Geriatric Syndromes in Older Homeless Adults

BACKGROUND  

The average age of the US homeless population is increasing. Little is known about the prevalence of geriatric syndromes in older homeless adults.     

Length of Stay for Older Adults Residing in Nursing Homes at the End of Life

OBJECTIVES: To describe lengths of stay of nursing home decedents. DESIGN: Retrospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS: The mean age of decedents was 83.3±9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1–20) and 13.7±18.4 months, respectively. Fifty‐three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support.     

Effect of Dysphasia and Dysphagia on Inpatient Mortality and Hospital Length of Stay: A Database Study

OBJECTIVES: To examine the effect of dysphasia and dysphagia on stroke outcome. DESIGN: Retrospective database study. SETTING: Norfolk, United Kingdom. PARTICIPANTS: Two thousand nine hundred eighty‐three men and women with stroke admitted to the hospital between 1997 and 2001. MEASUREMENTS: Inpatient mortality and likelihood of longer length of hospital stay, defined as longer than median length of stay (LOS). Dysphagia was defined as difficulty swallowing any liquid (including saliva) or solid material. Dysphasia was defined as speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language. An experienced team assessed dysphagia and dysphasia using explicit criteria. RESULTS: Two thousand nine hundred eighty‐three patients (1,330 (44.6%) male), median age 78 (range 17–105), were included, of whom 77.7% had ischemic, 10.5% had hemorrhagic, and 11.8% had undetermined stroke types. Dysphasia was present in 41.2% (1,230) and dysphagia in 50.5% (1,506), and 27.7% (827) had both conditions. Having either or both conditions was associated with greater mortality and longer LOS (P<.001 for all). Using multiple logistic regression models controlling for age, sex, premorbid Rankin score, previous disabling stroke, and stroke type, corresponding odds ratios for death and longer LOS were 2.2 (95% confidence interval (CI)=1.8–2.7) and 1.4 (95% CI=1.2–1.6) for dysphasia; 12.5 (95% CI=8.9–17.3) and 3.9 (95% CI=3.3–4.6) for dysphagia, 5.5 (95% CI=3.7–8.2), 1.9 (95% CI=1.6–2.3) for either, and 13.8 (95% CI=9.4–20.4) and 3.7 (95% CI=3.1–4.6) if they had both, versus having no dysphasia, no dysphagia, or none of these conditions, respectively. CONCLUSION: Patients with dysphagia have worse outcome in terms of inpatient mortality and length of hospital stay than those with dysphasia. When both conditions are present, the presence of dysphagia appears to determine the likelihood of poor outcome. Whether this effect is related just to stroke severity or results from problems related directly to dysphagia is unclear.     

Effect of Hospitalists on Length of Stay in the Medicare Population: Variation According to Hospital and Patient Characteristics

OBJECTIVES: To assess how shorter length of stay (LOS) associated with hospitalist care than with care by other physicians varied according to patient and hospital characteristics and to explore whether these differences in LOS changed over time in the Medicare population. DESIGN: Retrospective cohort study using data from a 5% national sample of Medicare beneficiaries. SETTING: Hospital. PARTICIPANTS: To examine temporal trends, 1,981,654 Medicare admissions in 2001 to 2006 at 5,036 U.S. hospitals were used. To examine the influence of patient and hospital characteristics, 314,590 admissions in 2006 were used. MEASUREMENTS: Hospital LOS. RESULTS: In multivariable analyses controlling for patient and hospital characteristics, differences in LOS associated with hospitalist care increased from 0.02 fewer days in 2001/02 to 0.22 days in 2003/04 to 0.35 days in 2005/06. For 2006 admissions, differences in LOS were greater in older patients and patients with a higher diagnosis‐related group (DRG) weight. The differences were three times as great for medical as for surgical DRGs, with greater differences in LOS at nonprofit than for‐profit hospitals and at community than teaching hospitals. CONCLUSION: The shorter LOS associated with hospitalist care would appear to be greatest in older, complicated, nonsurgical patients cared for at community hospitals.     

Hospital Length of Stay in Patients with Non-ST-segment Elevation Myocardial Infarction

PurposeSubstantial heterogeneity in hospital length of stay exists among patients admitted with non-ST-segment elevation myocardial infarction. Furthermore, little is known about the factors that impact length of stay.MethodsWe examined 39,107 non-ST-segment elevation myocardial infarction patients admitted to 351 Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines hospitals from January 1, 2007-March 31, 2009 who underwent cardiac catheterization and survived to discharge. Length of stay was categorized into 4 groups (≤2, 3-4, 5-7, and ≥8 days), where prolonged length of stay was defined as >4 days.ResultsThe overall median (25^th, 75^th) length of stay was 3 (2, 5) days. Patients with a length of stay of >2 days were older with more comorbidities, but were less likely to receive evidence-based therapies or percutaneous coronary intervention. Among the factors associated with prolonged length of stay >4 days were delay to cardiac catheterization >48 hours, heart failure or shock on admission, female sex, insurance type, and admission to the hospital on a Friday afternoon or evening. Hospital characteristics such as academic versus nonacademic or urban versus rural setting, were not associated with prolonged length of stay.ConclusionPatients with longer length of stay have more comorbidities and in-hospital complications, yet paradoxically, are less often treated with evidence-based medications and are less likely to receive percutaneous coronary intervention. Hospital admission on a Friday afternoon or evening and delays to catheterization appear to significantly impact length of stay. A better understanding of factors associated with length of stay in patients with non-ST-segment elevation myocardial infarction is needed to promote safe and early discharge in an era of increasingly restrictive health care resources.     

Factor Structure of the Geriatric Depression Scale in Cognitively Impaired Older Adults

This study explores the factor structure of the 30-item Geriatric Depression Scale (GDS) obtained from a sample of elderly adults who were diagnosed with some level of cognitive impairment. Principle components analysis obtained a four-factor solution utilizing all 30 GDS items. The derived factors were labeled Dysphoria, Meaninglessness, Apathy, and Cognitive Impairment. Although differences in factor structure were noted, some commonalities exist between this and former factor solutions conducted on healthy elderly populations. Further validation of this factor structure in the cognitively impaired elderly may provide another point of validation during clinical assessment and research when attempting to distinguish between geriatric depression, the onset of dementia, or a combination of these conditions.