Problem-Based Learning for Interprofessional Education: A Review of the Concept and Its Application in a Geriatric Team.

The global population is aging, with those aged 65 years or over increasing in number and accounting for a growing share of the population. There are increasing demands for geriatric care which makes the development and delivery of effective geriatric team training a priority. Training in geriatrics is complex because of the multiplicity of medical, psychosocial, and functional issues in elderly individuals which need to be addressed by a multidisciplinary approach using interprofessional education (IPE). Problem-based learning, a student-centered educational model that brings several natural strengths to IPE, is a unique curriculum replacing the traditional lecture-based learning model. This model enhances physician competency after graduation, mainly in psychosocial and teamwork issues that are fundamentally essential for geriatrics. IPE has been shown to have a substantial positive impact on team collaboration, individual development, and healthcare improvement. In this paper, we summarize the current findings from recent studies on training professionals from different healthcare disciplines to deliver care for the elderly in collaborative practice. We also discuss if an interprofessional problem-based geriatric team program in geriatrics is a promising solution to enhance professional collaboration and quality of patient care.

Delirium management in perioperative geriatric services: a narrative review of non-pharmaceutical strategies.

Delirium, a common complication in elderly surgical patients, poses significant challenges in perioperative care. Perioperative geriatric services (PGS) aim at managing comorbidities, postoperative complications, and initiating early recovery of mobility to enhance elderly patients' prognosis in the perioperative period. Studies have shown that patients with preoperative cognitive disorders are at a significantly increased risk of postoperative delirium. While postoperative delirium affects up to 70% of people over 60 and 90% of people with neurodegenerative diseases, it remains underdiagnosed in many cases. Postoperative delirium can lead to functional decline, prolonged hospitalization, increased healthcare costs, cognitive impairment, and psychological malaise. This article briefly summarizes the literature on delirium, its risk factors, and its non-pharmaceutical management strategies within the perioperative period. It highlights the importance of integrating cognitive and psychological assessments into perioperative care protocols to provide baseline data, improve patient outcomes, reduce hospital stays, and minimize complications associated with delirium. By embracing evidence-based delirium management protocols, healthcare professionals can better identify and manage delirium, ultimately improving the quality of care for elderly surgical patients, which would also benefit healthcare staff and healthcare institutions.

Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review.

BACKGROUND: Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults. METHODS: MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed. RESULTS: Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples. CONCLUSION: The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.

App-based telerehabilitation program for older adults on waiting list for physiotherapy after hospital discharge: a feasibility pragmatic randomized trial.

BACKGROUND: Inactivity while waiting for outpatient physiotherapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages. This study aimed to evaluate the feasibility of the study procedures of a telerehabilitation program for older adults waiting for outpatient physiotherapy after hospital discharge. METHODS: This pragmatic randomized controlled trial recruited older adults (≥ 60 years) with several clinical diagnoses on the waiting list for outpatient physiotherapy in the Brazilian public health system after hospital discharge. The telerehabilitation group (n = 17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n = 17) followed the usual waiting list. We assessed recruitment and dropout rates, safety, adherence, and satisfaction. The preliminary effects were verified on clinical outcomes. RESULTS: We recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program. The weekly adherence was 2.85 (1.43) days, and in 63.3% of the weeks the participants were enrolled, they performed the exercise program at least twice a week. Participants rated the telerehabilitation program as 9.71 (0.21), and the safety of remote exercises without professional supervision as 8.6 (2.2) on a 0-10 scale. CONCLUSIONS: The telerehabilitation program using a smartphone app was safe and presented high participants' satisfaction and adequate adherence, recruitment, and dropout rates. Therefore, the definitive study can be conducted with few modifications. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020. https://ensaiosclinicos.gov.br/rg/RBR-9243v7 .

[Characterization of older adult patients admitted to an acute unit of a high complexity hospital in Bogotá, Colombia]. / Caracterización de los pacientes adultos mayores ingresados a una unidad de agudos de un hospital de alta complejidad en Bogotá, Colombia.

