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Background and Purpose: Regaining functional independence and independent living is challenging in hospitalized geriatric patients. Different from community dwelling and institutionalized older people, geriatric patients on rehabilitation wards generally receive more frequent and structured physiotherapy with the primary aim to discharge them to their home or place of residence. There is a paucity of evidence concerning the structure and components of physiotherapy programs to improve functional performance in this particular group. In this paper, we describe how we developed the Geriatric Activation Program Pellenberg (GAPP) based on patients' needs and available literature. Methods: We searched the literature on physiotherapy interventions focusing on the core components for improvement of functional performance: strength, balance, function, (gait)speed, coordination, and endurance training. Based on physiotherapist staffing and physiotherapy time allocated to each patient, we organized the practical, daily delivery of the program. Results: GAPP is a 5‐day program, repeated weekly, delivered by physiotherapists and physiotherapy students. Each day, one or a combination of two to three different core components of functional performance is trained intensively in 45‐min sessions. A set of standard exercises is constantly adjusted to each patients' capacity. On day 5, there is a mix of these core elements in a group session (e.g., chair‐dance, table tennis, karate) and the Berg Balance Scale is completed to evaluate progress. Conclusion: GAPP is a multicomponent physiotherapy program for hospitalized patients on a geriatric rehabilitation ward, aimed at improving functional performance. [ABSTRACT FROM AUTHOR]

Background/Objectives: Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse‐led geriatric co‐management program leads to better functional status at hospital discharge. Design: A quasi‐experimental before‐and‐after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow‐up at 6 months. Setting: Two cardiac care units of the University Hospitals Leuven. Participants: One hundred and fifty‐one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. Intervention: A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow‐up and coached the cardiac team. A geriatrician co‐managed patients with complications. MEASUREMENTS: The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one‐point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS: The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7–9.3 versus 9.5, 95% CI = 9.2–9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6‐month follow‐up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION: This first nurse‐led geriatric co‐management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES To compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department Screener for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged ≥70 years) community‐dwelling adults admitted to the ED. DESIGN Single‐center, prospective, observation study. SETTING ED with embedded observation unit in University Hospitals Leuven (Belgium). PARTICIPANTS A total of 794 patients (median age = 80 years; 55% female) were included. MEASUREMENTS Study nurses collected data using semistructured interviews and patient record review during ED admission. Outcome data were collected with patient record review. RESULTS: Hospitalization (following index ED stay) and unplanned ED readmission at 30 and 90 days occurred in 67% (527/787) of patients and in 12.2% (93/761) and 22.1% (168/761) of patients, respectively. For all outcomes at cutoff 2, the three screening tools had moderate to high sensitivity (range = 0.71‐0.90) combined with (very) low specificity (range = 0.14‐0.32) and low accuracy (range = 0.21‐0.67). At all cutoffs, likelihood ratios and interval likelihood ratios had no or small impact (range = 0.46‐3.95; zero was not included) on the posttest probability of the outcomes. For all outcomes, area under the receiver operating characteristics curve varied in the range of 0.49 to 0.62. CONCLUSION: Diagnostic characteristics of all screening tools were comparable. None of the tools accurately predicted the outcomes as a stand‐alone index. Future studies should explore the clinical effectiveness and implementation aspects of ED‐specific minimum geriatric assessment and intervention strategies. J Am Geriatr Soc 68:1454‐1461, 2020. See related editorial by Christopher Carpenter. in this issue. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine and compare the added prognostic value of screening tools, geriatric assessment (GA) components, and GA summaries to clinical information for overall survival (OS) in older patients with cancer.Methods: A screening and a 10-item GA were systematically performed in patients ≥70 years old with cancer. Cox regression analyses were conducted to evaluate the added prognostic value for OS of screening tools, GA, and GA summaries to clinical information (age, stage, and tumor type) in 2 cohorts (A and B). Cox models were compared on the basis of the Akaike information criterion and the concordance probability estimate. The 2 cohorts for the analyses were similar but independent.Results: A complete case analysis was available for 763 patients (median age, 76 years) in cohort A and for 402 patients (median age, 77 years) in cohort B. In both cohorts, most individual GA components were independent prognostic factors for OS. Nutritional status (assessed with the Mini Nutritional Assessment Short Form) and functional status (assessed with the Instrumental Activities of Daily Living) consistently displayed a strong capacity to predict OS. Less consistent results were found for screening tools. GA summaries performed the best in comparison with the screening tools and the individual GA components.Conclusions: Most individual GA components, especially nutritional status and functional status, are prognostic factors for OS in older patients with cancer. GA summaries provide more prognostic information than individual GA components but only moderately improve the prognostic baseline model with clinical information. [ABSTRACT FROM AUTHOR]

