Impairment In Older Patients Research Articles

A - 2 Risk Factors for Reduced Mobility and Falls in Older Adults: the Role of Medication Use and Cognitive Impairment

Abstract Objective Sedative and anticholinergic (AC) medication use and cognitive impairment impose risk of gait imbalance and falls in older adults, but their combined effects on mobility have not been assessed. Method This cross-sectional study of 392 outpatients (age = 72 ± 7.7; 60.5%women; 93%White; education = 14 ± 3 years) characterized AC use (Anticholinergic Cognitive Burden Scale [ACB]) and number of sedative medications. Balance confidence (Activities-specific Balance Confidence Scale), walking decline compared to 5 years prior (0–3 scale), and recurrent falls (dichotomized by ≥2) were self-reported. Neuropsychological performance was averaged into a norm-adjusted composite (COG). T-tests and Pearson correlations assessed bivariate relationships across medication use, COG, and mobility. Multivariate models regressed falls, balance confidence, and gait changes (in separate models) on COG and medication use (ACs and sedatives examined separately), controlling for covariates. Results Most patients (70%–85%) used ≥1 sedative or AC medication. Few (12%) reported recurrent falls (range = 0–30), but balance confidence was reduced (M = 77.68 ± 21.31%) with mild walking declines reported (M = 1.34 ± 1.03). More sedative medication use and higher ACB scores were bivariately related to worse COG and mobility, and stronger COG was associated with better mobility (p’s ≤ 0.004). Worse COG (β = 0.196, p = 0.002) and more medication use, both sedatives (β = −0.246, p = 0.002) and ACB (β = −0.147, p = 0.047), independently predicted worse balance confidence. Higher ACB (β = 0.182, p = 0.022) and worse COG (β = −0.193, p = 0.007) uniquely predicted walking decline. Each sedative medication increased odds of falls by 27.4% (adjOR = 1.274, p = 0.034). Conclusion AC/sedative medication use and cognitive impairment pose complementary risks for compromised mobility. Clinicians should be alert to AC/sedative use and cognitive impairment in older patients at risk of falls.

Depressive symptom mediates the association between the number of chronic diseases and cognitive impairment: a multi-center cross-sectional study based on community older adults.

The purpose of this study was to understand the relationship between the multiple chronic conditions (MCC), mental health and cognitive function of older adults in the community, and to propose a hypothesis that depressive symptom mediate the number of chronic diseases and cognitive impairment in older adults. Participants aged 65 years and older from 35 communities in 14 cities in Guangxi, China were recruited. The residents' depressive symptom (PHQ-9) and cognitive status (AD-8) were evaluated, Chi-square test was used to explore the effects of different socio-demographic characteristics on depressive symptom and cognitive impairment. Pearson correlation analysis and the process model 4 were used to explore the relationship between the number of chronic diseases, depressive symptom and cognitive impairment. A total of 11,582 older adults were included in our analysis. The rate of MCC reaching 26.53%. Hypertension combined with diabetes accounts for the highest proportion of two chronic diseases (13.2%). Among the combination of three chronic diseases, the highest incidence of coexisting hypertension combined with cervical/lumbar spondylosis, and rheumatoid arthritis (7.1%). In this study, depression symptoms accounted for 12.9% of older adults aged 65 and above, and cognitive impairment accounted for 27.4%. Female, older age, reside in urban areas, lower educational levels, no spouse, live alone, and MCC were risk factors for depressive symptom and cognitive impairment in older adults (P<0.05). Depressive symptom had a mediating effect in the number of chronic diseases and cognitive impairment, and the mediating effect (1.109) accounted for 44.13% of the total effect (0.247). The mental health of the older adult needs to be taken seriously, and improving depressive symptom can reduce the occurrence of cognitive impairment in older patients with MCC to a certain extent.

Validity of the MoCA as a cognitive screening tool in epilepsy: Are there implications for global care and research?

This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) as the gold standard. Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC-CoDE taxonomy divided participants into IC-CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests. IC-CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336-2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency. This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed. The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood.

