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Aim Methods Results Conclusions To compare the performance of the Programme of Research on the Integration of Services for the Maintenance of Autonomy (PRISMA‐7), which is used to assess the frailty of older patients visiting emergency departments, with the quick Sepsis Related Organ Failure Assessment (qSOFA) and Emergency Severity Index (ESI) in terms of 28‐day mortality and intensive care unit (ICU) admission.This study was prospective and observational. All patients above the age of 65 who were admitted to the Sivas Republic University Medical Faculty Hospital from March 1 to April 30 in the year 2024 were included in the study. Patients' all‐cause mortality values and ICU acceptance rates were evaluated for a 28‐day period following their applications.The area under the receiver operating characteristic curve stood for the 28‐day mortality, while the values for PRISMA‐7, ESI, and qSOFA were, respectively, 0.81 (95% confidence interval [CI]: 0.78–0.84), 0.78 (95% CI: 0.72–0.83), and 0.71 (95% CI: 0.65–0.77). Our findings have demonstrated PRISMA‐7 to be more effective than ESI and qSOFA in terms of hospitalization predictions. However, while it was found to be more effective than qSOFA in mortality predictions, it was determined that, despite PRISMA‐7 having a larger AUC than ESI, no meaningful difference existed between PRISMA‐7 and ESI.In conclusion, PRISMA‐7, which is thought of as a reliable and valid tool for the determination of frailty in emergency departments, has predictive value for individuals' 28‐day mortality risk as well as for their acceptance to the ICU. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To investigate the relationship between delirium and tryptophan and its metabolites in critically ill older patients. Findings: The level of TRP was significantly (borderline) decreased among patients with delirium (p = 0.056). The KYN/TRP and QA/TRP ratios were statistically and significantly higher in patients with delirium than those without (p < 0.001 and p = 0.016, respectively). The best predictive values for detecting delirium were calculated as ≤14,100 ng/mL for TRP (AUC: 0.601, p = 0.052), >1.12 for KYN/TRP ratio (AUC: 0.704, p < 0.001), and > 0.75 for QA/TRP ratio (AUC: 0.627, p = 0.013). The QA/TRP ratio showed independent and borderline significant association with being delirium in multivariable regression analysis (Odds ratio: 2.007, p = 0.066). Message: This study demonstrated that tryptophan and its metabolites obtained within the first 24 h of ICU admission might have predictive value for determining high-risk older patients for delirium. Aim: The present study aimed to investigate the relationship between delirium and tryptophan and its metabolites in critically ill older patients. Methods: This prospective and observational study was conducted on patients who were > 60 years of age and hospitalized for at least 24 h at the internal medicine ICU in the tertiary health care unit (n = 120). All consecutively selected patients were evaluated for delirium at the baseline and follow-up period at the bedside by an intensive care specialist. At the end of the 24 h follow up, the patients were divided into two groups (with and without delirium). Clinical properties and tryptophan (TRP) and its metabolites [kynurenine (KYN), kynurenic acid (KYNA), quinolinic acid (QA), 3-hydroxykynurenine (3-HK), 3-hydroxyanthranilic acid (3HAA)] were compared between groups. Results: The median age of the patients was 79.5 (62–95) years and 53.3% were female. The median age and CCI score were significantly higher among patients with delirium than in those without delirium (P = 0.001 and 0.031, respectively). The level of TRP was significantly (borderline) decreased among patients with delirium (P = 0.056). The KYN/TRP and QA/TRP ratios were statistically and significantly higher in patients with delirium than those without (P < 0.001 and P = 0.016, respectively). The best predictive values for detecting delirium were calculated as ≤ 14,100 ng/mL for TRP (AUC: 0.601, P = 0.052), > 1.12 for KYN/TRP ratio (AUC: 0.704, P < 0.001), and > 0.75 for QA/TRP ratio (AUC: 0.627, P = 0.013). The QA/TRP ratio showed independent and borderline significant association with being delirium in multivariable regression analysis (Odds ratio: 2.007, P = 0.066). Conclusion: This study demonstrated that tryptophan and its metabolites obtained within the first 24 h of ICU admission might have predictive value for determining high-risk older patients for delirium. [ABSTRACT FROM AUTHOR]

Objective: Glioblastoma multiforme (GBM) is a significant health issue in older patients. In recent years, there has been an increase in the number of studies on radiotherapy and concomitant temozolomide administration. However, there is not enough research on the tolerance of adjuvant temozolomide after this intensive therapy procedure. Materials and Methods: Patients with GBM who were followed up between 2010 and 2020 were included. Patients were retrospectively screened. Side effect grading of patients was performed using the common terminology criteria for adverse events version 5.0. Results: In patients ≤65 years old, 79.1% (121) received adjuvant temozolomide treatment for six months or more, whereas this rate decreased to 48.4% (15) in patients >65 years old (p<0.001). In the comparison of hematological toxicities arising during adjuvant temozolomide treatment in the ≤65 years old and older patient groups, no significant differences were found. The rates of patients experiencing grade 2 and above hematologic toxicity (p=0.91) and treatment discontinuation due to hematologic toxicity (p=0.53) were found to be similar in both groups. The median progression-free survival (p=0.004) and the median overall survival were (p<0.001) determined longer in the younger group. Conclusion: Cancer and aging are dynamic, multidimensional processes that pose challenges to older patients and require multidisciplinary evaluation. Our study showed that although age-related differences in treatment completion and survival outcomes were observed, it is necessary to approach especially older patients individually, considering a comprehensive assessment of their general health status, comorbidities, and treatment tolerance, emphasizing the importance of geriatric oncology. [ABSTRACT FROM AUTHOR]

