PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative ... more PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution‐acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries.DesignThis study reports the outcome of a secondary data analysis of cross‐sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents.MethodsDescriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data.FindingsIAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and...
Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the pre... more Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the presence of significant hepatic dysfunction and the diversion of the portal blood to the systemic circulation (porto-systemic shunts). Hereditary Hemorrhagic Telangiectasia (HHT) or Osler-Weber-Rendu disease, can also involve the liver along with the skin, mucous membranes, lung, brain, and gastrointestinal tract. The prevalence of hepatic involvement in HHT ranges between 41% and 78%. Although most patients with HHT are asymptomatic, some may have symptoms due to high-output heart failure, portal hypertension and biliary disease. Less commonly, patients may also develop porto-systemic encephalopathy. In this case report, we present a woman aged 63 years, who was diagnosed as having hepatic encephalopathy due to a portosystemic shunt.
To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functi... more To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home. Male residents aged >60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m(2), skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m(2)) were calculated. The participants were regarded as having low SMMI if they had SMMI <9.2 kg/m(2) according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded. One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged >70 years. Thirty-five men (23%) had low SMMI in group aged >60 years, and twenty-eight subjects (25%) in the group aged >70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p< 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged >70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01). Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.
To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of... more To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of sarcopenia defined by the SARC-F was 48.8%. Sarcopenia risk was associated with unfavorable health care outcomes including dependency, malnutrition, and dysphagia. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients and it is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032–1.104, p < 0.001), female gender (OR: 2.414, CI 1.510–3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922–8.632, p < 0.001) were independently associated with sarcopenia risk. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.
all included patients and subgroups. Determination of predictors was done by multivariable binary... more all included patients and subgroups. Determination of predictors was done by multivariable binary logistic regression. Results.– Four hundred and forty-two people aged 75 years or older were included in the study, 73.5% (n=325) were admitted to the hospital, of which 35.1% (n=114) were admitted to an acute geriatric ward. Of the patients being discharged from the ED, 26.5% (31/117) had an unplanned ED revisit within 3 months. Nursing care at home (OR 4.63, 95% CI 1.45–14.77) and depression (OR 3.91, 95% CI 1.16–13.19) were found to be independent predictors for unplanned ED readmission in the multivariable analysis. A significant trend was found for falls in the last year (OR 2.99, 95% CI 0.95–9.37). Conclusion.–This study confirms thehigh readmission rates of older persons being discharged from the ED and suggests the potential value ofmultidisciplinary, psychosocial and functional assessment, interventions and follow-up to avoid early-unplanned ED readmissions.
OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional ... more OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey. METHODS This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed. RESULTS Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention. CONCLUSIONS The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.
PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative ... more PurposeFalls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution‐acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries.DesignThis study reports the outcome of a secondary data analysis of cross‐sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents.MethodsDescriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data.FindingsIAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and...
Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the pre... more Hepatic encephalopathy is a common complication of end-stage liver disease. It happens in the presence of significant hepatic dysfunction and the diversion of the portal blood to the systemic circulation (porto-systemic shunts). Hereditary Hemorrhagic Telangiectasia (HHT) or Osler-Weber-Rendu disease, can also involve the liver along with the skin, mucous membranes, lung, brain, and gastrointestinal tract. The prevalence of hepatic involvement in HHT ranges between 41% and 78%. Although most patients with HHT are asymptomatic, some may have symptoms due to high-output heart failure, portal hypertension and biliary disease. Less commonly, patients may also develop porto-systemic encephalopathy. In this case report, we present a woman aged 63 years, who was diagnosed as having hepatic encephalopathy due to a portosystemic shunt.
To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functi... more To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home. Male residents aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m(2), skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m(2)) were calculated. The participants were regarded as having low SMMI if they had SMMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9.2 kg/m(2) according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded. One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years. Thirty-five men (23%) had low SMMI in group aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 years, and twenty-eight subjects (25%) in the group aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01). Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.
To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of... more To evaluate sarcopenia risk in hospitalized older patients. The percentage of patients at risk of sarcopenia defined by the SARC-F was 48.8%. Sarcopenia risk was associated with unfavorable health care outcomes including dependency, malnutrition, and dysphagia. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients and it is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032–1.104, p < 0.001), female gender (OR: 2.414, CI 1.510–3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922–8.632, p < 0.001) were independently associated with sarcopenia risk. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.
all included patients and subgroups. Determination of predictors was done by multivariable binary... more all included patients and subgroups. Determination of predictors was done by multivariable binary logistic regression. Results.– Four hundred and forty-two people aged 75 years or older were included in the study, 73.5% (n=325) were admitted to the hospital, of which 35.1% (n=114) were admitted to an acute geriatric ward. Of the patients being discharged from the ED, 26.5% (31/117) had an unplanned ED revisit within 3 months. Nursing care at home (OR 4.63, 95% CI 1.45–14.77) and depression (OR 3.91, 95% CI 1.16–13.19) were found to be independent predictors for unplanned ED readmission in the multivariable analysis. A significant trend was found for falls in the last year (OR 2.99, 95% CI 0.95–9.37). Conclusion.–This study confirms thehigh readmission rates of older persons being discharged from the ED and suggests the potential value ofmultidisciplinary, psychosocial and functional assessment, interventions and follow-up to avoid early-unplanned ED readmissions.
OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional ... more OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey. METHODS This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed. RESULTS Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention. CONCLUSIONS The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.
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