Association between social isolation and outpatient follow-up in older adults following emergency department discharge

ObjectivesFollow-up with outpatient clinicians after discharge from the emergency department (ED) reduces adverse outcomes among older adults, but rates are suboptimal. Social isolation, a common factor associated with poor health outcomes, may help explain these low rates. This study evaluates social isolation as a predictor of outpatient follow-up after discharge from the ED.Materials and methodsThis cohort study uses the control group from a randomized-controlled trial investigating a community paramedic-delivered Care Transitions Intervention with older patients (age≥60 years) at three EDs in mid-sized cities. Social Isolation scores were measured at baseline using the PROMIS 4-item social isolation questionnaire, grouped into tertiles for analysis. Chart abstraction was conducted to identify follow-up with outpatient primary or specialty healthcare providers and method of contact within 7 and 30 days of discharge.ResultsOf 642 patients, highly socially-isolated adults reported significantly worse overall health, as well as increased anxiety, depressive symptoms, functional limitations, and co-morbid conditions compared to those less socially-isolated (p<0.01). We found no effect of social isolation on 30-day follow-up. Patients with high social isolation, however, were 37% less likely to follow-up with a provider in-person within 7 days of ED discharge compared to low social isolation (OR:0.63, 95% CI:0.42–0.96).ConclusionThis study adds to our understanding of how and when socially-isolated older adults seek outpatient care following ED discharge. Increased social isolation was not significantly associated with all-contact follow-up rates after ED discharge. However, patients reporting higher social isolation had lower rates of in-person follow-up in the week following ED discharge.     

Patterns and correlates of depression in hospitalized older adults

Depression is often associated with illness or injury requiring acute hospitalization, particularly in older adults. We sought to determine patterns of change in depressive symptoms in older adults from hospitalization to 3 months post discharge and to examine factors associated with depressive symptoms 3 months after discharge. The study included 197 patients aged 65 years or older hospitalized with an acute medical illness. Sociodemographic and clinical measures, including depressive symptoms using the Center for Epidemiologic Study—Depression (CES-D) scale, were collected during the inpatient stay and at 3 months post discharge. Mean age was 75.3 ± 7.5 (±S.D.) years, 59% of the participants were female, 61% unmarried, and 72% had a high school education or more. High depressive symptoms (i.e., CES-D ≥ 16) were reported in 37% at admission. Of the 8% depressed at follow-up, 81% were also depressed at admission; 19% were new cases of depression. Depressive symptoms 3 months post-hospitalization were significantly associated with follow-up daily living skills (p = 0.001) and social support (p < 0.0001). Patients with persistent depressive symptoms make up the majority of post-hospitalization depression cases. Post-hospitalization social support and daily living skills appear to be important in the management of follow-up depressive symptoms.     

Risk of Social Isolation among Older Patients: What Factors Affect the Availability of Family,Friends, and Neighbors upon Hospitalization?

Objectives: To examine the prevalence of social isolation among older patients admitted to a hospital, and the effects of sociodemographic and health-related factors on the availability of their family, friends, and neighbor networks.

Methods: Analyses are based on interviews with a sample of 2,449 older patients admitted to an urban academic medical center in the United States. A nine-item version of Lubben’s Social Network Scale was developed and used to assess the availability of different social networks.

Results: About 47% of the sample was at risk of social isolation. The oldest old and non-White older adults showed greater risk. The availability of family networks was associated with age, sex, marital status, and prior hospitalization; friend networks with age, race, education, prior hospitalization, and functional limitations; neighbor networks with race, education, marital status, and functional limitations.

Conclusions: The risk of social isolation and the availability of social support for hospitalized older adults varies by both patient and network characteristics. Health professionals should attend to this risk and the factors associated with such risk.

Clinical Implications: By assessing the availability of various types and frequency of support among older patients, health professionals can better identify those who may need additional support after discharge. Such information should be used in discharge planning to help prevent unnecessary complications and potential readmission.     

