Comprehensive Geriatric Assessment
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Predictors of emergency room visits or acute hospital admissions in Palliative Home Care Clients

Predictors of emergency room visits or acute hospital admissions in Palliative Home Care Clients | Comprehensive Geriatric Assessment | Scoop.it

Hospitals are considered a setting ill-prepared for end of life issues; therefore, use of such acute care services has to be considered an indicator of poor quality end of life care. This study examines predictors of ERVH prior to death among HPC home care clients. 

Methods: A retrospective cohort study of a sample of 764 HPC home care clients who received services from a community care access centre (CCAC) in southern Ontario, Canada.

All clients were assessed using the Resident Assessment Instrument for Palliative Care (interRAI PC) as part of normal clinical practice between April 2008 and July 2010. The Andersen-Newman framework for health service utilization was used as a conceptual model for the basis of this study.

Logistic regression and Cox regression analyses were carried out to identify predictors of ERVH. 

Results: Half of the HPC clients had at least one or more ERVH (n = 399, 52.2%). Wish to die at home (OR = 0.54) and advanced care directives (OR = 0.39) were protective against ERVH.

Unstable health (OR = 0.70) was also associated with reduced probability, while infections such as prior urinary tract infections (OR = 2.54) increased the likelihood of ERVH. Clients with increased use of formal services had reduced probability of ERVH (OR = 0.55). 

Conclusions: Findings of this study suggest that predisposing characteristics are nearly as important as need variables in determining ERVH among HPC clients, which challenges the assumption that need variables are the most important determinants of ERVH.

Ongoing assessment of HPC clients is essential in reducing ERVH, as reassessments at specified intervals will allow care and service plans to be adjusted with clients'changing health needs and end of life preferences.

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Author: Lialoma Salam-WhiteJohn P HirdesJeffrey W PossJane Blums
Source: BMC Palliative Care 2014, 13:35

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Understanding How Older Adults Use the U.S. Health Care System: From Measurement to Meaning

In their article, Ganguli and colleagues characterized a new measure of health care utilization—“health care contact days.” The editorialists find the measure a promising new way to understand ho
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Whooping cough rises sharply in UK and Europe | The BMJ

Whooping cough rises sharply in UK and Europe | The BMJ | Comprehensive Geriatric Assessment | Scoop.it
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The future of the NHS depends on its workforce | The BMJ

The future of the NHS depends on its workforce | The BMJ | Comprehensive Geriatric Assessment | Scoop.it
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Common Oral Conditions: A Review | Dental Medicine | JAMA | JAMA Network

Common Oral Conditions: A Review | Dental Medicine | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This review discusses diagnosis and first-line treatment options for dry mouth, oral candidiasis, and recurrent aphthous ulcers.
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Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care: A Position Paper From the American College of Physicians

Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.
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Reflexiones corporativistas (probablemente pertinentes en la actualidad) desde un modelo americano donde la existencia de Nurse Practitioners y Physician Assistants ya existen desde hace 50 años. 

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The Impact of High- Versus Low-Dose Home Rehabilitation for Functional Independence after Hip or Knee Replacement - ClinicalKey

The Impact of High- Versus Low-Dose Home Rehabilitation for Functional Independence after Hip or Knee Replacement - ClinicalKey | Comprehensive Geriatric Assessment | Scoop.it

Evidence supports including home OT/PT in postoperative pain management guidelines more for TKA than THA. These findings may be attributable to different postoperative rehabilitation approaches for TKA and THA. For example, early TKA recovery focuses on remediating postoperative impairments. In comparison, patients with THA follow conservative precautions to reduce the 2.1% incidence of dislocation. 10 Therefore, compensatory techniques take precedence over remediation. During compensatory rehabilitation, a high OT/PT dose may have less impact due to temporary compensation through quick environmental modifications like shower chairs, grab bars, and patient education

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Outcomes for Long-Stay Nursing Facility Residents Following On-Site Acute Care under a CMS Initiative - ClinicalKey

The Centers for Medicare & Medicaid Services (CMS) Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform enabled participating NFs to bill Medicare for providing on-site care to eligible long-stay residents meeting specified severity criteria due to any of 6 medical conditions, as an alternative to hospitalization. For billing purposes, residents were required to meet clinical criteria severe enough to warrant hospitalization.

