In a prospective observational study, influenza vaccination prevented hospitalization among older home care patients

OBJECTIVE: The aim of the study is (1) to describe the prevalence of vaccination against influenza in older home care patients and (2) to investigate the protective effect of influenza vaccination for hospitalization events. STUDY DESIGN AND SETTING: This is an observational study conducted in four large cohorts of elderly patients in home care during the 1998-1999, 1999-2000, 2000-2001, and 2001-2002 influenza seasons. We analyzed data from the Italian Silver Network Home Care project. A total of 2,201 patients were enrolled in the present study. The main outcome measures were prevalence of vaccination against influenza and the rate of hospitalization according to vaccination status and influenza season. RESULTS: The rate of influenza vaccination was around 48% of the studied sample. During the follow-up including the peak of influenza and the total influenza season, 412 subjects (40%) were hospitalized among vaccinated compared to 610 subjects (59%) among not vaccinated (P<0.001). After adjusting for age, gender, location of home care program, and all the variables significantly different between vaccinated and not-vaccinated subjects, vaccinated subjects were less likely to be hospitalized compared to not-vaccinated subjects (OR, 0.73; 95% CI 0.60-0.90). CONCLUSIONS: Vaccination against influenza has an important prognostic implication for frail geriatric patients living in the community.     

老年外科患者跌倒风险与营养状态的相关性

目的　调查老年外科患者的跌倒风险和营养状态,分析其相关性。方法　对2015年1至6月在北京医院普外科住院的年龄≥65岁的老年患者,应用Morse 跌倒评估量表评价其跌倒风险,应用人体物理测量指标、人体组分测定和营养风险筛查2002（NRS2002）等方法,评价老年患者的营养状态,并进行相关性分析。结果　共纳入383例患者,普通老年（65~79岁）患者314例,高龄（≥80岁）患者69例。与普通老年患者比较,高龄患者的握力［（24.53±8.09）kg比（30.57±8.48）kg］和4 m步速［（0.66±0.19）m/s比（0.84±0.20）m/s］显著降低（均P＜0.05）。高龄患者营养不足和营养风险发生率显著高于普通老年患者［15.9%（11/69）比7.0%（22/314）,56.5%（39/69）比38.2%（120/314）,均P＜0.05］。总体跌倒高度风险患者占33.9%（130/383）,高龄患者中跌倒高度风险者占44.9%(31/69),显著高于普通老年患者的31.5%（99/314）（P=0.036）;有跌倒高度风险的老年患者,其体质量指数［（22.33±1.82）kg/m2比(23.76±3.26)kg/m2］和握力［(24.95±8.56)kg比（30.72±8.39）kg］更低,营养风险发生率较高［46.9%（61/130）比38.7%（98/253）］（均P＜0.05）。结论　老年普外科住院患者存在较高的跌倒高度风险发生率,且与患者的营养状态相关联,应重视老年外科患者的护理和营养干预,预防跌倒发生,提高医疗质量。     

Selection bias in evaluating of influenza vaccine effectiveness: a lesson from an observational study of elderly nursing home residents

Selection bias is of critical concern in the study of influenza vaccine effectiveness when using an observational study design. This bias is attributable to the inherently different characteristics between vaccinees and non-vaccinees. The differences, which are related both to vaccination and signs of clinical disease as an outcome, may lead to erroneous estimation of the effectiveness. In this report, we describe how selection bias among elderly nursing home residents may lead to a spurious interpretation of the protective effect of influenza vaccine. Our results should be a lesson in the importance of regarding selection bias when assessing influenza vaccine effectiveness.     

Unwanted incidents during transition of geriatric patients from hospital to home: a prospective observational study

Background  

Geriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored the transition of the patients from hospital to home and four weeks after discharge in order to reveal unwanted incidents.     

Prevalence and predictors of influenza vaccination among frail, community-living elderly patients: an international observational study

