Abuse and neglect of the elderly: are emergency department personnel aware of mandatory reporting laws?

Alabama emergency department personnel were surveyed in 1988 concerning elder abuse and Alabama's mandatory reporting and protective services law. Most ED personnel did not understand the requirements of the law. While emergency physicians, registered nurses, and licensed practical nurses had seen cases of elder abuse in their careers, differences existed in their satisfaction with the disposition of cases reported to state authorities. Licensed practical nurses and physicians reported greater satisfaction with the response received; registered nurses were much less satisfied. However, all accepted responsibility for reporting elder abuse. ED registered nurses and emergency physicians were divided on the degree to which they could diagnose elder abuse, did not believe there were sufficient services to care for those who had been abused, and were unsure whether there were procedures for reporting cases of elder abuse. All ED personnel need to know that cases they report will result in protection of abuse victims.     

… But Does It Stick? Evaluating the Durability of Improved Knowledge Following an Undergraduate Experiential Geriatrics Learning Session

Canada's aging population, fewer medical students training in geriatric medicine, and inadequate geriatric curricula require that medical schools immediately address how future physicians will be able to care for older people effectively. The medical literature suggests that experiential learning strategies improve undergraduate medical students' knowledge of and interest in less-popular subjects, but the durability of improvements resulting from these resource-intensive learning approaches remains unclear. In October 2001, a convenience sample of all University of Western Ontario medical students attending the geriatric component of their first year was randomized to attend one 3-hour didactic lecture or 3-hour experiential learning session. Approximately 1 year later, students completed a follow-up knowledge and attitudes survey that was matched to their first-year surveys using date-of-birth data. Of 100 completed follow-up surveys, 42 were used in formal analysis. Although initially the experiential group demonstrated a better knowledge score, at 1-year follow-up, there was no significant difference in knowledge, attitudes toward older people, or interest in geriatric medicine between the didactic (n=17) and experiential (n=25) groups. Nevertheless, these students (n=42) demonstrated better attitude scores than those (n=22) who had not attended either educational intervention. This study challenges the belief that an experiential approach is a superior training method to a didactic approach. One year after an educational intervention, there was no difference in geriatric knowledge, attitude scores, or interest in geriatric medicine between students who underwent a didactic lecture or a participatory, experiential learning session.     

Bioelectric impedance phase angle is associated with hospital mortality of geriatric patients

Malnutrition is regularly associated with weight loss and changes in body composition, which lead to an increase in disability, complications and mortality. Bioelectric impedance analysis (BIA) is a simple and non-invasive bedside body composition analysis technique. In particular, bioelectric impedance phase angle (PA) has been shown to predict prognosis and mortality in several clinical conditions. The purpose of this study was to determine the relationship of BIA measurements and hospital mortality in multimorbid geriatric patients. The data obtained from the routine clinical admissions of 1071 consecutive patients (783 women and 288 men, age 81.4 ± 8.5 years) to a geriatric hospital unit was analyzed retrospectively. A significant difference of PA (50 kHz) between survivors (4.2 ± 1.1°) and non-survivors (3.6 ± 1.2°; p < 0.001) of the hospital stay could be detected. Subjects with a PA below 3.5° showed a significant fourfold increased hospital mortality of 20% (95% CI = 15-24%) compared to all other subjects (5%; 95% CI = 4-7%). No calculated parameters of BIA reflecting body composition were associated with hospital mortality. Although the extent to which the PA may be regarded as a marker of nutritional state is still controversial, it was associated with hospital mortality in geriatric patients.     

Évaluation comparative et objective de la production scientifique des services hospitaliers au sein de l’Assistance publique–Hôpitaux de Paris : analyse des scores SIGAPS

Purpose

To analyze the results of the bibliometric system (SIGAPS score) of scientific publications in the Assistance publique–Hôpitaux de Paris (AP–HP) and to compare the scientific production among the various medical and surgical specialties of the academic hospitals of Paris.

Methods

All the publications imported from Pubmed between 2006 and 2008 were included. The following data were taken into account and analysed: the hospital department of origin, the number of articles published, the number of full-time physicians, the SIGAPS score.

