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Introduction: Hospital associated deconditioning is a well-established phenomenon. Whilst mechanisms are not well understood, one is thought to be skeletal muscle wasting and/or loss of muscle strength. The primary aim of this study was to investigate changes in knee-extension muscle strength in older patients during and after an acute-hospital admission. We also aimed to explore the potential contributions of frailty, acute-illness severity and sedentary activity, with changes in knee-extension strength. Methods: This was a prospective repeated-measures cohort study. Measurements of muscle strength and functional mobility were taken at recruitment, on day 7 of admission (or at discharge if earlier) and again 4-6 weeks post-hospitalisation. During the first 7 days of admission, daily measurements of muscle strength were taken. Results: We recruited 70 participants, of which 65 had at least one repeated measure in hospital. Median age was 84 years, and participants participated in the study for a median of 6 days whilst in hospital, on average participants were ‘active’ for less than 4% of the day. Knee-extension strength significantly reduced by approximately 11% during hospitalisation, but no significant changes occurred post-hospitalisation. A repeated measures mixed model included 292 observations from 62 participants and showed a significant decrease in the reduction in muscle strength as patients’ sedentary time decreased on days 2 to 7 of the study. Additionally, the model showed that a higher frailty score, higher baseline knee-extension strength, lower baseline c-reactive protein levels were associated with greater loss in knee-extension strength during hospitalisation. Association between change in functional mobility after hospitalisation and change in knee-extension strength during hospitalisation was non-significant. Conclusion: Our findings provide an important link in understanding themechanisms and relative contributions of risk factors to hospital associated deconditioning. Further research is needed to confirm these findings and examine the impact of reducing sedentary time on muscle strength during and post-hospitalisation. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether admissions for orthostatic hypotension (OH) and its consequences, such as falls, have changed over the past 10 years in the National Health Service (NHS) England., Setting: Data from NHS England Hospital Episode Statistics, a database containing details of all admissions, accident and emergency attendances and outpatient appointments at NHS hospitals in England, were obtained and analysed., Participants: Data on hospital admissions in NHS England, as defined by finished consultant episodes (FCEs), were examined between 2008 and 2017., Main Outcome Measures: FCEs for the following International Classification of Disease codes were examined: OH (I95.1), tendency to fall (R29.6), epilepsy (G40) and chronic obstructive pulmonary disease (COPD) (J44). The total number of FCEs was also examined., Results: Between 2008 and 2017, FCEs for OH rose from 14 658 to 30 759, a 110% increase. The greatest increase was in the over 75 years age group where FCEs went from 10 639 to 22 756, a 114% rise. The number of falls related FCEs in this age group rose from 61 841 to 89 622 (45%). Admissions for epilepsy and COPD rose by 7% and 35%, respectively., Conclusions: The number of admissions for OH has risen dramatically over the past 10 years, as have admissions for falls and related disorders. This rise is out of proportion with admissions for other conditions such as epilepsy and COPD. We postulate that this relates to tighter blood pressure (BP) targets. This suggests caution in the application of recent BP targets to older, frailer adults., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: In the English National Health Service there is an increasing interest in understanding the factors associated with delayed discharges in older hospitalized adults. The present study sought to analyze whether clinical frailty was a significant and independent risk factor for having a delayed discharge when the data were controlled for potential health and social confounders., Methods: This was a retrospective observational study in an English National Health Service teaching hospital. We analyzed all first hospitalization episodes to the Department of Medicine for the Elderly between 1 May 2016 and 31 July 2016. A delayed discharge was operationally defined as a patient being discharged more than 24 h after his/her last recorded clinically fit date., Results: A total of 924 cases were analyzed. The independent risk factors for having a delayed discharge were: needing a new package of care (OR 4.05, 95% CI 2.68-6.10), new institutionalization (OR 2.78, 95% CI:1.67-4.62), living alone (OR 1.98, 95% CI 1.40-2.81), delirium (OR 1.79, 95% CI 1.17-2.74) and frailty (i.e. ≥5 on the Clinical Frailty Scale, OR 1.74, 95% CI 1.15-2.63)., Conclusions: The present results are consistent with previous reports that delayed discharges in older hospitalized patients are mainly related to new formal social care requirements in survivors of acute illness. Frailty was an independent risk factor for delay, but its effect might have been confounded by the unmeasured variable of informal care requirements. Our operational definition of delayed discharge does not mirror the legal definition of delayed transfer of care in England, and the results are not externally valid. Geriatr Gerontol Int 2018; 18: 530-537., (© 2017 Japan Geriatrics Society.)