Background: Eosinophilic gastrointestinal diseases are the rare gastrointestinal disorders. To our knowledge, there have been no reports of eosinophilic gastrointestinal diseases with overall gastrointestinal tract involvement causing liver abscess in an older patient. Case presentation: We report a 68-year-old man with eosinophilic gastrointestinal disease with overall gastrointestinal tract involvement. He was admitted with suspected acute gastroenteritis, and histological examination showed eosinophilic infiltration accompanied by liver abscess. The collected pus was tested for Metagenomics Next-Generation Sequencing and confirmed the presence of Klebsiella pneumoniae. Conclusions: We conducted a literature review on the complications of eosinophilic gastrointestinal diseases and discussed how eosinophilic gastrointestinal diseases lead to liver abscess caused by Klebsiella pneumoniae. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the ability of SMART‐COP (systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH) score to predict the need for intensive care unit (ICU) admission and mortality among patients with non–ventilator‐associated hospital‐acquired pneumonia (NV‐HAP) and to compare ICU‐hospitalized patients with those followed‐up in the clinic, as well as the patients who survived with those who died in the ICU, in terms of clinical and laboratory parameters. Methods: A total of 203 patients (aged > 65 years) who were diagnosed with NV‐HAP while staying in the geriatric clinic were enrolled in this retrospective observational study. Patient information was retrieved from hospital files. Results: In a total of 203 patients with NV‐HAP, the rate of ICU admission was 77.3% and the rate of mortality was 40.9%. The SMART‐COP score was significantly higher in those admitted to the ICU and those died in the ICU (ICU nonsurvivors). The rate of ICU mortality was 52.9%. The SMART‐COP score had significantly poor to moderate ability to predict the need for ICU admission (area under the curve [AUC] = 0.583) and both in‐hospital mortality (AUC = 0.633) and ICU mortality (AUC = 0.617) with low sensitivity. The regression analysis revealed that a one‐unit increase in SMART‐COP score resulted in a 1.2‐fold increase in both the hospital and ICU mortality (P < 0.05 for both) and 1.1‐fold increase in ICU admission (P = 0.154). Conclusion: The SMART‐COP score has poor to moderate ability to predict the need for ICU admission, in‐hospital mortality and ICU mortality, and a one‐unit increase in the SMART‐COP score significantly increases the risk of both hospital and ICU mortality. Geriatr Gerontol Int 2024; 24: 1165–1172. [ABSTRACT FROM AUTHOR]

Objectives: Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA. Methods: These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology. Results: The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline. Conclusions: The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated that neutrophil extracellular traps (NETs) are crucial in infectious diseases. This study aims to evaluate the clinical value of NET-related biomarkers in identifying the risk of COVID-19 and diagnosing the disease. Methods: This study involved 32 patients who tested positive for COVID-19 via polymerase chain reaction (PCR) between April and August 2023. During the same period, 30 healthy volunteers were enrolled as a control group. The principal biomarkers related to NETs are citrullinated histone H3 (CitH3), double-stranded DNA (dsDNA), myeloperoxidase-DNA complex (MPO-DNA), and Nucleosome. Elevated levels in two or more of these biomarkers indicate raised NET concentrations. Multivariable logistic regression analysis was employed to assess whether NET-related biomarkers were the independent risk factor of COVID-19. The diagnostic value of NET-related biomarkers in COVID-19 was further evaluated using receiver operating characteristic (ROC) curve analysis. Statistical procedures were executed in SPSS software (version 24.0, USA). Results: Compared with the control group, patients infected with COVID-19 had higher levels of dsDNA and nucleosomes (P < 0.001). Correlation analysis revealed a positive correlation between dsDNA levels and neutrophil count (r = 0.309, P = 0.015) as well as between nucleosome levels and neutrophil count (r = 0.446, P < 0.001). Further analysis showed that dsDNA and nucleosomes were independent risk factors for COVID-19 infection. ROC curve analysis showed that dsDNA area under the curve (AUC) = 0.777, 95% confidence interval (CI), 0.661– 0.893, P < 0.001, and nucleosomes (AUC = 0.884, 95% CI, 0.778– 0.991, P < 0.001) had well diagnostic value in the diagnosing COVID-19 infection. Conclusion: NET-related biomarkers, dsDNA and nucleosomes, were independent risk factors of COVID-19 infection and potentially useful biomarkers in diagnosing COVID-19 infection in older patients. [ABSTRACT FROM AUTHOR]

Abstract Background Eosinophilic gastrointestinal diseases are the rare gastrointestinal disorders. To our knowledge, there have been no reports of eosinophilic gastrointestinal diseases with overall gastrointestinal tract involvement causing liver abscess in an older patient. Case presentation We report a 68-year-old man with eosinophilic gastrointestinal disease with overall gastrointestinal tract involvement. He was admitted with suspected acute gastroenteritis, and histological examination showed eosinophilic infiltration accompanied by liver abscess. The collected pus was tested for Metagenomics Next-Generation Sequencing and confirmed the presence of Klebsiella pneumoniae. Conclusions We conducted a literature review on the complications of eosinophilic gastrointestinal diseases and discussed how eosinophilic gastrointestinal diseases lead to liver abscess caused by Klebsiella pneumoniae.

Abstract Objectives To estimate the frequency of potentially inappropriate prescribing (PIP) in outpatients according to STOPP/START criteria, and to identify risk factors. For this purpose, an algorithm was developed and validated in RStudio® based on the information collected in the electronic prescription. Methods The data corresponds to dispensations from two pharmacies in Spain made to patients over 18 years, over 4 years. For the analysis, only patients aged ≥ 65 years who are targeted by the STOPP/START criteria are included. The statistical programming language RStudio® was used to develop the algorithm. The STOPP criteria used as models for the implementation of the method were L2 and B12. A logistic regression analysis was performed. Results A total of 15,601 treatment plans were obtained from 2312 patients ≥ 65 years (56% women), of whom 46.6% had polypharmacy (≥ 5 drugs) and 9.3% had excessive polypharmacy (≥ 10 drugs). In this group, PIPs were detected in 57% of patients and in 38% of their treatment plans; of these PIPs the most common were those related to the use of benzodiazepines for more than 28 days (D5 criterion) in 25.9% of patients, followed by the use of opioids prescribed without an associated laxative (L2 criterion) in 13.8% and finally, drugs duplication (A3 criterion) in 5.7%. The most numerous duplications related to criterion A3 were benzodiazepines (39%) and non-steroidal anti-inflammatory drugs (37.4%). Conclusions The method developed and validated in RStudio® with different STOPP criteria allows us to analyse the pharmacological treatment of many patients using different databases and to identify those at risk of suffering a PIP according to the STOPP criteria. Our results indicate a high prevalence of PIPs in patients ≥ 65 years, with polypharmacy being the most common risk factor affecting PIP.

