Important outcomes for patients with frailty admitted to hospital with peripheral arterial disease, their caregivers and their health professionals: A Nominal Group Technique study.

BackgroundPrescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions.ObjectiveWe aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing.MethodsWe used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥ 65 years with an expected length of stay of ≥ 2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined.ResultsThere were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0–85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0–84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients (p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12).ConclusionsGeriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-023-01015-7.

Review Question/Objective The objective of this systematic review is to synthesize the best available evidence on the impact of pre-injury anticoagulation therapy in the older adult patient who experiences a traumatic brain injury. Inclusion Criteria Types of Participants This systematic review will consider studies which include patients age 65 years or older, regardless of gender or ethnicity, who have experienced a traumatic brain injury. Types of Intervention The intervention of interest is the use of anticoagulants and/or antiplatelet prescription medication prior to the traumatic brain injury. Types of Comparator The intervention of interest will be compared to non-use of prescription anticoagulants and/or antiplatelet medication therapy. Types of Outcome Measures This review will consider studies that include the following outcome measure: death before discharge from the acute care setting.

ObjectiveAnalysis of influencing factors and action pathways of social frailty in older adult patients with ischemic stroke.MethodsA cross-sectional study was conducted among older adult inpatients with ischemic stroke in the Department of Neurology of two Grade A tertiary hospitals in Sichuan Province, China, from January to May 2025. Multiple stepwise linear regression analysis was used to analyze the influencing factors of social frailty in older adult patients with ischemic stroke, and structural equation modeling was employed to conduct path analysis on these influencing factors.ResultsA total of 437 older adult patients with ischemic stroke completed the study. The prevalence of social frailty in older adult ischemic stroke patients was 38%. Regression analysis showed that activities of daily living, sleep quality, depression, social support, employee medical insurance, language function impairment and stroke recurrence are influencing factors of social frailty levels in older adult patients with ischemic stroke (p < 0.05). The structural equation model revealed that in the biological dimension, the direct effect of ADL on social frailty was significant (β = −0.154, p = 0.002), accounting for 16% of the total direct effects, while its indirect effect through social support was also significant (β = −0.061, p = 0.003, 95% CI: −0.114 to −0.019), representing 28% of the total effect in the ADL-social frailty pathway; the direct effect of sleep quality on social frailty (β = 0.057, p = 0.282) and the indirect effect via social support (β = 0.014, p = 0.546, 95% CI: −0.032 to 0.062) were not significant. In the psychological dimension, depression had a significant direct effect on social frailty (β = 0.390, p < 0.001), accounting for 40% of the total direct effects, along with a significant indirect effect via social support (β = 0.113, p < 0.001, 95% CI: 0.063–0.181), representing 22% of the total effect in the depression-social frailty pathway. In the social dimension, social support showed a significant direct effect on social frailty (β = −0.373, p < 0.001), representing 38% of the total direct effects.ConclusionThis study found that the prevalence of social frailty in older adult patients with ischemic stroke was 38%, and it is closely associated with health insurance type, stroke recurrence, language function, activities of daily living, depression, and social support. These findings provide a reference for clinical practitioners to design targeted interventions.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

BackgroundHead and neck squamous cell carcinoma (HNSCC) is a geriatric cancer. However, older adult patients are frequently underrepresented in large clinical trials.AimsThe aim of this study is to assess the efficacy and safety of the EXTREME regimen (platinum + fluorouracil + cetuximab) in older and younger adult patients with HNSCC.Methods and resultsPatients with recurrent or metastatic HNSCC treated with the EXTREME regimen were retrospectively analyzed. We compare the efficacy and safety in older (aged ≥70 years) younger (aged <70 years) adult patients. Of the 86 patients examined in this study, 21 (24.4%) were older adults. There was no difference in overall response rate (46.9% vs 38.5%, P = .76), median progression‐free survival [5.7 months vs 5.8 months, hazard ratio (HR) 0.88, 95% confidence interval (CI) = 0.52‐1.51, P = .66] and overall survival (OS) (14.6 months vs 15.2 months, HR 0.79, 95% CI 0.43‐1.43, P = .44) in younger vs older patients. There was also no difference in the incidence of grade 3/4 adverse events between groups. The exploratory analysis for geriatric nutritional risk index (GNRI) showed the association with lower GNRI (≤98) and poor OS in older adult patients (37.7 months vs 7.0 months, HR 0.53, 95% CI 0.31‐0.89, P = .002).ConclusionsThe EXTREME regimen with optimal dose modification is safe and effective for both older and younger adult patients with HNSCC. The GNRI can be an indicator to select the older adult patients who can get benefit from the EXTREME regimen.

BackgroundThis study compared the perceived social support of young and older adult cancer patients, examining possible influencing factors as well as associations with health-related quality of life.MethodsA total of 179 young patients (18–39 years) and 200 older adult patients (> 70 years) with haematological malignancies completed questionnaires on their perceived social support (ISSS-8, scales: Positive Support and Detrimental Interactions, range 0–16) and health-related quality of life (EORTC QLQ-C30). Tests for mean differences, correlations and regression analyses to determine associated variables of social support were performed.ResultsNo difference was reported between young (M = 13.40, SD = 2.81) and older adult patients (M = 13.04, SD = 3.82; p = .313) for Positive Support. However, young patients (M = 4.16, SD = 3.10) reported having had more Detrimental Interactions than older patients did (M = 1.63, SD = 2.42; p < .001, Cohen’s d = .910). Comparison of the EORTC QLQ-C30 Function scales showed poorer outcomes for young patients on Emotional, Cognitive and Social Functions and a higher outcome on Physical Function compared with older adult patients. Regression analyses indicated that age (young vs. older adult patients) significantly explained proportions of variance in all models, with young age having a negative impact on Emotional, Cognitive and Social Functions and a positive impact on Physical and Role Functions compared with old age. Significant associations between Detrimental Interactions and all the scales examined except Cognitive Function were found.ConclusionsThe difference in negative perceptions of social support in young vs. older adult patients and its impact on health-related quality of life emphasises the necessity of differentiating between positive and negative social support. Negative interactions should be addressed through psychosocial care, particularly with young cancer patients.

