Physiology Considerations in Geriatric Patients

We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.

We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, p = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, p = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, p = <0.004).

Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.

Open abdominal aortic aneurysm repair (OAR) is a major vascular procedure that incurs a large physiologic demand, increasing the risk for complications such as postoperative delirium (POD). We sought to characterize POD incidence, identify delirium risk factors, and evaluate the effect of delirium on postoperative outcomes. We hypothesized that POD following OAR would be associated with increased postoperative complications and resource utilization.

This was a retrospective study of all OAR cases from 2012 to 2020 at a single tertiary care center. POD was identified via a validated chart review method based on key words and Confusion Assessment Method assessments. The primary outcome was POD, and secondary outcomes included length of stay, non-home discharge, 90-day mortality, and 1-year survival. Bivariate analysis as appropriate to the data was used to assess the association of delirium with postoperative outcomes. Multivariable binary logistic regression was used to identify risk factors for POD and Cox regression for variables associated with worse 1-year survival.

Overall, 198 OAR cases were included, and POD developed in 34% (n = 67). Factors associated with POD included older age (74 vs 69 years; P < .01), frailty (50% vs 28%; P < .01), preoperative dementia (100% vs 32%; P < .01), symptomatic presentation (47% vs 27%; P < .01), preoperative coronary artery disease (44% vs 28%; P = .02), end-stage renal disease (89% vs 32%; P < .01) and Charlson Comorbidity Index score >4 (42% vs 26%; P = .01). POD was associated with 90-day mortality (19% vs 5%; P < .01), non-home discharge (61% vs 30%; P < .01), longer median hospital length of stay (14 vs 8 days; P < .01), longer median intensive care unit length of stay (6 vs 3 days; P < .01), postoperative myocardial infarction (7% vs 2%; P = .045), and postoperative pneumonia (19% vs 8%; P = .01). On multivariable analysis, risk factors for POD included older age, history of end-stage renal disease, lack of epidural, frailty, and symptomatic presentation. A Cox proportional hazards model revealed that POD was associated with worse survival at 1 year (hazard ratio, 3.8; 95% confidence interval, 1.6-9.0; P = .003).

POD is associated with worse postoperative outcomes and increased resource utilization. Future studies should examine the role of improved screening, implementation of delirium prevention bundles, and multidisciplinary care for the most vulnerable patients undergoing OAR.

Aging profoundly affects people's visual functions, and older persons generally show a declination of visual abilities. The indoor visual environment (IVE) in residential care homes (RCHs) is vital to ensure the visual-related physical health of older people (i.e., general vision, functional vision, visual acuity, physical discomfort, and injuries). The IVE, including opening design, interior design, and lighting conditions components, should be designed to satisfy older people's special visual needs. Hence, this study aims to investigate the effects of older people's subjective perceptions of the IVE on their visual-related physical health. In total, 197 questionnaires were collected from older persons living in RCHs. The integrated IVE–Visual-related Physical Health model was established based on multiple statistical methods for older residents in RCHs. The model revealed that the view out, window, corridors, furniture locations, curtains or louvers, handrails, and light level significantly affected the visual-related physical health of older people. Practical recommendations were proposed, including beds and seats near the windows with beautiful scenery, corridors with night lights and unblocked vision, automatic curtains with light sensors, handrails with a high color contrast with the background walls, minimum 200lx ambient lighting, etc. This study's findings provide valuable insight into enhancing the IVE in RCHs for older people's visual-related physical health.

Frailty increases the risk of disability, falls, cognitive decline, hospitalisation, dependency, and mortality in older adults. The study aimed to find out the prevalence and associated factors of frailty among the elderly using Field's physical constructs of frailty.

It was a hospital-based cross-sectional study, conducted in a tertiary care hospital in central Rajasthan, from May 2022 to October 2022. Data were collected from 288 participants. Categorical data were presented as proportion, and continuous data were presented as mean (SD). The Chi-square test and multivariate logistic regression were used to find out the association between frailty and other variables.

About one-third (32.3%) of participants were frail, 32.3% were pre-frail, and 35.4% were robust. In multivariate analysis, frailty was found more in the participants who were not in union than those who were in union (aOR = 3.62, p = 0.001). It was more in sedentary persons (aOR = 13.54, p < 0.01) and persons with some physical activity (aOR = 4.39, p = 0.003) than the persons with strenuous physical activity levels. The prevalence of frailty was also associated with morbidity (aOR = 5.84, p < 0.01); and with a history of falls (aOR = 2.67, p = 0.003).

