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Background: Delirium has been associated with poor outcomes in hospitalized older adults. Rates of delirium have increased in the context of coronavirus disease 2019 (COVID-19). Purpose: To explore the prevalence of delirium in older adult patients hospitalized with COVID-19 as well as correlations with age, gender, length of stay (LOS), occurrence of an intensive care unit admission or transfer, and in-hospital mortality in 2 hospitals in the southeast United States. Methods: A retrospective study of 1502 patients admitted between 2020 and 2021 was completed. Results: Older adult patients hospitalized with delirium and COVID-19 demonstrated significantly prolonged LOS (14.1 days vs 7.1 days, P < .0001) and higher rates of in-hospital mortality (33.5% vs 12.8%, P < .0001). Conclusions: Findings of this study add to the growing literature on delirium in hospitalized patients and support the need for future initiatives to create protocols for monitoring and nursing care management of delirium to improve care delivery. [ABSTRACT FROM AUTHOR]

Inpatient falls have a significant impact on the outcomes of older patients during inpatient rehabilitation. A retrospective case-control study was conducted using data of 7066 adults aged 55 yrs or older to evaluate significant predictors of inpatient falls during inpatient rehabilitation and the association of inpatient falls with discharge destination and length of stay. A stepwise logistic regression was used to model odds of inpatient falls and home discharge with demographic and clinical characteristic variables and a multivariate linear regression to evaluate the association between inpatient falls and length of stay. Nine hundred thirty-one of 7066 patients (13.18%) had inpatient falls during inpatient rehabilitation. The group with inpatient falls had longer length of stay (14.22 ± 7.82 vs. 11.85 ± 5.33 days, P < 0.0001) and a decreased proportion of home discharges when compared with the group without inpatient falls. There were increased odds of inpatient falls among patients with diagnoses of head injury, other injuries, a history of falls, dementia, a divorced marital status, and a use of laxatives or anticonvulsants. Inpatient falls were associated with an increased length of stay (coefficient = 1.62, confidence interval = 1.19–2.06) and decreased odds of home discharge (odds ratio = 0.79, confidence interval = 0.65–0.96) after inpatient rehabilitation. This knowledge may be incorporated into strategies for reducing inpatient falls during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options. Objectives: Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population. Method: This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed. Results: There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, −2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate. Conclusions: In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care. [ABSTRACT FROM AUTHOR]

The article discusses research which evaluated the completeness of comprehensive geriatric assessment (CGA) in relation to care outcomes among hospitalized older patients in Indonesia. The study assessed readmission rates, medical records of patients after hospital discharge, in-hospital mortality and predictors of length of hospital stay. Results show care outcomes in relation to ward type and the implications of CGA completeness for nurse leaders.

Delirium is a common neurocognitive disorder among hospitalized older adults, and it can have devastating effects. The purpose of this article is to inform NPs in the hospital setting to recognize, prevent, and manage delirium in older adults. The roles of nonpharmacologic and pharmacologic interventions are described. [ABSTRACT FROM AUTHOR]

This article describes the Elder Veteran Program (EVP), a nurse practitioner (NP)–led inpatient consult service at one Midwestern Veterans Administration (VA) hospital. The EVP was designed to address the needs of older hospitalized veterans and serves as a model that uses geriatric expert clinicians as mentors to grow geriatric expertise. Unique to EVP, nurses are coached to identify high-risk older veterans, initiate the consult process to drive geriatric medical and nursing review, and implement best geriatric nursing practice. As a result of EVP implementation, there was a 13-fold increase in the number of older hospitalized veterans receiving geriatric evaluation. The EVP highlights how NPs lead implementation of an evidence-based program that creates a path for engaging, educating, and growing geriatric nursing knowledge and skill while improving veteran access to geriatric sensitive care. [ABSTRACT FROM AUTHOR]

Frailty is a clinical geriatric syndrome where loss of physical resiliency increases vulnerability to external stressors. Frailty is predictive of many adverse health outcomes. Frailty exists across a spectrum where prefrailty is an intermediary, subclinical state of frailty. Evidence suggests that it is easier to reverse prefrailty states than to reverse established frailty, and therefore may be an ideal target for preventative interventions. This narrative review discusses clinical methods of identifying individuals with prefrailty, and interventions shown to be effective in improving frailty status in older adults. [ABSTRACT FROM AUTHOR]

Frailty is a clinical syndrome observed in older adults that associates with poor health outcomes. Despite the attempt to standardize its definition and clinical features, the complexity and the multiplicity of the physiologic dysregulations observed in frailty have led to the development of innumerous assessment tools. Herein, we highlight frequently used assessment tools for frailty describing the criteria, pros and cons regarding clinical feasibility, reliability, and validity as well as risk predictability. We further compare the 2 well-established landmark frailty assessment tools, the Physical Frailty Phenotype and the Frailty Index, in an attempt to unravel how such distinct methodologies prevail as the most commonly used clinical tools to prevent adverse outcomes worldwide. [ABSTRACT FROM AUTHOR]

Background: Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults. Methods: For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge. Mann-Whitney U and χ2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre–post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores. Results: Within-group pre–post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores. Conclusion: The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs. This pilot study evaluated the use of a device equipped with exergames—interactive video games that incorporate physical exercise—in preventing functional decline and increasing patients' independence in basic activities of daily living. [ABSTRACT FROM AUTHOR]

