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Biomedical subjects

D H Sullivan

Publications and source records attributed to D H Sullivan.

28 records · Page 2Linked to original sources
PubMed1994

The utility of an admission assessment to predict in-hospital nutrient intake.

OBJECTIVE: To determine if pre-complication nutrient intake can be predicted based on an admission assessment. DESIGN: Survey (cross-sectional study). SETTING: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital. PATIENTS: Three-hundred-twelve randomly selected admissions to the GRU. MEASUREMENTS: At admission, each patient completed a comprehensive medical, neuropsychological, functional, and nutritional assessment. While remaining hospitalized, each subject was monitored on a daily basis for the development of complications. Complete calorie counts were obtained at least every other day, and the average pre-complication daily volitional nutrient intake was expressed as a percent of predicted requirements as determined using the Harris-Benedict equation. RESULTS: Based on a stepwise linear regression analysis, the strongest predictor of pre-complication volitional intake was the first day calorie count, followed by waist circumference, the percent of weight lost in the 6 months prior to admission, supra-iliac skinfold thickness, and admission Katz ADL score. The model R2 = 0.66. CONCLUSIONS: It is possible to predict pre-complication nutrient intake with a fair degree of accuracy based on an admission assessment, which includes a 1-day calorie count.

Activities of Daily Living↗
PubMed1993

Oral health problems and involuntary weight loss in a population of frail elderly.

OBJECTIVE: To evaluate whether poor oral health is a potentially reversible contributor to the development of significant involuntary weight loss in elderly rehabilitation patients. DESIGN: Survey (cross-sectional study). SETTING: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital. PATIENTS: One hundred ten consecutive admissions to the GRU, of whom 99% were male and 80% were white. The average age of the study patients was 77 years. MEASUREMENTS: At admission each patient completed a comprehensive medical, neuro-psychological, social, nutritional, and dental assessment. Previous weights were documented by review of old medical records. Involuntary weight loss was considered significant if it was greater than 5% of pre-weight-loss weight within 6 months or 10% of pre-weight-loss weight within 1 year. Of the 97 variables evaluated, the strongest predictors of significant involuntary weight loss prior to GRU admission were identified using univariate and multivariate (stepwise logistic regression) analyses. RESULTS: The number of general oral problems was the best predictor of significant involuntary weight loss within 1 year prior to GRU admission, followed by household income, age, smoking status, adequacy of nutrient intake prior to admission, and education. When all six of the variables were included in the stepwise logistical regression analysis, the model had a sensitivity of 63.2%, a specificity of 91.1%, and overall predictive accuracy of 86.2%. The number of general oral problems was also a strong predictor of significant weight loss within 6 months prior to GRU admission. CONCLUSIONS: Poor oral health may be an important contributing factor to the development of significant involuntary weight loss among the frail elderly. If this is true, it places even greater emphasis on the need for maintaining an optimal state of oral health in our elderly patients.

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PubMed1992

Risk factors for early hospital readmission in a select population of geriatric rehabilitation patients: the significance of nutritional status.

OBJECTIVE: To test the strength of the evidence in favor of the hypothesis that protein-energy undernutrition is an independent risk factor for non-elective hospital readmission within 3 months of discharge in a population of elderly hospitalized patients. DESIGN: Retrospective analysis of data from prospective observational study. METHODS: All 110 elderly patients admitted to a geriatric recuperative care and rehabilitation unit during a 6-month period completed a comprehensive in-patient evaluation. Ninety-eight of these patients were subsequently discharged alive and followed prospectively for 3 months. All hospital readmissions during the observation period were identified by patient interview and, within the VA hospital system, computer tracking of admissions. Based on the discharge assessment, the strongest predictors of non-elective readmission were identified using univariate and multivariate statistical procedures. RESULTS: Twenty-eight of the 98 patients discharged alive and completing the 3-month follow-up (29%) had at least one non-elective readmission. The patients discharged home were non-electively readmitted more frequently than were the patients discharged to a nursing home (32% vs 11%, P = 0.05). Of the 109 discharge assessment variables analyzed, the best predictor of which patients would have at least one non-elective hospital readmission was the discharge serum albumin, followed by a diagnosis of dementia, discharge gamma globulin, the subscapular skinfold thickness, home ownership, and the discharge Katz Index of ADL score. Discharge serum albumin concentration, subscapular skinfold thickness, and discharge serum gamma globulin concentration were all negatively correlated with risk of non-elective readmission. The presence of functional debilitation or dementia was associated with a lower likelihood of non-elective readmission compared with the absence of these conditions. CONCLUSIONS: Protein-energy undernutrition appears to be a strong independent risk factor for non-elective hospital readmission especially among the highest risk patients, those who are functionally independent and cognitively intact.

Activities of Daily Living↗
PubMed1991

Protein-energy undernutrition and the risk of mortality within 1 y of hospital discharge in a select population of geriatric rehabilitation patients.

