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BACKGROUND: The delivery of a high and consistent FIO2 is imperative to treat acute hypoxemia. The objective of this study was to analyze the effective inspired oxygen concentration delivered by different low-flow oxygen therapy systems challenged with different oxygen flows and respiratory patterns in an experimental lung model. METHODS: An adult lung model ventilated in volume control mode simulated different respiratory patterns to obtain mean inspiratory flow of 22.5, 30.0, 37.5, or 45.0 L/min. The oxygen concentration sampled inside the lung model by nasal cannula, simple face mask, non-rebreather mask, and double-trunk mask above nasal cannula tested at oxygen flows of 10, 12.5, and 15 L/min was quantified. The 3 masks were sealed tight onto the model's airway opening. They were also tested with standardized leaks to determine their clinical performance. RESULTS: All oxygen delivery systems delivered higher oxygen concentration with increasing oxygen flows, regardless of the respiratory pattern. Within each device, the increase in inspiratory flow decreased oxygen concentration when using nasal cannula (P = .03), the simple face mask (P = .03), but not the non-rebreather mask (P = .051) nor the double-trunk mask (P = .13). In sealed condition, the double-trunk mask outperformed the non-rebreather mask and simple face mask (P < .001); mean oxygen concentration was 84.2%, 68.5%, and 60.8%, respectively. Leaks amplified oxygen concentration differences between the double-trunk mask and the other masks as the oxygen delivery decreased by 4.6% with simple face mask (95% CI 3.1-6.1%, P < .001), 7.8% with non-rebreather mask (95% CI 6.3-9.3%, P < .001), and 2.5% with double-trunk mask (95% CI 1-4%, P = .002). With leaks, the oxygen concentration provided by the simple face mask and the non-rebreather mask was similar (P = .15). CONCLUSIONS: Lung oxygen concentration values delivered by the double-trunk mask were higher than those obtained with other oxygen delivery s

It is unclear whether the association between atrial fibrillation (AF) and intra-hospital mortality in patients aged 75 years and older is causal or not. This study aims (1) to describe the prevalence and clinical characteristics of AF in ≥75-year-old inpatients and (2) to study the association between AF and length of stay (LOS) and intra-hospital mortality. This retrospective cohort study includes consecutive patients aged ≥75 years admitted between January 2017 and December 2019 to a Belgian secondary hospital. Survival analysis was conducted on the whole dataset and a propensity score-matched dataset separately. Propensity score matching (PSM) was performed to account for the individual probability of having AF given a set of covariates. In 9,105 patients, 3,137 (34%) had a diagnosis of AF upon hospital admission. AF prevalence increased with age strata (from 29% to 38%), and Charlson Co-morbidity Index (from 28% to 57%). Intra-hospital mortality (20%) was higher in the AF group than in the AF-free group (25% vs 17%, p <0.001). The median LOS was 11 days and was shorter in those without AF (10 [4, 17] days) compared with those with AF (11 [5, 19], p <0.001). After PSM, AF was not associated with increased odds of LOS >10 days (odds ratio 1.08, confidence interval: 0.98 to 1.20, p = 0.13). The risk of intra-hospital death for patients with AF remained higher compared with those without AF (log-rank p = 0.0015 and hazard ratio 1.17; confidence interval: 1.04 to 1.32, p = 0.008). In conclusion, the prevalence of AF was high (34%) in inpatients aged ≥75 years and increased with age and co-morbidity burden. After PSM, patients with AF had a 17% higher risk of intra-hospital mortality than patients without AF.