Results

Thirty-eight thousand, seven hundred and nine publications were included. The departments were consisted of 747 full-time practitioners 5719 (1895 Professors [33.1%], 2772 Assistant Professors [48.4%] and 1052 fellows [18.4%]). The average number of full-time practitioner by department was 7.7 ± 6.7 (range 1–69). The average total number of articles published in a department was 51.8 ± 49.4 (range 1–453). The average SIGAPS score was more important in medicine than in surgery (621.2 ± 670.1 vs. 401 ± 382.2; P = 0.01) but not the average number of article per practitioner (8.1 ± 8.3 vs. 6.6 ± 6.2; P = 0.0797). The mean number of publication by full-time practitioner was 7.9 ± 7.8 (1–45), or an average of 2.7 ± 2.6 for each full-time practitioner each year.

Conclusion

Academic hospitals in Paris have a reasonably scientific output but with a mean of 2.7 articles per full-time practitioner per year. No major differences between medical and surgical disciplines were observed.     

Enfermedades de declaración obligatoria: conocimiento y notificación en el ámbito hospitalario

Introduction

Notifiable infectious diseases represent a public health hazard, which is why they are under surveillance and must be reported. We tried to assess hospital physicians’ knowledge of hospital physicians on notifiable infectious diseases and their self-reported attitudes to notification.

Methods

An observational study was conducted using a questionnaire with 11 multiple choice questions, two yes/no questions and one short-answer question. It was distributed to all senior doctors and residents in 19 medical and surgical departments.

Results

A total of 248 questionnaires were sent out, with a response rate of 79.84%. More than three-quarters (76.3%) of the respondents were senior doctors. As regards specific knowledge about whether a particular disease is a notifiable disease, 29.5% identified correctly 100% of the named diseases, 3.2% could not identify any of them. All urgent named notifiable infectious diseases were correctly identified by 25.3% of physicians. Statistically significant differences were found in the knowledge of notifiable diseases knowledge in medical and surgical departments, as well as for senior doctors (P = .047) and residents (P = .035). A high percentage of medical services (40%) and surgical (70%) department reported never failing to notify. When asked about the causes of under-reporting, 72% did not know whether notification was mandatory or not, and 88% did not know what diseases must be notified.

Conclusions

Although many respondents are aware that diseases notification is part of their daily activity, many of them admit under-reporting. There is insufficient knowledge about what diseases are considered notifiable infectious diseases and how to notify them.     

Knowledge and attitudes about geriatrics of medical students, internal medicine residents, and geriatric medicine fellows

OBJECTIVES: To evaluate the attitudes and knowledge of medical students (MS1-3), internal medicine residents (postgraduate years 1 to 3 (PGY1-3)), and geriatric medicine fellows about elderly patients before implementation of a new geriatrics curriculum. DESIGN: Cross-sectional study. SETTING: An academic medical center. PARTICIPANTS: Two hundred eleven people participated: 54 MS1, 52 MS2, 50 MS3, 20 PGY1, 12 PGY2, 12 PGY3, and 11 geriatric medicine fellows. MEASUREMENTS: Each participant completed a questionnaire, including a 16-item geriatrics attitude scale, and a 23-item knowledge test (both revised versions of the University of California at Los Angeles (UCLA) Geriatrics Survey). Pearson correlation coefficients and t tests were used for statistical analyses. RESULTS: Both surveys demonstrated high internal consistency (alpha=0.70 and 0.71, respectively). Knowledge test scores increased with advancing level of training. MS1 and MS2 scored significantly lower and fellows scored significantly higher than others. PGY3 scored significantly higher than PGY1 on the knowledge test. All groups demonstrated positive attitudes toward geriatric patients (score>3.5). MS1 and fellows had significantly more favorable attitudes scores than more advanced students and residents. CONCLUSION: The results suggest that the UCLA Attitudes Scale and Knowledge Test can be used reliably to assess attitudes and knowledge level across all levels of medical education and training. The information from this study will be used to implement a more structured and comprehensive geriatrics curriculum across all trainee levels to improve attitudes and knowledge in the care of the geriatric patient.     

Peeking through the cracks: An assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting

Little is known about the prevalence of the recently defined polypathology notion in hospital populations. Patients admitted to medical wards were assessed using established criteria of polypathology. Prevalence of polypathology, interobserver reliability, clinical features, nutritional status, and HRQoL were assessed using clinical data and interview, mini-nutritional assessment (MNA), and the 12-item short-form health survey (SF-12) scales. Of a total of 812 patients studied, 196 (24%) met polypathology criteria (65% men, of mean age 71.3 ± 11.6 years, mean defining chronic diseases 2.4 ± 0.046, and other comorbidities 2.6 ± 0.094). Interobserver reliability for the detection of cases was good (κ = 0.628). Their mean Charlson index/prescribed drugs were 3.3/6, respectively. Severe dyspnea, delirium, or active neoplasia were present in 44, 15, and 11%. A bad nutritional status/risk of malnutrition was evident in 10.3/52.6%, and correlated with the number of previous hospitalizations (p = 0.041), and the presence of active neoplasia (p = 0.037). Mean physical/mental summaries of HRQoL were 33.9 ± 10, and 42 ± 13, and correlated with a better nutritional status (p = 0.011, and p = 0.001, respectively). Polypathology affects one quarter of inpatients in a hospital setting, and can be easily and reliably identified. The diversity and complexity of patient needs underscore the need for continuity of care between community and hospital, crossing sub-speciality lines and institutional boundaries.     