The annual winter outbreak of influenza is one of the major cause of morbidity and mortality among frail elderly people. The aim of the present study was to identify prevalence and predictors of influenza vaccination in a large European population of frail and old people living in community. This was an observational study conducted in 11 European countries. We enrolled 3878 people 65 years and older already receiving home care services within the urban areas. All participants were assessed with the Minimum Data Set-Home Care (MDS-HC) instrument containing over 300 items, including socio-demographic, physical and cognitive characteristics of patients as well as medical diagnoses and medications received. A single question about the influenza vaccination status was used. The rate of influenza vaccination was around 59% of the studied sample. Significant geographical variations were evident in the prevalence of vaccination ranging from 31% of Prague (Czech Republic) to 88% of Rotterdam (The Netherlands). Overall, persons living alone were less likely to receive influenza vaccine as compared with those living with an informal caregiver (OR, 0.78; 95% CI 0.67-0.90). Similarly, cognitive impairment and presence of economic problems were associated with a lower likelihood of being vaccinated (OR: 0.69, 95% CI 0.59-0.80 and OR, 0.58; 95% CI 0.45-0.74, respectively). On the other hand, old age and comorbidity were associated with an higher probability of being vaccinated. In conclusion, more than 40% of subjects in this sample of home care patients in Europe did not receive influenza vaccination. Recommendations for influenza vaccination have not been adequately implemented.     

Non-typhoidal Salmonella bacteraemia in elderly patients: an increased risk for endovascular infections, osteomyelitis and mortality

SUMMARY Non-typhoidal Salmonella (NTS) is a common pathogen causing foodborne infections, bacteraemia, and extra-intestinal focal infections (EFIs) in humans. The study compares the clinical characteristics of elderly patients with NTS bacteraemia with those of young adults. Of 272 adults with NTS bacteraemia identified in this study, 162 (59·6%) were aged ?55 years. EFIs were observed in 36% of the 162 patients. The most common EFIs in the elderly patients (?55 years) was mycotic aneurysm, followed by pulmonary infections and bone/joint infections. Elderly patients more often had chronic heart, lung, renal and malignant diseases, had more EFIs, and a higher 30-day mortality rate. Independent factors of 30-day mortality in elderly patients were solid-organ tumour [adjusted odds ratio (aOR) 4·4, P=0·003], mycotic aneurysm (aOR 3·7, P=0·023) and shock (aOR 12·1, P<0·0001). HIV infection, autoimmune diseases, and receipt of immunosuppressive therapy were more often observed in young patients.     

The risk of falling in the elderly: a subjective approach

Accidental injury resulting from falling is the leading cause of death in the elderly population. In fact, 11% of the nation's annual injury deaths occur in this age group. A significant number of accidental deaths occur in resident institutions. A short-term risk index was constructed and validated for the purpose of predicting the risk of a fall in an elderly institutionalized population. The risk index was developed from expert insights, using Bayesian inference. A group of experts identified major risk factors that influence the chance of a fall and provided estimates of the impacts of the identified risk factors. Identification of risk factors, elicitation of experts' insights, construction of the subjective risk index, and validation of the index are discussed.     

Health hazards due to lead in an an accumulator-production plant of the Suhl district

In a lead accumulator producing factory the health risk of workers has been studied for more than 30 years by means of measuring the lead concentration at the working places for many years and by carrying out several exposure tests on the 22 workmen. At most workshop places the maximum allowable concentration was considerably exceeded. In many workmen the concentration of lead in the blood and the delta aminolevulinic acid in the urine were increased above the control values. Since 1955 six occupational diseases have been diagnosed which demonstrates the high health risk.     

Obligate nasal breathing in an elderly woman: increased risk of nasogastric tube feeding

The initiation of oronasal breathing when the nasal pathway becomes obstructed requires a complex interaction of neuromuscular responses which are normally present in all but very young infants. We describe an elderly lady who developed respiratory failure partially due to an inability to initiate oral breathing when her nasopharynx was compromised by a nasogastric tube.     

ICU老年患者医院感染经济学损失病例对照研究

目的 研究ICU老年患者医院感染所造成的直接经济损失.方法 采用回顾性调查和前瞻性监测的方法,调查2004年1月1日-2010年12月31 日某省级医院ICU的老年患者,共1152例,按条件1∶1配比,发生医院感染的患者为感染组,未发生医院感染的患者为对照组,比较两组的平均住院总费用、药费和住院天数的差异.结果 感染组住院总费用平均为91 710.67元/例,对照组住院总费用平均为32 021.51元/例;医院感染经济学损失平均为59 689.16元/例,感染组显著高于对照组(P＜0.05);感染组药费平均为48 717.45元/例,对照组药费平均为14 276.88元/例,增加的药费支出为34 440.57无/例,感染组显著高于对照组(P＜0.05);感染组住院天数平均为21.0d/例,对照组住院天数平均为7.5 d/例,每例延长住院天数13.5 d;感染组显著高于对照组(P＜0.05).结论 老年患者是医院感染的高危人群,老年患者医院感染造成的经济损失较大,应采取有效措施,降低老年患者医院感染发生率,减少医院感染经济损失.     

