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.

Multimorbilidad y síndromes geriátricos. Su efecto sobre la mortalidad en adultos mayores con sepsis / Multimorbidity and geriatric syndromes. Their effect on mortality in older adults with sepsis

Resumen Introducción: la sepsis se diagnostica en más de 60% de los adultos mayores (AM) en el mundo. Estos AM con frecuencia presentan multimorbilidad y alguno de los síndromes geriátricos, llevando a discapacidad física, cognitiva y psicosocial, lo cual produce altos costos para los sistemas de salud, resultando en un problema grave de salud pública. Objetivo: identificar el impacto de la multimorbilidad y los síndromes geriátricos en la morta lidad de AM hospitalizados por sepsis en una unidad geriátrica de agudos a 30 días de su ingreso. Material y métodos: estudio observacional, analítico de casos y controles anidado en una cohorte. Resultados: se analizaron 238 pacientes con edad media de 83.15±7.12 años, 52.1% fueron mujeres y el 99% tenían al menos una comorbilidad, la mortalidad a 30 días fue 34%. La infección urinaria fue la causa principal de hospitalización (42.9%), obteniendo un aislamiento microbio-lógico en 43.3% de los casos, siendo la Escherichia coli el agente causal más frecuente (46.6%). La regresión logística múltiple mostró que la enfermedad renal crónica (OR 2.1 IC 95% 1.1-4.8; p=0.037), el delirium (OR 3.1 IC 95% 1.6-5.8; p=0.001) y la discapacidad (índice de Barthel <60; OR 3.4 IC 95% 1.5-7.5; p=0.002) se asociaron de manera significativa con la mortalidad a 30 días desde el ingreso a la unidad geriátrica de agudos en paciente con sepsis. Conclusión: en los AM hospitalizados por sepsis, la multimorbilidad, la enfermedad re nal crónica y los síndromes geriátricos representados por delirium y discapacidad fueron los predictores de mortalidad a 30 días. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Abstract Introduction: sepsis is diagnosed in more than 60% of older adults (OAs) worldwide. These OAs often have multimorbidity and one of the geriatric syndromes, leading to physical, cognitive and psychosocial disability with consequently high healthcare costs, resulting in a serious public health problem. Objective: to determine the impact of multimorbidity and geriatric syndromes on the 30-day mortality rate of OAs hospitalized for sepsis in an acute geriatric unit Materials and methods: an observational, analytical, nested case-control study. Results: 238 patients with a mean age of 83.15±7.12 were analyzed; 52.1% were women and 99% had at least one comorbidity; the 30-day mortality was 34%. Urinary tract infection was the main cause of hospitalization (42.9%), with microbiological isolation achieved in 43.3% of cases and Escherichia coli being the most common causal agent (46.6%). Multiple logistic regression showed that chronic kidney disease (OR 2.1 95% CI 1.1-4.8; p=0.037), delirium (OR 3.1 95% CI 1.6-5.8; p=0.001) and disability (Barthel index <60; OR 3.4 95% CI 1.5-7.5; p=0.002) were significantly related to 30-day mortality in patients with sepsis admitted to an acute geriatric unit. Conclusion: in OAs hospitalized for sepsis, multimorbidity, chronic kidney disease and geriatric syndromes (represented by delirium and disability) were the predictors of 30-day mortality. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Investigation on the incidence of geriatric syndrome in Beijing area and analysis of influencing factors and its relationship with Barthel ADL score and quality of life / 公共卫生与预防医学

