Spectrum of cardiovascular diseases with increasing age and its association with geriatric syndromes

Objective: The burden of cardiovascular diseases (CVDs) is highest among the older adults, who are often carriers of various geriatric syndromes. Studies evaluating CVDs among the old adults in the low? and middle?income countries are limited. This study was conducted to assess the frequency of CVDs and their risk factors among the older population and their association with geriatric syndromes. Subjects and Methods: In this cross?sectional study, 200 health?care seeking adults aged ?75 years were subjected to routine comprehensive geriatric assessment (assessment for functionality, cognition, depression, frailty, and various geriatric syndromes) and a detailed cardiovascular evaluation using electrocardiography, chest X?ray, echocardiogram, HbA1c level, fasting lipid profile, thyroid function test, serum homocysteine level, and serum NT?pro?BNP. Results: The overall frequency of CVDs in this study was 76%. Polypharmacy, multi-morbidity, cognitive impairment, depression, frailty, and impairment of basic and instrumental activities of daily living were present in 50.5%, 91.5%, 6.5%, 10%, 30.5%, 24.5%, and 55% individuals, respectively. CVDs were significantly associated with increased risk of geriatric syndromes (multi?morbidity [odds ratio (OR) 3.61, confidence interval (CI) 1.13 – 11.54, P = 0.030], polypharmacy [OR 5.46, CI 2.23 – 13.34, P = 0.001] and frailty [OR 3.29, CI 1.01 – 10.64, P = 0.047]). Conclusion: The prevalence of CVDs and their risk factors among the older population was high and significantly associated with increased risk of geriatric syndromes. These observations further strengthen the need for routine geriatric assessment and integrated management of geriatric syndromes in older patients with CVDs.

Risk factors for falls in older adults with cognitive impairment

Background: Falls are one of the leading causes of disability among older people. The risk factors of falls widely vary among the older populations, including the different stages of cognitive impairment. We aim to identify the risk factors for falls among cognitively impaired older adults. Materials and Methods: In a cross-sectional study, older adults attending the memory clinic were screened for falls and their risk factors. A total of 112 subjects who satisfied the inclusion criteria and provided informed consent were subjected to a semi?structured interview and comprehensive geriatric assessment. Cognitive impairment was graded by the Clinical Dementia Rating (CDR). Subjects were divided into fallers and nonfallers. A multivariable logistic regression analysis was done to identify the independent risk factors of falls. Results: The prevalence of falls was 39.28% in the study population. Gender (adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.21 [0.690�117]), body mass index (aOR [95% CI]: 0.89 [0.773�028]), socioeconomic status (middle-class aOR [95% CI]: 0.34 [0.077�526], lower-class aOR [95% CI]: 2.44 [0.349�.160]), multimorbidity (aOR [95% CI]: 19.39 [1.043�0.373]), depression (mild aOR [95% CI]: 2.90 [0.896� 9.429] and moderate aOR [95% CI]: 4.77 [0.967�.597]), and impairment in hobbies and home (aOR [95% CI]: 24.78 [6.251�.294]) part of CDR were the independent predictors of falls. Conclusion: Older adults with cognitive impairment are at high risk of falling with definitive risk factors. Regular screening will help to identify older adults at risk of falls and enable fall prevention to reduce morbidity and dependency.