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Anette Hylen Ranhoff

Publications and source records attributed to Anette Hylen Ranhoff.

7 recordsLinked to original sources
PubMed2006

Subintensive care unit for the elderly: a new model of care for critically ill frail elderly medical patients.

OBJECTIVE: An increasing number of elderly patients are admitted to the hospital for critical diseases and the gap between supply and demand of intensive care resources is a growing problem. To meet this challenge, 4 beds in a 24-bed acute care for the elderly (ACE) medical unit were dedicated to a subintensive care unit (SICU). Severely ill elderly medical patients, requiring a higher level of care than provided in ordinary wards, are admitted. The aim of the study was to describe the characteristics of the setting and to discuss its usefulness based on data obtained after the first period of implementation. METHODS: This article describes the development, management, economics and patient characteristics of the SICU. Patient care combines the ACE model with a highly specialised medical care. Patients admitted to the SICU are compared with patients treated in the ordinary ACE unit before the SICU opened. All patients received a multidimensional evaluation, including demographics, main diagnosis, number of chronic somatic diseases, Charlson index, APACHE II score, APACHE-APS subscore, number of currently administered drugs, serum albumin, cognitive status (Mini-Mental State Examination), depression (Geriatric Depression Scale) and functional status (basic and instrumental activities of daily living). Ward physicians performed assessment and collection of data. RESULTS: During the first 16 months, 489 patients were admitted, 401 according to the selection criteria (60 +/- years and APACHE II score > or =5 and/or APACHE-APS score > or =3). Mean age was 78.1 years, mean APACHE II score 14.5 (moderate severity) and non-invasive mechanical ventilation was received by 87 (21.7%). The most common diagnoses were respiratory failure, cardiac disease and stroke. Mean length of stay in the SICU was 61.8 h, and 6.0 days in the hospital. Compared with ACE-unit patients admitted during 2002 (n=1380), SICU patients were obviously more seriously ill (APACHE II score 14.5 vs 6.7). When comparing patients of same illness severity (APACHE-APS score > or =3) (n=125), patients treated in the SICU had lower in-hospital mortality than those treated in the ordinary ACE ward (12.5 vs 19.2%). Only a few patients (3.5%) were transferred to the intensive care unit as a consequence of increased severity of illness. CONCLUSIONS: The SICU is an innovative method to treat frail elderly patients with more severe conditions. Low hospital mortality compared with that of severe patients in the ACE unit supports the usefulness of this model. It could be implemented in medical units of large hospitals in order to give optimal care and advanced interventions to the frail elderly and to avoid intensive care unit overcrowding.

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PubMed2006

Delirium in a sub-intensive care unit for the elderly: occurrence and risk factors.

BACKGROUND AND AIMS: The objective was to study occurrence and risk factors of delirium in a new model of care, the Sub-Intensive Care Unit for the elderly (SICU), which is a level of care between that offered by ordinary wards and intensive care. METHODS: A prospective observational study of 401 consecutively admitted patients, 60+ years, in a four-bed SICU in the geriatric ward of a general hospital. Delirium was detected by the Confusion Assessment Method (CAM) at admission (prevalent) and during SICU stay (incident). Impaired function (Barthel Index) and/or IADL two weeks prior to admission identified disability, and additional Mini-Mental State Examination (MMSE) <18 at discharge identified probable dementia. RESULTS: Delirium was detected in 117 patients (29.2%). Of these 62 (15.5%) had delirium at admission and a further 55 developed delirium during their time in the SICU. Delirium occurred in 19 (11.4%) of the "robust" (no dementia or disability), 28 (24.1%) of the disabled and 70 (58.4%) of the demented patients (p<0.001). Prevalent delirium was found in 8 (4.8%), 11 (9.5%) and 43 (36.1%) (p<0.001) and incident in 11 (6.6%), 17 (14.7%) and 27 (22.7%) (p<0.001) of the robust, disabled, and demented patients respectively. Heavy alcohol use, maximum intake of 7 or more drugs, and the use of a bladder catheter were independently associated with delirium. CONCLUSIONS: Delirium was common in the SICU, and patients with probable dementia had the highest risk. They tended to have delirium at admission, whereas patients without dementia, although less at risk, were more prone to developing delirium during their stay in the SICU.

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PubMed2005

[When should nursing home residents be transferred to hospital?].

BACKGROUND: Nursing home residents are old persons with chronic diseases, functional impairment and often dementia. Acute illness is common and nursing home staff often has to consider transfer to hospital. MATERIAL AND METHODS: The aim was to find why nursing home residents are transferred to hospital and to discuss when such transfers are appropriate. The results are taken from the literature. RESULTS: No studies are reporting the reasons why nursing home residents in Norway are transferred to hospital. Hip fracture, pneumonia, stroke, chest pain, cardiac failure and anaemia are the most common causes of hospital admissions among the very oldest, in our experience also from nursing homes. Hospital transfer can be appropriate for: 1) diagnostic work up, 2) medical treatment to avoid death and functional impairment, and 3) palliative care. Admission for hip fracture and serious anaemia will improve survival and function if the patient is not dying from other diseases. Admission for pneumonia, stroke and acute coronary syndrome may improve survival and function for patients without advanced dementia and with some life expectancy. Transfer for palliative care will benefit the patient only if nursing home care is insufficient. Medical services and knowledge about palliative care should be increased; guidelines for hospitalisation and end-of-life decisions are recommended.

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PubMed2002

[Accidental hypothermia in the elderly].

BACKGROUND: Accidental hypothermia is unintended body core temperature of 35 degrees C or below, a known hazard to elderly people in temperate and cold climates. MATERIAL AND METHODS: We present two old patients with severe hypothermia and a review of the literature focusing on risk factors, clinical presentation, and the treatment of hypothermia in the elderly. RESULTS: Two patients, aged 90 and 102 years, with body core temperature < 28 degrees C were successfully treated at Ullevål University Hospital, Oslo, Norway with slow active external rewarming and a low stress strategy as recommended in the geriatric literature. Successful treatment with more rapid rewarming and use of internal rewarming like peritoneal lavage has also been published. The prognosis of elderly victims of hypothermia is known to be worse than for younger individuals. Epidemiological data are scanty. The most important risk factors are connected to ageing itself and to the morbidity often found in elderly hypothermia victims. Treatment is based on experience from few cases, minor prospective studies mainly on rewarming of younger patients and clinical experience from younger patients. INTERPRETATION: There is a need for more knowledge and experience of treating elderly hypothermia victims.

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