Hospitalized Elderly Patients Research Articles

A-69 | Impact of Depression in Hospitalized Elderly Patients undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Nationwide Study From 2016-2020

A-69 | Impact of Depression in Hospitalized Elderly Patients undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Nationwide Study From 2016-2020

A Retrospective Study on Azvudine in Hospitalized Elderly Patients with COVID-19

Background:: The ongoing 2019 novel coronavirus pneumonia pandemic continues to pose a serious threat to public health and safety. In response, numerous specific anti-SARS-CoV-2 drugs have been urgently approved for use. Azvudine has been recommended as a priority treatment for COVID-19 patients, but its efficacy and safety in elderly patients remain unexplored. Methods:: In this retrospective, single-center, observational study, we assessed the impact of Azvudine treatment on elderly hospitalized patients aged over 70 years. We analyzed parameters such as the time of SARS-CoV-2 negative conversion, clinical outcomes, length of hospital stay, and respiratory support requirements. Additionally, we compared changes in blood routine indicators, liver and kidney function indicators, and the incidence of adverse events before and after Azvudine administration to provide real-world data concerning elderly patients. Results and Discussion:: The study included 36 elderly patients aged 70 to 95 years. Following Azvudine administration, the average time for SARS-CoV-2 negative conversion was 5.15 days. Clinical outcomes revealed improvement and discharge in 74.3% of the patients, exacerbation in 5.7% of the patients, and mortality in 20% of the patients. Analysis of blood routine indicators and liver function indicators before and after medication showed no clinically significant changes. However, serum creatinine levels (Scr) demonstrated a statistically significant increase (71.12 ± 44.22 vs. 87.88 ± 57.39, p < 0.05). Conclusion:: Although correlation analysis was not conducted, limited by the small sample size and retrospective nature of the study, these findings underscore the importance of monitoring Azvudine’s impact on renal function.

Frequency of Potentially Inappropriate Medications in Iranian Elderly Hospitalized Patients

Background: Potentially inappropriate medications (PIMs) should not be prescribed to the elderly due to low effectiveness and adverse drug reactions. This study was conducted to determine the frequency of PIMs in the elderly admitted to educational hospitals in Kerman, in 2023. Methods: This cross-sectional study was conducted on 1500 elderly patients hospitalized in educational hospitals. The data collection forms were completed according to the health information system (HIS) of the hospital, which includes the patient’s age and gender, drug information, and the name of the hospital and ward. PIMs prescriptions were assessed according to Zhan’s criteria. Statistical analyses were performed using SPSS version 20.0. The results were presented as mean±standard deviation (SD) and frequencies (percents). Results: Nearly 17.8% (n=267) of patients were treated with at least one PIMs included in the Zhan criteria. Among 331 PIMs used for patients, 43.5% (n=144), 23.3% (n=77), and 33.2% (n=110) of drugs were classified as always avoid, rarely appropriate, and some indication, respectively. Sedative-hypnotics, opioids, and antihistamines were the most prevalent PIMs with 29.5% (n=98), 25.4% (n=84), and 23.3% (n=77) frequency. Approximately 71.4% (n=10) of patients who were admitted to the Oncology ward, and 38.9% (n=33) of patients who were admitted to the Critical Care Unit were treated with at least one PIMs. Conclusion: Today PIMs are a problem for elderly patients. Paying attention to PIMS in oncology, and critical care unit wards is important. More attention should be paid to sedative-hypnotics, opioids, and antihistamines as the most frequently prescribed PIMs.

Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia

Background and objectivesThe elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. MethodsThe data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. ResultsThere were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. ConclusionThe study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department’s prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.

Screening of Hospitalized Elderly Patients for Frailty and Associated Co-morbid Conditions in Western Gujarat in India.

