Introduction: Tracheostomy is commonly performed in elderly intensive care unit patients requiring prolonged ventilatory support to facilitate airway management, ventilator weaning, secretion control, and patient comfort. Because these patients often have prolonged critical illness, comorbidity burden, and reduced physiological reserve, accurate prognostic assessment is important for clinical management and family counseling. This study evaluated the prognostic value of the Modified Frailty Index-5, disease severity scores, albumin, and lactate in elderly patients undergoing tracheostomy. Materials and Method: Patients aged >= 65 years who underwent elective percutaneous tracheostomy for prolonged mechanical ventilation in a general adult intensive care unit between 2021 and 2025 were retrospectively analyzed. Demographic data, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Modified Frailty Index-5, and pre-procedural albumin and lactate concentrations were recorded. The outcomes were 28-day mortality and post-procedural complications. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: A total of 114 patients were analyzed. Twenty-eight-day mortality was 58.8% and post-procedural complications occurred in 13.2% of patients. Non-survivors had significantly higher Modified Frailty Index-5 and SOFA scores and higher lactate concentrations, while albumin concentrations were lower. In multivariable analysis, the Modified Frailty Index-5 score independently predicted mortality and post-procedural complications. Both the SOFA score and serum lactate concentration emerged as independent predictors of mortality. Conclusion: Frailty assessed by the Modified Frailty Index-5 predicts mortality and post-procedural complications in elderly intensive care unit patients undergoing tracheostomy and may improve clinical risk stratification when integrated with conventional severity scores and pre-procedural lactate and albumin concentrations.
Introduction: Patients aged 80 years or older undergoing major abdominal surgery represent a high-risk group with substantial postoperative mortality. Frailty and reduced physiological reserve are key determinants of adverse outcomes; however, data focusing specifically on this population are limited. This study aimed to identify predictors of 30-day mortality, with emphasis on frailty and physiological reserve. Materials and Method: This retrospective single-center cohort study included patients aged 80 years or older who underwent major abdominal surgery between 2021 and 2025. Frailty was assessed using the five-item modified frailty index. Physiological reserve was evaluated using preoperative albumin, hemoglobin, and creatinine levels. The primary outcome was 30-day mortality. Multivariable logistic regression analysis was performed. Results: A total of 92 patients were included, with a 30-day mortality rate of 18.5%. Emergency surgery was more frequent among non-survivors (70.6% vs. 12.0%, p<0.001), as was preoperative sepsis (33.3% vs. 4.0%, p=0.003). Severe frailty was present in 50.0% of non-survivors compared to 14.9% of survivors (p=0.025). Non-survivors had lower albumin levels (28.4 vs. 37.0 g/L, p=0.001). In the multivariable analysis, frailty was an independent predictor of mortality (odds ratio 2.71, 95% confidence interval 1.03-7.16, p=0.044). Albumin showed a trend toward significance (odds ratio 0.87 per unit increase, p=0.069). The model demonstrated high discriminative ability (area under the curve 0.899). Conclusion: Frailty is an independent predictor of 30-day mortality in patients aged 80 years or older undergoing major abdominal surgery. Incorporating frailty assessment into routine preoperative evaluation may improve risk stratification and clinical decision-making.
Introduction: Epidural steroid injections are often preferred in elderly patients with low back pain. The present study aimed to determine the types of injections applied to elderly patients, evaluate the choice of procedure type according to diagnosis, and assess the effectiveness of pain control. Materials and Method: Patients who underwent lumbar epidural steroid injections between January 2024 and January 2026 were retrospectively evaluated. The patient's age, gender, body mass index, numeric rating scale, diagnosis, type of procedure, procedure time, and radiation dose were evaluated. The study also investigated which type of procedure was preferred in patients based on their diagnoses. Results: The study included 243 elderly patients and a control group of 581 patients aged 18-65. No significant differences were found between elderly and adult patients in terms of gender, body mass index, or numeric rating scale scores. It was found that the number of caudal and interlaminar approach was significantly higher in the elderly. Also, it was found that the transforaminal approach was preferred in disc herniation patients, interlaminar approach in spinal stenosis, and the caudal approach in the failed back surgery group. Furthermore, radiation dose and procedure times were significantly lower in the control group. Conclusions: In elderly patients, interlaminar epidural steroid injections and caudal epidural steroid injections are performed more frequently than in adult patients; the choice of epidural steroid injection approach varies according to diagnosis and is associated with longer procedure times and higher radiation exposure.
Introduction: The growing proportion of the elderly population worldwide and in T & uuml;rkiye has significantly affected healthcare utilization patterns and expenditure structures. This study aimed to evaluate healthcare service utilization and expenditures among individuals aged >= 65 years according to service type, service area, and age group. Materials and Method: This descriptive, cross-sectional study utilized administrative data from the 2024 Social Security Institution (SSI) General Health Insurance system. Individuals aged >= 65 years who used at least one SSI-covered healthcare service were included. Healthcare utilization and expenditures were analyzed descriptively across hospital services, pharmacy services, medical supplies, and outpatient visits, stratified by age groups and selected chronic disease categories. Results: Healthcare expenditures were mainly driven by hospital and pharmacy services, with hospital services accounting for approximately half of total spending. Cardiovascular diseases showed the highest healthcare utilization and expenditure among chronic disease groups. Although total expenditures were highest in the 65-69 age group, per capita expenditure increased steadily with age and reached its highest level in individuals aged >= 80 years, where it was approximately twice that of the 65-69 age group. Conclusion: The findings indicate that healthcare utilization among the elderly population is shaped by the burden of chronic diseases and age-related care needs, while per capita healthcare expenditures increase markedly in more advanced age groups. These results provide important implications for healthcare planning and the financial sustainability of health systems in the context of population aging.
Introduction: The global increase in the geriatric population has led to a parallel rise in the number of surgical procedures performed in elderly patients. The aim of this study was to evaluate the predictive value of the FRAIL score, ASA score, and hemogram parameters obtained in the preoperative period for postoperative mortality and morbidity. Materials and Method: This prospective study was conducted between May 1, 2020 and December 31, 2021 with geriatric patients who were scheduled for elective surgery. FRAIL score and ASA scores were assessed during the preoperative evaluation. Preoperative and postoperative hemogram parameters were recorded for all patients. Results: Atotal of 167 patients were included in the study, of whom 56 (33.5%) were female and 111 (66.5%) were male. The mean age of the patients was 74.6 +/- 8.01 (age range 65-102). According to the FRAIL score, 66 patients (39.5%) were categorized as robust, 63 patients (37.7%) as prefrail, and 38 patients (22.8%) as frail. FRAIL score, ASA score, preoperative NLR, postoperative NLR, preoperative RDW-SD, and postoperative RDW-SD were identified as the most significant parameters associated with postoperative mortality and morbidity (p<0.0001, p<0.0001, p<0.0001, p=0.002, p<0.0001, respectively). Conclusion: Our findings suggest that combined preoperative evaluation of ASA score, FRAIL score, NLR, and RDW of the geriatric patients may improve the prediction of postoperative mortality and morbidity during the threemonth follow-up period. These parameters, when used together, may provide a practical and effective approach for perioperative risk stratification in geriatric patients.