BACKGROUND AND OBJECTIVES: The objective is to describe the demographic, clinical, functional characteristics and outcomes of older adult patients hospitalized in the acute unit of the San Ignacio University Hospital (HUSI). METHODS: Descriptive, cross-sectional observational study, based on the review of the medical records of patients hospitalized in the Geriatrics Unit of the HUSI during the period 2019-2021. VARIABLES: Demographics, comorbidities, baseline situation, main cause of entry and outcomes. The diagnosis of geriatric syndromes was made through the Barthel index, the Lawton and Brody scale, FRAIL scale, mini nutritional assessment short form and Confusion Assessment Method criteria. RESULTS: A total of 4601 patients were analyzed, whose average age was 83years (56.2% women). 72.4% had some degree of dependency for basic activities of daily living, 90.8% had some degree of dependency for instrumental activities of daily living, 32.2% had malnutrition, 15. 7% falls, 9.9% oropharyngeal dysphagia, 32.2% frailty, 28.1% delirium, 54.1% previous dementia. The main comorbidities presented were arterial hypertension, chronic obstructive pulmonary disease and diabetes. 2.9% had some complication during their hospitalization, 10.8% died, and the hospital stay was 5days. CONCLUSION: Older adult patients admitted to the acute unit of the HUSI have a high frequency of dependency, dementia and nutritional disturbances.

A principal component analysis of metabolome and cognitive decline among Japanese older adults: cross-sectional analysis using Tohoku Medical Megabank Cohort Study.

BackgroundDementia is the leading cause of disability and imposes a significant burden on society. Previous studies have suggested an association between metabolites and cognitive decline. Although the metabolite composition differs between Western and Asian populations, studies targeting Asian populations remain scarce.MethodsThis cross-sectional study used data from a cohort survey of community-dwelling older adults aged ≥ 60 years living in Miyagi, Japan, conducted by Tohoku Medical Megabank Organization between 2013 and 2016. Forty-three metabolite variables quantified using nuclear magnetic resonance spectroscopy were used as explanatory variables. Dependent variable was the presence of cognitive decline (≤ 23 points), assessed by the Mini-Mental State Examination. Principal component (PC) analysis was performed to reduce the dimensionality of metabolite variables, followed by logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline.ResultsA total of 2,940 participants were included (men: 49.0%, mean age: 67.6 years). Among them, 1.9% showed cognitive decline. The first 12 PC components (PC1-PC12) accounted for 71.7% of the total variance. Multivariate analysis showed that PC1, which mainly represented essential amino acids, was associated with lower odds of cognitive decline (OR = 0.89; 95% CI, 0.80-0.98). PC2, which mainly included ketone bodies, was associated with cognitive decline (OR = 1.29; 95% CI, 1.11-1.51). PC3, which included amino acids, was associated with lower odds of cognitive decline (OR = 0.81; 95% CI, 0.66-0.99).ConclusionAmino acids are protectively associated with cognitive decline, whereas ketone metabolites are associated with higher odds of cognitive decline.

Amyloid-related imaging abnormalities (ARIA) and their radiological, biological and clinical characteristics: a plain language summary.

What is this summary about? This is a plain language summary of an article published in the journal Brain. People with Alzheimer's disease may receive treatments that target amyloid-ß ­ a protein in the brain that is one of the key characteristics of Alzheimer's disease when it is present in higher levels than normal. This article is about amyloid-related imaging abnormalities (ARIA), which can be adverse events for people with Alzheimer's disease receiving antibody treatments targeting amyloid-ß (known as anti­amyloid-ß antibody treatments). This article also discusses ways to identify and manage ARIA.ARIA are adverse events that happen due to amyloid-ß buildup in the brain or following treatments targeting amyloid-ß. ARIA are identified on MRI scans as swelling or bleeding in the brain, and people with ARIA do not typically have symptoms. In rare cases, ARIA can cause serious symptoms or lead to disability.What are the key takeaways? There are two types of ARIA: ARIA-E (swelling in the brain) and ARIA-H (bleeding in the brain).Presence of an APOE ε4 gene variant and exposure to anti­amyloid-ß antibody treatments are major risk factors for ARIA.With the recent availability in the clinic of antibody treatments targeting amyloid-ß, increased awareness is needed to identify, monitor and manage ARIA effectively.What were the main conclusions reported by the researchers? Uniform detection, monitoring and management of ARIA are essential in patients receiving antibody treatments targeting amyloid-ß. To increase ARIA detection in clinical trials and clinical practice, the authors recommend the implementation of uniform imaging protocols and rigorous reporting standards.

