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Special Issue "Efficient Use of Acute Hospital Services for Older People"

Special Issue Editors

Guest Editor
Prof. Dr. David William Molloy

Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Interests: dementia; frailty; risk; screening and assessment; more efficient use of hospital resources
Guest Editor
Dr. Rónán O’Caoimh

Department of Medicine, National University of Ireland, Galway, Ireland
Website | E-Mail
Interests: frailty; dementia; mild cognitive impairment; risk assessment; screening; community geriatrics; public health aspects of ageing

Special Issue Information

Dear Colleagues,

This issue will focus on the screening and assessment of older adults, including cognitive assessment and risk assessment that predicts negative outcomes of older adults, such as hospitalization, death, and institutionalization, as well as how to improve efficiency of discharge planning using tools to predict patient outcomes.

It will also focus on screening tools and short dementia assessments and more efficient use of hospital services for older adults by improving our assessment techniques.

Prof. Dr. David William Molloy
Dr. Rónán O’Caoimh
Guest Editors

Manuscript Submission Information

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Keywords

  • Screening
  • Assessments
  • Dementia
  • Risk Assessment
  • Hospitalization

Published Papers (5 papers)

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Research

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Open AccessArticle
Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles
Int. J. Environ. Res. Public Health 2019, 16(7), 1175; https://doi.org/10.3390/ijerph16071175
Received: 20 February 2019 / Revised: 21 March 2019 / Accepted: 1 April 2019 / Published: 2 April 2019
Cited by 3 | PDF Full-text (341 KB) | HTML Full-text | XML Full-text
Abstract
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South [...] Read more.
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings. Full article
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
Open AccessArticle
Validity of the Japanese Version of the Quick Mild Cognitive Impairment Screen
Int. J. Environ. Res. Public Health 2019, 16(6), 917; https://doi.org/10.3390/ijerph16060917
Received: 14 January 2019 / Revised: 28 February 2019 / Accepted: 8 March 2019 / Published: 14 March 2019
Cited by 1 | PDF Full-text (617 KB) | HTML Full-text | XML Full-text
Abstract
Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and [...] Read more.
Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and then we examined its validity. Community-dwelling adults aged 65–84 in Niigata prefecture, Japan, were concurrently administered the Qmci-J and the Japanese version of the standardized Mini-Mental State Examination (sMMSE-J). Mild cognitive impairment (MCI) and dementia were categorized using established and age-adjusted sMMSE-J cut-offs. The sample (n = 526) included 52 (9.9%) participants with suspected dementia, 123 (23.4%) with suspected MCI and 351 with likely normal cognition. The Qmci-J showed moderate positive correlation with the sMMSE-J (r = 0.49, p < 0.001) and moderate discrimination for predicting suspected cognitive impairment (MCI/dementia) based on sMMSE-J cut-offs, area under curve: 0.74, (95%CI: 0.70–0.79), improving to 0.76 (95%CI: 0.72 to 0.81) after adjusting for age. At a cut-off of 60/61/100, the Qmci-J had a 73% sensitivity, 68% specificity, 53% positive predictive value, and 83% negative predictive value for cognitive impairment. Normative data are presented, excluding those with any sMMSE-J < 27. Though further research is required, the Qmci-J screen may be a useful screening tool to identify older adults at risk of cognitive impairment. Full article
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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Open AccessArticle
Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults
Int. J. Environ. Res. Public Health 2019, 16(4), 641; https://doi.org/10.3390/ijerph16040641
Received: 27 December 2018 / Revised: 5 February 2019 / Accepted: 14 February 2019 / Published: 21 February 2019
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Abstract
Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This [...] Read more.
Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan–Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p < 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults. Full article
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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Open AccessArticle
Urinary and Faecal Incontinence: Point Prevalence and Predictors in a University Hospital
Int. J. Environ. Res. Public Health 2019, 16(2), 194; https://doi.org/10.3390/ijerph16020194
Received: 16 December 2018 / Revised: 6 January 2019 / Accepted: 8 January 2019 / Published: 11 January 2019
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Abstract
Incontinence is common and associated with adverse outcomes. There are insufficient point prevalence data for incontinence in hospitals. We evaluated the prevalence of urinary (UI) and faecal incontinence (FI) and their predictors among inpatients in an acute university hospital on a single day. [...] Read more.
Incontinence is common and associated with adverse outcomes. There are insufficient point prevalence data for incontinence in hospitals. We evaluated the prevalence of urinary (UI) and faecal incontinence (FI) and their predictors among inpatients in an acute university hospital on a single day. Continence status was recorded using the modified Barthel Index (BI). Baseline characteristics, Clinical Frailty Scale (CFS) and ward type were recorded. In all, 435 patients were assessed, median age 72 ± 23 years and 53% were male. The median CFS score was 5 ± 3. The point prevalence of UI was 26% versus 11% for FI. While UI and FI increased with age, to 35.2% and 21.1% respectively for those ≥85, age was not an independent predictor. Incontinence also increased with frailty; CFS scores were independently associated with both UI (p = 0.006) and FI (p = 0.03), though baseline continence status was the strongest predictor. Patients on orthopaedic wards had the highest prevalence of incontinence. Continence assessments were available for only 11 (2%) patients. UI and FI are common conditions affecting inpatients; point prevalence increases with age and frailty status. Despite this, few patients receive comprehensive continence assessments. More awareness of its high prevalence is required to ensure incontinence is adequately managed in hospitals. Full article
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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Review

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Open AccessReview
Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review
Int. J. Environ. Res. Public Health 2019, 16(14), 2457; https://doi.org/10.3390/ijerph16142457
Received: 15 May 2019 / Revised: 29 June 2019 / Accepted: 5 July 2019 / Published: 10 July 2019
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Abstract
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) [...] Read more.
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up. Full article
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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