Abstract 2301: Frail Elderly Patients at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dana H Lee ◽  
Billie Jean Martin ◽  
Alexandra M Yip ◽  
Karen J Buth ◽  
Gregory M Hirsch
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Frail Elderly ◽  
Independent Predictor ◽  
Institutional Care ◽  
Biological Age ◽  
Younger Patients ◽  
Frail Patients

Patients referred for cardiac surgery are increasingly older, but chronological age does not always capture biological age. This study assessed frailty, as a functional parameter of biological age, as a predictor of mortality or prolonged institutional care. Functional measures of frailty and clinical preoperative data were collected for all cardiac surgery patients at a single center (2004 –2007). Based on the Katz Index of Activities of Daily Living, frailty was defined as any impairment in feeding, bathing, dressing, transferring, toileting, continence, or ambulation, or dementia. The impact of frailty on in-hospital mortality or institutional discharge (other hospital or nursing facility) was assessed with multivariate logistic regression. The interaction of frailty and age was examined, with non-frail patients age<70 as the referent group. Results: Of 3096 patients, 133 (4.3%) were frail. Frail patients were older, more likely to be female, have COPD, CHF, EF<40%, recent MI, pre-operative renal failure, cerebrovascular disease, greater acuity, and more complex operations (p<0.05). Frail patients experienced higher rates of mortality, sepsis, delirium, post-operative renal failure, and transfusion (p<0.001). A greater proportion of frail patients than non-frail patients (49% vs. 9%) were discharged to a setting other than home. In the risk-adjusted models, frailty was an independent predictor of mortality (OR 1.8, 95% CI 1.0 –3.2) or institutional discharge (OR 6.4, 95% CI 4.1–9.9). Furthermore, frail elderly (age≥70) patients had greater risk of institutional discharge (OR 22.7, CI 12.4 – 41.7) than frail younger patients (OR 6.5, CI 3.4 –12.5) or non-frail elderly patients (OR 3.5, CI 2.6 – 4.6). Similarly, frail elderly patients had greater risk of mortality (OR 4.0, CI 1.9 – 8.1) than frail younger patients (OR 1.9, CI 0.8 – 4.7) or non-frail elderly patients (OR 2.4, CI 1.7–3.5). Frailty was an independent predictor of in-hospital mortality and prolonged institutional care. Frailty combined with older age further discriminated those at highest risk. Special consideration should be given to the management of frail elderly patients who have surgical cardiac disease.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

Management and survival of frail elderly cancer patients within a Geriatric Oncology Program

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8547-8547 ◽  
Author(s):  
U. Basso ◽  
L. Vamvakas ◽  
C. Falci ◽  
E. Lamberti ◽  
L. M. Pasetto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Frail Elderly ◽  
Geriatric Oncology ◽  
Drop Out ◽  
Geriatric Syndromes ◽  
Elderly Cancer Patients ◽  
Frail Patients

8547 Background: Abstention from administration of either chemo- or endocrine therapy to elderly cancer patients deemed frail at the Multidimensional Geriatric Assessment is still controversial, and few data are available concerning the actual survival of such patients. Methods: To evaluate the management and survival of all consecutive frail cancer patients older than 70 years, seen from October 2004 to December 2005 within our Geriatric Oncology Program. Frailty was defined by one or more of the following: age ≥ 85 years, dependence in one or more Activity of Daily Living (ADL), presence of at least three comorbidity of grade 3 or one of grade 4 according to CIRS-G, one or more geriatric syndromes [Balducci L, Cancer Control 2001]. Results: A total of 364 elderly patients were divided into three categories: fit (26.4%), vulnerable (49.5%) and frail patients (24.2%). These 88 frail patients had a median age of 79 years (range, 70–93), 43.2% males. Motives for being considered frail were age alone (13.6% of patients), ADL dependence (25%), comorbidity (14.8%), geriatric syndromes (6.8%) or, more frequently, the co-existence of two or more of these factors (39.8%). Thirty patients (34.1%) underwent chemotherapy: 8 for gastro-intestinal tumors, 7 lung, 7 hematological and 8 other sites. Patients received standard regimens at standard doses (27.6%) or with ≥ 25% dose reduction (24.1%), age-adapted regimens at standard doses (44.8%) or with reduced doses (6.9%). Six patients (20%) derived some clinical benefit but only two (6.7%) showed radiological response. Twenty-two patients interrupted chemotherapy prematurely due to toxicity/death (23.3%) or refusal/drop out (26.7%). All twenty-eight women with estrogen receptor positive breast cancer (31.9% of all frail patients) were prescribed endocrine therapy either adjuvantly, neo-adjuvantly or for metastatic disease, with a predominance of aromatase inhibitors (82.1%) compared to tamoxifen. Thirty out of 88 patients have died, with a 2-year overall survival of 35%. Conclusions: Frailty was observed in one fourth of all our elderly patients, but it did not prevent treatment of tumor with either chemo- or endocrine therapy in 66% of cases. Overall survival of frail elderly patients with cancer appears worse than in geriatric series. No significant financial relationships to disclose.

