The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

Beil, Michael; Guidet, Bertrand; Sviri, Sigal; Jung, Christian; Lange, Dylan W. de; Leaver, Susannah; Fjølner, Jesper; Szczeklik, Wojciech; Heerden, Peter Vernon van

doi:10.1186/s13054-021-03750-y

Cited by 18 publications

(15 citation statements)

References 45 publications

(50 reference statements)

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“…On another note, multiple chronic health problems in the same individual (known as multimorbidity) can constitute profiles or patterns, some of which have already been described in older patients [ 7 , 8 ]. Multimorbidity, together with geriatric syndromes and frailty, frequently coexisting in the ageing process, increase clinical complexity and can lead to significant medicalization [ 9 ]. In these circumstances, there is an increased likelihood of low-value clinical practices, such as excessive polypharmacy and potentially inappropriate prescribing (PIP) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Baré

Lleal

Sevilla-Sánchez

et al. 2023

IJERPH

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There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.

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Section: Introductionmentioning

confidence: 99%

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Baré

Lleal

Sevilla-Sánchez

et al. 2023

IJERPH

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“…Aging is associated with an increase in comorbidities and a higher risk of “multimorbidity” or the co-occurrence of two or more chronic conditions. 9 , 10 Common comorbidities in aging include hypertension, diabetes, chronic obstructive pulmonary disease, heart failure, cancer, and cognitive impairment. 10 Multimorbidity is associated with increased short- and long-term mortality among all ICU patients 11 and poses a significant risk for older populations.…”

Section: Geriatric Syndromes and Comorbiditiesmentioning

confidence: 99%

“… 9 , 10 Common comorbidities in aging include hypertension, diabetes, chronic obstructive pulmonary disease, heart failure, cancer, and cognitive impairment. 10 Multimorbidity is associated with increased short- and long-term mortality among all ICU patients 11 and poses a significant risk for older populations. 12 The aging process and comorbidities in older adults increase the risk of developing frailty, a syndrome resulting from decline across multiple physiologic systems that decreases the body’s reserve for managing stressful events and increases vulnerability to adverse outcomes.…”

Section: Geriatric Syndromes and Comorbiditiesmentioning

confidence: 99%

Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Brunker

Boncyk

Rengel

et al. 2023

CIA

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There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.

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“…Multimorbidity, the coexistence of two or more chronic conditions, is a recognized geriatric syndrome that is heterogenous in phenotype and outcome [32]. In 2008, 62% of older adults had multimorbidity [33], and the prevalence of multimorbidity among older ICU patients continues to rise [12 ▪▪ ].…”

Section: Multimorbidity and Polypharmacymentioning

confidence: 99%

Long-term recovery after critical illness in older adults

Kaushik¹,

Ferrante

2022

Current Opinion in Critical Care

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Purpose of reviewThe population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge. Recent findingsA recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact of social factors in long-term outcomes after critical illness; for example, social isolation was recently shown to be associated with disability and mortality among older adults in the year after critical illness. Socioeconomic disadvantage is associated with higher rates of dementia and disability following critical illness impacting recovery, and further studies are necessary to better understand factors influencing this disparity. The COVID-19 pandemic disproportionately impacted older adults, resulting in worse outcomes and increased rates of functional decline and social isolation. In considering how to best facilitate recovery for older ICU survivors, transitional care programs may address the unique needs of older adults and help them adapt to new disability if recovery has not been achieved. SummaryRecent work demonstrates increasing trends of geriatric syndromes in the ICU, all of which are known to confer increased vulnerability among critically ill older adults and decrease the likelihood of post-ICU recovery. Risk factors are now known to extend beyond geriatric syndromes and include social risk factors and structural inequity. Strategies to improve post-ICU recovery must be viewed with a lens across the continuum of care, with post-ICU recovery programs targeted to the unique needs of older adults.

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The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

Cited by 18 publications

References 45 publications

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Long-term recovery after critical illness in older adults

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