The risks of immobility and functional decline in older adults during an acute care admission are associated with adverse outcomes. This study explored patient attitudes toward mobility and symptom severity as potential barriers to in-hospital mobility. [ABSTRACT FROM AUTHOR]

Frailty is a condition of vulnerability characterized by instability and inconsistency after a stressor event. It is associated with a range of adverse outcomes including delirium, falls, disability, mortality, and increased healthcare utilization. A subset of frail patients who are increasingly high risk for poor outcomes are older adults with hip fracture. Palliative care is a philosophy of care focused on maximizing the quality of life for seriously ill patients and their families. For frail patients with hip fracture, timely referrals to palliative care are essential to have a meaningful impact on quality of life. Recommendations for frailty screening have been offered by professional organizations; however, multiple barriers to routine preoperative frailty assessment exist. This quality improvement project evaluated the feasibility of utilizing a frailty screening tool on patients (age > 65) with hip fracture to readily identify patients with palliative care needs at the time of admission. Although nurses' compliance with the screening tool was less than expected, having a standardized process to accurately identify this high risk population resulted in a higher percentage of appropriate palliative care referrals when compared to usual practice. Improvement in quality of life was reported in patients who received a palliative care consultation. [ABSTRACT FROM AUTHOR]

Background and Purpose: One of the interventions that can be effective in preventing recurrence and readmission due to falls is the use of nursing discharge planning program. The aim of this study was to determine the effect of nursing discharge planning program in preventing recurrent falls and readmission in the elderly referred to the trauma center. Methods: The study was a parallel randomized controlled trial. The data were collected from hospital electronic data, patients' self-report, and injury severity scale. In this study, participants (n = 169) were divided into 2 groups using an Excel-generated random sequence. In the experimental group, a discharge planning program was applied. Individualized training with a booklet for the patient and his primary caregiver was conducted for 4 sessions; each session lasted 30 to 60 minutes. The participants were followed for 6 months. Results: The mean and standard deviation of the participants' age were 76 ± 10 years. Prior to implementation of the program, the participants in the control and intervention groups did not differ significantly in age, independence, cognitive status, and severity of the injury. Postimplementation of discharge planning program, a significant decrease in falls (P <.049), hospitalization readmission (P <.014), length of hospital stay (P <.018), and severity of injury (P <.00) were observed in the intervention group compared with the control group. Discussion and Conclusions: Participants in the discharge planning program experienced lower severity of injury in the subsequent episode of falls. In addition, subjects' readmission and hospital stay were shorter in the experimental group. Discharge planning program is recommended to be implemented in other age-related distributions. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Patient-Specific Functional Scale (PSFS) is an individualized patient-reported outcome measure designed to assess the limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI). Methods: The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients—83.0 (6.4) years—with and without CI (Mini-Mental State Examination [MMSE] score 18-23, n = 52, and MMSE ≥24, n = 68, respectively) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (r s) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects. Results: The PSFS showed fair to moderate correlations with all construct variables in patients with CI (r s = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (r s = |0.27 to 0.36|), but low for the SPPB and DEMMI (r s =−0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (<8 min), and no floor/ceiling effects in either subgroup. Conclusions: The PSFS has adequate clinimetric properties for assessing patient-specific functional limitations and changes in acutely hospitalized older patients with and without CI. It might be an appropriate complement to traditional functional scales to enhance patient-centeredness in clinical geriatric assessment. [ABSTRACT FROM AUTHOR]

Visual impairment presents challenges for older adults to participate in physical activity or exercise. The purpose of this collective case study is to explore how older adults with visual impairment participate in physical activity. Four older adults with visual impairment were recruited to participate in the study. Three out of the 4 participants were able to complete all rounds of the study prior to COVID-19 pandemic halting the study. Five themes emerged from the study: exercise to enhance health and well-being, occupations as activity, loss of participation, adaptation to vision loss, and motivation to stay healthy. The findings support the use physical activity to enhance overall health and well-being. [ABSTRACT FROM AUTHOR]

This article is the second in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System , published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet— Information for Family Caregivers —and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background and Purpose: To evaluate the effectiveness of multicomponent functional maintenance initiatives (MFMIs) on functional outcomes and adverse events associated with functional decline among acutely hospitalized older adults. Data Sources: Studies were sourced from OVID Medline, PubMed, Embase, CINAHL, the Cochrane Library, and PEDro databases from inception to April 15, 2020, and their bibliographies. Study Selection: Randomized controlled trials were included if they investigated multicomponent interventions comprising more than one nonpharmacological intervention targeting physical functional decline and another shared risk factor for geriatric syndromes in acutely hospitalized medical or nonelective surgical patients 65 years and older. Data Extraction: Two reviewers independently assessed for eligibility, extracted data, and conducted risk of bias assessments. Data Synthesis: Eight studies involving 5534 patients were included. Multicomponent functional maintenance initiatives did not appear to confer significant effects on functional status, length of stay, or 30-day hospital readmissions; however, clinical heterogeneity limited meta-analysis for some specific functional outcomes. Patients who did not receive MFMIs were more likely to be discharged to a nursing staff facility (odds ratio = 1.53; 95% confidence interval, 1.23 to 1.90). No effect of MFMI on all-cause mortality was observed, and adverse events were rare and unlikely attributed to nonpharmacological interventions. Conclusions: Data from a small number of studies suggest MFMIs reduce the likelihood of discharge to a nursing staff facility in acutely hospitalized older adults; however, this effect may not be driven via improvements in physical function. Standardized evaluation methods to determine MFMI effectiveness appear indicated to assist decision-making regarding their implementation in clinical practice. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effects of multicomponent exercise program (Vivifrail) in patients with hip fracture after surgery over the gait pattern, balance, and muscle strength in the lower body. Methods: Thirty-seven patients operated of hip fracture were enrolled between 2017 and 2018. Results: There were significant improvements (P < .05) in the Short Physical Performance Battery, Tinetti balance, and gait scales, improving the independence measured with the Barthel Index and reducing the risk of falls. Conclusions: The multicomponent exercise improved with minimally obnoxious changes and the ability to balance and walk in older people who have undergone surgery for hip fracture, and also the number of responders who meet the minimally detectable changes is 70.27%. [ABSTRACT FROM AUTHOR]