 

Our findings lend support to the practice of treating residents for these 6 conditions on-site, when clinically appropriate, instead of transferring to a hospital. It is advisable that NF medical directors consider our findings and be reassured that treatment within the facility is often the better choice for residents and their health outcomes. Further research is warranted to develop best practice criteria to guide decisions as to when to treat residents with these conditions on-site vs in the hospital. In addition to outcomes measured in this study, there are other benefits to treating nursing facility residents on-site, such as supporting continuity of care and supporting residents to remain in a stable, familiar environment.

 

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Parece que funciona como era de prever, si bien la clave es que existe una transferencia de pago por episodio agudo a la residencia (difícil de trasladar este modelo a nuestro entorno).

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Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Socie...

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Socie... | Comprehensive Geriatric Assessment | Scoop.it
IntroducciónDada la creciente adopción de la ecografía clínica en medicina,
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Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine | NEJM

Wearable Technologies in Cardiovascular Medicine This article reviews the use of digital wearable technologies for monitoring of three common cardiovascular conditions: hypertension, hear
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How to construct a frailty index from an existing dataset in 10 steps | Age and Ageing | Oxford Academic

How to construct a frailty index from an existing dataset in 10 steps | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps

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Construct validity of the electronic Veterans Affairs Frailty Index against clinician frailty assessment - DuMontier - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

Electronic frailty indices (eFIs) can expand measurement of frailty in research and practice and have demonstrated predictive validity in associations with clinical outcomes. However, their construct validity is less well studied. We aimed to assess the construct validity of the VA-FI, an eFI developed for use in the U.S. Veterans Affairs Healthcare System.

 

Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.

 

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Comparing frailty prevalence between countries: validation of the Global Burden of Disease study Frailty Index (GBD-FI) in the survey of health, ageing and retirement in Europe | Age and Ageing | O...

Comparing frailty prevalence between countries: validation of the Global Burden of Disease study Frailty Index (GBD-FI) in the survey of health, ageing and retirement in Europe | Age and Ageing | O... | Comprehensive Geriatric Assessment | Scoop.it

The GBD-FI demonstrated concurrent and predictive validity, suggesting it is a valid measure of frailty. It has the potential to be an efficient, replicable and consistent approach to comparing frailty between countries and regions across time using GBD data.

 

 

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Non-acute heart failure management in primary care | The BMJ

Non-acute heart failure management in primary care | The BMJ | Comprehensive Geriatric Assessment | Scoop.it
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Biomarker Changes Can Begin 18 Years Before Alzheimer Disease Diagnosis | Dementia and Cognitive Impairment | JAMA | JAMA Network

Biomarker Changes Can Begin 18 Years Before Alzheimer Disease Diagnosis | Dementia and Cognitive Impairment | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
Variations in several biomarkers, including proteins found in cerebrospinal fluid (CSF), might appear 6 to 18 years before a person develops Alzheimer disease, according to a prospective cohort study that included more than 600 participants in China with no family history of the condition.
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Progress for Parkinson’s?: ITT Episode 28: New England Journal of Medicine: Vol 390, No 13

Progress for Parkinson’s?: ITT Episode 28: New England Journal of Medicine: Vol 390, No 13 | Comprehensive Geriatric Assessment | Scoop.it
This podcast episode explores the fastest-growing neurologic condition in the world, Parkinson’s disease. What have we learned in recent years, and where are the greatest hopes for the future?
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Prodromal dementia with Lewy bodies in REM sleep behavior disorder: A multicenter study - Joza - 2024 - Alzheimer's & Dementia - Wiley Online Library


INTRODUCTION
Isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) is a powerful early predictor of dementia with Lewy bodies (DLB) and Parkinson's disease (PD).

