Test In Elderly Patients Research Articles

Averaged Oxygen Desaturation Improves the Prognostic Value of the Six-Minute Walk Test in Elderly Patients with Heart Failure.

Heart failure (HF) is a major cause of hospitalization, and exercise capacity is a key prognostic marker. The six-minute walk test (6MWT) is widely used to assess exercise capacity, but six-minute walk distance (6MWD) varies among individuals, especially the elderly. This study aimed to assess the hypothesis that ΔSpO₂-Ex, the average oxygen desaturation during the 6MWT, could enhance the prognostic value of 6MWD in elderly HF patients for cardiovascular risk prediction. In this single-center, prospective observational study, 55 patients aged ≥ 65 years with acute HF were evaluated before discharge. Patients were divided into small and large ΔSpO₂-Ex groups and short and long 6MWD groups based on cut-off values of 6.7% and 220 m, respectively, obtained from the Receiver Operating Characteristics curve analysis. Patients were followed for one year to assess major adverse cardiovascular events, including rehospitalization for heart failure or cardiovascular death. The mean ΔSpO₂-Ex was 5.8 ± 4.3%, and the mean 6MWD was 237.5 ± 106.7 m. Patients with large ΔSpO₂-Ex had significantly higher event rates (HR 6.66, p < 0.001), while those with short 6MWD had HR of 2.40 (p = 0.03). Combining ΔSpO₂-Ex with 6MWD improved predictive accuracy (AUC 0.78) compared to either marker alone (AUC 0.72 for ΔSpO₂-Ex and 0.62 for 6MWD). Importantly, patients with both large ΔSpO₂-Ex and short 6MWD had the highest event rates, indicating the additive prognostic value of combining both markers. ΔSpO₂-Ex is a complementary marker to 6MWD, improving risk stratification in elderly HF patients.

Use of diagnostic tests in elderly patients consulting the emergency department. Analysis of the emergency department and elder needs cohort (EDEN-8)

ObjectiveAnalyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED). MethodsWe performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model. ResultsA total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 – 1.950), ECG 1.793 (95 %CI 1.664 – 1.932) and X-ray 1.707 (95 %CI 1.583 – 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests. ConclusionsAge, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED.

Feasibility of the Two-Minute Walk Test in Elderly Patients After Acute Myocardial Infarction: A Cross-Sectional Study

Feasibility of the Two-Minute Walk Test in Elderly Patients After Acute Myocardial Infarction: A Cross-Sectional Study

Psychological Experience of the First Pulmonary Function Test in Elderly Patients with Poor Cooperation: A Qualitative Study

Objectives: In this study, we aimed to understand the real psychological experience of the first pulmonary function test (PFT) of elderly patients with poor cooperation, provide a reference for reporting their psychological characteristics and needs, and offer suggestions for developing appropriate guidance strategies to improve cooperation and compliance of patients. Methods: We used a phenomenological approach. We selected 21 elderly patients with poor cooperation who underwent PFT in a Tertiary Grade A comprehensive hospital in Nanning from December 2021 to June 2022 for a semi-structured interview using an objective sampling method. We used the Colaizzi analysis method to collate and analyze the data. Results: We extracted 6 distinct psychological experiences of elderly patients with poor cooperation in the first PFT, including distrust, tension and worry, the desire to understand PFT-related information, high psychological sensitivity, frustration and positive self-adjustment, and negative self-perception of aging. According to participants′ own explanation, most of the psychological experience was mainly related to the lack of understanding of PFT related knowledge, which was greatly affected by the way of information acquisition and the allocation of PFT resources. In addition, elderly patients also revealed that unfamiliarity with their own disease history and physical status affected their psychological enthusiasm during the examination. Conclusions: Elderly patients who failed to cooperate during the first PFT have complex psychological states and a wide range of psychological needs. In clinical practice, medical staff should focus on patients, thoroughly investigate the psychological experiences of elderly patients undergoing PFT and implement corresponding measures to encourage elderly patients′ cooperation and improve examination compliance.