Objective To investigate the incidence and influencing factors of geriatric syndrome (GS) in Beijing area, and to analyze the relationship between GS and Barthel Index (Barthel ADL) score and quality of life. Methods From June 2018 to December 2018, a community-based or door-to-door survey of elderly people >65 years old in some communities in Beijing was conducted. The incidence of GS and its gender distribution, age distribution, and type distribution were investigated. At the same time, GS patients were selected as the observation group, and among people without GS in physical examination, a random sampling method was used to select the control group. The general data, Barthel ADL score, and World Health Organization Quality of Life (WHOQOL-BREF) score were compared between the two groups. The relevant influencing factors of GS and its correlation with the Barthel ADL score and WHOQOL-BREF scores were analyzed. Results Among 500 elderly people in the community investigated in the present study, 97.00% of patients had ≥1 types of GS, 84.80% of patients had ≥2 types, and 70.20% of patients had ≥3 types of GS. High education level (OR=0.329, 95%CI: 0.259-0.418) and retirement pension (OR=0.727, 95%CI: 0.576-0.918) were the protective factors for the occurrence of GS. Hyperlipidemia (OR=3.176, 95%CI: 2.518-4.007), diabetes (OR=2.473, 95%CI: 1.718-3.559), coronary heart disease (OR=2.658, 95%CI:1.649-4.286), hypertension (OR=3.230, 95%CI:2.008-5.197), osteoarthropathy (OR=4.166, 95%CI: 3.008-5.769), cancer (OR=3.008, 95%CI: 1.894-4.778), acute cerebral infarction (OR=3.420, 95%CI: 2.335-5.009), and acute myocardial infarction (OR=2.112, 95%CI: 1.169-3.814) were the risk factors for GS (P<0.05). The Barthel ADL score and WHOQOL-BREF score of the observation group were lower than those of the control group (P<0.05). GS was negatively correlated with Barthel ADL and WHOQOL-BREF scores (P<0.05). Conclusion GS was common in the elderly in Beijing, and its occurrence was related to factors such as education level, retirement pension, hyperlipidemia, diabetes, coronary heart disease, hypertension, osteoarthropathy, cancer, acute cerebral infarction, and acute myocardial infarction. Strengthening the early assessment and management of GS will help improve the daily life and quality of life of the elderly.

The effect of grip strength on geriatric syndromes in elderly inpatients / 中华老年医学杂志

Objective:To investigate the occurrence of geriatric syndromes in elderly inpatients with different grip strength levels and the effect of grip strength on geriatric syndromes and thus to provide insight for the management of geriatric syndromes in elderly inpatients.Methods:A total of 225 elderly inpatients who had received comprehensive geriatric assessment at the geriatrics department of our hospital were selected retrospectively, and their general and geriatric syndrome data were collected.With grip strength of 28 kg for men and 18 kg for women as the cut-offs, the patients were divided into the normal grip strength group(114 cases)and the decreased grip strength group(111 cases). Based on demographic characteristics including age, gender, type of work, income, educational background and social support, 1∶1 propensity score matching(PSM)for the two groups was conducted, successfully resulting in a total of 77 pairs.Differences in geriatric syndromes between the two groups were compared, and the relationship between grip strength and geriatric syndromes was analyzed in these elderly inpatients.Results:After adjustment for the general demographic characteristics by PSM, the decreased grip strength group showed higher rates than the normal grip strength group of frailty/pre-frailty(87.0% vs.55.8%), disability(53.2% vs.27.3%), malnutrition/malnutrition risk(57.1% vs.22.1%), cognitive impairment(35.1% vs.9.1%), constipation(44.2% vs.20.8%), falls(32.5% vs.13.0%)and number of geriatric syndromes(4, range: 2-5 vs.2, range: 0-4)and higher Carlson comorbidity index(CCI)scores(6, range: 5-8 vs.5range: 4-6)and higher body mass index scores[(25±3)kg/m 2vs.(23±4)kg/m 2](all P<0.05). There was no significant difference in the incidence of pain, sleep disorders, depression, anxiety or polypharmacy, or in short physical performance scores between the two groups(all P>0.05). Spearman correlation analysis showed that decreased grip strength was positively correlated with the incidence of frailty/pre-frailty( r= 0.345), disability( r= 0.265), malnutrition/malnutrition risk( r= 0.358), cognitive impairment( r=0.313), constipation( r= 0.250), falls( r= 0.232)and number of geriatric syndromes( r=0.370)(all P<0.05). There was no significant correlation between grip strength and the incidence of pain, sleep disorder, depression or anxiety(all P> 0.05). Multivariate logistic regression analysis showed that, compared with the normal grip strength group, the decreased grip strength group had a higher risk of developing geriatric syndromes such as frailty/pre-frailty( OR=10.906), disability( OR=4.025), malnutrition/ malnutrition risk( OR=2.699), cognitive impairment( OR=6.620), constipation( OR=2.848)and falls( OR=4.145, all P<0.05). Conclusions:Decreased grip strength is an independent risk factor for many common geriatric syndromes such as frailty/pre-frailty, disability, malnutrition/ malnutrition risk, cognitive impairment, constipation and falls.Elderly patients with decreased grip strength should be a key population group when screening for geriatric syndromes.