Association Between Epilepsy Characteristics and Cognitive Impairment in Older Patients with Epilepsy (P2-9.006)

Association Between Epilepsy Characteristics and Cognitive Impairment in Older Patients with Epilepsy (P2-9.006)

The diagnostic accuracy of the Mini-Cog screening tool for the detection of cognitive impairment-A systematic review and meta-analysis.

The Mini-Cog is a rapid screening tool that can be administered to older adults to detect cognitive impairment (CI); however, the accuracy of the Mini-Cog to detect CI for older patients in various healthcare settings is unclear. To evaluate the diagnostic accuracy of the Mini-Cog to screen for cognitive impairment in older patients across different healthcare settings. We searched nine electronic databases (including MEDLINE, Embase) from inception to January 2023. We included studies with patients ≥60 years old undergoing screening for cognitive impairment using the Mini-Cog across all healthcare settings. A cut-off of ≤ 2/5 was used to classify dementia, mild cognitive impairment (MCI), and cognitive impairment (defined as either MCI or dementia) across various settings. The diagnostic accuracy of the Mini-Cog was assessed against gold standard references such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). A bivariate random-effects model was used to estimate accuracy and diagnostic ability. The risk of bias was assessed using QUADAS-2 criteria. The systematic search resulted in 4,265 articles and 14 studies were included for analysis. To detect dementia (six studies, n = 4772), the Mini-Cog showed 76% sensitivity and 83% specificity. To detect MCI (two studies, n = 270), it showed 84% sensitivity and 79% specificity. To detect CI (eight studies, n = 2152), it had 67% sensitivity and 83% specificity. In the primary care setting, to detect either MCI, dementia, or CI (eight studies, n = 5620), the Mini-Cog demonstrated 73% sensitivity and 84% specificity. Within the secondary care setting (seven studies, n = 1499), the Mini-Cog to detect MCI, dementia or CI demonstrated 73% sensitivity and 76% specificity. A high or unclear risk of bias persisted in the patient selection and timing domain. The Mini-Cog is a quick and freely available screening tool and has high sensitivity and specificity to screen for CI in older adults across various healthcare settings. It is a practical screening tool for use in time-sensitive and resource-limited healthcare settings.

Psychosocial Impairment in Older Patients With Bipolar I Disorder.

The goal of this study was to assess psychosocial functioning in older patients with bipolar I disorder compared with healthy subjects and to identify the psychopathological factors associated with poor functioning in patients. We recruited 68 euthymic patients with bipolar I disorder from the outpatient unit and 89 healthy controls who were older than 50 years of age. In addition to clinical variables, we used other standardized measures, including the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment Short Test, and the Montreal Cognitive Assessment. Older patients with bipolar I disorder had poorer psychosocial functioning in general and in the domains of occupation, autonomy, and cognition than the healthy controls on the basis of previously defined Functional Assessment Short Test cutoff scores. We found that 35.3% (95% CI: 23%-47%) of the patients did not have clinically significant functional impairment, 38.2% (95% CI: 26%-50%) had mild impairment, and 26.5% (95% CI: 16%-37%) had moderate impairment. Depressive symptoms and impaired cognition were associated with poor overall functioning. The level of psychosocial functioning was heterogeneous among the patients. Subsyndromal depressive symptoms, even at low levels, and impaired cognition predicted poor functioning in euthymic middle-aged and older patients with bipolar I disorder.

