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Managing End of Life Needs of Frail, Older Adults in the Community: The Role of a Hospital-Based Community Outreach Team 管理社区中体弱老年人的临终需求:医院社区外联团队的作用
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.281
Megan Alcock, Mary Hayes, Catherine O'Sullivan, Kieran O'Connor
Background Our current healthcare systems are designed around periods of acute illness and are ill equipped to meet the needs of multimorbid and frail adults with worsening mobility, cognition and function. According to The Irish Longitudinal Study on Aging (TILDA), Ireland has a high proportion of hospital deaths, indicating inadequate community and home care supports. Recognizing patients who are likely to benefit from supportive and palliative approaches with a goal to die at home can be done using a combination of tools and based on advanced care planning discussions. Methods In 2021, our Department for Older Persons Services allocated a team consisting of a Registrar and Advanced Nurse Practitioner in Frailty to form an outreach service. Inpatients who appear nearing end of life who have expressed wishes to avoid further hospitalization and to die at home are identified during their admission. Home visits allow for a holistic assessment and family members are given the opportunity to ask questions. We provide education on end of life, trying to anticipate needs and often see patients and families through periods of deterioration until they stabilize again in a ‘new normal’ or begin the process of active dying. We communicate with Public Health Nurses, General Practitioners and the Community Palliative Care Team. Results Families and carers supporting loved ones who wish to avoid further hospitalization and die at home benefit from combined medical and nursing support & specialist expertise the team brings. Conclusion Addressing end of life for multimorbid patients living with severe frailty is a global challenge. Hospital admission is an ideal time to begin conversations regarding goals of care and initiate advanced care planning. The outreach team work together with hospital and community colleagues to the common goal of following patients’ wishes at end of life.
背景 我们目前的医疗保健系统是围绕急性病时期设计的,无法满足行动能力、认知能力和功能不断恶化的多病和体弱成年人的需求。根据爱尔兰老龄化纵向研究(TILDA),爱尔兰的住院死亡比例很高,这表明社区和家庭护理支持不足。要识别哪些患者有可能受益于支持性和姑息治疗方法,并以在家中去世为目标,可以综合使用多种工具,并根据晚期护理规划讨论结果来进行。方法 2021 年,我们的老年人服务部指派了一个由一名注册医师和体弱高级执业护师组成的团队,负责提供外展服务。住院病人在入院时,如果表示希望避免继续住院并在家中去世,就会被识别出来。通过家访可以进行全面评估,家属也有机会提出问题。我们提供有关生命末期的教育,努力预测需求,并经常看望病情恶化的病人和家属,直到他们的病情再次稳定在 "新常态 "或开始积极的死亡过程。我们与公共卫生护士、全科医生和社区姑息关怀团队进行沟通。结果 支持希望避免进一步住院治疗并在家中逝世的亲人的家庭和照护者受益于联合医疗和护理支持以及团队带来的专业知识。结论 解决严重虚弱的多病症患者的生命终结问题是一项全球性挑战。入院是开始讨论护理目标和启动晚期护理计划的理想时机。外展团队与医院和社区同事通力合作,以实现遵从患者临终意愿的共同目标。
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引用次数: 0
Improving Advanced Care Planning: Documentation of DNA CPR Orders and TEPs in Residential Care Admissions 改进预先护理计划:住院护理中 DNA CPR 命令和 TEP 的记录
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.278
Eleanor Marks, Sophie Buckley, Orlaith O'Connell, Claire O'Brien, Mary Buckley
Background Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation. Methods We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer. Results We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient. Conclusion These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.
