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Background Functional decline (FD) is a common and serious problem among hospitalised older adults. Objective This systematic review and meta-analysis aims to identify patient-related risk factors for in-hospital FD in older adults. Methods Previous reviews on this topic (1970-2007) and the databases PubMed, Embase, and CINAHL (January 2007-December 2020) were searched. Reference lists of included articles were screened. Studies investigating patient-related risk factors for FD from (pre)admission to discharge in older adults admitted to an acute geriatric or internal medical unit were included. Study quality was assessed using the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. The quality of evidence was assessed using GRADE. Results Twenty-nine studies met the inclusion criteria. Statistically significant risk factors were living in a nursing home (OR, 2.42; 95% CI, 1.29-4.52), impairment in instrumental activities of daily living (OR, 2.08; 95% CI, 1.51-2.86), history of falls (OR, 1.71; 95% CI, 1.00-2.92), cognitive impairment (OR, 1.83; 95% CI, 1.56-2.14), dementia (OR, 1.71; 95% CI, 1.23-2.38), delirium (OR, 2.34; 95% CI, 1.88-2.93), (risk of) malnutrition (OR, 1.76; 95% CI, 1.03-3.03), hypoalbuminemia (OR, 1.79; 95% CI, 1.36-2.36), comorbidity (OR, 1.09; 95% CI, 1.03-1.16), and the presence of pressure ulcers (OR, 3.33; 95% CI, 1.82-6.09). The narrative synthesis suggested prehospital FD, needing assistance with walking, and low body mass index as additional risk factors. Conclusions Several patient-related risk factors for in-hospital FD were identified that can be used at hospital admission to identify older patients at risk of FD. [ABSTRACT FROM AUTHOR]

Background: Hospital admissions in older adults are frequently drug related and avoidable. Clinical pharmacy interventions during hospital stay might reduce drug-related harm and reduce hospital visits. Moreover, several recent positive clinical pharmacy investigations incorporated a transitional care component to further improve medication use after discharge. It is currently unclear what the strength of evidence is and what the exact components should be of such clinical pharmacy interventions in older adults. Objective: An evidence-based review was performed to determine the status of the evidence and also to explore whether a clinical pharmacy intervention incorporating transitional care was associated with reduced hospital visits after discharge. Methods: Prospective controlled investigations were included if they contained a clinical pharmacy intervention that was initiated before discharge in older inpatients. Relevant quasi-experimental and randomized controlled trials were searched in MEDLINE. First, an evidence-based review was performed, including a description of the study design, characteristics, and outcomes. Major components of successful clinical pharmacy interventions were described and potential implications for clinical practice and research were determined. Second, the Fisher's exact test was used to explore the association between transitional care and reduced hospital visits. Third, based on these findings, a medication review proposal was developed to improve medication use in older adults. Results: Thirty-five studies were included, with 26 randomized controlled trials. Median patient follow-up after discharge was 90 days (interquartile range 37–180 days) and investigators enrolled a median of 210 (interquartile range 110–498) study participants. On average, patients were aged 77.5 years (interquartile range 73–82.2 years). Nine randomized controlled trials had sufficient power to detect a reduction in hospital visits after discharge; this was reduced in three randomized controlled trials. Post-discharge follow-up was not associated with reduced post-discharge hospital visits (20 randomized controlled trials: follow-up vs. no follow-up: 6/11 vs. 1/9, p = 0.070). There was a significant reduction in post-discharge hospital visits in patients aged 75 years or older (12 randomized controlled trials: follow-up vs. no follow-up: 5/7 vs. 0/5, p = 0.028). A medication review proposal was developed, consisting of six steps. Conclusions: Three powered randomized controlled trials were identified that found a significant association between a pharmacist-led intervention in older adults and a reduction in post-discharge hospital visits. In clinical practice, an intervention consisting of medication reconciliation, review, counseling, and post-discharge follow-up should be provided to such high-risk inpatients. Regarding research priorities, large, multi-center randomized controlled trials should be performed to generate more evidence on the impact of clinical pharmacy interventions on the patient trajectory and economic outcomes. [ABSTRACT FROM AUTHOR]

Background: geriatric consultation teams have failed to impact clinical outcomes prompting geriatric co-management programmes to emerge as a promising strategy to manage frail patients on non-geriatric wards. Objective: to conduct a systematic review of the effectiveness of in-hospital geriatric co-management. Data sources: MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to 6 May 2016. Reference lists, trial registers and PubMed Central Citations were additionally searched. Study selection: randomised controlled trials and quasi-experimental studies of in-hospital patients included in a geriatric co-management study. Two investigators performed the selection process independently. Data extraction: standardised data extraction and assessment of risk of bias were performed independently by two investigators. Results: twelve studies and 3,590 patients were included from six randomised and six quasi-experimental studies. Geriatric co-management improved functional status and reduced the number of patients with complications in three of the four studies, but studies had a high risk of bias and outcomes were measured heterogeneously and could not be pooled. Co- management reduced the length of stay (pooled mean difference, -1.88 days [95% CI, -2.44 to -1.33]; 11 studies) and may reduce in-hospital mortality (pooled odds ratio, 0.72 [95% CI, 0.50-1.03]; 7 studies). Meta-analysis identified no effect on the number of patients discharged home (5 studies), post-discharge mortality (3 studies) and readmission rate (4 studies). Conclusions: there was low-quality evidence of a reduced length of stay and a reduced number of patients with complica- tions, and very low-quality evidence of better functional status as a result of geriatric co-management. [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 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 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]

The article compares the diagnostic characteristics of the Identification of Seniors at Risk (ISAR), the Triage Risk Screening Tool (TRST) and the Variable Indicative of Placement (VIP) for predicting functional decline in older, hospitalised patients. It was found that the ISAR and TRST seem to be good screening instruments. However, their low positive predictive and high false positive values may result in poorly targeted interventions.