2015 Identifying and Managing Visual Impairment in Older Patients with Falls on a Care of the Elderly (COTE) ward

Abstract Introduction In 2019, the Royal College of Physicians (RCP) advised that all patients should have their vision screened if identified as a falls risk. Our aim was to implement a bedside visual screening test and establish an onward inpatient referral to Hospital Eye Services (HES). Method This is a collaborative Quality Improvement project involving Geriatric Medicine, HES and the Royal National Institute of Blind People (RNIB). A pilot study cross referenced falls admissions with previous known ophthalmic data to estimate the proportion of known vision loss in this group. In the second phase of the project, a bedside visual screening test has been introduced for all patients admitted to COTE with a fall. Patients failing the screening are reviewed by an RNIB Eye Clinic Liaison Officer (ECLO) and if necessary, a prompt inpatient HES review is arranged. Results Of 182 patients admitted following a fall, in the pilot study, 112 (61%) were known to ophthalmology previously. Of patients known to ophthalmology, 28 (25%) had vision of 6/18 or worse and would be considered to struggle with daily living tasks. 12 (10%) had a certificate of visual impairment (CVI) and 3 (3%) were eligible for CVI but had not been previously registered. One year following implementation of bedside vision testing, 287 patients had been reviewed after failing bedside screening. 97 of these had an onward referral sent or an intervention performed. The first ‘COTE ECLO’ post has been funded as a result of this work. Conclusion Assessing vision is a critical element of the assessment of patients with falls. Through collaboration with the RNIB and Ophthalmology a successful pathway has been developed to address visual impairment in this vulnerable group of patients.

Knowledge and practice regarding frailty and cognitive impairment in older patients - a survey of surgical unit staff.

Knowledge and practice regarding frailty and cognitive impairment in older patients - a survey of surgical unit staff.

Utility of the Comprehensive Trail Making Test in the Assessment of Mild Cognitive Impairment in Older Patients.

The purpose of this study is to determine the usefulness of the CTMT (Comprehensive Trail Making Test) in diagnosing mild cognitive impairment in older patients. The test is used to assess executive functions, of which impairment is already observed in the early stages of the neurodegenerative process. The study includes 98 patients of a geriatric ward assigned to 2 groups of 49 patients each: patients diagnosed with a mild cognitive impairment and patients without a cognitive impairment, constituting the control group (group K). A set of screening tests was used in the initial study: the MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), and CDT (Clock Drawing Test), GDS (Geriatric Depression Scale). The second study included the performance of the CTMT; the performance indicator was the time of performance. Statistically significant differences are obtained between patients with mild cognitive impairments and those in cognitive normality in the performance of the CTMT test (p < 0.01). Patients with MCIs took longer to complete all trails of the test. To identify cognitive impairment, cutoff points were proposed for the CTMT total score and the other test trails. The CTMT overall score and CTMT 5 scored the highest AUCs (CTMT overall score = 0.77, CTMT Trail 5 = 0.80). The Comprehensive Trail Making Test may be useful in diagnosing mild cognitive impairment as a complementary screening tool.

Factors which Influence the Frequency of Cognitive Assessment in the Emergency Department.

The practice of safe emergency medicine requires accurate and adequate assessments. However, screening for cognitive deficits is not performed regularly in the emergency department (ED). This study aimed to determine factors influencing the frequency of cognitive testing by ED doctors. This study included all doctors working in the EDs of three teaching hospitals. A 17-item online survey instrument that collected information on sex, experience, perceived prevalence, perception, and practice of cognitive assessment was distributed through electronic mail and data messaging services. Of the 210 participants, 72 were male. The estimated mean with standard deviation prevalence of cognitive impairment in older patients in the ED was 39.5%±19.7%. Among the participating ED doctors, 75.8% performed cognitive testing up to 10% of the time. Moreover, the participants ranked cognitive impairment the lowest compared to the other four chronic conditions in terms of its impact on hospitalization outcomes. Multiple linear regression revealed that the doctors' perceptions of the responsible personnel and the importance of cognitive testing, as well as their lack of expertise, were independently associated with the frequency of testing. Lack of expertise, perception of the importance of cognitive testing, and lack of consensus on which discipline is responsible for performing cognitive testing in older patients in the ED were the limiting factors in performing cognitive testing in the ED. Improving perception and awareness of the importance of cognitive assessment as a screening tool could improve the detection and overall management of older patients.

Cognitive impairment and outcomes in older adults with non-ST-elevation acute coronary syndrome

ObjectiveThis study aimed to explore the prognostic impact of cognitive impairment on the long-term risk of major adverse cardiovascular events (MACEs) in older patients with non-ST-elevation acute coronary syndrome (NSTEACS)...

