Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.AimTo investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.MethodsProspective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.ResultsAmong the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1.ConclusionsFrail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.

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Correction to: Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03312-6 ◽

2019 ◽

Vol 140 (4) ◽

pp. 493-493

Author(s):

Babette C. van der Zwaard ◽

Charlotte E. Stein ◽

Janet E. M. Bootsma ◽

Hendrikus J. A. A. van Geffen ◽

Conny M. Douw ◽

...

Keyword(s):

Hip Fracture ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients

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Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03294-5 ◽

2019 ◽

Vol 140 (4) ◽

pp. 487-492 ◽

Cited By ~ 1

Author(s):

Babette C. van der Zwaard ◽

Charlotte E. Stein ◽

Janet E. M. Bootsma ◽

Hendrikus J. A. A. van Geffen ◽

Conny M. Douw ◽

...

Keyword(s):

Hip Fracture ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients

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435 THE IMPACT OF COMPREHENSIVE GERIATRIC ASSESSMENT IN THE OUTCOMES OF OLDER ACUTE NEUROSURGICAL PATIENTS

Age and Ageing ◽

10.1093/ageing/afab116.02 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii8-ii13

Author(s):

L Soutter ◽

D Sivapathasuntharam ◽

C Uff ◽

S Yordanov

Keyword(s):

Length Of Stay ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Clinical Pathways ◽

Control Group ◽

Clinical Approach ◽

Neurosurgical Patients ◽

Significant Difference ◽

The Impact

Abstract Introduction As the population ages, an increasing proportion of the neurosurgical caseload is comprised of older patients. This trend is reinforced by technical advances and anaesthetic considerations within the field, allowing a higher proportion of patients eligible for surgery. Comprehensive geriatric assessment (CGA) is the gold standard clinical approach for evaluating older patients. Peri-operative care of older people (POPS) has provided strong evidence that CGA services can result in fewer post-operative complications. However, this evidence stems largely from trauma and orthopaedic surgery. Currently, there is little evidence of the impact CGA has on older neurosurgical patients. The study aimed to investigate whether CGA for older neurosurgical patients improved outcomes such as thirty-day mortality and length of stay. Methods A control group was established by collecting retrospective data for all acute neurosurgical patients over the age of 65. This was then compared with an intervention group who received CGA in the form of regular geriatric consultant reviews. 49 patients were recruited into each group. Results Analysis showed that the interventional group had a significantly higher mean age and level of frailty. They also had more confirmed complications with a significant difference in the diagnosis of pneumonia (p = 0.05) and hyponatremia (p = 0.015). Despite this, the thirty-day mortality was lower and average length of stay was on average two days shorter compared to the control group, although this did not reach statistical significance (p = 0.701). The study showed that more patients who received a CGA were discharged home (p = 0.209). Conclusion Our findings suggest that CGA input for older neurosurgical patients improves outcomes and should be incorporated routinely into neurosurgical clinical pathways.

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Faculty Opinions recommendation of A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1064694.517604 ◽

2007 ◽

Author(s):

Martine Extermann

Keyword(s):

Prostate Cancer ◽

Pilot Study ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Androgen Ablation

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Faculty Opinions recommendation of Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726644717.793523230 ◽

2016 ◽

Author(s):

Gretchen Kimmick

Keyword(s):

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Deficit Accumulation ◽

Patients With Cancer ◽

Accumulation Index

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Faculty Opinions recommendation of The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.738437978.793577490 ◽

2020 ◽

Author(s):

Martine Extermann

Keyword(s):

Randomised Controlled Trial ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Controlled Trial ◽

Patients With Cancer ◽

Randomised Controlled ◽

The Impact

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Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

BMC Geriatrics ◽

10.1186/1471-2318-11-18 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 33

Author(s):

Olav Sletvold ◽

Jorunn L Helbostad ◽

Pernille Thingstad ◽

Kristin Taraldsen ◽

Anders Prestmo ◽

...

Keyword(s):

Hip Fracture ◽

Older People ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment

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Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

Medicine Health Care and Philosophy ◽

10.1007/s11019-021-10052-1 ◽

2021 ◽

Author(s):

Merle Weßel

Keyword(s):

Standardized Testing ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Geriatric Medicine ◽

Assessment Tools ◽

Assessment Process ◽

Social Category ◽

Social Categories ◽

The Social

AbstractDespite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine.

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