Journal of the American Medical Directors Association
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Comparative Study
A Frailty Index Based on Common Laboratory Tests in Comparison With a Clinical Frailty Index for Older Adults in Long-Term Care Facilities.
Easily employed measures of frailty are needed in the evaluation of elderly people. Recently, a frailty index (FI) based on deficits in commonly used laboratory tests (the FI-LAB) has been proposed. To address the usefulness of the FI-LAB in long-term care (LTC) settings, we studied institutionalized participants in the Canadian Study of Health and Aging first clinical examination database. Our objectives were to compare the FI-LAB with a clinical FI LTC (FI-Clinical-LTC) focused on common health deficits seen in LTC and to assay its relationship with mortality. ⋯ An FI based on routinely collected laboratory data can identify LTC residents at increased risk of death. This approach may be a useful screening tool in this setting.
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Comparative Study
Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?
To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes. ⋯ Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions.
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Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. ⋯ The MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.
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Early transfer to intermediate-care hospitals, low-tech but with geriatric expertise, represents an alternative to conventional acute hospitalization for selected older adults visiting emergency departments (EDs). We evaluated if simple screening tools predict discharge destination in patients included in this pathway. ⋯ Among geriatric screening tools, ISAR was independently associated with discharge destination in older adults transferred from ED to intermediate care. Predictive validity was poor. Further research on selection of candidates for alternatives to conventional hospitalization is needed.
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To investigate if understated cognitive impairment existed in individuals with physical frail or earlier prefrail state but without cognitive complaints and the susceptible cognitive domains to the physical frailty. ⋯ Even without subjective cognitive complaints, higher risk of cognitive impairment is presented in the prefrail and frail individuals. The incremental impact of frailty on cognition and the susceptibility of nonmemory domain may provide a new view in evaluating the pathogenesis of the relationship between frailty and cognitive impairment.