Dietary fiber intake and cognitive impairment in older patients with chronic kidney disease in the United States: A cross-sectional study.

High-fiber diet has been associated with better cognitive performance. However, the association between dietary fiber intake and cognition in older patients with chronic kidney disease (CKD) remains unknown. Hence, this study aimed to investigate the effect of dietary fiber intake on cognition in older patients with CKD. This study included participants aged ≥60 years who provided data on social demography, cognitive tests (Consortium to Establish a Registry for Alzheimer's disease Word Learning [CERAD-WL], CERAD Delayed Recall [CERAD-DR], Animal Fluency Test [AFT], and Digit Symbol Substitution Test [DSST]), diet, and other potential cognition-related variables from the National Health and Nutrition Examination Survey 2011-2014. Fully-adjusted multivariate logistic regression subgroup models were performed, and multiple linear regression analyses were employed to examine the association between dietary fiber intake and cognition in patients with CKD. A total of 2461 older adults were included, with 32% who suffered from CKD. Participants with CKD scored lower in CERAD-WL, CERAD-DR, AFT, and DSST. Patients with CKD consuming low dietary fiber (≤25 g/day) had a higher risk of CERAD-WL and DSST impairments. High dietary fiber intake eliminated the differences in CERAD-WL and DSST impairments between the CKD and non-CKD participants. However, no associations were observed between CKD and CERAD-DR and AFT impairments regardless of dietary fiber intake. A positive linear relationship between dietary fiber intake and AFT score was observed in older patients with CKD. High dietary fiber intake may benefit cognitive function in older patients with CKD. High-fiber diet management strategies could potentially mitigate cognitive impairment in this group of patients.

Association of Temporalis Muscle Mass with Early Cognitive Impairment in Older Patients with Acute Ischemic Stroke.

The prognostic value of temporal muscle mass has been studied in various neurological disorders. Herein, we investigated the association between temporal muscle mass and early cognitive function in patients with acute ischemic stroke. This study included 126 patients with acute cerebral infarction aged ≥65 years. Temporal muscle thickness (TMT) was measured using T2-weighted brain magnetic resonance imaging at admission for acute stroke. Within 2 weeks of stroke onset, skeletal mass index (SMI) and cognitive function were assessed using bioelectrical impedance analysis and the Korean version of the Montreal Cognitive Assessment (MoCA), respectively. Pearson's correlation analyzed the correlation between TMT and SMI, and multiple linear regression analyzed independent predictors of early post-stroke cognitive function. TMT and SMI were significantly positively correlated (R = 0.36, p < 0.001). After adjusting for covariates, TMT was an independent predictor of early post-stroke cognitive function, stratified by the MoCA score (β = 1.040, p = 0.017), age (β = -0.27, p = 0.006), stroke severity (β = -0.298, p = 0.007), and education level (β = 0.38, p = 0.008). TMT may be used as a surrogate marker for evaluating skeletal muscle mass because it is significantly associated with post-stroke cognitive function during the acute phase of ischemic stroke; therefore, TMT may help detect older patients at a high risk of early post-stroke cognitive impairment.

