Hospitalization In Older Patients Research Articles

Body Weight and Composition Changes in Geriatric Rehabilitation Are Dependent on Sarcopenia and Malnutrition: RESORT

ObjectivesBody weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients. DesignRESORT is an observational, longitudinal cohort. Setting and ParticipantsGeriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the xxx, Australia (N = 1006). MethodsChanges in body weight and body composition (fat mass [FM], appendicular lean mass [ALM]) from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ. ResultsA total of 1006 patients (median age: 83.2 [77.7–88.8] years, 58.5% female) were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia. Conclusions and ImplicationsIn geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients’ nutritional risk.

Value of the Safety Management System (VMS) frailty instrument as a frailty screener in care for older hospital patients: a systematic review.

Dutch hospitals are required to screen older patients for the risk of developing functional decline using the Safety Management System (VMS) which assesses four domains associated with functional decline; fall risk, risk of delirium, malnutrition, and physical impairment. The aim is twofold, first to compare the VMS frailty instrument as a frailty screener with existing frailty instruments and second to provide an overview of the available evidence. We performed a literature search to identify studies that used the VMS instrument as frailty screener to asses frailty or to predict adverse health outcomes in older hospitalized patients. Pubmed, Cinahl, and Embase were searched from January 1st 2008 to December 11th 2023. Our search yielded 603 articles, of which 17 studies with heterogenous populations and settings were included. Using the VMS, frailty was scored in six different ways. The agreement between VMS and other frailty instruments ranged from 57 to 87%. The highest sensitivity and specificity of VMS for frailty were 90% and 67%, respectively. The association of the VMS with outcomes was studied in 14 studies, VMS was predictive for complications, delirium, falls, length of stay, and adverse events. Conflicting results were found for hospital (re)admission, complications, change in living situation, functional decline, and mortality. The VMS frailty instrument were studied as a frailty screening instrument in various populations and settings. The value of the VMSinstrument as a frailty screener looks promising. Our results suggest that the scoring method of the VMS could be adapted to specific requirements of settings or populations.

Factors impeding physical activity in older hospitalised patients: A qualitative meta-synthesis.

Older hospitalised patients have low levels of physical activity and multiple impairing factors. To systematically evaluate the perceived barriers to physical activity among older patients during hospitalisation, and provide reference for future intervention programs. Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations. An exhaustive exploration was conducted across the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science from their inception until August, 2023 to identify qualitative research on obstacles to physical activity among older hospital patients. The quality of the literature was evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative research. Meta-synthesis method was used to integrate the results. In total, 8 literatures were included, 43 themes were extracted, and analogous research results were amalgamated to generate 10 categories and 3 syntheses: individual level, interpersonal influencing factors and hospital environment and resources level. Older inpatients are faced with multiple barriers to physical activity. Medical staff should pay attention to changes in physical activity during hospitalisation, identify barriers to physical activity in older inpatients and provide references for promoting physical activity programs for the older. This study is a meta-synthesis and does not require relevant contributions from patients or the public. Older patients are at low physical activity levels during hospitalisation. Older inpatients are faced with multiple barriers to physical activity. Factors of physical activity impairment in hospitalised older patients should be considered in the context of health status, psychological factors, motivation and social support. Disease-induced psychological fallout has a greater impact on physical activity in the older.

More than a mouth to clean: Case studies of oral health care in an Australian hospital.

This study aimed to explore older patients' oral health status, their opinions about oral health care and their experiences with oral health care while in hospital. Improving older adults' oral health is considered an urgent priority at both the national and international levels, especially for hospitalised older patients who have been found to have poor oral health. However, a one-size-fits-all standardised approach to oral care delivery may not be the answer. This study was an embedded, multiple-case study, integrating qualitative and quantitative data. Seven patients were recruited from a geriatric ward of an acute hospital in Australia and participated in semi-structured interviews and oral health assessments using the Oral Health Assessment Tool (OHAT) in June-July 2022. Data were analysed descriptively and presented in case summaries. OHAT assessments identified oral health problems in all patients, but not all patients self-reported problems with their mouths. Each patient valued oral health care, but the reasons given varied. Patients had established, individualised oral health care routines, which they brought to hospital. Clinical observations of patient's oral health status might not match the patient's own judgement of their oral health and, if not explicitly addressed, may mask the need for oral health and hygiene intervention. Assessment and care planning needs to incorporate patients' own perceptions of their oral health and existing oral health care routines. Oral health histories may provide a means of facilitating this person-centred oral health care for older patients in hospital.

