European Geriatric Medicine最新文献

Purpose: Older patients with heart failure are vulnerable to hospitalization-associated disability (HAD). This study aimed to develop and validate a scoring system to predict the occurrence of HAD in these patients, enabling early risk assessment.

Methods: This study was a secondary analysis of the Japanese PT multicenter Registry of Older Frail patients with heart failure, a multicenter prospective cohort of heart failure patients aged 65 years and older. A predictive score for HAD was developed based on the beta coefficients of a logistic regression model in a development cohort. The score's performance was then evaluated in a validation cohort using C-statistics and calibration plots, comparing predicted probabilities with observed values.

Results: Based on the analysis of 9412 patients (median age 83 years, 49% female), a prediction scoring system (0-14 points) was developed. The final model included age, serum albumin, New York Heart Association class, preadmission functional independence, frailty, low muscle strength, and cognitive decline. The C-statistic was 0.69 (95% confidence interval [CI] 0.67-0.70, p < 0.001) in the development cohort and 0.69 (95% CI 0.67-0.70, p < 0.001) in the validation cohort. The incidence of HAD significantly increased with higher score groups: 54.0% (high score, ≥ 10), 38.7% (moderate score, 5-9), and 12.8% (low score, < 4) (p < 0.001).

Conclusions: A scoring system was developed to predict the occurrence of HAD in older patients with heart failure. This score can help identify high-risk patients early in hospitalization.

Purpose: Breast cancer incidence is increasing among older women, yet data on aggressive subtypes such as triple-negative and HER2-positive remain limited. This retrospective study aimed to evaluate the real-world management of these tumors, specifically examining whether chronological age, beyond comorbidity or anesthetic risk, is a determining factor in therapeutic decision-making.

Methods: A retrospective observational study was conducted, including women aged ≥70 years who underwent surgery for triple-negative or HER2-positive breast cancer between 2014 and 2024. Clinical, tumor, and treatment variables were collected. Comorbidity was assessed using the Charlson Comorbidity Index, and anesthetic risk by ASA classification. Undertreatment was defined as omission of NCCN-recommended therapies. Logistic regression analysis was used to identify independent predictors of therapeutic decisions.

Results: Among 129 patients aged ≥70 years, undertreatment was observed in 58.1%, reaching near-universal levels in those over 80 years. Chronological age emerged as the primary determinant of omission of sentinel lymph node biopsy, chemotherapy, anti-HER2 therapy, and radiotherapy, independent of comorbidity, anesthetic risk, or tumor stage.

Conclusion: This study underscores the disproportionate influence of chronological age on therapeutic decision-making in older women with triple-negative and HER2-positive breast cancer, reflecting entrenched ageism in oncological practice. Such bias contributes to undertreatment and undermines equity in cancer care for this high-risk population. Integrating geriatric assessment tools is essential to identify patients capable of tolerating guideline-concordant therapies and to support individualized, evidence-based treatment decisions.

Purpose: To analyze the clinical characteristics and risk factors associated with short-term multiple organ dysfunction (MODS) in older people suffering from wasp stings.

Methods: The study assessed the demographic, clinical, and laboratory data of patients aged > 65 years old suffering from wasp stings. The patients were categorized into the non-MODS and MODS groups based on the occurrence of MODS, and their clinical data were then compared. Logistic regression analysis was performed to determine the risk factors associated with the development of MODS in older people with wasp stings.

Results: A total of 118 patients with complete clinical data were assigned to two groups: non-MODS (n = 69) and MODS (n = 49). The mean age of the subjects was 68.3 ± 5.3 years, and the ratio of male/female was 54/64. Significant differences between the two groups were observed in age, pre-hospital time, and the proportion of patients receiving advanced life support therapy (p < 0.05). Acute kidney injury (AKI) was determined to be the most common complication, occurring in 20 (17.0%) patients overall (MODS vs. non-MODS: 32.7% vs.5.8%, p < 0.001), followed by acute respiratory distress syndrome (ARDS), which occurred in 18 (15.3%) patients (MODS vs. non-MODS: 30.6% vs. 4.3%, p < 0.001), with significant differences recorded between the groups. Logistic regression analysis indicated that advanced age, a greater number of stings, longer pre-hospital time, and the occurrence of AKI and ARDS acted as independent risk factors for MODS.

Conclusion: Older people stung by wasps have a high incidence of MODS. ARDS and AKI are the key complications associated with MODS. Clinicians should therefore use the following five indicators: age, number of stings, pre-hospital time, and the occurrence of AKI and ARDS to rapidly assess the risk and implement targeted intensive treatment focused on early respiratory support and active blood purification in high-risk older people for improving the prognosis.

