Understanding Local Consultation Patterns of Inpatient Geriatric Medicine Teams: a Cross-Sectional Study

Background

Geriatric consultation for Comprehensive Geriatric Assessment (CGA) improves outcomes of older adults living with frailty who are hospitalized, but consultation patterns and utilization of inpatient geriatric consultation teams by other hospital-based services are poorly understood.

Methods

We conducted a cross-sectional study using linked health administrative data to describe characteristics of older adults (≥ 65 years) who received a CGA while hospitalized between January 1, and December 31, 2019. We identified hospital-based services requesting CGA and the frequency and reasons for referral. We used multivariable logistic regression to estimate the association between patient-level characteristics and receiving a CGA.

Results

A total of 29,090 older adults were admitted to hospital; 38.7% were classified as frail and 5.4% (1,563 patients) received at least one CGA. The top three reasons for requesting a CGA were to assess the need for care on an inpatient geriatric rehabilitation unit (43%), and for assessment and management of delirium (27%) and dementia (24%). Referrals were most frequently received from Hospitalists (48%). Frailty was associated with increased odds of receiving a CGA (adjusted odds ratio [aOR] 12.02; 95% confidence interval [CI] 9.67-14.82). A diagnosis of cancer was associated with lower odds of receiving a CGA (aOR 0.75; 95% CI 0.60-0.93).

Conclusions

Inpatient geriatric consultation teams support 5.4% of hospitalized older adults. With the rapidly growing aging population, future efforts are needed to explore the optimal delivery of inpatient geriatric services to support its sustainable provision.

Evaluation of Neurosurgery Consultations in Hospitalized Geriatric Patients During and After the COVID-19 Pandemic

Background and Objectives: This study aims to evaluate neurosurgery consultations for elderly patients during and following the COVID-19 pandemic. Materials and Methods: This study included patients aged 65 and older who were hospitalized in non-neurosurgery departments at Istinye University Gaziosmanpasa Medical Park Hospital and were referred for neurosurgery consultations between 1 April 2020 and 31 May 2024. Patients in the intensive care unit and emergency department were excluded. The period from 1 April 2020 to 30 April 2022 was defined as the pandemic period, and from 1 May 2022 to 31 May 2024 as the post-pandemic period. Results: A total of 123 patients were included in this study, with 57 from the pandemic period and 66 from the post-pandemic period. The average age during the pandemic period was 73.45 years (range: 65-93), compared to 71.09 years (range: 65-94) in the post-pandemic period. During the pandemic, 26.3% of patients were recommended for physical therapy and rehabilitation, 24.6% were advised to undergo surgery, 19.3% received neurology consultations, and 17.5% received medical treatment. In the post-pandemic period, 37.9% were recommended for surgery, 16.7% for neurology, 13.6% for physical therapy and rehabilitation, and 7.6% for medical treatment. Overall, 56.4% of patients accepted surgery. Conclusions: Despite the high prevalence of comorbidities in geriatric patients, appropriate neurosurgical referrals significantly improve treatment success, enhance quality of life and mobility, and reduce mortality. We therefore recommend earlier and more attentive referrals to neurosurgery for elderly patients with relevant symptoms to facilitate timely and effective interventions.