Non-geriatric Population Research Articles

Routine documentation of pre-treatment functional variables to predict survival in patients on immunotherapy.

e14701 Background: Medical providers often describe concerns about a patient’s functional status in routine clinical documentation (e.g., hard of hearing, recent falls, difficulty with home medication). These clinician-documented pretreatment functional variables (PFVs) may be predictive of outcomes among patients receiving immunotherapy. The goal of this retrospective study is to check for an association between the documentation of PFVs with overall survival (OS), progression-free survival (PFS), and the incidence of immune-related adverse events (irAEs). Methods: We created a retrospective registry of all patients who received at least one dose of an immune checkpoint inhibitor for any indication between 2/1/2011 and 4/7/2022 at a comprehensive cancer center. The investigators created a validated REDCap registry; clinical research specialist at Vasta Global captured most data. PFVs were collected by review of routine clinical documentation 30 days before or after the first dose. Patients were stratified by their number of PFVs (0,1, or 2+) and by their age (≥ or <65 years). PFVs assessed function, nutritional status and social support and were dichotomized to indicate impaired vs not with ten total categories. We used Cox proportional hazard modeling for survival analyses between the three PFV groups, calculated from the first dose of immunotherapy to disease progression, death, and last known follow-up controlling for age, BMI, smoking, and disease type with a two-sided alpha of 0.05. Results: From the overall cohort (n = 3,101), 35% had no PFVs, 32% had one PFV, and 32% had two or more PFVs; 52.5% were considered younger, and 47.5% geriatric-aged (≥65yo). PFVs were more common among the geriatric-aged population (mean 1.43 vs 0.89). The most common cancer types were lung cancer (45%), melanoma (14%), and kidney (6%). The most noted PFVs were visual impairment (26%), unintentional weight loss (22%), inability to walk a quarter block (17%), living alone (16%), and falls (14%). In the overall population, an increasing number of PFVs was associated with shorter OS. When stratified by age, the number of PFVs was associated with shorter progression-free survival (p <0.01) and overall survival (p <0.01) among the geriatric and non-geriatric populations (Table). There was no association between increasing PFVs and incidence of irAEs. Conclusions: Although often considered to be signs of aging, documentation of multiple PFVs was associated with worse OS and PFS among geriatric-aged and non-geriatric-aged populations. This study highlights the utility of routine clinical documentation on health status, including function, nutrition, and social support, to estimate survival regardless of chronologic age. [Table: see text]

Outpatient Antipsychotic Use and Severe COVID-19: Avoiding the Impact of Age in a Real-World Data Study.

The association between use of antipsychotics and COVID-19 outcomes is inconsistent, which may be linked to use of these drugs in age-related diseases. Furthermore, there is little evidence regarding their effect in the nongeriatric population. We aim to assess the association between antipsychotic use and risk of disease progression and hospitalization due to COVID-19 among the general population, stratifying by age. We conducted a population-based, multiple case-control study to assess risk of hospitalization, with cases being patients with a PCR(+) test who required hospitalization and controls being individuals without a PCR(+) test; and risk of progression to hospitalization, with cases being the same as those used in the hospitalization substudy and controls being nonhospitalized PCR(+) patients. We calculated adjusted odds-ratios (aOR) and 95% confidence intervals (CI), both overall and stratified by age. Antipsychotic treatment in patients younger than 65 years was not associated with a higher risk of hospitalization due to COVID-19 (aOR 0.94 [95%CI = 0.69-1.27]) and disease progression among PCR(+) patients (aOR 0.96 [95%CI = 0.70-1.33]). For patients aged 65 years or older, however, there was a significant, increased risk of hospitalization (aOR 1.58 [95% CI = 1.38-1.80]) and disease progression (aOR 1.31 [95% CI = 1.12-1.55]). The results of our large-scale real-world data study suggest that antipsychotic use is not associated with a greater risk of hospitalization due to COVID-19 and progression to hospitalization among patients younger than 65 years. The effect found in the group aged 65 years or older might be associated with off-label use of antipsychotics.

