scholarly journals Delirium in geriatric patients

2022 ◽  
Author(s):  
Bernhard Iglseder ◽  
Thomas Frühwald ◽  
Christian Jagsch
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Older Patients ◽  
Geriatric Patients ◽  
Pharmacological Intervention ◽  
Medical Complications ◽  
Medical Illness ◽  
Current Clinical Practice ◽  
Drug Reactions ◽  
Life Threatening

SummaryDelirium is the most common acute disorder of cognitive function in older patients. Delirium is life threatening, often under-recognized, serious, and costly. The causes are multifactorial, with old age and neurocognitive disorders as the main risk factors. Etiologies are various and multifactorial, and often related to acute medical illness, adverse drug reactions, or medical complications. To date, diagnosis is clinically based, depending on the presence or absence of certain features. In view of the multifactorial etiology, multicomponent approaches seem most promising for facing patients’ needs. Pharmacological intervention, neither for prevention nor for treatment, has been proven effective unanimously. This article reviews the current clinical practice for delirium in geriatric patients, including etiology, pathophysiology, diagnosis, prognosis, treatment, prevention, and outcomes.

scholarly journals Risk Factors and Characteristics of Adverse Reactions Associated with the Use of Beta-Lactam Antibiotics in Older Patients

2021 ◽  
Vol 9 (3) ◽  
pp. 128-135
Author(s):  
E. A. Sokova ◽  
V. V. Arkhipov ◽  
O. A. Demidova ◽  
I. A. Mazerkina ◽  
T. V. Alexandrova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Drug Reactions ◽  
Older Patients ◽  
Geriatric Patients ◽  
Scientific Literature ◽  
Community Acquired Pneumonia ◽  
Drug Reactions ◽  
Beta Lactam ◽  
Younger Patients ◽  
Beta Lactam Antibiotics

The frequency of adverse drug reactions (ADRs) in older patients is approximately 11.0%, according to scientific literature. Antibiotics are the third largest group (19.5%) of medicinal products in terms of ADR frequency in geriatric patients. Beta-lactam antibiotics are the empiric treatment of choice for older outpatients and inpatients with community-acquired pneumonia. The mortality in this group of patients accounts for 85% of the overall mortality from community-acquired pneumonia. The aim of the study was to analyse scientific data on risk factors and characteristics of adverse drug reactions associated with the use of beta-lactam antibiotics in older patients. Specificity of ADRs to beta-lactam antibiotics in this group of patients is due to age-related changes in pharmacokinetics and pharmacodynamics as well as polymorbidity and polypharmacy. The analysis of scientific literature demonstrated that there have not been so many pharmacoepidemiological studies in this group of patients, and their results have been inconsistent. The frequency, causes, and clinical manifestations of ADRs in geriatric patients are diverse and differ considerably from those in younger patients. Of the most widely used antibiotics, ceftriaxone and cefaclor exhibited a statistically lower risk of ADRs in older patients than in younger patients. At the same time, ceftriaxone was associated with a relatively higher frequency of serious ADRs in older patients as compared to younger patients, whereas the frequency of serious ADRs was lower with cefaclor. The likelihood of nephrotoxic, neurotoxic, and hepatotoxic ADRs associated with the use of beta-lactam antibiotics is becoming more and more obvious but it is still underestimated in clinical and geriatric practice. Safety monitoring, therapeutic drug monitoring with due consideration of ADR risk factors in older patients, and inclusion of older patients in clinical trials of antimicrobial drugs, would improve efficacy and safety of antibiotic treatment.

Diagnostic Studies for Thrombophilia in Women on Hormonal Therapy and During Pregnancy, and in Children

2002 ◽  
Vol 126 (11) ◽  
pp. 1296-1303
Author(s):  
Benjamin R. Brenner ◽  
Ulrike Nowak-Göttl ◽  
Andrea Kosch ◽  
Marilyn Manco-Johnson ◽  
Michael Laposata
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Oral Contraceptive ◽  
Medical Literature ◽  
Data Extraction ◽  
Data Sources ◽  
Current Clinical Practice ◽  
Extensive Review ◽  
Prothrombotic Risk Factors

Abstract Objective.—To review the role of acquired and inherited prothrombotic risk factors that increase the risk of thrombosis in oral contraceptive users, during pregnancy, and in neonates, infants, and children; and to determine by the consensus opinion of recognized experts in the field which risk factors should be determined in which individuals at which time. Data Sources.—Review of the medical literature and current clinical practice by a panel of experts in the field of thrombophilia. Data Extraction and Synthesis.—The experts made an extensive review of the published literature and prepared a draft manuscript, which included preliminary recommendations. The draft manuscript was circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 26 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—This report reviews the options for testing for thrombophilic states in women using oral contraceptives, during pregnancy, and in neonates and children. General guidelines for testing in these clinical situations are provided, along with citation of the appropriate supporting literature.