背景 不要尝试心肺复苏(DNA CPR)指令和治疗升级计划(TEP)是管理进展性局限生命疾病和严重虚弱患者的高级护理计划的关键组成部分。我们的研究旨在确定从住院护理机构转来的此类患者中在入院时有治疗升级计划记录的比例,检查这些治疗升级计划是否在住院期间进行了修订,并评估患者入院后 14 天的治疗效果。方法 我们查阅了一个月内经急诊科转诊入院的患者名单,并确定了从安老院转来的患者。我们排除了 65 岁以下的患者。我们查阅了相关医疗记录,并在一台受密码保护的电脑上将匿名数据收集到 Excel 电子表格中。结果 我们确定了 34 名相关患者。有 31 个病例(17 名男性;年龄在 66 岁至 96 岁之间,平均年龄为 82.3 岁)的病历可供查阅。在审查的 31 个病例中,平均临床虚弱评分为 7.4。在 19/31 个病例中,寄宿护理机构发送了概述 "技术性治疗方案 "的文件。在这些病例中,4/19 的病例规定了全面复苏。其中 3/4 的病例在入院时修改了 TEP。有 1 例患者在文件中明确表示在任何情况下都不希望转院。共有 14 名患者没有 TEP 相关文件。其中,7/14 的患者在入院时填写了 DNA CPR 命令。入院 14 天后,7 名患者在医院死亡,16 名患者出院返回其居住的护理机构,其余患者仍在住院治疗。结论 这些研究结果表明,有必要制定更好的预先护理计划,从而改善患者管理,并在关键时刻减轻患者、医疗服务提供者和家属的精神负担。
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引用次数: 0
Engaging with First Line Nutrition Information - Insights from Health Care Professionals and Older Persons 接触第一线营养信息--来自医疗保健专业人员和老年人的见解
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.117
Lorna King, Catherine Devaney, Karen Sayers, Christina Donnellan
Background Health care professionals (HCPs) working with older persons are often asked nutrition related questions. This study explored how first line nutrition information such as general leaflets are accessed and used by HCPs and older persons. Is there a role for video-based nutrition education? Methods HCPs working with older persons completed an online survey. An older person’s reference group participated in a virtual focus group. Participants were asked about knowledge seeking, accessing and providing nutrition information, and engaging with videos on nutrition topics. Results were analysed using descriptive statistics and thematic analysis. Results Ninety five HCPs completed the survey (44% Nursing, 27% Physiotherapy, 14% Occupational Therapy, 6% Speech & Language Therapy and 9% other (doctors, social worker, pharmacist and care needs facilitator).Eighty-eight (90%) HCPs reported being asked nutrition related questions, topics included poor appetite (n=77, 83%), weight loss (n=68, 75%) and constipation (n=66, 72%).Twenty HCPs (21%) reported confidence answering questions, while 28 (29%) reported low confidence. Forty-three (44%) had little or no awareness of available first line information and 37 (39%) rarely or never provided information. Eighty-two (86%) HCPs agreed that nutrition education videos would be used if available. Three themes emerged from the HCPs survey: (i) importance of nutrition for HCPs (ii) barriers to use of first line information and (iii) support systems. Fourteen persons (64% women, 36% men) attended the focus group. Two themes were identified: (i) access to health information and (ii) barriers to access. Discussions included difficulty in proactively seeking information, joined up sharing and that education videos would be beneficial, but the distribution needed consideration. Conclusion Timely access to information is empowering for the older person. HCPs were identified as a resource for seeking nutrition advice. The communication of and access to nutrition information merits consideration. Following these findings, nutrition videos are currently being developed.