Abstract 19153: In-Hospital Outcomes and Complications of Atrial Fibrillation Ablation: A Comparison Between Geriatric and Non-Geriatric Population

Introduction: Atrial fibrillation (AF) is the most common arrhythmia associated with significant morbidity and mortality. The availability of different types of ablation for the treatment of AF is improved patient mortality and mitigate the disease burden. However, there is limited data on comparing post ablation results for AF in the geriatric population on geriatric population. Hypothesis: To study the in-hospital outcomes and complication of AF ablation among the geriatric and non-geriatric population groups. Methods: The National Inpatient Sampling from October 2016 to December 2019, a nationally representative sample of US hospitalizations. Adult (>18 years) inpatient admissions with AF and ablation were identified based on International Classification of Diseases-Tenth Revision. The patient population is divided into three groups based on age i.e., group A (18-64 years), group B (65-74 years), group C (>75 years). Results: A total of 15,800 AF patients over the age of 18 undergoing ABLA were identified. Among them, Group A accounted for 36.8%, Group B for 34.2%, and Group C for 28.9% of the patients. The female population in Group A was 28.7%, in Group B it was 40%, and in Group C it was 54.3% (p=0.03). Group C had higher prevalence rates of CHF (53.5%), COPD (22%), and CKD (30%) compared to the other groups (p<0.000). When comparing Group C with Group A and B, patients in Group C experienced higher in-hospital mortality (0.8% vs 0.3% vs 0.4%; p<0.000), cardiac complications (13.4% vs 5.9% vs 7.5%; p<0.000), AKI (17% vs 11% vs 11.8%; p<0.000), and major adverse events (MI or non-fatal stroke or CV death) (28.5% vs 16.9% vs 19.2%; p<0.000). The rates of ICD/pacemaker implantation differed among Group A, B, and C (5.9% vs 10% vs 20.5%; p=0.000). Conclusions: Among AF patients undergoing ablation, those aged over 75 demonstrated higher rates of CHF, COPD, and CKD compared to other age groups. This population also experienced increased in-hospital mortality, cardiac complications, AKI, major adverse events (MI or non-fatal stroke or CV death), and had a significantly higher rate of ICD/pacemaker implantation. These findings emphasize the need for tailored interventions and closer monitoring for AF patients aged over 75 to improve outcomes.

Retinal microvascular abnormalities in major depression.

The aim of our study was to find a possible association between retinal microvascular abnormality and major depression in a non-geriatric population. The participants with major depression were hospitalised at the University Hospital in Hradec Kralove, Department of Psychiatry. Retinal images were obtained using a stationary Fundus camera FF450 by Zeiss and a hand-held camera by oDocs. Fifty patients (men n=18, women n=32) aged 16 to 55 (men's average age 33.7±9.9 years, women's average age 37.9±11.5 years) were compared with fifty mentally healthy subjects (men n=28, women n=22) aged 18 to 61 (men's average age 35.3±9.2 years, women's average age 36.6±10.6 years) in a cross-sectional design. The patients were diagnosed with a single depressive episode (n=26) or a recurrent depressive disorder (n=24) according to the ICD-10 classification. Our results confirmed significant microvascular changes in the retina in patients with depressive disorder in comparison to the control group of mentally healthy subjects, with significantly larger arteriolar (P<0.0001) as well as venular (P<0.001-0.0001) calibres in major depression. According to the literature, acute and chronic neuroinflammation is associated with changes in microvascular form and function. The endothelium becomes a major participant in the inflammatory response damaging the surrounding tissue and its function. Because the retina and brain tissue share a common embryonic origin, we suspect similar microvascular pathology in the retina and in the brain in major depression. Our results may contribute to a better understanding of depression etiopathogenesis and to its personalized treatment.

Influence of greater trochanteric starting point on distal anterior cortical perforation during antegrade femoral nailing