Abstract Aims The ALIMENT‐HF trial aims to determine whether high‐calorie and high‐protein oral nutritional supplements (ONS) are safe and beneficial for older adult outpatients with heart failure (HF). Methods and results This multicentre, single‐arm, interventional pilot trial is designed to evaluate the tolerance, efficacy, and safety of ONS in older adult outpatients with chronic HF, malnutrition, and anorexia. In total, 80 outpatients with HF regardless of their left ventricular ejection fraction will be treated with ONS, including high‐energy (900 kcal/day) and high protein (36 g/day) supplementation, at eight sites in Japan. Inclusion criteria are as follows: age, ≥65 years; outpatients receiving maximally tolerated guideline‐directed medical therapy for HF and without change in their diuretic dosage during the last 3 months; outpatients at risk of malnutrition, defined as a Malnutrition Universal Screening Tool score ≥1 point, and anorexia, defined using a Simplified Nutritional Appetite Questionnaire for the Japanese Elderly (SNAQ‐JE) score of ≤14 points. Nutritional intervention will continue for up to 120 days, with an observational period lasting for a further 60 days. The primary outcome is a change in body weight between baseline and day 120. Conclusions The ALIMENT‐HF trial will evaluate the tolerance, efficacy, and safety of high‐calorie and high‐protein‐rich ONS in older outpatients with HF co‐morbid with malnutrition and anorexia and will provide insightful information for future randomized controlled trials.

Background: Locally advanced rectal cancer (LARC) presents significant treatment challenges, particularly as patient age may influence disease progression and treatment response. Understanding the differences in progression patterns and treatment outcomes between older patient (OP) and non-older patient (NOP) is essential for tailoring effective management strategies. Objectives: We aimed to explore the differences of progression pattern, postoperative treatment, and survival outcome between OP and NOP groups in LARC. Design/Methods: The random survival forest model was used to determine the probability of time-to-event occurrence every 3 months. Patients in the NOP and OP group were both categorized into three risk groups based on progression-free survival nomogram scores. We employed inverse probability of treatment weighting (IPTW) analysis and the Surveillance, Epidemiology, and End Results (SEER) database to verify our findings. Results: Our results revealed that Groups 1, 2, and 3 experienced peaks in progression within the first 24 months in NOP group. As for OP group, Group 4 reached a progression peak at the 18th month, Group 5 at the 12th month, and Group 6 at the 9th month. In NOP group, high-risk patients who underwent postoperative chemotherapy had significantly improved overall survival compared to those who did not. Additionally, postoperative chemotherapy did not significantly improve prognosis for patients in low-, moderate-, or high-risk groups of OP group. Finally, the validation results of IPTW analysis and SEER database showed compliance with our findings. Conclusion: For NOP group, we recommended close follow-up during the first 2 years. As for OP group, it was suggested to conduct close follow-up at the 18th, 12th, and 9th month for low-, moderate-, and high-risk groups, respectively. Furthermore, postoperative chemotherapy can provide survival benefits for patients in high-risk group of NOP group. However, OP group patients should be informed that the potential benefits of postoperative chemotherapy may be minimal. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the frequency of potentially inappropriate prescribing (PIP) in outpatients according to STOPP/START criteria, and to identify risk factors. For this purpose, an algorithm was developed and validated in RStudio® based on the information collected in the electronic prescription. Methods: The data corresponds to dispensations from two pharmacies in Spain made to patients over 18 years, over 4 years. For the analysis, only patients aged ≥ 65 years who are targeted by the STOPP/START criteria are included. The statistical programming language RStudio® was used to develop the algorithm. The STOPP criteria used as models for the implementation of the method were L2 and B12. A logistic regression analysis was performed. Results: A total of 15,601 treatment plans were obtained from 2312 patients ≥ 65 years (56% women), of whom 46.6% had polypharmacy (≥ 5 drugs) and 9.3% had excessive polypharmacy (≥ 10 drugs). In this group, PIPs were detected in 57% of patients and in 38% of their treatment plans; of these PIPs the most common were those related to the use of benzodiazepines for more than 28 days (D5 criterion) in 25.9% of patients, followed by the use of opioids prescribed without an associated laxative (L2 criterion) in 13.8% and finally, drugs duplication (A3 criterion) in 5.7%. The most numerous duplications related to criterion A3 were benzodiazepines (39%) and non-steroidal anti-inflammatory drugs (37.4%). Conclusions: The method developed and validated in RStudio® with different STOPP criteria allows us to analyse the pharmacological treatment of many patients using different databases and to identify those at risk of suffering a PIP according to the STOPP criteria. Our results indicate a high prevalence of PIPs in patients ≥ 65 years, with polypharmacy being the most common risk factor affecting PIP. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: The aim of the present study was to investigate differences in characteristics and outcomes between vaccinated and unvaccinated older patients hospitalized for COVID-19 infection. Findings: Compared to older unvaccinated patients hospitalized for COVID-19, vaccinated patients were frailer, had more comorbidities and, independent of these factors, a three times lower risk for in-hospital mortality. Message: Although being frailer, vaccinated older patients have a lower risk of in-hospital mortality than unvaccinated patients. Purpose: The aim of the present study was to investigate characteristics and outcomes in vaccinated and unvaccinated older patients hospitalized for COVID-19 infection. Methods: A retrospective multicentre cohort study among patients aged ≥70 years hospitalized for COVID-19 infection. Results: 263 vaccinated and 82 unvaccinated patients were included. Vaccinated patients were older (median age 79 vs. 76 years; p < 0.001), more patients were male (66.2% vs. 53.7%; p = 0.040), had more comorbidities [median Charlson Comorbidity Index (CCI) 2 vs. 1; p 0.016] and were frailer [Clinical Frailty Scale (CFS) ≥ 4 68% vs. 49%; p 0.015]. Vaccinated patients were admitted earlier after symptom onset (median 5 days vs. 7 days) but were equally ill at time of hospital admission. After correction for frailty, comorbidity and disease severity, risk of in-hospital mortality was three times lower for vaccinated patients (HR 0.30 95% CI 0.16–0.56; p < 0.001) compared to unvaccinated patients. Conclusion: Vaccinated patients had lower risk of in-hospital mortality than unvaccinated patients with COVID-19 infection. These findings suggest that vaccinated patients benefit from the protective effect of the vaccine against death during hospital stay, outweighing the increased mortality risk that is associated with older age, greater frailty and more numerous comorbidities. This could be an encouragement for older people to receive age-appropriate vaccines, although no definite conclusions can be drawn for this was no intervention study. [ABSTRACT FROM AUTHOR]