Background. Decision making on transcatheter aortic valve replace- ment (TAVI) is challenging in older patients. The predictive value for mortality of the Clinical Frailty Scale (CFS) is unclear. This study analyzed risk factors of 2-year mortality in older patients undergoing TAVI. Methods: Retrospective cohort study of consecutive older patients (C 75 years) with a comprehensive geriatric assessment (CGA) who underwent TAVI at our university hospital between 2012 and 2019. The CFS was derived from the CGA: not frail (1–4), mildly frail5, moderately frail6or severely frail7. Predictors of two-year mortality were determined using multi-variable logistic regression, with several independent variables either scores (e.g. Euroscore.2, NYHA, Charlson, Lawton, Katz, MNA-SF, BMI) or co-morbidities (e.g. dementia, falls, diabetes, atrial fibrillation, congestive heart failure, severe renal failure). Results: The 345 patients (median age 87 years, 54% women) were not frail (31.6%), mildly frail (37.1%) and moderately/severely frail (31.3%). A trend was observed in 2-year mortality rates between frailty classes i.e. non-frail (23%), mildly frail (24%) and moder- ately/severely frail (30%). In multivariable analysis, two-year mortality rate was not associated with CFS but with four variables, namely, age (OR 1.08 per year, p = 0.02), atrial fibrillation (OR 2.34, p = 0.003), hemoglobin (OR 0.84, p = 0.037) and time-period (2017–2019 vs. 2012–2016: OR 0.46, p = 0.005). Conclusion: The CFS is insufficient to predict 2-year mortality in older patients undergoing a TAVI. Clinical frailty should therefore not preclude a TAVI in these patients. The strong association between atrial fibrillation and mortality should be further studied in this population.

Background High-flow oxygen therapy (HFOT) has been widely used as an effective alternative to invasive mechanical ventilation (IMV) in some critically ill patients with COVID-19 pneumonia. This study aimed to compare different tools, including the respiratory rate and oxygenation (ROX) index, to predict HFOT failure in this setting. Methodology This single-center retrospective observational study was conducted from September to December 2020 and assessed COVID-19 patients who required HFOT as the first treatment at admission; HFOT failure was defined as IMV use. Prognostic scoring tools were as follows: the Sequential Organ Failure Assessment (SOFA), Acute Physiology And Chronic Health Evaluation (APACHE) II, and Simplified Acute Physiology Score (SAPS) III scores; C-reactive protein; lung consolidation percentage on chest CT; mean partial pressure of oxygen in arterial blood (PaO)/fraction of inspired oxygen (FiO) ratio; and ROX index and modified ROX index, calculated using PaO instead of blood oxygen saturation, within the first 24 hours after admission to the intensive care unit (ICU). These scores were analyzed using a multivariate Cox proportional hazard model; optimal cutoffs were computed using the R system for statistical computing. Results The study enrolled 52 patients, 31 (60%) of whom experienced HFOT failure. The best predictors of HFOT failure measured 24 hours after HFOT initiation were as follows: PaO/FiO (threshold 123.6, sensitivity 87%, specificity 81%, hazard ratio [HR] 7.76, and 95% confidence interval [CI] 2.39-17.1); ROX index (threshold 5.63, sensitivity 68%, specificity 95%, HR 6.18, and 95% CI 2.54-13.4); and modified ROX index (threshold 4.94, sensitivity 81%, specificity 90%, HR 8.16, and 95% CI 3.16-21.5) ( < 0.001 for all). Conclusions Early assessment of the ROX index, modified ROX index, and PaO/FiO ratio can adequately predict, with high accuracy, HFOT failure in COVID-19 patients. Because thresholds remain debated and are still no

