Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Atrios Cardíacos , Venas Pulmonares , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Venas Pulmonares/cirugía , Venas Pulmonares/fisiopatología , Ablación por Catéter/métodos , Masculino , Femenino , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Atrios Cardíacos/diagnóstico por imagen , Resultado del Tratamiento , Persona de Mediana Edad , Anciano , Potenciales de Acción , Técnicas Electrofisiológicas Cardíacas , Función del Atrio IzquierdoRESUMEN
Our objective was to determine whether the provision of therapeutic advice (i.e., any recommendation for an increase or decrease in drug dosage, or for the addition, withdrawal or replacement of at least one drug) by hospital geriatric mobile teams (GMTs) was associated with long-term mortality among older inpatients. Data on therapeutic advice provided by the GMT of Angers University Hospital, France, were collected from 694 consecutive inpatients examined in 2012 (mean age 84.4 ± 6.3 years; 65.6% female), who were followed up after 3 years. We found no between-group differences regarding the 3-year mortality (P = 0.30) and no cumulative survival difference (log-rank P = 0.43). The provision of therapeutic advice by a GMT was not associated with better 3-year survival (HR = 1.18, P = 0.40) in these frail inpatients.
Asunto(s)
Evaluación Geriátrica , Geriatría , Comunicación Interdisciplinaria , Anciano , Anciano de 80 o más Años , Femenino , Fragilidad/mortalidad , Fragilidad/terapia , Francia , Hospitales Universitarios , Humanos , Masculino , Grupo de Atención al Paciente , Polifarmacia , Tasa de SupervivenciaRESUMEN
Falls in older adults are a frequent reason for admission to the emergency department, associated with greater morbidity and mortality risks, and justify specialized geriatric expertise. Our objective was to determine i) the number of older fallers admitted to the emergency department for a serious fall, and ii) the proportion of those who were referred to a geriatrician in the following 12 months. METHODS: We included all patients aged 75 and over admitted to the emergency department of the University hospital of Angers, France, for a fall between 1st October and 1st November 2015. The consensual criteria proposed by the French national authority for health (2009) were used to define serious falls. RESULTS: Of the 214 older fallers admitted to the emergency department, 213 (99.5%) had at least one severity criterion for the fall. Only 40 older patients (18.7%) were referred to a geriatrician during the following 12 months. They exhibited more frequently a post-fall syndrome (p=0.007), more than 3 fall risk factors (p <0.001), and took more often an anticoagulant (p=0.032) than those who had not been referred to a geriatrician. CONCLUSIONS: Although almost all older fallers admitted to the emergency room had experienced a serious fall, only a minority of them received a geriatric assessment in the following year.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Francia/epidemiología , Evaluación Geriátrica/estadística & datos numéricos , Guías como Asunto , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , Índices de Gravedad del Trauma , Resultado del Tratamiento , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
BACKGROUND: The 6-item Brief Geriatric Assessment (BGA) is a screening tool to identify frail inpatients who are at risk of adverse health events. Its predictive value for in-hospital mortality has not been examined yet. OBJECTIVE: This study examined whether the BGA is able to predict in-hospital mortality in older patients. METHODS: A total of 1082 participants were included in this observational prospective cohort study. At their admission to the medical wards of Angers University Hospital (France), all inpatients aged ≥65 years were screened with the BGA. Its 6 items are: age ≥85 years, male gender, polypharmacy (i.e., ≥5 drugs per day), non-use of home-help services, history of falls in the previous 6 months, and temporal disorientation (i.e., inability to give the month and/or year). Three levels (low, intermediate and high) of risk of adverse health events had previously been identified, based on different combinations of BGA items. Patients were separated into 2 groups using the occurrence of in-hospital death. The length of stay was calculated as the number of days in hospital using the hospital registry. The use of psychoactive drugs and the reason for admission were used as covariates. RESULTS: Older inpatients who died were more frequently admitted for an acute organ failure (Pâ¯<â¯0.001). Cox regression models showed that a priori intermediate risk (HRâ¯=â¯1.89, Pâ¯<â¯.001) and high risk (HRâ¯=â¯2.34, Pâ¯<â¯.001) risk levels predicted in-hospital mortality. Kaplan-Meier survival curves confirmed that inpatients at high risk (Pâ¯=â¯.047) and those at intermediate risk (Pâ¯=â¯.013) died earlier than patients at low risk. CONCLUSIONS: Combinations of items on the BGA successfully predicted the risk of in-hospital mortality in this sample of older inpatients.