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Acute Care and Medication Management in Older Adults
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Acute Care and Medication Management in Older Adults

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 20778

Special Issue Editors

Prof. Dr. Patrick Manckoundia

E-Mail Website
Guest Editor
1. Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21000 Dijon, France
2. UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy and Franche Comté, 21000 Dijon, France
3. INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, 21000 Dijon, France
Interests: older adults; falls; gait; balance; drugs in older adults; post-fall syndrome; acute care in older adults; anticoagulant drugs; cognitive disorders
Special Issues, Collections and Topics in MDPI journals
Dr. Alain Putot

E-Mail Website
Guest Editor
1. Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
2. Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, Dijon, France
Interests: older adults; infectious diseases in older adults; pneumonia; urinary tract infection; type 2 myocardial infarction; myocardial injury; myocardial infarction in older adults; acute care in older adults

Special Issue Information

Dear Colleagues,

The number of healthy and frail older adults is increasing worldwide, especially in industrialized countries, as a result of the increase in life expectancy. Indeed, medical advances and improvements in hygiene and living conditions have led acute diseases that were once fatal to be less and less so, leading to an increase in the frequency of chronic diseases.

Healthy life expectancy is one of the major public health issues of the moment. Increasing healthy life expectancy requires a good understanding of the specific conditions found in older adults, whether they are frail or not. It is essential to fully understand, among other things, the acute diseases of the elderly and very elderly to provide them with the most suitable treatments. Ensuring appropriate management will help to avoid a number of pitfalls including undertreatment and overtreatment. Despite the specific aspects of older patients in terms of both semiology and therapeutics, still relatively few publications address acute care in this population.

This Special Issue of JCM offers teams with recognized expertise in the care of the elderly the opportunity to publish quality research work on acute care and/or drug management in this population. This Special Issue is open to varied topics in these two fields (acute care in older adults and medication management in older adults). Original articles on age-related atypical presentation, diagnostic tools, and the acute management of common conditions in older patients (including acute infections and acute cardiovascular disorders) are particularly welcome.

In closing, in this issue, we challenge you to provide your best visionary science to help to advance the management of acute diseases in the elderly population.

Prof. Dr. Patrick Manckoundia
Dr. Alain Putot
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • infectious diseases
  • drugs
  • anticoagulants
  • antibiotics
  • pneumonia
  • myocardial infarction
  • falls
  • benzodiazepine drugs
  • inflammatory syndrome
  • heart failure

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Published Papers (7 papers)

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Editorial

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1 pages, 155 KiB  
Editorial
Acute Care and Medication Management in Older Adults
by Patrick Manckoundia and Alain Putot
J. Clin. Med. 2021, 10(2), 166; https://doi.org/10.3390/jcm10020166 - 6 Jan 2021
Viewed by 1428
Abstract
The number of healthy and frail older adults is increasing worldwide, especially in industrialized countries, as a result of the increase in life expectancy [...] Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)