背景 与老年人打交道的医疗保健专业人员(HCPs)经常会被问到与营养有关的问题。本研究探讨了医护人员和老年人如何获取和使用普通传单等一线营养信息。视频营养教育是否可以发挥作用?方法 为老年人服务的保健医生完成了一项在线调查。一个老年人参考小组参加了一个虚拟焦点小组。调查询问了参与者有关知识寻求、获取和提供营养信息以及观看营养主题视频的情况。调查结果采用描述性统计和主题分析法进行分析。结果 95 名保健专业人员完成了调查(44% 护理人员、27% 物理治疗人员、14% 职业治疗人员、6% 言语治疗人员和 9% 其他人员(医生、社工、药剂师和护理需求促进人员))。88 名保健专业人员(90%)表示曾被问及与营养相关的问题,主题包括食欲不振(人数=77,83%)、体重减轻(人数=68,75%)和便秘(人数=66,72%)。43人(44%)对可用的一线信息知之甚少或一无所知,37人(39%)很少或从未提供过信息。82(86%)名保健医生同意在有营养教育视频的情况下使用。在对保健医生的调查中发现了三个主题:(i) 营养对保健医生的重要性;(ii) 使用一线信息的障碍;(iii) 支持系统。14 人(64% 为女性,36% 为男性)参加了焦点小组。确定了两个主题(i) 获取健康信息;(ii) 获取信息的障碍。讨论内容包括主动寻求信息的困难、联合共享以及教育视频的好处,但需要考虑视频的分发问题。结论 及时获取信息对老年人来说是一种能力。保健医生被认为是寻求营养建议的资源。营养信息的传播和获取值得考虑。根据这些发现,目前正在制作营养视频。
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引用次数: 0
Shared decision-making with older people on TReatment Escalation planning for Acute deterioration in the emergency Medical Setting: a qualitative study of Clinicians’ perspectives (STREAMS-C) 与老年人共同决策急诊医疗环境中急性病情恶化的治疗升级计划:临床医生观点的定性研究(STREAMS-C)
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-26 DOI: 10.1093/ageing/afae204
Bronwen E Warner, Mary Wells, Cecilia Vindrola-Padros, Stephen J Brett
Background Shared decision-making (SDM) is increasingly expected in healthcare systems prioritising patient autonomy. Treatment escalation plans (TEPs) outline contingency for medical intervention in the event of patient deterioration. This study aimed to understand clinicians’ perspectives on SDM in TEP for older patients in the acute medical setting. Methods This was a qualitative study following a constructivist approach. Semistructured interviews with vignettes were conducted with 26 consultant and registrar doctors working in emergency medicine, general internal medicine, intensive care medicine and palliative care medicine. Reflexive thematic analysis was performed. Results There were three themes: ‘An unequal partnership’, ‘Options without equipoise’ and ‘Decisions with shared understanding’. Clinicians’ expertise in synthesising complex, uncertain clinical information was contrasted with perceived patient unfamiliarity with future health planning and medical intervention. There was a strong sense of morality underpinning decision-making and little equipoise about appropriate TEP decisions. Communication around the TEP was important, and clinicians sought control over the high-stakes decision whilst avoiding conflict and achieving shared understanding. Conclusions Clinicians take responsibility for securing a ‘good’ TEP decision for older patients in the acute medical setting. They synthesise clinical data with implicit ethical reasoning according to their professional predictions of qualitative and quantitative success following medical intervention. SDM is seldom considered a priority for this context. Nonetheless, avoidance of conflict, preserving the clinical relationship and shared understanding with the patient and family are important.
背景 在优先考虑患者自主权的医疗系统中,人们越来越期待共同决策(SDM)。治疗升级计划(TEP)概述了患者病情恶化时医疗干预的应急措施。本研究旨在了解临床医生对急诊科老年患者治疗升级计划中 SDM 的看法。方法 这是一项采用建构主义方法进行的定性研究。研究人员对 26 名从事急诊医学、普通内科、重症监护医学和姑息治疗医学的顾问医生和注册医生进行了小故事半结构化访谈。进行了反思性主题分析。结果 有三个主题:"不平等的合作关系"、"不平等的选择 "和 "共同理解的决定"。临床医生在综合复杂、不确定的临床信息方面的专业知识与病人对未来健康规划和医疗干预的不熟悉形成了鲜明对比。决策过程中的道德感很强,而对于适当的《治疗方案》决策则几乎没有共识。围绕治疗前计划的沟通非常重要,临床医生在避免冲突和达成共识的同时,也在寻求对这一利害攸关的决策的控制。结论 临床医生有责任在急诊医疗环境中为老年患者做出 "好的 "TEP 决定。他们根据自己对医疗干预后定性和定量成功率的专业预测,综合临床数据和隐含的伦理推理。在这种情况下,SDM 很少被视为优先事项。尽管如此,避免冲突、维护临床关系以及与患者和家属达成共识都非常重要。
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引用次数: 0
Why the UK is vaccinating its older adult population against RSV—what geriatricians should know 为什么英国要为老年人群接种 RSV 疫苗--老年病学专家应该知道的事
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-24 DOI: 10.1093/ageing/afae202
Johnny Naylor, Antonia Ho, Roy L Soiza
The UK is launching a new free vaccination programme against respiratory syncytial virus (RSV) in adults aged 75 or over. This follows the development of safe and effective vaccines against RSV and the growing realisation of the burden of RSV-related disease in older adults—estimated at circa 8000 deaths and 175 000 GP episodes every year in the UK. It is likely that the full burden of RSV-related illness is under-appreciated and under-reported due to a lack of testing and awareness of its dangers in older adults. Healthcare professionals working with older people should be aware of the evidence base and be in a position to advise patients on the risks and benefits of vaccination and nonvaccination. We briefly review the evidence for the safety and effectiveness of the two licensed vaccines against RSV with a special focus on what geriatricians and others working with frailer, older people need to know.