Impact of English proficiency on use of Glasgow Coma Scale in geriatric patients with traumatic brain injury.

Background: The relationship between English proficiency (EP), Glasgow Coma Scale (GCS) and traumatic brain injury (TBI) is not well characterized. We aimed to understand the impact of limited English proficiency (LEP) on the evaluation and outcomes of TBI. Methods: Retrospective comparative study in a single institution of patients aged ⪰65 who presented to the emergency department after a fall with head strike between January 2018 and December 2021. TBI was defined as documented loss of consciousness or intracranial hemorrhage (ICH). Relationships between EP, GCS, and TBI were analyzed with multivariable and propensity score-matched models. Results: Of the 2905 included, 1233 (42%) had LEP. Most LEP patients were Asian (60%) while the majority of EP patients were non-Hispanic Caucasians (72%). In a univariate analysis, LEP had higher incidence of decreased GCS and was strongly correlated with risk of TBI (OR 1.47, CI 1.26 to 1.71). After adjusting for multiple covariates including race, LEP did not have a significantly increased risk for GCS score <13 (OR 1.66, CI 0.99 to 2.76) or increased risk of TBI. In the matched analysis, LEP had a small but significantly higher risk of GCS score <13 (OR 1.03, CI 1.02 to 1.05) without an increased risk in TBI. Decreased GCS remained strongly correlated with presence of ICH in LEP patients in the adjusted model (OR 1.39, CI 1.30 to 1.50). Conclusions: LEP correlated with lower GCS in geriatric patients with TBI. This association weakened after adjusting for factors like race, suggesting racial disparities may have more influence than language differences. Moreover, GCS remained effective for predicting ICH in LEP individuals, highlighting its value with suitable translation resources. Level of evidence: This is a Level III evidence restrospective comparative study.

Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study.

Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.

Feasibility of the Remembering Warmth and Safeness Intervention in older ADRD caregivers.

BACKGROUND: The number of older adults in the U.S. living with ADRD is projected to increase dramatically by 2060. As older adults increasingly assume informal caregiving responsibilities, community-based intervention to sustain caregiver well-being is a dementia research priority. OBJECTIVE: To evaluate the feasibility of the RWSI among older ADRD caregivers. The RWSI is informed by the Neurovisceral Integration Model, in which memories that engage safety signals cultivate feelings of safety and well-being. METHODS: A within-subjects pre/post-intervention design with older ADRD caregivers to evaluate feasibility (acceptability, demand, fidelity) and empirical promise (well-being). RESULTS: The feasibility of the RWSI, implemented with fidelity, was strongly endorsed, as participants attended each intervention session, after which reported experiencing feelings of warmth and safeness, and provided the highest possible acceptability ratings. Participant narratives provided corroboration. DISCUSSION: Findings support the feasibility of the RWSI in older ADRD caregivers, providing the basis for continued research.

Follow-up of Cardiopulmonary Responses Using Submaximal Exercise Test in Older Adults with Post-COVID-19.

Background: Data on cardiopulmonary fitness in older adults in the longer term after coronavirus disease 2019 (COVID-19) are of interest as the time required for the full recovery of physical fitness after COVID-19 remains unclear. Some studies have reported that patients do not recover physical fitness for up to 6 or 12 months after COVID-19, whereas other studies have observed full recovery after 12-months. Therefore, this study evaluated and compared the cardiopulmonary responses induced by the 6-minute walk test (6MWT) and 1-minute sit-to-stand-test (STST) results at 3, 6, and 12 months in older adults with and without COVID-19. Methods: This study included 59 older adults with and without a history of COVID-19. The cardiopulmonary response parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (O2 sat), rate of perceived exertion (RPE), and leg fatigue were evaluated in the participants after 6MWT and 1-min-STST assessments. Results: Post-COVID-19, older adults showed statistically significant differences in HR, SBP, DBP, O2 sat, RPE, leg fatigue, 6MWT time, and 1-min-STST step numbers at 3, 6, and 12 months (P < 0.001). Moreover, older adults showed statistically significant differences in HR, SBP, DBP, RPE, leg fatigue, O2 sat, and 6MWT distance at 3 months post-COVID-19 compared with those in older adults without COVID-19 (P < 0.001). Conclusion: While older adults showed recovery of cardiopulmonary response parameters according to 6MWT and 1-min-STST findings at the 12-month follow-up post-COVID-19, these results of these measurements did not return to the values observed in older adults without COVID-19.

