PURPOSE:To define the frequency and annual rate of hypertensive crisis in older patients attending emergency department (ED), the sociodemographic and baseline patient profile, and clinical characteristics and long-term outcome of the hypertensive crisis episode. We also looked for differences between men and women. METHODS:This was a retrospective analysis of the multipurpose EDEN cohort, which recruited during 1-week period all patients aged 65 years who visited the ED of 52 Spanish public hospitals covering 19.3% of Spanish population. Demographic, social, baseline and clinical data of the episode of hypertensive crisis were recorded. Estimations of annual incidence were made, in general and through patient age. Outcome consisted of 1-year post-discharge combined adverse event (revisit to ED, hospitalization, or death). Comparison between men and women were performed in unadjusted and adjusted models. RESULTS:There were 186 cases of hypertensive crises among the 25,557 patients included in the EDEN cohort. The relative frequency of hypertensive crisis was 0.73% of ED visits (95%CI 0.63-0.84), with 0.56% (0.44-0.72) in men and 0.87% (0.73-1.04) in women (OR for men 0.64, 0.47-0.87), and annual rate of hypertensive crisis in Spanish older population was 429 cases per 100.000 inhabitants (95%CI 371-493), with 341 (267-436) in men and 493 (413-590) in women (OR for men 0.69, 0.51-0.94). Patients with hypertensive crisis had better baseline health status than the rest of the older patients attending the ED, with cardiovascular comorbidity being frequent (previously known hypertension in 88.2%) and with 22% having additional acute diagnoses on top of the hypertensive crisis. Hospitalization was needed in 7.5% of cases (0.5% in intensive care unit) and in-hospital mortality was observed in 2 cases (1.1%). Combined adverse events 1 year after discharge accounted for 57.9% of patients, with 65.6% in men and 52.5% in women (adjusted HR 1.61, 1.01-2.57). CONCLUSIONS:Hypertensive crises are more frequent in older women than men and they present a worse profile at baseline and higher severity than men. Nonetheless, men with hypertensive crisis may have a worse long-term prognosis compared to women, highlighting the need for targeted post-discharge monitoring strategies in this subgroup.
INTRODUCTION:Delirium is common in hospitalized older adults and is associated with higher morbidity and mortality in this population. Our geriatric trauma co-management (GTC) program integrates a geriatrician in the trauma team, with a focus on team-based, interdisciplinary care coordination to mitigate geriatric syndromes, including delirium. METHODS:We analyzed 12,631 patients aged 65 and older admitted to the trauma surgery team at a level-1 trauma center from 2017 to 2024. We perform a 1:1 ratio matching of propensity scores. The primary outcome was delirium incidence, defined by acute encephalopathy, positive Confusion Assessment Method (CAM) score, or new use of antipsychotic medicine between GTC and usual standard care (UC). The secondary outcomes included discharge disposition, in-hospital falls, intensive care unit (ICU) length of stay (LOS), mortality, and 30-day readmission. Chi-square and Students's t tests were used for bivariate analyses. Multivariate linear or logistic regression analyses were used for outcomes. When applicable, the analyses were adjusted. RESULTS:The propensity score-matched cohort included 1,318 patients (659 GTC; 659 UC). Mean age was 82.1 ± 8.1 years, 45% were male. GTC patients had a 37% higher likelihood of being discharged to SNF (1.37 [1.04-1.79]). The mean ICU LOS was higher in the GTC group (3.9 ± 5.7 days vs. 2.3 ± 3.7 days, adjusted p = 0.002), but there were no significant differences in mean LOS, in-hospital falls, in-hospital mortality, discharge to hospice or death during hospitalization, death within 30 days after discharge, or 30-day readmissions. For the prespecified composite delirium outcome, GTC patients had higher documented delirium (51.9%) compared with 28.1% for UC patients (2.50 [1.88-3.34]). Secondary exploratory analyses of individual delirium definitions showed higher rates of acute encephalopathy occurred in 7.6% of GTC patients versus 1.2% of UC patients (OR 14.80, 95% CI [4.82-45.45]; p < 0.0001). Positive CAM score was documented in 42.6% of GTC patients compared with 11.1% of UC patients (4.68 [3.23-6.78]; p < 0.0001). Positive CAM score and/or new use of antipsychotic medicine occurred in 27.2% of GTC patients versus 22.2% of UC patients (1.38 [1.02-1.87]; p = 0.038). In contrast, new antipsychotic alone was more common in UC (15.8% vs. 7.9%, p < 0.05). Among patients with a positive CAM score, GTC patients had lower in-hospital mortality compared with UC (8.2% vs. 18.4%; OR 0.40, 95% CI: 0.17-0.95; p < 0.05). CONCLUSION:GTC in older trauma patients helps identify delirium and potentially reduces the need for antipsychotics and improves mortality. A randomized controlled trial is needed to verify these findings.