Background: Distal anterior cortical perforation is 1 complication of antegrade femoral nailing. The effect of greater trochanteric (GT) starting points on cortical perforation risk has not been described in human femoral models. This study assessed the influence of sagittal plane starting point on rate of anterior cortical perforation using 3D CT-reconstructions of human femora. Secondarily, patient age and nail radius of curvature (ROC) were assessed as risk factors. Methods: CT scans of 53 patients (18 non-geriatric (&lt;65 yr), 35 geriatric (&gt;65 yr)) with non-fractured femora were converted into dynamic 3D-reconstructed renderings. Medullary nails from two manufacturers that differed in ROC were digitally templated in each femur from an anterior, central, and posterior ⅓ GT starting point. The rate of anterior cortical perforation and distance from the inner anterior cortex to the nail tip were recorded. Results: Perforation rate increased significantly as starting point moved from anterior (6%), to central (43%), to posterior (79%) regardless of patient age or implant manufacturer (P&lt;0.001). On average, an anterior starting point positioned the nail tip furthest from the inner anterior cortex (5. mm), safely within the canal (P&lt;0.001). Perforation rate was significantly increased in the geriatric versus non-geriatric population (47% vs. 34%) (P=0.028), and when using the nail with the larger versus smaller ROC (50% vs. 36%) (P=0.03). Conclusion: Distal nail sagittal alignment is sensitive to both patient and treatment factors. A posterior starting point, increased age (&gt;65 yr), and increased implant ROC significantly increase risk for anterior cortical perforation of the distal femur. Level of Evidence: III

Femoral neck fractures in non-geriatric patients: femoral neck system versus cannulated cancellous screw

BackgroundThe fractures of femoral neck account for 50% among hip fractures with around 3%-10% occurring in younger population of below 65 years. The newly introduced FNS as management approach appears to be a potential alternative to the traditional CCS. The aim of this study was to compare the clinical efficacy and outcome of the femoral neck system (FNS) and the cannulated cancellous screw (CCS) in the treatment of femoral neck fractures in adult below 65 years of age.MethodsData of 114 patients between 18–65 years, admitted in our department for femoral neck fracture from January 2019 to March 2021 were retrospectively studied and ranged into two groups based on the surgical methods: FNS group (56 patients) and CCS group (58 patients). The variables of interest including demographic and clinical variables (age, gender, fracture mechanism, injury side and classification), perioperative parameters(operation time, intraoperative bleeding, incision length and hospitalization time), postoperative outcomes and complications (fracture healing time, nonunion rate, femoral neck avascular necrosis, aseptic screw loosening and the Harris Hip Score), were analyzed and compared between the two groups.ResultsAll 114 patients presented satisfactory reduction and were followed-up for a period of 12 to 36 months (mean 27 ± 2.07 months); there were no significant differences between both groups in terms of age, gender, fracture classification, side of injury, mechanism of injury, the operative time, intraoperative blood loss and the hospital length of stay. However, the fracture healing time between FNS group and CCS group was statistically significant (p < 0.05), respectively 2.86 ± 0.77 and 5.10 ± 0.81 months. The significant differences were also found in terms of numbers of fluoroscopies 8.34 ± 1.38 Vs 17.72 ± 2.19, the HHS 87.80 ± 1.92 Vs 84.28 ± 2.24, postoperative complications 8 (14.28%) Vs 26 (44.82) respectively in FNS and CCS group.ConclusionFNS presented satisfactory outcomes had significantly lower complications rate, therefore, can be one of the alternatives for internal implantation devices in treatment of femoral neck fracture in non-geriatric population.

Perioperative Telemedicine Utilization Among Geriatric Patients Being Evaluated for Abdominal Wall Reconstruction and Hernia Repair.

Introduction: Perioperative telemedicine services have increasingly been utilized for ambulatory care, although concerns exist regarding the feasibility of virtual consultations for older patients. We sought to review telemedicine encounters for geriatric patients evaluated at a hernia repair and abdominal wall reconstruction center. Methods: A retrospective review of telemedicine encounters between May 2020 and May 2021 was performed. Patient characteristics and encounter-specific outcomes were compared among geriatric (older than65 years old) and nongeriatric patients. Clinical care plans for encounters were reviewed to determine potential downstream care utilization. Patient-derived benefits related to time saved in travel time was calculated using geo-mapping. Outcomes for postoperative encounters were assessed to determine if complication rates differed between geriatric and nongeriatric populations. Results: A total of 313 telemedicine encounters (geriatric: 41.9%) were conducted among 251 patients. Reviewing preoperative factors for hernia care, geriatric patients presented with higher rates of recurrent or incisional hernias (87.9% vs. 70.7%, p < 0.01). Potential travel time was longer for geriatric patients (104 min vs. 42 min, p = 0.03) in the preoperative setting. No differences in clinical care plans were found. Only 8.6% of preoperative encounters resulted in recommendations for supplemental in-person evaluation. Operative plans were coordinated for 42.5% of all preoperative telemedicine encounters. There was no difference in complication rate between geriatric and nongeriatric patients (p > 0.05) in the postoperative setting, with no complications directly attributable to telemedicine-based care. Conclusions: Telemedicine-based evaluations appear to function well among geriatric patients seeking hernia repair and abdominal wall reconstruction. Clinical care plans rendered following telemedicine-based encounters are appropriate with a low rate of supplemental in-person evaluations. Telemedicine use resulted in significantly more time saved in commuting to and from clinic for geriatric patients.