Older patients admitted to hospitals have a greater impact on the healthcare system as the population ages. The relationship between the recovery of functional impairments and frailty status in geriatric care units is still not clear. Simple screening technologies are required in order to operationalize frailty management in this susceptible population due to these restrictions. Aim: The study aims to screen hospitalized older adults for frailty and associated co-morbid conditions in western Gujarat, India. This is an institutionally based cross-sectional study conducted on the elderly patients (aged 60 years or more) admitted at the tertiary-level government hospital of Jamnagar District of Gujarat State during the period of October 22 to December 22. The assessment was done with a structured questionnaire for FRAIL screen, the Rapid Cognitive Screen (RCS), Charles Co-morbidity Index, Geriatric Depression Scale-5 (GDS-5), and Short Form-12 (SF-12) Health Survey. The overall findings of this study reveal that of 124 participants 34 (27%) were frail, 52 (42%) were found to be a likelihood of depression by the GDS, and 29 (23%) were having dementia by RCS, respectively. In our study, we also found a statistically significant association between frailty and dementia (P value < 0.001). The present study implies the prevalence of frailty among old age elderly patients and its association with various socio-demographic and co-morbid conditions of the participants. Early identification of frailty and co-morbid conditions can help to prevent adverse health outcomes.

Elderly Patients at Risk of Malnutrition Presenting to a Tertiary Hospital in Nepal: A Descriptive Cross-sectional Study

Introduction: The nutritional status of elderly people is crucial for healthy aging, enabling them to maintain productive lives and reduce the progression of chronic diseases. Given that the quality of life tends to decline with age, it becomes particularly crucial for elderly individuals. Therefore, this study was aimed to find out the prevalence of elderly patients at risk of malnutrition in a tertiary hospital. Methods: This descriptive cross-sectional study was conducted among 281 elderly patients in a tertiary hospital from 2 January 2023 to 10 February 2023 after obtaining ethical approval. Non-probability purposive sampling technique was used. A face-to-face interview was conducted using a structured interview schedule with the elderly in the absence of their caregiver using a standard Mini-Nutritional Assessment tool for nutritional status, and WHOQOL_OLD quality of life for the elderly to assess the quality of life. Point estimate at 95% Confidence Interval was calculated.Results: Out of 281 elderly patients enrolled in our study, 164 (58.36%) (52.64-64.16, 95% Confidence Interval) were at risk of malnutrition. Conclusions: The study concluded that older people could be at risk of malnutrition, which could impair their quality of life.

Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients.

a total of 361 patients were retrospectively recruited and divided into three groups based on the CONUT score. patients with a score ≥5 exhibited significantly higher levels of inflammatory markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Neutrophil/Lymphocytes ratio (NLR), main platelet volume (MPV), and ferritin, compared to those with a lower score. Furthermore, these patients showed unfavorable changes in body composition, including a lower percentage of skeletal muscle mass (MM) and fat-free mass (FFM) and a higher percentage of fatty mass (FM). A positive correlation was found between the CONUT score and inflammatory markers, Geriatric Depression Scale Short Form (GDS-SF), and FM. Conversely, the Mini Nutritional Assessment (MNA), Mini-Mental Status Examination, activity daily living (ADL), instrumental activity daily living (IADL), Barthel index, FFM, and MM showed a negative correlation. Frailty was highly prevalent among patients with a higher CONUT score. The receiver operating characteristic (ROC) curve demonstrated high accuracy in identifying frail patients (sensitivity). a high CONUT score is associated with a pro-inflammatory status as well as with unfavorable body composition. Additionally, it is a good tool to identify frailty among hospitalized elderly patients.

1868 Eight to Hydrate: Promoting oral hydration of elderly patients in hospital

Abstract Introduction Dehydration is associated with prolonged hospital admissions and complications. Elderly patients are more susceptible due to physiology, dexterity and cognition. The British Dietetic Association recommends minimum 7 beverages per day whilst The British Nutrition Foundation advises proactive dehydration risk management in hospital. This project aimed to reduce the proportion of elderly patients at risk of dehydration in hospital. Methods Staff documented oral hydration over 24 hours for patients on the Care of the Elderly ward. Additional factors obtained retrospectively included demographics, dementia diagnosis, fluid prescriptions and fluid restriction. Criteria adapted from a ‘Hydration Care Assessment Tool’ defined risk of dehydration by daily intake as low (&amp;gt;1500mls), medium (800-1500mls), high (400-800mls) or very high (&amp;lt;400mls). Approximating each drink as 200mls, we set a daily target of 8 beverages; equating to low risk. Visual hydration trackers were placed at patients' bedsides and junior doctors reminded the multi-disciplinary team each morning. Data collection was repeated after 2 weeks. Results First cycle recruited 13 males, 16 females with mean age 78.5. Over 50% were Very High Risk (5/29) or High Risk (12/29) of dehydration whilst the remainder were Medium Risk (10/29), or Low risk (2/29). 4/5 (80%) at Very High Risk received intravenous fluids. Of the High-Risk group, more than half had a diagnosis of dementia and 3/12 (25%) received fluids intravenously. Following intervention, 12 males and 7 females were recruited with mean age 76. Proportion at highest risk was reduced: Very High Risk (5/29 to 0/19; -100%), High Risk (12/29 to 3/19; -61%). Therefore, more were at Medium Risk (10/29 to 13/19; +101%) and Low Risk (2/29 to 3/19; +131%). Conclusion Though improved, few patients meet hydration recommendations. However simple visual reminders are an effective starting point. Further interventions could include oral fluid prescriptions and reflect staff and patient feedback.

