Clinical Implications of Oral Assessment In Elderly Patients With Acute Heart Failure: A Single-Center, Retrospective Study

Background: Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the clinical implications of oral assessment in elderly patients with acute heart failure.Methods: We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Poor oral health was defined as a revised oral assessment guide score ≥ 9.Results: Poor oral health was identified in 66.2% of the patients. Patients with poor oral health had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with poor oral health than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate regression analyses. Conclusions: Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.Trail registration: Patients were retrospectively registered.

Clinical and Utilization Outcomes of Matched People With and Without HIV Aged 65+

The prevalence of age-standardized comorbidities is significantly elevated for PLWH across an array of cohorts. However, healthcare needs of older people living with (PLWH) and without (PWOH) HIV may be similar if they have similar geriatric conditions. PLWH and PWOH aged 65+ and eligible for Medicare from 7/1/2014-1/1/2015 were matched 1:1 on age, sex, race, and census region (n=7654). Cox regression assessed count of prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty, and polypharmacy), and risk for clinical or utilization outcomes (cancer, kidney disease, muscle wasting, hepatitis C, liver disease, myocardial infarction, stroke; hospitalization, nursing home and home health admission) during follow-up between 1/1/2015-12/31/2016. PLWH and PWOH are similar in count of geriatric conditions. Compared to those with none, those having 2+ geriatric conditions were similar across PLWH and PWOH in their risk of ≥1 clinical outcome (PLWH: HR 1.57 95% CI [1.29-1.90]; PWOH: HR 1.31 [1.02-1.67]), hospitalization (PLWH: HR 2.35 [1.96-2.83]; PWOH: HR 2.07 [1.65-2.60]), and home health admission (PLWH: HR 2.09 [1.58-2.76]; PWOH: HR 2.20 [1.55-3.12]). Having 2+ geriatric conditions, PWOH had 4.45 times the risk (95% CI 3.16-6.26) and PLWH had 2.88 times the risk (95% CI 2.18-3.81) of NH admission compared to no geriatric conditions. In this study, PLWH use nursing homes less than PWOH despite having a similar number of geriatric conditions and clinical outcomes. Further research to understand this apparent discrepancy will be critical to achieve equity in nursing home access.

Clinical Implications of Oral Assessment in Elderly Patients with Acute Heart Failure: A Single-center, Retrospective Study

Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the clinical implications of oral assessment in elderly patients with acute heart failure. We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Poor oral health (defined as a revised oral assessment guide score ≥ 9) was identified in 66.2% of the patients. Patients with poor oral health had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with poor oral health than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate regression analyses. In conclusion, oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.

Description of a closed pyometra on a wild boar (Sus scrofa, Linnaeus 1758)

Pyometra is a pus accumulation in the uterine lumen. This paper reports an unusual case of pyometra in a female Sus scrofa of Parque Biologico de Gaia (Avintes, Portugal). The animal was of advanced age, and the clinical signs (e.g., anorexia, lethargy) were originally associated with geriatric conditions. The animal presented a large uterus, which likely further contributed to the locomotion difficulties and poor body condition. To the extent of our knowledge, this is the first report of a close pyometra in wild boar (Sus scrofa, Linnaeus, 1758). However, this diagnosis must be taken into account during uterine evaluation and special attention must be given to its inspection in meat animals.

Acute Coronary Syndrome in the Older Patient

Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.