英国正在为 75 岁或以上的成年人启动一项新的免费呼吸道合胞病毒 (RSV) 疫苗接种计划。在此之前,英国已开发出安全有效的 RSV 疫苗,而且人们日益认识到老年人与 RSV 相关疾病的负担--据估计,英国每年约有 8000 人死亡,175000 人次在全科医生处就诊。由于缺乏对老年人 RSV 危险的检测和认识,与 RSV 相关疾病的全部负担很可能未得到充分重视和报告。为老年人提供服务的医疗保健专业人员应该了解证据基础,并能够就接种和不接种疫苗的风险和益处向患者提供建议。我们简要回顾了两种获得许可的 RSV 疫苗的安全性和有效性证据,并特别强调了老年病学家和其他从事体弱老年人工作的人员需要了解的内容。
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引用次数: 0
Amyotrophic lateral sclerosis as a disease model of sarcopenia 肌萎缩性脊髓侧索硬化症作为肌少症的疾病模型
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-23 DOI: 10.1093/ageing/afae209
Domenico Azzolino, Rachele Piras, Aida Zulueta, Tiziano Lucchi, Christian Lunetta
Sarcopenia, the progressive decline of muscle mass and function, has traditionally been viewed as an age-related process leading to a broad range of adverse outcomes. However, it has been widely reported that sarcopenia can occur earlier in life in association with various conditions (i.e. disease-related sarcopenia), including neuromuscular disorders. As early as 2010, the European Working Group on Sarcopenia in Older People included neurodegenerative diseases characterised by motor neuron loss among the mechanisms underlying sarcopenia. Despite some differences in pathogenetic mechanisms, both amyotrophic lateral sclerosis (ALS) and age-related sarcopenia share common characteristics, such as the loss of motor units and muscle fibre atrophy, oxidative stress, mitochondrial dysfunction and inflammation. The histology of older muscle shows fibre size heterogeneity, fibre grouping and a loss of satellite cells, similar to what is observed in ALS patients. Regrettably, the sarcopenic process in ALS patients has been largely overlooked, and literature on the condition in this patient group is very scarce. Some instruments used for the assessment of sarcopenia in older people could also be applied to ALS patients. At this time, there is no approved specific pharmacological treatment to reverse damage to motor neurons or cure ALS, just as there is none for sarcopenia. However, some agents targeting the muscle, like myostatin and mammalian target of rapamycin inhibitors, are under investigation both in the sarcopenia and ALS context. The development of new therapeutic agents targeting the skeletal muscle may indeed be beneficial to both ALS patients and older people with sarcopenia.
