Early Identification of Relocation Risk in Older Adults With Critical Illness

Over half of people with critical illness are older adults, and the number of older adults admitted to intensive care units has been increasing over time. Older adults have increased vulnerability to disease, disability, and adverse outcomes across many domains. To address this most effectively, a unique, interdisciplinary approach is necessary to optimize not only survival but also functional status and quality of life. A shortage of health care professionals equipped to care for the aging population makes it imperative that all professionals become aware of basic principles of caring for older adults. To equip them to care for this complex population, this chapter provides an overview of how aging impacts multiple domains of an older person with critical illness and describes evidence-based approaches to caring for older adults with critical illness.

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Screening for cancer

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0092 ◽

2017 ◽

pp. 707-712

Author(s):

Anne Horgan ◽

Shabbir M. H. Alibhai

Keyword(s):

Prostate Cancer ◽

Older Adults ◽

Life Expectancy ◽

Early Identification ◽

Remaining Life ◽

Supportive Evidence ◽

Curative Intent ◽

Remaining Life Expectancy ◽

Breast And Prostate Cancer ◽

Potential Methods

Cancer screening is the early identification of an asymptomatic malignancy. The aim of screening is to identify cancer at a stage where it can be more effectively treated and ideally with curative intent. Guidelines regarding screening in the older population differ widely across countries, in part due to the underrepresentation of older adults in the large screening trials on which the recommendations are based. In this chapter, we present the screening recommendations for colorectal, lung, breast, and prostate cancer from four international groups. The benefits of screening in the overall population are highlighted, and the data supporting screening in older adults outlined. Factors to be considered in screening decisions are discussed, including remaining life expectancy and patient and physician wishes. Potential methods to overcome these challenges along with supportive evidence are highlighted.

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Prospective Evaluation of Cognitive Function Following Critical Illness in Older Adults

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a4326 ◽

2020 ◽

Author(s):

W.J. Ehlenbach

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Critical Illness ◽

Prospective Evaluation

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Contemporary Challenges and Management of Dental Caries in the Older Population

Primary Dental Journal ◽

10.1177/2050168420943075 ◽

2020 ◽

Vol 9 (3) ◽

pp. 18-22

Author(s):

Martina Hayes ◽

Igor R. Blum ◽

Cristiane da Mata

Keyword(s):

Older Adults ◽

Health Professionals ◽

Early Identification ◽

Dental Health ◽

Ageing Population ◽

Cavity Preparation ◽

Reduction Strategies ◽

Concomitant Reduction ◽

Risk Reduction Strategies ◽

Topical Fluoride

The prevalence of caries is set to increase in the coming years as a result of a growing ageing population and a concomitant reduction in levels of edentulousness. Evidence for management of caries in older adults is scarce compared to that for the child population, however, similar principles of risk assessment, prevention and minimal intervention should be applied by dental health professionals. Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, such as topical fluoride regimes. When operative intervention cannot be avoided, Atraumatic Restorative Technique (ART) may allow for conservative cavity preparation and has the advantage of being suitable for the domiciliary setting.

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Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults

Journal of the American Geriatrics Society ◽

10.1111/jgs.13663 ◽

2015 ◽

Vol 63 (10) ◽

pp. 2061-2069 ◽

Cited By ~ 35

Author(s):

William J. Ehlenbach ◽

Eric B. Larson ◽

J. Randall Curtis ◽

Catherine L. Hough

Keyword(s):

Older Adults ◽

Critical Illness ◽

Physical Function ◽

Acute Care ◽

Prospective Cohort

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Turning Difficulty Characteristics of Adults Aged 65 Years or Older

Physical Therapy ◽

10.1093/ptj/80.12.1174 ◽

2000 ◽

Vol 80 (12) ◽

pp. 1174-1187 ◽

Cited By ~ 113

Author(s):

Mary T Thigpen ◽

Kathye E Light ◽

Gwenda L Creel ◽

Sheryl M Flynn

Keyword(s):

Older Adults ◽

Young Adults ◽

Hip Fracture ◽

Early Identification ◽

Elderly Adults ◽

Total Absence ◽

Movement Characteristics ◽

Increased Risk ◽

Group Methods ◽

Age Range

Abstract Background and Purpose. Falls that occur while walking have been associated with an increased risk of hip fracture in elderly people. This study's purpose was to describe movement characteristics in older adults that serve as indicators of difficulty in turning while walking. Subjects. Three groups were assessed: young adults who had no difficulty in turning (age range=20–30 years, n=20) (YNDT group), elderly adults who had no difficulty in turning (age range=65–87 years, n=15) (ENDT group), and elderly adults who had difficulty in turning (age range=69–92 years, n=15) (EDT group). Methods. All subjects were videotaped performing a self-paced 180-degree turn during the Timed “Up & Go” Test. Movement characteristics of each group were identified. Four characteristics were used to identify difficulty in turning: (1) the type of turn, (2) the number of steps taken during the turn, (3) the time taken to accomplish the turn, and (4) staggering during the turn. Results. In general, the EDT group took more steps during the turn and more time to accomplish the turn than the YNDT and ENDT groups did. Although the only turning strategy used by the YNDT group was a pivot type of turn, there was an almost total absence of a pivot type of turn in the EDT group. No differences were found among the groups on the staggering item, yet the EDT group was the only group in which staggering was present. We believe these changes observed in the 4 characteristics only in the EDT group are indicators of difficulty in turning while walking. Conclusion and Discussion. These indicators of difficulty may be useful for the early identification of individuals aged 65 years or older who are having difficulty in turning and may well serve as the basis for the development of a scale for difficulty in turning in older adults. Preliminary findings indicate the need for further study into the reliability, validity, and sensitivity of measurements obtained with such a scale.

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Simplified Diagnosis of Critical Illness Polyneuropathy in Patients with Prolonged Mechanical Ventilation: A Prospective Observational Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9124029 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4029

Author(s):

Chul Jung ◽

Nak-Jun Choi ◽

Won Jun Kim ◽

Yoon Mok Chun ◽

Hak-Jae Lee ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Illness ◽

Clinical Outcomes ◽

Diagnostic Criteria ◽

Early Identification ◽

Prolonged Mechanical Ventilation ◽

Critical Illness Polyneuropathy ◽

Single Center Study ◽

Sum Score ◽

Observational Cohort

Background: Although early identification of critical illness polyneuropathy (CIP) is necessary, the established diagnostic criteria have several limitations in the intensive care unit (ICU) setting. The purpose of this study was to define simplified diagnostic criteria of CIP that best predict clinical outcomes. Methods: This prospective, single-center study included 41 ICU patients with prolonged mechanical ventilation (≥21 days). We applied three different sets of diagnostic criteria (combining the results of the Medical Research Council (MRC) sum score and nerve conduction studies (NCS)) for CIP in order to identify the criteria with the best predictive power for clinical outcomes. Results: The simplified diagnosis of CIP meeting the criteria, i.e., that the MRC sum score < 48 and amplitudes of the tibial and sural nerve < 80% of the lower limit of normal, showed the strongest association with 0 ventilator-free days at day 60 (odds ratio, 6.222; p = 0.029). Conclusions: The diagnostic criteria combining the MRC sum score and the tibial and the sural NCS were identified as the simplified criteria of CIP that best predicted the clinical outcomes. The implementation of these simplified criteria may allow for early identification of CIP in the ICU, thereby contributing to prompt interventions for patients with a poor prognosis.

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