Background/Introduction: Atrial fibrillation (AF) affects 7.3–13.7% of community-dwelling patients aged 80 years or older. AF is related to a wide panel of complications among which an augmented risk of mortality, hospitalization, stroke, and heart fail- ure as well as cognitive decline. Intra-hospital prevalence and impact of those complications are not well-described in the elderly. Purpose: This study aims to analyse the prevalence of AF among patients older than 74 years and its association with intra- hospital death. Methods: Anonymized medical data from 7653 hospitalization stays of patients 75 years and older between 01/01/2019 to 31/ 12/2019 were extracted from the central ‘minimal medical summary’ from Jolimont Hospital. To consolidate data, variables were also extracted from the medical history from medical files. Results: Among 7670 hospital stays of patients 75 years and older, 671 (8.7%) deaths were recorded among which 324 (48%) had atrial fibrillation. AF was recorded in a total of 2492 (38%) hospital stays among which 324 (324/2492, 11%) deaths were recorded. Among studied variables, Age, Atrial Fibrillation, Hypertension, Oncologic diagnosis, and heart failure were strongly associated with mortality (p < 0.001). After adjusting for age and heart failure, AF remained significantly associated with in-hos- pital death (p 1⁄4 0.017, OR 1.23). Conclusion(s): This pilot study reports a very high prevalence of AF at 38.35%. Near half (48%) of the recorded deaths were concomitantly recorded with atrial fibrillation whereas the mortality rate during hospital stay among patients with atrial fibrilla- tion was 11.01%. The difference between the mortality rate of hospitalized patients with AF and without AF (11.01 vs. 7.34, p < 0.0001) was highly significant. AF was significantly related to in-hospital mortality even after adjusting for HF and age.

Background: It has been suggested that patients with atrial fibrilla- tion (AF) are sicker patients with poorer cardiovascular health thereby explaining higher morbidity and mortality following Transcatheter Aortic Valve Replacement (TAVR). This study aimed at investigating whether clinical frailty is associated to AF independently of cardio- vascular co-morbidities. Methods: Retrospective study of consecutive older patients (C 75 years) with comprehensive cardiac and geriatric assessments at our university hospital before a TAVR (2012–2019). Data were col- lected to allow the calculation of several scores: CHADS2, MNA-SF and clinical frailty scale (CFS). 2-year mortality was studied with Kaplan-Meier. Associations between AF pre-existing to TAVR, and frailty (CFS C 5) were addressed using uni- and multivariable logistic regression analyses. Results: Of the 345 patients (mean age 86 ± 4.4 years, 54% women), 129 presented with AF (37%) during the pre-TAVI assessment. Those patients with AF died more frequently within two years after TAVR (OR: 1.85, p = 0.014, Log-rang p = 0.017). In univariate analyses, AF showed a strong statistical association (p \ 0.01) with pulmonary hypertension (OR 3.49), pacemaker (OR 2.49), congestive heart failure (OR 2.17), CHADS2 score (OR 1.46, per unit), C 5 daily drugs (OR 2.84), frailty (OR 1.90) and albuminemia (OR 0.91, per g/L). In multivariate analysis, AF remained significantly associated (p\0.05) with ischemic disease (OR 0.58), CHADS2 score (OR 1.46, per unit) and clinical frailty (OR 1.74). Conclusion: Clinical frailty was associated to AF in older patients with severe aortic valve stenosis independently of cardiovascular co- morbidities, and may thereby participate in explaining the association between AF and mortality following TAVR.

BACKGROUND AND OBJECTIVE: Inappropriate prescriptions (IP) are common among hospitalized older adults. Reducing IP is a major and global challenge. Incorporating clinical decision support systems (CDSS) into electronical medical records across hospitals might be a good strategy to optimize prescription in hospitalized older patients. The aim of this study is to develop, implement and assess a CDSS based on STOPP/START (Screening Tool of Older People’s Prescription/Screening Tool to Alert to Right Treatment) Version 2 in order to reduce the number of potentially inappropriate prescriptions (PIP) among older patients. [...]

BACKGROUND AND OBJECTIVE: Interruptive clinical decision support (CDS) integrated to computerized prescriber order entry can alert physicians about potential risks and suggest suitable alternatives. Physicians bypass most of them, limiting their effectiveness. The study assesses the effects of conversion to a commercial electronic health record (EHR) (Epic®) on the use of drug alerts. [...]