Hospitalization risk following admission to an academic nursing home

OBJECTIVES: Nursing home residents are at risk for experiencing acute illness and hospitalization early in nursing home stay. The objectives of this study were (1) to measure the probability of hospitalization over time from nursing home admission, and (2) to determine resident risk factors for early hospitalization. DESIGN: Prospective observational study. SETTING: 409-bed urban, not-for-profit academic nursing home. PARTICIPANTS: 204 consecutive newly admitted residents who did not previously reside in the nursing home. MEASUREMENTS: Demographic profile, chronic comorbidity, physical function, recent medical events, admission condition and anticipated length of stay were ascertained on admission to the nursing home. Hospitalization and acute illness were recorded each week after nursing home admission. Data were collected primarily by chart review except for acute illness, which was identified by nurse report and chart review according to previously established criteria. RESULTS: Subjects were 69% female and 62% white. The mean age was 83. The percentage of residents experiencing their first hospitalization peaked 2 and 7 weeks after nursing home admission and after 14 weeks plateaued at a low rate. The percentage with acute illness (commonly gastroenteritis, urinary tract infection, and pneumonia) paralleled that of hospitalization. In multivariate proportional hazards analysis, resident factors independently associated with early first hospitalization were atrial fibrillation (21% of subjects, 2.6 risk ratio), history of stroke (26%, 2.5), history of depression (25%, 1.9), absence of dementia (62%, 2.3), and receiving antibiotics on admission (23%, 3.3). Residents with 0, 1, 2,> or = 3 of these characteristics had 9%, 19%, 34% and 62% probability, respectively, of being hospitalized in the first 8 weeks of nursing home stay. CONCLUSIONS: In a large, urban, academic nursing home, residents' risk of hospitalization varied over time from admission and among different subgroups of residents. These results can be used to develop interventions to prevent acute illness and hospitalization early in nursing home stay and to enhance the communication of prognostic risk to nursing home residents, their caregivers and medical providers.     

Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men

In a community based, prospective study to determine risk factors for falls, 465 women and 296 men 70 years and over were followed for 1 year and 507 falls were documented. A greater proportion of women (32.7%) than men (23.0%) experienced at least one fall in which there was no or minimal external contribution. Using unconditional logistic regression models we investigated the effect of physical and sociological variables on the sex difference in fall rate. Controlling for the variables age, use of psychotropic drugs, inability to rise from a chair without using arms, going outdoors less than daily and living alone decreased the relative risk of women falling compared to men from 2.02 (95% CI, 1.40–2.92) to 1.55 (95% CI 1.04–2.31). Some of the increased risk of falling associated with being a women was able to be explained and is potentially correctable. But even after controlling for the physical and social variables which we had assessed, women compared to men still had a significantly increased relative risk of falling.     

Evaluation of ocular hazards due to electric arc flash at an in-line switch

We investigated the ocular damage resulting from operation of a solid blade pole-mounted in-line electrical switch at between 16 and 17 kV with current loads between 38 A and 340 A. Spectroradiometric data for the electric arcs produced as the switch was opened were obtained over the waveband 200 to 1500 nm. The eyes of adult pigmented rabbits were exposed to the arc flash at a distance of 2 m. The ocular tissues were assessed clinically and histologically up to 48 h postexposure. Threshold damage was clinically detectable only in eyes exposed to a 340 A arc. We conclude that at the normal current loads on a 17-kV electric power transmission line, the principal oculovisual hazards are due to molten metal fulminated from the switch by the arc, and after-images due to the bright visible light flash. At a working distance of 2 m, the ultraviolet ocular hazard is negligible. Adequate eye protection is provided by clear polycarbonate safety lenses.     

老年人跌倒居家危险因素干预效果及需求研究

目的了解老年人跌倒居家环境危险因素的干预效果。方法选择上海市长宁区一个居委会内居住的所有家中有60岁以上老年人的住户,就家中可能引起老年人跌倒的28项环境危险因素开展上门调查评估和干预。初次上门10个月后,再次入户评估危险因素的改变情况,并进行4组老年人的小组访谈。结果干预后,所有28项危险因素的总体发生率从干预前的30.1%降低到15.3%,改变率为49.2%。其中20项发生率显著下降,但地面易打滑、楼梯不使用双控开关、阳台没封闭等8项危险因素的改变无统计学差异,访谈结果显示没有发生改变的主要原因是硬件设施改善难度较高且花费较大,希望改变但没有能力。结论入户干预可以减少老年人跌倒居家危险因素。     

Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population.     

Functional status decline as a measure of adverse events in home health care: an observational study

Background  

Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research.