Purpose: Ultrasound is a bedside assessment tool used in some medical specialties. Studies have used this modality for the assessment of the skeletal muscle in hospitalized older patients for whom functional tests and imaging assessment by magnetic resonance imaging and computed tomography are not feasible. This study aimed to investigate whether skeletal muscle thickness (MT) and echo intensity (EI) obtained via ultrasonography are parameters for detecting the risk of malnutrition and physical conditions in acutely hospitalized older patients.

Methods: Fifty-nine men and women (31 men, 28 women; 84.4 ± 5.7 years) hospitalized for acute care were included. B-mode ultrasonographic images were obtained within 1 week of admission. MT and EI were measured in the rectus femoris (RF), vastus lateralis (VL), and vastus intermedius (VI) muscles. We utilized the Mini Nutritional Assessment-Short Form (MNA-SF), handgrip strength, calf circumference, the Barthel Index (BI), instrumental activities of daily living (ADL) scale, and the clinical frailty scale (CFS) to determine malnutrition and physical conditions in the participants.

Results: Stepwise regression analysis showed that the MNA-SF, BI, IADL, handgrip strength, calf circumference, and CFS scores were explained by MT in the VL and EI in the VI and RF (adjusted R² = 0.13-0.29, P < 0.05). The receiver operating characteristic analysis revealed that the MT and EI detect malnutrition, decreased ADL, and lower handgrip strength (area under the curve was 0.19-0.76, P < 0.05).

Conclusion: These results suggest that the MT and EI in the quadriceps may reflect malnutrition risk and physical conditions in acutely hospitalized older patients.

Purpose: Ceilings of treatment, including do-not-resuscitate (DNR), do-not-intubate (DNI), or decisions to forgo intensive care unit (ICU) admission, are increasingly recognised in frail older adults, but evidence in hip fracture care is scarce. We aimed to (1) describe the prevalence and predictors of treatment ceilings, (2) evaluate associations with mortality and length of stay, and (3) assess the association of orthogeriatric care (OGC) with ceilings and outcomes.

Methods: This retrospective cohort study included 1,120 hip fracture patients admitted to Maastricht University Medical Centre + in 2017-2018 and 2021-2022. Treatment ceilings were classified as full (no limitations), limited (DNR, optional ICU/intubation), or completely limited (DNR/DNI/no ICU). Multinomial logistic regression identified predictors, and Cox models estimated associations with 1-year mortality.

Results: The median age of the patients was 82 years (IQR 74-87); 66% were female, while 14% lived in nursing homes. Overall, 50% had a limited or completely limited order. These were more common in patients with higher age, comorbidity, care dependency, higher ASA classification, and nursing home residency. Compared with full treatment, limited (aHR 2.44, 95% CI 1.66-3.58) and completely limited orders (aHR 3.79 95% CI 2.79-5.16) were independently associated with higher 1-year mortality. OGC was not linked to more ceilings, but was associated with lower 1-year mortality across all categories (aHR 0.69, 95% CI 0.54-0.87).

Conclusion: Half of hip fracture patients had a documented ceiling of treatment, strongly predicting mortality. OGC was associated with improved survival regardless of ceiling status, underscoring the need for geriatric integration and standardised definitions of treatment ceilings in hip fracture care.

Purpose: Reducing drug-related problems is a major challenge in older adults taking multiple medications. The IATROPREV program aims to improve prescribing appropriateness through multidisciplinary medication optimization, a personalized pharmaceutical plan (PPP), and direct, structured communication between hospital and community healthcare professionals. To analyze the medication optimizations generated by IATROPREV and validated by healthcare professionals through inclusion in PPPs. Potentially inappropriate medications (PIMs) were identified using the Anatomical Therapeutic Chemical (ATC) classification and the REview of potentially inappropriate MEDIcation pr(e)scribing in Seniors (REMEDI(e)S) criteria.

Methods: IATROPREV was a prospective, observational, multicenter study (2021-2024) conducted in two French university hospitals. It involved 504 patients admitted to geriatric units. Multidisciplinary meetings brought together geriatricians, attending physicians, hospital pharmacists, and community pharmacists. The patients' prescriptions before and after hospitalization were compared, and PIMs were screened using 73 REMEDI[e]S criteria.

Results: A total of 4977 prescriptions were analyzed. 38% of the recommendations involved discontinuations, 20% modifications, and 37% additions. 42% of prescriptions remained unchanged. Most optimizations targeted ATC classes A (alimentary tract and metabolism), C (the cardiovascular system), and N (the nervous system). Additions mainly involved class A drugs (e.g., laxatives, vitamins), while discontinuations frequently affected class C drugs (e.g., renin-angiotensin-aldosterone system inhibitors, lipid-lowering drugs). PIMs decreased from 1437 at inclusion to 936 at discharge (-35%), with variations across REMEDI[e]S criteria.

Conclusion: IATROPREV highlights the complexity of medication optimizations in geriatrics. Although the REMEDI[e]S criteria enable partial assessment, they do not fully capture all clinically relevant adjustments made through the program.