With the improvement of life expectancy, the world faces increasing demands for care of older persons. In this manuscript, we define the characteristics of primary informal caregivers (PIC) of patients aged 75 years and older admitted to geriatric day hospitals (GDH) in Belgium. A PIC is defined as the person who most often provides care and assistance to persons who need to be cared for. We describe PIC socio-demographic characteristics, satisfaction, burden and wishes about caring; the type of assistance provided and received, their self-rated health, socio-demographic and medical characteristics of proxies, in particular the presence of behavioural disorders. We conducted a cross-sectional study in 25 GDH. Four hundred seventy-five PIC of patients ≥75 years and their proxies. PIC completed a questionnaire at the GDH assessing burden by Zarit Burden Index-12 (ZBI-12), self-rated health, social restriction due to caregiving and financial participation. We compared the characteristics of PIC with high and low burden, and the characteristics of spouses and adult children PIC. We also analyzed factors associated with a high burden in a multivariable logistic regression model. PIC were mainly women (72%), adult children (53.8%) and spouses (30.6%). The mean age was 64 ± 14 years for PIC and 84 ± 5 years for care recipients. PIC helped for most of Activities in Daily Living (ADL) and Instrumental ADL (iADL). The median ZBI-12 score was 10 [IQR 5-18]. In multivariable regression analysis, a high burden was positively associated in the total group with living with the relative (p = 0.045), the difficulty to take leisure time or vacation (p < 0.001), behavioral and mood disorders (p < 0.001;p = 0.005), and was negatively associated with bathing the relative (p = 0.017) and a better subjective health status estimation (p < 0.001). Primary informal caregivers, who were predominantly women, were involved in care for ADL and iADL. A high burden was associated with living wi

Older people are frequently exposed to polypharmacy, inappropriate prescribing, and adverse drug events. Two clinical processes can help geriatricians to optimize and increase the safety of drug prescriptions for older adults: medication reconciliation and medication review. Medication reconciliation provides the best possible medication history and identifies and resolves discrepancies in drug prescriptions. During the medication review, the best possible medication history is crosschecked against other data, including morbidities, patient’s preferences, or geriatric syndromes, to produce a personalized medication strategy. Alignment of treatment recommendations with patient preferences and goals through shared decision-making is particularly important in medication review. Medication reconciliation and medication review have proven to be effective, but their broad implementation remains difficult. Indeed, these procedures are time-consuming and require specific skills, coordination between different healthcare professionals, organizations and dedicated means. The involvement of geriatricians therefore remains essential for the successful implementation of medication reconciliation and medication review in geriatric settings and among frail older people.

Objectives: We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years. Design: A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided. Setting and participants: Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries. Measures: For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round. Results: Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs. Conclusion and implications: We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies.

Background An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. Aim To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients. Design Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed. Setting/participants Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals. Results In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only. The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs. Conclusions SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.

BACKGROUND: The delivery of a high and consistent fraction of inspired O2 (FiO2) is imperative to treat severe acute hypoxemia. [...]

Introduction La dysphagie touche 30% des patients admis en gériatrie aiguë, justifiant des adaptations des médicaments. Objectifs Mise en évidence des facteurs prédictifs des troubles de la déglutition (TD), corrélation de ceux-ci avec l’administration des médicaments par l’infirmier et évaluation de l’intérêt d’utiliser un dispositif médical facilitant l’ingestion des médicaments (DMF). Méthode Etude prospective incluant 70 patients (âge:86±6ans) admis dans un service de gériatrie entre juillet et septembre 2017. Cinq patients exclus: décès, dégradation sévère, sortie précoce, sonde nasogastrique sans prise orale de médicaments. Pour chaque patient, des données ont été recueillies: âge, lieu de vie, nombre total de médicaments oraux journaliers, échelle d’indépendance et cognitive (KATZ, LAWTON, MMSE). Les infirmiers ont évalué la facilité de prise des médicaments oraux et si nécessaire ont utilisé le DMF. En parallèle, une étude de la déglutition par la logopède a été menée. Discussion Sur 23% des 70 patients présentant des TD, 56% ont reçu du DMF. Les patients pour lesquels les infirmiers ont adapté la prise des médicaments avaient des TD (p=0,04). Nous observons une corrélation entre le niveau de dépendance (KATZ) et l’existence de TD (p<0,01) mais pas avec les autres échelles. L’observation d’une sécheresse buccale (p<0,01) ou d’un encombrement respiratoire (p<0,01) est associée à la présence de TD. Conclusion Les infirmières adaptent spontanément chez un patient dysphagique sur deux les administrations de médicaments. Les trois facteurs identifiés (dépendance élevée, sécheresse buccale, encombrement respiratoire) permettraient de cibler davantage les adaptations nécessaires.