Aims: The ALIMENT‐HF trial aims to determine whether high‐calorie and high‐protein oral nutritional supplements (ONS) are safe and beneficial for older adult outpatients with heart failure (HF). Methods and results: This multicentre, single‐arm, interventional pilot trial is designed to evaluate the tolerance, efficacy, and safety of ONS in older adult outpatients with chronic HF, malnutrition, and anorexia. In total, 80 outpatients with HF regardless of their left ventricular ejection fraction will be treated with ONS, including high‐energy (900 kcal/day) and high protein (36 g/day) supplementation, at eight sites in Japan. Inclusion criteria are as follows: age, ≥65 years; outpatients receiving maximally tolerated guideline‐directed medical therapy for HF and without change in their diuretic dosage during the last 3 months; outpatients at risk of malnutrition, defined as a Malnutrition Universal Screening Tool score ≥1 point, and anorexia, defined using a Simplified Nutritional Appetite Questionnaire for the Japanese Elderly (SNAQ‐JE) score of ≤14 points. Nutritional intervention will continue for up to 120 days, with an observational period lasting for a further 60 days. The primary outcome is a change in body weight between baseline and day 120. Conclusions: The ALIMENT‐HF trial will evaluate the tolerance, efficacy, and safety of high‐calorie and high‐protein‐rich ONS in older outpatients with HF co‐morbid with malnutrition and anorexia and will provide insightful information for future randomized controlled trials. [ABSTRACT FROM AUTHOR]

Recent studies indicate that gut microbiota may play a crucial role in cognitive function. Individuals with cognitive impairment tend to have fewer beneficial gut bacteria and lower microbial diversity. Therefore, gut microbiota could be a potential biomarker for cognitive vulnerability. Further research is needed to understand the mechanisms and lifestyle factors affecting both microbiota composition and cognitive health. While the direct impact of microbiota and diet on cognitive impairment remains unconfirmed, this area holds promise for developing new preventive and treatment strategies. [ABSTRACT FROM AUTHOR]

Chakkarin Sommana,1 Samoraphop Banharak,1 Supin Sim-Im,2 Khanisorn Ransinyo1 1Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand; 2Nursing Department, Srinagarind Hospital, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Samoraphop Banharak, Email sbanharak@kku.ac.thAim: Incontinence-associated dermatitis is a common health problem among older clinical patients, causing related severe skin damage such as pressure ulcers, secondary infection, and long length of hospital stay. This pilot study aimed to develop and examine the effects of nursing programs in preventing incontinence-associated dermatitis (IAD) among older patients. Ten older patients at high risk of incontinence-associated dermatitis were included in this study: five patients received a nursing program combined with mixed products, and another five received a nursing program combined with separate use of products. The program was evaluated using a perianal assessment tool (PAT-T) for risk assessment, the incontinence-associated dermatitis invention tool (IADIT-T) for severity assessment, the skin surface pH, and skin surface moisture. The results revealed that the nursing program and skin products are usable and acceptable, provide step-by-step details, and are simple and easy to follow. The nursing program combined with using zinc oxide products followed by petroleum jelly can prevent and decrease the severity of incontinence-associated dermatitis in older patients. Moreover, it can also improve the skin surface pH to a mild acidity appropriate for the skin condition and increase the skin’s moisture better the nursing program with mixed skin products. This pilot study confirmed that the developed program can be applied in practice. Moreover, the program could be used to decrease the incidence of IAD and skin surface pH but increase skin moisture. However, future study with a larger sample size and applying a more substantial research design for more accuracy and generalization is needed.Clinical Trial Registration Number: OSF https://osf.io/8gj3d.Keywords: nursing program, incontinence-associated dermatitis, older patient, skin care, critical care

In the context of pancreatic cancer, surgical intervention is typically recommended for localized tumours, whereas chemotherapy is the preferred approach in the advanced and/or metastatic setting. However, pancreatic cancer is closely linked to ageing, with an average diagnosis at 72 years. Paradoxically, despite its increased occurrence among older individuals, this population is often underrepresented in clinical studies, complicating the decision-making process. Age alone should not determine the therapeutic strategy but, given the high comorbidity and mortality of this disease, a comprehensive geriatric assessment (CGA) is necessary to define the best treatment, prevent toxicity, and optimize older patient care. In this review, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica, SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours (Grupo Español de Tratamiento de los Tumores Digestivos, TTD), and the Multidisciplinary Spanish Group of Digestive Cancer (Grupo Español Multidisciplinar en Cáncer Digestivo, GEMCAD) have assessed the available scientific evidence and propose a series of recommendations on the management and treatment of the older population with pancreatic cancer. [ABSTRACT FROM AUTHOR]

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

The aim of this article is to provide frailty education that is relevant to the orthopaedic surgeon. An ageing population has led to an increase in the number of orthopaedic operations in patients living with frailty. Accumulating evidence suggests that a patient's outcome is better estimated by measuring their frailty score rather than their chronological age. If a patient lives with frailty, they are much more susceptible to complications and mortality. This article will explain how to identify frailty, what complications are associated with frailty and when, and what, interventions can be used to help reduce complications. It will also educate on current British Orthopaedic Association and Centre for Perioperative Guidelines for patients living with frailty, for both trauma and elective patients. [ABSTRACT FROM AUTHOR]

Background/purpose: Healthy states of human microbiota depend on a stable community of symbiotic microbes irrespective of external challenges from the environment. Thus, long-term stability of the oral microbiota is of importance, particularly for older patient populations. Materials and methods: We used next-generation sequencing (NGS) to examine the tongue microbiota of 18 individuals receiving long-term care over a 10-month period. Results: Beta diversity analysis demonstrated temporal stability of the tongue microbiota, as microbial compositions from all time points were indistinguishable from each other (P = 0.0887). However, significant individual variation in microbial composition (P = 0.0001) was observed, underscoring the presence of a unique microbial profile for each patient. Conclusion: The temporal dynamics of tongue microbiota exhibit long-term stability, providing diagnostic implications for oral diseases within older patient populations.