scholarly journals Analysis of the Interventions of Medical Emergency Teams in Older Patients in Selected Polish Cities with County Status: A Retrospective Cohort Study

2021 ◽  
Vol 18 (14) ◽  
pp. 7664
Author(s):  
Mariusz Celiński ◽  
Mateusz Cybulski ◽  
Joanna Fiłon ◽  
Marta Muszalik ◽  
Mariusz Goniewicz ◽  
...  
Keyword(s):  
Older Patients ◽  
Emergency Service ◽  
Geriatric Patients ◽  
Health Care Facilities ◽  
Medical Emergency ◽  
Ambulance Dispatch ◽  
Medical Emergency Teams ◽  
Threatening Condition ◽  
Emergency Interventions ◽  
Life Threatening

Introduction: Geriatric patients account for a large proportion of interventions of medical emergency teams (METs). The aim of this study was to analyse medical emergency interventions in the Biała Podlaska and Chełm (Poland) between 2016 and 2018 in a group of patients ≥ 65 years of age. Materials and Methods: We analysed medical records of 1200 older patients treated by METs in Biała Podlaska and Chełm (Lublin Province, Poland). The research was conducted from June 2019 to March 2020 at the Emergency Medical Service Station in Biała Podlaska and the Medical Rescue Station in Chełm (Independent Public Complex of Health Care Facilities). Results: A total of 92.5% of medical emergency service interventions took place at the patient’s home. The mean time of stay at the scene was 20 min. The highest number of interventions occurred between 8:00 p.m. and 8:59 p.m. There were no statistically significant differences in the type of ambulance used depending on the patient’s sex, while there was a statistically significant relationship between priority code and sex. Cardiovascular diseases were diagnosed in 40% of patients, and the symptoms were not precisely classified in almost the same percentage of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the hospital emergency department in 69.1% of cases. Conclusions: METs were called for a variety of diseases due to the fact that geriatric patients are not able to distinguish a life-threatening condition. Medical procedures performed by METs from Biała Podlaska and Chełm were closely related to the initial diagnoses made by these teams. It was irrelevant whether a specialist or non-specialist medical emergency service was used. Paramedics are very well trained to practice their profession and are able to provide treatment to older patients in a state of sudden life threat.

scholarly journals Factors associated with acute myocardial infarction in older patients after hospitalization with community-acquired pneumonia: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Kang ◽  
Xiang-Yang Fang ◽  
Dong Wang ◽  
Xiao-Juan Wang
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Older Patients ◽  
Geriatric Patients ◽  
Community Acquired Pneumonia ◽  
Artery Disease

Abstract Background Community-acquired pneumonia (CAP) and acute myocardial infarction cardiovascular (AMI) are two important health issues in older patients. Little is known regarding characteristics of AMI in older patients hospitalized for CAP. Therefore, we investigated the prevalence, characteristics compared with younger patients, impact on clinical outcomes and risk factors of AMI during hospitalization for CAP in geriatric patients. Methods Eleven thousand nine adult inpatients consisted of 5111 patients≥65 years and 5898 patients< 65 years in respiratory ward diagnosed with CAP were retrospectively analyzed by electronic medical records. Results 159 (3.1%) older patients in respiratory ward experienced AMI during hospitalization for CAP. AMI were more frequently seen in patients≥65 years compared with patients< 65 years (3.1% vs. 1.0%). Patients≥65 years who experienced AMI during hospitalization for CAP had higher percentage of respiratory failure (P = 0.001), hypertension (P = 0.008), dyspnea (P = 0.046), blood urea nitrogen (BUN) ≥7 mmol/L (P < 0.001), serum sodium< 130 mmol/L (P = 0.005) and had higher in-hospital mortality compared to patients< 65 years (10.1% vs. 6.6%). AMI was associated with increased in-hospital mortality (odds ratio, OR, with 95% confidence interval: 1.49 [1.24–1.82]; P < 0.01). Respiratory failure (OR, 1.34 [1.15–1.54]; P < 0.01), preexisting coronary artery disease (OR, 1.31[1.07–1.59]; P = 0.02), diabetes (OR, 1.26 [1.11–1.42]; P = 0.02) and BUN (OR, 1.23 [1.01–1.49]; P = 0.04) were correlated with the occurrence of AMI in the older patients after hospitalization with CAP. Conclusions The incidence of AMI during CAP hospitalization in geriatric patients is notable and have an impact on in-hospital mortality. Respiratory failure, preexisting coronary artery disease, diabetes and BUN was associated with the occurrence of AMI in the older patients after hospitalization with CAP. Particular attention should be paid to older patients with risk factors for AMI.

scholarly journals Probable causes and risk factors for positive SARS-CoV-2 test in recovered patients: Evidence from Brunei Darussalam

