Particularities of Anemia in the Elderly: Experience in a Geriatrics Department in Senegal

Background/Objective: Anemias are frequent conditions in geriatric practice. The etiologies are numerous, overlapping chronic and acute pathologies. it is also associated with high morbidity and mortality. In our context, few studies have addressed this issue, and none have been carried out in geriatric units with integrated geriatric dimensions. The aim of this study was to describe the particularities of anemia in old people in a geriatric short-stay service in Senegal. Materials and methods: This was a retrospective, descriptive study from 01 May 2019 to 31 December 2021, involving people aged 60 or over, hospitalized in the geriatrics department of Fann Hospital (Senegal) and presenting with anemia. Epidemiological, clinical and evolutionary characteristics were collected and analyzed using SPSS 24.0 software. Results: The prevalence of anemia was 32.3%. The mean age of our sample was 78.7 ± 8.5 years. Arterial high blood pressure (59.3%), diabetes mellitus (22.8%), prostate disease (12.3%) were the most frequent comorbidities. Clinical manifestations were dominated by physical asthenia (80%) and severe alteration of general condition (72%). The geriatric syndromes were essentially represented by the loss of Activities Daily Living (ADL) autonomy (65%), undernutrition (59%) and frailty (46%). The mean hemoglobin level was 8.4 g/dl ± 2.1. The main etiologies were infections (32.7%), chronic kidney disease (20.9%), iron deficiency (7.4%). The mean hospital stay was 8 days ± 3.7 days and the mortality rate was 19%. Conclusion: Anemia is a frequent occurrence in geriatric medicine, with a high morbidity and mortality rate;its expression is often atypical, with frequent geriatric syndromes;the etiologies are multiple and often interrelated, requiring an exhaustive and multidimensional approach.

Current research status and research hotspots in Chinese geriatric medicine: Data retrieved from the Chinese Journal of Geriatrics

Objective: To investigate the research hotspots and development trends of Chinese geriatric medicine by analyzing the high-frequency keywords, core authors, research institutions and their collaborations in papers published in the Chinese Journal of Geriatrics.Methods: Bibliometric methods and information visualization software(CiteSpace Ⅲ) were used to analyze the following 3 aspects: keywords, institutions and authors.Results: Overall, the number of papers published in the Chinese Journal of Geriatrics grew between 1994 and 2015. The top 3 institutions with the greatest numbers of published papers were Beijing Hospital,People's Liberation Army General Hospital and the Second Xiangya Hospital of Central South University.The authors with high productivity were Pulin Yu, Jianye Wang and Xiaoying Li. The terms "Diabetes","hypertension" and "myocardial infarction" were hotspot words that drew sustained attention in this field.Conclusions: Research on geriatric medicine is growing steadily in China. Hospitals and teaching hospitals are major contributors to publications. The collaboration of authors is more common within the same institutions or in the same regions. Clinical research is still the focus of current research. In the future, basic research should be strengthened, and collaborations between different institutions and regions should be promoted to achieve coordinated and integrated development in Chinese geriatric medicine.

C-Reactive protein role in assessing COVID-19 deceased geriatrics and survivors of severe and critical illness

Numerous risk variables,including age,medical co-morbidities,and deranged inflammatory response,lead to higher mortality in a senior population with coronavirus disease 2019.C-reactive protein(CRP),an acute phase inflammatory protein secreted by the liver,was tested in the elderly,showing a diagnostic and prognostic role.However,recent research has shed light on new applications for CRP in geriatrics.It was used as a follow-up marker and as a therapeutic target.Early and accurate identification of patients’ risks may mitigate the devastation of the invading virus in older cases and permit the implementation of a quick treatment plan for those most likely to deteriorate.

Geriatrics intensive care unit: Outcome and risk factors for in hospital mortality

OBJECTIVES: To evaluate outcome and risk factors, particularly the (APATCHE II) score in elderly patients after admission to a geriatrics intensive care unit (ICU). Methods: A cross sectional study of patients ≥ 60 years admitted to the intensive care unit (ICU) of the Geriatrics department at Ain Shams University Hospital over 2 years period. We recorded age, sex, previous medical history, primary diagnosis, date of admission and discharge or death and APACHE II score on admission. Results: 202 patients admitted to the ICU were studied. The mean ICU mortality rates for these patients were (32, 5%), the mean APATCHE II score was (19.07). 27.3% of patients who died had hypokalemia and 43.2% had hyponatremia. Conclusion: ICU mortality rate are higher in elderly patients particularly with long ICU stay and hyponatremia.

Psycho-Social Hazards for Staff in Geriatrics and Geriatric Psychiatry

Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.

Effect of a comprehensive geriatric assessment nursing intervention model on older patients with diabetes and hypertension

BACKGROUND The Comprehensive Geriatric Assessment(CGA)was introduced late in China and is primarily used for investigating and evaluating health problems in older adults in outpatient and community settings.However,there are few reports on its application in hospitalized patients,especially older patients with diabetes and hypertension.AIM To explore the nursing effect of CGA in hospitalized older patients with diabetes and hypertension.METHODS We performed a retrospective single-center analysis of patients with comorbid diabetes mellitus and hypertension who were hospitalized and treated in the Jiangyin Hospital of Traditional Chinese Medicine between September 2020 and June 2022.Among the 80 patients included,40 received CGA nursing interventions(study group),while the remaining 40 received routine nursing care(control group).The study group's comprehensive approach included creating personalized CGA profiles,multidisciplinary assessments,and targeted inter-ventions in areas,such as nutrition,medication adherence,exercise,and mental health.However,the control group received standard nursing care,including general and medical history collection,fall prevention measures,and regular patient monitoring.After 6 months of nursing care implementation,we evaluated the effectiveness of the interventions,including assessments of blood glucose levels fasting blood glucose,2-h postprandial blood glucose,and glycated hemoglobin,type A1c(HbA1c);blood pressure indicators such as diastolic blood pressure(DBP)and systolic blood pressure(SBP);quality of life as measured by the 36-item Short Form Survey(SF-36)questionnaire;and treatment adherence.RESULTS After 6 months,the nursing outcomes indicated that patients who underwent CGA nursing interventions experienced a significant decrease in blood glucose indicators,such as fasting blood glucose,2-h postprandial blood glucose,and HbA1c,as well as blood pressure indicators,including DBP and SBP,compared with the control group(P<0.05).Quality of life assessments,including physical health,emotion,physical function,overall health,and mental health,showed marked improvements compared to the control group(P<0.05).In the study group,38 patients adhered to the clinical treatment requirements,whereas only 32 in the control group adhered to the clinical treatment requirements.The probability of treatment adherence among patients receiving CGA nursing interventions was higher than that among patients receiving standard care(95%vs 80%,P<0.05).CONCLUSION The CGA nursing intervention significantly improved glycemic control,blood pressure management,and quality of life in hospitalized older patients with diabetes and hypertension,compared to routine care.

Study on the Application of Refined Nursing Care in The Care for Elderly Patients with Reflux Esophagitis

Objective: To investigate the application effect of refined nursing care in the care for elderly patients with reflux esophagitis. Methods: Following the difference in nursing style, 84 cases of elderly patients with reflux esophagitis admitted to our hospital from May 2022 to May 2023 were randomly grouped into a control group and a research group, with 42 cases each. The control group was given conventional nursing care and the research group was given refined nursing care. The psychological state and treatment adherence of the two groups of patients after the nursing intervention were compared. Results: After the nursing intervention, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of the research group were lower than those of the control group (P < 0.05). The treatment compliance of the research group was better than the control group (P < 0.05). Conclusion: The implementation of refined nursing care for elderly patients with reflux esophagitis exhibited a significant effect on improving the patient’s psychological state, treatment compliance, and rehabilitation.

Management of geriatric acetabular fractures:Contemporary treatment strategies

Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height.Compromised bone quality in the elderly,as well as this population’s concomitant medical comorbidities,render the management of such fractures challenging and controversial.Non-operative management remains the mainstay of treatment,although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient.On the other hand,operatively treating acetabular fractures(e.g.,with osteosynthesis or total hip arthroplasty)is gaining popularity.Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques.Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum.Regardless of the implemented treatment,orthogeriatric co-management is considered extremely crucial,and it is currently one of the pillars of a successful outcome after an acetabular fracture.

Triceps skinfold thickness trajectories and the risk of all-cause mortality:A prospective cohort study

BACKGROUND The measurement of triceps skinfold(TSF)thickness serves as a noninvasive metric for evaluating subcutaneous fat distribution.Despite its clinical utility,the TSF thickness trajectories and their correlation with overall mortality have not been thoroughly investigated.AIM To explore TSF thickness trajectories of Chinese adults and to examine their associations with all-cause mortality.METHODS This study encompassed a cohort of 14747 adults sourced from the China Health and Nutrition Survey.Latent class trajectory modeling was employed to identify distinct trajectories of TSF thickness.Subjects were classified into subgroups reflective of their respective TSF thickness trajectory.We utilized multivariate Cox regression analyses and mediation examinations to explore the link between TSF thickness trajectory and overall mortality,including contributory factors.RESULTS Upon adjustment for multiple confounding factors,we discerned that males in the‘Class 2:Thin-stable’and‘Class 3:Thin-moderate’TSF thickness trajectories exhibited a markedly reduced risk of mortality from all causes in comparison to the‘Class 1:Extremely thin’subgroup.In the mediation analyses,the Geriatric Nutritional Risk Index was found to be a partial intermediary in the relationship between TSF thickness trajectories and mortality.For females,a lower TSF thickness pattern was significantly predictive of elevated all-cause mortality risk exclusively within the non-elderly cohort.CONCLUSION In males and non-elderly females,lower TSF thickness trajectories are significantly predictive of heightened mortality risk,independent of single-point TSF thickness,body mass index,and waist circumference.

Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.

Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Actuality and underlying mechanisms of systemic immuneinflammation index and geriatric nutritional risk index prognostic value in hepatocellular carcinoma

This editorial contains comments on the article“Correlation between preoperative systemic immune inflammation index,nutritional risk index,and prognosis of radical resection of liver cancer”in a recent issue of the World Journal of Gastrointestinal Surgery.It pointed out the actuality and importance of the article and focused primarily on the underlying mechanisms making the systemic immuneinflammation index(SII)and geriatric nutritional risk index(GNRI)prediction features valuable.There are few publications on both SII and GNRI together in hepatocellular carcinoma(HCC)and patient prognosis after radical surgery.Neutrophils release cytokines,chemokines,and enzymes,degrade extracellular matrix,reduce cell adhesion,and create conditions for tumor cell invasion.Neutrophils promote the adhesion of tumor cells to endothelial cells,through physical anchoring.That results in the migration of tumor cells.Pro-angiogenic factors from platelets enhance tumor angiogenesis to meet tumor cell supply needs.Platelets can form a protective film on the surface of tumor cells.This allows avoiding blood flow damage as well as immune system attack.It also induces the epithelial-mesenchymal transformation of tumor cells that is critical for invasiveness.High SII is also associated with macro-and microvascular invasion and increased numbers of circulating tumor cells.A high GNRI was associated with significantly better progression-free and overall survival.HCC patients are a very special population that requires increased attention.SII and GNRI have significant survival prediction value in both palliative treatment and radical surgery settings.The underlying mechanisms of their possible predictive properties lie in the field of essential cancer features.Those features provide tumor nutrition,growth,and distribution throughout the body,such as vascular invasion.On the other hand,they are tied to the possibility of patients to resist tumor progression and development of complications in both postoperative and cancer-related settings.The article is of considerable interest.It would be helpful to continue the study follow-up to 2 years and longer.External validation of the data is needed.

Safety and efficacy of peroral endoscopic myotomy for treating achalasia in pediatric and geriatric patients:A meta-analysis

BACKGROUND As a less invasive technique,peroral endoscopic myotomy(POEM)has recently been widely accepted for treating achalasia with an excellent safety profile,durability,and efficacy in adults.In pediatric and geriatric patients,the treatment is more difficult.AIM To discuss the clinical outcomes of POEM in pediatric and geriatric patients with achalasia.METHODS We conducted a comprehensive search of PubMed,Embase and Cochrane Library databases from inception to July 2024.The primary outcomes were technical and clinical success.Secondary outcomes of interest included adverse events and gastroesophageal reflux disease(GERD).The pooled event rates were calculated by comprehensive meta-analysis software.RESULTS A total of 32 studies with 547 pediatric patients and 810 geriatric patients were included in this study.The pooled event rates of technical success,clinical success,GERD and adverse events of POEM for treating achalasia in pediatric patients were 97.1%[95%confidence interval(CI):95.0%-98.3%;I^(2)=0%;P<0.000],93.2%(95%CI:90.5%-95.2%;I^(2)=0%;P<0.000),22.3%(95%CI:18.4%-26.7%;I^(2)=43.874%;P<0.000)and 20.4%(95%CI:16.6%-24.8%;I^(2)=67.217%;P<0.000),respectively.Furthermore,in geriatric patients,the pooled event rates were 97.7%(95%CI:95.8%-98.7%;I^(2)=15.200%;P<0.000),93.2%(95%CI:90.3%-95.2%;I^(2)=0%;P<0.000),23.9%(95%CI:19.4%-29.1%;I^(2)=75.697%;P<0.000)and 10.8%(95%CI:8.3%-14.0%;I^(2)=62.938%;P<0.000],respectively.CONCLUSION Our findings demonstrated that POEM was an effective and safe technique for pediatric and geriatric patients with achalasia.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Malnutrition and Its Association with the Mortality of Patients with Femoral Intertrochanteric Fractures: A Retrospective Analysis of Japanese Patients

Background: The incidence of femoral intertrochanteric fractures in older adults is higher than that of femoral neck fractures;however, both conditions are often analyzed together as proximal femoral fractures. Considering the difference in treatment, postoperative complication, and mortality risk, these two fractures should be analyzed separately. This study aimed to analyze 1-year mortality and its risk factors in patients with surgically treated femoral intertrochanteric fractures. Methods: Consecutive patients with intertrochanteric fractures who underwent surgical interventions at our institution between January 2017 and December 2021 were retrospectively reviewed. A total of 238 patients were eligible for inclusion in this study. Patients’ demographic and clinical information were retrospectively collected. Patients were divided into the 1-year mortality (n = 16) and survival (n = 222) groups. The incidence of 1-year mortality and its independent risk factors were investigated using univariate and multivariate logistic regression analyses. Results: The mean age of patients was 85.6 ± 8.5 years. The 1-year mortality rate was 6.7% (16/238). Preoperative albumin level, the Geriatric Nutritional Risk Index (GNRI), and malnutrition status (GNRI p = 0.02, p = 0.02, and p = 0.0011, respectively). Multivariate analysis showed that malnutrition status (GNRI p = 0.035) was an independent risk factor for 1-year mortality. Conclusion: Malnutrition status assessed using GNRI (GNRI < 92) was an independent risk factor for 1-year mortality. Our findings suggest that GNRI may be an effective screening tool for predicting postoperative 1-year mortality of patients with surgically treated femoral intertrochanteric fractures.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Demands and influencing factors of digital transition care service in discharged older patients:a cross-sectional study

Objective:To identify the group classification of discharged older adults’digital transition care demands and analyze its influencing factors.Methods:From July to August 2022,we used stratified random sampling to recruit older patients who were discharged between July 2021 and July 2022 from tertiary hospitals in Shanghai.We used latent profile analysis to classify the older patients into distinct groups based on their service demands:low,medium,and high.We use multiple logistic regression to explore the factors influencing the different demand levels.Results:The degree of discharged older patients’demand was classified as low(Category 1(C1),34.2%),medium(Category 2(C2),49.5%),high-demand levels(Category 3(C3),16.3%).Compared to those have C2,older adults in C1 are more likely to be male(Odds Ratio(OR)=2.81,P=0.02),have 2 chronic diseases(OR=3.91,P=0.03),and are less likely to be junior high and below(OR=0.09,P=0.00),hospitalized for 1–2 times in the past year(1 times:OR=0.19,P=0.07;2 times:OR=0.14,P=0.02),living with children(OR=0.32,P=0.05),have less insurance(OR=0.48,P=0.03),less understanding of digital transitional care(OR=0.47,P=0.01),have less eHealth literacy(OR=0.80,P=0.00),have less degree of importance attributed by family(OR=0.52,P=0.03);Compared to those have medium demand level,older adults in high demand level are more likely to have self and spouse as primary income(self:OR=26.35,P=0.00;spouse:OR=24.06,P=0.02),walking to the nearest health facility(self:6.74,P=0.03),have higher eHealth literacy(OR=1.88,P=0.00),degree of importance within the family(OR=5.19,P=0.01),higher self’s influence on medical decisions-making(OR=5.69.P=0.01).They are less likely to be in 60–79 years group(OR=0.00–0.37,P=0.00–0.03),Household Annual Income<5,000 CNY(OR=0.05,P=0.02).Conclusion:Digital transitional care demands of discharged older patients can be divided into three categories.Constructing a digital transitional care service system that aligns with the demands of discharged older patients is essential.Communication,care plan development,and follow-up are the most fundamental services.Additionally,it is essential to understand the characteristics of high-demand populations to provide tailored services and identify vulnerable populations from health and social perspectives to offer cost-effective transitional care services.