Abstract Background An increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure. Methods In this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis. Results During the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p

Background: Metastatic colorectal cancer is one of the most common causes of cancer death worldwide, and its incidence increases with age. Treating an older RAS and BRAF wild-type patient represents a challenge for the medical oncologist, even more so for those patients defined as "vulnerable" and undergoing at least two lines of therapy. In this context, recent evidence supports the role of retreatment with anti-EGFR inhibitors and the use of liquid biopsy. However, frequent skin toxicity constitutes a limitation of therapy, especially in older people. Since it has been described that continuous administration of these monoclonal antibodies leads to acquired resistance to anti-EGFRs, with consequent therapeutic failure, an intermittent strategy with chemotherapy plus an anti-EGFR could help maintain the efficacy of the treatment over time, delaying the resistance and improving patients' quality of life. Case presentation: In this case report, we describe the case of an older RAS and BRAF wild-type patient reporting a clinical response after first-line chemotherapy with FOLFOX + panitumumab, subsequently interrupted in the absence of disease progression. After radiological worsening and two additional lines of therapy, the reintroduction of panitumumab plus 5-fluorouracil, administered with a stop-and-go strategy, allowed the patient to benefit from the same drugs for 2 years from diagnosis, to achieve a clinical response during fourth-line treatment lasting more than 3 years, to delay resistance and to avoid unacceptable anti-EGFR skin toxicity. This patient, who died from a myocardial infarction more than 5 years after diagnosis, represents the case of a good synergy between molecular profile of disease and reintroduction of an anti-EGFR with intermittent strategy. [ABSTRACT FROM AUTHOR]

Healthy states of human microbiota depend on a stable community of symbiotic microbes irrespective of external challenges from the environment. Thus, long-term stability of the oral microbiota is of importance, particularly for older patient populations. We used next-generation sequencing (NGS) to examine the tongue microbiota of 18 individuals receiving long-term care over a 10-month period. Beta diversity analysis demonstrated temporal stability of the tongue microbiota, as microbial compositions from all time points were indistinguishable from each other (P = 0.0887). However, significant individual variation in microbial composition (P = 0.0001) was observed, underscoring the presence of a unique microbial profile for each patient. The temporal dynamics of tongue microbiota exhibit long-term stability, providing diagnostic implications for oral diseases within older patient populations. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is a common type of liver cancer and is a widespread cause of death from malignancy worldwide. The diagnosis of HCC is made by radiological liver imaging and the presence of serum alfa-fetoprotein. Our patient, a 75-year-old man, had a mass (14x17 cm) in the right liver lobe. Serum alfa-fetoprotein (AFP) was normal. There were no signs of metastasis except for several suspicious subcentimetric lymph nodes. Diagnosis of HCC confirmed by liver biopsy. He was evaluated by a multidisciplinary team. The team favored Yttrium-90 radioembolization treatment. The tumor showed slight regression. However, a new subcentimetric nodule was detected in the posterior segment of the left lower lobe of the lung. Sorafenib was initiated as a salvage drug by medical oncology. In conclusion, this case shows that with HCC can present with normal AFP levels even in advanced diseases. Biomarkers other than AFP are believed to contribute to HCC tumor growth. Moreover, we can infer from this case that the tumor shows less aggression in HCC patients with normal AFP levels. The treatment of HCC should be based on the patient's age and comorbidities. : [ABSTRACT FROM AUTHOR]

Background: An increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure. Methods: In this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis. Results: During the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p < 0.001). After adjustments for other covariates, laparoscopic surgery was an independent preventive factor for postoperative functional decline (OR, 0.22; 95% CI, 0.05–0.83; p < 0.05). Conclusions: In emergency abdominal surgery, laparoscopic surgery reduces postoperative physical functional decline in older patients. Widespread use of laparoscopic surgery can potentially preserve patient quality of life and may be important for the better development of emergency abdominal surgery. [ABSTRACT FROM AUTHOR]

Ulcerative colitis (UC) has been associated with increased prostate cancer (PCa) risk. However, the mechanisms underlying UC and increased PCa risk remain unclear, and research on this topic is scarce in Japan. We have investigated whether UC is associated with PCa risk in the Japanese population and the risk factors related to PCa among older UC patients. This retrospective single-center cohort study was conducted between January 2010 and April 2022. A total of 68 cases were analyzed, and 9 cases of PCa were observed (13.2%). PCa occurred more frequently in the adult-onset group (8/40, 20.0%) than in the older-onset group with UC (1/28; 3.57%). No significant differences were observed between immunosuppressive therapies and PCa in patients, excluding those with pancolitis-type UC. PCa occurred more frequently in the pancolitis type, and the biologics group had no PCa cases, but the difference was not statistically significant (p = 0.07). This study suggests that pancolitis type and UC onset in middle-aged patients may be risk factors and found that biologics potentially suppress PCa development. [ABSTRACT FROM AUTHOR]

Background: It is essential to establish both the appropriateness of palliative care (PC) and the prognosis in daily clinical practice to guide decision making in the management of older people with multiple advanced chronic diseases. Objectives: We assessed patients who were appropriate for PC using the NECPAL tool in a hospitalized older population and then we investigated its predictive validity on one-year mortality compared with the multidimensional prognostic index (MPI), a validated geriatric prognostic tool. Design: Prospective cohort study. Setting/Subjects: We enrolled 103 older adults hospitalized for acute medical and surgical conditions in a geriatric hospital in Italy. Measurements: The variables of interest were obtained at baseline through interviews of the ward medical staff and by consulting the computerized medical records. Long-term mortality (one-year) was assessed through the analysis of data acquired from hospital or territorial databases or through telephone contact with caregivers. Results: Mean age was 86.8 ± 7.2 years, with a female prevalence of 54.4%. Prevalence of NECPAL+ patients was 65.1%. MPI low risk: 30.1%; moderate risk: 41.7%; severe risk: 28.2%. Patients deceased during follow-up were 54.4%. NECPAL+ patients were more likely to die, even after adjusting for age, sex, and MPI score (hazard ratio [HR] 2.7, p = 0.020). All the NECPAL categories were associated with one-year mortality. MPI showed a better predictive power than NECPAL (area under the curve [AUC] 0.85 vs. 0.75, p = 0.030). After the exclusion of "Comorbidity: ≥2 concurrent diseases" item from NECPAL, its AUC increased to 0.78 with no statistically significant differences from MPI (p = 0.122). Conclusions: NECPAL is useful to identify the appropriateness of PC in hospitalized older adults, also allowing to predict long-term mortality with a performance similar to that of a validated geriatric prognostic tool. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common and serious neuropsychiatric disorder. The prognosis of delirium in older patients living at home has not been studied often before. The aim of this study is to examine the prognosis of delirium in patients attending a memory clinic of a psychiatric hospital. Method: The study population consisted of 85 outpatients diagnosed with delirium between October 2013 and October 2014. Seventeen patients had already been diagnosed as having dementia. Three months after the diagnosis, consenting patients underwent a follow‐up visit. We recorded delirium status (remitted or not), new dementia diagnosis, subjective cognitive functioning compared to baseline and to before delirium, level of daily functioning, and place of residence. Results: After 3 months, 45 (53%) had recovered from delirium, 19 (22,4%) had persistent/recurrent delirium, 12 (14%) patients had died, and another nine (11%) could not be revisited for other reasons than death. None of the 64 re‐examined patients reported that their cognitive functioning had recovered to the pre‐delirium level, and the mean level of daily functioning did not substantially improve either. The rate of diagnosed dementia increased to 63.8%, and 18 patients (28.1%) had moved to a nursing home. Conclusions: Delirium in older outpatients has a poor prognosis. A larger study on the risk factors of the prognosis of delirium in older persons living at home is advised. [ABSTRACT FROM AUTHOR]