The interplay of infections, function and length of stay (LOS) in newly admitted geriatric psychiatry patients

The purpose of this study was to determine the impact of identifying and treating infections on functional outcomes and length of stay (LOS). Our retrospective naturalistic study reviewed all new admissions to a tertiary geriatric psychiatry teaching hospital from 2003 to 2007. Over this four-year period, 390 patients were admitted and discharged with 21% (85) of patients identified as having infections on admission. Those with infections were compared to the group without to determine and compare clinical characteristics. Factors included in analysis were: age, gender, diagnoses, medical comorbidity, neuropsychiatric symptoms, functional outcomes, medications and LOS. Both groups were similar in gender, psychiatric diagnoses and severity of dementia. Those requiring antibiotics for treatment of infections on admission, were older (p = 0.003), had poorer baseline function (p = 0.005) and higher medical comorbidity (p < 0.001). At discharge, the group with infections showed greater functional improvement (p < 0.001), particularly in mobility (p = 0.005) and cognition (p = 0.046), and had a shorter LOS (p = 0.02). We conclude that a significant number of patients in tertiary geriatric services continue to have infections on admission. Early identification and treatment of infections can result in improved function and decreased LOS.     

L’anémie dans l’insuffisance cardiaque

Anemia is a common disorder in congestive heart failure and an independant prognostic factor. The aims of this study are to evaluate the prevalence of anemia among a population of in-hospital congestive heart failure patients, to compare anemic patients (A) with non anemic patients (NA) and to study their cares.

Results

One hundred and thirty-two patients, 70 men (53%), et 62 women (47%) are enrolled. Mean age is 76.4 ± 13.5 years. The prevalence of anemia (WHO criteria) is 49%. Patients A are older than NA: 79.1 ± 13.8 years versus 73.8 ± 12.9 years (p = 0.025), renal function is more altered in A than in NA, creatinine clearance is 56.5 ml/min (A) versus 76.2 ml/min (NA) (p = 0.003). Ejection fraction (EF) is lower in A than in NA: 35.1 ± 15.3% versus 50.9 ± 15.9%, (p < 0.0001.) Anemia is less frequent in preserved EF (28%) than in low EF (63%) (p < 0.0001). Hospitalization duration is longer in A than in NA: 10.7 ± 10.1 days versus 6.9 ± 3.7 days (p = 0.005). There are more re hospitalized patients among A than NA: 38 versus 10 (p = 0.0001). There is a significant difference of survival of NA versus A at day 614 (p = 0.03).

Conclusion

Anemia is frequent in our population, and is associated with others prognostic factors and comorbidity.     

Recognition and perception of elder abuse by prehospital and hospital-based care providers

The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers suspected the existence of abuse, neglect and domestic violence among the elderly were not rare events. In Maryland, there are a limited number of specific educational programs dealing with abuse and neglect of the elderly. A statewide training program is needed to ensure PCP and HCP can recognize the signs and symptoms of elder abuse and neglect, and to ensure that the providers are aware of their legal requirements for reporting the abuse to the proper state or local agencies.     

Incidence and clinical characteristics of postcardiac injury syndrome complicating cardiac perforation caused by radiofrequency catheter ablation for cardiac arrhythmias

Background

Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which small heart perforation is the etiology that is often unrecognized. We reported a series of patients with PCIS secondary to cardiac perforation during catheter ablation procedures.

