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Lee SI, Huh JW, Hong SB, Koh Y, Lim CM. Age Distribution and Clinical Results of Critically Ill Patients above 65-Year-Old in an Aging Society: A Retrospective Cohort Study. Tuberc Respir Dis (Seoul) 2024; 87:338-348. [PMID: 38419573 PMCID: PMC11222105 DOI: 10.4046/trd.2023.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Increasing age has been observed among patients admitted to the intensive care unit (ICU). Age traditionally considered a risk factor for ICU mortality. We investigated how the epidemiology and clinical outcomes of older ICU patients have changed over a decade. METHODS We analyzed patients admitted to the ICU at a university hospital in Seoul, South Korea. We defined patients aged 65 and older as older patients. Changes in age groups and mortality risk factors over the study period were analyzed. RESULTS A total of 32,322 patients were enrolled who aged ≥65 years admitted to the ICUs between January 1, 2007, and December 31, 2017. Patients aged ≥65 years accounted for 35% and of these, the older (O, 65 to 74 years) comprised 19,630 (66.5%), very older (VO, 75 to 84 years) group 8,573 (29.1%), and very very older (VVO, ≥85 years) group 1,300 (4.4%). The mean age of ICU patients over the study period increased (71.9±5.6 years in 2007 vs. 73.2±6.1 years in 2017) and the proportions of the VO and VVO group both increased. Over the period, the proportion of female increased (37.9% in 2007 vs. 43.3% in 2017), and increased ICU admissions for medical reasons (39.7% in 2007 vs. 40.2% in 2017). In-hospital mortality declined across all older age groups, from 10.3% in 2007 to 7.6% in 2017. Hospital length of stay (LOS) decreased in all groups, but ICU LOS decreased only in the O and VO groups. CONCLUSION The study indicates a changing demographic in ICUs with an increase in older patients, and suggests a need for customized ICU treatment strategies and resources.
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Affiliation(s)
- Song I Lee
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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2
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Verghese J, Chalmer R, Stimmel M, Weiss E, Zwerling J, Malik R, Rasekh D, Ansari A, Corriveau RA, Ehrlich AR, Wang C, Ayers E. Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial. Nat Med 2024:10.1038/s41591-024-03012-8. [PMID: 38834847 DOI: 10.1038/s41591-024-03012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/22/2024] [Indexed: 06/06/2024]
Abstract
Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care.ClinicalTrials.gov: NCT03816644 .
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Affiliation(s)
- Joe Verghese
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Rachel Chalmer
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marnina Stimmel
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erica Weiss
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Zwerling
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rubina Malik
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Rasekh
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Asif Ansari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Roderick A Corriveau
- Department of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MA, USA
| | - Amy R Ehrlich
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cuiling Wang
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MA, USA
| | - Emmeline Ayers
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Halloran EC. Adult Development and Associated Health Risks. J Patient Cent Res Rev 2024; 11:63-67. [PMID: 38596352 PMCID: PMC11000702 DOI: 10.17294/2330-0698.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care. Knowing the prominent issues, stressors, and risks at each stage of development is important in understanding patients. This knowledge can help customize medical advice to patients regarding obesity, disability, sleep, substance use, relationships, and age-related declines. This paper summarizes an updated view of adult development and discusses its relevance to health risks and patient-centered care practices at different stages.
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Affiliation(s)
- Elizabeth C Halloran
- Family Medicine Residency Program, Bon Secours Mercy Health - St. Vincent Medical Center, Toledo, OH
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Geijerstam PA, Harris K, Johansson MM, Chalmers J, Nägga K, Rådholm K. Orthostatic Hypotension and Cognitive Function in Individuals 85 Years of Age: A Longitudinal Cohort Study in Sweden. Aging Dis 2024:AD.2024.0205. [PMID: 38421828 DOI: 10.14336/ad.2024.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Orthostatic hypotension (OH) is more common in the elderly and associated with increased mortality. However, its implications for 85-year-olds are not known. In the prospective observational cohort study Elderly in Linköping Screening Assessment (ELSA 85), 496 individuals in Linköping, Sweden, were followed from age 85 years with cognitive assessments. Blood pressure (BP) was measured supine and after 1, 3, 5, and 10 minutes of standing. Participants with a BP fall of ≥20 mmHg systolic or ≥10 mmHg diastolic after 1 or 3 minutes were classified as classical continuous or classical transient OH depending on whether the BP fall was sustained or not, at subsequent measurements. Those with a BP fall of the same magnitude, but only after 5 or 10 minutes were classified as delayed OH. Of participants, 329 took part in BP measurements and were included. Of these, 156 (47.4%) had classical OH (113 [34.3%] continuous classical, 38 [11.6%] transient classical), and 15 (4.6%) had delayed OH. Cognitive assessments were not markedly different between groups. After 8.6 years, 195 (59.3%) of the participants had died, and delayed vs no OH was associated with twice the risk of all-cause mortality, HR 2.15 (95% CI 1.12-4.12). Transient classical OH was associated with reduced mortality, HR 0.58 (95% CI 0.33-0.99), but not after multiple adjustments, and continuous classical OH was not associated with mortality. OH may have different implications for morbidity and mortality in 85-year-olds compared with younger populations.