INTRODUCTION:The recommended target durations for moderate-to-vigorous physical activity (MVPA) to promote health have been established; however, evidence supporting the use of step counts as a measure of physical activity remains limited. We aimed to compare the predictive ability of MVPA and step counts for incident disability among community-dwelling older adults. METHODS:This prospective cohort study included a total of 8664 community-dwelling older adults from a community-based setting. MVPA and step counts were measured using an accelerometer. Disability incidence and mortality rates were prospectively assessed over 60 months. Inverse probability weighting-adjusted receiver operating characteristic curve analysis was used to evaluate the predictive ability of MVPA and step counts for disability incidence, while adjusting for covariates. RESULTS:A total of 1,373 (15.8%) patients developed an incidental disability within 60 months. In the inverse probability weighting analysis based on the covariate model, the areas under the curve for MVPA and step counts were 0.572 (95% CI, 0.542-0.603) and 0.565 (95% CI, 0.537-0.596), respectively. CONCLUSION:Among community-dwelling older adults, step counts and MVPA showed comparable associations and predictive performance for incident disability after adjustment for background risk factors. Our findings support the use of step counts as a measure of physical activity in this population.
Tämän tutkimuksen tavoitteena oli kuvata asukaslähtöisiä tekijöitä, jotka ovat yhteydessä palveluasumisessa asuvien iäkkäiden asumistyytyväisyyteen. Tutkimus oli poikkileikkauksena toteutettava kyselytutkimus. Tutkittavat olivat Uudenmaan alueen palveluasumisyksiköissä asuvia iäkkäitä (n = 842). Vastaajista 86 prosenttia oli tyytyväisiä nykyiseen asuinpaikkaansa. Korkeampi ikä, hyvät sosiaaliset suhteet ja mielen hyvinvointi olivat yhteydessä parempaan asumistyytyväisyyteen. Vastaavasti yksinäisyys ja masennuksen kokemus olivat yhteydessä huonompaan asumistyytyväisyyteen. Asumistyytyväisyys oli parempi, mikäli iäkäs itse oli saanut osallistua asuinpaikkansa valintaan. Vaikka iäkkäiden asumispalvelut näyttäytyvät julkisessa keskustelussa usein kielteisessä valossa, ovat iäkkäät asukkaat kuitenkin valtaosin tyytyväisiä asuinpaikkoihinsa. Asumistyytyväisyys on tärkeä asumispalveluiden laadun mittari ja sen edistämiseksi tulisi työskennellä. Older residents are satisfied with their service housing – which factors are associated with this? The aim of the study was to describe factors associated with residential satisfaction among older people living in assisted living facilities. The study was a cross-sectional postal survey. The participants were older residents (n = 842) living in assisted living facilities in the Uusimaa region. Eighty-six percent of respondents were satisfied with their current place of residence. Higher age, good social relationships, and mental well-being were associated with better residential satisfaction. Conversely, loneliness and experiencing depression were associated with poorer residential satisfaction. Residential satisfaction was also improved if the older person had been involved in choosing their place of residence. Although residential care of older people is often viewed negatively in public discourse, most older residents are satisfied with their current living arrangements. Residential satisfaction is an important measure of the quality of housing services and should be actively promoted.