Chronic inflammatory response syndrome in the elderly / 中华老年医学杂志

Chronic inflammatory response syndrome(CIRS)is a chronic, low-grade, systemic inflammatory response, resulting from sustained long-term stimulation of the innate immune system.CIRS is not only associated with certain chronic diseases, but also associated with aging, the development and progression of a variety of diseases in the elderly, and functional decline.Additionally, it is closely related to adverse clinical outcomes and is not uncommon in the elderly.Here we review the characteristics of CIRS and their clinical implications and consider whether CIRS can be classified as a geriatric syndrome, in order to identify new targets for the prevention and treatment of diseases and functional decline in the elderly.

Investigation of chronic disease and geriatric syndrome in hospitalized elderly patients with multimorbidity / 中华老年医学杂志

Objective To investigate the distribution of chronic disease and geriatric syndrome in hospitalized elderly patients with multimorbidity by chronic disease investigation and comprehensive geriatric assessment.Methods A total of 176 patients aged ≥60 years admitted into the geriatric department in our hospital were selected,and demographic factors were collected.Their chronic diseases and geriatric syndrome were recorded.The comprehensive geriatric assessment was consummated,and the biochemical indicators for chronic disease and geriatric syndrome were detected.Results All patients suffered from two or more kinds of chronic diseases.The top three most common diseases were hypertension (112 cases),diabetes (94 cases),and respiratory diseases (73cases).The sum of chronic diseases kinds were ≥3 in 137 patients,≥4 in 78 patients,≥5 in 40 patients.The amount of chronic diseases showed an increased tendency along with ageing.Totally 175 patients had more than one geriatric syndrome,the top three most common types were frailty and prefrailty(133 cases),visual impairment (117 cases),impaired daily activities (107 cases).There were significant differences in the number of geriatric syndrome among different age groups(x2 =16.989,P ＜ 0.001).Spearman analysis showed that the number of patients with geriatric syndrome were positively correlated with age(r =0.307,P＜0.001).Conclusions The prevalence of chronic disease and geriatric syndrome is high in hospitalized elderly patients with multimorbidity,which is increased with aging.We should pay attention to the screening of chronic disease and geriatric syndrome in multimorbid elderly patients

Association of Geriatric Syndromes with Urinary Incontinence according to Sex and Urinary-Incontinence-Related Quality of Life in Older Inpatients: A Cross-Sectional Study of an Acute Care Hospital / 가정의학회지