Research

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7 pages, 772 KiB  
Article
Physician-Led Thoracic Trauma Management in a Specialist Emergency Care Centre
by Jonathan Bates-Powell, David Basterfield, Karl Jackson and Avinash Aujayeb
J. Clin. Med. 2021, 10(24), 5806; https://doi.org/10.3390/jcm10245806 - 11 Dec 2021
Cited by 2 | Viewed by 2705
Abstract
Introduction: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide [...] Read more.
Introduction: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide variation in care. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anesthetists for thoracic-trauma management on a respiratory support unit. Methods: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between 20 August–21 April were analyzed. A descriptive statistical methodology was applied. Results: A total of 119 patients were identified with a mean age of 71.1 years (range 23–97). Of the 119 patients, 53 were male, 66 females. The main mechanism of injury was falls from standing (65) and falls down stairs/bed or in the bath (18). Length of stay was 7.3 days (range 1–54). In total, 85 patients had more than one co-morbidity, 26 had a full trauma assessment and 75 had pan CTs. The mean number of rib fractures was 3.6 and 31 (26%) patients had a pneumothorax and/or haemothorax. A total of 18 chest drains were inserted (all small bore) and one needle aspiration was performed. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All patients had a pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. Overall, 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. Furthermore, 20 (17%) developed pneumonias and 16 (14%) deaths occurred within 30 days—all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality. Conclusions: High level care for thoracic trauma can be performed by a physician led team. Overall, 42% pneumothoraces/haemothoraces were observed. Further large scale randomised trials are warranted for definitive outcomes. Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)
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10 pages, 269 KiB  
Article
Assessment of Prescriptions in Elderly Patients Hospitalized in Medicine Departments
by Audrey Giroux, Christelle Prudent, Pierre Jouanny, Géraldine Muller, Hervé Devilliers and Lucie Vadot
J. Clin. Med. 2021, 10(22), 5343; https://doi.org/10.3390/jcm10225343 - 16 Nov 2021
Cited by 1 | Viewed by 1931
Abstract
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were [...] Read more.
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients. Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)
8 pages, 432 KiB  
Article
Risk Factors Associated with 30-Day Mortality in Older Patients with Influenza
by Charles Guesneau, Anne Sophie Boureau, Céline Bourigault, Gilles Berrut, Didier Lepelletier, Laure de Decker and Guillaume Chapelet
J. Clin. Med. 2021, 10(16), 3521; https://doi.org/10.3390/jcm10163521 - 11 Aug 2021
Cited by 1 | Viewed by 1673
Abstract
Background: Influenza is a common viral condition, but factors related to short-term mortality have not been fully studied in older adults. Our objective was to determine whether there is an association between geriatric factors and 30-day mortality. Methods: This was a retrospective cohort [...] Read more.
Background: Influenza is a common viral condition, but factors related to short-term mortality have not been fully studied in older adults. Our objective was to determine whether there is an association between geriatric factors and 30-day mortality. Methods: This was a retrospective cohort design. All patients aged 75 years and over, with a diagnosis of influenza confirmed by a positive RT-PCR, were included. The primary endpoint was death within the 30 days after diagnosis. Results: 114 patients were included; 14 (12.3%) patients died within 30 days. In multivariate analysis these patients were older (OR: 1.37 95% CI (1.05, 1.79), p = 0.021), and had a lower ADL score (OR: 0.36 95% CI (0, 17; 0.75), p = 0.006), and a higher SOFA score (OR: 2.30 95% CI (1.07, 4.94), p = 0.03). Oseltamivir treatment, initiated within the first 48 h, was independently associated with survival (OR: 0.04 95% CI (0.002, 0.78), p = 0.034). Conclusions: Identification of mortality risk factors makes it possible to consider specific secondary prevention measures such as the rapid introduction of antiviral treatment. Combined with primary prevention, these measures could help to limit the mortality associated with influenza in older patients. Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)
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8 pages, 961 KiB  
Article
Chronology of COVID-19 Symptoms in Very Old Patients: Study of a Hospital Outbreak
by Carmelo Lafuente-Lafuente, Quoc Duy Nghiem, Héloïse Keravec, Sihem Oukbir-Ferrag, Maurizio Magri, Bruno Oquendo, Cristiano Donadio, Antonio Rainone and Joël Belmin
J. Clin. Med. 2021, 10(13), 2962; https://doi.org/10.3390/jcm10132962 - 30 Jun 2021
Cited by 2 | Viewed by 2354
Abstract
Background: We wanted to better understand the frequency and temporal distribution of symptoms of COVID-19 in very old patients, which are currently not well defined. Methods: In an observational, descriptive study, we followed all patients being at three geriatric convalescence and rehabilitation units [...] Read more.