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Affiliation(s)
- Peder Af Geijerstam
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Maria M Johansson
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katarina Nägga
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Coelho-Junior HJ, Marzetti E, Picca A, Tosato M, Calvani R, Landi F. Sex- and age-specific normative values of lower extremity muscle power in Italian community-dwellers. J Cachexia Sarcopenia Muscle 2024; 15:45-54. [PMID: 37986667 PMCID: PMC10834342 DOI: 10.1002/jcsm.13301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/12/2023] [Accepted: 07/11/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Muscle power is associated with health-related parameters. Simple equations were validated to estimate lower extremity muscle power measures based on the time to complete the five-repetition sit-to-stand test. The present study was conducted to provide lower extremity muscle power estimates and produce centile values in a large and relatively unselected population across a wide age spectrum. METHODS Data were from the Longevity Check-up 7+ (Lookup 7+) project, an ongoing initiative conducted in unconventional settings (e.g., exhibitions, shopping centres and health promotion campaigns) across Italy to foster adoption of healthy lifestyles. Absolute, relative, allometric and specific muscle power measures of the lower extremities were estimated using validated formulas. Cross-sectional centile and normative values for muscle power measures from 18 to 81+ years were produced for the two sexes. Smoothed normative curves for men and women were constructed using the lambda-mu-sigma method. RESULTS From 1 June 2015 to 31 October 2021, 13 515 participants were enrolled of whom 12 864 were eligible for the present study. Mean age was 55.9 years (standard deviation: 14.8 years; range: 18-98 years), and 7217 (56.%) were women. Absolute, relative, allometric and specific muscle power declined significantly with age. Specific patterns of decline were observed according to sex and muscle power parameter. Absolute muscle power peaked at 41-50 and 31-40 years in men and women, respectively. Afterwards, a decline rate of approximately 12% per decade was observed, regardless of sex. Relative muscle power showed the largest reduction with age, such that it was 40.6% and 46.4% smaller in men and women older than 80, respectively, compared with those aged 18-30 years. Age-related changes in allometric and specific muscle power measures were similar between men and women. CONCLUSIONS Data from the Lookup 7+ project indicate that lower extremity muscle power estimated using simple equations is significantly associated with age. Sex-specific patterns of decline in absolute and relative muscle power were observed with age. Allometric and specific muscle power declined at a similar rate in men and women.
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Affiliation(s)
| | - Emanuele Marzetti
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Matteo Tosato
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
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Ciucurel C, Tudor MI, Ciucurel MM, Boca IC, Iconaru EI. Comparative Analysis of Social Networks in Institutionalized Older Adults versus Aging-in-Place Scenarios. Geriatrics (Basel) 2024; 9:18. [PMID: 38392105 PMCID: PMC10887761 DOI: 10.3390/geriatrics9010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: This research aims to compare social networks among institutionalized and aging-in-place (AIP) older adults through the validation of a new questionnaire. (2) Methods: The cross-sectional study included 100 older adults (mean age: 73.53 ± 5.49 years; age range: 65-85 years), with 48 institutionalized subjects and 52 AIP subjects. We developed, validated, and administered a new questionnaire, the Social Network Assessment for Older People Questionnaire (SNAOPQ), to assess older adults' social networks using descriptive and inferential statistical methods. (3) Results: The SNAOPQ demonstrated excellent internal consistency (Cronbach's alpha of 0.91 and McDonald's omega of 0.91). Statistical analysis revealed significant associations between variables, highlighting differences in social networks between institutionalized and AIP individuals (p ≤ 0.001). Sociodemographic factors like age, education, living arrangement status, and number of descendants significantly influenced SNAOPQ scores (p ≤ 0.001). Age and residence type notably impacted participants' scores, indicating reduced social network size with age. Tertiary education and living in a couple were associated with more extensive social networks, while a higher number of descendants correlated with social network expansion. (4) Conclusions: Our study highlights significant differences in social networks among older adults based on residence type, emphasizing the impact of sociodemographic factors such as age, education, living arrangement, and the number of descendants.