Background: Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital., Objective: To study the association of frailty (≥6 points in the Clinical Frailty Scale [CFS]), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery)., Design: Retrospective observational study., Setting: Large university hospital in England., Patients: We analyzed 8202 first nonelective inpatient episodes of people aged 75 years and older between October 2014 and October 2015., Measurements: The outcomes studied were prolonged length of stay (LOS ≥10 days), inpatient mortality, delayed discharge, institutionalization, and 30-day readmission. Statistical analyses were based on multivariate regression models., Results: Independently of controlling variables, prolonged LOS was predicted by CFS ≥6: odds ratio (OR) =1.55; 95% confidence interval [CI], 1.36-1.77; P ⟨ 0.001; HoD: OR = 2.16; 95% CI, 1.79-2.61; P ⟨ 0.001; and ACS: OR = 3.31; 95% CI, 2.64-4.15; P ⟨ 0.001. Inpatient mortality was predicted by CFS ≥6: OR = 2.29; 95% CI, 1.79-2.94; P ⟨ 0.001. Delayed discharge was predicted by CFS ≥6: OR = 1.46; 95% CI, 1.27-1.67; P ⟨ 0.001; HoD: OR = 2.17; 95% CI, 1.80-2.62; P ⟨ 0.001; and ACS: OR = 2.29; 95% CI: 1.83-2.85; P ⟨ 0.001. Institutionalization was predicted by CFS ≥6: OR = 2.56; 95% CI, 2.09-3.14; P ⟨ 0.001; HoD: OR = 2.51; 95% CI, 2.00-3.14; P ⟨ 0.001; and ACS: OR 1.93; 95% CI, 1.46-2.56; P ⟨ 0.001. Readmission was predicted by ACS: OR = 1.36; 95% CI, 1.09-1.71; P = 0.006., Conclusions: Routine screening for frailty, HoD, and ACS in hospitals may aid the development of acute care pathways for older adults. Journal of Hospital Medicine 2017;12:83-89., (© 2017 Society of Hospital Medicine)

Background: The clinical frailty scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people. In our hospital, the use of the CFS in emergency admissions of people aged ≥ 75 years was introduced under the Commissioning for Quality and Innovation payment framework., Aim: We retrospectively studied the association of the CFS with patient characteristics and outcomes., Design: Retrospective observational study in a large tertiary university National Health Service hospital in UK., Methods: The CFS was correlated with transfer to specialist Geriatric ward, length of stay (LOS), in-patient mortality and 30-day readmission rate., Results: Between 1st August 2013 and 31st July 2014, there were 11 271 emergency admission episodes of people aged ≥ 75 years (all specialties), corresponding to 7532 unique patients (first admissions); of those, 5764 had the CFS measured by the admitting team (81% of them within 72 hr of admission). After adjustment for age, gender, Charlson comorbidity index and history of dementia and/or current cognitive concern, the CFS was an independent predictor of in-patient mortality [odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.48 to 1.74, P < 0.001], transfer to Geriatric ward (OR = 1.33, 95% CI: 1.24 to 1.42, P < 0.001) and LOS ≥ 10 days (OR = 1.19, 95% CI: 1.14 to 1.23, P < 0.001). The CFS was not a multivariate predictor of 30-day readmission., Conclusions: The CFS may help predict in-patient mortality and target specialist geriatric resources within the hospital. Usual hospital metrics such as mortality and LOS should take into account measurable patient complexity., (© The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)