Who is High Risk Elderly Patient?

Abstract

A 77-year-old male patient was brought to emergency services because he had fallen. It was learned from his history that he had been examined by cardiologists and orthopedists many times, and he had consulted a neurologist for gait difficulty approximately one month earlier. He had also fallen four times in the preceding month. He had comorbidities of coronary artery disease, type 2 diabetes mellitus, and lumbar disc herniation. He had undergone total right hip prosthesis replacement 3 years earlier. He was retired and lived with his wife. He had been having difficulty performing his activities of daily living due to gait difficulty for 6 months. The patient and his wife stated that he took 16 different medications. His physical examination revealed his arterial blood pressure while standing to be 86/62 mmHg, and his other vitals were normal. The movements of his right shoulder were restricted after he had fallen. Serious pain and restricted movement (probable effusion), accompanied by mild warmth and tenderness in the left knee, restricted left hip movements, and mild weakness in the left leg were detected. Apart from these, there were no other important findings. Detailed geriatric assessment revealed multiple factors that could lead to falls. These factors were evaluated to be postural hypotension, polypharmacy, degenerative joint disease in the left hip and knee, and spinal stenosis-induced neuropathy. Sample Case 2A 92-year-old female patient was brought to the hospital by her family because she had lost her appetite for 3 days. She had comorbidities of hypertension, congestive heart failure, urinary incontinence (overactive bladder), and depression. She used a walker. It was learned from her history that she had fallen because she had stepped on her urine in the restroom, broke her hip, and become dependent while walking. As a result of examination and analyses, she was hospitalized after having been diagnosed with malnutrition, dehydration, and a urinary tract infection. Because improvement was observed after treatment, the patient was discharged from the hospital on the fifth day of hospitalization. However, she was readmitted due to recurring urinary tract infection one week after being discharged. IntroductionAs in developed and developing countries, the proportion of the elderly population is increasing in Turkey, which is in a period of demographic change. According to the 2015 Who is High Risk Elderly Patient?The acute and post-acute care of the elderly is a process fraught with problems. Elderly patients at high risk are individuals who have to be admitted more frequently to a hospital due to developed complications, who are faced with a constant risk of hospitalization, and who have increased risks of functional decline, nursing home admittance, and death. These adverse outcomes cause discrepancies and problems in the implementation and regulation of treatment and coordination between health entities. Factors increasing these risks vary among these individuals, but existing chronic diseases and ge...