Anna Zisberg

Low Mobility During Hospitalization and Functional Decline in Older Adults

OBJECTIVES: To examine the association between mobility levels of older hospitalized adults and functional outcomes.

Hospital‐Associated Functional Decline: The Role of Hospitalization Processes Beyond Individual Risk Factors

To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1‐month follow‐up in older adults with nondisabling conditions.

Emotional Intelligence in Applicant Selection for Care-Related Academic Programs

Two studies describe the development of the Audiovisual Test of Emotional Intelligence (AVEI), aimed at candidate selection in educational settings. Study I depicts the construction of the test and the preliminary examination of its psychometric properties in a sample of 92 college students. Item analysis allowed the modification of problem items, resulting in acceptable reliability (intraclass correlation = .67) and moderate to good discrimination indices. Study II examined criterion-related validity of the AVEI based on a sample of 102 nursing students in a large university in northern Israel. The results suggest that the AVEI correlated with students’ performance in field practice and in human relations training courses better than with any other relevant variable (e.g., GMA, GPA). Associations remained in the .45 to .60 range, even after controlling for factors such as academic ability, GPA, and gender. These results suggest that the AVEI may be a valid instrument in student selection for care-related programs.

In‐Hospital Use of Continence Aids and New‐Onset Urinary Incontinence in Adults Aged 70 and Older

OBJECTIVES: To describe the types of continence aids that older adults hospitalized in acute medical units use and to test the association between use of continence aids and development of new urinary incontinence (UI) at discharge.

Cultural- and Educational-Level Differences in Students Knowledge, Attitudes, and Preferences for Working With Older Adults An Israeli Perspective

Background: The aim of this study was to examine the effect of nursing education on students’ knowledge, attitudes, and preferences to work with older adults in an ethnically diverse Israeli society. Methods: In a cross-sectional design, Kogan’s Old People Scale was used to measure attitudes toward older adults and Palmore’s Facts on Aging Quiz-1 to assess the level of knowledge of nursing students in four cohorts. Results: Of the 224 nursing students who responded to the survey, 55% were Jewish and 45% were Arabs. Ethnicity and knowledge were the strongest correlates (p < .0001) of attitudes, and attitudes and ethnicity (p < .0001) correlated with work preferences. Conclusions: While knowledge of old age among students increased, preferences for future career in geriatrics declined with education. Ethnicity was a strong predictor of attitudes and future intentions to work with older adults. Culturally tailored educational programs focused on changing the attitudes toward aging are critically needed.

From Research to Reality: Minimizing the Effects of Hospitalization on Older Adults

This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient’s acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.

Impact of Functional Change Before and During Hospitalization on Functional Recovery 1 Month Following Hospitalization

BACKGROUND The functional changes that occur immediately before acute hospitalization and those that occur during hospitalization are pertinent to posthospitalization functional status in older adults. Our primary aim was to estimate the effects of membership in categories that take into account pre- and within-hospital functional changes on the likelihood of functional recovery (FR) 1 month after discharge. METHODS The sample included 691 older (≥70) adults admitted to general-medical inpatient units in two hospitals in Israel. FR was defined as a restoration of functioning 1 month postdischarge to levels reported 2 weeks prior to admission. Patients were classified according to functional decline or stability during the prehospital stage and decline, stability, or improvement between admission and discharge in terms of ability to perform self-care or mobility activities. We performed multivariate logistic regressions to test the association between categories of functional change and FR. RESULTS Patients who remained stable before and during hospitalization had the highest odds of maintaining their premorbid functional levels. Those who experienced functional improvement during hospitalization, despite previous functional loss, were 2.3-2.9 times more likely than persistent decliners to experience FR (p < .05 for all). Comparable patterns were found in the relationship between pre- and in-hospital functional trajectories and recovery, both in self-care and in mobility. CONCLUSIONS Differentiating between pre- and in-hospital functional changes is important for promoting short-term posthospitalization FR. In-hospital function-focused care that takes into account preadmission functional history may help improve posthospitalization FR.