scholarly journals Biological age and its role in stratification of cardiac risk

2019 ◽  
Vol 178 (1) ◽  
pp. 17-20
Author(s):  
N. N. Shikhverdiev ◽  
D. I. Ushakov ◽  
A. S. Peleshok ◽  
V. A. Krivopalov ◽  
V. A. Sizenko
Keyword(s):  
Cardiac Surgery ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Blood Circulation ◽  
Cardiac Risk ◽  
Biological Age ◽  
Qualitative Assessment ◽  
Elective Cardiac Surgery ◽  
Prediction Of Mortality ◽  
Extracorporeal Blood Circulation

Risk stratification in elderly patients is very important, as none of the applied models for the prediction of mortality in cardiac surgery does not take into account the whole complex of physiological features of the aging organism.Theobjectivewas to analyze the effectiveness of the method of qualitative assessment of biological age.Material and methods.Our study included 127 patients (87 male and 40 female) aged 65 to 84 years (mean age – 72.2±4.7 years) who underwent elective cardiac surgery. Perioperative factors were analyzed. The primary endpoint of the study was a 30-day mortality rate.Results.The total 30-day mortality rate was 13.4 % (17 patients). Perioperative predictors of 30-day mortality rate were the calculated values of the CAF scale (p=0.006), the surgery volume (p=0.044), the use of extracorporeal blood circulation (p=0.048).Conclusion.The use of qualitative assessment of biological age allows to more accurate predict the mortality in cardiac elderly patients.

scholarly journals Clinical outcomes of oesophagectomy in elderly versus relatively younger patients: a meta-analysis

2019 ◽  
Vol 29 (6) ◽  
pp. 897-905 ◽  
Author(s):  
Yu Han ◽  
Shengjun Liu ◽  
Wei Guo ◽  
Yajie Zhang ◽  
Hecheng Li
Keyword(s):  
Survival Rate ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Survival Rates ◽  
Incidence Rates ◽  
Conclusive Evidence ◽  
Cochrane Library ◽  
Younger Patients

Abstract OBJECTIVES The surgical efficacy of oesophagectomy for elderly patients (>80 years old) is still unclear. The aim of this meta-analysis was to compare the clinical outcomes of oesophagectomy between elderly and relatively younger patients. METHODS PubMed, EMBASE and the Cochrane Library were searched for relevant studies comparing the clinical outcomes of oesophagectomy for elderly and relatively younger patients. Odds ratios were extracted to obtain pooled estimates of the perioperative effect, and hazard ratios were extracted to compare survival outcomes between the 2 cohorts. RESULTS Nine studies involving 4946 patients were included in this meta-analysis. For patients older than 80 years of age, in-hospital mortality [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.28–3.13; P = 0.002] and the incidence rates of cardiac (OR 1.55, 95% CI 1.10–2.20; P = 0.01) and pulmonary (OR 1.57, 95% CI 1.11–2.22; P = 0.01) complications were higher than those of relatively younger patients. The overall postoperative complication rate (OR 1.40, 95% CI 0.82–2.40; P = 0.22) and the incidence of anastomotic leak (OR 0.92, 95% CI 0.58–1.47; P = 0.73) were not significantly different between the 2 groups. Elderly patients had a worse overall 5-year survival rate (HR 2.66, 95% CI 1.65–4.28; P < 0.001) than that of relatively younger patients. The cancer-related 5-year survival rate of elderly patients was also lower than that of relatively younger patients (HR 3.37, 95% CI 2.36–4.82; P < 0.001). CONCLUSIONS Compared with relatively younger patients, elderly patients with oesophageal cancer undergoing oesophagectomy are at higher risk of in-hospital mortality and have lower survival rates. However, there is no conclusive evidence that the overall rate of complications is elevated in elderly patients.

scholarly journals P1275 In-hospital outcome of patients with infective endocarditis: is echocardiography enough?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Motoc ◽  
J Kessels ◽  
B Roosens ◽  
P Lacor ◽  
N Van De Veire ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Hospital Death ◽  
Valvular Regurgitation ◽  
Cardiac Murmur ◽  
Hospital Outcome