Exercise and epigenetic ages in older adults with myeloid malignancies

BackgroundOlder adults with myeloid malignancies are susceptible to treatment-related toxicities. Accelerated DNAm age, or the difference between DNA methylation (DNAm) age and chronological age, may be used as a biomarker of biological age to predict individuals at risk. In addition, cancer treatment can also lead to accelerated DNAm age. Exercise is a promising intervention to reduce or prevent functional, psychological, and cognitive impairments in older patients with myeloid malignancies, yet there is little evidence of the effects of exercise on DNAm age. We explored (1) the associations of accelerated DNAm age with physical, psychological, and cognitive functions at baseline; (2) changes in DNAm age from baseline to post-intervention; and (3) the associations of changes in accelerated DNAm age with changes in functions from baseline to post-intervention.MethodsWe enrolled older patients with myeloid malignancies to a single-arm pilot study testing a mobile health (mHealth) exercise intervention that combines an exercise program (EXCAP©®) with a mobile application over 2 cycles of chemotherapy (8–12 weeks). Patients completed measures of physical, psychological, and cognitive functions and provided blood samples for analyses of DNAm age at baseline and post-intervention. Paired t-tests or Wilcoxon signed rank tests assessed changes in DNAm ages, and Spearman’s correlation assessed the relationships between accelerated ages and functions.ResultsWe included 20 patients (mean age: 72 years, range 62–80). Accelerated GrimAge, accelerated PhenoAge, and DunedinPACE were stable from baseline to post-intervention. At baseline, DunedinPACE was correlated with worse grip strength (r = -0.41, p = 0.08). From baseline to post-intervention, decreases in accelerated GrimAge (r = -0.50, p = 0.02), accelerated PhenoAge (r = − 0.39, p = 0.09), and DunedinPace (r = − 0.43, p = 0.06) were correlated with increases in distance walked on 6-min walk test. Decreases in accelerated GrimAge (r = − 0.49, p = 0.03), accelerated PhenoAge (r = − 0.40, p = 0.08), and DunedinPace (r = − 0.41, p = 0.07) were correlated with increases in in grip strength.ConclusionsAmong older adults with myeloid malignancies receiving chemotherapy, GrimAge and PhenoAge on average are stable after a mHealth exercise intervention. Decreases in accelerated GrimAge, accelerated PhenoAge, and DunedinPACE over 8–12 weeks of exercise were correlated with increased physical performance. Future trials assessing the effects of exercise on treatment-related toxicities should evaluate DNAm age.Trial registration Clinicaltrials.gov identifier: NCT04981821.

Dietary sodium/potassium intake and cognitive impairment in older patients with hypertension: Data from NHANES 2011-2014.

This study aimed to assess the relationship between dietary sodium/potassium intake and cognition in elderly individuals with hypertension. We designed a cross-sectional study based on the 2011-2014 National Health and Nutrition Examination Survey (NHANES) 2011-2014. A multivariable-logistic regression analysis was performed to analyze the relationship between sodium/potassium intake and cognitive impairment. Restricted cubic spline (RCS) based on regression analysis to assess the nonlinear dose-response relationship between dietary sodium intake and cognitive performance. Out of the 2276 participants included in this study, 1670 patients had hypertension. Compared with the lowest quartile of dietary sodium intake, the lowest weighted odds ratio of cognitive impairment in DSST was observed in Q4 (OR=0.45, 0.29-0.70), and a similar trend was observed in AFT (OR=0.34, 0.18-0.65). After adjusting the covariates, the lowest weighted multivariable-adjusted OR of cognitive impairment in DSST were also observed in Q4 (OR=0.47, 0.26-0.84) compared with the lowest quartile of dietary sodium intake. The RCS results showed that dietary sodium intake was U-shaped and associated with the risk of cognitive impairment in the DSST (Pnon-linearity =0.0067). In addition, no significant association was observed between dietary potassium intake and different dimensions of cognitive performance. In conclusion, excessively high and low low dietary sodium were associated with impairment of specific processing speed, sustained attention, and working memory for elderly patients with hypertension in the United States. However, no association was observed between dietary potassium intake and cognition.

Nephrology-tailored geriatric assessment as decision-making tool in kidney failure.

Dialysis might not benefit all older patients with kidney failure, particularly those with multimorbid conditions and frailty. Patients' and healthcare professionals' awareness of the presence of geriatric impairments could improve outcomes by tailoring treatment plans and decisions for individual patients. We aimed to explore the perspectives of patients and healthcare professionals on nephrology-tailored geriatric assessment to fuel decision-making for treatment choices in older patients with kidney failure. In an exploratory qualitative study using focus groups, participants discussed perspectives on the use and value of nephrology-tailored geriatric assessment for the decision-making process to start or forego dialysis. Patients (n = 18) with kidney failure, caregivers (n = 4), and professionals (n = 25) were purposively sampled from 10 hospitals. Interviews were audio-recorded, transcribed verbatim and inductively analysed using thematic analysis. Three main themes emerged that supported or impeded decision-making in kidney failure: (1) patient psycho-social situation; (2) patient-related factors on modality choice; (3) organisation of health care. Patients reported feeling vulnerable due to multiple chronic conditions, old age, experienced losses in life and their willingness to trade longevity for quality of life. Professionals recognised the added value of nephrology-tailored geriatric assessment in three major themes: (i) facilitating continual holistic assessment, (ii) filling the knowledge gap, and (iii) uncovering important patient characteristics. nephrology-tailored geriatric assessment was perceived as a valuable tool to identify geriatric impairments in older patients with kidney failure. Integration of its outcomes can facilitate a more holistic approach to inform choices and decisions about kidney replacement therapy.

