Thirty to sixty per cent of older patients experience functional decline after hospitalisation, associated with an increase in dependence, readmission, nursing home placement and mortality. First step in prevention is the identification of patients at risk. The objective of this study is to develop and validate a prediction model to assess the risk of functional decline in older hospitalised patients.
Falls are common after stroke. This article presents a literature review of the incidence and risk factors of falls and the consequences for professionals working with stroke patients. It is important to consider the specific problems after stroke. Depression and cognitive impairments were found to be risk factors for fall incidents after stroke. In the relevant literature many different risk factors and circumstances are described. When patients move from bed to chair, walk to the bathroom and the first few days after the patient is discharged to another setting, - all these circumstances showed high percentages of falling. A fall during hospital stay is a significant risk factor for future fall incidents. A reliable index to measure the fall risk is not (yet) available. But scores on the Barthel Index and the Timed-Up-and-Go test can be used as fall risk indicators. Fear of falling is an important complication after a fall and therefore it is recommended prior to discharge to inquire about the patients self efficacy in maintaining balance. Few intervention studies use the number of falls as an outcome measure. Exercising balance following a mass training protocol seems to diminish the risk of falling.
Background: after hospitalisation for cardiac disease, older patients are at high risk of readmission and death. Objective: the cardiac care bridge (CCB) transitional care programme evaluated the impact of combining case management, disease management and home-based cardiac rehabilitation (CR) on hospital readmission and mortality. Design: single-blind, randomised clinical trial. Setting: the trial was conducted in six hospitals in the Netherlands between June 2017 and March 2020. Community-based nurses and physical therapists continued care post-discharge. Subjects: cardiac patients ≥ 70 years were eligible if they were at high risk of functional loss or if they had had an unplanned hospital admission in the previous 6 months. Methods: the intervention group received a comprehensive geriatric assessment-based integrated care plan, a face-to-face handover with the community nurse before discharge and follow-up home visits. The community nurse collaborated with a pharmacist and participants received home-based CR from a physical therapist. The primary composite outcome was first all-cause unplanned readmission or mortality at 6 months. Results: in total, 306 participants were included. Mean age was 82.4 (standard deviation 6.3), 58% had heart failure and 92% were acutely hospitalised. 67% of the intervention key-elements were delivered. The composite outcome incidence was 54.2% (83/153) in the intervention group and 47.7% (73/153) in the control group (risk differences 6.5% [95% confidence intervals, CI -4.7 to 18%], risk ratios 1.14 [95% CI 0.91-1.42], P = 0.253). The study was discontinued prematurely due to implementation activities in usual care. Conclusion: in high-risk older cardiac patients, the CCB programme did not reduce hospital readmission or mortality within 6 months.
Over a million people in the Netherlands have type 2 diabetes (T2D), which is strongly related to overweight, and many more people are at-risk. A carbohydrate-rich diet and insufficient physical activity play a crucial role in these developments. It is essential to prevent T2D, because this condition is associated with a reduced quality of life, high healthcare costs and premature death due to cardiovascular diseases. The hormone insulin plays a major role in this. This hormone lowers the blood glucose concentration through uptake in body cells. If an excess of glucose is constantly offered, initially the body maintains blood glucose concentration within normal range by releasing higher concentrations of insulin into the blood, a condition that is described as “prediabetes”. In a process of several years, this compensating mechanism will eventually fail: the blood glucose concentration increases resulting in T2D. In the current healthcare practice, T2D is actually diagnosed by recognizing only elevated blood glucose concentrations, being insufficient for identification of people who have prediabetes and are at-risk to develop T2D. Although the increased insulin concentrations at normal glucose concentrations offer an opportunity for early identification/screening of people with prediabetes, there is a lack of effective and reliable methods/devices to adequately measure insulin concentrations. An integrated approach has been chosen for identification of people at-risk by using a prediabetes screening method based on insulin detection. Users and other stakeholders will be involved in the development and implementation process from the start of the project. A portable and easy-to-use demonstrator will be realised, based on rapid lateral flow tests (LFTs), which is able to measure insulin in clinically relevant samples (serum/blood) quickly and reliably. Furthermore, in collaboration with healthcare professionals, we will investigate how this screening method can be implemented in practice to contribute to a healthier lifestyle and prevent T2D.