Increasing Trends in Mortality Rate Among Salivary Gland Tumors in Non-Geriatric African Americans.

BackgroundThe treatment of salivary gland tumors has not changed significantly in the past two decades. However, the increase in the geriatric population with these tumors poses a new challenge for their management. This study explores the incidence-based mortality trends in the geriatric and non-geriatric population for the time period of 2000 - 2014 and compares the trends between races.MethodsMortality data were extracted from the Surveillance, Epidemiology, and End Results (SEER) Database for the years 2000 - 2014. Incidence-based mortality for all stages of salivary gland tumors was queried and the results were grouped by age (geriatric vs. non-geriatric determined as 65 vs. below 65 years of age) and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significant difference between various subgroups. Linearized trend lines were used to visualize the mortality trends between various subgroups (geriatric vs. non-geriatric and Caucasian vs. African American).ResultsIncidence-based mortality for salivary gland tumors has worsened since 2000 to 2014 for both geriatric and non-geriatric patients (P < 0.05). There was a statistically significant difference between these two groups in both Caucasian/White patients and African American/Black patients. Notably, the worst incidence-based mortality rates were noted in African American/Black non-geriatric patients followed by Caucasian/White non-geriatric patients. However, there was no statistical difference in incidence-based mortality between Caucasian/White patients and African American/Black geriatric patients.ConclusionsThe similarity in incidence-based mortality for geriatric patients with salivary gland tumors in both Caucasian/White patients and African American/Black groups suggests that the effects of race may not be pronounced in the elderly population. The high rate of incidence-based mortality in African American/Black non-geriatric patients may suggest environmental influence and warrants further study.

A comparative assessment of antidiabetic drug usage and related pharmaceutical care issues between Geriatric and non-Geriatric population in teaching hospital

A comparative assessment of antidiabetic drug usage and related pharmaceutical care issues between Geriatric and non-Geriatric population in teaching hospital

Instruments for Measuring Violence on Acute Inpatient Psychiatric Units: Review and Recommendations.

Violence by patients against inpatient psychiatric unit staff is common, causing considerable suffering. Despite the Joint Commission's 2018 requirement for behavioral health organizations to use standardized instruments, no identified gold standard measures of violence and aggression exist. Therefore, accurate data are lacking on the frequency of patient-to-staff violence to guide development of safer institutional clinical policies or to assess the impact of targeted interventions to reduce violence. To inform recommendations for developing standardized scales, the authors reviewed the scoring instruments most commonly used to measure violence in recent studies. A comprehensive literature search for violence measurement instruments in articles published in English from June 2008 to June 2018 was performed. Review criteria included use of instruments measuring patient-to-staff violence or aggression in acute, nonforensic, nongeriatric populations. Exclusion criteria included child or adolescent populations, staff-to-staff violence, and staff- or visitor-to-patient violence. Overall, 74 studies were identified, of which 74% used structured instruments to measure aggression and violence on inpatient psychiatric units during the past 10 years. The instruments were primarily variants of the Observed Aggression Scale (OAS); 26% of the studies used unstructured clinical notes and researcher questionnaires. Major obstacles to implementing measurement instruments included time and workflow constraints and difficulties with use. In the past 10 years, OAS variants with evidence of validity and reliability that define aggression and violence have been consistently used. The authors propose that adapting the Modified OAS to collect real-time clinical data could help overcome barriers to implementing standardized instruments to quantify violence against psychiatric staff.