Methods and results

Out of 1728 radiofrequency catheter ablation procedures, 21 patients (1.2%) were complicated by echo-defined cardiac perforation not requiring surgical intervention. Among them, 6 patients (6/21, 28.6%) were diagnosed with PCIS secondary to cardiac perforation because they also developed pleural effusions (6/6, 100%) and fever (4/6, 66.7%) in addition to pericardial effusion/tamponade. Four patients with PCIS (4/6, 66.7%) and four patients without PCIS (4/15, 26.7%) underwent pericardial drainage but the drainage volume during the first 24 h was not significantly different (441.3 ± 343.9 mL vs. 182.5 ± 151.3 mL, P = 0.248). In the 6 PCIS patients, pleural effusion was detected from 3 h to 4 days (median: 2 days) after ablation procedure, predominantly bilateral (66.7%) or left-sided if unilateral. Patients with PCIS were older (64.8 ± 7.3 years vs. 45.9 ± 14.8 years, P = 0.0078), were more likely accompanied by hypertension (66.7% vs. 6.7%, P = 0.0114) and had a prolonged hospital stay (34.2 ± 15.8 days).

Conclusions

More than 25% of patients with small cardiac perforation during catheter ablation may develop PCIS which can be masked by pericardial effusion/tamponade. This kind of PCIS is more likely associated with elder or hypertensive patients and is usually characterized by early onset of pleural effusion.     

Investigating the predictive ability of gait speed and quadriceps strength for incident falls in community-dwelling older women at high risk of fracture

Gait speed is a recommended geriatric assessment of physical performance, but may not be regularly examined in clinical settings. We aimed to investigate whether quadriceps strength tests demonstrate similar predictive ability for incident falls as gait speed in older women. We investigated 135 female volunteers aged mean ± SD 76.7 ± 5.0 years (range 70–92) at high risk of fracture. Participants completed gait speed assessments using the GAITRite Electronic Walkway System, and quadriceps strength assessments using a hand-held dynamometer (HHD). Participants reported incident falls monthly for 3.7 ± 1.2 years. N = 99 (73%) participants fell 355 times during the follow-up period (mean fall rate 83 per 100 person years). We observed a reduced odds ratio for multiple falls (0.83, 95% CI 0.70–0.98) and a reduced hazard ratio for time to first fall (0.90, 95% CI 0.83–0.98), according to quadriceps strength. There was also a significantly shorter time to first fall for those with low quadriceps strength (<7.0 kg; lowest tertile) compared with those with normal quadriceps strength (estimated means [95% CI] 1.54 [1.02, 2.06] vs. 2.23 [1.82, 2.64] years; P = 0.019), but not for those with low (<1.0 m/s) vs. normal gait speed (P = 0.15). Quadriceps strength is a significant predictor of incident falls over three years amongst community-dwelling older women at high risk of fracture. Quadriceps strength tests may be an acceptable alternative to gait speed for geriatric assessments of falls risk.     

Valoración geriátrica y factores pronósticos de mortalidad en pacientes muy ancianos con neumonía extrahospitalaria

Introduction

To assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit.

Methods

Four hundred fifty-six patients (≥ 75 years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin).

Results

A hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6 ± 6.4 vs 85.1 ± 6.4, P < .04), had more comorbidity (ChI 2.35 ± 1.61 vs 2.08 ± 1.38; P < .083), worse functional impairment [(LI: 0.49 ± 1.15 vs 1.45 ± 2.32, P < .001) (BIp: 34.6 ± 32.9 vs 54.0 ± 34.1, P < .001) (BIa: 5.79 ± 12.5 vs 20.5 ± 22.9, P < .001)], a higher percentage of functional loss at admission (85.9 ± 23.2 vs 66.4 ± 28.6; P < .0001), worse cognitive impairment (PT: 7.20 ± 3.73 vs 5.10 ± 3.69, P < .001) and malnutrition (albumin 2.67 ± 0.54 vs 2.99 ± 0.49, P < .001). Mortality was higher with impaired consciousness [49.2% (P < .01)], tachypnea [33.3% (P < .01)], tachycardia [44.4% (P < .002), high urea levels [31.8 (P < .001)], anemia [44.7% (P < .02)], pleural effusion [42.9% (P < .002)], and multilobar infiltrates [43.2% (P < .001)]. In the multivariate analysis, variables associated with mortality were: age ≥ 90 years [OR: 3.11 (95% CI: 1.31 to 7.36)], impaired consciousness [3.19 (1.66 to 6.15)], hematocrit < 30% [2.87 (1.19 to 6.94)], pleural effusion [3.77 (1.69 to 8.39)] and multilobar infiltrates [2.76 (1.48 to 5.16)]. Female sex and a preserved functional status prior (LI ≥ 5) and during admission (BIa ≥ 40) were protective of mortality [0.40 (0.22 to 0.70), 0.09 (0.01 to 0.81) and 0.11 (0.02 to 0.51)].