Background: Older patients are often vulnerable and highly dependent on healthcare professionals' assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim: To describe ambulance clinicians' understanding of older patients' self-determination when the patient's decision-making ability is impaired. Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology. Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will ; and (2) Contradictions about the patient's best interests. The clinicians' interpretations are based on an understanding of the patient's situation using substitute decision-making in emergency situations and conversations that reveal the patient's explicit wishes. Sometimes the clinicians collaborate to validate the patient's implicit will, while they at other times subordinate themselves to others' opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient's self-determination. Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient's unique needs based on a holistic perspective and their ability to be autonomous. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Knee adduction moment and knee adduction angular impulse enlargement is the main biomechanical risk factor of knee osteoarthritis. According to the survey, a change in the foot progression angle could effectively change the motion mode of patients with knee osteoarthritis. However, the impact of toe-in and toe-out on knee adduction moment and knee adduction angular impulse in young and elderly patients did not reach a consensus. Therefore, this study comprehensively discussed the effect of foot progression angle on knee adduction moment and knee adduction angular impulse in different populations through meta-analysis and provided a reference for the treatment of knee osteoarthritis. METHODS: By June 2022, searches were conducted on Web of Science, EBSCO, PubMed and CNKI databases using “foot progression angle, knee adduction moment, knee adduction angular impulse, gait” as Chinese and English search terms. Self-controlled randomized controlled studies analyzing the effects of toein and toe-out on knee adduction moment bimodality and knee adduction angular impulse were included. The cochrane bias risk assessment tool was utilized to make a quality evaluation of the literature. Stata 15.1 software was used for subgroup analysis to determine the effect of foot progression angle on knee adduction moment and knee adduction angular impulse. Meta-regression analysis was used to further determine characteristics of outcome indicators (knee adduction moment, knee adduction angular impulse) changing with foot progression angle. RESULTS: (1) A total of 15 self-control trials and 2 randomized controlled trials (455 subjects) were included in the meta-analysis. All of the included articles were of medium to high quality. (2) The meta-analysis results showed that the toe-in gait could reduce the first peak of knee adduction moment (SMD=-0.380, 95%CI:-0.710 to -0.060, P=0.022) and knee adduction angular impulse (SMD=-1.470, 95%CI:-2.160 to -0.770, P < 0.001) in young patients. The toe-out gait reduced the second peak of knee adduction moment (SMD=-0.720, 95%CI:-1.010 to -1.440, P < 0.001) in young patients. In addition, toe-in gait could reduce the first peak of knee adduction moment in elder patients (SMD=-0.550, 95%CI:-0.800 to -0.300, P < 0.001), but increase the second peak knee adduction moment of elderly (SMD=0.280, 95%CI:-0.010 to 0.560, P=0.047). The toe-out gait could decrease the second peak knee adduction moment in this population (SMD=-0.510, 95%CI:-0.830 to -0.190, P=0.002). (3) Meta-regression showed that the greater the toe-out in elderly patients, the lower the second peak knee adduction moment. CONCLUSION: (1) Toe-in reduced the first peak knee adduction moment and knee adduction angular impulse in young knee osteoarthritis patients aged 18 to 34 years. Since knee adduction moment and knee adduction angular impulse were associated with medial knee loading and knee osteoarthritis incidence, toe-in gait intervention may be a suitable rehabilitation strategy for young patients. (2) Toe-in increased the second peak of knee adduction moment in older knee osteoarthritis patients over 60 years of age, which may exacerbate knee osteoarthritis in this population. However, the second peak of knee adduction moment during walking in this population decreases as the toe-out increases, contributing to a reduction in medial knee loading, suggesting that older patients may consider using toe-out gait during walking. [ABSTRACT FROM AUTHOR]

In older patients, ground-level falls are the most common cause of injury. Many intrinsic and extrinsic factors influence ground fall injuries. However, the characteristics and severity of ground fall injuries have not been compared according to the activity levels. We compared the characteristics of ground fall injuries by the activity level to establish a preventive strategy for ground fall injuries in older patients. We retrospectively reviewed the records of older patients who were admitted to six university hospitals for ground-level fall injuries from 2011 to 2020. The patients were classified into active and inactive groups. Active activities were defined as paid work, exercise and leisure activities. General and clinical characteristics of both groups for ground-level fall injury were analyzed. Propensity score matching analysis (1:1) was performed for baseline characteristics (sex, age and alcohol consumption). A total of 33,924 patients were enrolled, of which 4887 (14.4%) were classified in the active group. Injury severity was not different between the active and inactive groups. The main factors significantly associated with ground fall injuries during activities in elderly patients were male sex, age from 65 to 74 years and 75 to 84 years compared to greater than 85 years, an injury time other than 00:00-05:59, alcohol consumption, sloping floor and floor type other than concrete. After propensity score matching analysis, the factors associated with ground-level fall injuries in older patients when they were active were a time of injury from 06:00-17:59 compared to 00:00-05:59, slippery floor, slope, the absence of obstacles and type of floor other than concrete. We should establish preventive strategies for reducing ground-level fall injuries in older patients during activity, which could include wearing compatible footwear, caution on sloping areas, and maintenance of unpaved roads. [ABSTRACT FROM AUTHOR]