Research on COVID-19 pandemic's clinical features and risk factors for long-term hospitalizations

The authors of this study were interested in learning more about the clinical aspects of COVID-19 and risk factors associated with in-hospital mortality among older patients in hospitals due to the established association between advanced age and poor prognosis. This nationwide, multicenter, retrospective, observational study comprised patients aged 80 and up hospitalized during the COVID-19 pandemic. There had been no previous evaluation of reliance and mortality in COVID-19 pandemic patients over the age of 65, but this study indicated that it was an independent predictor. Despite greater rates of severe reliance among individuals residing in nursing homes, the study found that survival rates for the elderly in these settings were comparable to those of the elderly in their own homes. This study emphasizes the necessity of assessing the functional state of very elderly hospitalized patients having the COVID-19 pandemic and sheds light on the risk variables associated with death in this population.

Relationship between Anemia and Readmission among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study.

Readmission rates among older adults are a growing concern, and the association of readmission with anemia and the potential benefits of a systematic assessment and intervention remain unclear. This study investigated the association between anemia and readmission within 28 and 90 days in an older population. Data from 1280 patients admitted to the Department of General Medicine of Unnan City Hospital between April 2020 and December 2021 were retrospectively analyzed. Variables such as anemia status, Charlson comorbidity index (CCI) score, Functional Independence Measure (FIM) score, and dependent status were evaluated. Multivariate logistic regression was used to determine the associations between 28-day and 90-day readmissions. The average age was 84.9 years, and the prevalence of anemia was 36.4%. The readmission rates within 28 and 90 days were 10.4% and 19.1%, respectively. Anemia was significantly associated with readmission in both periods (28-day adjusted odds ratio, 2.28; 90-day adjusted odds ratio, 1.65). CCI score, FIM score, and dependent status were also identified as significant factors. Anemia is significantly associated with short- and medium-term readmissions in older patients. Addressing anemia, along with other identified factors, may help reduce readmission rates.

Effect of poor oral health status at hospital admission on in-hospital outcomes of older patients with aspiration pneumonia.

To investigate the effects of oral health status at admission on in-hospital outcomes and how it varies during hospitalization in older patients with aspiration pneumonia. This prospective cohort study involved patients aged ≥ 65 years who were admitted to an acute care hospital with a diagnosis of aspiration pneumonia. The patients' basic health information, length of hospital stay (LOS), and oral health assessment tool (OHAT), functional oral intake scale (FOIS), pneumonia severity index, and clinical frailty scale scores were recorded. Patients were divided into two groups based on their median OHAT scores, and intergroup changes were analyzed as a function of time. The relationship between the LOS, FOIS score upon discharge, and OHAT scores at admission was examined using multiple regression analysis. Of the 89 participants (52 were men, with a mean age of 84.8 ± 7.9 years), 75 were discharged. The patients' oral health was measured weekly for 3 weeks after the initial assessment via the OHAT, wherein the median score was 7, with a significant between-group difference. Moreover, OHAT scores improved within both groups throughout their stay. OHAT scores at admission were independently associated with the LOS (B = 5.51, P = 0.009). Poor oral health status at admission was associated with longer hospital stays. Both the high- and low-OHAT groups showed OHAT score improvements. Oral health status is critical in preventing the onset of and treating aspiration pneumonia.

An educative nutritional intervention supporting older hospital patients to eat sufficiently using eHealth: a mixed methods feasibility and pilot study

BackgroundInsufficient food intake is common in older hospital patients and increases the risk of readmission, mortality, and decline in functional status. To improve food intake in older patients, an eHealth solution (Food’n’Go) enabling them to participate in their own nutritional care was implemented in a hospital unit. We developed an educative nutritional intervention (ENI) to support hospitalized older adults (aged ≥ 65 years) to participate in their own nutritional care using Food’n’Go. In this study, we evaluate the feasibility of the ENI and its potential to improve nutritional intake.MethodsFeasibility was evaluated using process evaluation, and nutritional intake was examined by using a pre- and post-test design. Assessment of feasibility: Contextual factors (availability of Food’n’Go and prevalence of counseling by a dietitian); Intervention fidelity (whether patients were informed of nutrition and Food’n’Go, and whether their needs for support were assessed); and Mechanism of impact (patients’ knowledge and skills related to nutrition and the use of Food’n’Go and their acceptance of the ENI). Assessment of nutritional intake: Patients’ intake of protein and energy based on one-day observations before implementation of the ENI (pre-test; n = 65) and after a three-month intervention (post-test; n = 65).ResultsFeasibility: Food’n’Go was available for more patients after the intervention (85 vs. 64%, p = .004). Most patients managed the use of Food’n’Go and were involved in ordering their food, but only a few monitored their food intake. Information on nutrition was not provided sufficiently to all patients. In general, the ENI had high acceptability among the patients. Nutritional intake: Compared to patients in the pre-test, patients in the post-test had a higher daily mean intake of energy (kJ) (6712 (SD: 2964) vs. 5660 (SD: 2432); difference 1052 (95% CI 111–1993)), and of protein (g) (60 (SD: 28) vs. 43 (SD: 19); difference 17 (95% CI 9–26)). Likewise, there was an increase in the mean attainment of protein requirements: 73% (SD: 34) vs. 59% (SD: 29) (p = .013).ConclusionThe ENI is feasible for supporting hospitalized older adults to participate in their own nutrition using eHealth and preliminary results indicate that it may lead to an increasing energy and protein intake.