Identifikacija terapijskih problema tokom uvođenja usluga farmaceuta na Odeljenju gerijatrije Kliničko-bolnickog centra

Introduction: Patients with multiple comorbidities and undergoing polypharmacy are at a high risk of experiencing drug-related problems (DRPs). These DRPs can lead to increased morbidity, mortality, and healthcare costs. Objective: This study aims to identify the prevalence and causes of DRPs in geriatric inpatients, as well as the factors that contribute to them. Additionally, the study intends to evaluate the implementation of ward-based pharmacy services in the geriatric department. Method: The pharmacist analyzed inpatient therapy, identified DRPs, and formulated recommendations. DRPs were categorized according to the PCNE-DRP classification, version 9. A total of 100 patients, of which 52% were men, average age of 79.7±7.88 years, were included in the study. Results: Our study found that on average, each patient had 2.36 drug-related problems (DRPs). The most common DRP was related to treatment safety, accounting for 44.9% of cases, followed by treatment effectiveness (33.1%) and unnecessary drug treatment (22%). The main cause of DRPs was inadequate drug selection (61%) and inadequate dose selection (38.1%). Patients with atrial fibrillation and chronic renal failure had more DRPs than those without these conditions. In total, we identified 229 interventions to address these DRPs. However, the acceptance rate of these recommended interventions was low at 25.9%. Conclusion: The rate of drug-related issues in elderly hospital patients was found to be high, but the rate of acceptance of interventions to address these issues was low. In order to enhance the implementation of pharmaceutical services and improve healthcare for elderly patients, it is crucial to improve the collaboration between healthcare providers and pharmacists. Recognizing the unique skills and expertise that pharmacists bring to the table can facilitate their integration as a valuable member of a multidisciplinary healthcare team.

Accuracy and Applicability of the SARC-F and SARC-CalF Questionnaire in the Screening of Sarcopenia in Hospitalized Elderly Patients

Accuracy and Applicability of the SARC-F and SARC-CalF Questionnaire in the Screening of Sarcopenia in Hospitalized Elderly Patients

The Information Needs and Seeking Behavior of Elderly Patients in Educational and Therapeutic Hospitals: Unveiling Barriers to Information Accessibility

Background: With the aging population on the rise, it becomes increasingly important for healthcare providers and policymakers to grasp the preferences of elderly patients when it comes to seeking health information. Such understanding can pave the way for tailored interventions aimed at enhancing health literacy and encouraging healthy behaviors among older adults. Objectives: This study sought to investigate the information needs and seeking behavior of elderly patients in educational and therapeutic hospitals while also identifying the barriers that hinder these patients’ access to relevant information sources. Methods: A cross-sectional study was conducted involving 200 older adults who were hospitalized in educational and therapeutic hospitals in Sari, located in northern Iran, within 2018 to 2020. The data collection tool consisted of a researcher-made questionnaire with four sections: demographic information, health information needs, health information-seeking behavior (HISB), and barriers to finding information. The questionnaire’s reliability was validated, and the chi-square test was employed to explore the association between demographic variables and barriers to information retrieval. Data analysis was performed using SPSS software (version 24). Results: The key demographic characteristics influencing HISB among older patients included age (70 - 79 years), gender (female), educational level (illiterate), and employment status (housewife). The primary health information needs of older patients encompassed staying updated with current health news, seeking information from nurses and allied healthcare staff, and encountering obstacles in accessing information due to a lack of internet literacy. The most pronounced associations between demographics and HISB among older patients were observed in educational level, employment status, and reliance on newspapers and magazines. Moreover, significant associations existed between age groups and seeking support from groups, family, relatives, and friends in addition to using brochures, books, internet resources, short message service (SMS), and radio/television. Conclusions: Elderly patients often encounter challenges in accessing health information due to their limited internet skills. To assist older adults in navigating and utilizing the Internet more effectively, it is crucial to identify trustworthy online sources and bolster their confidence in using the Internet. Healthcare professionals can contribute to the well-being of older adult patients by providing access to current health news, delivering educational programs tailored to individuals with lower levels of education, and offering alternative sources of information for patients who lack internet access.