Impact of hospital admission on functional and cognitive measures in older subjects

IntroductionHospital admission is frequently a major health transition for older adults, related with physical and mental disability that may persist after hospital discharge. We aimed to describe changes in physical and cognitive status in hospitalized older subjects, both during hospital admission and 3 months after hospital discharge, and to search for risk factors of impairment in physical and cognitive function.MethodsRandomized sample of all patients over 65 years admitted during a 5-month period, both for urgent or elective care. Basic and instrumental ADL and mental status were assessed on admission, at hospital discharge, and 3 months after discharge. Predictors of physical and mental disability were assessed.ResultsHundred and ninety-nine patients, mean age 75.9 years, were included. At hospital discharge, 16.5% of them had suffered a meaningful decrease in basic ADL, 24.6% in instrumental ADL, and 30.2% in cognitive tests. Three months later, 12.1% of those not lost or dead still reduced ability to perform basic ADL, 21.1% in instrumental ADL, and 35.2% had reduced cognitive scoring. In multivariate analysis, admission to surgical departments and discharge to a nursing home were related to loss of basic ADL; urgent admission and being widowed were related to loss of instrumental ADL; and older age, urgent admission, polypharmacy, and nursing home admission were related to reduced cognitive performance.ConclusionsPhysical and cognitive status change with hospitalization and after hospital discharge in older subjects. Some risk factors can be identified that predict these changes and allow for specific targeting of patients for preventive interventions.     

Hospital readmission risks in older adults following inpatient subacute care: A six-month follow-up study

BackgroundHigh rates of unplanned hospital readmissions are a burden on healthcare systems and individuals. This study examined factors at, and after initial hospital discharge and their associations with unplanned hospital readmission for older adults up to six months post-discharge from subacute care.MethodsOlder subacute care patients were surveyed prior to discharge, and assessed monthly post-discharge for six months. Data included the Geriatric Depression Scale, Phone-Fitt sub-scales, Friendship Scale, modified Lubben Social Network Scale, unplanned hospital readmission, self-reported physical capacity and falls in the last month were collected. Regression analyses were used to examine relationships between unplanned hospital readmission and variables that may predispose this outcome.ResultsParticipants (n = 311) completed the baseline assessment. N = 218 (70%) completed all at six-month post-discharge. Eighty-nine (29%) participants shared 143 readmissions. Those with cancer history (adjusted OR [95% CI]) (1.97 [1.15, 3.39]), neurological disease other than stroke (2.95 [1.32, 6.57]) and dependence on others to assist in bending tasks (1.94 [1.14, 3.29]) at initial discharge were associated with readmission within six months post-discharge. Those who fell in the last month (adjusted OR [robust 95% CI]) (2.28 [1.43, 3.64]), being less physical active (0.98 [0.96, 0.99]), and dependence on others in moving around residence (2.63 [1.37, 5.06]) after initial discharge were associated with a readmission in the next month within six months post-discharge.ConclusionTrials investigating the effectiveness of strategies to reduce falls, build physical capacity, increase physical activity level, and connection with health care services after discharge to prevent readmission are warranted.     

Association between changes in potentially inappropriate medication use and adverse outcomes during hospitalization in older adults: A retrospective study

PurposeTo evaluate the association between the change in the number of PIMs in older adults during hospitalization and adverse outcomes.MethodsThis retrospective cohort study was conducted in the internal medicine wards of a tertiary teaching hospital between May and December 2017. 3,460 patients (77.5±8.4 years, 60.4% male) were enrolled, and 206 patients died during hospitalization. PIMs were defined using the Beers Criteria as suggested by the American Geriatrics Society. Adverse outcomes studied were functional decline (a loss in 1 or more activities of daily living from admission to discharge), prolonged length of stay (LOS) (≥14 days), and mortality.Results2258 patients (65.3%) had increasing PIMs during hospitalization. They tended to be younger (77.0±8.3 versus 78.5±8.5 years, p<0.001) and had lower numbers of PIMs at admission (0.4±0.8 versus 0.8±1.1, p<0.001). Increasing PIM use was strongly associated with greater functional decline (aOR 1.36, 95%CI 1.01–1.67, p=0.005), prolonged LOS (aOR 3.47, 95%CI 2.71–4.44, p<0.001) and higher mortality rate (aOR 2.68, 95%CI 1.75–4.12, p<0.001), even after adjusting for all covariates. We observed a strong association between adverse outcomes and increasing PIMs in older adults during hospitalization (p for trend <0.001).ConclusionsOlder adults with increasing PIMs during hospitalization were at greater risk for functional decline, prolonged LOS, and mortality, especially in those with three or more PIMs. Further studies are needed to better understand the complex interactions and to evaluate the effectiveness of intervention programs to lower PIM number and improve discharge outcomes for patients who had increasing PIM use during hospitalization.     

Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study

BackgroundShort-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients.MethodsThis prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR ≤ 29 mL/min/1.73 m²; severe dementia; albuminemia ≪2.5 g/dL; hospital admissions in the six months before the index admission.ResultsOf 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08–0.19, p ≪ 0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12–3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22–4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22–3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39–7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12–5.44) were significantly associated with higher risk of three-month mortality.ConclusionsBedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.     

The Experience of Homebound Older Adults During the COVID-19 Pandemic

BackgroundHomebound older adults have heightened risks for isolation and negative health consequences, but it is unclear how COVID-19 has impacted them. We examine social contact and mood symptoms among previously homebound older adults during the COVID-19 pandemic.Design/SettingCross-sectional analysis using data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of aging in the USA.ParticipantsA total of 3,112 community-dwelling older adults in 2019 who completed the COVID-19 survey in the summer/fall of 2020.MeasurementsHomebound status was defined via self-report as rarely/never leaving home or leaving the house with difficulty or help in the prior month. We measured limited social contact during COVID-19 (in-person, telephone, video or email contacts <once/week), as well as loneliness, anxiety, and depression.ResultsAmong homebound older adults, 13.2% experienced limited social contact during COVID-19 vs. 6.5% of the non-homebound. Differences in social contact were greatest for contacts via email/text/social media: 54.9% of the homebound used this <once/week vs. 28.4% of the non-homebound. In adjusted analyses of those without limited social contact prior to the pandemic, the homebound had higher but not significantly different odds (OR 1.83; 95% CI 0.95–3.52) of limited social contact during COVID-19, with increased risk among the older individuals, those with dementia, and those in assisted living facilities. Of the homebound, 13.2% felt lonely every/most days during the pandemic vs. 7.7% of non-homebound older adults. Homebound and non-homebound older adults reported similar rates of increased loneliness, anxiety, or depression during COVID-19. Fewer homebound older adults learned a new technology during the pandemic (16.3%) vs. non-homebound older adults (30.4%).DiscussionIsolation among homebound older adults increased during COVID-19, partially due to differences in technology use. We must ensure that homebound persons have the connection and care they need including new technologies for communication during and beyond COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07361-9.KEY WORDS: Homebound, COVID-19, NHATS, Isolation, Social contact     

Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection

BackgroundThe clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00–1.02]), diabetes (1.54 [1.06–2.23]), and the need for inpatient dialysis (3.78 [2.23–6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05–1.11]) and Asian race (2.89 [1.27–6.61]) were significantly associated with mortality.ConclusionsAmong patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06924-0.KEY WORDS: COVID-19, mortality, re-admission, discharge     

Prescriptions for Potentially Inappropriate Medications from the Beers Criteria Among Older Adults Hospitalized for Heart Failure

BackgroundWe sought to better understand patterns of potentially inappropriate medications (PIMs) from the Beers criteria among older adults hospitalized with heart failure (HF). This observational study of hospitalizations was derived from the geographically diverse REasons for Geographic and Racial Differences in Stroke cohort.Methods and ResultsWe examined participants aged 65 years and older with an expert-adjudicated hospitalization for HF. The Beers criteria medications were abstracted from medical records. The prevalence of PIMs was 61.1% at admission and 64.0% at discharge. Participants were taking a median of 1 PIM (interquartile range [IQR] 0–1 PIM) at hospital admission and a median of 1 PIM (IQR 0–2 PIM) at hospital discharge. Between admission and discharge, 19.1% of patients experienced an increase in the number of PIMs, 15.1% experienced a decrease, and 37% remained on the same number between hospital admission and discharge. The medications with the greatest increase from admission to discharge were proton pump inhibitors (32.6% to 38.6%) and amiodarone (6.2% to 12.2%). The strongest determinant of potentially harmful prescribing patterns was polypharmacy (relative risk 1.34, 95% confidence interval 1.16–1.55, P < .001).ConclusionsPIMs are common among older adults hospitalized for HF and may be an important target to improve outcomes in this vulnerable population.     

Age Differences in Death and Suicidal Ideation in Anxious Primary Care Patients

Objectives: The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders.

Method: Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and/or social anxiety disorder (SAD).

Results: Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared with younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared with older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association.

Conclusions: Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults. Findings speak to the importance of physical health, social functioning, and MDD in this association.

Clinical Implications: When working with anxious older adults it is important to conduct a thorough suicide risk assessment and teach skills to cope with death and suicidal ideation-related thoughts.     