Purpose: To explore the prevalence, overall and in different clinical settings, and interconnectedness, of delirium, dementia, and frailty clinical pathways across Europe.

Methods: An online anonymous survey was distributed via the mailing list of the European Geriatric Medicine Society (EuGMS), national member groups and the authors' professional networks, targeting geriatricians, or trainees in their final 2 years of specialist geriatric training, working in a hospital, rehabilitation, post-acute care or residential setting in a European country. Quantitative data were summarized using descriptive statistics and frequency distributions. Inductive content analysis was used to interpret open-text questions.

Results: The 240 respondents were predominantly female (63%), with a 6:1 consultant to trainee ratio and marked underrepresentation of Eastern Europe. Integrated care pathways (current or in-development) for delirium, dementia, or frailty are reported in 48-78% of settings. Dementia and delirium pathways are common except in radiology, neurosurgery, and operating/recovery settings. Frailty pathways are less common overall, and specific frailty staff are less common than dementia or delirium staff. Dementia pathways commonly incorporate delirium screening (76%) and prevention (73%), but less commonly frailty screening (61%). Similarly, delirium pathways often provide guidance on formal dementia diagnosis (62%) but less than half incorporate frailty screening/assessment (46%). Notably, only 19% of delirium pathways differentiate between managing delirium and delirium-superimposed-on-dementia (DSD). Frailty pathways frequently incorporate cognitive assessment (81%) and delirium screening/assessment (75%), but only 57% incorporate delirium prevention.

Conclusion: Dementia and delirium pathways are more common and more integrated and inclusive of each other than frailty pathways. More unified approaches could maximize the value of staff time, reduce duplications, and avoid a siloed approach to the care of older people.

Purpose: To examine whether lower medication adherence in individuals without documented dementia or cognitive impairment (DCI) is associated with subsequent clinically recognized DCI.

Methods: Retrospective cohort analysis that included veterans aged ≥ 65 years, without documented DCI at baseline, without past or current prescription for DCI medications, with ≥ 1 annual Veterans Affairs (VA) primary care visit, and with an ongoing VA prescription for any of the one or more of the following during a 3-year assessment period: lisinopril, metoprolol, omeprazole, or simvastatin. Adherence was estimated for each medication using proportion of days covered (PDC) and, secondarily, using medication possession ratio (MPR), with < 0.8 classified as low adherence. Incident DCI was determined via ICD-9/ICD-10 diagnosis codes.

Results: Analyses included 794,569 unique veterans, separated in 4 medication cohorts (mean ages ranged from 75.6 [7.2] to 76.5 [7.2]), % male range was 98.2-98.6%). Between 16-21% of participants were categorized with low medication adherence by PDC. Over a 10-year follow-up period, incident DCI ranged from 17-18% in the low adherence group and 14-15% in the high adherence group. After multivariate adjustment, hazard for incident DCI in users of each of the four medications was significantly increased, about 20% greater among individuals with low adherence compared to those with high adherence.

Conclusion: Among veterans without clinically recognized DCI, lower baseline medication adherence was associated with an increased risk for future clinically recognized DCI. Further studies should seek to disentangle whether low adherence is a risk factor for future DCI or an indicator of existing but not yet recognized DCI and whether this can inform clinical practice decisions.

Purpose: Dementia with Lewy bodies (DLB) is a common neurodegenerative disorder, yet difficult to diagnose. Carefully selected research cohorts may not represent the clinical reality. We aimed to characterize a naturalistic cohort of patients with clinical features of DLB, reporting their final diagnosis, clinical features, and cognitive profile.

Methods: Patients were recruited from a specialized cognitive clinic. Data from patient visits such as core clinical features, biomarkers, cognitive screening, and neuropsychological assessment were collected from health records. We used normative data to assess distribution of impairment in patients with DLB and Parkinson's disease (PD) with and without dementia.

Results: A total of 143 patients were included in the cohort. Following specialized dementia evaluation, 88 patients fulfilled clinical criteria for DLB, 35 patients for PD with dementia (PDD), 14 had mild cognitive impairment (MCI), and the remaining 6 patients had other types of dementia. Parkinsonism was the most common core clinical feature (87%), followed by visual hallucinations (65%), cognitive fluctuations (52%) and, lastly, probable REM sleep behavior disorder (RBD, 47%). A majority of DLB patients had cognitive impairment on visuospatial constructive, attentional and executive tasks, and visual memory.

Conclusions: The differential diagnosis of DLB may be difficult within a clinical context because other cognitive disorders frequently present with core features of DLB. The cognitive profile and frequency of core clinical features in the DLB group were generally in line with previous reports. Probable RBD was lower than in other cohorts, which may reflect challenges in collecting this information in a clinical interview.