Background: The current study was performed to evaluate the prognostic value of laboratory parameters and geriatric assessment (GA) in addition to a baseline model with clinical information regarding overall survival (OS) in patients with cancer.Methods: GA was systematically performed in patients aged ≥70 years. The baseline model consisted of age, tumor type, and stage of disease. The incremental prognostic values of the GA as a whole (10-item GA) and laboratory parameters were assessed separately and combined. The parameters included hemoglobin (Hb), albumin, C-reactive protein (CRP), and the Glasgow Prognostic Score (GPS). Analyses were conducted with continuous and dichotomized variables. Cox models were compared based on Akaike information criterion (ΔAIC) and their discriminatory ability was assessed using the concordance probability estimate (CPE).Results: A total of 328 patients were considered for this analysis. The baseline model had a CPE of 0.725. The addition of CRP, albumin, and Hb combined resulted in the best performing model (ΔAIC: 40.12 and CPE: 0.757) among the laboratory parameters. However, the 10-item GA improved the baseline model even more (ΔAIC: 46.03 and CPE: 0.769). Similar results were observed in the analysis with dichotomous variables. The addition of the 3 laboratory parameters (CRP, albumin, and Hb) improved the CPE by 1.4% compared with the baseline model already extended with the 10-item GA. The CPE increase (1.7%) was the highest with the GPS in the analysis with dichotomous variables.Conclusions: GA appears to add slightly more prognostic information than laboratory parameters in addition to clinical information. The laboratory parameters have an additional prognostic value beyond clinical and geriatric information. [ABSTRACT FROM AUTHOR]

Aim To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients. Methods A secondary data analysis comprising data from a prospective non-randomized trial including 86 patients with a hip fracture aged 65 years and older was carried out. State anxiety was measured preoperatively using the State-Trait Anxiety Inventory. Delirium and its severity was measured pre- and postoperatively (day 1, 3, 5, 8) by trained research nurses using the Confusion Assessment Method and Delirium Index. Results A total of 24 patients (27.9%) developed delirium postoperatively. Preoperative state anxiety (State-Trait Anxiety Inventory) was not associated with postoperative delirium (rb = 0.135, P = 0.353), duration of postoperative delirium (rho = 0.038, P = 0.861) or severity of postoperative delirium (rho = 0.153, P = 0.160). Independent predictors of postoperative delirium were lower MMSE scores ( OR 0.75, 95% CI 0.60-0.95, P = 0.015), osteosynthesis surgery ( OR 3.66, 95% CI 1.02-13.15, P = 0,047) and lowest intraoperative diastolic blood pressure ( OR 0.92, 95% CI 0.85-0.99, P = 0.031). Conclusion No relationship between state anxiety and postoperative delirium was found, but significant methodological hurdles were observed and discussed providing important groundwork for further research in this area. Further research should focus on reliable measurement of state anxiety in cognitively impaired older populations. Geriatr Gerontol Int 2016; 16: 948-955. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the responsiveness of the Minimum Data Set inter RAI Acute Care ( AC), a comprehensive geriatric assessment system, to detect clinical changes in patient status during hospital stays. Design An explorative secondary data-analysis comparing prospectively collected data with the inter RAI AC before hospitalization, upon admission, and at discharge. Setting Clinicians from multiple disciplines in nine geriatric and eight nongeriatric wards of nine acute hospitals performed the assessment. Participants The inter RAI AC was administered serially to 256 geriatric inpatients (aged 83.2 ± 5.2; 60% female). Measurements Responsiveness (capacity to detect changes in patients) was calculated for the output scales on five domains: activities of daily living ( ADLs), cognition, communication, depressive symptoms, and pain. Internal responsiveness was evaluated using the Friedman test and Guyatt technique. Results Significant differences in clinical status were found for all five domains, based on the Friedman test. Post hoc tests revealed differences between each assessment period, except for cognition and communication from admission to discharge and for depressive symptoms from before admission to discharge. The Guyatt Responsiveness Index showed good to excellent capacity to detect longitudinal changes during hospitalization for cognition, communication, and pain and substantial performance for ADLs and depressive symptoms. Conclusion In older inpatients, fluctuations in ADLs, cognition, communication, depressive symptoms, and pain can be captured using the inter RAI AC output scales, enabling clinicians to evaluate longitudinal changes from admission to discharge and to provide a comparison with patient status before the acute onset of the illness. These results support the use of these scales in geriatric and nongeriatric wards. [ABSTRACT FROM AUTHOR]

The interRAI Acute Care is a comprehensive geriatric assessment tool that provides a holistic picture of complex and frail hospitalized older persons. It is designed to support holistic care planning and to transfer patient data across settings. Its usefulness in clinical decision making depends on the extent to which clinicians can rely on the patient data as accurate and meaningful indicators of patients functioning. But its multidimensional character implies challenges for clinimetric testing as some of the traditional analyses techniques cannot be unconditionally applied. The objective was to present an overview of methods to examine the reliability of the interRAI Acute Care. For each line of evidence, examples of hypotheses and research questions are listed. [ABSTRACT FROM AUTHOR]