Association between high-sensitivity C-reactive protein levels and depression: Moderation by age, sex, obesity, and aerobic physical activity

Background: Low-grade systemic inflammation evidenced by elevated serum high-sensitivity C-reactive protein (hsCRP) levels can be a biomarker for depression. This study aimed to investigate the association between serum hsCRP levels and depressive symptoms and to explore the potential moderating effects of age, sex, body mass index (BMI), and aerobic physical activity on the association.Methods: Data of 10,702 adults (≥ 19 years) were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys of 2016 and 2018. Significant depressive symptoms were defined as ≥ 10 on the Patient Health Questionnaire-9, and high hsCRP level was defined as > 3.0 mg/L.Results: Adults with high hsCRP levels were more likely to have depressive symptoms (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.07–1.84) and suicidal ideation (OR: 1.39, 95% CI: 1.07–1.80) than those with low hsCRP levels. In the age- and sex-stratified analysis, high hsCRP levels were associated with depressive symptoms in the non-geriatric population (age ≤ 64 years) alone, with a higher OR in males than females. In subgroup analyses, the association between them was observed only among obese adults and adults without aerobic physical activity.Limitations: Causal interpretation is limited due to the cross-sectional design.Conclusions: Our results replicate previous findings of an association between high hsCRP levels and depressive symptoms in adults using a large nationally representative sample. The association between them was more prominent in the non-geriatric population, males, obese adults, and those without aerobic physical activity.

The distribution of geriatric problems in otolaryngology and their alteration from young adults.

Many changes occur in human physiology with aging, and as expected complaints of geriatric patients differ from the other age groups in population. The objective of the study was to investigate the common complaints of geriatric patients attending to an otolaryngology clinic (ENT clinic), and to compare their complaints with the 18-65 years aged patients'. Materials and. A total number of 41888 adult patients who visited the ENT clinic from 2015 to 2018 were retrospectively investigated. Patient complaints were scanned, and subcategorized as five groups (otologic/rhinologic/head and neck/ others/ neoplasias) and all data were evaluated. Forty-one thousand, eight hundred and eighty-eight patients were included in the study, and 3946 of them were geriatric patients. The most frequent problem was otologic problems, followed by rhinologic problems among geriatric patients. However, rhinologic problems were the major complaint among the 18-65-year-old patients. A comparison of all the individual complaints bringing the geriatric patients to the ENT clinic revealed the three most frequent complaints: 1. hearing loss, 2. balance disorders, and 3. common cold. However, the three major complaints beyond nongeriatric adults were 1. tonsillopharyngeal disease, 2. common cold, and 3. inflammatory and infectious diseases of the sinuses, and these differences were statistically significant (P = 0.001*). It was found in this study that the five most frequently reported complaints of geriatric patients when applying to an ENT clinic are hearing loss, loss of balance, common cold, cerumen, and tonsillopharyngeal diseases. Unlike from nongeriatric population, otologic problems (most commonly hearing loss) were the essential ENT clinic complaints of geriatric patients.

Assessment of morbidity and mortality factors affecting geriatric trauma: A comprehensive cross-sectional study in Central India

India is the second-most populous country in the world has about 76.6 million people at or over the age of 60, constituting above 7.7% of total population. A cross-sectional study of 300 cases of geriatric and non-geriatric population groups was conducted at well-established Trauma, Orthopaedic and Neurosurgical services centre in Central India. Mechanisms of injury sustained by the participants showed that Falls which include both Ground level falls (GLF) and Fall from height (&gt;2 metres) contributed to 55.4% cases in the geriatric population. The next most common cause of trauma in the geriatric population was road traffic accidents amounting to 34.3% of the cases. Data on the injuries sustained by both the study cohorts in terms of the different body regions based on Abbreviated Injury Scale (AIS) and Injury severity score (ISS) showed the head region was most consistently and maximally injured in both the study populations. Comorbidity profiles of geriatric and non-geriatric trauma populations showed significantly high hypertension, cerebrovascular disease, diabetes, diminished hearing and vision among the geriatric group. The maximum number of geriatric patients underwent Orthopaedic and spine surgeries (44.9%), Intercostal drain placements (34.6%), while the non-geriatric population had a higher number of Craniotomies (40%) and Intercostal drain placement (33.5%) surgeries respectively. The geriatric population had a significantly higher crude mortality rate of 39.3% compared to the non-geriatric population ( 26.3% ). With reference to intervention procedures, the geriatric population had a lower percentage of operative intervention and a higher rate of conservative management as compared to the non-geriatric population.

