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Objective: The unplanned transfers (UT) from post-acute intermediate care facilities, are associated with adverse outcomes for patients, and a significant cost to the system. We present a practical protocol and the design of an intervention study aimed at reducing avoidable UT from a geriatric post-acute rehabilitation setting to acute care hospitals., Patients and Methods: A quasi-experimental non randomized study. The intervention consists in: 1) protocol for early detection of symptoms in order to conduct a pro-active management of decompensation; 2) an advanced care planning structured protocol for the acute decompensations. We will compare the intervention group with a parallel and a historical cohort for demographic, functional, cognitive, comorbidity and social variables., Outcome: number of UT to acute care hospitals., Discussion: This is a quasi-experimental study, focused on everyday care practice that intends to assess the impact of multi-disciplinary and multi-factorial intervention to reduce UT from a post-acute rehabilitation unit. We expect that the project results will be useful for future randomized and controlled studies., (Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: Early transfer to intermediate-care hospitals, low-tech but with geriatric expertise, represents an alternative to conventional acute hospitalization for selected older adults visiting emergency departments (EDs). We evaluated if simple screening tools predict discharge destination in patients included in this pathway., Design, Setting, and Participants: Cohort study, including patients transferred from ED to the intermediate-care hospital Parc Sanitari Pere Virgili, Barcelona, during 14 months (2012-2013) for exacerbated chronic diseases., Measurements: At admission, we collected demographics, comprehensive geriatric assessment, and 3 screening tools (Identification of Seniors at Risk [ISAR], SilverCode, and Walter indicator)., Outcome: Discharge destination different from usual living situation (combined death and transfer to acute hospitals or long-term nursing care) versus return to previous situation (home or nursing home)., Results: Of 265 patients (mean age ± SD = 85.3 ± 7.5, 69% women, 58% with acute respiratory infections, 38% with dementia), 80.8% returned to previous living situation after 14.1 ± 6.5 days (mean ± SD). In multivariable Cox proportional hazard models, ISAR >3 points (hazard ratio [HR] 2.06, 95% confidence interval [95% CI] 1.16-3.66) and >1 pressure ulcers (HR 2.09, 95% CI 1.11-3.93), but also continuous ISAR, and, in subanalyses, Walter indicator, increased the risk of negative outcomes. Using ROC curves, ISAR showed the best prediction among other variables, although predictive value was poor (AUC = 0.62 (0.53-0.71) for ISAR >3 and AUC = 0.65 (0.57-0.74) for continuous ISAR). ISAR and SilverCode showed fair prediction of acute hospital readmissions., Conclusions: Among geriatric screening tools, ISAR was independently associated with discharge destination in older adults transferred from ED to intermediate care. Predictive validity was poor. Further research on selection of candidates for alternatives to conventional hospitalization is needed., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Unplanned acute hospital transfers (AT) from post-acute or long-term care facilities represent critical transitions, which expose patients to negative health outcomes and increase the burden of the emergency departments that receive these patients. We aim at determining incidence and risk factors for AT during the first 30 days of admission at an intermediate care and rehabilitation geriatric facility (ICGF)., Design and Setting: Prospective cohort study conducted in an ICGF of Barcelona, Spain. Sociodemographics, main diagnostics, and variables of the comprehensive geriatric assessment were recorded at admission. At the moment of AT, suspected diagnostic motivating the transfer was recorded. Multivariable Cox proportional hazard models were used to evaluate the association between admission characteristics and AT., Results: We included 1505 patients (mean age + standard deviation = 81.31 ± 7.06, 65.7% women). AT were 217 (14.4%, 5.64/1000 days of stay) resulting in only 81 final hospitalizations (37% of AT), whereas 136 patients returned to ICGF after visiting the emergency department. Principal triggers of AT were cardiovascular, falls/orthopedic, and gastrointestinal problems. Being admitted to ICGF after a general surgery [hazard ratio (HR) 1.88; 95% confidence interval (CI) 1.21-2.94; P < .001], taking 8 or more drugs at admission (HR 1.98; 95% CI 1.37-2.86; P < .001) and living with a partner (HR 1.35; 95% CI 1.01-1.81; P = .05) were independently associated with a higher risk of AT., Conclusions: In our sample, clinical and social characteristics at admission to an ICGF are associated with a higher risk of AT. A relevant proportion of AT is not admitted