Abstract Background Despite improvements in medical and surgical therapy, infective endocarditis (IE) remains a deadly disease. Echocardiography is the first-line diagnostic tool. However, data regarding its role in the prognostic assessment of in-hospital clinical outcome of IE are scarce. Purpose We sought to assess the role of echocardiography to predict the in-hospital outcome in a large cohort of patients diagnosed with definite IE and its association with clinical presentation and microorganisms. Methods We retrospectively included patients from two centers between 2006 and 2018. Transthoracic and transesophageal echocardiography were performed in all patients. The clinical endpoints were in-hospital death, embolic events (cerebrovascular and non-cerebrovascular), shock (septic shock and cardiogenic shock) and cardiac surgery. Results 183 patients with definite IE (age 68.9 ± 14.2 years old, 68.9% male) were evaluated. Ninety three (50.8%) patients had aortic valve IE and 81 (44.3%) patients presented with mitral valve IE. Twenty three patients had multivalvular IE. The in-hospital mortality rate was 22.4%. Sixty patients (32.8%) had embolic events and 42 (23%) patients developed shock during hospitalization. Surgery was performed in 103 (56.3%) patients. Mitral valve IE on echocardiography was an independent predictor of in-hospital mortality (p = 0.038, OR 0.38, 95% CI 0.15 – 0.94) and aortic valve IE on echocardiography was an independent predictor of embolic events (p = 0.018, OR 0.36, 95% 0.16-0.84). The presence of a new cardiac murmur upon admission was predictive for the need of cardiac surgery (p = 0.042, OR 0.51, 95% CI 0.22- 1.09) and correlated with the severity of valvular regurgitation identified by echocardiography (p = 0.024). Methicillin resistant Staphylococcus aureus (MRSA) as the causative microorganism was an independent predictor for in - hospital mortality and for the development of shock during hospitalization (p = 0.010, OR 0.13 95% CI 0.30 - 0.62 and p = 0.027, OR 6.11, 95% CI 1.22 – 30.37, respectively). No correlation was found between MRSA and echocardiographic parameters. Conclusion Mitral valve IE was an independent predictor of in - hospital mortality. Furthermore, aortic valve IE was an independent predictor of embolic events. The presence of a new cardiac murmur was predictive for the need of cardiac surgery and correlated with the severity of valvular regurgitation by echocardiography. Our findings suggest that a thorough physical examination upon admission is required in combination with a comprehensive echocardiographic exam for early identification of patients with IE at high - risk for in-hospital death and complications.

scholarly journals Gender- and age-based differences in outcomes of mechanically ventilated ICU patients: a Chinese multicentre retrospective study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jia-Gui Ma ◽  
Bo Zhu ◽  
Li Jiang ◽  
Qi Jiang ◽  
Xiu-Ming Xi
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Male Gender ◽  
Icu Patients ◽  
Younger Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Gender And Age ◽  
Multicentre Retrospective Study ◽  
Ventilated Patients

Abstract Background Previous studies have suggested that the gender and/or age of a patient may influence the clinical outcomes of critically ill patients. Our aim was to determine whether there are gender- and age-based differences in clinical outcomes for mechanically ventilated patients in intensive care units (ICUs). Methods We performed a multicentre retrospective study involving adult patients who were admitted to the ICU and received at least 24 h of mechanical ventilation (MV). The patients were divided into two groups based on gender and, subsequently, further grouped based on gender and age < or ≥ 65 years. The primary outcome measure was hospital mortality. Results A total of 853 mechanically ventilated patients were evaluated. Of these patients, 63.2% were men and 61.5% were ≥ 65 years of age. The hospital mortality rate for men was significantly higher than that for women in the overall study population (P = 0.042), and this difference was most pronounced among elderly patients (age ≥ 65 years; P = 0.006). The durations of MV, ICU lengths of stay (LOS), and hospital LOS were significantly longer for men than for women among younger patients (P ≤ 0.013) but not among elderly patients. Multivariate logistic regression analysis revealed that male gender was independently associated with hospital mortality among elderly patients but not among younger patients. Conclusions There were important gender- and age-based differences in the outcomes among mechanically ventilated ICU patients. The combination of male gender and advanced age is strongly associated with hospital mortality.

scholarly journals Conceptual modelling of the flow of frail elderly through acute-care hospitals

2018 ◽  
Vol 56 (10) ◽  
pp. 2101-2124 ◽  
Author(s):  
Silvia Bruzzi ◽  
Paolo Landa ◽  
Elena Tànfani ◽  
Angela Testi
Keyword(s):  
Elderly Patients ◽  
Conceptual Model ◽  
Acute Care ◽  
Frail Elderly ◽  
Current Practice ◽  
Acute Care Hospitals ◽  
Management Approach ◽  
Content Type ◽  
Frail Patients ◽  
The Impact

Purpose The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process. Design/methodology/approach The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice. Findings The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients. Research limitations/implications The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings. Practical implications The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required. Originality/value This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.

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