Objective: This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. Design: A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel index at discharge (controlling for Barthel index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. Results: Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. in contrast, general cognitive abilities, depression, medical co- morbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. Conclusions: For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are com-mon in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. [ABSTRACT FROM AUTHOR]

Background: Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. Sleep deprivation is a significant risk factor for developing delirium and is a patient dissatisfier. Problem: An internal assessment revealed that up to 25% of all patients on medical-surgical units had a diagnosis of delirium while in the hospital. Approach: An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions. Outcomes: Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P = .0005; CI, 0.05 to 0.67) with ongoing sustainment. Conclusions: Implementation of a dedicated period to sleep was associated with a reduction in delirium and increased patient satisfaction for quietness at night. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Background: The presence of cognitive impairment (CI) among hospitalized older adults (aged 85 years and older) could interfere with the identification and treatment of other important symptoms experienced by these patients. Little is known, however, about the nursing care provided to this group. Contrasting the nursing care provided to patients with and without CI may reveal important insights about symptom treatment in the CI population. Objective: The aim of this study was to examine the relationship of CI to nursing care provided and length of stay for hospitalized older adults using standardized nursing data retrieved from electronic health records. Methods: We conducted a comparative secondary data analysis. A data set of standardized nursing plan of care data retrieved from electronic health record data of nine units at four hospitals was analyzed. The plan of care data for this study were previously transformed into one of eight categories (family, well-being, mental comfort, physical comfort, mental, safety, functional, and physiological care). Fisher exact tests were used to compare the differences in the nursing care for hospitalized older adults with and without CI. Mixed-effects models were used to examine associations of patient's cognitive status and nursing care, and cognitive status and length of stay. Results: We identified 4,354 unique patients; 746 (17%) had CI. We observed that older adults with CI were less likely to receive physical comfort care than those without CI for seven of nine units. Older adults' cognitive status was associated with the delivery of mental comfort care. In addition, a worsening in cognitive status was associated with an increase in length of stay for older adults with CI. Discussion: Older adults with CI appeared to be undertreated for symptoms of pain when compared to those without CI across units. There is a need for further research to improve symptom recognition and management for this population. The presence of CI was associated with variation in nursing care provided and length of stay. Future studies that include the analysis of nursing data merged with elements stored in the electronic health record representing the contributions of other health professions are expected to provide additional insights into this gap. [ABSTRACT FROM AUTHOR]

Background: Despite the role caregivers play in the delivery of care, the interactions and training methods used with caregivers during an inpatient stay are not clear. Purpose: The purpose was to examine interactions and trainingmethods used with caregivers during hospital care. Methods: A mixed-methods case study was conducted. Observations were summarized and interviews were analyzed using thematic analysis. Results: The frequency of caregiver engagement varied at different points in the care process but was highest among observations during the stay care point. Providers were most commonly using written and verbal instructions to train caregivers. Three themes emerged from the interviews and were described to be both facilitators and barriers to caregiver involvement: experience, time, and relationship. Conclusions: High-quality person and family-centered care depends upon coordinated efforts among health care systems, providers, patients, and caregivers. Future caregiver initiatives should aim to decrease disengagement, increase assessment, and broaden the use of training methods. [ABSTRACT FROM AUTHOR]

With a growing population of transgender-identified elders in the United States, their unique spiritual end-of-life needs are coming to light. This article presents a case study of a hospice volunteer who used skillful means as an artist to help a transgender-identified woman express her spirituality in the last 6 months of her life. After data analysis, 4 themes emerged related to the expression of spirituality by lesbian, gay, bisexual, transgender, and queer (LGBTQ) elders at end of life. The themes that emerged included (1) the human element in advocacy for spiritual care, (2) the importance of safe spaces for reflection and meditation, (3) the importance of skillful means to work with LGBTQ people, and (4) acknowledgement of gender identity as a spiritual need. This case study serves as a springboard to advance research into the end-of-life needs of LGBTQ elders and the ways in which members of the hospice team can support spiritual care and alleviate suffering for this population. [ABSTRACT FROM AUTHOR]

The article presents questions and answers related to Delirium prevention and management in hospitalized older adults topics includes nonpharmacologic interventions and pharmacologic strategies, such as deprescribing medications and scheduling antipsychotics.