Background: We wanted to better understand the frequency and temporal distribution of symptoms of COVID-19 in very old patients, which are currently not well defined. Methods: In an observational, descriptive study, we followed all patients being at three geriatric convalescence and rehabilitation units when a COVID-19 outbreak emerged in those units in March 2020. For those who developed the disease, we recorded any new symptom occurring at diagnosis, in the previous 14 and the following 21 days. A group of SARS-Cov-2-negative patients served as controls. Results: Sixty-nine of the 176 inpatients (mean age: 86 years) were infected by SARS-Cov-2 during the outbreak. At the moment of diagnosis, a majority of patients had fever (71.0%), malaise-asthenia (24.6%), or respiratory symptoms (66.7%). However, 48 patients (69.6% of all SARS-Cov-2 positive patients) also presented, usually several days before, other symptoms: (a) gastrointestinal symptoms (39.1% of all patients, median onset eight days before diagnosis, IQR −9 to +3 days); (b) neurological symptoms (30.4% of all patients, median onset five days before diagnosis, IQR −11 to −3 days), notably delirium (24.6%); and (c) other symptoms, like falls and unexplained decompensation of chronic conditions (29.0% of all patients, median onset four days before diagnosis, IQR −10 to 0). None of those symptoms were observed in similar proportion in 25 control SARS-CoV-2-negative patients, hospitalized during the same period. Conclusions: Diarrhea, nausea-vomiting, delirium, falls, and unexplained decompensation of chronic conditions were the first symptoms of COVID-19 in a majority of older patients in this cohort, preceding typical symptoms by several days. Recognizing those early symptoms could hasten the diagnosis of COVID-19 in this population. Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)
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17 pages, 1270 KiB  
Article
Flexible Modeling of Net Survival and Cure by AML Subtype and Age: A French Population-Based Study from FRANCIM
by Morgane Mounier, Gaëlle Romain, Mary Callanan, Akoua Denise Alla, Olayidé Boussari, Marc Maynadié, Marc Colonna and Valérie Jooste
J. Clin. Med. 2021, 10(8), 1657; https://doi.org/10.3390/jcm10081657 - 13 Apr 2021
Cited by 6 | Viewed by 2336
Abstract
With improvements in acute myeloid leukemia (AML) diagnosis and treatment, more patients are surviving for longer periods. A French population of 9453 AML patients aged ≥15 years diagnosed from 1995 to 2015 was studied to quantify the proportion cured (P), time to cure [...] Read more.
With improvements in acute myeloid leukemia (AML) diagnosis and treatment, more patients are surviving for longer periods. A French population of 9453 AML patients aged ≥15 years diagnosed from 1995 to 2015 was studied to quantify the proportion cured (P), time to cure (TTC) and median survival of patients who are not cured (MedS). Net survival (NS) was estimated using a flexible model adjusted for age and sex in sixteen AML subtypes. When cure assumption was acceptable, the flexible cure model was used to estimate P, TTC and MedS for the uncured patients. The 5-year NS varied from 68% to 9% in men and from 77% to 11% in women in acute promyelocytic leukemia (AML-APL) and in therapy-related AML (t-AML), respectively. Major age-differenced survival was observed for patients with a diagnosis of AML with recurrent cytogenetic abnormalities. A poorer survival in younger patients was found in t-AML and AML with minimal differentiation. An atypical survival profile was found for acute myelomonocytic leukemia and AML without maturation in both sexes and for AML not otherwise specified (only for men) according to age, with a better prognosis for middle-aged compared to younger patients. Sex disparity regarding survival was observed in younger patients with t-AML diagnosed at 25 years of age (+28% at 5 years in men compared to women) and in AML with minimal differentiation (+23% at 5 years in women compared to men). All AML subtypes included an age group for which the assumption of cure was acceptable, although P varied from 90% in younger women with AML-APL to 3% in older men with acute monoblastic and monocytic leukemia. Increased P was associated with shorter TTC. A sizeable proportion of AML patients do not achieve cure, and MedS for these did not exceed 23 months. We identify AML subsets where cure assumption is negative, thus pointing to priority areas for future research efforts. Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)
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Review

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13 pages, 476 KiB  
Review
Tuberculosis in the Elderly
by Pauline Caraux-Paz, Sylvain Diamantis, Benoit de Wazières and Sébastien Gallien
J. Clin. Med. 2021, 10(24), 5888; https://doi.org/10.3390/jcm10245888 - 15 Dec 2021
Cited by 65 | Viewed by 7392
Abstract
The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of [...] Read more.
The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure. Full article
(This article belongs to the Special Issue Acute Care and Medication Management in Older Adults)
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