Conclusions

Geriatric assessment parameters and routine clinical variables were associated with mortality.     

Modalités ou charge de réentraînement : quelle modalité choisir pour améliorer l’aptitude aérobie du patient coronarien en seulement 4 semaines ?

Objective

The aim of this study was to compare the effects of 4 weeks of CT and AT, which training impulse (total external workload and perceived exertion), are similar on power associated at VO₂peak (pVO₂peak) and cardiorespiratory responses of patient with CAD.

Method

Eighteen male with CAD (62 ± 7 years, 175 ± 2 cm, 84 ± 16 kg, fraction of ejection = 0.49 ± 0.16) performed 4 weeks of CT (n = 9) or AT (n = 9). pVO₂peak, maximal and first ventilatory threshold values of oxygen uptake (VO₂peak, VO₂-vt) and heart rate (HRmax, HR-vt) were measured before and after training session. Total training impulse (exercise rehabilitation and other paramedical actions) were evaluated and harmonized between AT and CT according to Foster et al. formula (1996)

Results

No significant difference were found in training impulse between AT and CT (3650 ± 220 vs 3497 ± 190 U, P = NS). VO₂pic increased after AT (16.9 ± 4.4 vs 18.9 ± 4.9 mLO₂/min/kg, P < 0.05) and remained unchanged after CT (17.7 ± 7.8 vs 17.8 ± 7.2, P = NS). Four weeks of training induced significant increase in pVO₂peak, VO₂-vt and FC-vt, expressed in absolute or relative value (P < 0,05), without any difference between AT and CT modalities (P = NS).

Conclusions

Improving pVO₂pic following an exercise training does not necessarily preclude an improvement in coronary VO₂pic. pVO₂ peak was not improved with the same cardiorespiratory adaptations between AT and CT. Thus, there seems important to measure gas exchanges of subject with CAD during the incremental test and identify the respective part of muscular and cardiorespiratory functions in exercise exhaustion.     

Impact de la modification des prescriptions chez les sujets âgés hospitalisés en service de court séjour gériatrique en termes de coût

Purpose

Polypharmacy in the elderly increases the risk of adverse drug reactions and leads to increased medical costs. There is little data currently available on drug modification and cost reduction during hospitalization in a geriatric unit. The aims of this study were to analyse drug modification during hospitalization in a geriatric care unit and to evaluate the repercussions in terms of cost reduction.

Methods

This monocentric study included 691 patients over a period of 3.5 years. The drugs and their daily costs were counted and classified (10 classes, 37 subclasses) upon admission and upon discharge. The modifications in the number of drugs in each class and subclass, as well as their costs, were analysed. Predictive factors in drug modification between admission and discharge were investigated.

Results

Our study showed a significant decrease in the number of drugs (mean  ±  standard error [SE], 5.2 ± 0.11 to 4.5 ± 0.07), as well as in the daily medical costs (4.4 ± 0.18 to 3.67 ± 0.12 €) between admission and discharge. The higher the number of drugs was upon admission, the greater the reduction was upon discharge. Cardiovascular, metabolic, analgesic and pulmonary drugs were significantly reduced, whereas gastrointestinal and anti-osteoporotic treatments increased. Diabetes, adverse drug events and the one-leg balance were predictive factors in drug modification.

Conclusion

Hospitalization in a geriatric unit allows a re-evaluation of drug management with a significant reduction in the number and cost of treatments between admission and discharge. Given the multiple consequences of polypharmacy and its serious financial impact, research to develop optimal care of the elderly and to improve medication intervention is warranted.     

Evaluation of geriatrics education at a Chinese University: A survey of attitudes and knowledge among undergraduate medical students

ABSTRACT

Despite widespread reforms in medical education across China, nationally there has been no mandate or movement toward systemically incorporating geriatrics into curricula. To what degree medical students are trained and have exposure to geriatric topics remains unclear. We surveyed 190 medical students during their final year of medical school at a Chinese medical university, graduating from reformed and also traditional curricula. The survey was comprised of a subjective assessment of attitudes and reported knowledge, as well as an objective assessment of knowledge via a multiple choice test. Student attitudes were favorable toward geriatrics, with 91% supporting the addition of specialized clinical experiences to the curriculum. Students generally reported low exposure to geriatrics, with no statistically significant differences between reform and traditional curricula. There was a statistically significant difference in performance on the multiple choice test between curricula but at a degree unlikely to be practically significant. Students had very favorable attitudes toward geriatrics as a field and specialty; however scored poorly on competency exams, with the lowest performance around diagnosis and treatment of specific geriatric conditions. Our results suggest that there is a need and desire for increased geriatric-oriented learning at Chinese medical schools.     