Abstract Background Older people hospitalized for COVID-19 are a vulnerable group due to the disease itself, aging and often loss of hearing and vision. Person-centered care, where patients have opportunities to communicate and participate in their own care, is important. However, because healthcare staff needed to wear personal protective equipment during the pandemic, to protect the patients and themselves, providing person-centered care was often difficult. This study aims to describe older hospitalized patients’ experiences both of being cared for, while having COVID-19, and of the care provided by healthcare staff wearing PPE. Methods Fourteen older patients, over 65 years of age, were interviewed, and the data were analyzed using qualitative content analysis. The study adhered to Consolidated criteria for reporting qualitative research guidelines. Results Three subthemes and one overall theme, “The desire for survival overshadows difficulties”, emerged in the analysis. The main findings revealed that the older hospitalized patients experienced the care they received from the healthcare staff as satisfactory. The older patients reported understanding and accepting that the pandemic situation meant that their ability to participate in their own care and communicate with healthcare staff were given lower priority. Conclusions Older hospitalized patients need to be provided person-centered care, and situations such as a pandemic are no exception. Care tasks that are not acute in nature, e.g., planning for patients’ return home, could be conducted by healthcare staff not required to wear PPE.

BackgroundMetastatic colorectal cancer is one of the most common causes of cancer death worldwide, and its incidence increases with age. Treating an older RAS and BRAF wild-type patient represents a challenge for the medical oncologist, even more so for those patients defined as “vulnerable” and undergoing at least two lines of therapy. In this context, recent evidence supports the role of retreatment with anti-EGFR inhibitors and the use of liquid biopsy. However, frequent skin toxicity constitutes a limitation of therapy, especially in older people. Since it has been described that continuous administration of these monoclonal antibodies leads to acquired resistance to anti-EGFRs, with consequent therapeutic failure, an intermittent strategy with chemotherapy plus an anti-EGFR could help maintain the efficacy of the treatment over time, delaying the resistance and improving patients’ quality of life.Case presentationIn this case report, we describe the case of an older RAS and BRAF wild-type patient reporting a clinical response after first-line chemotherapy with FOLFOX + panitumumab, subsequently interrupted in the absence of disease progression. After radiological worsening and two additional lines of therapy, the reintroduction of panitumumab plus 5-fluorouracil, administered with a stop-and-go strategy, allowed the patient to benefit from the same drugs for 2 years from diagnosis, to achieve a clinical response during fourth-line treatment lasting more than 3 years, to delay resistance and to avoid unacceptable anti-EGFR skin toxicity. This patient, who died from a myocardial infarction more than 5 years after diagnosis, represents the case of a good synergy between molecular profile of disease and reintroduction of an anti-EGFR with intermittent strategy.

Objective: In this study, we were aimed to identify important variables via machine learning algorithms and predict postoperative delirium (POD) occurrence in older patients. Methods: This study was to make the secondary analysis of data from a randomized controlled trial. The Boruta function was used to screen relevant basic characteristic variables. Four models including Logistic Regression (LR), K-Nearest Neighbor (KNN), the Classification and Regression Tree (CART), and Random Forest (RF) were established from the data set using repeated cross validation, hyper-parameter optimization, and Smote technique (Synthetic minority over-sampling technique, Smote), with the calculation of confusion matrix parameters and the plotting of Receiver operating characteristic curve (ROC), Precision recall curve (PRC), and partial dependence graph for further analysis and evaluation. Results: The basic characteristic variables resulting from Boruta screening included grouping, preoperative Mini-Mental State Examination(MMSE), CHARLSON score, preoperative HCT, preoperative serum creatinine, intraoperative bleeding volume, intraoperative urine volume, anesthesia duration, operation duration, postoperative morphine dosage, intensive care unit (ICU) duration, tracheal intubation duration, and 7-day postoperative rest and move pain score (median and max; VAS-Rest-M, VAS-Move-M, VAS-Rest-Max, and VAS-Move-Max). And Random Forest (RF) showed the best performance in the testing set among the 4 models with Accuracy: 0.9878; Matthews correlation coefficient (MCC): 0.8763; Area under ROC curve (AUC-ROC): 1.0; Area under the PRC Curve (AUC-PRC): 1.0. Conclusion: A high-performance algorithm was established and verified in this study demonstrating the degree of POD risk changes in perioperative elderly patients. And the major risk factors for the development of POD were CREA and VAS-Move-Max. [ABSTRACT FROM AUTHOR]

Background: Older people hospitalized for COVID-19 are a vulnerable group due to the disease itself, aging and often loss of hearing and vision. Person-centered care, where patients have opportunities to communicate and participate in their own care, is important. However, because healthcare staff needed to wear personal protective equipment during the pandemic, to protect the patients and themselves, providing person-centered care was often difficult. This study aims to describe older hospitalized patients' experiences both of being cared for, while having COVID-19, and of the care provided by healthcare staff wearing PPE. Methods: Fourteen older patients, over 65 years of age, were interviewed, and the data were analyzed using qualitative content analysis. The study adhered to Consolidated criteria for reporting qualitative research guidelines. Results: Three subthemes and one overall theme, "The desire for survival overshadows difficulties", emerged in the analysis. The main findings revealed that the older hospitalized patients experienced the care they received from the healthcare staff as satisfactory. The older patients reported understanding and accepting that the pandemic situation meant that their ability to participate in their own care and communicate with healthcare staff were given lower priority. Conclusions: Older hospitalized patients need to be provided person-centered care, and situations such as a pandemic are no exception. Care tasks that are not acute in nature, e.g., planning for patients' return home, could be conducted by healthcare staff not required to wear PPE. [ABSTRACT FROM AUTHOR]

