Admission Diagnosis of FTT vs. Discharge Diagnosis in Older Adults on - - PowerPoint PPT Presentation

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Admission Diagnosis of FTT vs. Discharge Diagnosis in Older Adults on - - PowerPoint PPT Presentation

Jun 20, 2023 320 likes •552 views

Admission Diagnosis of FTT vs. Discharge Diagnosis in Older Adults on a Clinical Teaching Medicine Service in a Tertiary Care Teaching Hospital Kristine Kim Preceptor: Dr. Martha Spencer PGY 5 Geriatric Medicine Fellow UBC Geriatric Medicine

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Admission Diagnosis of “FTT” vs. Discharge Diagnosis in Older Adults on a Clinical Teaching Medicine Service in a Tertiary Care Teaching Hospital

Kristine Kim Preceptor: Dr. Martha Spencer PGY 5 Geriatric Medicine Fellow UBC Geriatric Medicine Email: Krissy.kim@gmail.com

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Presenter Disclosure

  • Faculty: Kristine Kim
  • Relationships with financial sponsors: None
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Disclosure of Financial Support

  • I have no financial disclosures
  • I have no conflicts of interest
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Failure To Thrive

  • FTT associated w/ weight loss, PO intake, poor nutrition and

inactivity (NIA)

  • NOT normal aging
  • Associated with
  • Morbidity
  • Mortality Rates
  • Medical Care/Readmission
  • Institutionalization

Kumeliauskas L et al, 2013, Berkman et al, 1989, Egbert A.M, 1996, Sarkisian 1996

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Current Thoughts – A quick feeler

“Better than...Circling. ..The..Drain” "The Dwindles“ “Dwindling” “I prefer Wasting

  • Syndrome. The patient will

need a medical and neurocognitive evaluation in hope to find a reversible

  • condition. Palliative referral

is a common outcome.” “or ‘piss poor protoplasm’ ” “It is to avoid the sort of workup someone our age would deserve and would get. I would not give that DX to the average 70 year old. In a 90 year old with chronic problems who took a sudden turn, I would rule out the obvious easy to fix things and then use FTT. Often would suspect occult malignancy, but without some mass somewhere, need a hospice diagnosis.”

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Goals of Study

  • To determine the disparities between the initial diagnosis of FTT and

final discharge diagnosis in a clinical teaching medical service.

  • We propose the term FTT is being utilized when an alternative

diagnosis for an underlying medical condition is determined as a diagnosis prior to discharge.

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Methods

Subjects Recruited (n= 94) Subjects included (n=76) Subjects Eligible (n=74) Excluded: ‐ Not admitted to CTU/FM (n= 1) ‐ Admitted prior Jan 1 2016 (n=1) Excluded: ‐ Concurrent Acute Admission Diagnosis (n= 18)

Retrospective cohort study Tertiary university hospital (St. Paul’s Hospital)

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Methods

  • Electronic Chart Review
  • Descriptive statistical analysis (means, proportions, ranges)
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TABLE 1: Demographics

Age (years) Number of patients % of patients 65‐74 22 29.7% 75‐84 27 36.5% 85+ 25 33.8% Range (y) 65‐100 Mean ± SD (y) 80 ± 9.2 Gender Female 33 45% Male 41 55%

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TABLE 2: Results

Length of Stays (Days) No. patients % patients 0 ‐ 14 37 50.0% 15‐30 24 32.4% 30‐45 9 12.2% 45‐60 3 4.0% >60 1 1.4% Multimorbidity 0 ‐ 5 20 27.0% 6 ‐ 10 38 51.4% More than 10 16 21.6% Geriatric Consults Yes 15 20.3% No 59 79.7%

P=0.03 P=0.03 P<0.01 P<0.01

KK1

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Slide 10 KK1

Kristine Kim, 4/4/2018

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Acute vs Chronic: 77% (65.8%‐86%, CI 95%) – No less than 2/3 still have an acute medical illness with 95% confidence

TABLE 3: Presentation

Presentation Number of patients % of patients Acute only 57 77.0% Chronic only 15 20.3% Mixed 2 2.7%

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Diagnosis

Acute Reversible

Medication s/e (10) Infectious disease (12) Cardiac Disease (11) Respirology (4) GI (3) Endo (6) Renal (9) Depression (4) Delirium (5) Anxiety (1)

Acute Non‐reversible

Malignancy –

new/metastasis (9)

Fractures (9)

Chronic

Dementia (9) Neurological Disorder (2) Deconditioning (5) Malignancy ‐Sx (2)

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Diagnosis

Acute Reversible

Medication s/e (10) Infectious disease (12) Cardiac Disease (11) Respirology (4) GI (3) Endo (6) Renal (9) Depression (4) Delirium (5) Anxiety (1)

Acute Non‐reversible

Malignancy –

new/metastasis (9)

Fractures (9)

Chronic

Dementia (9) Neurological Disorder (2) Deconditioning (5) Malignancy ‐Sx (2)

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Diagnosis

Acute Reversible

Medication s/e (10) Infectious disease (12) Cardiac Disease (11) Respirology (4) GI (3) Endo (6) Renal (9) Depression (4) Delirium (5) Anxiety (1)

Acute Non‐reversible

Malignancy –

new/metastasis (9)

Fractures (9)

Chronic

Dementia (9) Neurological Disorder (2) Deconditioning (5) Malignancy ‐Sx (2)

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17.6 % (9.7%‐28.2%, CI 95%) FEWER than 1/3 contain FTT in discharge diagnosis

17.6% 82.4%

FTT in Discharge Diagnosis

FTT included Acute Medical Diagnosis

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Discussion

‐ Misuse of FTT on admission in older adults

  • High rate of acute medical illnesses
  • High degree of multimorbidity
  • ?Delay diagnosis/medical care

‐ Further study needed

  • Reasons for using FTT (ie focus groups ‐ residents/ED staff)
  • Outcomes: morbidity/mortality
  • Intervention: education (residents/ED staff)
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Strengths and Limitations

‐ Strengths:

  • Builds on current literature
  • Tertiary Hospital in Canada
  • Practical goal of leading to practice change

‐ Limitations:

  • Systemic bias – limited algorithmic accessibility
  • Small sample size
  • Limited to internal medicine and family medicine
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Special Thanks

  • CGS (host)
  • Dr. Martha Spencer (PI)
  • Elena Szefer (Statistician)
  • Darby Thompson (Statistician)
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Thank you

Questions?