Abstract 3018: Sedation of Elderly Patients Undergoing Coronary Arteriography Does Not Result in Adverse Outcomes and Improves Postprocedural Care

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
M. Javed Ashraf ◽  
Neelima Vallurupalli ◽  
James R Cook ◽  
Marc J Schweiger ◽  
Sandra Bellantonio ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cardiac Catheterization ◽  
Randomized Study ◽  
Group Versus ◽  
Diagnostic Procedures ◽  
The Elderly ◽  
Assessment Method ◽  
Pain Medication ◽  
Adverse Outcomes ◽  
Post Procedure

Background: Elderly patients are undergoing invasive cardiac diagnostic procedures more frequently. Preprocedural sedation is often prescribed, intraprocedural medications administered, and appropriate concern raised regarding post procedure delirium and adverse consequences in the elderly. The objective of this prospective randomized study was to investigate the effect of premeditation on new onset delirium and procedural care. Methods: Patients ≤ 70 years old and scheduled for elective cardiac catheterization were screened for enrollment. All patients underwent a mini mental status exam (MMSE) and delirium assessment using confusion assessment method (CAM) prior to the procedure and repeated at 4 hours and prior to discharge or the next morning. Patients were randomly assigned to receive either diphenhydramine and diazepam (25 mg / 5 mg po) or no premedication. Patient cooperation during the procedure and ease of post-procedure management by nursing staff was measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, at one and two hours using Observer’s Assessment of Alertness/Sedation Scale (OAA/S). Results: Total of 93 patients enrolled in the study, of which 47 patients received premedication prior to the procedure. The mean age was 77 ± 4.2 years, 56% were male. The baseline mean MMES was similar in each group (27.6± 1.4 in premedication group versus 28.17±1.4 in patients without premedication). Patients with premedication were less alert immediately and at one hour after arrival on the floor (p<0.01), but no patient in either group developed delirium after the procedure as measured by CAM. The ease of procedure was greater, pain medication requirement lower and nursing reported an improvement with patient management after the procedure in the premedicated group (all p<0.05). Conclusion : Premedication did not cause delirium or confusion in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients under going cardiac catheterization.

scholarly journals Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

2021 ◽  
pp. 200-206
Author(s):  
Shrirang Bhurchandi ◽  
Sachin Agrawal ◽  
Sunil Kumar ◽  
Sourya Acharya
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Health Care Cost ◽  
Frailty Index ◽  
The Elderly ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Parametric Data ◽  
Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the patients.

scholarly journals Impact of clinical pharmacist’s interventions on pharmacotherapy management in elderly patients on polypharmacy with mental health problems including quality of life: A prospective non-randomized study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Matej Stuhec ◽  
Nika Bratović ◽  
Aleš Mrhar
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Elderly Patients ◽  
Mental Health Problems ◽  
Randomized Study ◽  
The Elderly ◽  
Health Problems ◽  
Potentially Inappropriate Medications ◽  
The Impact

AbstractMental health problems (MHPs) are very common in the elderly and can have an important influence on their quality of life (QoL). There is almost no data on the impact of clinical pharmacists’ (CPs) interventions on the QoL including elderly patients and MHPs. The main aim of this study was to determinate the impact of (CP’s) interventions on the QoL and quality of pharmacotherapy. A prospective non-randomized pre-post study was designed which included residents of a nursing home aged 65 age or more with at least one MHP. Each patient also filled out the EQ-5D questionnaire. The medical review MR included drug-related problems (DRPs) and potentially drug-drug interactions (pDDIs), as well as potentially inappropriate medications (PIMs). After 2 months, the participants were interviewed again. The mean number of medications before the intervention was 12,2 ± 3,1 per patient and decreased to 10,3 ± 3,0 medications per patient (p < 0,05) (n = 24). The total number of PIMs and pDDIs was also reduced and QoL was also significantly higher (p < 0,05). A collaborative care approach with a CP led to a decrease of DRPs, pDDIs, PIMs, the total number of medications and to an improvement in the patients’ QoL.