Pain management inequities by demographic and geriatric-related variables in older adult inpatients.

BACKGROUND: Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables. METHODS: This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME). RESULTS: A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70-0.80), Latinx (OR 0.90, 95% CI 0.83-0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64-0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66-0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77-96), Asian patients (55 MME, 95% CI 46-65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids. CONCLUSION: Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.

Geriatric trauma triage: optimizing systems for older adults-a publication of the American Association for the Surgery of Trauma Geriatric Trauma Committee.

Background: Geriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation. Methods: We conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older patient, evaluating existing literature and guidelines. Opportunities for improvement or standardization were identified. Results: Opportunities for improved geriatric trauma triage exist in the pre-hospital setting, in the trauma bay, and continue after admission. They may include physiologic criteria, biochemical markers, radiologic criteria and even age. Recent Trauma Quality Improvement Program (TQIP) Best Practices Guidelines for Geriatric Trauma Management published in 2024 support these findings. Conclusion: Trauma systems must adjust to provide optimal care for older adults. Further investigation is required to provide pertinent guidance.

Impact of Tai Chi and Aerobic Exercise on Cognitive Function, Balance, Cardiovascular Fitness, and Quality of Life in Older Adults: Randomized Control Trial.

Introduction Tai chi, an ancient Chinese martial art, was originally developed for combat and self-defense. Over time, it has evolved into both a sport and a form of exercise. This gentle, low-impact exercise involves performing a series of deliberate, flowing motions while focusing on deep, slow breaths. This study investigates the effects of chen tai chi and aerobic exercises on cognition, balance, cardiopulmonary fitness, and quality of life in older adults. Methodology This study employed a single-blinded randomized control trial design, enrolling 60 participants aged between 60 and 75 years. Participants were divided into three groups: Group A (aerobics), Group B (chen tai chi), and Group C (control). Exercise sessions were held four days per week over a period of four weeks. Evaluations included the Montreal Cognitive Assessment for cognition, a one-leg stand test for static balance, a Timed Up and Go Test for dynamic balance, a six-minute walk test for cardiopulmonary fitness, and a health-related quality-of-life scale. Assessments were conducted at baseline, immediately after the intervention, and at follow-up was taken after eight weeks. Results Post-intervention, improvements were observed in cognition and static balance across all groups. Within-group analysis revealed that the aerobics group experienced statistically significant enhancements in cognition (p = 0.0001) and static balance (p = 0.01). Although no statistically significant differences were found between groups in terms of dynamic balance, cardiopulmonary fitness, and quality of life, the within-group analysis showed significant improvements in the aerobics group in dynamic balance (p = 0.0009), cardiopulmonary fitness (p = 0.03), and quality of life (p = 0.0001). Conclusion Compared to chen tai chi and no intervention, the study concludes that aerobic exercise has a more pronounced effect on improving cognition, balance, cardiopulmonary fitness, and quality of life in older adults. Aerobic exercise is recommended as an effective method to prevent frailty and promote independence among the elderly.

The Eternal Present: A Photovoice Study of the Experience of Geriatrics Residents During the COVID-19 Pandemic.