Assessment of morbidity and mortality factors affecting geriatric trauma patients: A comprehensive cross-sectional study in central India

India has geriatric population of about 76.6 million over the age of 60, constituting above 7.7% of total population. A cross-sectional study on 300 cases of geriatric and non-geriatric subjects was conducted at well-established Trauma, Orthopaedic and Neurosurgical services centre in Central India. Mechanisms of injury sustained by the participants showed that Falls which include both Ground level falls (GLF) and Fall from height (>2 metres) contributed to 55.4% cases in the geriatric population. The next most common cause of trauma was the road traffic accidents (RTA) amounting to 34.3% of the cases in the geriatric population. Data on the injuries sustained in terms Abbreviated injury Scale (AIS) and Injury severity score (ISS) showed that the head region was most consistently and maximally injured in both the study populations. Comorbidity profiles of geriatric and non-geriatric trauma populations showed significantly high hypertension, cerebrovascular disease, diabetes, diminished hearing and vision among the geriatric group. The maximum number of geriatric patients underwent Orthopaedic and spine surgeries (44.9%), Intercostal drain placements (34.6%), while the non-geriatric population had a higher number of Craniotomies (40%) and Intercostal drain placement (33.5%) surgeries respectively. The geriatric population had a significantly higher crude mortality rate of 39.3% compared to the non-geriatric population (26.3%). With reference to intervention procedures, the geriatric population had a lower percentage of operative intervention and a higher rate of conservative management as compared to the non-geriatric population.

Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures.

Introduction:Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years).Materials and Methods:The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens.Results:A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly : higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001).Discussion:Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients.Conclusions:Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.

Frailty in Acute Care: Not Just Your Grandparents' Medical Condition

Background and Purpose: Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated declines in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Frailty assessment is commonly reserved for the geriatric population and the outpatient setting. The purpose of this review is to discuss the concept of frailty in the acute care setting and its relevance to those in the adult, nongeriatric population. Description: This review describes the characteristics of frailty in the acute care setting, the populations most likely to have non-age-related frailty, how current frailty outcome measures can be used in acute care, and the limitations of these assessments of frailty in the acute care setting. Outcomes: Frailty is associated with patients of all ages and is closely correlated with patients who have dysfunction of the heart, kidneys, liver, and lungs. Frailty is also associated with oncology-related diagnoses, critical care, multimorbidity, and obesity. Multiple assessments in the literature are aimed at assessing frailty but many are subjective and only valid with specific populations and criteria. Discussion: Frailty is a multidimentional clinical diagnosis that is not reserved solely to those older than 65 years. Many diagnoses have been closely linked to frailty. Clinicians across the spectrum need to recognize and assess for frailty, especially in acute care, as discharge planning is a key component in reducing readmissions. Creating and adapting a treatment plan that meets all the necessary domains of fitness, combined with the appropriate intensity and duration, will provide the greatest chance of reversing patients along the continuum from frail to prefrail to nonfrail.

Depression Severity as a Risk Factor of Sarcopenic Obesity in Morbidly Obese Patients.

Etiopathogenic factors of physical disability in obesity are numerous, underestimated and not sought in the non-geriatric population. Amongst these factors, depression may favor the development of sarcopenic obesity by reducing strength and physical performance even in the absence of overt muscle loss. Objectives and participants: To study the link between depression status and muscle functional disorders (dynapenia) in a population of adult subjects with severe and morbid obesity. Patients were assessed for body composition, grip strength, the Short Physical Performances Battery test (SPPB), for depression according to the Beck II score as well as for metabolic parameters through biological tests. In 373 obese subjects (mean age 44 ± 13y and BMI 43 ± 6 kg/m²), the prevalence of depression was 53% with 18% having mild depression, 18% moderate depression and 16% severe depression. Depression was significantly related to dynapenia: 62% of dynapenic (D) patients suffered from depression compared to 50% of non-dynapenic (ND) patients (p = 0.036). The Beck questionnaire score for D patients was 20 ± 13 and 15 ± 10 for ND patients (p = 0.001). The depression intensity was significantly correlated with dynapenia with D patients having a higher severe depression degree than ND patients (30% versus 11%; p < 0.0001). Fat-free to fat mass ratio was also significantly correlated with dynapenia (p = 0.01). In multivariate analysis, the presence of depression was twice as likely to be associated with dynapenia. Depression is associated with a reduction of muscle function in severe obesity in relation to its severity and to changes in fat to fat-free mass, suggesting that screening and prevention of sarcopenic obesity should be considered in adult obese patients with depression.