Dengue virus serotype did not contribute to clinical severity or mortality in Taiwan’s largest dengue outbreak in 2015

BackgroundDengue virus serotype 2 (DENV-2) was the major serotype in the 2015 dengue outbreak in Taiwan, while DENV-1 and DENV-3 were dominant between 2005 and 2014. We aimed to investigate whether DENV-2 contributed to disease severity and mortality in the outbreak in Kaohsiung city, Taiwan.MethodsWe collected serum samples from dengue patients to detect the presence of DENV and determine the serotypes by using quantitative reverse transcription-polymerase chain reaction. Our cohorts comprised 105 DENV-1-infected cases and 1,550 DENV-2-infected cases. Demographic data, DENV serotype, and comorbidities were covariates for univariate and multivariate analyses to explore the association with severity and mortality.ResultsThe results suggested that DENV-1 persisted and circulated, while DENV-2 was dominant during the dengue outbreak that occurred between September and December 2015. However, DENV-2 did not directly contribute to either severity or mortality. Aged patients and patients with diabetes mellitus (DM) or moderate to severe chronic kidney disease (CKD) had a higher risk of developing severe dengue. The mortality of dengue patients was related to a higher Charlson comorbidity index score and severe dengue. Among DENV-2-infected patients and older patients, preexisting anti-dengue IgG, DM, and moderate to severe CKD were associated with severe dengue. Moreover, female sex and severe dengue were associated with a significantly higher risk of death.ConclusionsOur findings highlight the importance of timely serological testing in elderly patients to identify potential secondary infections and focus on the meticulous management of elderly patients with DM or moderate to severe CKD to reduce dengue-related death.

The diagnostic accuracy of straight leg raise test in patients more than 60 years of age suffering lumbar disk herniation with low back pain and sciatica.

To determine the diagnostic accuracy of the SLR test in elderly patients suffering from lumbar disk herniation with sciatica and low back pain, using magnetic resonance imaging (MRI) as the gold standard. A cross-sectional study was conducted at Jinnah Postgraduate Medical Center and a total of 120 patients, above 60 years of age, with symptomatic lumbar disk herniation were enrolled. SLR test was performed and the results recorded. MRI of the lumbar spine was undertaken for confirmation of disk herniation. The sensitivity of the SLR test in patients 60 years and older is 33.3%. A decrease in the diagnostic accuracy of the SLR test with an increment in age was also noted. It was found that with an increment in age, there is a steady decline in the diagnostic accuracy of SLR Test.

Differences in Clinical and Angiographic Parameters Following Intracoronary Ergonovine and Acetylcholine Provocation Test in Elderly Patients

Differences in Clinical and Angiographic Parameters Following Intracoronary Ergonovine and Acetylcholine Provocation Test in Elderly Patients

Assessment of anterior pituitary reserve capacity based on growth hormone response to growth hormone-releasing peptide-2 test in the elderly

ObjectiveThe growth hormone (GH)-releasing peptide-2 (GHRP-2) test is relatively safe among endocrine stimulation tests for the elderly. We investigated whether anterior pituitary function in elderly patients could be assessed on the basis of GH response to the GHRP-2 test. DesignSixty-five elderly patients aged 65 years and older with non-functioning pituitary neuroendocrine tumor (PitNET) who underwent pituitary surgery and preoperative endocrine stimulation tests were classified into the “GH normal group” and “GH deficiency group” based on GH response to the GHRP-2 test. The baseline characteristics and anterior pituitary function were compared between the groups. ResultsThirty-two patients were assigned to the GH normal group and 33 to the GH deficiency group. The cortisol and adrenocorticotropic hormone (ACTH) results in the corticotropin-releasing hormone test were significantly higher in the GH normal group than in the GH deficiency group (p < 0.001). The relationship between the cortisol and ACTH results and the GH response revealed significant correlations (p < 0.001). In addition, receiver operating characteristic curve analysis identified that the optimal cut-off point for a peak GH level in the correlation between adrenocortical function and GH response to the GHRP-2 test was 8.08 ng/mL (specificity 0.868, sensitivity 0.852). ConclusionThe present study indicated that adrenocortical function was significantly correlated with GH response to the GHRP-2 test in elderly patients before pituitary surgery. For elderly patients with non-functioning PitNET, GH response to the GHRP-2 test may support in diagnosing adrenocortical insufficiency.

CRT-100.45 Differences in Clinical and Angiographic Parameters Following Intracoronary Ergonovine and Acetylcholine Provocation Test in Elderly Patients

CRT-100.45 Differences in Clinical and Angiographic Parameters Following Intracoronary Ergonovine and Acetylcholine Provocation Test in Elderly Patients

Feasibility and applicability of locomotive syndrome risk test in elderly patients who underwent total knee arthroplasty.