BACKGROUND: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. We investigated the relationship between geriatric syndromes and UI according to gender and UI-related QOL among older inpatients. METHODS: This study was conducted among 444 older inpatients (aged 65 years and older) between October 2016 and July 2017. We examined geriatric syndromes and related factors involving cognitive impairment, delirium, depression, mobility decline, polypharmacy, undernutrition, pain, and fecal incontinence. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. RESULTS: Geriatric syndromes and related factors were associated with UI. Mobility decline (odds ratio [OR], 4.16; 95% confidence interval [CI], 2.29–7.56), polypharmacy (OR, 3.35; 95% CI, 1.89–5.92), and pain (OR, 6.80; 95% CI, 3.53–13.09) were related to UI in both genders. Especially, delirium (OR, 7.55; 95% CI, 1.61–35.44) and fecal incontinence (OR, 10.15; 95% CI, 2.50–41.17) were associated with UI in men, while cognitive impairment (OR, 4.19; 95% CI, 1.14–15.44) was significantly associated with UI in women. Patients with depression were more likely to have poor UI-related QOL (OR, 8.54; 95% CI, 1.43–51.15). CONCLUSION: UI was associated with different geriatric syndromes and related factors according to gender. Care for patients with depression, related to poor UI-related QOL, should be considered in primary care to improve the UIrelated QOL of these individuals.

Characteristic analysis of 590 older adults with geriatric syndromes in Shanghai based on cluster analysis / 上海交通大学学报（医学版）

Objective • To investigate the distribution of geriatric syndromes in older adults in order to provide reference for the care of different types of the elderly. Methods • This study described distribution of 13 geriatric syndromes of 590 older adults from 5 hospitals and 6 nursing homes in Shanghai based on k-means clustering. The data were collected by Chinese version of continuity assessment record and evaluation (CARE) between May and November 2017. Results • 97.8% of the 590 older adults suffered from at least 1 geriatric syndrome. The top 5 geriatric syndromes were impairment in activities of daily living (80.7%), cognitive impairment (80.5%), polypharmacy (44.7%), visual impairment (45.3%), and hearing impairment (42.9%). The results of k-means clustering showed that the geriatric syndrome was divided into 4 clusters. Cluster 1 (named high incidence group of geriatric syndromes) exhibited high prevalence of impairment in activities of daily living, cognitive impairment, visual impairment, hearing impairment and delirium. On average, each older adult had 5.6±1.1 geriatric syndromes. Cluster 2 (named extremely high group) exhibited the highest prevalence of geriatric syndromes, excluding pain, depression and pressure ulcer. On average, each older adult had 8.3±1.1 geriatric syndromes. Cluster 3 was named low incidence group of geriatric syndromes, each older adult having 2.0±1.2 geriatric syndromes. The incidence of polypharmacy and fall was relatively high. Cluster 4 (named medium group) exhibited high prevalence of impairment in activities of daily living, cognitive impairment, polypharmacy, urinary incontinence and fall. On average, each older adult had 4.0±1.3 geriatric syndromes. Conclusion • Classification of geriatric syndromes is helpful to identify the high-risk older adults who may suffer certain patterns of geriatric syndromes, and thus to carry out targeted interventions.

Analysis of the influence factors ofgeriatric syndrome inthe elderly inpatients / 中国医师进修杂志

Objective To evaluate the morbidity and the influence factors of the geriatric syndrome in the elderly inpatients. Methods The characteristics of comprehensive geriatric assessment of180 elderly inpatients (83 male and 97 female) with age older than 65 in geriatric department from November 2014 to November 2015 were analyzed. Results Of 180 elderly patients, the incidences of visual loss, multiple co-morbidity, polypharmacy, impairment in activities of daily living, urinary incontinence, chronic constipation and chronic pain were 86.11%(155/180), 85.56%(154/180), 82.78%(149/180), 56.11%(101/180), 49.44%(89/180), 46.67%(75/180) and 42.22%(76/180). Female patients had more incidences compared with male in urinary incontinence [56.70%(55/97) vs. 40.96%(34/83)], chronic pain [56.70% (55/97) vs. 25.30%(21/83)] , impairment in activities of daily living [64.95%(63/97) vs. 45.78%(38/83)] and high risk of falling [43.30%(42/97) vs. 21.69%(18/83)], and there were significant differences (P<0.05). In addition, it was found that with the increasing of age, the incidences of hearing loss and chronic constipation, as well as medications were accordingly higher. When the patients′education level was higher, the incidences of urinary incontinence and impairment in activities of daily living were generally declined. Compared with non-diabetes mellitus group, diabetes mellitus group had higher incidences of comorbidities, multiple co-morbidity, medications, polypharmacy and impairment in activities of daily living:(10.59 ± 3.72) kinds vs. (8.29 ± 4.03) kinds, 94.59%(105/111) vs. 71.01%(49/69), (10.07 ± 3.77) kinds vs. (6.87 ± 3.07) kinds, 89.19%(99/111) vs. 72.46%(50/69), 62.16%(69/111) vs. 46.38% (32/69). With the increasing of the numbers of diabetes- related chronic complications, the incidences of visual loss, chronic constipation and multiple co- morbidity, comorbidities and medications were higher (P<0.05). Conclusions Geriatric syndrome such as visual loss, multiple co- morbidity, polypharmacy, impairment in activities of daily living and urinary incontinence are very common in the elderly inpatients. Elderly patients with diabetes mellitus are much easier to suffer from geriatric syndrome such as multiple co-morbidity, polypharmacy and impairment in activities of daily living.

Frailty and geriatric syndromes in elderly assisted in primary health care / Fragilidade e síndromes geriátricas em idosos assistidos na atenção primária à saúde

The aim of this study was to describe the association between frailty and geriatric syndromes (GS) [cognitive impairment (CI); postural instability (PI); urinary/fecal incontinence (UFI); polypharmacy (PP); and immobility (IM)] and the frequency of these conditions in elderly people assisted in primary health care. Five hundred twenty-one elderly participants of The Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) were evaluated. Sociodemographic data, identification of frailty (Fried phenotype) and GS were collected. Multinomial logistic regression analysis was performed. The frequency of frailty was 21.5%, prefrailty 51.1% and robustness 27.4%. The frequency of CI was 54.7%, PP 41.2%, PI 36.5%, UFI 14% and IM 5.8%. The odds of frailty when compared to robustness and adjusted for gender, age, depression, self-perception of health, nutritional status, falls, vision and hearing, was significantly higher in elderly with CI, PI and PP. The adjusted odds of prefrail when compared to robustness was significantly higher only in elderly with CI. The most frequently presented number of GS (0- 5) was two geriatric syndromes (26.87%). The frequency of frailty was high among elderly in primary health care and was associated with three of five GS (CI - PI - PP).

O objetivo deste estudo foi descrever a associação entre fragilidade e síndromes geriátricas (SG) [declínio cognitivo (DC); instabilidade postural (IP); incontinência urinária/fecal (IUF); polifarmácia (PF); e imobilidade (IM)] e a frequência destas condições em idosos assistidos na atenção básica. Foram avaliados 521 idosos, participantes do Estudo Multidimensional dos Idosos da Estratégia Saúde da Família (EMI-SUS). Foram coletados dados sociodemográficos, de identificação da fragilidade (fenótipo de Fried) e das SG. Realizou-se análise de regressão logística multinomial. A frequencia de fragilidade foi 21,5%, de pré-fragilidade 51,1% e de robustez 27,4%. A frequência de DC foi 54,7%, de PF 41,2%, de IP 36,5%, de IUF 14% e de IM 5,8%. A chance de fragilidade quando comparada à robustez, ajustada para sexo, idade, depressão, autopercepção de saúde, estado nutricional, quedas, visão e audição, foi significativamente maior em idosos com DC, IP e PF. A chance ajustada de pré -fragilidade, quando comparada à robustez foi significativamente maior somente nos idosos com DC. O número mais frequente de SG (0-5) presentes foram duas SG (26,8%). A frequência de fragilidade foi alta entre idosos da atenção básica e mostrou-se associada a três das cinco SG (DC-IP-PF).