Preliminary study of assessing cognitive impairment in older patients with chronic obstructive pulmonary disease by using a cognitive functional assessment tool via a touchscreen personal computer.

Unique cognitive impairments related to chronic obstructive pulmonary diseases (COPD) have been increasingly reported. Considering the dementia risk and medication management, older patients with COPD should be evaluated for cognitive impairment. This study aimed to examine whether specific cognitive impairments related to COPD could be detected by an assessment tool using a touchscreen personal computer (PC) in older patients with COPD. This study included 28 older male patients with COPD and 30 healthy older male individuals. A touchscreen PC-based cognitive assessment application called CogEvo was used to assess and compare the cognitive function according to five domains: spatial cognition, orientation, working memory, executive function, and attention. Analysis of variance showed an interaction effect on the indices of cognitive function based on five domains between the two groups, indicating differences in the characteristics of cognitive function in such groups. Betweengroup comparisons as a subtest showed that attention, executive function, and working memory were significantly lower in the COPD group than in the healthy group. CogEvo can detect specific cognitive impairments associated with COPD, suggesting that it can be potentially used as a screening tool for cognitive impairment in older patients with COPD.

Predictors of everyday functional impairment in older patients with schizophrenia: A cross-sectional study.

This study investigates the prevalence of everyday functional impairment among older adults with schizophrenia and builds a predictive model of functional decline. A total of 113 hospitalized older patients enrolled in this study. Functional impairment is defined according to the Functional Activities Questionnaire (FAQ). Patients who scored <9 could function independently daily, while those who scored ≥9 had problems in everyday functional activities. Data collected include sociodemographic characteristics, depressive symptoms, social support, and physical comorbidities, which were classified according to the eight anatomical systems of the human body. The sample comprised 75% female participants with a mean age of 63.74 ± 7.42 years old. A total of 33.6% had a functional impairment, while cognitive impairment was present in 63.7%. Independent participants had better urinary system and respiratory system health (P < 0.05). After adjusting for the potential confounders of age, disease course, physical comorbidities, psychiatric symptoms, the ability to independently carry out daily activities, and cognitive function, we found that impaired everyday function is associated with poor cognition, depressive symptoms, first admission, psychiatric symptoms (especially positive symptoms), ADL, and respiratory and urinary system diseases. Everyday functional capacity is predicted by disease course, admission time, cognition, depressive symptoms, severity of psychosis, ability to carry out daily activities, and respiratory and urinary system health status. Urinary system diseases contribute significantly to the prediction of impaired function. Future studies should focus on health status, drug use, and everyday functional recovery in older patients with schizophrenia.

Cognitive impairment in the elderly patient with symptomatic severe aortic stenosis. Therapeutic decisions and impact on one-year mortality