The concept of locomotive syndrome (LS) and its evaluation method, the LS risk test, have been applied in an integrated manner to capture the decline in mobility resulting from musculoskeletal disorders. The purpose of this study was to evaluate the impact of total knee arthroplasty (TKA) in the elderly with knee osteoarthritis, a common disorder found in LS. A total of 111 patients were registered prior to TKA and postoperatively followed up for 1 year. Three components of the LS risk test (the two-step test, stand-up test, and geriatric locomotive function scale-25) were assessed pre- and postoperatively. After surgery, all three components of the test showed significant improvements from the baseline. The ratio of stage 3 LS patients (progressed stage of decrease in mobility) reduced from 82.3% to 33.9% postoperatively. There was no significant difference in the degree of change in the scores between the younger (60-74 years) and older (≥75 years) age groups. We found that TKA has a major impact in preventing the progression of LS in patients with knee osteoarthritis. The LS risk test is a feasible tool for longitudinal evaluation of patients with musculoskeletal diseases of varying severity and with multiple symptoms.

Bedside assessment of dependence as an independent correlate of mortality in elderly patients admitted for Acute Coronary Syndromes

Abstract Background Elderly patients are at high risk of dependence and mortality after acute coronary syndrome (ACS) Purpose To assess the impact of dependence detected by a simple bedside test in elderly patients admitted for ACS on 1-year mortality. Methods We compared mortality between patients with or without dependence based on an Activities of Daily Living (ADL) index &amp;lt;6 in a prospective, cohort of patients ≥75 years old admitted for an ACS to the cardiology department of our center using a Cox proportional survival model adjusted on pre-defined confounding variables (age, gender, revascularization, heart failure, left ventricular ejection fraction and admission GRACE and CRUSADE scores). Results In a cohort of 1011 consecutive patients, 946 underwent ADL assessment and completed one-year follow-up. Dependence was identified in 190 (20%). At 1 year follow-up 112 patients died, 52 (27.4%) in the dependent and 60 (7.9%) in the independent groups. Dependence was associated with higher rates of 1 year mortality both on undajusted (HR 3.79; 95% CI 2.62; 5.50], p&amp;lt;0.0001) and adjusted models (adj-HR 2.85; 95% CI 1.89; 4.33], p&amp;lt;0.0001). Other independent correlates of mortality were female gender (p&amp;lt;0.0001), CRUSADE score (p&amp;lt;0.0001) and coronary revascularization (p&amp;lt;0.001). Conclusions Dependence detected by a simple bedside test in patients ≥75 admitted for ACS is associated with a 2 to 3-fold increase of the risk of mortality independent of other predictors of poor outcome. Assessment of dependence should be performed in all elderly patients as a risk stratification tool and considered for the management of such patients. Funding Acknowledgement Type of funding sources: None.

3D cardiac magnetic resonance stress-perfusion in elderly patients

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation Introduction Age related comorbidities and reduced compliance often limit ischaemia testing in elderly patients. Purpose To assessed the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population. Methods 56 patients aged ≥75 years underwent 3D CMR stress-perfusion and invasive coronary angiography with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as part of a multicenter study. The accuracy of 3D CMR stress-perfusion was compared to patients aged &amp;lt;75 years old (n = 360) using qualitative and quantitative imaging parameters. Results Sensitivity, specificity, positive and negative predictive values of qualitative 3D perfusion CMR were similar for both age groups in the detection of high-grade (≥50%) coronary stenosis on QCA and hemodynamically relevant (&amp;lt;0.8) stenosis on FFR, p &amp;gt; 0.05 all. Quantitative myocardial ischemia burden was larger in elderly patients (15% ± 17% vs. 9% ± 13%) with similarly high diagnostic accuracy of quantitative 3D CMR perfusion in both age groups to predict pathological FFR (AUC ≥75: 0.906; AUC &amp;lt;75: 0.866). Conclusions 3D CMR perfusion is well suited for myocardial ischaemia testing in the elderly patients with similarly high diagnostic accuracy as in younger individuals.

Preoperative laboratory testing in elderly patients.

Purpose of reviewPreoperative testing in elderly patients is performed to examine the patient's current medical condition in the context of evaluating vulnerabilities and predicting postoperative complications to ensure that all functions recover before surgery. This review focused on preoperative laboratory tests in geriatric patients.Recent findingsPreoperative complete blood count, electrolyte testing, and blood chemistry can predict postoperative complications. Preoperative elevated morning/evening salivary cortisol secretion ratio, C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratios, and preoperative decreased serum albumin level or 25-hydroxyvitamin D levels can predict postoperative cognitive dysfunction. Elevated brain-type natriuretic peptide or serum alkaline phosphatase levels can be biomarkers of major postoperative adverse cardiac events. Decreased preoperative estimated glomerular filtration rates and serum albumin levels can predict acute kidney injury. Hyponatremia, hypocalcemia, and low albumin/fibrinogen ratio predict postoperative complications. Hypoalbuminemia can predict surgical site infection or postoperative mortality after hip fracture surgery. A high CAR can predict anastomotic site leakage and is a risk factor for one-year mortality after hip surgery.SummaryPreoperative laboratory testing helps predict postoperative adverse complications; thus, a plan of care can be initiated.