 

Cognitive changes in iRBD begin up to 10 years prior to phenoconversion, starting with a decline in executive function followed by attention, then memory and visuospatial dysfunction closer to time of phenoconversion

 

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Considerar polisomnografia en el diagnostico diferencial...

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Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation - ClinicalKey

Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation.

Sergio Ariño Blasco's insight:

Obvio, probablemente los instrumentos utilizados tienen efecto techo-suelo y no discriminan cambios. Lástima que no se incorpore la situación funcional/cognitiva previa al ingreso

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Telemedicine in Nursing Home Residents Requiring a Call to an Emergency Medical Communication Center - ClinicalKey

Telemedicine in Nursing Home Residents Requiring a Call to an Emergency Medical Communication Center - ClinicalKey | Comprehensive Geriatric Assessment | Scoop.it

In the present study, the use of telemedicine in the management of

nursing home residents requiring a call to the EMCC decreased the

number of dispatches to the ED by 18%.

 

By reducing the number of dispatches to our ED, the implementation of telemedicine in nursing homes could prevent 450 unplanned admissions per year in our ED and 65,000 admissions per year in all French EDs. There are many benefits to be expected, both individually in terms of morbidity of older individuals by avoiding cognitive decline, iatrogenic complications, and other adverse events commonly associated with unplanned hospital admissions and collectively by limiting inappropriate hospitalizations and their associated costs.

 

Sergio Ariño Blasco's insight:

El dispositivo registraba...signos vitales, cámara para el registro de foto y video y la posibilidad de registro EKG.  Reducción de hasta el 18% de las derivaciones a ucias. 

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Are frailty measurements derived using electronic health records fit for clinical use? | Age and Ageing | Oxford Academic

Are frailty measurements derived using electronic health records fit for clinical use? | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
Frailty measures derived from primary care electronic health records (EHRs) offer a rapid and inexpensive means of segmenting large populations of older people
  • Frailty measures derived from routine data can predict key frailty-related outcomes with robust model performance

  • Utility of frailty measures needs to be determined by

    whether care informed by using them leads to better

    patient outcomes

  • Research should now focus on evaluating and enhancing

    existing frailty measures through multiple challenges of

    implementation

  • The development of methods to monitor and update the

    performance of frailty measures over time is now needed.

 

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Publishers’ and journals’ instructions to authors on use of generative artificial intelligence in academic and scientific publishing: bibliometric analysis | The BMJ

Publishers’ and journals’ instructions to authors on use of generative artificial intelligence in academic and scientific publishing: bibliometric analysis | The BMJ | Comprehensive Geriatric Assessment | Scoop.it
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Feasibility of Assessing Older Patients in the Acute Setting: Findings From the Copenhagen PROTECT Study

Older patients are typically underrepresented in clinical trials despite representing a major proportion of the patient population. We aim to describe the feasibility of performing body composition measures, physical function measures, and patient-reported
questionnaires within the first 24 hours of admission in a large sample of older acutely admitted medical patients. In addition, we aim to characterize patients with missing measurements.The assessment of HGS and PROs show excellent feasibility in clinical research including older patients, even when the patients are enrolled and tested within 24 hours of an acute admission. Assessments of DSM-BIA and the 30-second STS show good feasibility but are less feasible in immobile patients often presenting as more frail, weaker, and cognitively impaired.

 

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Common sense cancer care for older adults: Outcomes that matter - Frank - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

“Common sense oncology is about focusing on outcomes that matter to patients. The field needs to generate better evidence, with less bias, and use ‘universal goals’ of older patients to guide decisions. The narrative of ‘newer is better’ or ‘do something’ needs scrutiny”

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Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales | Revista Clínica E...

Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales | Revista Clínica E... | Comprehensive Geriatric Assessment | Scoop.it

Las admisiones en urgencias por ACSC procedentes de entornos residenciales suponen un impacto significativo tanto en la frecuencia como en los costes. La disminución de estas enfermedades mediante la aplicación de intervenciones específicas podría redirigir los costes evitados hacia la mejora del apoyo asistencial en los entornos residenciales.

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