Bacterial Translocation As the Origin of Gram-Negative Rods Bloodstream Infection Among Older Patients in Rural Hospitals: A Cross-Sectional Study.

Introduction Bloodstream infections caused by Gram-negative rods are a pressing concern for the aging global population, particularly in rural settings. This study investigates the prevalence and entry pathways of Gram-negative rod bloodstream infections in elderly patients at a rural Japanese hospital, aiming to clarify the frequency and associated factors of straightforward entry and bacterial translocation. Method In this cross-sectional study, we analyzed electronic medical records of patients over 18 years of age with symptomatic Gram-negative rod bloodstream infections at Unnan City Hospital, Japan, from September 2021 to August 2023. We used multivariate logistic regression to assess factors of age, sex, body mass index, care dependency, and comorbidities. Results Among the participants who met the inclusion criteria, significant differences were observed in age, sex, inpatient status, and prevalence of conditions like respiratory diseases and cancer between the straightforward entry and bacterial translocation groups. Escherichia coli was the most common pathogen identified. Conclusion The study emphasizes the need for tailored medical approaches for elderly patients with bloodstream infections, considering their unique health profiles and risks. It highlights the importance of age, inpatient status, and cancer in determining infection risks, pointing to areas for further research to enhance infection management and healthcare outcomes in older populations.

Malnutrition Screening Tools Are Not Sensitive Enough to Identify Older Hospital Patients with Malnutrition.

This study evaluates the concurrent validity of five malnutrition screening tools to identify older hospitalized patients against the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria as limited evidence is available. The screening tools Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Mini Nutritional Assessment-Short Form (MNA-SF), and the Patient-Generated Subjective Global Assessment-Short Form (PG-SGA-SF) with cut-offs for both malnutrition (conservative) and moderate malnutrition or risk of malnutrition (liberal) were used. The concurrent validity was determined by the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the level of agreement by Cohen's kappa. In total, 356 patients were included in the analyses (median age 70 y (IQR 63-77); 54% male). The prevalence of malnutrition according to the GLIM criteria without prior screening was 42%. The conservative cut-offs showed a low-to-moderate sensitivity (32-68%) and moderate-to-high specificity (61-98%). The PPV and NPV ranged from 59 to 94% and 67-86%, respectively. The Cohen's kappa showed poor agreement (k = 0.21-0.59). The liberal cut-offs displayed a moderate-to-high sensitivity (66-89%) and a low-to-high specificity (46-95%). The agreement was fair to good (k = 0.33-0.75). The currently used screening tools vary in their capacity to identify hospitalized older patients with malnutrition. The screening process in the GLIM framework requires further consideration.

Existing malnutrition screening tools fail to identify 30-60% of malnourished older hospital patients

Existing malnutrition screening tools fail to identify 30-60% of malnourished older hospital patients

Does Case-Finding for Admission to Aged Care Rapid Investigation and Assessment Unit for Older Patients Improve Hospital Length of Stay? Evaluation of ARIA Unit.

Many older people present to emergency departments annually, often with complex geriatric syndromes, yet current acute care models and traditional admissions process may under-serve their needs. The multidisciplinary Aged Care Rapid Investigation and Assessment (ARIA) Unit seeks to bridge this gap, by actively identifying and assessing patients. A prospective case-control study was undertaken at a single-centre tertiary referral institution. Patients were eligible for inclusion in ARIA group if admitted to ARIA via case-finding by the geriatrician or Aged Care Services Emergency Team, whilst standard geriatric admissions formed the control group. This study evaluates whether ARIA reduced hospital length-of-stay (LOS) and representation rates. 370 patients were included (185 each arm) with similar baseline demographics, frailty scores, and Charlson Comorbidity Indices. Patients admitted to ARIA had significantly shorter hospital LOS than those via standard pathway (3.3 days [IQR2.2-5.8] vs 7.5 days [IQR4.2-13.7], p < 0.00001). There were no significant differences in 90-day representation rates (n = 66 [35.7%] vs n = 64 [34.6%], p = 0.82). Introduction of an ARIA unit with a targeted approach to frontline geriatric services and case-finding is associated with improved LOS of older acute hospital patients. An economical cost analysis of this study would be beneficial in exploring potential financial savings.

