Fotini Sioulis

Predictive Value of the Short Physical Performance Battery Following Hospitalization in Older Patients

BACKGROUND Hospitalization represents a stressful and potentially hazardous event for older persons. We evaluated the value of the Short Physical Performance Battery (SPPB) in predicting rates of functional decline, rehospitalization, and death in older acutely ill patients in the year after discharge from the hospital. METHODS Prospective cohort study of 87 patients aged 65 years and older who were able to walk and with a Mini-Mental State Examination score ≥ 18 and admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease, or minor stroke. Patients were evaluated with the SPPB at hospital admission, were reevaluated the day of hospital discharge, and 1 month later. Subsequently, they were followed every 3 months by telephone interviews to ascertain functional decline, new hospitalizations, and vital status. RESULTS After adjustment for potential confounders, including self-report activity of daily living and comorbidity, the SPPB score at discharge was inversely correlated with the rate of decline in activity of daily living performance over the follow-up (p < .05). In a multivariable discrete-time survival analysis, patients with poor SPPB scores at hospital discharge (0-4) had a greater risk of rehospitalization or death (odds ratio: 5.38, 95% confidence interval: 1.82-15.9) compared with those with better SPPB scores (8-12). Patients with early decline in SPPB score after discharge also had steeper increase in activity of daily living difficulty and higher risk of rehospitalization or death over the next year. CONCLUSIONS In older acutely ill patients who have been hospitalized, the SPPB provides important prognostic information. Lower extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge.

Lower Extremity Performance Measures Predict Long-Term Prognosis in Older Patients Hospitalized for Heart Failure

BACKGROUND In older heart failure (HF) patients, survival depends on the severity of their cardiac condition and on their functional status. Lower extremity performance, assessed with the Short Physical Performance Battery (SPPB), predicts survival in older persons, both in epidemiologic and clinical settings. We evaluated whether SPPB predicts long-term survival in older subjects hospitalized for HF, independent of traditional measures of HF severity. METHODS AND RESULTS Subjects aged 65+ years were enrolled on discharge after hospitalization for decompensated HF. Participants underwent echocardiography, comprehensive geriatric assessment, and SPPB. Cox proportional hazards regression models were used to predict survival over a 30-month follow-up. Of 157 participants (mean age 80 years, range 65-101; 50% men), 61 died. After adjustment for potential confounders, including demographics, ejection fraction, New York Heart Association classification, and comorbidity, we found a graded independent association between SBBP score and mortality risk: compared with an SPPB score of 9-12, scores of 0, 1-4, and 5-8 were associated with hazard ratios (HR) and 95% confidence interval (CI) of death of 6.06 (2.19-16.76), 4.78 (1.63-14.02), and 1.95 (0.67-5.70), respectively. CONCLUSIONS SPPB is an independent predictor of long-term survival of older subjects hospitalized for decompensated HF.

Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia.

The aim of this study was to investigate the principal discharge diagnosis and related comorbidity in hospitalized older patients affected by dementia.

Subsyndromal Delirium and Its Determinants in Elderly Patients Hospitalized for Acute Medical Illness

BACKGROUND In older individuals, acute medical illnesses and admission to hospital are often associated with a deterioration of cognitive status, also in the absence of dementia and full-blown delirium. We evaluated the prevalence of subsyndromal delirium (SSD) and its correlates in a sample of elderly medical inpatients. METHODS From 763 consecutive inpatients, 325 participants with known dementia or delirium were excluded, whereas 438 (mean age: 80.6 years; female participants: 60.1%) were enrolled. SSD was diagnosed within 48 hour from admission, when at least two DSM-IV delirium criteria including disorientation, attention or memory deficit, altered level of consciousness, or perceptual disturbances were present. Cognitive performance was evaluated by Mini Mental Status Examination (MMSE). General, clinical, and laboratory parameters were also registered. RESULTS One hundred and sixty-six patients (37%) had SSD. Compared with controls, SSD patients were older individuals, had less formal education, higher comorbidity, lower hemoglobin/lymphocytes counts, and higher creatinine levels. A trend toward higher prevalence of previous stroke and widowhood was observed. A MMSE score of less than 24/30 identified SSD with 88% sensitivity and 78% specificity. In SSD patients, MMSE independently correlated with years of education, high-sensitivity C reactive protein levels, and O2 arterial saturation (model adjusted r (2) = 0.30, p = .001); conversely, only years of education were associated with MMSE in controls (adjusted r (2) = 0.06, p = .01). CONCLUSIONS Our data suggest that SSD is common in hospitalized older medical inpatients, and low MMSE score might be useful for identification of participants at risk of SSD. Current inflammatory response and reduced O2 arterial saturation were the only independent determinants of cognitive performance in SSD patients.

