Objectives
To develop and examine the validity and reliability of a targeted geriatric assessment (TaGA) for busy healthcare settings.
Design
The TaGA was developed through the consensus of experts ...(Delphi technique), and we investigated its construct validity and reliability in a cross‐sectional study.
Setting
Geriatric day hospital specializing in acute care in Brazil.
Participants
Older adults (N = 534) aged 79.5 ± 8.4, 63% female, consecutively admitted to the geriatric day hospital.
Measurements
The Frailty Index (FI), Physical Frailty Phenotype, and Identification of Seniors at Risk (ISAR) were used to explore the TaGA's validity. External scales were used to investigate the validity of each matched TaGA domain. The interrater reliability and time to complete the instrument were tested in a 53‐person subsample.
Results
In 3 rounds of opinion, experts achieved consensus that the TaGA should include 10 domains (social support, recent hospital admissions, falls, number of medications, basic activities of daily living, cognitive performance, self‐rated health, depressive symptoms, nutritional status, gait speed). They arrived at sufficient agreement on specific tools to assess each domain. A single numerical score from 0 to 1 expressed the cumulative deficits across the 10 domains. The TaGA score was highly correlated with the FI (Spearman coefficient = 0.79, 95% confidence interval (CI)=0.76–0.82) and discriminated between frail and nonfrail individuals better than the ISAR (area under the receiver operating characteristic curve 0.84 vs 0.72; P < .001). The TaGA score also had excellent interrater reliability (intraclass correlation coefficient = 0.92, 95% CI=0.87–0.95). Mean TaGA administration time was 9.5 ± 2.2 minutes.
Conclusion
The study presents evidence supporting the TaGA's validity and reliability. This instrument may be a practical and efficient approach to screening geriatric syndromes in fast‐paced healthcare settings. Future research should investigate its predictive value and effect on care.
...investigators did not assess transferences between different levels of acute care and it is plausible that older patients admitted to ICU for unforeseen clinical deterioration may have influenced ...their findings 4. ...we sought to compare the characteristics and outcomes of acutely ill older patients admitted from the emergency department (ED) based on whether their admissions to ICU were planned at the ED or occurred later due to unexpected clinical deteriorations.2 Material and methods We conducted a prospective cohort of patients aged ≥65 years admitted from the ED to a tertiary hospital in Brazil between November 2021 and April 2022 5. Demographic (age) and clinical characteristics (baseline functional and frailty status, delirium rates, and acute clinical severity) of patients experiencing unplanned ICU admissions differed from those directly admitted to the ICU and those not using ICU (Table 1). ...unplanned ICU admissions were associated with prolonged LoS and hospital-acquired infections (Table 1). ...although in-hospital mortality was higher in patients admitted to the ICU directly from the ED, those who had unplanned ICU admission while in the hospital presented higher mortality within the following months after discharge.4 Discussion Our findings indicate that older patients with unplanned ICU admissions generally present with worse baseline physical frailty and disability, and elevated levels of delirium and illness acuity in the ED compared to those not requiring ICU during hospitalization.
Searches for the lepton number violating K+→π−μ+e+ decay and the lepton flavor violating K+→π+μ−e+ and π0→μ−e+ decays are reported using data collected by the NA62 experiment at CERN in 2017–2018. No ...evidence for these decays is found and upper limits of the branching ratios are obtained at 90% confidence level: B(K+→π−μ+e+)<4.2×10−11, B(K+→π+μ−e+)<6.6×10−11 and B(π0→μ−e+)<3.2×10−10. These results improve by 1 order of magnitude over previous results for these decay modes.
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Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented ...mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short‐term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting. During the 6‐hour visits made weekly for up to 2 months, participants receive integrated evaluations of their various health domains, education, and rapid access to examinations and procedures based on a multidisciplinary approach. In the first 6 years, 2,322 individuals attended the GDH. The analysis of a representative sample (n = 645) revealed that 81% were treated in the GDH without the need for another type of hospital care. This percentage was high for the different reasons for referral (infection, 71%; delirium, 73%; decompensated chronic disease, 81%). Between baseline and discharge, participants maintained their functional status, and their self‐reported health improved. This study represents the first step in describing the role of the GDH as a possible alternative to emergency department use or hospitalization for older adults. Future studies are needed to determine the optimal individual for this model of care and to ensure its cost‐effectiveness.
