Search

Aim: Frailty results from age‐associated declines in physiological reserve and function and is prevalent in older people. Our aim is to examine the association of the Hospital Frailty Risk Score (HFRS) with adverse events in older patients hospitalized with community‐acquired pneumonia (CAP) and hypothesise that frailty is a comparable predictor of outcomes in CAP versus traditional severity indices such as CURB‐65. Methods: Retrospective review of electronic medical records in patients ≥65 years with CAP admitted to a tertiary hospital from 1 January to 30 April 2021. Patients were identified using ICD codes for CAP and categorized as high risk (>15), intermediate risk (5–15) and low risk (<5) of frailty using the HFRS. Results: Of 429 patients with CAP, 53.8% male, mean age of 82.9 years, older patients (85 vs. 79.7 years, P < 0.001) were at higher risk of frailty. Using the HFRS, 47.6% were deemed at high risk, 35.9% at intermediate risk, and 16.6% at low risk of frailty. Multivariate logistic regression shows that HFRS was more strongly associated (≥7 days, OR 1.042, CI 1.017–1.069) than CURB‐65 (OR 0.995, CI 0.810–1.222) with long hospital length of stay (LOS), while CURB‐65 (Confusion, Urea >7mmol/L, Respiratory rate >30, Blood pressure, age => 65 years old) was more strongly associated with mortality at 30, 90 and 365 days, compared with the HFRS. Comparing the values for the area under the receiver operator characteristic curve, the HFRS was found to be a better predictor of long LOS, while CURB‐65 remains a better predictor of mortality. Conclusions: Patients with high risk of frailty have higher healthcare utilization and HFRS is a better predictor of long LOS than CURB‐65 but CURB‐65 was a better predictor of mortality. Geriatr Gerontol Int 2024; 24: 135–141. [ABSTRACT FROM AUTHOR]

Background. Hospitalised older patients with coronavirus disease 2019 (COVID-19) have an increased risk of poor health outcomes. We aimed to determine the associations of length of stay (LOS) with frailty status and disease severity among older patients admitted to a community treatment facility (CTF) in Singapore. Methods. Medical records of consecutive patients admitted to the CTF were retrospectively reviewed. Data retrieved included demographics, frailty, LOS, 30-day readmission, disease severity, and functional statuses on admission and at discharge. Results. In total, 96 older patients (mean age, 80.3 years) were included. According to the Clinical Frailty Scale (CFS), 26.0% were robust (CFS 1-3), 27.1% were mildly frail (CFS 4-5), and 46.9% were moderately/ severely frail (CFS 6-9). Compared with the robust and mildly frail groups, the moderately/severely frail group had more severe COVID-19 cases (p=0.033), longer LOS at the CTF (p=0.005), and fewer patients discharged home (p=0.01). Greater disease severity was associated with poorer frailty status (p=0.033), worsening of functional status at discharge (p=0.02), higher International Severe Acute Respiratory and emerging Infection Consortium score (p=0.031), and receipt of <2 doses of COVID-19 vaccine (p=0.005). Risk factors for longer LOS at the CTF and overall LOS were basic ADL–assisted status on admission (p=0.09 and p=0.017, respectively), fully dependent status on admission (p=0.043 and p=0.002, respectively), presence of infective changes on chest X-ray (p=0.027 and p=0.003, respectively), and receipt of <2 doses of COVID-19 vaccine (p=0.007 and p=0.005, respectively). Conclusions. Risk factors for longer LOS in older patients with COVID-19 were basic ADL–assisted status and fully dependent status on admission, presence of infective changes on chest X-ray, and receipt of <2 doses of COVID-19 vaccine. High-risk patients should be identified through assessments of these characteristics. Identification of risk factors for longer LOS can help guide medical decisions and optimise healthcare resource utilisation. [ABSTRACT FROM AUTHOR]

Objective: To determine if the recurrence rates of BPPV in older adults were lower in the vitamin D-treated group as compared to placebo groups., Study Design: Double-blinded randomized control placebo trial., Setting: A single-centre study., Methods: Double-blinded randomized controlled trial design with 12 months follow-up. Vitamin D3 deplete participants were randomized into treatment (Group A) or placebo groups (Group B). Treatment group received 13 weeks of 2000 IU vitamin D3 followed by 1000 IU for the next 13 weeks. Patients who were replete were allocated to a control group (Group C) for observation and follow up. All groups had dietary interventions for vitamin D3 and calcium., Results: Results showed an 87% reduction in recurrence rates of BPPV in the treatment group (Group A), with 0.75 fewer clinical episodes per 1 person-year as compared to placebo (Group B). Time to first recurrence was also significantly longer in Group A. There was no statistically significant difference between Group A and C in both recurrence rates and dizziness handicap scores., Conclusions: This clinical trial has laid the foundation to expand the investigation of vitamin D as standard of care treatment in BPPV patients in future phase IIb and III studies., Summary: A reduction in BPPV episodes in older adults has implications on fall risk, as dizziness from BPPV may cause falls. With fewer BPPV episodes and longer time to recurrence, seniors may have better postural stability and hence reduced risk of falls., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)