Pengembangan Instrumen Deteksi Kemunduran Bio, Psiko, Sosio, Spiritual pada Pasien Lanjut Usia

This research aims to develop an instrument that detects bio, psycho, social, and spiritual decline in elderly hospital patients by using theoretical concepts in nursing care. The research method uses cross-sectional, with validity and reliability tests using the Product Moment correlation test. The research results show that the bio, psycho, social, and spiritual deterioration detection instrument consists of 26 questions with high validity and reliability. This instrument has been based on various concepts that focus on the individual's bio, psychological, social, and spiritual needs. In conclusion, this instrument is easy to use and is an evidence-based nursing assessment tool.&#x0D; Keywords: Bio-Psycho-Socio-Spiritual Decline; Elderly Patients

Prevalence and determinants of potentially inappropriate medications in elderly inpatients in Thailand: a retrospective observational study based on the 2019 Beers criteria.

The prevalence of potentially inappropriate medications (PIMs), including NSAIDs, first-generation antihistamines, tricyclic antidepressants (TCAs), and benzodiazepines among elderly inpatients in Thailand, based on the 2019 Beers criteria, is insufficiently investigated. This study retrospectively examined 300 elderly patients in a Thai tertiary hospital, assessing four PIM classes based on the 2019 Beers criteria and exploring factors and variations in PIM prescription patterns across different phases of hospitalisation. The study found an overall PIM prescription rate of 28%, consisting of: benzodiazepines (14%), first-generation antihistamines (9%), NSAIDs (3%), and TCAs (2%). Patients taking at least 5 medications prior to admission were more likely to receive PIMs (OR 3.77, 95% CI 1.15-12.35). Furthermore, PIM prescription was significantly associated with age, showing a 4.8% yearly increase (p = 0.01), and the number of comorbidities increased by 16.2% per unit (p = 0.021). Additionally, PIM use during admission was significantly linked to a longer hospital stay (OR 3.32, 95% CI 1.50-7.33). These findings emphasise the need for continued monitoring and optimisation of medication management, and collaboration between pharmacists and physicians to review and adjust prescriptions, especially in elderly inpatients experiencing polypharmacy and multiple comorbidities.

To Study the Pattern of Anemia in Type 2 Diabetes Mellitus in Elderly Hospitalized Patients

Background: Anemia found in diabetes patients is often unrecognized like many other chronic diseases. Anemia is more common in people with diabetes due to a variety of causes. The aim of this study was to determine the severity and morphological types of anemia among type II diabetic elderly hospitalized patients. Methodology: The present study was a hospital based cross sectional study conducted at Father Muller Medical Collage Hospital, Mangalore Karnataka over a period of 6 months. The cases for the study included 129 elderly patients with having Type 2 Diabetes Mellitus (DM). 129 Hospitalized elderly patients over the age of 60 years who were confirmed to have type 2 DM patient’s demographic data and the blood samples are analyzed for Complete blood count, Peripheral smear for type of anemia, Random blood glucose, Glycated hemoglobin. Result: A total 129 Hospitalized elderly type 2 DM patients were included in the study. Out of 129 subjects, 55.03% were males and 44.97% were females. Of these 24.8% patients had mild anemia, 63.56% had moderate anemia and 11.64% had severe anemia according to clinical degree of anemia based on hemoglobin level. 67.76% patients had microcytic hypochromic anemia, and 30.24% patients had normocytic normochromic anemia. The prevalence of type 2DM is high in male than the female population. Conclusion: The study results exhibit a higher level of the prevalence of anemia in Type 2 DM subjects. The findings of our study suggest that moderate degree of anemia is a common finding, and morphologically, the leading type of anemia was normocytic normochromic anemia. Keywords: Diabetes Mellitus, Anemia, Hemoglobin, Hyperglycemia.