To determine whether undernourished elderly patients are at increased risk for mortality, independent of nonnutritional factors affecting outcomes, 109 patients were evaluated at admission to a geriatric rehabilitation unit (GRU) and then followed prospectively for 1 y after hospital discharge. During the interval of observation, 33 (30%) patients died, 11 before hospital discharge and 22 within the year subsequent to discharge. Of the 81 nutritional and nonnutritional variables analyzed, the best predictor of mortality, as determined by stepwise-discriminant-function analysis, within 1 y of hospital discharge was the percent of usual body weight lost in the year previous to admission, followed by the subscapular skinfold thickness and the discharge Katz Index of Activities of Daily Living (ADL) score. Percent of weight lost was also the strongest predictor of 1-y post-GRU-admission mortality. These results provide compelling evidence for the importance of nutritional status in predicting both in-hospital and postdischarge mortality in a population of frail, male GRU patients.

Activities of Daily Living↗
PubMed1990

Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients.

To determine whether the level of protein-calorie undernutrition at presentation correlated with the subsequent risk of developing in-hospital complications independently of nonnutrition factors influencing outcomes, a prospective study was conducted of 110 consecutive admissions to a Geriatric Rehabilitation Unit (GRU) of a Veteran's Administration hospital. In total, 54 variables were evaluated as possible predictors of outcomes. The risk of developing at least one complication while on the GRU was studied by using multivariate techniques (discriminant function analysis) and was found to correlate with, in order of significance, functional status as admission, serum albumin concentration at admission, amount of weight lost in the year before admission, and the presence or absence of a renal or pulmonary disease. Nutrition variables also independently correlated with the risk of developing an infectious complication or a major life-threatening complication and dying within the hospital. These data indicate the importance of nutrition status in geriatric rehabilitation patients.

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PubMed1989

An approach to assessing the reliability of anthropometrics in elderly patients.

Although anthropometrics have traditionally been utilized in the assessment of protein-energy malnutrition, little is known of the reliability of these measurements in elderly patient populations. In this study, the reliability of an anthropometric measurement protocol, designed for ease in measurement of both independent and functionally debilitated elderly patients, is evaluated. An analysis of variance technique was used to calculate the test-retest variance for each of three observers. Although the experience of the three observers was equivalent, the precision of their measurements varied considerably. After repeat practice sessions, improved measurement reliability was demonstrated. For all the observers, the test-retest variance was found to be proportional to the size of the measurement and to be influenced by the accuracy in which the site for each measurement was located. Based on this study, we conclude that when using anthropometrics it is important to know the reliability of each observers' measurements. Because of the correlation between the test-retest variance and the measurement value, we suggest that the variance be expressed as a percentile. A method for transforming the variances is presented.

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PubMed1984

Urinary incontinence in the geriatric population of an acute care hospital.

To determine the incidence, prevalence, and duration of urinary incontinence, a survey was undertaken of all patients aged 65 and over admitted to a university hospital during a six-week period. The daily prevalence of incontinence, which was 19 per cent for the entire study population, was highly variable from one nursing unit to another. Twenty-five per cent of those on the acute care general medical units and 17 per cent of those on the general surgical units were incontinent on any given day. The burn unit had the highest daily prevalence of incontinence (75 per cent). The incidence of incontinence per hospital stay, which was determined for the 315 patients who were followed from admission to discharge, was 19 per cent. Of the 348 patients discharged to home during the survey period, 10.9 per cent were incontinent within the 24 hours prior to leaving the hospital, and, of the 27 referred to another institution, 48 per cent had been incontinent during that interval. The authors conclude that a substantial proportion of geriatric patients are incontinent at some stage during their hospital stays.

Age Factors↗
PubMedDate not supplied

Ambulatory care for patients with acute leukemia: an alternative to frequent hospitalization.

Over the past 5 years, 23 cancer patients diagnosed with adult acute leukemia have been able to receive their required therapies primarily on an ambulatory basis. This included chemotherapy, antimicrobials, and blood product infusions. The ambulatory primary nurse has been a vital facilitator in designing and implementing a care plan that includes drug administration, symptom management, and the complex coordination of community resources. The relationship that develops between the patient, family, and primary nurse is also a key factor in the effectiveness of such an ambulatory program.

Adult↗
PubMedDate not supplied

Patterns of care: an analysis of the quality of nutritional care routinely provided to elderly hospitalized veterans.

To assess the adequacy of the nutritional care provided, a prospective noninterventional study was carried out on 250 randomly selected patients aged 65 and over who were admitted to a Veterans Administration Hospital. Of this group, 97 patients (39%) were found to be at high risk of having clinically significant protein-energy malnutrition. In 43 cases (17%), an assessment of the patient's nutritional status was not possible because the available data were inadequate. No patient had a diagnosis of malnutrition recorded on the problem list. Only 13 percent of the high-risk patients received some form of nutrition support therapy; 10 (10%) received oral supplements, and four (4%) were started on enteral feedings. Patients who received enteral feedings experienced a high rate of complications resulting from use of the feeding tubes. Over all, none of the high risk study patients received optimal nutrition support therapy. These findings indicate that elderly patients hospitalized in the Veterans Administration hospital in this study are usually not screened appropriately for protein-energy malnutrition, the diagnosis is frequently missed or ignored, and nutrition support therapy is underutilized and often ineffectually managed.

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