Objective: The aim of the study was to identify the risk factors for mobility decline among hospitalized older patients early. Design: This is a prospective cohort study. A total of 875 older patients were divided into two groups: older patients with and without mobility decline. The mobility level was measured using the item of functional mobility in the Geriatric Screening for Care 10. The change in mobility between admission and discharge was determined as the dependent variable. There were a total of 18 independent variables, which consisted of three demographic variables, 10 most problematic domains of geriatric care, and five other health-related variables. A multivariable logistic regression analysis was conducted to identify the risk factors for mobility decline during hospitalization. Results: Of the 875 older patients, 135 (15.4%) experienced mobility decline during hospitalization. The multivariable logistic regression analysis revealed female sex, cognitive impairment, and underweight as the risk factors for mobility decline during hospitalization. Conclusions: The identified risk factors should be considered to identify patients at a risk of mobility decline early and to provide targeted interventions, which can prevent mobility decline. [ABSTRACT FROM AUTHOR]

Background: Rapid qualitative assessment was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobility for hospitalizeD older vEterans (STRIDE), mandated by a regional Department of Veterans Affairs health care system office (Veterans Integrated Service Network [VISN]). Methods: Data were collected from 6 hospital sites via semistructured interviews with key informants, observations of telephone-based technical assistance, and review of VISN-requested program documents (eg, initial implementation plans). An overarching framework of actionable feedback for VISN leadership and specification of locally initiated implementation strategies, using the Expert Recommendations for Implementing Change (ERIC) compilation, was used. Actionable feedback was shared with VISN leadership 1 month after the initiative. Results: ERIC implementation strategies identified were as follows: (1) promoting adaptability--A sites had physical therapists/kinesiotherapists instead of assistants walk patients; (2) promoting network weaving--strengthening nursing and PT/KT partnership with regular communication opportunities or a point person was important for implementation; (3) distributing educational materials--2 sites distributed information about STRIDE via e-mail and in person; and (4) organizing clinician implementation team meetings--3 sites used interdisciplinary team meetings to communicate with the clinical staff about STRIDE. Conclusion: This qualitative study sheds light on early experiences with implementing STRIDE; the results have been instructive for ongoing implementation and future dissemination of STRIDE, and the approach can be applied across contexts to inform implementation of other programs. [ABSTRACT FROM AUTHOR]

Background: In older adults hospitalized with heart failure (HF), cognitive impairment is associated with increased hospital readmission and mortality risk. There is no consensus on an objective, scalable method of cognitive screening in this population. Objective: The aim of this project was to determine the feasibility, test-retest reliability, and convergent validity of the Processing Speed Test (PST), a test of information processing, attention, and working memory administered on an iPad in older adults hospitalized with HF. Methods: Patients hospitalized with HF (n = 30) and age-, sex-, and education-matched controls (n = 30) participated in the study. To determine test-retest reliability, the PST was administered on an iPad on 2 occasions, separated by 12 to 48 hours. The Symbo lDigit Modalities Test was administered at the first testing time point to determine convergent validity. Results: Test-retest reliability of the PST was 0.80 and 0.92 in individuals with HF and controls, respectively. Convergent validity was 0.72 and 0.90 for individuals with HF and controls, respectively. Time to complete the PST was similar for both individuals with HF and controls (<5 minutes). Conclusion: The iPad-based deployment of the PST was a feasible, reliable, and valid cognitive screen for older adults hospitalized with HF. Using a tablet-based self-administered cognitive screen in older adults with HF provides a method of cognitive assessment that is amenable to widespread clinical utilization. [ABSTRACT FROM AUTHOR]

Objectives: Rapid response teams are groups of healthcare providers that have been implemented by many hospitals to respond to acutely deteriorating patients admitted to the hospital wards. Hospitalized older patients are at particular risk of deterioration. We sought to examine outcomes of older patients requiring rapid response team activation.Design: Analysis of a prospectively collected registry.Setting: Two hospitals within a single tertiary care level hospital system between 2012 and 2016.Patients: Five-thousand nine-hundred ninety-five patients were analyzed. Comparisons were made between older patients (defined as ≥ 75 yr old) and younger patients.Interventions: None.Measurements and Main Results: All patient information, outcomes, and rapid response team activation information were gathered at the time of rapid response team activation and assessment. The primary outcome was in-hospital mortality, analyzed using multivariate logistic regression. Two-thousand three-hundred nine were older patients (38.5%). Of these, 835 (36.2%) died in-hospital, compared with 998 younger patients (27.1%) (adjusted odds ratio, 1.83 [1.54-2.18]; p < 0.001). Among patients admitted from home, surviving older patients were more likely to be discharged to a long-term care facility (adjusted odds ratio, 2.38 [95% CI, 1.89-3.33]; p < 0.001). Older patients were more likely to have prolonged delay to rapid response team activation (adjusted odds ratio, 1.79 [1.59-2.94]; p < 0.001). Among patients with goals of care allowing for ICU admission, older patients were less likely to be admitted to the ICU (adjusted odds ratio, 0.66 [0.36-0.79]), and less likely to have rapid response team activation during daytime hours (adjusted odds ratio, 0.73 [0.62-0.98]; p < 0.001).Conclusions: Older patients with in-hospital deterioration requiring rapid response team activation had increased odds of death and long-term care disposition. Rapid response team activation for older patients was more likely to be delayed, and occur during nighttime hours. These findings highlight the worse outcomes seen among older patients with in-hospital deterioration, identifying areas for future quality improvement. [ABSTRACT FROM AUTHOR]