The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older

BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.

Receded near point of convergence as a predictor of mild cognitive impairment in the general geriatric population:results from a population-based study

AIM:To investigate the relationship between near point of convergence(NPC)and mild cognitive impairment(MCI)in the general elderly population.METHODS:The present report is a part of the Tehran Geriatric Eye Study(TGES):a population-based crosssectional study conducted on individuals 60 years of age and above living in Tehran,Iran using the multi-stage stratified random cluster sampling method.Cognitive status was assessed using the Persian version of the Mini-Mental State Examination(MMSE).All study participants underwent complete ocular examination including measurement of uncorrected and best-corrected visual acuity,objective and subjective refraction,cover testing,NPC measurement,and slit-lamp biomicroscopy.RESULTS:The data of 1190 individuals were analyzed for this report.The mean age of the participants analyzed was 66.82±5.42(60-92y)and 728(61.2%)of them were female.Patients with MCI had a significantly more receded NPC compared to subjects with normal cognitive status(10.89±3.58 vs 7.76±2.71 cm,P<0.001).In the multivariable logistic regression model and in the presence of confounding variables,a receded NPC was statistically significantly associated with an increased risk of MCI(odds ratio:1.334,95%confidence interval:1.263 to 1.410,P<0.001).According to receiver operating characteristic(ROC)analysis,a cut point NPC>8.5 cm(area under the curve:0.764,P<0.001)could predict the presence of MCI with a sensitivity and specificity of 70.9%and 69.5%,respectively.CONCLUSION:A receded NPC can be clinically proposed as a predictor of MCI in older adults.It is recommended that elderly with a receded NPC>8.50 cm undergo detailed cognitive screening for a definite diagnosis of MCI.In this case,the necessary interventions can be carried out to slow down MCI progression to dementia.

Evaluation of Post-Surgical Complications of Lower Limb Arteriopathy in the Elderly in a Geriatric Short-Stay Unit in Senegal

Background/Objectives: Global ageing is associated with an increase in the frequency of peripheral arterial disease (PAD), which is often complex to manage postoperatively. The aim of this study was to describe postoperative complications of Lower limb arteriopathy in geriatric units. Materials and Methods: This was a retrospective, descriptive study from July 2019 to June 2022 of patients aged at least 65 years hospitalized in the geriatric unit of the FANN hospital for postoperative management of a Lower limb arteriopathy. Sociodemographic, clinical and evolutionary characteristics were collected and analyzed using Epi info version 7.2.6 software. Results: Forty patients met the criteria, representing 7.69% of hospital admissions. The average age was 77.5 years, with women in majority (75%). The mean time to geriatric admission after surgery was 9 ± 3 days. Poly pathologies (≥3 comorbidities) were present in 55% of patients. Cardiovascular risk factors were dominated by high blood pressure (85%), followed by mellitus diabetes (52.5%) and dyslipidemia (12.5%). Other associated comorbidities were dominated by heart disease (40%), followed by ischemic stroke (27.5%) and major cognitive impairment (27.5%). Excessive chronic arterial disease of the limbs was the predominant vascular diagnosis (80%) and amputation was the most common surgical procedure (62.5%), especially of the thigh (42.4%). Symptoms included refusal to eat (70%) and mental confusion (70%). The geriatric syndromes were mainly acute loss of functional independence (97.5%) and malnutrition (77.5%). The average number of acute diagnoses on admission was 4 ± 1, represented mainly by infectious diseases (31.5%), dominated by superinfection of the amputation stump (55%) and pulmonary infection (25%). Mortality rate was 22.5%. Conclusion: Post-surgical complications are frequent in the geriatric population, with a high mortality rate. Prior geriatric assessment would optimize postoperative results.