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Comparison of older patient’s self-care abilities in acute geriatric and internal medicine departments

  • Manuela FriedliEmail author
  • Philipp Schuetz
  • Antoinette Conca
Original contributions
  • 8 Downloads

Abstract

Background

There is ongoing controversy whether patients show better functional outcomes when care is provided in acute geriatric (AG) or internal medicine (IM) departments.

Objective

This study compared the recovery of acutely ill patients concerning activities of daily living (ADL) and instrumental activities of daily living (IADL).

Material and methods

A total of 274 patients (≥70 years old, 67 in AG, 207 in IM) were included consecutively (AG intervention) or data were obtained (IM comparison) in a Swiss hospital with 2 locations. The ADL/IADL data were collected 14 days before admission (t1, retrospectively), on admission (t2), at discharge (t3), and 30 days after admission (t4). This study consisted of a prospective study with a longitudinal quasi-experimental design.

Results

The AG patients had a significantly higher probability to gain independence in mobility (between t2/t3, P = 0.008), grooming of the lower body (between t2/t3, P = 0.037) and defecation (between t2/t4, P < 0.001). The IM patients were significantly more independent in IADL at t4 (all P < 0.05) except for meal preparation. The odds for nursing home admission in AG with dependency at t1 were significantly lower in every ADL (all P < 0.05) and with shopping in IADL (P = 0.008).

Conclusion

This study shows a positive effect of AG compared to IM in self-care with a lower probability for nursing home admission. There is need for further education and research to improve outcomes in older hospitalized patients.

Keywords

Aged Activities of daily living Instrumental activities of daily living Early rehabiliation Physical function 

Vergleich der Selbstpflegefähigkeiten älterer Patienten in akutgeriatrischen und internistischen Abteilungen

Zusammenfassung

Hintergrund

Es ist weiterhin unklar, ob Patienten bessere Selbstpflegefähigkeiten bezüglich der Aktivitäten des täglichen Lebens (ATL) und der instrumentellen Aktivitäten des täglichen Lebens (IATL) zeigen, wenn die Pflege in einer akutgeriatrischen (AG) oder in einer internistisch-medizinischen Abteilung (IM) erfolgt.

Fragestellung

Diese Studie verglich die Veränderung bezüglich ATL und IATL von Patienten akutgeriatrischer und internistisch-medizinischer Abteilungen.

Material und Methoden

Insgesamt 274 Patienten (≥70 Jahre; 67 in AG, 207 in IM) wurden aufeinanderfolgend (AG oder routinemäßig IM) in einem Schweizer Krankenhaus mit zwei Standorten erfasst. ATL/IATL wurden rückwirkend 14 Tage vor der Aufnahme (t1), beim Eintritt (t2), bei der Entlassung (t3) und 30 Tage nach Eintritt (t4) erhoben. Es handelt sich hierbei um eine prospektive Längsschnittstudie mit einem quasi-experimentellen Design.

Ergebnisse

AG-Patienten hatten eine signifikant höhere Wahrscheinlichkeit, sich zwischen Eintritt und Austritt bezüglich der Mobilität und Selbstpflege der unteren Extremitäten zu verbessern (p = 0,008 bzw. p = 0,037) sowie zwischen Eintritt und 4 Wochen nach Austritt bezüglich Stuhlausscheidung selbständiger zu werden (p < 0,001). Die Wahrscheinlichkeit für einen Pflegeheimeintritt ist bei AG-Patienten mit einer Abhängigkeit bei t1 signifikant tiefer bei allen ATL (p < 0,05) und bei den IATL beim Einkaufen (p = 0,008).

Diskussion

Unsere Studie zeigt eine positive Wirkung der AG gegenüber der IM betreffend Selbstpflege und eine geringere Wahrscheinlichkeit für einen Pflegeheimeintritt. Es besteht ein Bedarf an weiterer Schulung und Forschung zur Verbesserung der Selbstpflegefähigkeiten älterer, hospitalisierter Patienten.

Schlüsselwörter

Alter Alltagsaktivitäten Instrumentelle Alltagsaktivitäten Früh-Rehabilitation Körperliche Funktionalität 

Notes

Acknowledgements

We would like to thank the people who were involved in

  • data collection: the nursing team of the Acute Geriatric Unit, Pascale Haus, as well as Katharina Regez, Ursula Schild, Zelijka Caldara, Merih Gugielmetti and Sonja Schwenne,

  • providing data exports: Susanne Biegner, Ingolf Drube, Christoph Reemts, Sebastian Haubitz, Lukas Faessler,

  • supporting the project: Alexander Kutz, Beat Mueller, Barbara Reutlinger.