Objectives: Critical illness is often associated with painful procedures and prolonged opioid infusions, raising the concern that chronic opioid users may be exposed to escalating doses that are continued after hospital discharge. We sought to assess patterns of opioid use after intensive care among elderly patients identified as chronic opioid users prior to hospitalization.Design: Population-based cohort study.Setting: All adult ICUs in the province of Ontario, Canada.Participants: Elderly patients (> 65 yr) admitted to ICUs between April 2002 and March 2015 who also survived to day 180 after hospital discharge, identified as chronic opioid users prior to hospitalization.Exposure: Chronic opioid use in the year before hospital admission, as well as a filled opioid prescription with a duration covering the day of hospital admission.Measurements and Main Results: The primary outcome was the proportion of patients who filled an opioid prescription with a duration covering day 180 after hospital discharge; secondary outcome was the difference in morphine equivalent daily dosage at day 180 after discharge compared with the amount prescribed prior to hospital admission. Of 496,985 elderly admissions to ICUs, 19,584 (3.9%) were chronic opioid users before hospitalization who also survived to day 180 after hospital discharge. The median daily dose of opioid prescriptions filled before hospital admission was 32.1 mg morphine equivalent (interquartile range, 17.5-75.0 mg morphine equivalent). Among these survivors, 63.3% had at least one opioid prescription filled with a duration covering day 180; 22.0% had filled prescriptions for a higher daily morphine equivalent dose compared with prehospitalization, 19.8% were unchanged, 21.5% had a lower dose, and 36.7% had no prescription filled. The majority of reduction was in prescriptions for codeine and oxycodone.Conclusions: Among chronic opioid users, hospitalization with critical illness was not associated with substantial increases in opioids prescribed in the 6 months following hospitalization. [ABSTRACT FROM AUTHOR]

Background and purpose: The elderly population is expected to double by 2050 with falls and hospitalizations due to adverse drug events having a major effect on health and quality of life. With the release of the revised 2015 American Geriatrics Society (AGS) Beers criteria, usage of potentially inappropriate medications (PIMs) should be studied to determine their effect on falls and hospitalizations in frail populations such as those in assisted living facilities. Methods: This quality improvement project used a retrospective chart review on residents from a purposive sample of two assisted living facilities in Northern Virginia. Residents were aged $65 and lived at the facility for at least 6 months and were not enrolled in hospice and/or palliative care or living in the dementia unit. The 2015 AGS Beers criteria were used to evaluate the effect of PIMs on falls and hospitalization rates. Conclusions: This project did not find statistical significance between PIMs and falls (p = .276). A favorable, but not statistically significant trend, was noted between PIMs and hospitalizations (p = .079). Implications for practice: Understanding the effect of PIMs on falls and hospitalizations could help providers improve prescribing practices for the elderly populationwho are at the greatest risk for potential adverse effects frompolypharmacy. [ABSTRACT FROM AUTHOR]

Background and purpose: Early rehabilitation is important for frail older adults due to reduced reserve capacity and physical fitness. To facilitate individualized rehabilitation programs, we need tools to make it possible to assess physical fitness in relation to frailty, instead of chronological age. The purpose of this study was, in a Swedish context, to describe measures of physical fitness in hospitalized frail older adults in relation to their degree of frailty. Methods: This was a cross-sectional study. A total of 408 frail older adults, mean age 86.6 years (75-99 years), in need of emergency medical inpatient care, were included in the NÄLUddevalla (NU) hospital group in Sweden. During the hospital stay, physical fitness was assessed using 4 different tests: handgrip strength, the Timed Up and Go Test, 5-time sit-to-stand test, and 6-minute walk test. In the analyses, the physical fitness outcomes were related to the degree of frailty using the FRail Elderly Support ResearcH group screening instrument and previously used cutoffs or age-related reference values for older adults. Results and Discussion: This study showed that most hospitalized frail older adults perform far lower than previously described age-related reference values relating to physical fitness. An increased degree of frailty contributes to reduced physical fitness in tests assessing strength and endurance. Conclusions: A frail-related screening instrument may be useful in the evaluation of physical fi tness in hospitalized frail older adults and may facilitate the development of realistic, individualized rehabilitation programs benefi cial to an early start on the emergency medical ward. [ABSTRACT FROM AUTHOR]

Background: Older hospitalized adults with hearing impairment are vulnerable to adverse outcomes. These patients are at risk for being labeled confused, experiencing a loss of control, experiencing heightened fear and anxiety, and misunderstanding the plan of care. Objective: This qualitative study sought to assess the hospital experience of older adults with hearing impairment in order to formulate suggestions for improving nursing care. Methods: Open-ended interviews were conducted with eight participants, ages 70 to 95 years, who were identified as having a hearing impairment and were admitted as inpatients to a midwestern medical center. Results: Through data analysis, three common themes emerged: health care communication difficulties, passivity and vulnerability, and frustration with family. Conclusions: Nurses will benefit from having a deeper understanding of the hospital experience of this vulnerable population. Efforts to address their needs can be accomplished through the following nursing actions: assess, accommodate, educate, empower, and advocate. [ABSTRACT FROM AUTHOR]