Editors' commentary

Peripheral vascular diseases are important components of cardiovascular medicine. The high prevalence of these disorders in the clinical setting mandates effective communication among healthcare providers. The public health significance of these conditions requires clear and consistent terminology for community audiences. Therefore, the goal of this writing group was to suggest definitions, usage, and nomenclature of specific terms commonly used to describe vascular diseases by cardiovascular specialists and primary care communities. The need for clarity is driven by 2 major challenges: (1) the need for use of common keywords for literature searches; and (2) the need for healthcare professionals to use common, reasoned terminology when communicating with each other and with the public. The major structural components of the vascular system are the veins, lymphatic vessels, and arteries. These serve as the basis of the nomenclature system for vascular diseases (Figure). Figure. Major classification of vascular diseases. *Includes inflammatory, artery dysplasias, congenital, traumatic, and infections. In this report, the writing group focuses only on nomenclature that applies to non–coronary artery diseases. Venous and lymphatic diseases were outside the scope of this conference. Diseases of arteries are classified further into atherosclerotic occlusive disorders, nonatherosclerotic occlusive disorders, and aneurysms. …

Is there a survival difference between older adult and younger adult patients with locally advanced gastric cancer with the same lymph node ratio?

Since 1980, the American College of Cardiology (ACC) and American Heart\nAssociation (AHA) have translated scientific evidence into clinical practice\nguidelines with recommendations to improve cardiovascular health. These\nguidelines, based on systematic methods to evaluate and classify evidence,\nprovide a cornerstone of quality cardiovascular care.

Peripheral arterial disease (PAD) is a distinct clinical manifestation of atherosclerosis, with an associated long-term risk of coronary and cerebrovascular events that is equivalent to that of a primary diagnosis of myocardial infarction or ischemic stroke.1,2 The prevalence of PAD, as estimated by an abnormal ankle-to-brachial systolic pressure index (ABI 55 years of age in Western societies.3–5 The majority of patients with PAD are asymptomatic, but recognition of the disease is clinically important because it may be the primary manifestation of systemic atherosclerosis. Indeed, numerous studies have demonstrated a correlation between the global risk of cardiovascular events and ABI, which portends a more dire outcome for those with increasing degrees of hemodynamic compromise in the limb.6,7 The major risk factors for PAD, aside from age, are cigarette smoking, diabetes mellitus, dyslipidemia, hyperhomocysteinemia, and hypertension. Among these, the recent explosion in the worldwide prevalence of diabetes mellitus is of particular concern, particularly because the risk of both mortality and limb loss in diabetic PAD patients is increased several-fold. Thus, a major focus of clinical management in PAD is on secondary prevention, including the aggressive treatment of these risk factors by dietary and behavioral modification, combined with medical therapies. Present evidence suggests that PAD patients should receive lifelong antiplatelet therapy, treatment with a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin), and appropriate antihypertensive therapy, which should probably include an angiotensin-converting enzyme inhibitor.8 Article p 816 Symptomatic PAD, which affects approximately one third of all PAD patients, is most commonly manifested as intermittent claudication (IC), a walking impairment that results at least in part from a classic mismatch between blood supply and metabolic demand of the leg muscle groups. Critical limb ischemia, the most severe form …

Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

ObjectivesTo systematically evaluate the risk prediction models for postoperative delirium in older adult hip fracture patients.MethodsRisk prediction models for postoperative delirium in older adult hip fracture patients were collected from the Cochrane Library, PubMed, Web of Science, and Ovid via the internet, covering studies from the establishment of the databases to March 15, 2023. Two researchers independently screened the literature, extracted data, and used Stata 13.0 for meta-analysis of predictive factors and the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk prediction models for postoperative delirium in older adult hip fracture patients, evaluated the predictive performance.ResultsThis analysis included eight studies. Six studies used internal validation to assess the predictive models, while one combined both internal and external validation. The Area Under Curve (AUC) for the models ranged from 0.67 to 0.79. The most common predictors were preoperative dementia or dementia history (OR = 3.123, 95% CI 2.108–4.626, p < 0.001), American Society of Anesthesiologists (ASA) classification (OR = 2.343, 95% CI 1.146–4.789, p < 0.05), and age (OR = 1.615, 95% CI 1.387–1.880, p < 0.001). This meta-analysis shows that these were independent risk factors for postoperative delirium in older adult patients with hip fracture.ConclusionResearch on the risk prediction models for postoperative delirium in older adult hip fracture patients is still in the developmental stage. The predictive performance of some of the established models achieve expectation and the applicable risk of all models is low, but there are also problems such as high risk of bias and lack of external validation. Medical professionals should select existing models and validate and optimize them with large samples from multiple centers according to their actual situation. It is more recommended to carry out a large sample of prospective studies to build prediction models.Systematic review registrationThe protocol for this systematic review was published in the International Prospective Register of Systematic Reviews (PROSPERO) under the registered number CRD42022365258.

Gait speed assessment as a prognostic tool for morbidity and mortality in vulnerable older adult patients following vascular surgery

Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure