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Older Patients: Clinical Challenges in the Hospital Acute Care Units and in the Sub-intensive and Intensive Care Settings

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 3824

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Dr. Filippo Luca Fimognari

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Unit of Geriatrics, Azienda Ospedaliera "Annunziata-Mariano Santo-S.Barbara", 87100 Cosenza, Italy
Interests: operative uni; old people; elderly

Special Issue Information

Dear Colleagues,

This Special Issue aims to explore the clinical challenges that healthcare professionals who care for older patients in acute care units, sub-intensive care units and intensive care settings face. The aging population is rapidly increasing worldwide, leading to a growing number of older adults requiring hospitalization. Older patients often suffer from more complex medical conditions and are at increased risk for adverse outcomes, such as prolonged hospital stays and higher mortality rates. This Special Issue offers valuable insights into the latest research and clinical practices for managing older patients in these settings. The articles included cover topics such as the management of delirium, fall prevention, geriatric pharmacology, team communication, and end-of-life care.

Dr. Filippo Luca Fimognari
Guest Editor

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Keywords

older patients
hospital acute care units
sub-intensive care units
intensive care settings
clinical challenges
delirium
fall prevention
geriatric pharmacology
team communication
end-of-life care
adverse outcomes
prolonged hospital stays
mortality rates
medical complexity
research and best practices

Published Papers (4 papers)

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Research

8 pages, 463 KiB

Open AccessArticle

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

by Shiho Amano, Ryuichi Ohta and Chiaki Sano

J. Clin. Med. 2024, 13(2), 539; https://doi.org/10.3390/jcm13020539 - 18 Jan 2024

Cited by 2 | Viewed by 732

Abstract

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

(This article belongs to the Special Issue Older Patients: Clinical Challenges in the Hospital Acute Care Units and in the Sub-intensive and Intensive Care Settings)

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15 pages, 922 KiB

Open AccessArticle

Evaluation of Multi-Frequency Bioelectrical Impedance Analysis against Dual-Energy X-ray Absorptiometry for Estimation of Low Muscle Mass in Older Hospitalized Patients

by Rikke Lundsgaard Nielsen, Aino Leegaard Andersen, Thomas Kallemose, Morten Damgaard, Olivia Bornæs, Helle Gybel Juul-Larsen, Louise Westberg Strejby Christensen, Baker Nawfal Jawad, Ove Andersen, Henrik Højgaard Rasmussen, Tina Munk, Trine Meldgaard Lund and Morten Baltzer Houlind

J. Clin. Med. 2024, 13(1), 196; https://doi.org/10.3390/jcm13010196 - 29 Dec 2023

Cited by 1 | Viewed by 884

Abstract

The accuracy of multi-frequency (MF) bioelectrical impedance analysis (BIA) to estimate low muscle mass in older hospitalized patients remains unclear. This study aimed to describe the ability of MF-BIA to identify low muscle mass as proposed by The Global Leadership Initiative on Malnutrition (GLIM) and The European Working Group on Sarcopenia in Older People (EWGSOP-2) and examine the association between muscle mass, dehydration, malnutrition, and poor appetite in older hospitalized patients. In this prospective exploratory cohort study, low muscle mass was estimated with MF-BIA against dual-energy X-ray absorptiometry (DXA) in 42 older hospitalized adults (≥65 years). The primary variable for muscle mass was appendicular skeletal muscle mass (ASM), and secondary variables were appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI). Cut-off values for low muscle mass were based on recommendations by GLIM and EWGSOP-2. MF-BIA was evaluated against DXA on the ability to estimate absolute values of muscle mass by mean bias, limits of agreement (LOA), and accuracy (5% and 10% levels). Agreement between MF-BIA and DXA to identify low muscle mass was evaluated with sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). The association between muscle mass, dehydration, malnutrition, and poor appetite was visually examined with boxplots. MF-BIA overestimated absolute values of ASM with a mean bias of 0.63 kg (CI: −0.20:1.46, LOA: −4.61:5.87). Agreement between MF-BIA and DXA measures of ASM showed a sensitivity of 86%, specificity of 94%, PPV of 75% and NPV of 97%. Boxplots indicate that ASM is lower in patients with malnutrition. This was not observed in patients with poor appetite. We observed a tendency toward higher ASM in patients with dehydration. Estimation of absolute ASM values with MF-BIA should be interpreted with caution, but MF-BIA might identify low muscle mass in older hospitalized patients. Full article