Background: Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied. Purpose: The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan. Methods: A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. Results: Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants. Conclusions: This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is often used during the hospitalization of elderly people. However, this procedure is associated with adverse outcomes; therefore, it is necessary to be aware of the circumstances that promote restraint use, such as the perceptions of professionals who use it. Objectives: The purpose of the research was to determine the situations in which nursing staff considered the use of physical restraint as most important and to evaluate the possible associations with the sociodemographic and professional variables. Methods: A descriptive cross-sectional multicenter study was carried out in 52 units of eight Spanish acute hospitals. A survey of registered nurses and nursing assistants was used to collect data related to sociodemographic characteristics, experience, training in restraint use, and the Perception of Restraint Use Questionnaire (PRUQ)--which assesses the perceived importance of reasons frequently given for the use of physical restraint. Results: The sample comprised 508 registered nurses and 347 nursing assistants. Almost all (98%) had used physical restraint, and 82%thought their training in the use of physical restraint was insufficient. Nursing assistants scored higher than registered nurses (p < .005, d = .68) on PRUQ total score and individual item scores, suggesting they thought the factors were more important in restraint use. Both registered nurses and nursing assistants considered restraint as most important in the prevention of falls and in the removal of medical devices such as intravenous lines and urinary catheters. Associations between PRUQ total score and other variables (unit type, sociodemographic factors, hospital) were nonsignificant. Discussion: The professionals considered restraint as very important in preventing safety problems. In order to improve the quality of care, it is essential to identify the factors that can have an effect on the application of physical restraint. Educational programs are of fundamental importance, but to be more effective in reducing the use of physical restraint, they should address commonly held views on rationale for restraint use and be accompanied by institutional policies promoting a restraint-free environment. [ABSTRACT FROM AUTHOR]

Purpose: Aging is associated with a gradual loss of muscle mass, which some have suggested to be accelerated by short periods of muscle disuse due to medical illness. We investigated the effect of hospitalization on skeletal muscle mass in acutely ill geriatric patients with focus on the relationship between systemic inflammatory marker C-reactive protein (CRP) and changes in muscle mass, as well as the influence of resistance training upon muscle mass. Method: Unilateral leg press resistance exercise was conducted daily during the hospital period. Outcomes included changes in whole body and regional lean mass, maximal voluntary contraction of the knee extensors, leg extension power, and functional performance. Activity level was measured using ActivPAL accelerometers, and CRP levels were obtained from blood samples. Results: Sixteen subjects completed the study (eight men and eight women, age = 84.8 ± 1.9 yr, mean ± SE). Lean mass at the midthigh region of the trained leg increased by 2.4% ± 1.1% (P < 0.05) after the intervention period. There was a negative association between changes in midthigh lean mass of the trained leg and CRP (rs = -0.53, P < 0.05). Leg extension power increased significantly in both legs (P < 0.05), with no difference observed between legs. There were no changes in maximal voluntary contraction or functional performance. Conclusion: Muscle mass is not significantly lost during short-term hospitalization of relatively high functioning and active geriatric patients although our findings are potentially affected by changes in hydration status. Resistance training during hospitalization increases skeletal muscle mass, and patients with high levels of systemic inflammation demonstrate less ability to increase or preserve muscle mass in response to resistance training during illness. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. Design: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department. Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (ActivPAL). Results: Results in DEMMI and 30-s CST gradually improved (P < 0.05), whereas handgrip strength remained unchanged (P > 0.05). Larger functional improvements were observed in patients with "high" compared to "low" and "moderate" activity level (P < 0.05). Changes in DEMMI score correlated with changes in 30-s CST (P < 0.05); however, changes in DEMMI score and 30-s CST were more likely to occur in patients with a low versus high functional level, respectively. Conclusions: Functional performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay of less than 14 days, with larger improvements in patients with high activity level. The DEMMI test and the 30-s CST seem to be complementary to each other when evaluating functional changes in a geriatric hospital population. [ABSTRACT FROM AUTHOR]

This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the perceptions of acute care medical patients in 11 Bon Secours Mercy Health System community hospitals in Virginia and Ohio of barriers to mobility. Topics covered include the characteristics of patients included in the study, the results of the correlational analysis of patient characteristics, symptom burden, and attitudes toward mobility, and predictors of diminishing attitudes toward mobility.

Background: A potentially important factor yet to receive adequate study is the time when hospital falls occur. A prior study conducted before the system-wide introduction of preventive measures revealed a biphasic 24-hour pattern of hospital falls with major peak in the morning. Objectives: The purpose was to identify the temporal patterning of falls among elderly patients in hospitals with comprehensive fall prevention programs in place. Methods: A 4-year observational study was conducted by the local health authority in the five nonteaching public hospitals located in the province of Ferrara, Italy. Fall records involving patients of ages ≥65 years hospitalized in the general medical departments were used. Single- and multiple-component cosinor (time series) analyses were used to explore 24-hour, weekly, and annual patterns of falls. Results: A total of 763 falls were experienced by 709 different elderly hospitalized patients. Falls typically took place in the patient's hospital room (72%) and bathroom (23%). Major causes were patient instability (32%) and accident (13%), and most occurred when not wearing footwear (45%) or wearing inappropriate sling-back open-toe shoes (39%). Falls happened while standing (39%), while seated (21%), and while getting into, out of, or laying in bed (32%)--either with the bed rails raised or lowered. Fall outcome usually involved no injury (58%) or slight injury (35%), but some (7%) were disabling. Fall occurrence was higher during the night (46%) compared to either the morning (30%) or afternoon (24%) shift. Patterns across 24 hours were characterized by a single major and one or more minor peaks that seemed to be associated with a variety of scheduled patient, hospital, and nursing activities. Multiple-component cosinor analysis identified significant (p < .05) prominent day-night patterns according to fall location, patient position, cause, injury severity, and type of footwear. Falls were more frequent, but not significantly so, on Fridays, Sundays, and Mondays compared with Tuesdays, and were more frequent in winter and spring (p = .003). Discussion: Documentation by cause and circumstance of these moderate- to high-amplitude temporal patterns in hospital falls of elderly patients advances the knowledge of fall epidemiology by identifying the times of day, week, and year and nursing shifts of elevated risk that is of critical importance to improving hospital patient safety programs. [ABSTRACT FROM AUTHOR]