Environmental predictors of objectively measured out-of-home time among older adults with cognitive decline

BackgroundOlder adults with cognitive decline are vulnerable to various health problems. Going out of home for longer time could be beneficial for their health. Identifying modifiable predictors is essential for developing effective strategies that would increase time spent out-of-home by older adults. This study examined social and physical environmental predictors of objectively measured out-of-home time spent among older adults with cognitive decline.MethodsThis study was a secondary analysis of a randomized controlled trial (n = 147). Out-of-home time per day was measured by a Global Positioning System at baseline and 1-year follow-up. Baseline data of social environment (living alone, social network [Japanese version of the Lubben Social Network Scale]), objective physical environment (road network distance from each home address to nearest supermarket store, convenience store, and public transportation), and demographic factors (gender, age, education, driving status, fear of falling) were examined as potential predictors.ResultsAfter adjusting main effects of allocation group, time of measures, and their interactive effect, a mixed model showed that younger age (p = 0.044), current driving status (p = 0.039), and stronger social network (p = 0.003) were predictors of out-of-home time. However, none of the physical environmental factors significantly predicted outdoor time.ConclusionsThe present study found that social network was a predictor of objectively measured out-of-home time among older adults with global cognitive decline. A sufficient social network might help increase out-of-home time among them. However, the influence of physical environment on out-of-home time might be small.     

Social network as a predictor of hospital readmission and mortality among older patients with heart failure

BackgroundThis study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure.Methods and ResultsProspective study conducted with 371 patients, age 65 and older, admitted for heart failure–related emergencies at 4 Spanish hospitals. Social network was measured at baseline with a 4-item questionnaire that ascertained whether subjects were married, lived with another person(s), saw or had telephone contact with family members daily or almost daily, and were at home alone for less than 2 hours per day. Social network was deemed “high” where all 4 items were present, “moderate” where 3 were present, and “low” where 2 or fewer were present. Analyses were performed using Cox models, and adjusted for the main confounders. A total of 55% of patients had high or moderate social networks. During a median follow-up of 6.5 months, 135 (36.4%) patients underwent a first emergency rehospitalization and 68 (18.3%) died. Compared with patients with high social network, hospital readmission was more frequent among those who had moderate (hazard ratio [HR] 1.87; 95% confidence interval [CI] 1.06–3.29; P < .05) and low social networks (HR 1.98; 95% CI 1.07–3.68; P < .05). This relationship showed a positive dose-response (p for linear trend 0.042). The magnitude of this association was comparable to that of other important predictors of readmission, such as previous hospitalization. No relationship was observed between social network and death.ConclusionA very simple questionnaire measuring social network can identify patients with a higher short-term risk of hospital readmission.     

Comprehensive geriatric assessment in the emergency department for the prediction of readmission among older patients: A 3-month follow-up study

BackgroundOlder people present to the emergency department (ED) with distinct patterns and emergency care needs. This study aimed to use comprehensive geriatric assessment (CGA) surveying the patterns of ED visits among older patients and determine frailty associated with the risk of revisits/readmission.MethodsThis prospective study screened 2270 patients aged ≥75 years in the ED from August 2018 to February 2019. All patients underwent CGA. A 3-months follow-up was conducted to observe the hospital courses of admission and revisit/readmission.ResultsA total of 270 older patients were enrolled. The independent predictors of admission at initial ED visit were the risk of nutritional deficit and instrumental activities of daily living (IADL). In the admission group, the independent predictors of revisit/readmission were a fall in the past year and mobility difficulties. In the discharge group, the independent predictors of revisit/readmission were frailty and insomnia. Regardless if older patients were either admitted or discharged at the initial ED visit, the independent predictor of revisit/readmission for older patients was frailty.ConclusionOur study showed that frailty was the only independent predictor for revisit/readmission after ED discharge during the 3-month follow up. For ED physicians, malnutrition and IADL were independent predictors in recognizing whether the older patient should be admitted to the hospital. For discharged older ED patients, frailty was the independent predictor for the integration of community services for older patients to decrease the rate of revisit/readmission in 3 months.     

