Associations of blood pressure levels with clinical events in older patients receiving home medical care

Actual conditions for returning home after hospitalization among older patients receiving home medical care in Japan: OHCARE Study

AIM

To examine the actual conditions of older patients receiving home medical care after hospitalization over a period of 2 years in Japan.

METHODS

The study population included 102 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan over a period of 2 years. We investigated the actual conditions for returning home after hospitalization.

RESULTS

The median age of the 102 participants was 84 years, and 61 (59.8%) were women. In the group that returned home, 42 (55.3%) of the respondents desired to recuperate in a familiar place, as in advanced care planning (ACP). During the 2-year follow-up period, the group that did not return home had significantly more deaths. A multivariate analysis showed the association in the presence of ACP (odds ratio: 4.72, 95% confidence interval: 1.60-13.86) and cardiac disease (odds ratio: 0.25, 95% confidence interval: 0.08-0.76). The lack of ACP in the medical records when the patient was admitted to the hospital may have prevented the return home.

CONCLUSION

In older patients who had difficulty returning home after hospitalization, the lack of ACP in home medical care may have been an influencing factor. ACP could help continue with home medical care. Geriatr Gerontol Int 2024; 24: 320-326.

[Seasonal changes in blood pressure and related factors among older patients receiving home medical care]

AIM

We investigated seasonal variations in blood pressure (BP) and factors related to these variations among older patients receiving home medical care.

METHOD

A total 57 patients ≥ 65 years old receiving home medical care who participated in the Osaka Home Care REgistry study (OHCARE), a prospective cohort study, were included. We investigated the seasonal patient characteristics and variations in the BP. In addition, to determine the influence of seasonal variations in the systolic blood pressure (SBP) on the occurrence of clinical events (hospitalization, falls and death), we classified patients into larger- and smaller- change groups based on the median seasonal variations in SBP.

RESULT

About 60% of subjects were very frail or bedridden. The mean BP was higher in winter than in summer (124.7±11/69.5±7 vs.120.5±12/66.9±8 mmHg) (P< 0.01). On comparing the characteristics of the two groups with larger and smaller changes in the SBP, the group with large BP changes had a significantly lower BP in summer than the group with small BP changes. In addition, the incidence of "hospitalization" was significantly higher in the group with large BP changes than in the group with small BP changes (P = 0.03).

CONCLUSION

The present study revealed that there were seasonal changes in the BP in older patients receiving home medical care. It was also suggested that seasonal changes in the BP might be associated with the risk of hospitalization events. Given these BP variations, doctors and visiting nurses should be alert for systemic abnormalities, especially in frail patients receinving home medical care.

Predictive value of attended automated office blood pressure and resting pulse rate for mortality in community-dwelling octogenarians: Minhang study

Systolic blood pressure (SBP) and resting pulse rate (RPR) have been linked to mortality and cardiovascular events in younger population. Till now, no studies simultaneously investigate the non-linear association of SBP and RPR with all-cause and cardiovascular mortality among population aged 80 and older. Data of 2828 eligible participants were selected from electronic health records linked attended automated office blood pressure measurement system. The dose-response relationship between the SBP, RPR, and the risk of all-cause and cardiovascular mortality was analyzed by Cox model with restricted cubic splines. During the 3.6-year follow-up, 442 deaths occurred. Comparing with the optimal SBP (117-145 mmHg), the lower (HR: 1.39, 95% CI: 1.07-1.81) and higher SBP (HR: 1.34, 95% CI: 1.08-1.65) were significantly associated with an increasing risk of all-cause mortality. The higher SBP (>144 mmHg) was associated with cardiovascular mortality, with the HR (95% CI) as 1.51 (1.07-2.12). The faster RPR showed the higher risk of all-cause (HR: 1.36, 95% CI: 1.05-1.76) and cardiovascular (HR: 1.51, 95% CI: 1.07-2.13) mortality. We found both higher SBP and faster RPR were independently associated with all-cause and cardiovascular mortality, and lower SBP was only associated with the increased risk of all-cause mortality in oldest old community-dwelling Chinese population. Our results demonstrate the prognostic importance of both SBP and RPR in the elderly.