Objectives To assess the value of nurses' clinical judgment ( NCJ) in predicting hospital inpatient falls. Design Prospective multicenter study. Setting Six Belgian hospitals. Participants Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours. Measurements Within 24 hours after admission, nurses gave their judgment on the question 'Do you think your patient is at high risk for falling?' Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form. Results During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75. Conclusion This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it. [ABSTRACT FROM AUTHOR]

The objective was to present an overview of methods to examine the validity of the minimum data set of the interRAI Acute Care (interRAI AC). Because of the multidimensional character of this comprehensive geriatric assessment tool, clinimetric testing of the interRAI AC can be more complex than that of one-dimensional instruments. Thus to facilitate testing of the interRAI AC, we translated this complexity into a structured methodological framework that outlines procedures to assess various lines of evidence. Our framework combined traditional clinimetric techniques and the standards of psychological testing. For each line of evidence, examples of hypotheses and research questions were summarized. Future clinimetric testing can use these guidelines as a basis to obtain and provide a wide and diverse body of evidence. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of inpatient geriatric consultation teams ( IGCTs), which have been introduced to improve the quality of care of older persons hospitalized on nongeriatric wards, on delirium and overall cognitive functioning in older adults with hip fracture. Design Controlled trial. Setting Two trauma wards in a university hospital setting. Participants One-hundred seventy-one people with hip fracture aged 65 and older assigned to a multidisciplinary geriatric intervention (n = 94) or usual care (n = 77). Measurements Incidence and duration of delirium were measured using the Confusion Assessment Method, severity of delirium using the Delirium Index, and cognitive status using the 12-item Mini-Mental State Examination. Results Significantly more controls (53.2%; n = 41) than intervention group participants (37.2%; n = 35; P = .04; odds ratio ( OR) = 1.92, 95% confidence interval ( CI) = 1.04-3.54) were delirious at any point after surgery. No significant difference was found between the groups for duration or severity of delirium episodes. The proportion of participants with cognitive decline at discharge was higher in controls than in those assigned to geriatric intervention (38.7% vs 22.6%; P = .02; OR = 2.16, 95% CI = 1.10-4.24). Conclusion Delirium episodes and cognitive decline during hospitalization were found to be common in older adults with hip fracture, as expected, but an IGCT intervention reduced the incidence of these adverse outcomes. In participants who developed delirium, a geriatric consultation had no effect on severity or duration of the delirium episode. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effect of an inpatient geriatric consultation team (IGCT) on end points of interest in people with hip fracture: length of stay, functional status, mortality, new nursing home admission, and hospital readmission. DESIGN: Controlled trial based on assignment by convenience. SETTING: Trauma ward in a university hospital. PARTICIPANTS: One hundred seventy-one people with hip fracture aged 65 and older. INTERVENTION: Participants were assigned to a multidisciplinary geriatric intervention (n=94) or usual care (n=77) during hospitalization after hip fracture. MEASUREMENTS: End points were functional status, length of stay, mortality, new nursing home admission, and hospital readmission 6 weeks, 4 months, and 12 months after surgery. RESULTS: Mean length of stay was 11.1 ± 5.1 days in the intervention group and 12.4 ± 8.5 days in the control groups (P=.24). Complete adherence to IGCT recommendations was 56.8%. A significant benefit of intervention on functional status in univariate analyses (P=.02) 8 days after surgery disappeared in a linear mixed model. Participants with dementia had better functional status in a linear mixed model than those without (P=.03), but this effect was no longer significant after Bonferroni correction for multiple testing. After 6 weeks, 4 months, and 12 months, no between-group differences could be documented for mortality, new nursing home admission, or readmission rate. CONCLUSION: This trial could not document functional benefits of an IGCT intervention in people with hip fracture. More research is needed to investigate whether a more-intensive approach with more-direct control over patient management, more-specific recommendations, and more-intense education would be effective. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU. DESIGN: Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors. SETTING: GEMUs. PARTICIPANTS: Elderly people admitted to a GEMU. MEASUREMENTS: Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow-up points. A random-effects meta-analysis was performed using Hedges' gu and variance of relative risk (RR). RESULTS: GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta-analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77–0.99; P=.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66–0.92; P=.003). For the other outcomes in the meta-analysis, a GEMU did not induce significantly different outcomes than usual care. CONCLUSION: This meta-analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well-designed studies using explicit CGA and more-structured and -coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented concerning an epidemiological study into pneumococcal colonization in older people in various settings.