OBJECTIVES: . To investigate the dose-response relationship between cardiovascular or psychotropic medication dosages and falling orthostatic blood pressure in geriatric inpatients. METHODS: . This cross-sectional study included 100 consecutive geriatric inpatients of a Belgian hospital. The end points were the maximum changes of systolic (sBP) and diastolic (dBP) blood pressure in a standing up position at one or three minutes. The dosages of six classes of vascular and five classes of psychotropic medications were expressed in terms of a proportion of defined daily doses (DDD). Bivariate and multivariate linear regression models were used. RESULTS: . The 100 geriatric patients (85 ± 5 years, 58 % women) received 7.7 ± 4 medications (mean DDD: vascular = 1.0, psychotropic = 0.74) on the day of an orthostatic test (lying sBP: 136 ± 21; dBP: 72 ± 14 mm Hg). In a standing position, sBP and dBP fell by 12 ± 17 and 11 ± 5 mmHg, respectively. At the individual level, BP change was not correlated with vascular DDD (sBP: p = 0.07, r2 = 0.04; dBP: p = 0.59; r2 = 0.004) nor with psychotropic DDD (sBP: p = 0.14, r2 = 0.02; dBP: p = 0.82; r2 = 0.0). In multivariate analysis, sBP drop was positively associated with age, diabetes, falls history, and number of medications, but not with the DDD of any of the medication classes, while dBP drop was positively associated with age, diabetes, stroke and anaemia, but again with the DDD of any of the medication classes. CONCLUSION: . No correlation was found between vascular and psychotropic medication dosages and the orthostatic blood pressure drop expressed as a continuous variable.

While functional decline is a common syndrome in geriatric medicine, the diagnosis of the underlying disease can be complex. We present a case of very late-onset systemic lupus erythematosus with fever, arthritis, lymphadenopathy, sicca syndrome, pleurisy, renal impairment and reversible functional and cognitive impairments. Prompt improvement was observed on prednisolone and hydroxychloroquine. LEARNING POINTS: Systemic lupus erythematosus (SLE) rarely occurs in octogenarian patients.In such oldest old patients, SLE may predominantly present with subacute cognitive and functional impairments.Low-dose treatment (prednisolone 7.5 mg/day and hydroxychloroquine 5 mg/kg/day) can reverse all SLE manifestations within 1 month.

Background: Little is known at the end of spring 2020 about in- hospital mortality (IHM) rates of older inpatients with COVID-19. Valid IHM rate calculations require a cohort study design with complete follow-up of all patients until hospital discharge. The aim of this study was to describe IHM rates in older patients (C 65 years) with COVID-19. Methods: Medical literature review from December 1, 2019 to June 17, 2020 of cohort studies including older patients (OP) with COVID- 19. The outcome was the patient’s vital status (death or alive) upon hospital discharge. Results: Twenty cohort studies selected and compared OP with the outcome at a certain hospital date (censoring bias). Four cohort studies completed the OP hospital follow-up, allowing calculation of the IHM rate. The IMH rate was 26.2% in 65 OP of the Pulmonary hospital in Wuhan [1], 34.5% in 55 OP of the Zhongnan hospital in Wuhan [2], 35.3% in 17 OP of the Dabieshan Medical Center in Huanggang [3] and 41.0%% in 117 OP of the Chelsea & Westminster hospital in London [4]. Pooling these four cohorts (710 COVID-19 inpatients), we calculated an average IHM rate of 35.4% [95% CI 29.6–41.3%] in the 254 OP, which was six times higher than the IHM rate of 5.9% [95% CI 3.6–8.2%] in the 456 younger patients. Conclusion: Few COVID-19 cohort studies which included older patients have reported the vital status of all patients at hospital dis- charge. Completed cohorts are deeply needed to determine the IHM rates in this high risk population.