Eosinophilic Gastroenteritis Cured with Helicobacter pylori Eradication: Case Report and Review of Literature

To the Editor: Eosinophilic gastroenteritis is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal mucosa, peripheral eosinophilia without other causes, and abdominal complaints including nausea, vomiting, diarrhea, and abdominal pain. The etiology of eosinophilic gastroenteritis remains unknown; although it has been associated with food allergy, the treatment with elimination diets gives poor results while steroid therapy is effective in 90% of patients [1]. We report a case of eosinophilic gastroenteritis resolved after eradication of Helicobacter pylori infection. A 21-year-old woman presented to our Department complaining nausea and postprandial vomiting lasting 6 months, with a weight loss of 10 kg. She had previously been treated with ursodeoxycholic acid for gallbladder microlithiasis, protonic pump inhibitors, and levosulpiride without any improvement; she was currently assuming prebiotics and oral contraceptives. Her anamnesis was positive for inhalant allergy (ragweed pollen rhinitis); she smoked 10 cigarettes/day and did not assume alcoholics nor other drugs. Clinical examination was unremarkable, with the exception of mild epigastric tenderness. Laboratory testing showed moderate eosinophilia (860 eosinophils/lL) with normal blood count. Renal, hepatic, and thyroid function, as well as inflammatory markers were normal. Serology for hepatitis viruses, research for parasites and their ova in stools, coproculture, and fecal occult blood were negative. Total IgE count (129 kU/L; normal value: <100) was slightly increased. Abdominal ultrasound showed moderate splenomegaly and confirmed gallbladder microlithiasis. The patient underwent chest X-rays and upper digestive tract X-rays (both normal). A gastroscopy showed erythematous mucosa with antral linear erosions. Histology from duodenal bulb and gastric antrum biopsies showed chronic superficial and deep gastritis with prevalent eosinophilic component, associated with Hp infection (Fig. 1). We counted 116 eosinophils per HPF (409) in the gastric antral and duodenal bulbar lamina propria. The patient was treated with amoxicillin 1 g bid, clarithromycin 500 g bid, pantoprazole 40 mg/day, and metoclopramide 10 mg tid, with rapid clinical improvement. The therapy was continued for a total of 2 weeks. Six weeks after the end of eradicating therapy, the patient reported the complete disappearance of symptoms and weight recovery. Eight weeks after the end of treatment, histology showed both Hp negativity and complete disappearance of gastric antral and duodenal bulbar eosinophilic infiltration. In the meantime, repeated laboratory testing showed normal eosinophilic count (350/ll). The patient did not complain of any relapse during the following 20 months and is currently undergoing follow-up as an outpatient. The only successful eradication therapy against Hp infection was able to resolve both Hp infection and eosinophilic gastroenteritis in our patient. Although eosinophilic gastroenteritis in H. pylori positive patients is a very rare finding, recent case reports seem to confirm the efficacy of Hp eradicating therapy in curing eosinophilic gastroenteritis [2,3]. Moreover, Moorchung et al. [4] showed a strong association between the density of eosinophils and of H. pylori in gastric biopsies, and a correlation between eosinophil score and severity of chronic gastritis. As we have previously showed that H. pylori presence is strongly associated with neutrophilic infiltration of the stomach [5], representing the Figure 1 Hematoxylin and eosin-stained preparation from gastric antral biopsy. Large numbers of eosinophils can be seen in the lamina propria.

Potential Prognostic Value of Handgrip Strength in Older Hospitalized Patients.

OBJECTIVES Objective measures of physical function are useful prognostic tools also for hospitalized elders. Low handgrip strength is predictive of poor outcomes and it can be assessed also in a sitting position, representing a potential alternative measure in bedridden patients. We evaluated grip strength prognostic value in hospitalized older patients. DESIGN Prospective cohort study. SETTING Geriatric, medical ward of an academic medical center in Ferrara, Italy. PARTICIPANTS Patients aged 65 and older (N = 88) admitted to the hospital for an acute medical condition. MEASUREMENTS Patients were evaluated for grip strength at hospital admission and were re-evaluated at discharge. After discharge, they were followed every 3 months for 1 year by telephone interviews to assess new hospitalizations and vital status. RESULTS The mean age of the sample was 77.3 years, 47% were women. At admission, mean height standardized handgrip strength was 15.7±5 kg/m; men had greater strength (p<0.001). There was a direct relationship of admission grip strength with BMI (p<0.05), serum albumin (p=0.07), and Short Physical Performance Battery score (p<0.05), and an inverse relationship with age (gender-adjusted p value <0.01). In multiple regression analysis, after adjustment for possible confounders, patients in third tertile of grip strength had a shorter hospital stay compared to those in the first tertile (β -2.8; p<0.05). Patients with higher grip strength at discharge also had a lower risk of rehospitalization or death over the follow-up, although the result was not statistically significant (OR: 0.68; 95% CI: 0.30-1.52). CONCLUSION In older hospitalized medical patients, grip strength assessment might provide useful prognostic information.