This study sought to explore and externally validate the Carpenter instrument's efficacy in predicting postdischarge fall risk among older adults admitted to the emergency department (ED) for reasons ...other than falls or related injuries.
A prospective cohort study was conducted on 779 patients aged ≥ 65 years from a tertiary hospital in São Paulo, Brazil, who were monitored for up to 6 months post-ED hospitalization. The Carpenter instrument, which evaluates the four risk factors nonhealing foot sores, self-reported depression, inability to self-clip toenails, and prior falls, was utilized to assess fall risk. Follow-up by telephone occurred at 30, 90, and 180 days to identify falls and mortality. Fine-Gray models estimated the predictive power of Carpenter instrument for future falls, considering death as a competing event and sociodemographic factors, frail status, and clinical measures as confounders.
Among 779 patients, 68 (9%) experienced a fall within 180 days post-ED admission, and 88 (11%) died. The majority were male (54%), with a mean age of 79 years. Upon utilizing the Carpenter score, those with a higher fall risk (≥2 points) displayed more comorbidities, greater frailty, and increased clinical severity at baseline. Regression analyses showed that every additional point on the Carpenter score increased the hazard of falls by 73%. Two primary contributors to its predictive potential were identified: a history of falls in the preceding year and an inability to self-clip toenails. However, the instrument's discriminative accuracy was suboptimal, with an area under the curve of 0.62.
While the Carpenter instrument associated with a higher 6-month postadmission fall risk among older adults post-ED visit, its accuracy for individual patient decision making was limited. Given the significant impact of falls on health outcomes and health care costs, refining risk assessment tools remains essential. Future research should focus on enhancing these assessments and devising targeted proactive strategies.
BACKGROUND
Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID‐19.
OBJECTIVES
To investigate the occurrence of delirium in ...hospitalized patients with COVID‐19 and explore its association with adverse outcomes.
DESIGN
Longitudinal observational study.
SETTING
Tertiary university hospital dedicated to the care of severe cases of COVID‐19 in São Paulo, Brazil.
PARTICIPANTS
A total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020.
MEASUREMENTS
We completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart‐Based Delirium Identification Instrument (CHART‐DEL). Trained physicians with a background in geriatric medicine completed all CHART‐DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in‐hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C‐reactive protein, glomerular filtration rate, D‐dimer, and albumin).
RESULTS
Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in‐hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in‐hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15–2.66); the association held both in middle‐aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization.
CONCLUSION
Delirium was independently associated with in‐hospital death in adults aged 50 years and older with COVID‐19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID‐19 patients.
The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between ...frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.
Abstract
Background
The relationship between hypertension and cognition in later life is controversial. We investigated whether the association of hypertension with cognition differs in older adults ...according to the frailty status using cross-sectional data from the Brazilian Longitudinal Study of Aging, a nationally representative sample of adults aged ≥50 years.
Method
Hypertension was defined by a medical diagnosis or measured blood pressure ≥140/90 mm Hg. Frailty status was assessed using the Cardiovascular Health Study criteria. We estimated the association of hypertension and systolic and diastolic blood pressure with global cognition, orientation, memory, and verbal fluency z-scores, using multiple linear regression models. We also investigated interactions between hypertension and frailty on cognitive performance and impairment.
Results
We evaluated 8609 participants (mean age = 61.9 ± 9.6 years, 53% women). Participants with hypertension (59% of adults aged 50–64 and 77% of those aged ≥65 years) had poorer scores for global cognitive performance than those without hypertension, especially among adults aged 50–64 years (β = −0.09; 95% confidence interval = −0.15, −0.04; p = .001). However, frailty modified the associations of hypertension with cognitive performance and impairment in those aged ≥65 years (p-values for interaction = .01 and .02, respectively). Among nonfrail older adults, hypertension was associated with cognitive impairment. In contrast, among frail older adults, hypertension was related to better global and memory cognitive z-scores.
Conclusions
Hypertension was associated with worse cognitive performance. Among older adults, hypertension was related to cognitive impairment only in nonfrail participants. Frailty evaluation may help clinicians offer personalized hypertension management in older adults.
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