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Background: Single-occupancy patient rooms in hospitals have become popular because of the privacy they offer. A downside, however, is the lack of social control from other patients, which might increase the risk of falls and undetected delirium. Aim: To study whether the incidence of falls in single-occupancy patient rooms differs from that in multibedded patient rooms. Secondary aims were to establish differences in the context of falls and differences in delirium incidence. Methods: An uncontrolled observational before-after study was performed during 16 months before and 16 after moving to a hospital with 100% single-occupancy patient rooms. Fall data were retrieved from the hospital incident reporting system. The Delirium Observation Screening Scale (DOSS) was retrieved from the hospital electronic patient data system. Main outcomes were the number of falls per 1,000 patient days, assessed with a Poisson regression analysis, and delirium incidence in fallers. Results: The incidence of falls was not significantly different between the before period (1.39 falls/1,000 patient days) and the after period (1.38 falls/1,000 patient days; p = .924). In the after period, falls in the bathroom were significantly more frequent than in the before period, respectively, 17.2% and 9.4% (p = .003). In both periods, one quarter of the patients who fell had been assessed for delirium. In the before period, 57/73 (78%) of those were suspected for delirium (DOSS >= 3) versus 37/55 (67%) in the after period (p = .225). Conclusions: In this study, we observed no change in incidence of falls after moving to a hospital with 100% single-occupancy bed rooms.

Background: Although leg ulcers are a burdensome disease most common in those aged 65 years and older, frailty in this population has not yet been well established. Objectives: The aim of this study was to prospectively explore and compare the presence of frailty in elderly patients with chronic leg or foot ulcers by applying different validated frailty screening methods in three healthcare settings and to assess the feasibility of frailty screening. Methods: We compared frailty of leg ulcer patients referred to an academic hospital with a non-academic hospital, leg ulcer patients receiving (primary) homecare, and a dermato-oncology patient population (control group). Frailty and quality of life were assessed using four validated questionnaires: the Groninger Frailty Indicator, Geriatric-8, Mini-Cog and Wound Quality of Life. To analyse data multiple (non)-parametric tests were performed. Results: Fifty of 60 included leg ulcer patients (83%) scored “frail” on at least one frailty questionnaire (GFI, G8 or Mini-Cog). The number of patients scoring “frail” on two or three out of three applied frailty questionnaires were significantly higher in the academic and homecare ulcer population compared with the non-academic ulcer population and control group (p = 0.002). In the academic ulcer population mean Wound Quality of Life scores were 30.2 (SD 17.6), compared with 17.7 (SD 13.1) in the non-academic and 15.0 (SD 10.4) in the homecare ulcer population (p = 0.002). Conclusion: The majority of patients suffering from leg ulcers in this study was frail. The highest frailty prevalence was observed in the academic and homecare ulcer populations. The largest impaired quality of life was reported in the academic ulcer population. In dermatology practice, implementing frailty screening and initiating appropriate (paramedical) supportive care should be considered to improve patient outcomes.

Purpose: In-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls. Patients and Methods: This retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium. Results: A total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional antic-holinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06–2.10). Other measures, ie anticholinergic drug use (yes/no) and different categories of anticholinergic drug burden, measured with the ARS, ACB and list of Chew, were all not associated with in-hospital falls. Conclusion: Anticholinergic drug exposure on admission is possibly not a main risk factor for in-hospital falls among older patients.

Özge Akgün,1 Christian Oudshoorn,1 Francesco US Mattace-Raso,1 Angelique Egberts1,2 1Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 2Department of Hospital Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam & Schiedam, the NetherlandsCorrespondence: Angelique Egberts, Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Room Rg-527, PO Box 2040, Rotterdam, CA, 3000, the Netherlands, Tel +31 10 70 35979, Fax +31 10 70 34768, Email a.egberts@erasmusmc.nlPurpose: In-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls.Patients and Methods: This retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium.Results: A total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional anticholinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06– 2.10). Ot

Objective: We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action. Method: Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed. Results: Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice (n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider. Discussion: Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

Francesco Mattace-Raso, Harmke Polinder-Bos, Barbara Oosterwijk, Rozemarijn van Bruchem-Visser, Jeannette Goudzwaard, Christian Oudshoorn, Gijsbertus Ziere, Angelique Egberts Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the NetherlandsCorrespondence: Francesco Mattace-RasoDivision of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Office RG 534, Dr. Molewaterplein 40, Rotterdam, GD 3015, the NetherlandsTel +31 10 703 59 79Email f.mattaceraso@erasmusmc.nlAbstract: The authors report a high prevalence of delirium in COVID-19 old patients admitted in an academic hospital. During the recent COVID-19 period, delirium was present in 38% of old patients admitted with delirium at the COVID ward of the Erasmus MC University Medical Center of Rotterdam. We do not know in which patients COVID-19 can cause delirium; however, considering the high prevalence of delirium in COVID-19 old patients and the potential serious consequences, attention is needed in order to reduce disability and mortality in this vulnerable category of patients.Keywords: delirium, old patients, COVID-19