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Affiliation(s)
- Constantin Ciucurel
- Department of Medical Assistance and Physical Therapy, University Center of Pitesti, National University for Science and Technology Politehnica Bucuresti, 110040 Pitesti, Romania
| | - Mariana Ionela Tudor
- Department of Medical Assistance and Physical Therapy, University Center of Pitesti, National University for Science and Technology Politehnica Bucuresti, 110040 Pitesti, Romania
| | - Manuela Mihaela Ciucurel
- Department of Psychology, Communication Sciences and Social Assistance, University Center of Pitesti, National University for Science and Technology Politehnica Bucuresti, 110040 Pitesti, Romania
| | - Ioan-Cosmin Boca
- Department of Physical Education, Sport and Physical Therapy, University of Oradea, 410087 Oradea, Romania
| | - Elena Ioana Iconaru
- Department of Medical Assistance and Physical Therapy, University Center of Pitesti, National University for Science and Technology Politehnica Bucuresti, 110040 Pitesti, Romania
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7
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Bally ELS, Ye L, van Grieken A, Tan SS, Mattace-Raso F, Procaccini E, Alhambra-Borrás T, Raat H. Factors associated with falls among hospitalized and community-dwelling older adults: the APPCARE study. Front Public Health 2023; 11:1180914. [PMID: 37457268 PMCID: PMC10344358 DOI: 10.3389/fpubh.2023.1180914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Background Falls are a leading cause of disability. Previous studies have identified various risk factors for falls. However, contemporary novel research is needed to explore these and other factors associated with falls among a diverse older adult population. This study aims to identify the factors associated with falls among hospitalized and community-dwelling older adults. Methods Cross-sectional data from the 'Appropriate care paths for frail elderly people: a comprehensive model' (APPCARE) study were analyzed. The study sample consisted of hospitalized and community-dwelling older adults. Falling was assessed by asking whether the participant had fallen within the last 12 months. Multivariable logistic regression models were used to evaluate associations between socio-demographic characteristics, potential fall risk factors and falls. Results The sample included 113 hospitalized (mean age = 84.2 years; 58% female) and 777 community-dwelling (mean age = 77.8 years; 49% female) older adults. Among hospitalized older adults, loneliness was associated with an increased risk of falls. Associations between female sex, secondary education lever or lower, multimorbidity, a higher score on limitations with activities of daily living (ADL), high risk of malnutrition and falling were found among community-dwelling participants. Conclusion The results of this study confirm the multi-factorial nature of falling and the complex interaction of risk factors. Future fall prevention programs could be tailored to the needs of vulnerable subpopulations at high risk for falls.
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Affiliation(s)
- Esmée L. S. Bally
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Lizhen Ye
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Siok Swan Tan
- Research Group City Dynamics, InHolland University of Applied Sciences, Rotterdam, Netherlands
| | - Francesco Mattace-Raso
- Division of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Elena Procaccini
- Funded Project Office, Local Health Authority n.2 Treviso, Treviso, Italy
| | | | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
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8
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Bennink C, Westgeest H, Schoonen D, Boersen F, Sonneveld P, Hazelzet J, Blommestein H, van der Klift M. High Hospital-related Costs at the End-of-life in Patients With Multiple Myeloma: A Single-center Study. Hemasphere 2023; 7:e913. [PMID: 37304934 PMCID: PMC10256370 DOI: 10.1097/hs9.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Christine Bennink
- Department of Oncology and Hematology Breda, Amphia Hospital, Breda, The Netherlands
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hans Westgeest
- Department of Oncology and Hematology Breda, Amphia Hospital, Breda, The Netherlands
| | - Daan Schoonen
- Department of Finance and Control/Business Intelligence Centre, Amphia Hospital, Breda, The Netherlands
| | - Femke Boersen
- Department of Finance and Control/Business Intelligence Centre, Amphia Hospital, Breda, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hedwig Blommestein
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Escourrou E, Joyeux T, Guilhem M, Oustric S, Gardette V. How general practitioners perceive the aging trajectory of oldest-old - A qualitative study. BMC PRIMARY CARE 2023; 24:5. [PMID: 36624382 PMCID: PMC9829226 DOI: 10.1186/s12875-023-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND A new population of older people is growing: the oldest-old. The care of the oldest-old (individuals aged 90 and over) is a new challenge in primary care. This study aimed to analyze the perception of General Practitioners (GP) on (1) the aging process of their patients up to a very advanced age, (2) how to adapt their practice to the care of these patients. METHODS We conducted a qualitative study using focus group (face to face) and individual (video call) interviews of GPs in southwest France. The sampling was purposive. We analyzed the interviews using an inductive approach based on the phases of thematic analysis. We used researchers' triangulation during the process. Collection was concluded when saturation was reached. RESULTS Three focus groups and one individual interview were conducted with a total of seventeen general practitioners. GP perception concerning aging and very advanced age were based on their personal experience and their daily clinical practice. Aging was perceived as an individual, unconscious, unpredictable and irreversible phenomenon. The shift towards "very old age" appeared inevitable. It could be a physical or psychological shift, or patients neglecting themselves or lacking a project. The care of the oldest-old became more specific and individual, adapted to the wishes of the patient. Those adaptations involve medical disengagement to focus on the most essential outcomes. The objectives of health care needed to be less strict with limited invasive practices. Prevention needed to focus mainly on prevention of falls and limitation of functional decline. CONCLUSION GPs identified an inevitable and unpredictable shift from old age to very old age. The adaption of the theory of disengagement allowed us to identify a medical disengagement of the GPs in the care of their oldest patients.
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Affiliation(s)
- Emile Escourrou
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France ,grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Thomas Joyeux
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France
| | - Matthieu Guilhem
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France
| | - Stéphane Oustric
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France ,grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Virginie Gardette
- grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,grid.411175.70000 0001 1457 2980Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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