The edition · Geriatrics
Dementia is not a reason to withhold the cath lab
Among 117,318 Medicare beneficiaries catheterised for STEMI, community-dwelling patients with dementia spent 225 days at home in the following year against 299 without — and more than half spent over 300. Plus three questions that predict mortality, what EMS gives older people for agitation, and frailty screening from two mornings of wear.
The edition in brief
Today's geriatrics edition opens with a national Medicare analysis of 117,318 beneficiaries aged 65 and over who presented with ST-elevation myocardial infarction between 2017 and 2022 and underwent cardiac catheterisation. Of these, 7,348 (6.3%) had Alzheimer's disease or a related dementia and 2,617 (2.2%) came from a nursing home. Among community-dwelling patients, dementia was associated with 37.8 fewer adjusted days alive at home over the following year (225.1 versus 299.4; 95% CI -41.1 to -34.5) — but more than half still spent over 300 days at home. Among those admitted from a nursing home the difference was 71.9 days and one-year survival was 42.4%. A cohort of 52,789 adults aged 65 and over in Okayama City found that a three-item self-reported oral function score predicted all-cause mortality: adjusted hazard ratios of 1.09, 1.26 and 1.49 for scores of one, two and three. Chewing difficulty (aHR 1.19) and dysphagia (aHR 1.18) were independently associated; xerostomia was not (aHR 1.02, 95% CI 0.98-1.06). A nationwide cross-section of 1,468,697 EMS encounters for behavioural health emergencies found older adults more likely to be chemically sedated than younger adults (69.2% versus 61.3%) and more often with a benzodiazepine (52.8% versus 45.3%). And accelerometry over 72 hours predicted five-year mortality and frailty progression from morning activity alone.
After STEMI, most community-dwelling patients with dementia went home and stayed there
Do not let a dementia diagnosis alone steer a STEMI patient away from catheterisation — use living situation and goals instead.
Older adults in crisis were more likely to get a benzodiazepine than anything else
Ask specifically what sedation was given before arrival in an agitated older patient, and treat prehospital benzodiazepine exposure as a modifiable system problem.
Two or three mornings of accelerometry were enough to predict five-year risk
Watch the shortened-protocol accelerometry work as a plausible route to feasible frailty screening, but do not act on device data yet.
Two questions about eating belong in every older adult's review
Add two questions — chewing difficulty and choking — to the routine review of every patient over 65.
Three self-reported symptoms graded mortality risk across 52,789 older adults
Put chewing difficulty and swallowing difficulty into the routine review of older adults as a two-question mortality risk marker.
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