141-7

Authors: Lang PO, Zekry D, Michel JP, Drame M, Novella JL, Jolly D, Blanchard F

BACKGROUND: Dementia is a serious, chronic, and costly public health problem. Prior studies have described dementia as increasing length of hospital stay, but so far no explanations have been proposed. METHODS: To identify early markers for prolonged hospital stay in demented elderly inpatients, 178 community-dwelling or institutionalized subjects aged 75+, hospitalized through an emergency department in 9 teaching hospitals in France, were analyzed. Prolonged hospital stays were defined according a limit adjusted for Diagnosis Related Group. All patients underwent a comprehensive geriatric assessment at admission. Logistic regression multifactorial mixed model was performed. Center effect was considered as a random effect. RESULTS: Of the 178 stays, 52 were prolonged. Most concerned community-dwelling patients (86%). Multifactor analysis demonstrated that demographic variables had no influence on the length of stay, while diagnosis of delirium (OR 2.31; 95% CI 1.77 – 2.91), walking difficulties (OR 1.94; 95% CI 1.62 – 2.43) and report by the informal caregiver of moderate or severe burden (OR 1.52; 95% CI 1.19 – 1.86) or low social quality-of-life score (OR 1.25; 95% CI 1.03 – 1.40), according to the Zarit’s Burden Inventory short scale (12 items) and the Duke’s Health Profile respectively, were identified as early markers for prolonged hospital stays. CONCLUSION: At the time of the rising incidence of cognitive disorders, these results suggest that preventive approaches might be possible. In a hospital setting as well as in a community-dwelling population, more specific, specialized and coordinated care, using the expertise of multiple disciplines appears as a probable effective measure to limit prolonged hospital stay. Such approaches require (i) clear patient-oriented goal definition, (ii) understanding and appreciation of roles among various health care and social disciplines and, (iii) cooperation between partners in patient’s management. However, the cost- and health-effectiveness of such approaches should be evaluated.

PMID: 20126963 [PubMed - indexed for MEDLINE]

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Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects.

J Nutr Health Aging. 2010 Jan;14(1):57-61

Authors: Trivalle C, Cartier T, Verny C, Mathieu AM, Davrinche P, Agostini H, Becquemont L, Demolis P,

OBJECTIVES: Evaluate the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting. Design: Randomised prospective study. SETTING: The study was performed in France in the Paris area, in 16 rehabilitation geriatric centres of APHP (Assistance Publique – Hôpitaux de Paris). Patient capacity per centre varied from 15 to 57 with a total of 526. PARTICIPANTS: All the patients > or = 65 years hospitalized during the 4 week study period were included. MEASUREMENTS: During a first 2 week phase without intervention ADE's were recorded in all centres. Then units were then randomised for an educational intervention or not. The educational phase lasted 1 week, without ADE tracking. Then, both types of units (I+ and I-) recorded ADEs for 2 weeks. Possible drug-related incidents were detected using a standardized check list (nurses) and a weekly review of all charts by investigators. Possible drug-related incidents were analysed by a group of reviewers selected from the authors to classify them as ADE or not. RESULTS: 576 patients (mean age: 83.6 +/- 7.9 years) were consecutively included. The mean number of drugs at inclusion was 9.4 +/- 4.24 drugs per patient. 223 out of 755 events were considered "probable" ADEs (29.5%). Among the 223 ADEs, 62 (28%) could have been prevented. The main outcome of this trial was the change in the proportion of ADEs in elderly patients in the intervention-units, compared to the control group. The main errors were: to high a dose (26%), double therapy (21%), under dose (13%), inappropriate drug (13%), drug-drug interaction (6%), previous same adverse drug reaction (3%) and miscellaneous (11.18%). After a specific educational intervention program, there were fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004). CONCLUSION: Educational programs could help reduce the prevalence of ADEs by 14% and encourage physicians to change outdated prescription habits.

PMID: 20082055 [PubMed - indexed for MEDLINE]

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Usage of megestrol acetate in the treatment of anorexia-cachexia syndrome in the elderly.

J Nutr Health Aging. 2009 May;13(5):448-54

Authors: Yeh SS, Lovitt S, Schuster MW

The aim of this review is to assess the efficacy and safety of megestrol acetate (MA) in geriatric cachexia. The paper presented here reviews a previously published study of MA use in 69 patients in a randomized double blind placebo-controlled trial. This paper will also address the underlying pathogenesis of cachexia (specifically, the role of cytokines) along with the use of MA, its mechanism of action and its side effects. OBJECTIVE: To compare the effects of MA oral suspension (O.S.), 800 mg/day, versus placebo on weight in geriatric nursing home patients with weight loss or low body weight. DESIGN: Twelve weeks, randomized, double-blind, placebo-controlled trial with a 13-week follow-up period. PATIENTS: Northport VAMC Nursing home patients with weight loss of * 5% of usual body weight over the past 3 months, or body weight 20% below their ideal body weight. INTERVENTIONS: Patients were randomly assigned to receive placebo or MA 800 mg/d for 12 weeks and were then followed for 13 weeks off treatment and mortality 4 years post treatment. MEASUREMENTS: Primary outcome- weight and appetite change. Secondary outcome-sense of well being, enjoyment of life, change in depression scale, laboratory nutrition parameters, energy intake counts, body composition, and adverse events. RESULTS: At 12 weeks there were no significant differences in weight gain between treatment groups, while MA-treated patients reported significantly greater improvement in appetite, enjoyment of life, and well being. At week 25 (3 months after treatment), 61.9% of MA-treated patients had gained * 1.82 kg (4 lbs) compared to 21.7% of placebo patients. There was no difference in survival between MA and placebo groups. Considering possible confounders, higher initial IL-6, initial TNFR-p75 levels, and final neutrophil percentage were associated with elevated mortality, whereas higher initial pre-albumin, initial albumin, final pre-albumin, final albumin and final weight gain were associated with decreased death.

PMID: 19390752 [PubMed - indexed for MEDLINE]

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Varying insulin use in older hospitalized patients with diabetes.

J Nutr Health Aging. 2009 May;13(5):456-9

Authors: Jover N, Traissac T, Pinganaud G, Moras JB, Rainfray M, Bourdel-Marchasson I

OBJECTIVE: Observation of insulin use in consecutive hospitalized diabetic older patients in acute care wards with reference to nutritional intakes, measures of functional status, and varying clinical situations. METHODS: Prospective case study in a geriatric medicine ward with CGA, dietary intake measure and used insulin dosage. RESULTS: Among 600 inpatients, 90 diabetic subjects were found. Only 12.2 % diabetic patients had MMSE > 23 and 23.3% were unable to eat without assistance. During the stay 54 patients had received insulin. From admission to discharge or death, doses were 0.39 to 0.19 U/kg (SD 0.41-0.15) during palliative care, 0.43 to 0.45 U/kg (SD 0.20-0.20) in the event of failure of oral therapy, 0.38 to 0.42 U/kg (SD 0.18-0.25) if creatinine clearance was 30 ml/min or lower, and 0.38 to 0.27 U/kg (SD 0.24-0.26) in critical diseases. Dietary intake increased in all during the stay with an energy intake close to 20 kCal/kg/d at discharge, except for those in palliative care, who had a final intake of 8.2 kCal/kg/d (SD 9.1). CONCLUSION: Insulin treatment guidelines adapted to this frail diabetic population are necessary.

PMID: 19390753 [PubMed - indexed for MEDLINE]

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