Nearly one third elderly population is frail and one third is prefrail. The growing older population and the corresponding increase in the prevalence of frailty would have a significant negative impact on the already overburdened health services. Community-based interventions should be developed and incorporated to avert and mitigate the effects of frailty.

The population worldwide is rapidly ageing, and demand for intensive care is increasing. People aged 85 years and above, known as the oldest old, are particularly vulnerable to critical illness owing to the physiological effects of ageing. Evidence surrounding admission of the oldest old to the intensive care is limited.

The objective of this study was to systematically and comprehensively review and synthesise the published research investigating factors that influence decisions to admit the oldest old to the intensive care unit.

This was a systematic review and narrative synthesis. Following a comprehensive search of CINAHL, Embase, and Medline databases, peer-reviewed primary research articles examining factors associated with admission or refusal to admit the oldest old to intensive care were selected. Data were extracted into tables and narratively synthesised.

Six studies met the inclusion criteria. Three studies identified factors associated with admission such as greater premorbid self-sufficiency, patient preferences, alignment between patient and physicians’ goals of treatment, age less than 85 years, and absence of cancer, or previous intensive care admission. Factors associated with refusal to admit were identified in all six studies and included limited or no bed availability, level of ICU physician experience, patients being deemed too ill or too well to benefit, and older age.

Published research investigating decision-making about admission or refusal to admit the oldest old to the intensive care unit is scant. The ageing population and increasing demand for intensive care unit resources has amplified the need for greater understanding of factors that influence decisions to admit or refuse admission of the oldest old to the intensive care unit. Such knowledge may inform guidelines regarding complex practice decisions about admission of the oldest old to an intensive care unit. Such guidelines would ensure the specialty needs of this population are considered and would reduce admission decisions that might disadvantage older people.

We aimed to identify preoperative and intraoperative factors associated with serious postoperative outcomes, which may help patients and clinicians make better-informed decisions.

We conducted a retrospective study including all patients aged ≥90 years who underwent surgery between January 1, 2011, and January 1, 2021, at Chongqing University Central Hospital. We assessed 30 pre- and intraoperative demographic and clinical variables. Logistic regression was used to identify the independent risk factors for serious postoperative outcomes in patients aged ≥90 years.

A total of 428 patients were included in our analysis. The mean age was 92.6 years (SD ± 2.6). There were 240 (56.1%) females and 188 (43.9%) males. The most common comorbidities were hypertension (44.9%) and arrhythmias (34.8%). The 30-day hospital mortality was 5.6%, and severe morbidity was 33.2%. Based on the multivariate logistic regression classification analysis of the American Society of Anesthesiologists (ASA)≥ Ⅳ [odds ratio (OR), 5.39, 95% confidence interval (CI), 2.06–14.16, P = .001], emergency surgery (OR, 5.02, 95% CI, 2.85–15.98, P = .001) and chronic heart failure (OR, 6.11, 95% CI, 1.93–13.06, P = .001) were identified as independent risk factors for 30-day hospital mortality, and ASA≥ Ⅳ (OR, 4.56, 95%CI, 2.56–8.15, P < .001), Barthel index (BI) < 35 (OR, 2.28, 95%CI, 1.30–3.98, P = .001), chronic heart failure (OR, 3.67, 95%CI, 1.62–8.31, P = .002), chronic kidney disease (OR, 4.24, 95%CI, 1.99–9.05, P < .001), general anesthesia (OR, 3.31, 95%CI, 1.91–5.76, P < .001), emergency surgery (OR, 3.72, 95%CI, 1.98–6.99, P < .001), and major surgery (OR, 3.44, 95%CI, 1.90–6.22, P < .001) were identified as independent risk factors for serious postoperative complications.

Patients aged ≥90 years with ASA≥ Ⅳ, BI < 35, combined with chronic heart failure or chronic kidney disease, undergoing emergency surgery, major surgery or general anesthesia have a higher risk of serious postoperative outcomes. Identifying these risk factors in an early stage may contribute to our clinical decision-making and improve the quality of treatments.