The benefit of the use of short physical performance battery test in elderly patients in cardiac rehabilitation

The benefit of the use of short physical performance battery test in elderly patients in cardiac rehabilitation

Antibody titers and rapid antigen testing in elderly patients with SARS-CoV-2 pneumonia vs. staff of ICU and "Covid-19" wards.

Aim: The majority of patients hospitalized with COVID-19 are older individuals. Age and the comorbidities typically associated with it usually go hand in hand with a less favorable course of the disease. We were interested in the antibody response in this particular patient group as well as in the results of rapid antigen testing.Methods: In 30 elderly patients (>75 years), antibody titers (IgA and IgG) against COVID-19 were measured, and rapid antigen testing was determined about 3 weeks after the onset of symptoms of SARS-CoV-2 infection. The results were compared with those of a “high-risk” group consisting of “Covid-19” ward regular staff, as well as with “low-risk” staff consisting of members of the intensive care unit (ICU). The antibody titer against SARS-CoV-2 was determined by ELISA (EUROIMMUN™, PerkinElmer, Inc. Company); for rapid antigen testing, we used the SARS-CoV-2 Rapid Antigen test (Roche®).Results: Our investigations demonstrate a robust antibody response in the majority of elderly, comorbid patients about three weeks after the onset of infection. At this timepoint, most of the results of rapid antigen testing were negative. Furthermore, in the group of employees of our clinic (“Covid-19” ward vs. the ICU staff), the prevalence of antibodies was very low and antigen testing was negative in the whole ICU group.Conclusion: Although frequently comorbid, elderly patients are capable of significantly increasing antibodies against COVID-19 about 3 weeks after the onset of infection. Since the viral load can be assumed to have been low at that point, rapid antigen testing was negative in most cases. In the test group of employees of our clinic (“Covid-19” ward vs. the ICU staff), the data demonstrate that – given adequate protective measures – the risk of infection is not higher in a “Covid-19” ward compared to other wards.

Novel Variants in the CLCN1, RYR2, and DCTN1 Found in Elderly Japanese Dementia Patients: A Case Series.

Dementia has an enormous impact on medical and financial resources in aging societies like Japan. Diagnosis of dementia can be made by physical and mental examinations, imaging tests, and findings of high abnormal proteins in cerebrospinal fluids. In addition, genetic tests can be performed in neurodegenerative diseases such as Alzheimer’s disease (AD), frontotemporal dementia (FTD), and Parkinson’s disease (PD). In this case series, we presented three cases of dementia with unknown causes who carry novel variants in the genes associated with neurodegenerative diseases. Three patients (Patients 1, 2, and 6) were found by screening 18 dementia patients using a gene panel including 63 genes. The age of onset for Patient 1 was 74 years old, and his father had PD and mother had AD. The age of onset for Patient 2 was 75 years old, and her mother had AD. The age of onset for Patient 6 was 83 years old, and her father, two sisters, and daughter had dementia. The Mini-Mental State Examination produced results of 20, 15, and 22, respectively. The suspected diagnosis by neurological examinations and imaging studies for Patients 1 and 2 was AD, and for Patient 6 was FTD. Patient 1 was treated with donepezil; Patient 2 was treated with donepezil and memantine; and Patient 6 was treated with donepezil, galantamine, and rivastigmine. The three rare variants identified were: CLCN1, encoding a chloride channel, c.2848G>A:p.Glu950Lys (Patient 1); RYR2, encoding a calcium releasing ryanodine receptor, c.13175A>G:p.Lys4392Arg (Patient 2); and DCTN1, encoding a subunit of dynactin, c. 3209G>A:p.Arg1070Gln (Patient 6). The detected variants were interpreted according to the American College of Medical Genetics (ACMG) guidelines. The minor allele frequency for each variant was 0.025%, 0.023%, and 0.0004% in East Asians, respectively. The DCTN1 variant found in Patient 6 might be associated with FTD. Although none of them were previously reported in dementia patients, all variants were classified as variants of unknown significance (VUS). Our report suggests that results of genetic tests in elderly patients with dementia need to be carefully interpreted. Further data accumulation of genotype–phenotype relationships and development of appropriate functional models are warranted.