Furthermore, our thanks go to Tim Deters and Allison Iwan for English corrections.

Compliance with ethical guidelines

Conflict of interest

M. Friedli, P. Schuetz and A. Conca declare that they have no competing interests.

All AG patients provided written consent. Data from IM patients were collected for quality improvement purposes. The Cantonal Ethical Advisory Board of North and Central Switzerland approved this study (EKNZ 2015-309). The Declaration of Helsinki was applied.

Supplementary material

391_2019_1570_MOESM1_ESM.docx (40 kb)
Supplementary Table S1: ICD-10 Chapters and main diagnosis
391_2019_1570_MOESM2_ESM.docx (18 kb)
Supplementary Table S2: Patients’ characteristics before and after matching
391_2019_1570_MOESM3_ESM.docx (15 kb)
Supplementary Table S3: ADL/IADL dependency at t1–t4 (dichotomous variables)
391_2019_1570_MOESM4_ESM.docx (42 kb)
Supplementary Table S4: Patients’ characteristics subgroup home/nursing home
391_2019_1570_MOESM5_ESM.docx (36 kb)
Supplementary Figure S1: ADL ordinal, independency at t2 and t4

References

  1. 1.
    Ballinger GA (2004) Using generalized estimating equations for longitudinal data analysis. Organ Res Methods 7:127–150.  https://doi.org/10.1177/1094428104263672 CrossRefGoogle Scholar
  2. 2.
    Bartholomeyczik S (2016) Interventionen im Vergleich: Pille und Fallbesprechung. Pflege 29:5–7.  https://doi.org/10.1024/1012-5302/a000463 CrossRefGoogle Scholar
  3. 3.
    Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J et al (2009) Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 338:b50.  https://doi.org/10.1136/bmj.b50 CrossRefGoogle Scholar
  4. 4.
    Breslow NE (2005) Case-control studies. In: Ahrens W, Pigeot I (eds) Handbook of epidemiology. Springer, Berlin, pp 287–319.  https://doi.org/10.1007/978-3-540-26577-1 CrossRefGoogle Scholar
  5. 5.
    Büttner P, Müller R (2012) Epidemiology. Oxford University Press, Oxford. Vol.1Google Scholar
  6. 6.
    Conca A, Gabele A, Regez K et al (2015) Erfassung eines Nachakutpflegebedarf bei hospitalisierten, medizinischen Patienten durch die „Post-Acute Care Discharge scores“ (PACD). Pflegewissenschaft 11:584–597.  https://doi.org/10.3936/1319 Google Scholar
  7. 7.
    Covinsky KE, Palmer RM, Fortinsky RH et al (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51:451–458.  https://doi.org/10.1046/j.1532-5415.2003.51152.x CrossRefGoogle Scholar
  8. 8.
    Ellis G, Gardner M, Tsiachristas A et al (2017) Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 9:Cd6211.  https://doi.org/10.1002/14651858.CD006211.pub3 Google Scholar
  9. 9.
    Ellis G, Whitehead MA, Robinson D et al (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553.  https://doi.org/10.1136/bmj.d6553 CrossRefGoogle Scholar
  10. 10.
    European Union of Medical Specialists (Uems) (2013) Definition of geriatrics. https://uemsgeriatricmedicine.org/www/land/definition/english.asp. Accessed 27 Mar 2019
  11. 11.
    Fitzpatrick JJ, Stone P, Nyamathi A et al (2007) Annual review of nursing research vol 25. Springer, New YorkGoogle Scholar
  12. 12.
    Fox MT, Persaud M, Maimets I et al (2012) Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc. 2237–2245.  https://doi.org/10.1111/jgs.12028 Google Scholar
  13. 13.
    Frick KD, Cohen CC, Stone PW (2013) Analyzing economic outcomes in advanced practice nursing. In: Kleinpell R (ed) Outcome assessment in advanced practice nursing. Springer, New York, pp 45–72Google Scholar
  14. 14.
    Holzer B (2013) Fallschwere und SwissDRG. Schweiz Aerztez 94:913–915.  https://doi.org/10.4414/saez.2013.01670 CrossRefGoogle Scholar
  15. 15.
    Hunstein D (2009) Das ergebnisorientierte PflegeAssessment AcuteCare (ePA-AC). In: Bartholomeyczik S, Halek B (eds) Assessmentinstrumente in der Pflege: Möglichkeiten und Grenzen. Schlütersche, Hannover, pp 60–78Google Scholar
  16. 16.
    Jamieson S (2004) Likert scales: how to (ab)use them. Med Educ 38:1217–1218.  https://doi.org/10.1111/j.1365-2929.2004.02012.x CrossRefGoogle Scholar
  17. 17.
