European Geriatric Medicine

To explore treatment and outcomes in older patients with AAV. Retrospective review (1 year) of patients > 75 years with positive MPO/PR3 antibodies. Thirty-nine evaluable patients had new positive MPO/PR3 antibodies. Nine patients had AAV and two possible AAV (2M, 9F mean age 82 years). Nine patients had renal impairment and three died during their presenting admission, all having required dialysis ± plasma exchange. Non-survivors had higher average creatinine (442 vs 265 µmol/L) and more co-morbidities (2 or more co-morbidities vs 0 or 1). All patients deemed fit received treatment, one discontinued (infection). Survival in AAV was 46% at 1 year and 18% at 2 years. 1/3 of positive MPO/PR3 results were not acknowledged in case records by clinicians. Renal involvement is common in elderly patients with AAV. High creatinine, co-morbidity and need for dialysis are associated with a poorer prognosis. Mortality is high but survivors tolerate treatments well.

To investigate medical student attitudes towards older persons and frailty over an entire medical student cohort. Global student attitudes towards older persons are positive, but decline with regard to functionality. Negative, often stereotypical perceptions of frailty persist despite high regard for older persons. Medical student attitudes towards older persons and frailty are generally positive, but appear most negative with the introduction of clinical placement, which may provide opportunity for targeted educational intervention. Older persons and patients with frailty constitute an ever increasing proportion of hospital patients. Improving student attitudes towards both groups is important in preparing future doctors for this demographic shift. We aimed to investigate medical student attitudes towards older persons and frailty over an entire medical school cohort. All current Brighton and Sussex Medical School students were invited to complete an online questionnaire consisting: (i) the Australian Ageing Semantic Differential (AASD), (ii) the Medical Condition Regard Scale (MCRS) with regards to frailty, (iii) a qualitative question asking participants to record three words regarding both a person over 70 years and frailty. 187 students participated (66% female, 25.2% response rate). Participants reported positive attitudes with mean scores of 73.45/114 on the AASD and 52.4/66 on the MCRS. The most positive attitudes towards both older persons and frailty were held by year 1 students, and most negative by year 3 and year 4 students for older persons and frailty, respectively. Examining AASD subgroups, students held negative attitudes towards the instrumentality (function) of older persons (mean score: 17.6/36) with significant variation across year groups (p < 0.05), with the most negative attitudes expressed in year 3. Word clouds of qualitative responses showed that medical students consider the two concepts differently with frailty attracting more negative associations. Generally medical student attitudes were positive towards older persons and frailty. However, these declined when focusing on the functionality, with word cloud analysis of attitudes revealing a dichotomy between the quantitative and qualitative data surrounding frailty.

To assess impact of frailty screening and two markers of illness severity on survival following discharge from the hospital. Independently of age, ward (acute geriatric and general medical) and comorbidity, both higher degree of frailty and illness severity associated with reduced survival probability following discharge. The impact of frailty on survival was higher in those experiencing high clinical and laboratory illness severity. The prognostic value of frailty screening increased when performed in conjunction with two markers of illness severity. Study associations between frailty, illness severity and post-discharge survival in older adults admitted to medical wards with acute clinical conditions. Prospective cohort study of 195 individuals (mean age 86; 63% females) admitted to two medical wards with acute illness, followed up for all-cause mortality for 20 months after discharge. Ward physicians screened for frailty and quantified its degree from one to eight using Clinical Frailty Scale (CFS), while clinical illness severity was estimated by New Early Warning Score 2 (NEWS2) and laboratory illness severity was calculated by a frailty index (FI-lab) using routine blood tests. CFS, NEWS2 and FI-lab scores were independently associated with post-discharge survival in an adjusted Cox proportional hazards model with age, ward category (acute geriatric and general medical) and comorbidity as covariates. Adjusted hazard ratios and 95% confidence intervals were 1.54 (1.24–1.91) for CFS, 1.12 (1.03–1.23) for NEWS2, and 1.02 (1.00–1.05) for FI-lab. A frailty × illness severity category interaction effect (p = 0.003), suggested that the impact of frailty on survival was greater in those experiencing higher levels of illness severity. Among patients with at least moderate frailty (CFS six to eight) and high illness severity according to both NEWS2 and FI-lab, two (13%) were alive at follow-up. Frailty screening aided prognostication of survival following discharge in older acutely ill persons admitted to medical wards. The prognostic value of frailty increased when combined with readily available illness severity markers acquired during admission.