In the acute care setting, pain, agitation, and delirium (PAD) often occur as interrelated parts of a syndrome rather than as separate entities. Because the three facets of PAD may be similar in presentation, it is often difficult for clinicians to recognize the syndrome and to assess and treat it. The challenge is particularly great in older patients, who are more likely than their younger counterparts to have such comorbid conditions as dementia, which may impair the ability to report pain, or age-related physiologic changes that may affect the metabolism and clearance of certain medications. This article provides an overview of each aspect of PAD, discusses clinical considerations related to the assessment and treatment of the syndrome in older adults receiving acute care, and illustrates the application of published PAD guidelines through the use of a hypothetical patient scenario. [ABSTRACT FROM AUTHOR]

As the prevalence of Alzheimer disease and related dementias increases, dementia-related behavioral symptoms present growing threats to care quality and safety of older adults across care settings. Behavioral and psychological symptoms of dementia (BPSD) such as agitation, aggression, and resistance to care occur in nearly all individuals over the course of their illness. In inpatient care settings, if not appropriately treated, BPSD can result in care complications, increased length of stay, dissatisfaction with care, and caregiver stress and injury. Although evidence-based, nonpharmacological approaches to treating BPSD exist, their implementation into acute care has been thwarted by limited nursing staff expertise in behavioral health, and a lack of consistent approaches to integrate behavioral health expertise into medically focused inpatient care settings. This article describes the core components of one evidence-based approach to integrating behavioral health expertise into dementia care. This approach, called STAR-VA, was implemented in Veterans’ Health Administration community living centers (nursing homes). It has demonstrated effectiveness in reducing the severity and frequency of BPSD, while improving staff knowledge and skills in caring for people with dementia. The potential for adapting this approach in acute care settings is discussed, along with key lessons learned regarding opportunities for nursing leadership to ensure consistent implementation and sustainability. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to investigate the relationship between nurse caring behavior scores and the use of the "Get to Know Me" poster in hospitalized older adults. BACKGROUND: Hospitalization can be an isolating experience for the patient and his/her family. Within the high-tech healthcare arena, the focus of the "patient/ person" can be lost. The art of caring and basic communication between the nurse and person is essential to nursing. METHODS: This was a 2-group quasi-experimental pretest-posttest design using the intervention of the Get to Know Me poster and measurement of nurse caring behaviors with the Caring Assessment of Care Givers (CACG) instrument. RESULTS: Nurse caring behavior scores of the nurses in the experimental group who utilized the Get to Know Me poster were significantly higher on the total CACG scores as well on the subscale dimensions of maintaining belief, being with, and doing for than those of the nurses forming the control group. CONCLUSIONS: The results of this research indicated that interventions that focus the attention on the person and emphasize patient-focused care can enhance nurse caring behaviors and strengthen the patient-nurse relationship. [ABSTRACT FROM AUTHOR]

Background: High prevalence rates of delirium have been found in intensive care units (ICUs), ranging from 20%to 80%. The development of delirium may prolong length of stay, impair cognition, and result in placement in a nursing home for the patient. Purpose: There is a lack of research focused on the aging population, so the purpose of this study was to establish the incidence rate of delirium among ICU elderly patients and to identify its risk factors. Methods: An observational design with repeated measures was used. Subjects older than 65 years who had been admitted to the ICU within 24 hours were recruited. The Confusion Assessment Method for the Intensive Care Unit and Richmond Agitation--Sedation Scale were used twice a day to identify subjects experiencing delirium by RA. The demographic data, history of illness, Acute Physiology and Chronic Health Evaluation II scores, and laboratory data of the participants were recorded. Results: Ninety participants were included from a medical ICU. The incidence rate of delirium was 75.6% (n = 68). Average age was 78.28 T 7.6 years; Acute Physiology and Chronic Health Evaluation II scores ranged from 7 to 35. Most participants were diagnosed with respiratory failure (73.3%), and 86.76% of participants developed delirium within 24 hours. The most frequently experienced type of delirium was the mixed subtype (47.05%); the second most frequently experienced was hypoactive next. The risk factors were analyzed using logistic regression. The number of anesthetic analgesics used, total number of medications prescribed, duration of dehydration, use of corticosteroids before admissions, and shock were identified and explained 31.3% of variance. Conclusions/Implications for Practice: Delirium is a severe problem among elderly patients in the ICU. Healthcare professionals should pay more attention to elderly patients at greater risk for experiencing delirium. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Predictive models for falls, injury falls, and restraint prevalence were explored within nursing unit structures and processes of care. BACKGROUND: The patient care team is responsible for patient safety, and improving practice models may prevent injuries and improve patient safety. METHODS: Using unit-level self-reported data from 215 hospitals, falls, injury falls, and restraint prevalence were modeled with significant covariates as predictors. RESULTS: Fewer falls/injury falls were predicted by populations with fewer frail and at-risk patients, more unlicensed care hours, and prevention protocol implementation, but not staffing per se, restraint use, or RN expertise. Lower restraint use was predicted by fewer frail patients, shorter length of stay, more RN hours, more certified RNs, and implementation of fall prevention protocols. CONCLUSION: In the presence of risk, patient injuries and safety were improved by optimizing staffing skill mix and use of prevention protocols. [ABSTRACT FROM AUTHOR]

The article presents a study to search for the associated factors that impact the nutritional status of hospitalized geriatric patients in Taiwan, because malnutrition is prevalent among hospitalized geriatric patients. The result of the study indicated that significant predictors of malnutrition are cognitive status, concomitant complicities and care status.