MDS-120: Molecular and Diagnostic Testing Patterns in Elderly Patients with Myelodysplastic Syndromes (MDS) in the Connect® MDS/AML Disease Registry

Context: Molecular genetic testing is an important diagnostic tool for MDS. WHO MDS classification criteria were updated in 2016; how they are implemented in practice is unclear. Our knowledge of molecular testing in elderly patients is limited. Objective: To compare testing patterns in elderly (≥80 years) and younger ( Design: Baseline characteristics and laboratory data were collected from patients enrolled from Dec 12, 2013 to data cutoff Dec 13, 2019 in the Connect® MDS/AML Disease Registry ( NCT01688011 ), an ongoing, US, multicenter, prospective observational cohort study of patients with newly diagnosed MDS (aged ≥18 years) or AML (aged ≥55 years). Testing patterns were compared between elderly and younger MDS patients. Results: 234/800 (29.3%) MDS patients were aged ≥80 years and 566/800 (70.7%) Conclusions: Although molecular testing rates have increased since 2017, testing rates for elderly MDS patients remained lower than for younger patients. Education focused on increasing testing rates in elderly patients is needed to ensure appropriate care. The study was supported by Bristol-Myers Squibb.

Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults.

Simple SummaryThe use of risk-stratification systems for thyroid nodules based on ultrasound features may reduce the number of biopsies to be performed. The aim of our study was to assess the diagnostic performance of these systems in different age groups. We confirmed that all systems had a significant discriminative performance in all age groups. The system proposed by the American College of Radiology was the best performing one, but all risk-stratification systems could avoid a sizable number of biopsies when applied as rule-out tests (to exclude malignancy) in elderly patients.Ultrasonographic risk-stratification systems (RSS), including various Thyroid Imaging Reporting and Data Systems (TIRADS), were proposed to improve reporting and reduce the number of fine-needle aspiration biopsies. However, age might be a confounder since some suspicious ultrasonographic features lack specificity in elderly patients. We aimed to investigate whether the diagnostic performance of the RSS varied between age groups. All patients consecutively referred for thyroid biopsy between November 1, 2015, and March 10, 2020, were included. The malignancy risk of each nodule was estimated according to five RSS: the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, the American College of Radiology (ACR) TIRADS, the American Thyroid Association guidelines, the European TIRADS, and the Korean TIRADS. Overall, 818 nodules (57 malignant) were evaluated. The malignancy rate was higher in patients ≤ 65 years (8.1%) than in patients > 65 years (3.8%; p = 0.02). All RSS confirmed a significant discriminative performance in both age groups, with a negative predictive value of 100% in patients > 65 years, although specificity was lower in older patients. The ACR TIRADS was the best performing in both age groups. RSS could avoid a sizable number of biopsies when applied as rule-out tests in elderly patients.

Neurological Diagnostic Testing in Elderly Patients with Acute Altered Mental Status (982)

Neurological Diagnostic Testing in Elderly Patients with Acute Altered Mental Status (982)

Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting?

Elderly patients presenting to the emergency department (ED) with nonspecific complaints (NSCs) often undergo troponin testing to assess for atypical acute coronary syndrome (ACS). However, the rate of ACS and utility of troponin testing in this population is unknown. We sought to determine the rate of ACS and diagnostic yield of troponin testing in elderly patients with NSCs. We retrospectively identified all patients aged ≥ 65 years triaged in the ED with NSCs from January 1, 2017, to June 30, 2017. NSCs were defined a priori and included complaints such as weakness, dizziness, or fatigue. NSCs were verified in ED provider notes by trained abstractors blind to testing results. Exclusions were focal chief complaint in provider notes, fever, and no troponin ordered. ACS was strictly defined and independently adjudicated by two trained physician researchers blind to the study hypothesis. We calculated the proportion of patients with ACS within 30 days and the test characteristics of troponin to diagnose ACS. Screening identified 1,146 encounters, and 552 were excluded for fever or focal chief complaints in the provider notes. Of the remaining 594 patients, troponin was ordered in 412 (69%), comprising the study cohort. The mean (±SD) age was 78.7 (±8.3) years, with 58% female and 75% admitted. Troponin elevation occurred in 81 patients (20%). ACS occurred in 5 of 412 (1.2%). Troponin was 100% sensitive (95% confidence interval [CI]=48% to 100%) and 81% specific (95% CI= 77% to 85%) for ACS. Of patients with elevated troponin, 93.8% were false positives (no ACS). All patients with troponin elevation were admitted, but only one underwent angiography and no patients received reperfusion therapy. While consideration for ACS is prudent in selected elderly patients with NSCs, ACS was rare and no patients received reperfusion therapy. Given the false-positive rate in our study, our results may not support routine troponin testing for ACS in this population.