Association between multiple geriatric syndromes and quality of life in elderly type 2 diabetes / 中国实用护理杂志

Objective To explore the effects of multiple geriatric syndromes on quality of life in the hospitalized elderly type 2 diabetes. Methods A cross sectional study was carried out in 397 elderly patients with type 2 diabetes mellitus by convenience sampling method. Each subject was assessed for general condition, quality of life as well as chronic pain, chronic constipation, urinary incontinence, high risk of falling, malnutrition, sleep disorder, polypharmacy. The influencing factors of quality of life were analyzed by multiple stepwise regression analysis. Results The patients averagely had 3.23 ± 1.51 geriatric syndromes, and 87.2% (346/397) of them had two or more geriatric syndromes. The average physical component summary of patients was (277.11±64.30) points, and mental component summary was (307.00 ± 60.46) points. The influencing factors of physical component of quality of life were quantity of geriatric syndromes, number of complications and course of disease, while the influencing factors of mental component of quality of life were quantity of geriatric syndromes, number of complications. Conclusions Multiple geriatric syndromes are closely related to the patients′quality of life to a greater degree as demographic factors and condition of diabetes. Nursing staffs should pay attention to the assessment and intervention of multiple geriatric syndromes in elderly patients with type 2 diabetes, so as to improve patients′quality of life effectively.

Clinical implications of geriatric syndromes

A decline in organ function, accompanying risk factors, and diseases altogether make disease presentation-diagnosis-management obscure. Geriatric clinical situations are rarely simple. Geriatric syndromes are clinical conditions that are highly prevalent in aged persons, have multifactorial pathophysiology, and associated with considerable morbidity and poor quality of life. Geriatric syndromes are associated with increased risk of activities of daily livings) loss and death rate. There are 3 approaches to Geriatric syndrome management, such as traditional approach by diagnosis and treatment, geriatric approach by risk factor assessment and reduction, and 'mom' approach through 3 domains. In older patients, complicated associations of multiple contributors generally cause a single symptom, which is accompanied and accumulated by multiple impairments. The management of geriatric syndromes includes the treatment of multiple contributors, the treatment of one geriatric symptom or sign, the management of multiple outcomes, and prevention. I'd like to name this approach as 'mom' approach after the acronym of multiple contributors, one phenotype, and multiple outcomes. The understanding of geriatric syndromes will be an important stepping stone in clinical practice of geriatrics.

Management of Type 2 Diabetes Mellitus in Older Adults

In the near future, the majority of patients with diabetes will be adults aged 65 or older. Unlike young adults with diabetes, elderly diabetic people may be affected by a variety of comorbid conditions such as depression, cognitive impairment, muscle weakness (sarcopenia), falls and fractures, and physical frailty. These geriatric syndromes should be considered in the establishment of treatment goals in older adults with diabetes. Although there are several guidelines for the management of diabetes, only a few are specifically designed for the elderly with diabetes. In this review, we present specific conditions of elderly diabetes which should be taken into account in the management of diabetes in older adults. We also present advantages and disadvantages of various glucose-lowering agents that should be considered when choosing a proper regimen for older adults with diabetes.

Frailty: A Core Geriatric Concept

Frailty, a progressive physiologic decline in multiple body systems, is defined as a state of increased vulnerability to the stress that carries an increased risk of disability, hospitalization, functional decline, and mortality in older adults. Frailty is a new and emerging syndrome in the field of geriatrics. With the advance of population aging, frail elderly continue to increase and frail older adults are among the most challenging for medical management. Contrary to popular belief, frailty is not present in all elderly persons, which suggests that it is associated with aging but not an inevitable process of aging and may be prevented or treated. Common signs and symptoms of frailty are fatigue, weight loss, muscle weakness, slowness, and low activity. The purpose of this article is to review what is known about frailty, including the definition, epidemiology, pathophysiology, and to examine potential areas of future research.

The Long-term Care Management for the Elderly in Korea

No abstract available.