2020 ◽  
Author(s):  
Justin Wong ◽  
Wee Chian Koh ◽  
Riamiza Natalie Momin ◽  
Mohammad Fathi Alikhan ◽  
Noraskhin Fadillah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Infection Control ◽  
Older Patients ◽  
National Study ◽  
Viral Shedding ◽  
Probable Explanation ◽  
Brunei Darussalam ◽  
Most Probable Explanation ◽  
Causes And Risk Factors

We report findings of a national study in Brunei Darussalam indicating that one in five recovered patients subsequently test positive again for SARS-CoV-2 - this risk is nearly three times higher in older patients (age 53 and above) than younger ones (below age 53). Review of clinical and epidemiological records do not support reinfection or reactivation as likely causes of the 're-positive' observation. Instead, prolonged but intermittent viral shedding is the most probable explanation. We discuss the implications of these findings for infection control and clinical practice.

scholarly journals Predictors of adverse drug reactions in geriatric patients: An exploratory study among cancer patients

2019 ◽  
Vol 08 (02) ◽  
pp. 130-133
Author(s):  
S. George Sneha ◽  
Kalpana Simhadri ◽  
Viswam K. Subeesh ◽  
S. Varghese Sneha
Keyword(s):  
Risk Factors ◽  
Adverse Drug Reactions ◽  
Geriatric Patients ◽  
Medical Oncology ◽  
Multivariate Logistic Regression Analysis ◽  
Drug Reactions ◽  
Chemotherapeutic Regimen ◽  
Potential Risk Factors ◽  
History Of ◽  
Independent Risk Factors

Abstract Objectives: The objective of this study was to study the predictors of adverse drug reactions (ADRs) among geriatric patients in the Department of Medical Oncology. Methods: A hospital-based prospective observational study was carried out among 153 inpatients in the Department of Medical Oncology for 6 months. Patients above 60 years of age with a confirmed history of malignancy were included in the study. The potential risk factors for ADR were defined in relation to the patient and chemotherapeutic regimen and relationship between them was assessed by univariate and multivariate logistic regression analysis. Results: Among 153 patients, 94 (64.43%) experienced ADRs. The mean ADR per patient was 0.88 ± 1.2. The common ADRs found were alopecia (30.18%) and diarrhea (28.68%). Risk estimates revealed that there was a significant association between smokers (odds ratio [OR] = 10.326; 95% confidence interval [CI] 2.345–45.47, P = 0.001), alcoholics (OR = 10.897; 95% CI 2.479–47.902, P = 0.001), increasing age (OR = 2.22; 95% CI 1.698–2.909, P = 0.001), overweight (OR = 16.68; 95% CI 2.179–127.741, P = 0.001), and male participants (OR = 0.143; 95% CI 0.05–0.390 P = 0.001) with the development of ADRs. The risk of carboplatin (OR = 13.359; 95% CI 3.056–58.406 P = 0.001) and 5-fluorouracil (OR = 1.938 95% CI 1.266–2.935 P = 0.001) use and occurrence of ADRs were also found to be high. Conclusion: The study findings showed that smoking, alcohol consumption, age more than 70 years, and overweight had a high risk for developing ADRs in geriatric patients who underwent chemotherapy. The independent risk factors identified should be targeted for preventive measures to improve anticancer agent prescription and reduce the risk of ADRs.

Current clinical practice in patients with cardiac implantable electronic devices undergoing radiotherapy: a literature review

EP Europace ◽  
2021 ◽  
Author(s):  
Meor Azraai ◽  
Daniel D’Souza ◽  
Yuan-Hong Lin ◽  
Voltaire Nadurata
Keyword(s):  
Clinical Practice ◽  
Electronic Devices ◽  
Complementary Metal Oxide Semiconductor ◽  
Cmos Technology ◽  
Oxide Semiconductor ◽  
Clinical Effects ◽  
Current Clinical Practice ◽  
Memory Errors ◽  
Cardiac Implantable Electronic Devices ◽  
Life Threatening

Abstract Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to the ageing of the population. With newer CIEDs’ implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturization of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life-threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to the lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recently updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.

scholarly journals Malnutrition in hospitalized older patients. Clinical case

2021 ◽  
pp. 110-115
Author(s):  
V. S. Ostapenko ◽  
M. M. Balaeva ◽  
N. K. Runikhina ◽  
K. Yu. Krylov
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Clinical Case ◽  
Geriatric Patients ◽  
Pain Syndrome ◽  
Geriatric Syndrome ◽  
Mental Functioning ◽  
Aseptic Necrosis ◽  
Risk Zone ◽  
Patient Prognosis

Malnutrition is a common geriatric syndrome, which often undiagnosed, leads to impaired physical and mental functioning and patient prognosis. Geriatric patients admitted to hospital with acute and subacute conditions and pain syndrome are in an especial risk zone. The article presents a clinical case of the development and correction of malnutrition in an 84-year-old patient with aseptic necrosis of the femoral head. Risk factors and existing approaches to the management of patients with malnutrition are discussed.

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