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acute geriatric

Abdulkerim Yildiz, Ali Yigit, Ali Ramazan Benli
Background: The geriatric population in intensive care units (ICUs) has recently increased. The aim of this study was to analyse the impact of initial complete blood count (CBC)-related parameters and nutritional status on morbidity and mortality in geriatric ICU patients. Methods: A retrospective analysis was made of geriatric patients admitted to our tertiary adult ICU for 1 year. Patients with a length of stay (LOS) of < 48 h, with hematological malignancy or age < 65 years age were excluded from the study...
July 2018: Journal of Clinical Medicine Research
Olga Theou, Emma Squires, Kayla Mallery, Jacques S Lee, Sherri Fay, Judah Goldstein, Joshua J Armstrong, Kenneth Rockwood
BACKGROUND: The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. METHODS: This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors...
June 11, 2018: BMC Geriatrics
Jarlath C Bolger, Akif Zaidi, Adrian Fuentes-Bonachera, Michael E Kelly, Aqeel Abbas, Ailin Rogers, Tom McCormack, Brian Waldron, Kevin P Murray
AIM: The Western world has an expanding older population, who are living longer with increasing numbers of comorbidities. In addition, expectations of patients and relatives are increasing. As a general hospital operating in a rural setting, our University Hospital Kerry, Tralee, Ireland, deals with a significant number of emergency presentations to the acute surgical service. The aim of the present study was to examine outcomes for patients in the extremes of age who present requiring emergency surgical procedures...
June 13, 2018: Geriatrics & Gerontology International
Jesús Díez-Manglano, José-María Mostaza, Antonio Pose, Francesc Formiga, José-María Cepeda, Alejandra Gullón, Miguel Camafort, Jesús Castiella, Eduardo Rovira, Estíbaliz Jarauta, Carmen Suárez
AIM: To determine the factors associated with discontinuing or not starting oral anticoagulation (OA) therapy in older patients with non-valvular atrial fibrillation (NVAF). METHODS: A prospective, multicenter cohort study was carried out of patients aged >75 years with NVAF hospitalized in internal medicine departments in Spain. For each patient, we recorded creatinine, hemoglobin and platelets levels, as well as CHA2DS2-VASc and HAS-BLED scores and the Charlson Comorbidity Index...
June 13, 2018: Geriatrics & Gerontology International
P Koskas, C Pons-Peyneau, M Romdhani, N Houenou-Quenum, A Tigue-Wato, S Galleron, O Drunat
BACKGROUND: To avoid emergency hospitalisation of elderly people with dementia, which often has negative consequences, there are two main approaches: consultation and day care hospitalisation. However, it usually takes some time to arrange a consultation, and geriatric day hospital facilities are over-subscribed and costly. In 2014, we created a "consultation de crise" (CMC) programme in our sector of Paris, with several special features: a short wait for an appointment, a consultation involving an interdisciplinary team, a weekly multi-disciplinary meeting to reassess complex patients, and the possibility of a rapid referral to a social worker...
June 7, 2018: L'Encéphale
Tasuku Matsuyama, Sachiko Morita, Naoki Ehara, Nobuhiro Miyamae, Yohei Okada, Takaaki Jo, Yasuyuki Sumida, Nobunaga Okada, Makoto Watanabe, Masahiro Nozawa, Ayumu Tsuruoka, Yoshihiro Fujimoto, Yoshiki Okumura, Tetsuhisa Kitamura, Bon Ohta
BACKGROUND: Accidental hypothermia (AH) has higher incidence and mortality in geriatric populations. Japan has a rapidly ageing population, and little is known about the epidemiology of hypothermia in this country. METHODS: We created an AH registry based on retrospective review of patients visiting the ED of 12 institutions with temperature ≤35°C between April 2011 and March 2016. The severity of AH was classified as mild (≤35, ≥32°C), moderate (<32, ≥28°C) or severe (<28°C)...
June 9, 2018: Emergency Medicine Journal: EMJ
Avital Hershkovitz, Shai Brill, Lior Neuhaus Sulam, Tal Luria, Snir Heller
BACKGROUND: Various factors have been shown to affect rehabilitation outcome of hip fractured patients. The degree of extracapsular fracture stability may also affect functional recovery. The aim of our study was to assess the relationship between extracapsular hip fracture stability and rehabilitation outcome in a post-acute setting. METHODS: A retrospective cohort study of 144 hip fractured patients was carried out in a post-acute geriatric rehabilitation center from 1/2014 to 6/2015...
May 24, 2018: Injury
Giovanni Capobianco
Atrial fibrillation represents one of the most significant aging markers and its prevalence increases with age, reaching 11.1% in men and 9.1% in women aged over 85 years. Fragility is nowadays defined according to two different phenotypes: the biologic-physiologic phenotype developed by L. Fried and Baltimora School and the clinic-multidimensional phenotype, proposed by Rockwood and Halifax School. If the clinical characteristics of elder patients hospitalized in acute geriatric unit care are considered, differences appear in the clinical features, in co-morbidity, in therapy and prognosis...
June 7, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Abrar-Ahmad Zulfiqar, Paul Blazejczyk, Nadir Kadri, Jean Doucet
Digitalis remains a treatment that is difficult to manage, especially in the elderly. METHODS: A retrospective, unicentric study carried out within the unit of Internal medicine and geriatrics, Reims University Hospital Center, between January and June 2014. Collection of all patients hospitalized, after 75 years, receiving treatment with digitalis, either as soon as they enter (present on the usual prescription of the patient), during their hospitalization and on their exit. RESULTS: 20 patients were included...