2960. A Gut Pathobiont Triggers Neuroinflammation and Neurocognitive Impairment via Breaching the Gut-Brain Axis in a Preclinical Model of Alzheimer’s Disease: From Microbial Pathogenesis to Neuropathogenesis

Abstract Background Klebsiella pneumoniae (Kpn) is notorious for causing nosocomial infections and is commonly found in elderly patients in hospitals with Alzheimer's disease (AD). This bacterium can cause bloodstream infection, which may worsen AD pathophysiology, but there are no studies demonstrating the mechanistic role of this pathogen in AD. Methods We infected APP/PS mice intestinally with Kpn with (Kpn+Ab) and without antibiotics (Kpn) for a week and then fecal and serum samples were collected 1 and 3 weeks afterwards. Neurocognitive function and motor coordination were tested followed by collection of intestinal and brain tissues at 5 weeks. Microbiome profiles were measured using 16S rRNA amplicon sequencing. Study design Results Kpn was found to have explosively increased in the gut of all mice that received antibiotics and negatively correlated with microbial diversity. Conversely, Kpn was barely detected in the mice that did not receive antibiotics. This underscores the role of antibiotic-induced gut dysbiosis in instigating a ‘pathobiome’ signature. Notably, after five weeks post-infection, Kpn was found to be more abundantly colonized in the small intestine than large colon. Importantly, in the Kpn+Ab group, Kpn was detected not only in the blood but also in the brain, indicating the translocation of Kpn from the intestine to the brain via circulation. In mice in which Kpn was found in the brain, a substantial amount of neuroinflammation caused by bacterial infection was observed. Subsequent neurocognitive and behavioral tests revealed that mice infected with Kpn, especially those in the Kpn+Ab group, had impaired memory function and motor coordination. Effects of Klebsiella pneumoniae colonization. A. Changes in microbial composition before and after K. pn colonization, B. Correlation between microbial diversity (Shannon entropy) and abundance of Kpn of Kpn+Ab group C. Assessment of motor coordination (incline screen and hanging wire test) and memory function (T-maze) test. D. Neuroinflammation after K.pn translocation from gut to brain, E. Abundance of K.pn in the three parts of small intestine, colon, blood, and brain. Conclusion These results corroborate the emerging notion of the implicating role of the gut dysbiosis and consequent gut-brain axis impairment in Alzheimer’s neuropathology. Our findings suggest that Alzheimer's patients who are hospitalized and treated with antibiotics are at a higher risk of contracting multi-drug resistant Kpn. Further, these data also hint that gut pathobiome may increase the host’s predisposition to AD by breaching the gut-brain axis thereby triggering neuroinflammation and impairing neurocognitive function. Our ongoing studies are anticipated to reveal underlying mechanisms and will be presented at the conference. Disclosures All Authors: No reported disclosures

636. Epidemiology and Outcome Among the Elderly Hospitalized Patients with Respiratory Syncytial Virus Infections

Abstract Background Elderly patients with congestive heart failure (CHF), chronic lung diseases (CLD) and immunocompromised conditions are considered a high-risk category for severe respiratory syncytial virus (RSV) infections. Our study aimed to identify RSV disease epidemiology and its outcomes among the elderly hospitalized patients with and without high-risk conditions (HRC). Methods We conducted a multicenter historical cohort study of adult patients for laboratory-confirmed RSV-related diseases in Ascension hospitals in southeast Michigan between January 2017 and December 2021. Patients were identified using ICD 10 codes for RSV diseases. Patients with HRC were those elderly patients with CHF, CLD and immune-compromised conditions. Data were analyzed using SPSS v. 29.0. Results Among 240 patients, 31.3% (75) were without HRC whereas 68.7% (165) had at least one HRC. The mean (sd) age of the patients without HRC was 81.9 + 8.9 years, 47 (62.7%) were female, 52 (69.3%) were white and mean body mass index (BMI) was 28.9 + 8.3 years. The mean (sd) age of the patients with HRC was 76.6 + 7.7 years, 111 (67.3%) were female, 125 (75.8%) were white and BMI was 29.8 + 9.0 years. Major comorbidities among patients without HRC compared to those with HRC were hypertension (77.3% vs 69.1%), cerebrovascular condition (25.3 vs 10.9%), diabetes (18% vs 37.6%), dementia (21.3% vs 8.5%), and chronic kidney disease (CKD) (16% vs 21.2%). Current smokers were 30.7% vs 66.1% among patients without HRC compared to those with HRC. On admission, median (IQR) qSOFA scores were 0 (0-2) vs 1 (0-3) among patients without HRC compared to those with HRC. Lower respiratory tract infections (LRTI) were 32% vs 43%, acute kidney injury (22.7% vs 24.2%), liver injury (1.3% vs 3%), mechanical ventilation (6.7% vs 9.1%), pressors (1.3% vs 1.8%), and ICU requirement (10.7% vs 15.2%) among patients without HRC compared to those with HRC. In-hospital mortality were 1.3% vs 5.5% among patients without HRC compared to those with HRC. Conclusion In our study, elderly patients with HRC were younger, smokers with higher incidence of diabetics, CKD, higher qSOFA on presentation with higher LRTIs, and other complications including mortality. Targeted risk mitigation strategies can help reduce disease burden and cost associated with RSV infections. Disclosures All Authors: No reported disclosures