Patterns of social participation among older adults with disabilities and the relationship with well-being: A latent class analysis

AimLiving with a chronic condition or a disability at older age impacts social participation. Social connections and social activities seem interrelated leading to heterogeneous patterns in social participation. The aim of this study was to identify a typology in social participation among older adults with disabilities, and to relate this typology to their background characteristics and well-being measures.MethodsA total of 1775 older adults with disabilities or chronic conditions aged 65–97 were sampled from a nationwide panel study in the Netherlands. Social participation was assessed by various measures related to social connections, social informal activities, voluntary work, effort to increase social participation, and online social participation. A latent class analysis was carried out to identify a typology of social participation. Differences between these classes were explored with multinomial regression analyses and pairwise comparisons.ResultsFour classes were found: social withdrawers (22.5%, n = 399), proximate social dwellers (14.5%, n = 257), moderately active social dwellers (37.2%, n = 660) and pro-active social dwellers (25.9%, n = 459). Background characteristics, such as living alone and severity of disability, differed significantly among classes. Regarding well-being measures, it appeared that pro-active social dwellers had the most positive scores. Social withdrawers were most prone to reduced life satisfaction and health related quality of life and increased loneliness and experienced participation restrictions.ConclusionsA typology with four patterns based on a wide spectrum of social participation aspects in older adults with disabilities was identified. This typology may help to assess the risk for reduced well-being of older adults with disabilities.     

Risk factors for hospital readmission of elderly patients

BackgroundThe aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards.MethodsOf the 1178 patients aged 65 years or more and discharged from one of the 66 wards of the ‘Registry Politerapie SIMI (REPOSI)’ during 2010, 766 were followed up by phone interview 3 months after discharge and were included in this analysis. Univariate and multivariate logistic regression models were used to evaluate the association of several variables with rehospitalization within 3 months from discharge.ResultsNineteen percent of patients were readmitted at least once within 3 months after discharge. By univariate analysis in-hospital clinical adverse events (AEs), a previous hospital admission, number of diagnoses and drugs, comorbidity and severity index (according to Cumulative Illness Rating Scale-CIRS), vascular and liver diseases with a level of impairment at discharge of 3 or more at CIRS were significantly associated with risk of readmission. Multivariate logistic regression analysis showed that only AEs during hospitalization, previous hospital admission, and vascular and liver diseases were significantly associated with the likelihood of readmission.ConclusionsThe results demonstrate the need for increased medical attention towards elderly patients discharged from hospital with characteristics such as AEs during the hospitalization, previous admission, vascular and liver diseases.     

Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review

BackgroundSocial isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear.We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps.MethodsMedline, Embase and PsychInfo were searched from inception to the 28^th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927ResultsTwenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes.DiscussionOverall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.     

Survival of cognitively impaired older hospitalized patients at risk of malnutrition

IntroductionIn our society offering extra nutritional support is a standard for malnourished patients at admission to hospital. Whether cognitively impaired, older, hospitalized patients at risk of malnutrition would also benefit from this regimen is unknown. This study assesses their 3-months and 1-year survival. Prognostic characteristics predicting life expectancy are also studied.MethodsThis prospective cohort included cognitively impaired, older, hospitalized patients at risk of malnutrition (group 1: dementia, 2: delirium and 3: combination dementia/delirium) newly admitted to an acute hospital and receiving usual nutritional care. Data on survival was completed until 1 year after patients’ admission to the hospital. Possible prognostic characteristics predicting life expectancy data were collected.ResultsA cohort of 116 cognitively impaired, older, hospitalized patients at risk of malnutrition is described. Forty-nine patients were described to have dementia, 48 delirium and 19 a combination of dementia and delirium. Mean age was 81.6 years (SD 8.3, range 60–99 years). Fifty-five patients (47.4%) died within 1 year after hospital admission, 36 of them (31%) died within 3 months after hospital admission. There were no significant differences in survival between the three groups (P = 0.672). Patients with a malignancy or vascular disease were more likely to die within 3 months after discharge. Multivariate analysis showed malignant neoplasm, vascular disease and age as prognostic factors for mortality.ConclusionAlmost half of a cohort of malnourished, cognitive impaired, older, hospitalized patients died within 1 year after hospital admission. Patients with a malignancy or vascular disease were more likely to die early after discharge. It could be defended that in these patients, extra-nutritional support should no longer be offered as a standard.     

The Virtual Care Farm: A Preliminary Evaluation of an Innovative Approach to Addressing Loneliness and Building Community through Nature and Technology

ABSTRACT

Social relationships and engagement are critically important to well-being in later life and have been found to be strongly correlated with isolation and loneliness. Addressing loneliness has emerged in recent years as a grand challenge for our health and social care systems. In this article, the author introduces, describes, and provides a preliminary evaluation of the “virtual care farm” – an innovative union of high-technology online communities and low-technology care farms. Preliminary evaluation suggests that connecting older adults with nature and older adults with each other have the potential to facilitate social engagement, foster relationships, and address loneliness and isolation.