to the acute hospital, suggesting perhaps some avoidable AT. Identification of risk factors might be relevant to design strategies to reduce AT., (Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the prevalence of benzodiazepine (BZD) prescription and the factors related to prescribing them in the elderly in the community, in an acute general hospital (AH) and in a convalescence geriatric unit (CGU)., Material and Methods: Retrospective study of 334 CGU inpatients discharged from an AH. A comprehensive geriatric assessment included functional and cognitive evaluation before hospitalization, at admission and at discharge from CGU (Barthel index, Lawton index and Folstein Mini-Mental State Examination), as well as comorbidity (Charlson index), polypharmacy and social situation. The percentage of benzodiazepine prescriptions at the different healthcare levels was compared and their related factors were evaluated (Chi-squared test)., Results: The prevalence of benzodiazepine prescriptions in the community was 23.6%, and being female and polypharmacy were related factors to prescribing at this level. During AH admission, this proportion increased up to 38.6%, and after CGU admission decreased to 21.,9%. Factors related to prescription in AH were, being female, polypharmacy and osteoarticular-fracture related diagnosis, and in CGU, being female and polypharmacy., Conclusions: The prevalence of benzodiazepine prescribing was high among elderly people at every healthcare level (community, AH and CGU), and polypharmacy was one of the significant factors associated with prescribing. This prescribing was increased during AH admission due to a medical or surgical process., (Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.)

Background: When reactivations of chronic diseases cannot be managed at home, postacute intermediate-care geriatric units (ICGUs) might provide adequate and specialized support to primary care, based on comprehensive geriatric assessment and rehabilitation., Objectives: To explore if direct admission to ICGUs of older adults with reactivated chronic diseases or acute common conditions superimposed to chronic diseases might be an alternative clinical pathway to conventional acute hospitalization followed by intermediate care rehabilitation., Methods: Quasiexperimental pilot study. We compared characteristics at admission and outcomes at discharge between two groups admitted to our ICGU: the first one admitted directly, and the second one admitted to complete treatment and rehabilitation after discharge from acute hospital., Results: Sixty-five patients from the same primary care area (mean age ± SD 85.6 ± 7.2, 66% women) were admitted to the ICGU for the same main diagnostics, mainly reactivation of heart failure and chronic obstructive pulmonary disease: 32 directly from home (DA) and 33 following acute hospital discharge (HD). Baseline clinical, functional, and social characteristics, as well as outcomes at discharge, including mortality and acute transfers, were comparable between groups. Global length of stay was significantly higher in HD, compared with DA (60.8 ± 26.6 vs 38.4 ± 23 days, P < .001)., Conclusions: From our preliminary results, direct admission to geriatric intermediate care units might represent a potential alternative to acute hospitalization for selected older patients., (Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Olive oil is an energy-dense food frequently consumed in south European countries with increasingly high obesity prevalence. Evidence of the impact of olive oil consumption on BMI and the risk of obesity is limited. We analyzed this association taking into consideration the problem of energy underreporting., Methods: Cross-sectional data on 6,352 Spanish adults were analyzed. Dietary intake was assessed using a validated food frequency questionnaire. Height and weight were measured., Results: Higher olive oil consumption was not associated with energy compensation in the overall diet. Olive oil consumption was positively associated (p < 0.004) with BMI in non-energy-adjusted multivariate linear regression models. Statistical significance of this association disappeared after controlling for energy intake in plausible energy intake reporters. The obesity risk increased for olive oil consumption of more than 2 tablespoons/day in both plausible energy intake reporters (odds ratio 1.30 (95% CI 1.01-1.70)) and energy intake underreporters (odds ratio 3.06 (95% CI 2.15-4.35)). This association was not significant after additional adjustment for energy intake (odds ratio 1.19 (95% CI 0.91-1.56)) in plausible energy intake reporters., Conclusion: Olive oil intake did not affect BMI and the risk of obesity after adjustment for total energy intake in plausible energy intake reporters. The lack of energy intake compensation for olive oil consumption might explain the positive associations in models not adjusted for energy., (Copyright © 2012 S. Karger GmbH, Freiburg.)