Interventional treatment of severe aortic stenosis includes valve replacement by surgery or transcatheter - transcatheter aortic valve implantation (TAVI). In order to make an adequate selection and to rule out patients with little/no therapeutic benefit, it is recommended to assess comorbidities, frailty and cognitive impairment. a) To determine the prevalence of cognitive impairment in older patients with severe aortic stenosis; b) to analyse its influence on decision-making (surgery, TAVI or conservative treatment); and c) to analyse its impact on mortality at one year. Prospective, longitudinal epidemiological study of patients aged 75 years and older with severe aortic stenosis treated by the Heart-Team. sociodemographic, clinical, cardiological, functional and mental variables; cognitive impairment assessed by applying the Mini-Mental State Examination (MMSE). We included 300 patients in the study (83.99 ± 4.02 years old; 61.2%, women). Prevalence of cognitive impairment of 15.3%, which was associated with albumin level - odds ratio (OR): 0.082; p = 0.011 - and Barthel (OR: 0.962; p = 0.02) and Lawton (OR: 0.787; p = 0.025) index scores. Surgery was chosen in 24.7% of cases; TAVI in 63.3%; and conservative treatment in 12%. This decision was associated with the score on the Barthel (OR: 0.93; p = 0.012) and Lawton indices (OR: 0.678; p = 0.014), the Short Physical Performance Battery (OR: 0.75; p = 0.037) and the MMSE (OR: 0.691; p < 0.001). Mortality at one year was 14%, and higher in patients with MMSE scores <24 (23.5% vs. 12.8%; p = 0.094). Cognitive impairment is a very common geriatric syndrome in older patients with severe aortic stenosis that is associated with functional disability in activities of daily living. Cognitive impairment has a high impact on decision-making and appears to be a variable associated with increased mortality.

MO928: Patients’ and Healthcare Professionals’ Perspectives on Nephrogeriatric Assessment as Shared Decision Making Tool for Older Patients With Kidney Failure: A Qualitative Study

Abstract BACKGROUND AND AIMS Dialysis might not benefit all older patients with kidney failure, particularly those with multi-morbid conditions and frailty. Awareness of the presence of geriatric impairments has the potential to improve outcomes by tailoring treatment plans and decisions for individual patients. Geriatric assessment has been recommended in guidelines to support shared decision making (SDM) in older patients with kidney failure. We aimed to describe the perspectives of patients and healthcare professionals on the Nephro-Geriatric Assessment (NGA) as a SDM tool for treatment choice in older patients approaching kidney failure (eGFR)&amp;lt;20 mL/min/1.73 m2). METHOD Patients (N = 18) with kidney failure, caregivers (N = 4) and professionals (N = 25) were purposively sampled from three university medical centre initiatives and seven regional hospitals from different provinces in the Netherlands. Six semi-structured focus groups were held to discuss participants’ experiences with and perspectives on NGA as an aid to SDM in their choices to start or forego dialysis. Transcripts were analysed inductively using thematic analysis. RESULTS Professionals reported that NGA, performed prior to SDM about kidney replacement therapy (KRT), creates awareness of patients’ possibilities but also of their limitations. Somatic frailty is unearthed alongside in-depth knowledge about patients’ social system and psychological wellbeing––information they consider vital for good quality SDM relative to KRT. Professionals reported NGA as being a valuable tool to initiate discussions on treatment decisions and patient goals, and improve awareness to (re)consider different treatment options. Although patients and caregivers had positive attitudes towards NGA, they were mostly unaware of the purpose and role that NGA could play in SDM about KRT. Several interconnecting themes, which could facilitate or hinder SDM in kidney failure were identified and grouped under three main themes: (1) patient psycho-social situation: social support system and who influences decisions (e.g. choosing to dialyze due to family pressure), trusting patient–professional relationships, patient emotions (e.g. anxiety about being a burden to family and society), quality of life and life goals; (2) on modality choice: medical history and frailty, patient character and attitudes (e.g. an optimistic or pessimistic view of life), health-related information and education, continual assessment of situation; (3) organization of health care: multidisciplinary approach, consultation with geriatrician, early referral to kidney failure care and consultation time. CONCLUSION Professionals confirmed the benefits of NGA as a tool to identify geriatric impairments in older patients approaching kidney failure and how integration of its outcomes can facilitate a more holistic approach to inform choices about KRT based on patient values, expectations and goals. Recognition of supporting factors and resolution of impeding factors to SDM about KRT can be beneficial for good SDM. Our study underscores the importance of clear patient–professional communication. Conducting NGA provides anchors to include information on geriatric impairments, which is potentially valuable for the prevention of decisional regret.