Interventions in the elderly: special considerations

ESC CardioMed ◽  
2018 ◽  
pp. 2980-2985
Author(s):  
Adrian Messerli ◽  
Khaled M Ziada
Keyword(s):  
Elderly Patients ◽  
Valve Replacement ◽  
Age Groups ◽  
Vascular Complications ◽  
Interventional Cardiology ◽  
The Elderly ◽  
Adverse Outcomes ◽  
St Segment Elevation ◽  
Transcatheter Aortic Valve ◽  
St Segment

The elderly population has high rates of coronary and valvular heart disease, hence the need for interventional cardiology solutions. Despite the safety of interventional procedures, older age independently predicts adverse outcomes. The elderly are more likely to have co-morbidities and suffer complications after invasive procedures. For these and other reasons, invasive therapies are disproportionately underutilized in this population. The elderly account for the majority of acute coronary syndrome-related deaths. Randomized trials and observational data confirm the favourable benefit versus risk ratio of early invasive approaches, but these strategies remain underutilized. Those presenting with ST-segment elevation are at higher risk of mechanical complications and death. Evidence supports the superiority of primary angioplasty over thrombolysis in ST-segment elevation infarction in the elderly. Although the benefit of early revascularization in elderly patients with cardiogenic has been questioned, recent analysis of larger datasets confirms that they benefit from earlier intervention like other age groups. Transcatheter aortic valve replacement (TAVR) has improved survival and quality of life of elderly patients frequently considered ineligible to undergo open valve replacement. The elderly remain at highest risk of death, stroke, and vascular complications with TAVR, but such complications remain limited and outcomes of the transcatheter approaches are better than open valve replacement or medical therapy. Concerns regarding overuse of TAVR in terminal patients have been raised, but standardized and methodical assessment of frailty and co-morbidity help in selection of patients in whom the benefit outweighs the risk.

Dementia in acutely-ill medical elderly patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S190-S190 ◽  
Author(s):  
P. Sá Esteves ◽  
D. Loureiro ◽  
E. Albuquerque ◽  
F. Vieira ◽  
L. Lagarto ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Barthel Index ◽  
Medical Condition ◽  
Neuropsychiatric Symptoms ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Adverse Outcomes ◽  
Dementia Prevalence ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients

IntroductionDementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.ObjectivesDetermine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.ResultsThe final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).ConclusionsThere is a high prevalence of dementia and an appreciable rate of delirium among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis in the Elderly

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
J. D. Spiliotis ◽  
E. Halkia ◽  
V. A. Boumis ◽  
D. T. Vassiliadou ◽  
A. Pagoulatou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Combined Treatment ◽  
Group Versus ◽  
Disease Free Survival ◽  
The Elderly ◽  
Morbidity Rate ◽  
Crs And Hipec

Background. The combined treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment, most suitable for young and good performance status patients. We evaluated the outcomes of elderly patients undergoing CRS and HIPEC for peritoneal carcinomatosis with careful perioperative care.Methods. All consecutive patients 70 years of age or older who were treated for peritoneal carcinomatosis over the past five years were included. Primary outcomes were perioperative morbidity and mortality. Secondary outcomes were disease-free survival and overall survival.Results. From a pool of 100 patients, with a diagnosis of PC who underwent CRS and HIPEC in our center, we have included 30 patients at an age of 70 years or older and the results were compared to the patients younger than 70 years. The total morbidity rate was 50% versus 41.5% in the group younger than 70 years (NSS). The mortality rate was 3.3% in the elderly group versus 1.43% in the younger group (NSS). Median overall survival was 30 months in the older group versus 38 months in the younger group.Conclusion. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis may be safely performed with acceptable morbidity in selected elderly patients.