Association of home care needs and functional recovery among community-dwelling elderly hip fracture patients

The aim of this study was to assess the home care needs and task difficulty of community-dwelling aged hip fracture and the association of functional recovery with care received. A cohort of hip fracture patients admitted to orthopedic wards for surgery was collected from August 2009 to December 2010. Patients transferred to long-term care facilities after surgery were excluded. Functional status (feeding, clothing, grooming, bathing, getting in/out of bed, walking, toileting, standing up/sitting down, and walking up/down stairs) and task difficulty for caregivers were recorded at discharge, one week and one month after discharge. In total, 116 patients (mean age: 79.4 ± 8.5 years, 51.7% males) were enrolled. The mean age of primary caregivers was 53.4 ± 14.2 years, and most were daughters or sons (54.3%), spouses (34.5%) or foreign workers (11.0%). The most common care needs were wound care (95.7%), medical visits (94.8%), cleaning and maintaining living quarters (92.2%) and vigilance to ensure patient safety (92.2%). The care needs and task difficulty significantly correlated with physical function before, one week and one month after discharge (r = −0.530, p < 0.001; r = −0.326, p = 0.001; r = −0.432, p < 0.001; r = −0.684, p < 0.001; and r = −0.475, p < 0.001, respectively). The complex and taxing home care needs of community-dwelling elderly hip fracture patients were significantly associated with functional recovery. Comprehensive geriatric assessment and related special medical services may greatly help caregivers and promote the practice of aging in place. Further study is needed to develop appropriate caregiver education to promote the functional recovery of elderly hip fracture patients at home.     

Résultats diagnostiques à court terme et pronostiques à long terme chez des patients avec syncopes inexpliquées : résultats d’un série menée en centre hospitalier

Objective

Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope.

Method

Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews.

Results

A head-up tilt test was realized in 77 patients (47.8 ± 20 years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32 ± 11 months (range 6–54 months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n = 5/48; 10%) or a negative head-up tilt test response (n = 2/19; 10%).

Conclusion

The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope.     

Evaluating diagnostic strategy of older patients with unexplained unintentional body weight loss: a hospital-based study

Unexplained unintentional weight loss (UUWL) is a common health problem in older adults, and raises significant diagnostic challenges. Currently, there is no consensus or guideline to help physicians approach these patients. The main purpose of this study is to evaluate physicians’ behaviors in evaluating elderly patients with UUWL and to compare the diagnostic strategy of internists and geriatricians. From January of 2008 to December of 2009, medical records of all elderly patients admitted to Taipei Veterans General Hospital with UUWL were obtained for study. All diagnostic procedures used during admissions were evaluated and the final diagnosis for each patient was obtained. Overall, data of 136 patients (mean age: 79.8 ± 6.3 years, 80.9% males) were obtained for study with their mean weight loss of 8.6 ± 6.4 kg. Among them, 79 (58.1%) patients were admitted to the geriatric evaluation and management unit (GEMU) and 57 (41.9%) patients were admitted to the general medical wards. There were no statistically significant differences in terms of age, sex, mean age and average weight loss between these two groups. After extensive diagnostic effort, the most common diagnostic entity was benign organic disease (33.8%), followed by unknown (25.7%), neuropsychiatric disorder (23.5%), and malignancy (16.9%). Tumor markers are commonly used, including carcinoembryonic antigen (CEA) (80.9%), prostate specific antigen (PSA) (81.8%), and carbohydrate 19-9 (CA 19-9) (65.4%). Imaging studies were also commonly used diagnostic tools, including gastrointestinal endoscopy (70.6%), colonoscopy (42.6%) and computerized tomography (44.1%). Compared with internists, geriatricians were more likely to order PSA testing (70.5% vs. 89.4%, p = 0.021). In contrast, internists were more likely to order CA-199 (75.4%% vs. 58.2%, p = 0.045), and to arrange gastrointestinal endoscopy than geriatricians (82.4% vs. 62.0%%, p = 0.013). In conclusion, cancer accounts for only 16.9% of all elderly patients with UUWL in this study, tumor markers are very commonly used for screening of occult cancer. Compared with internists, geriatricians are more likely to order PSA and to establish neuropsychiatric diagnosis, and internists are more prone to order carbohydrate (CA 19-9) and gastrointestinal endoscopy.