Objectives To investigate whether serum 25-hydroxy vitamin D (25(OH)D) is associated with physical performance in men and women. Design Cross-sectional. Setting Emergency departments (EDs) of five hospitals. Participants Older adults who visited an ED because of a fall (N = 616). Measurements Physical performance was assessed using the Timed Up and Go Test, the Five Time Sit to Stand Test, handgrip strength, and the tandem stand test. Multivariate linear regression was used to assess the association between physical performance and log-transformed 25(OH)D concentration adjusted for potential confounders. Results In men, higher serum 25(OH)D concentration was significantly associated with better handgrip strength (regression coefficient (B) = 3.86, 95% confidence interval (CI) = 2.04-5.69), faster TUG time (B = -2.82, 95% CI = -4.91 to -0.73), and faster FTSS time (B = -3.39, 95% CI = -5.67 to -1.11). In women, higher serum 25(OH)D concentration was significantly associated with faster TUG time (B = -2.68, 95% CI = -4.87 to -0.49). Conclusion A positive association was found between serum 25(OH)D level and physical performance in men and women. Intervention studies are needed of vitamin D-deficient older men and women to further investigate the effect of vitamin D supplementation in this group.

Background: Vertebral fractures are a common consequence of osteoporosis in older persons. With the ageing of the population, numbers are expected to rise. Objective: To determine trends in health care demand due to vertebral fracture related emergency department (ED) visits and hospitalizations in the older Dutch population. Design and setting: Secular trend analysis of vertebral fracture related ED visits between 1986 and 2008, using the Dutch Injury Surveillance System. All ED visits with a primary diagnosis of a vertebral fracture in persons aged >= 65 years were extracted from this database. Main outcome measure: Numbers, age-specific and age-adjusted incidence rates (per 100,000 population) of ED visits and hospitalization rates due to vertebral fractures in the older Dutch population were calculated for each year of the study. Results: The total number of ED visits due to a vertebral fracture increased from 913 in 1986 to 2502 in 2008 (174% increase). The majority of fractures were caused by a low-energetic fall incident (83%). The overall age-adjusted incidence rate increased from 51.6 per 100,000 population in 1986 to 103.6 in 2008. Incidence rates increased with age and were higher in females than in males. The hospitalization rate remained stable at about 50-55%, in both females and males. Conclusion: Vertebral fracture related ED visits and hospitalizations are increasing rapidly in the older Dutch population, especially in the oldest-old. Most vertebral fractures were associated with falls. These findings indicate that a pro-active approach in the diagnosis and treatment of osteoporosis and in the prevention of falls in both men and women is warranted. (C) 2011 Elsevier Ltd. All rights reserved.

Background: Hip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the combination of an increased fall risk and osteoporosis. The aim of this study was to determine time trends in numbers and incidence rates of hip fracture-related hospitalizations and admission duration in the older Dutch population. Methods and Findings: Secular trend analysis of all hospitalizations in the older Dutch population (>= 65 years) from 1981 throughout 2008, using the National Hospital Discharge Registry. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons) of hospital admissions and hospital days due to a hip fracture were used as outcome measures in each year of the study. Between 1981 and 2008, the absolute number of hip fractures doubled in the older Dutch population. Incidence rates of hip fracture-related hospital admissions increased with age, and were higher in women than in men. The age-adjusted incidence rate increased from 52.0 to 67.6 per 10,000 older persons. However, since 1994 the incidence rate decreased (percentage annual change -0.5%, 95% Cl: -0.7; -0.3), compared with the period 1981-1993 (percentage annual change 2.3%, 95% Cl: 2.0; 2.7). The total number of hospital days was reduced by a fifth, due to a reduced admission duration in all age groups. A possible limitation was that data were obtained from a linked administrative database, which did not include information on medication use or co-morbidities. Conclusions: A trend break in the incidence rates of hip fracture-related hospitalizations was observed in the Netherlands around 1994, possibly as a first result of efforts to prevent falls and fractures. However, the true cause of the observation is unknown.

Background/Aims: Recent studies suggest that vitamin D metabolites may be important for preserving cognitive function via specific neuroprotective effects. No large studies have examined the association between vitamin D status and cognition. Methods: In this cross-sectional study, we analyzed the serum 25-hydroxyvitamin D-3 levels and Mini-Mental State Examination (MMSE) test scores of 225 older outpatients who were diagnosed as having probable Alzheimer's disease (AD). In addition to the 25-hydroxyvitamin D-3 levels, we analyzed the serum vitamin B-1, B-6 and B-12 levels. Results: An association was found between MMSE test scores and serum 25-hydroxyvitamin D-3 levels, with a beta-coefficient of 0.05 (p = 0.01). Vitamin-D-sufficient patients had significantly higher MMSE scores as compared to vitamin-D-insufficient ones. No association was found with the other serum vitamin levels. Conclusions: These data support the idea that a relationship exists between vitamin D status and cognition in patients with probable AD. However, given the cross-sectional design of this study, no causality can be concluded. Further prospective studies are needed to specify the contribution of vitamin D status to the onset and course of cognitive decline and AD. Copyright (C) 2008 S. Karger AG, Basel.