Facing uncertainty - Pilot testing of a palliative prognostic index training with hospital aged care assessment teams

BackgroundPrognostic avoidance can delay discussions about older hospital patients’ life expectancy. This pilot study examined the effects of a prognostic training program on hospital clinicians’ knowledge and confidence in identifying older patients at risk of dying. MethodsFifty-seven clinicians from aged care assessment teams at two Australian hospitals were introduced to the Palliative Prognostic Index, a 5-item checklist indicating prognoses between 3 and 6 weeks. Mixed-methods training evaluation included pre-post-training surveys and semi-structured interviews, conducted three months post-training. ResultsClinicians used a combination of experience, knowledge, and intuition as strategies to generate prognoses. Allied health staff relied on intuition more often than medical and nursing staff. Prognostic tools were rarely used. Pre-post-training comparisons showed significant improvements in clinicians’ knowledge and confidence in identifying signs of dying, particularly amongst allied health. Follow-up interviews highlighted advantages and challenges of using prognostic tools. Recommendations are made for addressing these.

Older high-cost patients in Norwegian somatic hospitals: a register-based study of patient characteristics

ObjectiveTwo-thirds of the economic resources in Norwegian hospitals are used on 10% of the patients. Most of these high-cost patients are older adults, which experience more unplanned hospital admissions, longer...

Drug-related problems in older adults in outpatient settings: Results from a 6-year long prospective study in a tertiary hospital of north India.

Drug-related problems (DRPs) are a common cause of hospitalization in older patients. So far, these issues have been studied in hospitalized settings, and evidence on patterns and outcomes of DRPs, such as adverse drug reactions, is relatively scarce in older outpatients. The main aim of this study was to provide a comprehensive description and possible solutions for DRPs in older adults in outpatient settings. The study was carried out from January 2015 to September 2021 in a tertiary hospital in north India. Patients aged ≥50 years with DRPs were enrolled. DRPs causing hospitalization, drug interactions and drug-disease interactions were identified, along with preventive measures. Of 10 400 patients registered, 1031 DRPs occurred in 666 patients (9.9%). Adverse drug reactions were the major DRPs (n = 933, 8.9%). Metabolic disorders were the commonest DRP in individuals aged ≥65 years compared with gastrointestinal disorders in the 50-64 years group. Drug interactions and drug-disease interactions contributed to 20.1% and 7.9% of patients, respectively. Nearly 15.8% of DRPs directly led to hospitalization, with drug-induced metabolic disturbances and movement disorders as the common causes. The Naranjo scale was not applicable in 35.3% of patients, and drug interactions were the commonest cause. Frequent monitoring, omission of unnecessary drugs, slow titration and proper instructions on therapy, together, could avoid one-third of DRPs. One out of 10 prescriptions of older outpatients carries a DRP. New-onset metabolic and neurological disturbances should prompt a thorough drug history. A multifaceted holistic approach can prevent significant drug-related morbidity and requires future evaluation. Geriatr Gerontol Int 2024; 24: 285-291.

Association between worsening renal function severity during hospitalization and low physical function at discharge: a retrospective cohort study of older patients with heart failure and chronic kidney disease from Japan.

The number of hospitalized older patients with chronic heart failure, chronic kidney disease, and worsening renal function is rising in Japan. This study aimed to clarify the impact of the severity of worsening renal function during hospitalization on low physical function at discharge of these patients. We included 573 consecutive heart failure patients who underwent phase I cardiac rehabilitation. Worsening renal function severity was defined according to elevation during hospitalization of baseline serum creatinine on admission: non-worsening renal function, serum creatinine < 0.2mg/dL; worsening renal function II/I, serum creatinine ≥ 0.2 to < 0.5mg/dL; worsening renal function III, and serum creatinine ≥ 0.5mL/dL. Physical function was measured with the Short Performance Physical Battery. We compared background factors, clinical parameters, pre-hospitalization walking levels, Functional Independence Measure score, and physical function in the three renal function groups. Multiple regression analysis was performed with the Short Performance Physical Battery at discharge as the dependent variable. The final analysis included 196 patients (mean age 82.7years, male 51.5%) categorized into three groups based on worsening renal function: worsening renal function grade III group (n = 55), worsening renal function grade II/I group (n = 36), and non-worsening renal function group (n = 105). There is no significant difference in walking levels before hospitalization between the three groups, but physical function at discharge was significantly lower in the worsening renal function III group. Moreover, worsening renal function III was an independent factor for low physical function at discharge. Worsening of renal function during hospitalization in older patients with heart failure and chronic kidney disease was strongly associated with low physical function at discharge, even after adjusting for other potentially confounding factors, such as pre-hospitalization walking levels, walking start day, and Geriatric Nutrition Risk Index at discharge. Notably, worsening renal function of mild or moderate severity (grade II/I) did not show a significant association with low physical function.