To determine the prevalence and factors independently associated with chronic pain. More than half of geriatric outpatients reported chronic pain. Female gender and frailty were independently associated with chronic pain. Chronic pain is common and independently associated with frailty. This study aims to determine the prevalence and factors independently associated with chronic pain. Participants  ≥ 65 years of age admitted to a geriatric outpatient-clinic were recruited between November 2012 and May 2018. Chronic pain is defined as presence of musculoskeletal system-based pain ongoing more than 3 months. Numeric rating scale (NRS) was applied to assess pain severity. Physical activity status was recorded as never or 1–2 times per week or everyday as appropriate. Following geriatric syndromes were assessed: sleep problem, fall within past year, depression by Geriatric Depression Scale Short Form (GDS-SF), frailty by FRAIL scale, functionality by modified Katz activities of daily living (ADL) and Lawton instrumental ADL scales, and quality of life by Euro-Quality of Life-5D (EQ-5D) and EQ Visual Analog Scale. The study population consisted of 1441 patients. Of those, 969 were female and 472 were male. Mean age was 75.5 ± 6.6 years. The prevalence of chronic pain was 54.2% (n = 781). The median NRS score was 5 (1–10). Female gender, sleep problem, decreased functionality, and lower quality of life were independently associated with chronic pain after adjustment for educational status, presence of physical activity, fall within the past year, depression, and frailty. When the second analysis performed after the data with larger amount of missing value is removed, female gender and frailty remained independently associated with chronic pain. Chronic pain is common and independently associated with female gender and frailty in geriatric outpatients. Factors those are associated with chronic pain, as documented in this study, may induce further longitudinal studies.

To study the characteristics of older patients with hip fracture admitted to rehabilitation units in Italy with a specific focus on geriatric syndromes and the rehabilitation process. Of 615 patients included almost half of the patients lived alone before the hip fracture. Most of the falls happened at home. Clinicians identified geriatric syndromes including delirium, dementia, and depression in a significant number of patients. We found a relatively low involvement of the multiprofessional team in the rehabilitation process. This two-year multicenter point prevalence study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the management of geriatric syndromes in this frail population To date in Italy we do not have sufficient information on the rehabilitation process of older patients with hip fractures especially in the context of dementia. The main aims of the study were to gather information on the characteristics of older patients with hip fracture admitted to rehabilitation units with a specific focus on geriatric syndromes and the rehabilitation process. A national multi-center “point prevalence study” was conducted in Italy over two index days in 2017 and 2018. All patients aged 70 years and older hospitalized on the index day in Rehabilitation Units after a hip fracture were eligible. A total of 615 patients were included. Most of the hospitals involved were from northern Italy, to a lesser extent from central and from southern Italy. The mean age was 83.08 ± 7.9 years. Almost half of the patients lived alone before the hip fracture. Most of the falls happened at home and while walking. The prevalence of delirium, dementia and malnutrition was 9.1%, 36.6%, and 19.3%, respectively. Antidepressants were prescribed in 27% of the population. The multidisciplinary team was activated as follows: occupational therapist in 18.9% of the cases, psychologists in 14.5%, social workers in 15.3%, and speech therapists in 6.5%. The study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the correct management of geriatric syndromes in this frail population. Future multicenter longitudinal studies are required to further study this population.

To analyze the process from the prescription of the drug to the health outcome, from a medical and pharmaceutical perspective, to prevent the occurrence of drug-related problems (DRPs) in older adults. A mapping of a logical process of drug use from the perspective of physicians, pharmacists, and patients has been established, but many fields remain unexplored (e.g. off-label use, substance use disorders, therapeutic failure), especially in some settings (e.g. home-dwelling) as little data is available in older adults. Prevention of DRPs imperatively requires taking into account the opinions of all healthcare professionals as well as those of patients and their caregivers. To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. A narrative overview. The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient’s clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.