June 1, 2018: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
Jui-Yuan Chung, Chien-Chin Hsu, Jiann-Hwa Chen, Wei-Lung Chen, Hung-Jung Lin, How-Ran Guo, Chien-Cheng Huang
BACKGROUND: The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue. METHODS: We conducted a retrospective case-control study, recruiting geriatric patients (≥ 65 years) with influenza visiting the ED of a medical center between January 01, 2010 and December 31, 2015...
May 29, 2018: American Journal of Emergency Medicine
Mario Bo, Paola Porrino, Simona G Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Angelo Bianchetti, Massimo Musicco, Alberto Ferrari, Nicola Ferrara, Claudia Filippini, Marco Trabucchi, Alessandro Morandi, Giuseppe Bellelli
BACKROUND: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. AIM: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. METHODS: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status...
June 1, 2018: Aging Clinical and Experimental Research
Elizabeth J Lilley, Katherine C Lee, John W Scott, Nicole J Krumrei, Adil H Haider, Ali Salim, Rajan Gupta, Zara Cooper
BACKGROUND: Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. METHODS: This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission...
May 30, 2018: Journal of Trauma and Acute Care Surgery
Chikul Mittal, Hsien Chieh Daniel Lee, Kiat Sern Goh, Cheng Kiang Adrian Lau, Leeanna Tay, Chuin Siau, Yik Hin Loh, Teck Kheng Edward Goh, Chit Lwin Sandi, Chien Earn Lee
BACKGROUND: To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. METHODS: The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program...
May 30, 2018: Journal of Orthopaedic Surgery and Research
C P Launay, A Kabeshova, A Lanoé, J Chabot, E J Levinoff, O Beauchet
BACKGROUND: With the rapid growth of elderly patients visiting the Emergency Department (ED), it is expected that there will be even more hospitalisations following ED visits in the future. The aim of this study was to examine the age effect on the performance criteria of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. METHODS: Based on an observational prospective cohort study, 1117 older patients (i...
May 30, 2018: BMC Geriatrics
Sergey Motov, Stefan Mann, Jefferson Drapkin, Mahlaqa Butt, Antonios Likourezos, Elizabeth Yetter, Jason Brady, Nechama Rothberger, Ankit Gohel, Peter Flom, Mo Mai, Christian Fromm, John Marshall
STUDY OBJECTIVE: We compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine (SDK) versus morphine in geriatric Emergency Department (ED) patients. METHODS: This was a prospective, randomized, double-blind trial evaluating ED patients aged 65 and older experiencing moderate to severe acute abdominal, flank, musculoskeletal, or malignant pain. Patients were randomized to receive SDK at 0.3 mg/kg or morphine at 0.1 mg/kg by short intravenous infusion over 15 min...
May 16, 2018: American Journal of Emergency Medicine
A Martín, O Ortega, M Roca, M Arús, P Clavé
BACKGROUND: Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population. OBJECTIVE: Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD. DESIGN AND PARTICIPANTS: An open label trial was performed on 186 hospitalized older patients (>70y) with OD; 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls...
2018: Journal of Nutrition, Health & Aging
Jennifer C Alyono
Vertigo and dizziness are common conditions among older adults. They are closely associated with fall risk and portend major implications for geriatric injury and disability. Management can be particularly challenging, because symptoms are often nonspecific and may reflect multiple etiologies. Chronic dizziness can reflect dysfunction in the vestibular, somatosensory, or visual systems or in their central integration. Systemic processes, such as postural hypotension, arrhythmias, heart failure, medication use, and lower extremity weakness or frailty, also contribute...
May 24, 2018: Otolaryngologic Clinics of North America
Hiroshi Yamamoto, Kenichi Ogawa, Henry Huaman Battifora, Kaori Yamamuro, Tatsuya Ishitake
BACKGROUND: Cognitive dysfunction due to delirium or dementia is a common finding in acutely ill geriatric patients, but often remains undetected. A brief and sensitive clinical identification method could prevent errors or complications while evaluating the mental status of elderly patients. AIMS: To evaluate the usefulness and clinical implications of the revised simplified short-term memory recall test (STMT-R) in geriatric patients admitted in the emergency department; with age, gender, dementia history, serum albumin, underlying diseases and clinical outcome used as comparative factors...
May 24, 2018: Aging Clinical and Experimental Research
Katrina A Booth, Emily E Simmons, Andres F Viles, Whitney A Gray, Kelsey R Kennedy, Shari H Biswal, Jason A Lowe, Anisa Xhaja, Richard E Kennedy, Cynthia J Brown, Kellie L Flood
The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms. Completion of the geriatric assessments by nursing staff in patients aged 65 years and older and measures of patient mobility and prevalence of an abnormal delirium screening score were compared preintervention and postintervention...
May 23, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Linda Shavit, Shuli Silberman, Rachel Tauber, Ofer Merin, Daniel Bitran, Daniel Fink
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a less invasive treatment modality for patients with severe aortic valve stenosis (AS) who are at a higher risk if they have surgery. Preoperative chronic kidney disease (CKD) influences outcomes of cardiac surgery and is associated with a higher mortality and more complicated hospital course. The aims of our study were to evaluate the comparative outcomes of TAVI versus surgical aortic valve replacement (SAVR) in geriatric patients with preoperative CKD...
May 24, 2018: Clinical Nephrology
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