Nurses’ discursive construction of older adult immigrant patients in hospitals

BackgroundThe immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses.MethodsAn exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses’ narratives were analysed using critical discourse analysis (CDA) as described by Fairclough.ResultsThe analysis identified an overarching, stable, and dominant discursive practice; ‘The discourse of the other’, with three interdiscursive practices: (1) ‘The discourse on the immigrant patient versus an ideal patient’; (2) ‘The expert discourse’; and (3) ‘The discourse of adaption’. Older immigrant adults were constructed as ‘othered’ patients, they were different, alienated, and ‘they’ were not like ‘us’.ConclusionThe way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient’s autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses’ norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as ‘othered’, have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient’s wishes.

Struggling to Restore Oneself as a Unique Human Being: Dignity in Older Hospital Patients—A Hermeneutic Study

This study aims to gain a deeper understanding of what dignity is for older people cared for in a hospital. Old age is one stage in life where dignity might be threatened during hospitalization. This study is rooted in the theoretical perspective of caring and caring science. The overall methodology is the hermeneutical philosophy of understanding as outlined by Hans-Georg Gadamer. The interpretation revealed the patients’ struggle between death and life, and the struggle between being dignified and being violated. Being old and hospitalized entail a struggle in standing on one’s dignity.

Absorbent incontinence pad use and the association with urinary tract infection and frailty: A retrospective cohort study

BackgroundUp to 40% of adults over 65 years are full-time users of absorbent incontinence pads due to urinary incontinence. Simultaneously, urinary tract infection is amongst the most common hospital-acquired infection in older patients. ObjectivesTo explore the association between (1) full-time use of absorbent incontinence pads and urinary tract infection at acute hospital admission, (2) state of frailty and becoming a pad user during hospitalization, and (3) becoming a pad user and acquiring a urinary tract infection during hospitalization in older patients. DesignA retrospective cohort study. SettingAdmissions in an emergency department with transfers to geriatric, cardiac, infectious, or endocrinological wards from September 7th, 2017 to February 18th, 2019. Patients1,958 patients aged 65 years or more, having daily homecare or moderate comorbidity, hospitalized due to acute illness, and living in the municipality of Aarhus. MethodsThe study was conducted by two researchers reviewing the patients' electronic health records combined with data on frailty status from a geriatric quality database. In the electronic health records, data on baseline characteristics, absorbent incontinence pad use at admission and during the hospital stay, and urinary tract infection were obtained. ResultsFull-time users of absorbent incontinence pads had a higher probability of being admitted with urinary tract infection (Odds Ratio=2.00 (95% Confidence Interval: 1.61–2.49); p<.001). Patients identified as severely frail had a higher probability of becoming pad users during hospitalization (Odds Ratio=1.57 (95% Confidence Interval: 1.45–1.71); p<.001) compared to non/mild/moderate frail patients. Patients who became pad users during hospitalization had a higher risk of a hospital-acquired urinary tract infection (Odds Ratio=4.28 (95% Confidence Interval: 1.92–9.52); p<.001). ConclusionsThere was an association between the use of absorbent incontinence pads and the development of urinary tract infections in older hospitalized patients, both in full-time users and those who were frail and became pad users during hospitalization. These findings emphasize the need for further research on preventing urinary tract infections and unnecessary pad use in older patients.

Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies

Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies Abstract: Older patients face an increased risk of complications and adverse outcomes during and after operations, interventions, and intense oncological therapies. At the same time, this patient group should not be excluded per se from potentially beneficial medical procedures based on chronological age alone. The timely identification of geriatric syndromes and increased vulnerability by means of comprehensive geriatric assessment is becoming increasingly important and is already recommended in the guidelines of professional societies of several medical disciplines. Nonetheless, the geriatric assessment should ideally be followed by proactive co-management in the sense of integrated care. The establishment of interdisciplinary and integrated care pathways for older hospital patients can contribute to significantly improved treatment outcomes. In addition to better patient-related outcomes and rising quality indicators, this approach may also offer positive health economic effects.