INTRODUCTION: Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehensive geriatric assessment; however, malnutrition still remains under-recognized and under-managed. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. METHODS: A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Aging (EAMA, 2017-2019 class). RESULTS: Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n = 36, 100%), body mass index (n = 30, 85.7%), and low energy/food intake (n = 27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM = 0%, ASPEN = 0%; n = 9, ESPEN = 25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. CONCLUSIONS: Nutritional assessment is systematically performed in geriatrics; but differs widely among geriatricians and countries. Harmonizing guidelines with the new international consensus might provide best-evidence care for older people across Europe.

BACKGROUND: Older persons are at significant risk of drug-related admissions (DRAs). We previously demonstrated that 27% of hospitalizations in geriatric patients were associated with potentially inappropriate medicines (PIMs) and/or potential prescribing omissions (PPOs) identified by the Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria version 1 (v1). The updated STOPP/START criteria version 2 (v2) comprised a 31% increase in prescribing criteria. OBJECTIVE: As a secondary analysis of our study conducted in 2008, we aimed to compare the prevalence and types of DRAs identified by STOPP/START.v1 and STOPP/START.v2. METHODS: We applied the STOPP/START.v2 criteria to a subset of 100 consecutively admitted geriatric patients selected from our original cross-sectional study of 302 patients. A geriatrician and a pharmacist adjudicated whether the identified PIMs and PPOs were related to acute hospitalization. Admissions were defined as DRAs if the identified PIM(s) and/or PPO(s) were related to the main cause of admission or played a significant contributory role in the admission. RESULTS: The median patient age was 83 years and the median number of medications at home was 8. Compared with STOPP/START.v1, STOPP/START.v2 not only yielded more instances of inappropriate prescribing but also targeted significantly more PIMs and PPOs associated with preventable DRAs (23% vs. 40% of all admissions, p < 0.001). PIMs of fall-risk-increasing drugs, and PPOs of musculoskeletal and cardiovascular system drugs, were most frequently associated with DRAs. CONCLUSION: The latter instances of inappropriate prescribing with major clinical relevance warrant particular attention during medication review in older persons.

INTRODUCTION: Multimorbidity and polypharmacy are important risk factors for drug-related hospital admissions (DRAs). DRAs are often linked to prescribing problems (overprescribing and underprescribing), as well as non-adherence with drug regimens for different reasons. In this trial, we aim to assess whether a structured medication review compared with standard care can reduce DRAs in multimorbid older patients with polypharmacy. METHODS AND ANALYSIS: OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people is a European multicentre, cluster randomised, controlled trial. Hospitalised patients ≥70 years with ≥3 chronic medical conditions and concurrent use of ≥5 chronic medications are included in the four participating study centres of Bern (Switzerland), Utrecht (The Netherlands), Brussels (Belgium) and Cork (Ireland). Patients treated by the same prescribing physician constitute a cluster, and clusters are randomised 1:1 to either standard care or Systematic Tool to Reduce Inappropriate Prescribing (STRIP) intervention with the help of a clinical decision support system, the STRIP Assistant. STRIP is a structured method performing customised medication reviews, based on Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment criteria to detect potentially inappropriate prescribing. The primary endpoint is any DRA where the main reason or a contributory reason for the patient's admission is caused by overtreatment or undertreatment, and/or inappropriate treatment. Secondary endpoints include number of any hospitalisations, all-cause mortality, number of falls, quality of life, degree of polypharmacy, activities of daily living, patient's drug compliance, the number of significant drug-drug interactions, drug overuse and underuse and potentially inappropriate medication. ETHICS AND DISSEMINATION: The local Ethics Committees in Switzerland, Ireland, The Netherlands and Belgium approved this trial proto

