Risk factors for hospitalization among older persons


Authors: Hana Matějovská Kubešová;  Ondřej Výška;  Jiří Nakládal;  Emmanuela Fernandová;  Petra Vacková
Authors‘ workplace: Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno, pracoviště Bohunice
Published in: Vnitř Lék 2018; 64(11): 1070-1075
Category:

Overview

The hospitalization of older patients involves, in addition to treating of acute illness or acute worsening of chronic disease, the risk of a number of age-specific complications. Deliria are one of the most common events at the onset of the hospital stay. As the ethiology of deliria in addition to the underlying disease we have to consider the deteriorated adaptability to environmental change. Another serious complication is the emergence of immobilization syndrome, which can start the irreversible unfavourable outcome. Infection complications with a high tendency to develop sepsis are a frequent primary cause of hospitalization, but also a frequent complication of hospitalization from originally different indications. The onset of the infection complication is usually accompanied by a slower increase of inflammatory parameters, but it does not mean slower progression of the condition. The basic problem is the choice of appropriate antibiotic treatment with regard to the high risk of Clostridium difficile selection in older age. Other risks, such as malnutrition, dehydration, thromboembolic disease are more frequent in hospitalized older patients and it is advisable to start as soon as possible with preventive measures against their occurrence.

Key words:

dehydration – deliria – immobilization syndrome – instability – malnutrition – respiratory infection – urinary infection


