Caregiver burdens and nonmedical hospital admissions.
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
P G Jarrett
Publications and source records attributed to P G Jarrett.
Illness presentation in elderly patients.
BACKGROUND: Atypical disease presentations, such as delirium, are associated with adverse health outcomes. They are also markers of frailty in elderly people, which is itself associated with adverse hospital outcomes. We investigated the relationship between frailty and atypical disease presentation in predicting adverse hospital outcomes and complications of the hospital course of elderly patients admitted to general medical services. METHODS: We conducted a cohort study in a large (800 beds) tertiary care university hospital. The prevalence of atypical disease presentations and the incidence of adverse hospital outcomes (death, nursing home admission, prolonged hospital stay, and failure to regain premorbid functional status) were studied in previously well and previously frail elderly patients. RESULTS: Patients were classified as being well or frail on the basis of the premorbid Barthel Index (well, score of > or = 95 [n = 76]; frail, score of < 95 [n = 117]). Frail elderly were older (80 vs 76 years), more often female (62% vs 46%), and less likely to be community dwelling (89% vs 99%). Atypical disease presentation was more common in the frail elderly (59% vs 25%; P < .001). Of those who presented atypically, the frail most often presented with delirium (61%) and the well presented with falls (37%) and delirium (32%). Of the frail elderly with atypical symptoms, 60% had adverse hospital outcomes compared with 32% of the well elderly who presented typically (P < .05). Logistic regression analysis showed that premorbid functional dependence (odds ratio, 2.48; 95% confidence interval, 1.17 to 5.22), atypical disease presentation (odds ratio, 2.37; 95% confidence interval, 1.20 to 4.67), and functional decline at admission (odds ratio, 5.64; 95% confidence interval, 2.37 to 13.44) were all independently predictive of poor hospital outcomes. By contrast, severity of disease, age, and sex did not confer an increased risk of adverse events. CONCLUSIONS: Premorbid functional dependency, atypical disease presentation, and functional decline on admission have independent impacts on adverse hospital outcomes. Assessment of each should be incorporated into the routine care of elderly patients.
Activities of Daily Living↗
Behavioral problems in nursing home residents. Safe ways to manage dementia.
Behavioral problems in nursing home residents are already common and are likely to increase in number with the "graying" of the population. Effective treatment is available, and a structured and logical approach to management is needed. Patients should be assessed to differentiate delirium from dementia, and possible precipitants of disturbed behavior should be investigated. The best treatment of dementia-related behavioral problems includes nonpharmacologic measures (eg, environmental changes) and appropriate choice, dosing, and monitoring of pharmacologic agents. Long-term success with demented patients may depend on realistic expectations.
Aged↗
Patterns of paging medical interns during night calls at two teaching hospitals.
OBJECTIVE: To assess the patterns of paging medical interns during night calls. DESIGN: Descriptive study; diaries were used to log calls between 7 pm and 7 am for 1 week in February 1991. SETTING: Two teaching hospitals in Halifax. PARTICIPANTS: All 10 interns assigned to the 15 medical units and nurses from 3 representative medical units. MAIN OUTCOME MEASURES: Number and nature of calls. RESULTS: The overall response rate was 90%. A total of 309 calls were logged by the interns and 107 by the nurses. Each intern had 17 calls on average (range 6 to 33) per 12-hour period. Of the calls 27% occurred after midnight, 25% disrupted sleeping, and 19% interrupted direct patient contact. Overall, the most common reasons for paging interns were related to prescribing of medications (42% of the calls), direct patient assessment (25%) and reporting of laboratory results (18%). According to the nurses, there were no delays in the interns' responding to the pages, and 61% of the calls led to a new physician order. CONCLUSIONS: Paging frequently interrupts interns during work and rest on night calls. Assessment of paging patterns may be useful in identifying specific interventions to reduce the number of calls so that interns will have fewer interruptions during patient encounters and more rest. The collection of data from nurses in a routine nursing audit may be useful for evaluating the communication between interns and nurses and, indirectly, for assessing interns' workload.
Data Collection↗