(This article belongs to the Special Issue Older Patients: Clinical Challenges in the Hospital Acute Care Units and in the Sub-intensive and Intensive Care Settings)

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17 pages, 778 KiB

Open AccessArticle

The Prevalence of the Frailty Syndrome in a Hospital Setting—Is Its Diagnosis a Challenge? A Comparison of Four Frailty Scales in a Cross-Sectional Study

by Agnieszka Kasiukiewicz and Zyta Beata Wojszel

J. Clin. Med. 2024, 13(1), 86; https://doi.org/10.3390/jcm13010086 - 23 Dec 2023

Viewed by 1132

Abstract

The study aimed to assess the prevalence of the frailty syndrome in older patients hospitalized in the geriatric ward depending on the diagnostic criteria used, the feasibility of particular diagnostic scales in hospitalized patients, and their compatibility; 416 patients (81.2 ± 6.91 years) admitted to the Department of Geriatrics of Hospital of the Ministry of the Interior and Administration in Bialystok within eight months were included in the study. Four diagnostic scales were used to identify the frailty syndrome: Fried criteria, 7-point Clinical Frailty Scale (CFS), 40-item Frailty Index (FI), and FRAIL Scale. Depending on the scale, the prevalence of frailty syndrome varied from 26.8% (FRAIL Scale), 52.3% (Clinical Frailty Scale), and 58.1% (Fried criteria) up to 62.9% (Frailty Index). We observed the highest feasibility for CFS (100%) and the lowest for the Fried scale (79.8%). The highest level of agreement was found between the CFS and Frailty Index, with 80.3% consistent ratings (Cohen Kappa 0.6). Patients in the geriatric ward are characterized by a high prevalence of frailty, although it differs depending on the criteria. The most difficult to use in daily practice was the Fried scale, while the Clinical Frailty Scale was determined feasible in all patients. Full article

(This article belongs to the Special Issue Older Patients: Clinical Challenges in the Hospital Acute Care Units and in the Sub-intensive and Intensive Care Settings)

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9 pages, 1084 KiB

Open AccessArticle

Predicting In-Hospital Acute Heart Failure Worsening in the Oldest Old: Insights from Point-of-Care Ultrasound

by Tessa Mazzarone, Virginia Morelli, Andrea Giusti, Maria Giovanna Bianco, Lorenzo Maccioni, Cristina Cargiolli, Daniela Guarino, Agostino Virdis and Chukwuma Okoye

J. Clin. Med. 2023, 12(23), 7423; https://doi.org/10.3390/jcm12237423 - 30 Nov 2023

Viewed by 797

Abstract

The decompensation trajectory check is a basic step to assess the clinical course and to plan future therapy in hospitalized patients with acute decompensated heart failure (ADHF). Due to the atypical presentation and clinical complexity, trajectory checks can be challenging in older patients with acute HF. Point-of-care ultrasound (POCUS) has proved to be helpful in the clinical decision-making of patients with dyspnea; however, to date, no study has attempted to verify its role in predicting determinants of ADHF in-hospital worsening. In this single-center, cross-sectional study, we consecutively enrolled patients aged 75 or older hospitalized with ADHF in a tertiary care hospital. All of the patients underwent a complete clinical examination, blood tests, and POCUS, including Lung Ultrasound and Focused Cardiac Ultrasound. Out of 184 patients hospitalized with ADHF, 60 experienced ADHF in-hospital worsening. By multivariable logistic analysis, total Pleural Effusion Score (PEFs) [aO.R.: 1.15 (CI95% 1.02–1.33), p = 0.043] and IVC collapsibility [aO.R.: 0.90 (CI95% 0.83–0.95), p = 0.039] emerged as independent predictors of acute HF worsening after extensive adjustment for potential confounders. In conclusion, POCUS holds promise for enhancing risk assessment, tailoring diuretic treatment, and optimizing discharge timing for older patients with ADHF. Full article

(This article belongs to the Special Issue Older Patients: Clinical Challenges in the Hospital Acute Care Units and in the Sub-intensive and Intensive Care Settings)

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Older Patients: Clinical Challenges in the Hospital Acute Care Units and in the Sub-intensive and Intensive Care Settings

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