Abstract 13771: Left Atrial Size and Frailty Indexes Predict Poor Prognosis in Hospitalized Elderly Patients With Heart Failure

Background: Left ventricular ejection fraction (LVEF) is a cardiac index used to diagnose and determine heart failure (HF) treatment strategy. However, in elderly patients with HF, LVEF is not a good predictor of prognosis. We have previously found that patient outcomes are associated with left atrial (LA) size and noncardiac factors such as malnutrition, muscle weakness, and cognitive dysfunction. This study examined whether a combination of LA function and noncardiac indicators related to frailty can predict an accurate prognosis in hospitalized elderly patients. Methods: Hospitalized HF patients over 65 years of age from January 2019 to December 2022 were consequently enrolled in the Yamaguchi Prefectural Grand Medical (YPGM) Center. We divided three categories: sinus rhythm (SR) with normal LA, SR with LA enlargement (LAE), and persistent or chronic atrial fibrillation (AFib) with LAE. Cox proportional hazard analyses were employed to determine the prognosis factors, i.e., the primary outcome as all-cause death or HF readmission and the secondary outcome as major adverse cardiac and cerebrovascular events (MACCE). Results: Overall, 676 HF patients were admitted to YPGM Center. Of those, 462 (median age 84.0, 47% female) met the study criteria. During the follow-up of 204.0 days, 46 patients reached all-cause death (10%), 82 experienced HF readmission (18%), and 116 developed MACCE (25%). LA volume index (LAVI) (Hazard ratio [HR]: 1.012; 95% confidence interval [CI]: 1.003-1.022; p = 0.013) and handgrip strength (HR: 0.917; 95%CI: 0.868-0.970; p = 0.002) were associated with the primary outcome. Nutritional status assessed by geriatric nutritional risk index (GNRI) was associated with the primary and secondary outcome (HR: 0.956; 95%CI: 0.927-0.985; p = 0.003, and HR: 0.937; 95%CI: 0.909-0.966; p &lt; 0.001, respectively), but neither AFib nor LVEF. The adverse events were lower in SR with the normal LA group than in other groups. Furthermore, a multiple logistic regression model, including LAVI, AFib, GNRI, and handgrip strength, most accurately predicted the primary outcome than those with the AFib or LVEF. Conclusion: The value of benefits as a prognosis lies more in LAVI and frailty indexes than in the presence of AFib and LVEF in elderly HF patients.

Latent Profile Analysis of Fear of Hypoglycemia in Middle-Aged and Elderly Hospitalized Patients with Type 2 Diabetes and Its Relationship with Sleep Quality.

Hypoglycemia is an acute complication that can appear in people with type 2 diabetes treated with drugs which are associated with a risk of hypoglycemia, and it may lead to individual's fear of hypoglycemia (FoH). FoH adversely affects diabetic self-management, psychological well-being, and quality of life, and it is associated with sleep quality. Nevertheless, this problem is often underestimated. The purpose of this study was to explore the heterogeneous characteristics of FoH in middle-aged and elderly hospitalized patients with type 2 diabetes and assess its relationship with the sleeping quality. A cross-sectional study was performed on 263 middle-aged and elderly patients with type 2 diabetes hospitalized at the Zhejiang Veteran Hospital in Jiaxing, China, from May to August 2022, selected by a convenient sampling method. A questionnaire containing general information, fear of hypoglycemia scale-15 (FH-15) and the Pittsburgh sleep quality index (PSQI) was provided to the participants. Latent profile analysis was performed to examine the potential latent groups in the distribution of answers on the individual FoH items. The results identified three latent classes: Class 1 - Low FoH group (33%); Class 2 - No FoH group (61%); Class 3 - High FoH group (6%). The latent FoH class was the influencing factor of sleep quality, which was better in the No FoH group than in the Low FoH group, while the sleep quality of the Low FoH group was better than that in the High FoH group. A heterogeneity was found in the FoH of middle-aged and elderly hospitalized patients with type 2 diabetes. Health-care providers should pay more attention to these patients with high FoH and develop intervention strategies to mitigate it and improve their sleep quality.