肌肉疏松症是指肌肉质量和功能的逐渐下降,传统上被认为是一种与年龄相关的过程,会导致一系列不良后果。然而,有广泛报道称,肌肉疏松症可能在生命早期因各种疾病(即与疾病相关的肌肉疏松症)而发生,其中包括神经肌肉疾病。早在 2010 年,欧洲老年人肌肉疏松症工作组就将以运动神经元缺失为特征的神经退行性疾病纳入了肌肉疏松症的发病机制。肌萎缩性脊髓侧索硬化症(ALS)和老年性肌肉疏松症尽管在发病机制上存在一些差异,但两者都有共同的特点,如运动单位丧失、肌肉纤维萎缩、氧化应激、线粒体功能障碍和炎症。老年肌肉的组织学表现为纤维大小不均、纤维分组和卫星细胞丧失,这与渐冻症患者的情况类似。遗憾的是,肌萎缩性脊髓侧索硬化症患者的肌肉松弛过程在很大程度上被忽视了,有关该患者群体肌肉松弛状况的文献也非常稀少。一些用于评估老年人肌肉疏松症的工具也可用于 ALS 患者。目前,还没有获得批准的特效药物可以逆转运动神经元的损伤或治愈 ALS,就像没有药物可以治疗肌肉疏松症一样。不过,一些针对肌肉的药物,如肌生长抑素和哺乳动物雷帕霉素靶点抑制剂,正在针对肌肉疏松症和渐进性脊髓侧索硬化症进行研究。开发以骨骼肌为靶点的新治疗药物,可能对渐冻症患者和患有肌肉疏松症的老年人都有好处。
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引用次数: 0
The risk of geriatric syndromes in older COVID-19 survivors among the nonvaccinated population: a real world retrospective cohort study 未接种疫苗人群中 COVID-19 老年幸存者患老年综合征的风险:一项真实世界的回顾性队列研究
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-23 DOI: 10.1093/ageing/afae205
Chien-Chou Su, Yi-Ching Yang, Yu-Huai Yu, Yu-Hsuan Tsai, Deng-Chi Yang
Background We aimed to analyse the differences in the risk of geriatric syndromes between older adults with and without coronavirus disease 2019 (COVID-19). Methods We conducted a retrospective cohort study of patients from the US Collaborative Network in the TriNetX between January 1, 2020, and December 31, 2022. We included individuals aged older than 65 years with at least 2 health care visits who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) tests during the study period. We excluded those with SARS-CoV-2 vaccination, diagnosis with neoplasm and geriatric syndromes before the index date, and death within 30 days after the index date. The index date was defined as the first date of the PCR test for SARS-CoV-2 during the study period. Hazard ratios (HRs) and 95% confidence intervals (CIs) for eight geriatric syndromes were estimated for propensity score-matched older adults with and without COVID-19. Subgroup analyses of sex and age were also performed. Results After propensity score matching, 315 826 patients were included (mean [standard deviation] age, 73.5 [6.4] years; 46.7% males and 51.7% females). The three greatest relative increases in the risk of geriatric syndromes in the COVID-19 cohort were cognitive impairment (HR: 3.13; 95% CI: 2.96–3.31), depressive disorder (HR: 2.72; 95% CI: 2.62–2.82) and pressure injury (HR: 2.52; 95% CI: 2.34–2.71). Conclusions The risk of developing geriatric syndromes is much higher in the COVID-19 cohort. It is imperative that clinicians endeavour to prevent or minimise the development of these syndromes in the post-COVID-19 era.
背景 我们旨在分析患有和未患有 2019 年冠状病毒病(COVID-19)的老年人患老年综合征的风险差异。方法 我们对 2020 年 1 月 1 日至 2022 年 12 月 31 日期间来自 TriNetX 美国协作网络的患者进行了一项回顾性队列研究。我们纳入了在研究期间接受过至少 2 次严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)聚合酶链反应 (PCR) 检测的 65 岁以上患者。我们排除了接种过 SARS-CoV-2 疫苗、在指标日期前确诊患有肿瘤和老年综合症以及在指标日期后 30 天内死亡的人员。指标日期定义为研究期间首次进行 SARS-CoV-2 PCR 检测的日期。对患有和未患有 COVID-19 的倾向得分匹配的老年人进行了八种老年综合征的危险比(HRs)和 95% 置信区间(CIs)估算。同时还对性别和年龄进行了分组分析。结果 经过倾向评分匹配后,共纳入 315 826 名患者(平均 [标准差] 年龄为 73.5 [6.4] 岁;46.7% 为男性,51.7% 为女性)。在COVID-19队列中,认知障碍(HR:3.13;95% CI:2.96-3.31)、抑郁障碍(HR:2.72;95% CI:2.62-2.82)和压力损伤(HR:2.52;95% CI:2.34-2.71)是老年综合征风险相对增加最大的三种疾病。结论 COVID-19 组群中出现老年综合症的风险要高得多。在后 COVID-19 时代,临床医生必须努力预防或尽量减少这些综合症的发生。
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引用次数: 0
Preoperative clinical characteristics and 12-month outcomes following operative or non-operative management of asymptomatic aortic aneurysms 无症状主动脉瘤手术或非手术治疗后的术前临床特征和 12 个月疗效
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-21 DOI: 10.1093/ageing/afae193
Phoebe Scarfield, Amy R Sharkey, Jugdeep K Dhesi, Bijan Modarai, Mark R Tyrrell, Judith S L Partridge
Design An observational cohort study conducted at a tertiary referral center for aortic surgery to describe the medical and surgical characteristics of patients assessed for abdominal aortic aneurysm repair and examine associations with 12-month outcome. Methods Patients with aortic aneurysms referred for discussion at the aortic multidisciplinary meeting (MDM). Data were collected via a prospectively maintained clinical database and included aneurysm characteristics, patient demographics, co-morbidities, geriatric syndromes, including frailty, management decision and 12-month mortality, both aneurysm-related and all-cause including cause of death. The operative and non-operative groups were compared statistically. Results 621 patients referred to aortic MDM; 292 patients listed for operative management, 141 patients continued on surveillance, 138 patients for non-operative management. There was a higher 12-month mortality rate in the non-operative group compared to the operative group (41% vs 7%, P = <0.001). In the non-operative group, 16 patients (29%) died of aneurysm rupture within 12 months, with 39 patients (71%) dying from other medical causes. Non-operatively managed patients were older, more likely to have cardiac and respiratory disease and more likely to be living with frailty, cognitive impairment and functional limitation, compared to the operative group. Conclusion This study shows that preoperative geriatric syndromes and increased comorbidity lead to shared decision to non-operatively manage asymptomatic aortic aneurysms. Twelve-month mortality is higher in the non-operative group with the majority of deaths occurring due to cause other than aneurysm rupture. These findings support the need for preoperative comprehensive geriatric assessment followed by multispecialty discussion and shared decision making.
设计 在一家三级主动脉手术转诊中心进行的一项观察性队列研究,旨在描述接受腹主动脉瘤修复术评估的患者的内外科特征,并研究其与 12 个月预后的关系。方法 转诊至主动脉多学科会议(MDM)讨论的主动脉瘤患者。数据通过前瞻性维护的临床数据库收集,包括动脉瘤特征、患者人口统计学特征、合并疾病、老年综合症(包括体弱)、管理决策和 12 个月死亡率(动脉瘤相关死亡率和全因死亡率,包括死因)。对手术组和非手术组进行统计比较。结果 621 名患者转诊至主动脉 MDM;292 名患者被列入手术治疗名单,141 名患者继续接受监护,138 名患者接受非手术治疗。与手术组相比,非手术组的 12 个月死亡率更高(41% vs 7%,P = <0.001)。在非手术组中,16 名患者(29%)在 12 个月内死于动脉瘤破裂,39 名患者(71%)死于其他医疗原因。与手术组相比,非手术治疗的患者年龄更大,更有可能患有心脏和呼吸系统疾病,更有可能体弱多病、认知障碍和功能受限。结论 本研究表明,术前老年综合征和合并症的增加导致共同决定对无症状主动脉瘤进行非手术治疗。非手术组 12 个月的死亡率较高,其中大部分死亡是由于动脉瘤破裂以外的原因。这些研究结果表明,有必要在术前进行全面的老年病学评估,然后进行多专科讨论并共同做出决定。
{"title":"Preoperative clinical characteristics and 12-month outcomes following operative or non-operative management of asymptomatic aortic aneurysms","authors":"Phoebe Scarfield, Amy R Sharkey, Jugdeep K Dhesi, Bijan Modarai, Mark R Tyrrell, Judith S L Partridge","doi":"10.1093/ageing/afae193","DOIUrl":"https://doi.org/10.1093/ageing/afae193","url":null,"abstract":"Design An observational cohort study conducted at a tertiary referral center for aortic surgery to describe the medical and surgical characteristics of patients assessed for abdominal aortic aneurysm repair and examine associations with 12-month outcome. Methods Patients with aortic aneurysms referred for discussion at the aortic multidisciplinary meeting (MDM). Data were collected via a prospectively maintained clinical database and included aneurysm characteristics, patient demographics, co-morbidities, geriatric syndromes, including frailty, management