Hospitalization as a Turning Point for Sleep Medication Use in Older Adults

BackgroundUse of sleep medications as a result of hospitalization among older adults is common and has been shown to result in chronic use and increased risks for adverse effects such as falls and cognitive decline. However, few studies have explored in-hospital sleep medication use or disuse as a possible factor related to subsequent home use.ObjectiveThe aim of this study was to examine changes in sleep medication use pre- to post-hospitalization as a function of in-hospital use. Methods: The study was designed as a prospective cohort study, and included 485 acute medical patients aged 70 years and older, hospitalized in a large, Israeli, teaching medical centre. Sleep medication use was assessed by patient interviews regarding patterns of use prior to, during and at 1 and 3 months after discharge. Post-discharge using patterns were assessed as a function of in-hospital discontinuation or initiation of sleep medications; background demographic and clinical characteristics were assessed as well. Logistic regressions were modelled separately for discontinuation and initiation of sleep medication use at each follow-up.ResultsOf those patients who used sleep medications prior to admission, 37 (18% of 206 prior users) discontinued use during the hospital stay. Non-use of sleep medications during hospitalization was the main significant characteristic associated with post-hospitalization discontinuation among prior users, when comparing patients who continued with those who discontinued using sleep medications in bivariate analyses. Discontinuation was associated with an adjusted odds ratio (AOR, adjusted for cognitive status) of 3.91 (95% confidence interval [CI] 1.64, 9.30) for non-use at the 1-month follow-up. Of those who did not use sleep medications prior to admission, 39 (14% of 279 non-prior users) initiated use during hospitalization. Again, sleep medication initiation at time of hospitalization was the main correlate of change in post-hospitalization medication use status, when comparing post-discharge users and non-users, among the non-prior users. Hospital initiation of sleep medications was associated with an AOR (adjusted for levels of education and morbidity, readmission, and functional status) of 4.65 (95% CI 1.95, 11.09) for post-discharge use. Similar results were obtained for the 3-month follow-up, reaching significance levels only for the discontinuation group.ConclusionsThough overall prevalence rates of sleep medication use pre-and post-hospitalization are fairly similar, rigorous scrutiny of the findings demonstrates that in-hospital sleep medication use and disuse may be a significant turning point both for initiation and discontinuation of sleep medications, especially in the short post-discharge time frame. Thus, in-hospital sleep medication prescribing policies should acknowledge the potential for changes in the post-discharge sleep medication regimen.

Hospitalization as a turning point for sleep medication use in older adults: prospective cohort study.

BACKGROUND Use of sleep medications as a result of hospitalization among older adults is common and has been shown to result in chronic use and increased risks for adverse effects such as falls and cognitive decline. However, few studies have explored in-hospital sleep medication use or disuse as a possible factor related to subsequent home use. OBJECTIVE The aim of this study was to examine changes in sleep medication use pre- to post-hospitalization as a function of in-hospital use. METHODS The study was designed as a prospective cohort study, and included 485 acute medical patients aged 70 years and older, hospitalized in a large, Israeli, teaching medical centre. Sleep medication use was assessed by patient interviews regarding patterns of use prior to, during and at 1 and 3 months after discharge. Post-discharge using patterns were assessed as a function of in-hospital discontinuation or initiation of sleep medications; background demographic and clinical characteristics were assessed as well. Logistic regressions were modelled separately for discontinuation and initiation of sleep medication use at each follow-up. RESULTS Of those patients who used sleep medications prior to admission, 37 (18% of 206 prior users) discontinued use during the hospital stay. Non-use of sleep medications during hospitalization was the main significant characteristic associated with post-hospitalization discontinuation among prior users, when comparing patients who continued with those who discontinued using sleep medications in bivariate analyses. Discontinuation was associated with an adjusted odds ratio (AOR, adjusted for cognitive status) of 3.91 (95% confidence interval [CI] 1.64, 9.30) for non-use at the 1-month follow-up. Of those who did not use sleep medications prior to admission, 39 (14% of 279 non-prior users) initiated use during hospitalization. Again, sleep medication initiation at time of hospitalization was the main correlate of change in post-hospitalization medication use status, when comparing post-discharge users and non-users, among the non-prior users. Hospital initiation of sleep medications was associated with an AOR (adjusted for levels of education and morbidity, readmission, and functional status) of 4.65 (95% CI 1.95, 11.09) for post-discharge use. Similar results were obtained for the 3-month follow-up, reaching significance levels only for the discontinuation group. CONCLUSIONS Though overall prevalence rates of sleep medication use pre- and post-hospitalization are fairly similar, rigorous scrutiny of the findings demonstrates that in-hospital sleep medication use and disuse may be a significant turning point both for initiation and discontinuation of sleep medications, especially in the short post-discharge time frame. Thus, in-hospital sleep medication prescribing policies should acknowledge the potential for changes in the post-discharge sleep medication regimen.

Trait routinization, functional and cognitive status in older adults

This study examined the associations between trait routinization and functional and cognitive as well as demographic indicators. A sample of American older adults living independently in a retirement community (n = 80) were assessed regarding their functional status, cognitive status, and preference for routine. Robust associations between functional status and trait routinization were found, as well as correlations between education, age, and routinization. No association between routinization and cognitive status was found. The results suggest that trait routinization is linked with various aspects of well-being in older age. Various explanations regarding the role of trait routinization and its validity are presented.