Dialysis Access as an Area of Improvement in Elderly Incident Hemodialysis Patients: Results from a Cohort Study from the International Monitoring Dialysis Outcomes Initiative

2017 ◽  
Vol 45 (6) ◽  
pp. 486-496 ◽  
Author(s):  
Jochen G. Raimann ◽  
Claudia Barth ◽  
Len A. Usvyat ◽  
Priscila Preciado ◽  
Bernard Canaud ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cox Regression ◽  
Venous Catheter ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Asia Pacific ◽  
Dialysis Access ◽  
Treatment Practices ◽  
Kaplan Meier ◽  
Dialysis Outcomes

Background: Commencing hemodialysis (HD) using a catheter is associated with a higher risk of adverse outcomes, and early conversion from central-venous catheter (CVC) to arteriovenous fistula/graft (non-CVC) improves outcomes. We investigated CVC prevalence and conversion, and their effects on outcomes during the first year of HD in a multinational cohort of elderly patients. Methods: Patients ≥70 years from the MONDO Initiative who commenced HD between 2000 and 2010 in Asia-Pacific, Europe, North-, and South-America and survived at least 6 months were included in this investigation. We stratified by age (70-79 years [younger] vs. ≥80 years [older]) and compared access types (at first and last available date) and their changes. We studied the association between access at initiation and conversion, respectively, and all-cause mortality using Kaplan-Meier curve and Cox regression, and predicted the absence of conversion from catheter to non-CVC using adjusted logistic regression. Results: In 14,966 elderly, incident HD patients, survival was significantly worse when using a CVC at all times. In Europe, the conversion frequency from CVC to non-CVC was higher in the younger fraction. Conversion from non-CVC to CVC was associated with worsened outcomes only in the older fraction. Conclusion: These results corroborate the need for early HD preparation in the elderly HD population. Treatment of elderly patients who commence HD with a CVC should be planned considering aspects of individual clinical risk assessment. Differences in treatment practices in predialysis care specific to the elderly as a population may influence access care and conversion rate.

scholarly journals Frailty as a growing challenge for anesthesiologists – results of a Dutch national survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Bouwhuis ◽  
C. E. van den Brom ◽  
S. A. Loer ◽  
C. S. E. Bulte
Keyword(s):  
Elderly Patients ◽  
Frail Elderly ◽  
Perioperative Care ◽  
Elderly Population ◽  
Multidisciplinary Approach ◽  
Anesthetic Management ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Functional Reserve ◽  
Patient File

Abstract Background Frailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery. Anesthesiologists can reduce adverse outcomes when risk factors are recognized early and dedicated care pathways are operational. As the frail elderly population is growing, we investigated the perspective on the aging population, familiarity with the frailty syndrome and current organization of perioperative care for elderly patients among Dutch anesthesiologists. Methods A fifteen-item survey was distributed among anesthesiologists and residents during the annual meeting of the Dutch Society of Anesthesiology. The first section included questions on self-reported competence on identification of frailty, acquaintance with local protocols and attitude towards the increasing amounts of elderly patients presenting for surgery. The second part included questions on demographic features of the participant such as job position, experience and type of hospital. Answers are presented as percentages, using the total number of replies for the question per group as a denominator. Results A sample of 132 surveys was obtained. The increasing number of elderly patients was primarily perceived as challenging by 76% of respondents. Ninety-nine percent agreed that frailty should influence anesthetic management, while 85% of respondents claimed to feel competent to recognize frailty. Thirty-four percent of respondents reported the use of a dedicated pathway in the preoperative approach of frail elderly patients. However, only 30% of respondents reported to know where to find the frailty screening in the patient file and appointed that frailty is not consistently documented. Interestingly, only 43% of respondents reported adequate collaboration with geriatricians. This could include for example a standardized preoperative multidisciplinary approach or dedicated pathway for the elderly patient. Conclusions This survey demonstrated that the increasing number of frail elderly patients is perceived as important and relevant for anesthetic management. Opportunities lie in improving the organization and effectuation of perioperative care by more consistent involvement of anesthesiologists.

scholarly journals Elevated Procalcitonin and Depression As Risk Factors For Postoperative Delirium In The Elderly After Cardiac Surgery – A Prospective Observational Study.