AIMS: Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery. PATIENTS AND METHODS: All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery. RESULTS: We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01). CONCLUSION: Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into acc

BACKGROUND: Medication discrepancies, which are a threat to patient safety, can be reduced by medication reconciliation (MedRec). MedRec is a complex process that can be supported by the use of information technology and patient engagement. Therefore, the SEAMPAT project aims to develop a MedRec IT platform based on two applications. The application for the professionals is called: the "MedRec app". OBJECTIVE: In the present study, we aimed to describe the development and usability testing of the MedRec app, reporting results of a three iterations user-centered usability evaluation. METHODS: We used a three phase iterative user-centered study spread over 16 months. At each phase, the usability evaluation included several methods (observations, questionnaires, and follow-up discussions with participants) to collect quantitative and qualitative data in order to improve the current prototype and evolve to the next prototype. RESULTS: In total, 48 healthcare professionals (25 general practitioners and 23 hospital clinicians) participated to the MedRec app evaluation. There were 14, 32 and 5 participants for phases 1, 2 and 3 respectively. At each phase, many design modifications were done to strengthen usability. Concerning usability, participants considered the prototypes as an acceptable interface with a median System Usability Score of 73 at phase 2 and 75 at phase 3. Participants emphasized the need for improvements concerning workflow integration, usefulness and interoperability. CONCLUSION: The MedRec app was perceived as being useful, usable and satisfying. However, further improvements are required in several usability aspects. Our study demonstrates the importance of conducting usability assessments before investing time and resources in a large study evaluating the effect of an eMedRec approach on clinical outcomes. Our findings may also increase the chances of acceptability and sustained use over time by clinicians.

Older people use more drugs than any other age group. The prescription strategy constitutes a major challenge. Polypharmacy, inappropriate prescribing and drug-related problems in older people are important problem of public health as a link exists with significant morbidity and mortality and with a large waste of health resources. The main target is the balance between an unsustainable number of different prescription drugs to treat various chronic diseases and the failure to take preventive measures in these older patients. In this review, the difficulties in prescribing in the older population and the identification, prevention and optimization of inappropriate prescribing and drug related problems in older people are respectively discussed. Medication reconciliation, medication review, tools for detection of potentially inappropriate prescribing, use of health information technology, adherence optimization patient-tailored pharmacotherapy en judicious drug cessation) are highlighted as a part of collaborative and integrative approaches.

Medicatiereconciliatie zorgt ervoor dat een correcte en gedetailleerde medicatielijst van de patiënt op een consistente manier wordt overgedragen tijdens overgangsmomenten in de zorg.1 Deze volledige en nauwkeurige lijst van de huidige medicatie van een patiënt komt tot stand door samenwerking in de zorg en maakt het mogelijk om geneesmiddelgerelateerde discrepanties aan te pakken. Verschillende onderzoeksteams hebben applicaties of apps ontwikkeld waarmee patiënten hun medicatielijsten kunnen documenteren.2 Deze apps zijn meestal standalone of gekoppeld aan een enkele informatiebron en vaak ontwikkeld in de Verenigde Staten, waar het gezondheidssysteem, de setting en de cultuur sterk verschillen van Europa. In Wallonië ging daarom het SEAMPAT-project van start: dit is een multidisciplinair onderzoeksproject gericht op de ontwikkeling van een elektronisch medicatiereconciliatieproces (eMedRec). Het project wil patiënten actief betrekken bij dit proces met behulp van een ‘patiëntenapp’, alsook zorgverleners in de eerste en tweede lijn hierin ondersteunen met de ‘MedRec-app’.3,4 Beide apps zijn verbonden met Réseau Santé Wallon, het Waalse e-gezondheidsnetwerk.

info:eu-repo/semantics/nonPublished