decision and 12-month mortality, both aneurysm-related and all-cause including cause of death. The operative and non-operative groups were compared statistically. Results 621 patients referred to aortic MDM; 292 patients listed for operative management, 141 patients continued on surveillance, 138 patients for non-operative management. There was a higher 12-month mortality rate in the non-operative group compared to the operative group (41% vs 7%, P = <0.001). In the non-operative group, 16 patients (29%) died of aneurysm rupture within 12 months, with 39 patients (71%) dying from other medical causes. Non-operatively managed patients were older, more likely to have cardiac and respiratory disease and more likely to be living with frailty, cognitive impairment and functional limitation, compared to the operative group. Conclusion This study shows that preoperative geriatric syndromes and increased comorbidity lead to shared decision to non-operatively manage asymptomatic aortic aneurysms. Twelve-month mortality is higher in the non-operative group with the majority of deaths occurring due to cause other than aneurysm rupture. These findings support the need for preoperative comprehensive geriatric assessment followed by multispecialty discussion and shared decision making.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"23 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between dizziness and future falls and fall-related injuries in older adults: a systematic review and meta-analysis 老年人头晕与未来跌倒及跌倒相关伤害之间的关系:系统回顾与荟萃分析
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-19 DOI: 10.1093/ageing/afae177
Yuxiao Li, Rebecca M Smith, Susan L Whitney, Barry M Seemungal, Toby J Ellmers
Background Dizziness is common in older adults, especially in those attending falls services. Yet, the extent to which dizziness is associated with future falls has not been reviewed. This systematic review and meta-analysis assessed the association between dizziness and future falls and related injuries in older adults. Methods EMBASE, CINAHL Plus, SCOPUS and PsycINFO databases were searched from inception to 5 February 2024. The review was registered on PROSPERO (registration ID: CRD42022371839). Meta-analyses were conducted for the associations of dizziness with future falls (including recurrent and injurious falls). Three meta-analyses were performed on different outcomes: any-type falls (≥1 falls), recurrent falls (≥2 falls) and injurious falls. Results Twenty-nine articles were included in the systematic review (N = 103 306 participants). In a meta-analysis of 14 articles (N = 46 795 participants), dizziness was associated with significantly higher odds of any-type future falls (OR = 1.63, 95% CI = 1.44–1.84). In another meta-analysis involving seven articles (N = 5630 participants), individuals with dizziness also had significantly higher odds of future recurrent falls (OR = 1.98, 95% CI = 1.62–2.42). For both meta-analyses, significant overall associations were observed even when adjusted for important confounding variables. In contrast, a meta-analysis (three articles, N = 46 631 participants) revealed a lack of significant association between dizziness and future injurious falls (OR = 1.12, 95% CI = 0.87–1.45). Conclusions Dizziness is an independent predictor of future falls in older adults. These findings emphasise the importance of recognising dizziness as a risk factor for falls and implementing appropriate interventions.