2020 ◽  
Author(s):  
Anna Kupiec ◽  
Barbara Adamik ◽  
Natalia Kozera ◽  
Waldemar Gozdzik
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Inflammatory Marker ◽  
Functional Decline ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multivariable Logistic Regression Model

Abstract Background One of the most common complications after cardiac surgery is delirium. Determining the origin of this complication from possible pathomechanisms is difficult. The activation of an inflammatory response during surgery has been suggested as one possible mechanism of delirium. The usefulness of the inflammatory marker procalcitonin (PCT) as a predictor of delirium after cardiac surgery with cardiopulmonary bypass (CBP) has not yet been investigated. Methods The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative (PCT, comorbidities, functional decline, depression) and intraoperative risk factors. 149 elderly patients were included. Delirium was assessed using the Confusion Assessment Method for the ICU. Results Thirty patients (20%) developed post-operative delirium: hypoactive in 50%, hyperactive in 33%, mixed in 17%. Preoperative PCT above the reference range (> 0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p=0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL, IQR 0.03-0.15 vs. 0.05 ng/mL, IQR 0.02-0.09, p=0.011), and for consecutive days (day 1: 0.59 ng/mL, IQR 0.25-1.55 vs. 0.25 ng/mL, IQR 0.14-0.54, p=0.003; day 2: 1.21 ng/mL, IQR 0.24-3.29 vs. 0.36 ng/mL, IQR 0.16-0.76, p=0.006; day 3: 0.76 ng/mL, IQR 0.48-2.34 vs. 0.34 ng/mL, IQR 0.14-0.66, p=0.001). Patients with delirium were older (74 years, IQR 70 – 76 vs. 69 years, IQR 67 – 74; p=0.038) and more often had functional decline (47% vs. 28%, p=0.041). There was no difference in comorbidities with the exception of anaemia (43% vs. 19%, p=0.006). Depression was detected in 40% of patients with delirium and in 17% without delirium (p=0.005). In a multivariable logistic regression model of preoperative procalcitonin (OR= 3.05; IQR 1.02-9.19), depression (OR=5.02, IQR 1.67-15.10), age (OR=1.14; IQR 1.02-1.26), functional decline (OR=0.76; IQR 0.63-0.91) along with CPB time (OR=1.04; IQR 1.02-1.06) were significant predictors of postoperative delirium. Conclusion A preoperative PCT test and assessment of functional decline and depression may help identify patients at risk for developing delirium after cardiac surgery.

scholarly journals Oral Anticoagulation in the Elderly and Frail

2020 ◽  
Vol 40 (01) ◽  
pp. 074-083 ◽  
Author(s):  
Rupert M. Bauersachs ◽  
Joerg Herold
Keyword(s):  
Elderly Patients ◽  
Absolute Risk ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Absolute Risk Reduction ◽  
Bleeding Risk ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Elderly Age ◽  
Frail Patients

AbstractThe proportion of elderly patients will increase substantially over the next decades, and both atrial fibrillation (AF) and venous thromboembolism (VTE) are more common in the elderly. Age is a risk factor not only for stroke and thromboembolism but also for bleeding, particularly in frail patients, in whom numerous pathophysiological changes occur that alter drug kinetics and toxicity of standard doses of oral anticoagulants (OACs). AF trials showed that the relative benefits of direct OACs (DOACs) also applied to elderly patients, and due to their higher risk this translates into a higher absolute risk reduction compared with vitamin K antagonists, suggesting that DOACs are the better choice. All DOACs—at varying extent—are eliminated via the kidney and it is crucial to evaluate renal function at initiation and during follow-up, especially for dabigatran. The fear of falls is a common reason against OAC. However, there is still a benefit with OAC, particularly with DOACs given the lower risk of intracranial hemorrhage. Polypharmacy represents a common challenge, nevertheless DOACs and warfarin were classified as beneficial. Nonetheless, attempts should be undertaken to reduce comedication, and drug–drug interactions should be assessed. Coadministration of platelet inhibitors increases bleeding risk and should be avoided. In conclusion, elderly and frail patients requiring anticoagulation for AF or VTE are at higher risk of adverse outcomes, but also have a higher absolute benefit from OAC. Important practical aspects to improve efficacy and safety in this challenging population are summarized in this overview.

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