During the COVID-19 pandemic, medical residents had the task of being the frontline of the response, being exposed to high risk of infection, increased clinical duty, and long and irregular working hours in highly restricted environments, increasing their levels of stress. We sought to expose the experiences of a group of geriatrics residents during this period of change in their professional and personal lives through the photovoice methodology. Thirteen participants were recruited and had 2 weeks to take photographs. The photographs were discussed in group meetings; the content of the conversations was transcribed and analyzed using interpretive description. Sixteen themes were identified. They were divided into personal life (11 themes) and life as a resident (5 themes). Adaptation was the main theme that came into discussion. The photographs and themes show how life changed for the participants, having a feeling of isolation, especially from their families, and highlighting their experiences as a team and community. While the pandemic, particularly at its beginning, was a period of uncertainty and a heavy load of work, it also provided learning and experience to this group of young physicians, which should not hide the fact that mental health concerns and burnout were a common situation. An online gallery was created which is publicly accessible.

Evaluation of the surgical management strategy for acute cholecystitis in patients over 75years old.

INTRODUCTION: Acute cholecystitis occurs frequently in the elderly. According to the current recommendations specific to the characteristics of each case, these patients are most often treated by delayed cholecystectomy after medical treatment. Our study aimed to compare the success rate of this strategy in patients over and under 75years of age. PATIENTS AND METHODS: This was a retrospective single-center analytic observational study that included patients who were hospitalized for acute cholecystitis in a geriatric postoperative unit (unité postopératoire gériatrique [UPOG]) and gastrointestinal surgery unit between 2021 and 2022. The main endpoint was the failure rate of deferred cholecystectomy. Secondary endpoints included: respect for the recommended operative delay, loss of the patient's functional independence during hospitalization, and the reason for surgical abstention. RESULTS: In total, 290 patients were included. The strategy of delayed elective cholecystectomy was not achieved in 31 (44%) patients 75years old or older vs. eight (18%) patients younger than 75years old (P=0.005). The main reason was the decision not to operate after medical treatment. In both groups, the recommended operative interval was equitably respected and the loss of autonomy during hospitalization was minor. More than one-third of the elderly patients scheduled for elective surgery finally refused to undergo surgery. CONCLUSION: The strategy of routine elective cholecystectomy should not be strict in the elderly with acute cholecystitis; the indication for this procedure should take into account the wishes as well as the physiological status of the patient.

Challenges in Prognostication of an Older Adult with Severe Obesity and End-Stage Heart Failure: A Case Study.

In this report, we present the case of an older adult with severe obesity and multiple comorbidities, including heart failure with preserved ejection fraction (HFpEF), who experienced a prolonged decline complicated by recurrent hospitalizations and skilled nursing facility stays during the two years preceding death. This case highlights challenges in prognostication attributed to severe obesity complicated by HFpEF, which likely delayed goals of care conversations, and access to palliative care and hospice, despite high symptom burden. We discuss prognostic uncertainty among those with severe obesity and outline potential future directions.

A Criteria to Reduce Interhospital Transfer of Traumatic Brain Injuries in Greater East Texas.

BACKGROUND: Traumatic brain injury (TBI) due to single-level falls (SLF) are frequent and often require interhospital transfer. This retrospective cohort study aimed to assess the safety of a criteria for non-transfer among a subset of TBI patients who could be observed at their local hospital, vs mandatory transfer to a level 1 trauma center (L1TC). METHODS: We conducted a 7-year review of patients with TBI due to SLF at a rural L1TC. Patients were classified as transfer/non-transfer according to the Brain Injuries in Greater East Texas (BIGTEX) criteria. The primary outcome measure was the occurrence of a critical event defined as deteriorating repeat head computed tomography (CT) scan or neurological status, neurosurgical intervention, or death. RESULTS: Of the 689 included patients, 63 (9.1%) were classified as non-transfer. Although there were 4 cases with a neurological change and one with a head CT change among the non-transfer group, there were no neurosurgical procedures or deaths. The Cox Proportional Hazard model showed a near 3-fold increased risk of experiencing a critical event if classified as a non-transfer. The multivariable regression model showed patients with an Abbreviated Injury Scale (AIS) of 3 was twice as likely to experience a critical event, with an AIS of 4, three times, and 3 times more likely to be classified to transfer. DISCUSSION: The BIGTEX criteria identify a subset of patients who can safely be observed at their local hospital. To confirm the safety and efficacy of this transfer criteria recommendation, a prospective study is warranted.