背景头晕在老年人中很常见,尤其是在接受跌倒服务的老年人中。然而,头晕与未来跌倒的关联程度尚未得到研究。本系统综述和荟萃分析评估了老年人头晕与未来跌倒及相关伤害之间的关系。方法 对 EMBASE、CINAHL Plus、SCOPUS 和 PsycINFO 数据库进行了检索,检索时间从开始到 2024 年 2 月 5 日。该综述已在 PROSPERO 上注册(注册编号:CRD42022371839)。针对头晕与未来跌倒(包括复发性和伤害性跌倒)的相关性进行了荟萃分析。针对不同结果进行了三项荟萃分析:任何类型跌倒(≥1次跌倒)、复发性跌倒(≥2次跌倒)和伤害性跌倒。结果 29 篇文章被纳入系统综述(N = 103 306 名参与者)。在对 14 篇文章(样本数 = 46 795 名参与者)进行的荟萃分析中,头晕与未来发生任何类型跌倒的几率明显较高(OR = 1.63,95% CI = 1.44-1.84)。在另一项涉及 7 篇文章(N = 5630 名参与者)的荟萃分析中,头晕患者未来再次跌倒的几率也明显更高(OR = 1.98,95% CI = 1.62-2.42)。在这两项荟萃分析中,即使对重要的混杂变量进行调整,也能观察到显著的整体关联性。相反,一项荟萃分析(三篇文章,N = 46 631 名参与者)显示,头晕与未来伤害性跌倒之间缺乏显著关联(OR = 1.12,95% CI = 0.87-1.45)。结论 头晕是老年人未来跌倒的独立预测因素。这些发现强调了认识到头晕是跌倒风险因素并采取适当干预措施的重要性。
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引用次数: 0
Hospital-initiated palliative care interventions for adults with frailty: findings from a systematic review and narrative synthesis 针对虚弱成人的由医院发起的姑息关怀干预:系统综述和叙述性综述的结果
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-17 DOI: 10.1093/ageing/afae190
Phoebe Sharratt, Antony Zacharias, Amara Callistus Nwosu, Amy Gadoud
Background Adults with frailty have palliative care needs [1] but have disproportionately less access to palliative care services [2]. Frailty affects ~4000 patients admitted to hospital per day in the UK [3], making the hospital admission a unique opportunity to assess palliative care needs and deliver interventions. Objectives Synthesise the evidence regarding hospital palliative care (HPC) for patients with frailty. Narratively analyse the evidence regarding methods used to identify palliative care needs; types of palliative care interventions studied; and whether HPC improves outcomes. Methods Systematic literature review and narrative synthesis of experimental, observational and systematic review articles investigating palliative care interventions for hospitalised adults aged ≥65 years with frailty. Electronic search of five databases from database inception to 30 January 2023. Included studies analysed using narrative synthesis according to Popay et al [4]. Results 15 465 titles retrieved, 12 included. Three studies detailed how they identified palliative care needs; all three used prognostication e.g. the ‘surprise question’. Most papers (10/12) investigated specialist palliative care interventions. These interventions addressed a wider range of care needs than non-specialist interventions. Evidence suggested an improvement in some symptom burden and healthcare utilisation outcomes following HPC. Conclusion Prognostication was the main method of identifying palliative care needs, rather than individuals’ specific needs. Specialist palliative care interventions were more holistic, indicating that non-specialist palliative care approaches may benefit from specialist team input. Despite suggestions of improvement in some outcomes with palliative care, heterogenous evidence prevented establishment of conclusive effects.
背景 患有虚弱症的成年人有姑息关怀的需求[1],但获得姑息关怀服务的机会却少得不成比例[2]。在英国,每天约有 4000 名患者因体弱而入院[3],这使得入院成为评估姑息关怀需求和采取干预措施的独特机会。目标 综合有关针对虚弱患者的医院姑息关怀(HPC)的证据。叙述性地分析有关用于识别姑息关怀需求的方法、姑息关怀干预研究的类型以及 HPC 是否能改善疗效的证据。方法 对实验性、观察性和系统性综述性文章进行系统性文献综述和叙述性综述,这些文章调查了针对年龄≥65岁、身体虚弱的住院成人的姑息关怀干预措施。对五个数据库进行电子检索,检索时间从数据库建立之初至 2023 年 1 月 30 日。根据 Popay 等人[4]的方法,采用叙事综合法对纳入的研究进行分析。结果 检索到 15 465 篇文献,纳入 12 篇。三项研究详细介绍了如何确定姑息关怀需求;所有三项研究都使用了预后,如 "惊喜问题"。大多数论文(10/12 篇)调查了专业姑息关怀干预措施。与非专科干预相比,这些干预措施能满足更广泛的姑息关怀需求。有证据表明,采取姑息关怀干预措施后,某些症状负担和医疗服务利用率有所改善。结论 诊断是确定姑息关怀需求的主要方法,而不是个人的具体需求。专科姑息关怀干预更为全面,这表明非专科姑息关怀方法可能会受益于专科团队的投入。尽管有迹象表明姑息关怀改善了某些结果,但由于证据不一,无法确定最终效果。
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Age and ageing
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