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Arinzon Z.,Sapir Medical Center | Arinzon Z.,Frieda Schiff Warburg Geriatric Center | Peisakh A.,Meuhedet Health Care System | Schrire S.,Meuhedet Health Care System | And 2 more authors.
Archives of Gerontology and Geriatrics | Year: 2011

We aimed to investigate the incidence and characterize predictors associated with delirium in elderly demented and functionally dependent LTC patients. Data collection included: demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. The tools used to detect delirium were the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS), supported by clinical observation. The occurrence of delirium was 34%. The predominant primary etiologies for delirium were infections (58%), following by metabolic abnormalities (36%), and adverse drug effects (18%). The mean duration of delirium was 15.74 days (2-96 days). Independent predictors influencing duration of delirium were low plasma albumin level, high number of comorbid diseases, male gender, advanced age and presence of CVD. Complete resolution of the delirium was found in 33% (30/92), with persistence in 12% (11/92), and no change in 8% (7/92) of the patients. Forty-eight percent (44/92) of the patients died. Most deaths (50%) were in the first month. The main cause of death was infection related (70%), of which bronchopneumonia was predominant (39%), followed by sepsis (32%). Independent predictors of death were infection, advanced age, low plasma albumin level, dehydration and CHF. The early recognition, identification, correction and treatment of underlying conditions especially in very demented, uncooperative and functionally dependent patients may influence their outcome. Any changes in cognitive and functional status are critical in monitoring LTC patients. © 2010 Elsevier Ireland Ltd.


Arinzon Z.,Sapir Medical Center | Arinzon Z.,Frieda Schiff Warburg Geriatric Center | Shabat S.,Sapir Medical Center | Shabat S.,Tel Aviv University | And 5 more authors.
Archives of Gerontology and Geriatrics | Year: 2010

Hip fracture represents the most dramatic expression of the disease, in terms of morbidity, medical cost and mortality. The incidence of hip fracture increases substantially with age. The purpose of this study was to evaluate the association between gender and geriatric rehabilitation outcome after traumatic hip fracture. Ninety-nine community-dwelling elderly patients (older than 65 years), 64 women and 35 men, who were admitted to geriatric rehabilitation after operated hip fracture were studied. We assessed the patients' clinical and demographic data, preoperative risk (ASA), type of fracture and orthopedic repair, pain intensity (VAS), cognitive (MMSE), mood (Zung IDS), and functional status (FIM) on admission and at the end of geriatric rehabilitation. Men had higher mean number of comorbid conditions at the time of the fracture. Men recovered more from depressed mood in comparison with women during the rehabilitation. Significant improvement in FIM motor subscore on discharge was found in both groups. The FIM motor subscore gain was higher in men (24.47) in comparison with women (19.22, p = 0.036). Those differences were demonstrated in mean subscores of transfers (p = 0.004), and locomotion (p = 0.019). Women were more functionally dependent in locomotion, transfers and sphincter control. There were no differences between the groups by duration on rehabilitation stay. Recovery after hip fracture depends in large part on the pre-fracture health and functional ability of the patient. Gender differences in functional recovery may affect therapeutic and rehabilitative decision making. Functional recovery after traumatic hip fracture was better in men in comparison with women. © 2009 Elsevier Ireland Ltd. All rights reserved.


Arinzon Z.,Sapir Medical Center | Arinzon Z.,Frieda Schiff Warburg Geriatric Center | Peisakh A.,Meuhedet Health Care System | Schrire S.,Meuhedet Health Care System | And 2 more authors.
Archives of Gerontology and Geriatrics | Year: 2010

Electrolyte abnormalities are frequently observed in elderly long-term care (LTC) patients. Magnesium is a trace mineral, but is the second most abundant intracellular cation and the fourth most abundant cation in the body. This was a cross-sectional study to assess the prevalence of hypomagnesemia (HM) in non-selected elderly LTC patients. A total of 159 patients aged 65 years and older were included in the study. The attributes and variables related to the patients' hospital course were used to compare the two groups. We used univariate and multivariate analyses to correlate magnesium levels with demographic, clinical factors and laboratory data. HM was found in 36% of the patients, of whom 35% presented with moderate HM (0.8-0.9μequiv./l) and 18% with severe HM (≤0.7μequiv./l). Patients with HM had a higher number of comorbid diseases per patient (p=0.038), low body mass index (BMI) (p=0.044) and more of them presented with laboratory markers of malnutrition, such as low total cholesterol (TC) and serum albumin (SA) levels. Coexistence with other electrolyte abnormalities was higher among patients with HM than without (p=0.006), predominantly hypocalcemia and hypokalemia (p=0.023 and 0.032, respectively). Using regression analysis, independent variables significantly associated with serum magnesium levels were serum albumin, calcium, potassium, urea levels, chronic renal failure (CRF), chronic heart failure (CHF), diabetes mellitus (DM) and diuretic drugs (R2=0.877). Both early (up to 30 days) and late rate of death were higher in patients with HM. The incidence of HM in LTC elderly patients is high and multifactorial. Understanding the causes of HM, correction of magnesium level, and definitive and effective treatment of the cause leading to HM is important to improve patient prognosis. © 2009 Elsevier Ireland Ltd.


Arinzon Z.,Meir Medical Center | Arinzon Z.,Frieda Schiff Warburg Geriatric Center | Peisakh A.,Meuhedet Health Care System | Schrire S.,Meuhedet Health Care System | And 2 more authors.
Archives of Gerontology and Geriatrics | Year: 2011

Pneumonia is the second most common infection in long term care (LTC) residents and is a leading cause of death from infection in those groups of patients. Atypical presentations and fewer presenting signs and symptoms in older patients complicate diagnosis and delay initiation of adequate treatment. The aim of this study was to compare laboratory CRP levels to pneumonia severity scores, in prediction of short-term death from pneumonia. Diagnosis of pneumonia was performed according to the criteria of McGeer for the identification of pneumonia at an LTC facility. The severities of pneumonia and mortality prediction were assessed by three indices: PSI (pneumonia severity index), Missouri study index and the nursing home associated pneumonia (NHAP) severity index. A strong positive correlation was found between CRP levels and PSI (r=0.445, p<0.001), Missouri study index (r=0.315, p<0.001) and NHAP severity index (r=0.246, p=0.002). The initial values of CRP were significantly higher in patients with short term mortality and positively correlated with rate of death (r=0.493, p<0.001). By multivariate regression analysis, the variables that were independently and significantly associated with the rate of death included presence and duration of fever, respiratory rate, serum CRP and albumin levels, lymphocyte count, number of comorbid diseases, CHF, and DM (the R 2 was 0.711 and 0.685 when adjusted). Because presentation of nursing home acquired pneumonia is not specific, it is suggested that CRP should be performed in every patient with a suspicion of pneumonia. © 2011 Elsevier Ireland Ltd.

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