Postoperative cognitive worsening in seniors with an age above life expectancy: a prospective longitudinal study.

The growing number of elderly patients in hospitals is a challenge for healthcare systems. The main objective is to measure the postoperative change in the cognitive status at hospital discharge and one year after discharge in elderly patients undergoing planned or deferrable surgery. We planned a prospective longitudinal study, single-center study: secondary care level hospital, enrolment from September 2018 to May 2019. We enroll elderly patients, aged above life expectancy in Italy, who underwent planned or deferrable surgery (men over 80.5 years old, women over 85.0 years old). In six months, we enrolled 76 eligible patients. We collected the scores of the clinical impairment scales Charlson Index, Barthel Index, and Six-Item Cognitive Impairment Test (6CIT). The primary endpoint was the postoperative worsening of the cognitive status at one-year follow-up. Secondary endpoints aimed to describe postoperative disabilities and complications, to investigate possible risk factors for cognitive worsening, and to measure the role of anesthesia in cognitive changes. We recorded an increased rate of pathological 6CIT values during the hospitalization period, rising from 39.47% to 55.26% (McNemar test, P=0.007), and this rate was still increased at 55.56% (P=0.021) one year after discharge. Anesthesia did not show any significant harmful effect on cognitive status. The preoperative hemoglobin value seems to be a risk factor for cognitive status and one-year mortality. Elderly patients had a significantly worse 6CIT value after planned surgery, which may derive in part from age and in part from hospitalization. It is difficult to determine if general anesthesia alone has no harmful effects on cognitive performance in patients at discharge and one year later. Further data are necessary.

Factors Associated with Acute Injurious Falls in Elderly Hospitalized Patients: A Multicenter Descriptive Study.

The Centers for Medicare & Medicaid Services Hospital-Acquired Conditions (CMS-HAC) links Medicare payments to health care quality. Experiencing a serious disability or death associated with a fall in a health care facility based on diagnosis codes has been identified as an opportunity for improvement. Multiple factors contribute to an inpatient fall, including medications that affect cognition in older adults. The primary aim of this study was to investigate the effect of the commonly prescribed classes of medications on the CMS-HAC falls and trauma definition in US hospitals in a large inpatient database from 2019 to 2021. The authors analyzed data from 835 hospitals in the Vizient Clinical Data Base between January 1, 2019, and December 31, 2021, on patients ≥ 65 years of age with CMS-HAC patient falls and trauma codes. Using logistic regression and stepwise Poisson regression analysis, the authors identified demographic, clinical, and hospital-related variables associated with falls meeting the CMS-HAC definition. The top 20 prescribed drug classes in these patients were also identified. Among 11,064,024 patient encounters, 5,978 met the CMS-HAC definition of a serious fall. Patients who experienced a serious fall were significantly more likely to be > 79 years of age (p < 0.001, odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23-1.37), have a history of prior falls (p < 0.001, OR 2.30, 95% CI 2.11-2.50), have a code for dementia (p < 0.001, OR 1.50, 95% CI 1.40-1.60), and have higher anticholinergic cognitive burden (ACB) scores (p < 0.001, OR 1.14, 95% CI 1.13-1.14). Specific medication classes associated with CMS-HAC falls were first-generation antihistamines (p < 0.00, OR 1.21, 95% CI 1.09-1.35), second-generation antihistamines (p ≤ 0.001, OR 1.15, 95% CI 1.13-1.19), and atypical antipsychotics (p < 0.001, OR 1.18, CI 1.13-1.29). Patients who experience a fall meeting the CMS-HAC fall definition are significantly more likely to have a prior history of falling, dementia, and a higher ACB score. Results from this study may inform future quality improvement work aimed at reducing injurious falls.