The article discusses the occurrence of falls in hospitalized older adults, and proposed nursing interventions for preventing falls. Topics covered include the identified causes and implications of falls, the highlights of various studies conducted to develop nursing interventions and strategies for preventing falls, and the noted nursing implications of falls. It also discusses the need to improve hospital and clinical policies relating to falls.

Although it increases the risk of poor outcomes and raises the costs of care, cognitive impairment in hospitalized older adults is often neither accurately identified nor well managed. In conducting a two-phase, comparative-effectiveness clinical trial of the effects of three nursing interventions— augmented standard care, resource nurse care, and the transitional care model— on hospitalized older adults with cognitive deficits, a team of researchers encountered several challenges. For example, in assessing potential subjects for the study, they found that nearly half of those assessed had cognitive impairment, yet many family caregivers could not be identified or had no interest in participating in the study. One lesson the researchers learned was that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as address the complex process of managing postdischarge care. [ABSTRACT FROM AUTHOR]

The development of interdisciplinary interventions to improve resilience in older persons should be a priority. The small body of empirical studies demonstrates the effectiveness of these interventions, but the evidence is not adequate to recommend consensus and evidence-based approaches to practice. The 4 objectives of this article, based on major studies since 2000, are as follows: (1) to describe the origin of interdisciplinary interventions for resiliency in the development of geriatric assessment and treatment units; (2) to review programs targeting mental health to improve resilience in community and primary care populations; (3) to examine programs targeting physical health problems and functional impairments; and (4) to recommend research priorities for future research and clinical programs. [ABSTRACT FROM AUTHOR]

Background: Delirium increases mortality and length of stay among hospital inpatients. Little is known about the incidence of delirium among inpatients receiving care in internal medicine nursing units in Spain. Objectives: The aim of this study was to estimate frequency of delirium onset among internal medicine inpatients and identify factors associated with delirium onset using nursing records and administrative databases. Methods: Retrospective cohort study of 744 patients hospitalized in an internal medicine department in October 2010 and January, May, and October 2011. Data concerning occurrence of delirium, age, gender, living in a nursing residence, Barthel Index of activities of daily living, Norton scale for pressure ulcer risk, intravenous fluid therapy, urinary catheterization, presence of pressure ulcers, major diagnostic category at discharge, length of stay, and mean weight in the diagnosis-related group were gathered for each patient. Backward stepwise logistic regression was used to identify factors associated with onset of delirium. Results: Ninety-seven (13%) patients experienced delirium. Factors associated with delirium were age (OR = 1.03, 95% CI [1.01, 1.06]), Barthel Index (OR = 0.99. 95% CI [0.98, 0.99]), and urinary catheterization (OR = 2.00, 95% CI [1.19, 3.68]). Conclusion: Increased age and presence of a urinary catheter were associated with increased onset of delirium, whereas higher levels of independence in activities of daily living were protective. [ABSTRACT FROM AUTHOR]

Background--Complex antithrombotic therapy (CAT) prescribed to elderly patients increases the risk of gastrointestinal bleeding. We quantified upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations in a national cohort of elderly veterans prescribed CAT. Methods and Results--Veterans ≥60 years of age prescribed anticoagulant-antiplatelet, aspirin (ASA)-antiplatelet, ASA-anticoagulant, or triple therapy (ie, TRIP, anticoagulant-antiplatelet-ASA) were identified from the national pharmacy database (October 1, 2002 to September 30, 2008). Prescription-ill data were linked to Veteran Affairs and Medicare encounter files, each person-day of follow-up was assessed for CAT exposure, and outcomes were defined by using diagnostic code algorithms derived following chart abstraction. Incidence density ratios (compared with the reference category of no CAT) and survival analysis was conducted. Among 78 133 veterans (98.6% white; mean age, 72.3 [standard deviation 7.7]), 64% were prescribed ASA-antiplatelet and anticoagulant-antiplatelet and 6% were prescribed TRIP. The incidence of UGIE was 20.1/1000 patient-years, and the incidence of LGIE was 70.1/1000 patient-years. ASA-anticoagulant and TRIP were associated with the highest incidence of transfusion and hospitalization. A 40% to 60% increased risk of UGIE was observed with all strategies. LGIE was 30% higher with anticoagulant-antiplatelet, and transfusion increased with ASA-anticoagulant (hazard ratio, 6.1; 95% confidence interval, 5.2-7.1) and TRIP (hazard ratio, 5.0; 95% confidence interval, 4.2-5.8). Increased risk of hospitalization was noted with all strategies. The number needed to harm for UGIE or LGIE ranged from 52 to 65 and 15 to 23, respectively. The number needed to harm for hospitalization was 39 (anticoagulant-antiplatelet), 34 (ASA-anticoagulant), 67 (ASA-antiplatelet), and 45 (TRIP) patients. Conclusions--Among elderly patients, CAT-related LGIE and UGIE are clinically relevant risks resulting in increased hospitalizations and transfusions. [ABSTRACT FROM AUTHOR]