Browsing by Author "Wang, Charlotte"

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Functional trajectory 6 months posthospitalization - A cohort study of older hospitalized patients in Taiwan
(2008-03-01)
Chen, Cheryl Chia-Hui
;
Wang, Charlotte
;
Huang, Guan-Hua
;
統計學研究所
;
Institute of Statistics
Background. Although it is well-recognized that hospitalization often precipitates functional decline in older patients, there have been few studies to examine these functional changes carefully over multiple points in time. Objective: To describe functional trajectory during and 6 months posthospitalization and to ascertain the predictors that signal different classes of functional trajectory, using latent class analysis. Methods: A cohort study was conducted on 286 older hospitalized patients who were admitted to five surgical-medical units at a tertiary medical center in Northern Taiwan. Results: are reported of 241 participants who completed all four scheduled assessments during hospitalization (within 48 hr after admission and before discharge) and 3 and 6 months postdischarge. Functional trajectory was measured using the Barthel index over four time points, and decline was defined as a reduction on the Barthel index scores. Demographics, comorbidities, visual impairment, medications taken, cognitive status, nutritional status, oral health, depressive symptoms, social support, surgical diagnosis, and length of stay were assessed as the predictors of functional trajectory classes. Most (74.3%) participants developed functional decline during hospitalization, and 32.0% had persistent functional impairment at 6 months posthospitalization. Three functional trajectory classes (good, moderate, and poor) were identified, and gender, age, comorbidities, cognitive status, nutritional status, oral health status, and length of stay were associated with different trajectory classes. Conclusion: Visualizing different classes of functional trajectory and studying predictors that signal such differences during and posthospitalization help practitioners understand how function changed and the possible ways to intervene.
Prevalence of geriatric conditions: A hospital-wide survey of 455 geriatric inpatients in a tertiary medical center
(2011-07-01)
Chen, Cheryl Chia-Hui
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Yen, Chung-Jen
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Dai, Yu-Tzu
;
Wang, Charlotte
;
Huang, Guan-Hua
The aim of this study was to investigate the prevalence of common geriatric conditions in a tertiary medical center. We conducted a cross-sectional, hospital-wide survey of 455 inpatients, aged 65 and older, from 24 medical and surgical units of a 2200-bed urban academic medical center in Taiwan. Patients were screened in face-to-face interviews for 15 geriatric conditions. The prevalence of geriatric conditions was determined and compared by medical versus surgical services. Our sample of participants had a mean age of 75.3 +/- 6.1 years (+/- S.D.), range = 65-92. The prevalence of geriatric conditions ranged from 5% (pressure ulcers) to 57% (polypharmacy; taking > 5 prescriptions). The majority was visually impaired (74%) and complained of sleep disturbance during their hospital stay (58%). Prevalence rates of certain geriatric conditions differed significantly between medical and surgical units, suggesting that care should address not only common conditions but also those with higher rates on different units. Furthermore, high rates of geriatric conditions indicate strong needs for care that does not fit into traditional disease models of medicine. Care should be better targeted to address different risks for geriatric conditions of medical versus surgical geriatric inpatients in acute care settings. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
Shared Risk Factors for Distinct Geriatric Syndromes in Older Taiwanese Inpatients
(2010-09-01)
Chen, Cheryl Chia-Hui
;
Dai, Yu-Tzu
;
Yen, Chung-Jen
;
Huang, Guan-Hua
;
Wang, Charlotte
Background: Identifying shared common risk factors of geriatric syndromes is clinically useful in designing a unified approach to optimizing geriatric care. Objectives: The purpose of this study was to identify older Taiwanese inpatients' common shared risk factors among seven distinct geriatric syndromes: malnutrition, depression, cognitive impairment, functional dependence, incontinence, pressure ulcers, and dehydration. Method: A cross-sectional, hospital-wide survey was conducted to enroll inpatients (N = 455) older than 65 years and admitted to 24 medical and surgical units in a 2,200-bed urban academic medical center in northern Taiwan. Malnutrition was defined as a Mini-Nutritional Assessment score less than 17.5, depression was defined as a Geriatric Depression Scale score more than 10, cognitive impairment was considered a Mini-Mental State Examination score less than 20, and functional dependence was defined as a Barthel Index score less than 50. Incontinence, pressure ulcers, and dehydration were extracted from patients' medical records. Results: Participants had a mean age of 75.3 years (SD = 6.1 years, range = 65-92 years). The prevalence of geriatric syndromes ranged from 5% (pressure ulcers) to 33% (malnutrition). The selected geriatric syndromes were shown through logistic regression analysis to be predicted by female gender (odds ratio [OR] = 1.57-2.75), functional status (OR = 0.94-0.99), cognitive status (OR = 0.82-0.95), nutritional status (OR = 0.74-0.93), and depressive symptoms (OR = 1.07-1.26), supporting the notion of shared risk factors in geriatric syndromes. Conclusions: The findings support the theory that common geriatric syndromes have a shared set of risk factors-female gender, depressive symptoms, and functional, cognitive, and nutritional status. Revising care to target these shared risk factors in preventing common geriatric syndromes is theoretically sound.
Trajectory and determinants of nutritional health in older patients during and six-month post-hospitalisation
(2009-12-01)
Chen, Cheryl C-H
;
Tang, Siew T.
;
Wang, Charlotte
;
Huang, Guan-Hua
;
統計學研究所
Aim. The aim of this study was to characterise the trajectory and to identify determinants of nutritional health over time in a sample of older hospitalised patients, using the Generalized Estimating Equation. Background. Nutritional health deteriorates and may fluctuate over time during and post-hospitalisation. To develop a target intervention it is essential that we first have a clear picture of how the nutrition changes and examine the determinants of nutritional health during and post-hospitalisation. Design. A prospective cohort study was conducted on 306 older hospitalised patients aged 65 years and older. Methods. Subjects were recruited from five surgical and medical wards at a tertiary medical center in northern Taiwan and assessed at four points in time: within 48 hours after admission, before discharge and 3-6 months post-discharge. Results. Nutritional health fluctuated significantly over time. The curve dropped during hospitalisation, returned at three months and rose slightly at six months post hospitalisation. After controlling for length of stay and surgical treatment, patients showed decreased cognitive capacity, worsening oral health, increased use of medications, increased functional limitations and raised depressive symptoms, all of which affects their nutritional health over time. The extent of functional status impacting on nutrition varies at different points in time while the predictability of other determinants remained stable. Conclusion. The trajectory of nutritional health is a reflection of the patients' cognitive status, oral health, medication taken, functional status and depressive symptoms. The findings of our study should provide guidance in the development of intervention for the nutritional health of older patients during inpatient as well as transitional care. Relevance to clinical practice. Multi-faceted packages of interventions targeting a range of determinants for managing undernutrition and subsequent decline during and post-hospitalisation need to be tested.