Background: Drug‐related readmissions (DRAs) are defined as rehospitalizations with an adverse drug event as their main or significant contributory cause. DRAs represent a major adverse health burden for older patients. A prediction model which identified older hospitalized patients at high risk of a DRA <1 year was previously developed using the OPERAM trial cohort, a European cluster randomized controlled trial including older hospitalized patients with multimorbidity and polypharmacy. This study has performed external validation and updated the prediction model consequently. Methods: The MedBridge trial cohort (a multicenter cluster randomized crossover trial performed in Sweden) was used as a validation cohort. It consisted of 2516 hospitalized patients aged ≥65 years. Model performance was assessed by: (1) discriminative power, assessed by the C‐statistic with a 95% confidence interval (CI); (2) calibration, assessed by visual examination of the calibration plot and use of the Hosmer–Lemeshow goodness‐of‐fit test; and (3) overall accuracy, assessed by the scaled Brier score. Several updating methods were carried out to improve model performance. Results: In total, 2516 older patients were included in the validation cohort, of whom 582 (23.1%) experienced a DRA <1 year. In the validation cohort, the original model showed a good overall accuracy (scaled Brier score 0.03), but discrimination was moderate (C‐statistic 0.62 [95% CI 0.59–0.64]), and calibration showed underestimation of risks. In the final updated model, the predictor "cirrhosis with portal hypertension" was removed and "polypharmacy" was added. This improved the model's discriminative capability to a C‐statistic of 0.64 (95% CI 0.59–0.70) and enhanced calibration plots. Overall accuracy remained good. Conclusions: The updated OPERAM DRA prediction model may be a useful tool in clinical practice to estimate the risk of DRAs in older hospitalized patients subsequent to discharge. Our efforts lay the groundwork for the future development of models with even better performance. [ABSTRACT FROM AUTHOR]

Background: Older patients with cancer receive anticancer therapy in outpatient settings, and care-related issues may occur after discharge, which often requires family caregivers (FCs) to play a significant role in providing cancer care at home. However, relatively few studies have been focused on exploring the care experiences of these FCs. Purpose: The aim of this study was to explore the care experiences of FCs caring for older family members with cancer at home. Methods: A qualitative study design and in-depth individual interviews were used to explore the at-home care experiences of FCs of older patients with cancer. The research was conducted in chemotherapy outpatient settings of a medical center in northern Taiwan. Content analysis was used to analyze data. The analyses focused on first extracting meaningful units from the text and then inducting categories from these units and determining the major themes. Results: Twenty FCs were interviewed. The three themes identified included (a) increased information needs and challenges in diet preparation and treatment decision making, (b) personal and patient-induced emotional stress, and (c) life rebalancing through the care experience. Conclusions/Implications for Practice: The findings highlight the educational requirements, especially related to meeting personal dietary needs and obtaining psychological support, for FCs caring for older patients with cancer to help them rebalance their life. [ABSTRACT FROM AUTHOR]

Background: Prehospital (PH) tranexamic acid (TXA) improves survival from trauma haemorrhage. Injury mechanism, physiology, and sex demographics vary with patient age. The authors hypothesised that these factors influence TXA guideline compliance and examined national trends in PH use to identify any systematic biases in bleeding management. Materials and methods: The UK Trauma Audit and Research Network data for TXA eligible patients admitted to major trauma centres were divided into two cohorts: 2013-2015 (n =32 072) and 2017-2019 (n =14 974). Patients were stratified by PH, emergency department or no TXA use. Logistic regression models explored interaction between PH variables and TXA administration. Results are presented as odds ratios with a 95% CI. Results: PH TXA use increased from 8% to 27% over time (P<0.001). Only 3% of eligible patients who fell less than 2 m received PH TXA versus 63% with penetrating injuries (P< 0.001). Older patients eligible for PH TXA were less likely to receive it compared to younger patients [≥ 65 years old: 590 (13%) vs. <65 years old: 3361 (33%), P<0.001]. There was a significant interaction between age and sex with fewer older women receiving PH TXA. In shocked patients, one third of females compared to a fifth of men did not receive TXA (P <0.001). There was a decrease in PH TXA use as age increased (P<0.001). Conclusions: Despite a threefold increase in use, treatment guidance for PH TXA is not universally applied. Older people, women, and patients with low energy injury mechanisms appear to be systematically under treated. Training and education for PH providers should address these potential treatment biases. [ABSTRACT FROM AUTHOR]

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Abstract Background The growing trend of ageing population has become a worldwide concern. In comparison with the youth, older people are more likely to suffer from multimorbidity and polypharmacy, both of which are associated with adverse outcomes and increased healthcare costs. This study aimed to investigate the status of multimorbidity and polypharmacy in a large sample of hospitalized older patients aged 60 years and over. Methods A retrospective cross-sectional study was conducted among 46,799 eligible patients aged 60 years and over, who were hospitalized from January 1, 2021 to December 31, 2021. Multimorbidity was defined as the presence of 2 or more morbidities in one patient during the stay in hospital, and polypharmacy as prescription of 5 or more different oral medications. Spearman rank correlation analysis was used to assess the relationship of factors with the number of morbidities or oral medications. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated from logistic regression models to determine the predictors for polypharmacy and all-cause death. Results The prevalence of multimorbidity was 91.07% and increased with age. The prevalence of polypharmacy was 56.32%. Older age, polypharmacy, prolonged length of stay (LOS), higher cost on medications were significantly associated with an increased number of morbidities (all P

Purpose of reviewChronic kidney disease (CKD) is highly prevalent in elderly patients. There is growing recognition of the importance of attention to dietary protein intake (DPI) in this population given their predisposition to age-related changes in kidney function and coexisting comorbidities (i.e., hypertension). We reviewed the impact of DPI on kidney health and survival and the role of dietary protein management in older CKD patients.Recent findingsWhile kidney function parameters including glomerular filtration rate (GFR) and renal plasma flow are slightly lower in elderly patients irrespective of CKD status, the kidneys' ability to compensate for increased DPI by augmentation of GFR is preserved until 80 years of age or less. However, long-term consumption of high DPI in individuals of older age and/or with CKD may contribute to kidney function deterioration over time. Prescription of a plant-dominant low-protein diet of 0.6-0.8 g/kg/day with more than 50% from plant sources or very low protein diets less than 0.45 g/kg/day supplemented with essential amino acids or their keto-analogues may be effective in preserving kidney function in older patients and their younger counterparts, while also monitoring for development of protein-energy wasting (PEW).SummaryUsing tailored precision nutrition approaches in prescribing plant-dominant low DPI that also maintains adequate energy and nitrogen balance may ameliorate kidney function decline while also preventing development of PEW in elderly patients with CKD.