RESUMEN
BACKGROUND: Little is known on the bacteriological profile of consecutive urine samples in elderly patients institutionalized in nursing homes. AIM: This retrospective study aims to characterize urinary pathogens, rates of isolation of the same pathogen in subsequent urine samples and predicting factors associated with such repeated isolations. Data were retrospectively retrieved from medical charts of nursing home patients during a four-year period. The authors looked for changes in rates of positive cultures, changes in urine flora, in rates of repeated isolation of the same pathogens and the possible interrelations with the use of antibiotics. METHODS: A total number of 3229 urine cultures were studied, 1311 of which (43%) were positive and 493 out of these positive cultures (37.6%) were treated with antibiotics. The rates of positive cultures increased consistently during the study period (p=0.003). E. coli (68.1%), Klebsiella pneumoniae and Proteus mirabilis accounted for more than 90% of positive cultures. RESULTS: There was no difference with regard to pathogen types isolated from symptomatic or asymptomatic cases. The rates of recurrent bacteriuria, by the same pathogen isolated at baseline urine culture, were similar in treated and untreated cases. A regression analysis aiming to predict factors associated with subsequent positive cultures had negative results, except for cases of untreated bacteriuria with pseudomonas (CI 1.36-7.09, O.R. 3.11, p=0.006). CONCLUSION: Our data support earlier studies underscoring the need to carefully consider the role of antibiotics and for better clinical guidelines for the treatment of bacteriuria in this population.
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Antibacterianos/uso terapéutico , Bacteriuria/epidemiología , Anciano , Antiinfecciosos/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Bacteriuria/tratamiento farmacológico , Bacteriuria/patología , Escherichia coli/aislamiento & purificación , Hogares para Ancianos , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Cuidados a Largo Plazo , Valor Predictivo de las Pruebas , Proteus mirabilis/aislamiento & purificación , Estudios Retrospectivos , RituximabRESUMEN
The body mass index (BMI) is a key marker of nutritional status among older patients, but does not reflect changes in body composition, The aim of the present study was to investigate BMI levels and body composition in a sample of disabled nursing home residents, and to study possible interrelations between BMI, fat-free body mass (FFM), body fat mass (BFM), skeletal muscle mass (SMM) and 1-year mortality rates. FFM and SMM were assessed by 24-h urine creatinine excretion and BFM as the difference between BMI and FFM. We calculated relative risk (RR) and odds ratio (OR) of 1-year mortality, associated with different levels of BMI, FFM index (where index=value/height(2)), SMM index and BFM index in 82 disabled institutionalized elderly patients. One-year mortality rate was 29.3%. Adjusted relative risk of mortality of low BMI patients was 1.45 (95% CI=0.73-2.89; OR=1.73) and 0.63 (95% CI=0.33-1.60; OR=0.72) in high BMI. Risk of mortality was higher in those having low FMM index or SMM index (RR=2.42, 95% CI=0.36-16.18; OR=2.55 and RR=3.22, 95% CI=0.78-13.32; OR=3.67, respectively). It is concluded that low FFM and SMM indexes among disabled nursing home residents are far better predictors than BMI for 1-year mortality estimation.
Asunto(s)
Composición Corporal , Índice de Masa Corporal , Personas con Discapacidad/estadística & datos numéricos , Hogares para Ancianos/estadística & datos numéricos , Mortalidad , Casas de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Creatinina/orina , Femenino , Humanos , Israel/epidemiología , Masculino , Músculo Esquelético , Estado Nutricional , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess whether, and to what extent, cognitive outcome relates to overall functional outcome among elderly stroke patients. DESIGN: Nonconcurrent prospective study. SETTING: Geriatric rehabilitation division at a large, urban, academic, freestanding hospital in Israel. PARTICIPANTS: Three hundred thirty-six patients aged 60 years and older admitted consecutively for rehabilitation after first acute stroke. Inclusion criteria were met by 315 patients, who were included in the final analysis. Average age was 75.3 years. The stroke was right sided in 44.1%. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The motor subscale of the FIM instrument assessed functional status. Absolute functional gain was determined by the FIM motor gain. Relative functional gain was calculated according to the Montebello Rehabilitation Factor Score. Cognitive status was assessed with the Mini-Mental State Examination (MMSE) and the FIM cognitive subscale. RESULTS: FIM scores increased significantly during rehabilitation, mainly due to improvement in motor functioning. A strong association was found between the cognitive scales (r=.853, P<.001). Better rehabilitation outcomes were observed in patients with higher admission cognitive status, adjusting for the effect of age, sex, onset to admission interval, length of stay, and severity of stroke (odds ratio = 2.0; 95% confidence interval, 1.5-2.5). CONCLUSIONS: Impaired cognitive status at admission negatively affects the rehabilitation outcome of elderly stroke patients. The utility of routinely using a cognitive test for all patients before admission to rehabilitation, preferably the MMSE, is emphasized. The time, cost, and effort involved in performing such a test are negligible, and the potential benefits are considerable.
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Trastornos del Conocimiento/diagnóstico , Planificación de Atención al Paciente , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/diagnóstico , Actividades Cotidianas , Anciano , Trastornos del Conocimiento/complicaciones , Femenino , Asignación de Recursos para la Atención de Salud , Humanos , Israel , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estudios Prospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/economía , Resultado del TratamientoRESUMEN
OBJECTIVES: To compare 3 cognitive tests, used on admission, for predicting discharge functional outcome and to assess the efficacy of these tests in predicting functional outcome at discharge in stroke patients undergoing rehabilitation. DESIGN: Cohort study. SETTING: Geriatric rehabilitation department of a tertiary care hospital in Israel. PATIENTS: Sixty-six patients undergoing acute inpatient comprehensive rehabilitation after first clinical stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASUREMENTS: Cognitive status was assessed with the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), the Mini-Mental State Examination (MMSE), and the cognitive subscale of the FIM instrument. The FIM motor subscale was used to assess functional outcome status. Functional gain was determined by the motor FIM gain (efficacy), and the relative (to potential) functional gain was determined by the Montebello Rehabilitation Factor Score. Efficiency was calculated by efficacy divided by the length of hospital stay. RESULTS: A significant increase in total FIM scores (34.8 points) occurred during rehabilitation mainly because of improvement in motor functioning (31.5 points). Significant improvement in global cognitive status was documented by all 3 tests. Intertest correlation coefficients ranged between.47 and.67. The LOTCA showed somewhat higher correlation coefficients with most of the parameters of functional motor outcomes. Correlation between the MMSE and FIM cognitive subscale and these outcome parameters were nearly identical. CONCLUSION: The LOTCA is slightly better than the MMSE and the FIM cognitive subscale in predicting functional status change after stroke rehabilitation but it is a time-consuming and exhausting instrument to use. The FIM cognitive subscale requires a better overall understanding of the patient's situation at time of administration and therefore is less convenient for the initial assessment. The similar correlation of all 3 tests with functional outcomes and the simplicity of administration of the MMSE suggests its use in the initial assessment of stroke patients.