Sources
  1. Warnier RM, van Rossum, Velthuijsen E et al. Validity, Reliability and Feasibility of Tools to Identify Frail Older Patients in Inpatient Hospital Care: A Systematic Review. J Nutr Health Aging 2016; 20(2): 218–230. Dostupné z DOI: <http://dx.doi.org/10.1007/s12603–015–0567-z>.
  2. Pilotto A, Ferrucci L, Franceschi M et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008; 11(1): 151–161. Dostupné z DOI: <http://dx.doi.org/10.1089/rej.2007.0569>.
  3. Heim N, van Fenema EM, Weverling-Rijnsburger A et al. Optimal screening for increased risk for adverse outcomes in hospitalised older adults. Age Ageing 2015; 44(2): 239–244. Dostupné z DOI: <http://dx.doi.org/10.1093/ageing/afu187>.
  4. Buurman BM, Hoogerduijn JG, van Gemert EA et al. Clinical Characteristics and Outcomes of Hospitalized Older Patients with Distinct Risk Profiles for Functional Decline: A Prospective Cohort Study. PLoS One 2012; 7(1): 1–8. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0029621>.
  5. Berková M, Topinková E, Mádlová P et al. Krátká baterie pro testování fyzické zdatnosti seniorů – pilotní studie a validizace textu u starších osob v České republice. Vnitř Lék 2013; 59(4): 256–263.
  6. Franklin M, Berdunov V, Edmans J et al. Identifying patient-level health and social care costs for older adults discharged from acute medical units in England. Age Ageing 2014; 43(5): 703–707. Dostupné z DOI: <http://dx.doi.org/10.1093/ageing/afu073>.
  7. Asmus-Szepesi KJ, Koopmanschap MA, Flinterman LE et al. Formal and informal care costs of hospitalized older people at risk of poor functioning: A prospective cohort study. Arch Gerontol Geriatr 2014; 59(2): 382–392. Dostupné z DOI: <http://dx.doi.org/10.1016/j.archger.2014.04.014>.
  8. Katz S, Downs TD, Cash HR et al. Progress in development of the index of ADL. Gerontologist 1970; 10(1): 20–30.
  9. Lawton MP, Brody EM. Assessment of older people: self maintening and interumetanl activities of daily living. Gerontologist 1969; 9(3): 179–186.
  10. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189–198.
  11. Nasreddine ZS, Phillips NA, Bédirian V et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695–699. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1532–5415.2005.53221.x>.
  12. Rubenstein LZ, Harker JO, Salvà A et al. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA SF). J Gerontol A Biol Sci Med Sci 2001; 56(6): M366-M372.
  13. Norton D. Norton scale for decubitus prevention. Krankenpflege (Frankf) 1980; 34(1): 16.
  14. Schmid NA. 1989 Federal Nursing Service Award Winner. Reducing patient falls: a research-based comprehensive fall prevention program. Mil Med 1990; 155(5): 202–207.
  15. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol 1986; 5(1–2): 165–172. Dostupné z DOI: <http://dx.doi.org/http://dx.doi.org/10.1300/J018v05n01_09>.
  16. Kalvach Z, Zadák Z, Jirák R et al. Geriatrie a gerontologie. Grada: Praha 2004. ISBN 80–247–0548–6.
  17. Topinková E. Geriatrie pro praxi. 1. ed. Galén: Praha 2005. ISBN 80–7262–365–6.
  18. Inouye SK. Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol 1998; 11(3): 118–125. Dostupné z DOI: <http://dx.doi.org/10.1177/089198879801100302>.
  19. Jaffee EG, Arora VM, Matthiesen MI et al. Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors. J Health Commun 2016; 21(Supl 2): 135–140. Dostupné z DOI: <http://dx.doi.org/10.1080/10810730.2016.1179371>.
  20. Bielaková K, Matějovská Kubešová H. Závratě a pády jako častá symptomatologie kardiovaskulárního postižení ve vyšším věku. Kardiol Rev Int Med 2018; 20(1): 44–46.
  21. Tuka V, Daňková M, Riegel K et al. Pohybová aktivita – svatý grál moderní medicíny? Vnitř Lék 2017; 63(10): 729–736.
  22. Gorušová J. Rehabilitace starších nemocných v zařízeních následné péče. Geri a Gero 2018; 7: 72–75.
  23. Matějovská Kubešová H, Matějovský J. Věnujeme dost pozornosti orální hygieně seniorů? Geri a Gero 2015; 4(1): 31–33.
  24. Beneš J. Vývoj názorů na patofyziologii sepse. Vnitř Lék 2017; 63(7–8): 481–487.
  25. Freiberger T. PCR diagnostika infekcí. Vnitř Lék 2017; 63(7–8): 472–474.
  26. Bielakova K, Fernandova E, Matějovská Kubešová H. Can we improve the therapy of Clostridium difficile infection in elderly patients? Wien Klin Wochenschr 2016; 128(15–16): 592–598. Dostupné z DOI: <http://dx.doi.org/10.1007/s00508–016–1056-z>.
  27. Singh H, Nugent Z, Yu BN Hospital discharge abstracts have limited accuracy in identifying occurrence of Clostridium difficile infections among hospitalized individuals with inflammatory bowel disease: A population-based study. PLoS One. 2017; 12(2): e0171266. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0171266>.
  28. Zadák Z. Prevence a terapie sarkopenie ve stáří. Vnitř Lék 2016; 62(7–8): 671–677.
  29. Prudius D, Weber P, Meluzínová H et al. Deceased elderly in-patients with pulmonary embolism. Bratisl Lek Listy 2014; 115(12): 786–790.
  30. Schleyer AM, Robinson E, Dumitru R Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency. J Hosp Med 2016; 11(Suppl 2): S38-S43. Dostupné z DOI: <http://dx.doi.org/10.1002/jhm.2664>.
  31. Yassin M, Mitchell C, Diab M et al. The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty. Int Orthop 2014; 38(5): 1073–1075. Dostupné z DOI: <http://dx.doi.org/10.1007/s00264–013–2233–6>.
  32. Angriman F, Ferreyro BL, Posadas-Martinez ML. Wells Score and Poor Outcomes Among Adult Patients With Subsegmental Pulmonary Embolism: A Cohort Study. Clin Appl Thromb Hemost 2015; 21(6): 539–545. Dostupné z DOI: <http://dx.doi.org/10.1177/1076029614559772>.
Labels
Diabetology Endocrinology Internal medicine

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