Analysis of proportion of geriatric patients in phase III cancer clinical trials.

e23032 Background: Geriatric patients are often under-represented in cancer clinical trials. The presence of multiple comorbidities makes geriatric patients ineligible for most clinical trials. However, the increase in cancer incidence in geriatric patients raises the question of applicability of the results is such clinical trials. Methods: Data about Phase 3 trials was extracted from the clinical trials.gov for 3 common solid organs and 3 hematological malignancies [breast, colon, lung, diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)]. The time period studied was for the past 10 years and included only adult patients (≥ 18 years). The age distribution of the patient population in these trials were extracted and analyzed. Results: Geriatric patients are heavily under-represented in all phase 3 cancer clinical trials. Table shows the proportion of patients below 65 years, above 65 years and older in clinical trials for each organ specific malignancy. The range of the proportion of geriatric patients varied from 10% to 40%. Conclusions: The results of phase 3 clinical trials that are currently conducted on non-geriatric patient population may not meaningfully be applicable to geriatric patients. This study highlights the disparity of age for patients enrolled in clinical trials as against the patients seen in the real world.[Table: see text]

Comparison of mortality trends in geriatric and nongeriatric patients with salivary gland tumors.

e23026 Background: The treatment of salivary gland tumors has not changed significantly in the past two decades. However, its increased incidence in the geriatric population poses new challenges for their management. This study explores the incidence-based mortality (IBM) trends in the geriatric and non-geriatric population for the time period of 2000 to 2014 and compares the trends between races. Methods: Mortality data was extracted from the Surveillance, Epidemiology, and End Results (SEER) Database for the years 2000 to 2014. IBM for all stages of salivary gland tumors was queried and the results were grouped by age (geriatric vs. non-geriatric) and race (Caucasian/White, African American (AA)/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significance difference between various subgroups. Linearized trend lines were used to visualize the mortality trends between various subgroups (Geriatric vs. Non- geriatric and Caucasian vs. African American). Results: IBM for salivary gland tumors has worsened since 2000 to 2014 for both geriatric and non-geriatric patients (P &lt; 0.05), There was a statistically significant difference between these two groups in both Caucasian/White and AA/Black patients. Notably, the worst IBM rates were noted in non-geriatric AA/Black patients followed by non-geriatric Caucasian/White patients. However, there was no statistical difference in IBM between geriatric patients of Caucasian/White and AA/Black descent. Conclusions: The similarity in IBM for geriatric patients with salivary gland tumors in both Caucasian/White and AA/Black groups suggest that the effects of race may not be pronounced in the elderly population. The high rate of IBM in non-geriatric AA/Black patients may suggest environmental influence and warrants further study.

The Beers criteria: Not just for geriatrics anymore? Analysis of Beers criteria medications in nongeriatric trauma patients and their association with falls.

It has been well established that many classes of medications on the Beers list of Potentially Inappropriate Medications (PIMs) are associated with falls and injuries in the geriatric population, but little work has been performed to understand if similar relationships exist among the nongeriatric adult population. A retrospective chart review of 32 months of trauma encounters at our Level I trauma center was performed in nongeriatric adults aged 18 years to 64 years. Encounters were reviewed by mechanism of injury and intake medication reconciliation. The data were then evaluated for associations between PIMs and falls. Of the 7,897 trauma encounters in the study period, 6,493 had completed medication reconciliation, and 4,154 were between the ages of 18 years and 64 years. There was a statistically significant disproportionate number of those who sustained a fall on psychoactive medications and proton pump inhibitors, and the odds of a trauma patient presenting as a fall were also significantly higher on these select classes of PIMs. The PIMs associated with falls in the geriatric population are also associated with falls in the nongeriatric population. This study supports the judicious prescribing of these medications, as they may have risks beyond what was originally thought. Prognostic, level IV.