    Louis Simonet M, Kossovsky MP, Chopard P et al (2008) A predictive score to identify hospitalized patients’ risk of discharge to a post-acute care facility. BMC Health Serv Res 8:154.  https://doi.org/10.1186/1472-6963-8-154 CrossRefGoogle Scholar
  18. 18.
    Maxwell CA, Dietrich MS, Minnick AF et al (2015) Preinjury physical function and frailty in injured older adults: Self- versus proxy responses. J Am Geriatr Soc 63:1443–1447.  https://doi.org/10.1111/jgs.13486 CrossRefGoogle Scholar
  19. 19.
    Mccusker J, Kakuma R, Abrahamowicz M (2002) Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci 57:M569–M577.  https://doi.org/10.1093/gerona/57.9.m569 CrossRefGoogle Scholar
  20. 20.
    Mitchell M, Miller LS (2008) Executive functioning and observed versus self-reported measures of functional ability. Clin Neuropsychol 22:471–479.  https://doi.org/10.1080/13854040701336436 CrossRefGoogle Scholar
  21. 21.
    Noelker LS, Browdie R (2014) Sidney Katz, MD: a new paradigm for chronic illness and long-term care. Gerontologist 54:13–20.  https://doi.org/10.1093/geront/gnt086 CrossRefGoogle Scholar
  22. 22.
    Palleschi L, De Alfieri W, Salani B et al (2011) Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria study. J Am Geriatr Soc 59:193–199.  https://doi.org/10.1111/j.1532-5415.2010.03239.x CrossRefGoogle Scholar
  23. 23.
    Pérez-Zepeda MU, Gutierez-Robledo LM, Sanchez-Garcia S et al (2012) Comparison of a geriatric unit with a general ward in Mexican elders. Arch Gerontol Geriatr 54:e370–e375.  https://doi.org/10.1016/j.archger.2011.05.028 CrossRefGoogle Scholar
  24. 24.
    Polit DF, Beck CT (2012) Nursing research: generating and assessing evidence for nursing practice. Wolters Kluwer, Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  25. 25.
    Stuart EA (2010) Matching methods for causal inference: a review and a look forward. Stat Sci 25:1–21.  https://doi.org/10.1214/09-sts313 CrossRefGoogle Scholar
  26. 26.
    Thoemmes F (2012) Propensity score matching in SPSS. University of Tübingen, Tübingen.Google Scholar
  27. 27.
    United Nations (2013) World population ageing 2013, Department of Economic and Social Affairs, Population Division, New York. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed 29 Dec 2015Google Scholar
  28. 28.
    Van Craen K, Braes T, Wellens N et al (2010) The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc 58:83–92.  https://doi.org/10.1111/j.1532-5415.2009.02621.x CrossRefGoogle Scholar
  29. 29.
    Weaver M (2009) Introduction to analysis methods for longitudinal/clustered data. Part 3: generalized estimating equations, Institute for Familiy Health. Office of AIDS Research, NIH, Goa. http://www.icssc.org/Documents/AdvBiosGoa/Tab%2007.00_GEE.pdf. Accessed 29 May 2015Google Scholar
  30. 30.
    World Health Organization (2016) International Statistical Classification of Diseases and Related Health Problems 10th Revision, World Health Organization, Geneva. http://apps.who.int/classifications/icd10/browse/2016/en. Accessed 4 Mar 2016
  31. 31.
    World Medical Association (2013) WMA declaration of Helsinki—ethical principles for medical research involving human subjects, World Medical Association, Ferney-Voltaire. http://www.wma.net/en/30publications/10policies/b3/. Accessed 27 June 2015Google Scholar
  32. 32.
    Yasuda N, Zimmerman S, Hawkes WG et al (2004) Concordance of proxy-perceived change and measured change in multiple domains of function in older persons. J Am Geriatr Soc 52:1157–1162.  https://doi.org/10.1111/j.1532-5415.2004.52315.x CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Manuela Friedli
    • 1
    • 5
    Email author
  • Philipp Schuetz
    • 2
  • Antoinette Conca
    • 3
    • 4
  1. 1.Nursing DevelopmentRegional Hospital ZofingenZofingenSwitzerland
  2. 2.Division of General and Emergency Medicine; University Department of MedicineCantonal Hospital AarauAarauSwitzerland
  3. 3.Department of Health/Applied Research & Development in NursingBern University of Applied SciencesBernSwitzerland
  4. 4.Nursing DevelopmentCantonal Hospital AarauAarauSwitzerland
  5. 5.OftringenSwitzerland

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