Journal of the American Medical Directors Association
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Multicenter Study
Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease.
Exercise tolerance is an important clinical aspect of chronic obstructive pulmonary disease that can be easily and reliably measured with the 6-minute walking test (6MWT). To improve the utility of the 6MWT for patient and health care system management, the interpretation of the functional status measure in relation to death and hospitalization should be elucidated. ⋯ The 6MWD provides prognostic information that may be useful for identifying high-risk patients with COPD.
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Primary care medical practices dedicated to the needs of older adults who dwell in independent and assisted living residences in senior living communities (SLCs) have been developed. To date, the demographic and acute medical care use patterns of patients in these practices have not been described. ⋯ SLC primary care medical practices serve a population that is older, has significant medical comorbidity, and frequently accesses acute medical care. Although many acute care issues for this population are handled via phone, home visits and/or ED use is common. Understanding the acute care health utilization patterns of SLC dwellers is critical to designing systems to optimally address the acute care needs of aging older adults.
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To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium. ⋯ Detection of delirium is a major issue for nurses. Strategies to improve nurse recognition of delirium could well reduce adverse outcomes for this vulnerable population.
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To determine predictors of dying in VA nursing homes, community living centers (CLCs), compared with dying in a hospital. ⋯ Recognition of end-stage disease and documentation of advance directives are powerful determinants of site of death for CLC residents. Receipt of hospice care in a CLC is a strong predictor of site of death in a CLC even in the absence of collaboration with community-based hospice and financial incentives to avoid hospitalization.
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Problematic activities of daily life (ADLs) can be the main reason to refer patients with chronic obstructive pulmonary disease (COPD) for pulmonary rehabilitation. To date, information on problematic ADLs and their clinical correlates in COPD remain scarce. This retrospective chart review aimed to identify the most prevalent self-reported problematic ADLs in COPD patients, determine performance and satisfaction scores of these problematic ADLs, and explore the association between 13 clinical determinants and 4 problematic ADL domains. ⋯ The lack of a strong association between problematic ADLs and clinical determinants emphasizes the need for individualized assessment of these ADLs to allow tailored intervention.