The Predictive Value of the “Identification of Seniors at Risk” Score on Mortality, Length of Stay, Mobility and the Destination of Discharge of Geriatric Hip Fracture Patients

Hyponatremia and Identification of Seniors at Risk (ISAR) Score in Geriatric Patients: An Analytical Cross-Sectional Study

Aim and objective Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Age is an important, strong independent factor for hyponatremia. Geriatric at-risk groups are identified with six straightforward dichotomous questions. The research aims to determine the incidence of hyponatremia and correlate the identification of seniors at risk (ISAR) score with electrolytes in elderly individuals.  Materials and methods The 334 geriatric population of elderly men and women were recruited based on age cut-off as more than 70 to 75, 76 to 80, and more than 80. Patients were categorized based on serum sodium levels as severe hyponatremia group A (< 125 mEq/L), moderate hyponatremia B (126 to 130 mEq/L), mild hyponatremia C (131 to 135 mEq/L) and normonatremia D (136 to 145 mEq/L). At the time of admission, the ISAR Tool was utilized to identify the participants with hyponatremia at risk. Electrolytes sodium, potassium, and chloride were analyzed in the Beckman Coulter AU480 autoanalyzer by indirect ISE method. The mean of the data was compared with ANOVA, and the ISAR risk score was correlated with electrolytes by Pearson correlation analysis; p < 0.5 is considered significant.  Results and discussion About 16.76 % (56 patients) had severe hyponatremia (Serum sodium 119.14± 4.14 mEq/L) with a high ISAR score (6.0) and were reported as critical alert results by the central laboratory. Based on age-wise category, 70 to 75 yrs had serum sodium levels of 133.82 mEq/L, 76 to 80 yrs had 128.4 mEq/L, and more than 80 years had serum hyponatremia 119.17 mEq/L. Geriatrics with normonatremia had a 1.22 ISAR score, whereas geriatrics with severe hyponatremia had a 6.0 ISAR score. Correlation analysis of the ISAR score revealed a statistically significant negative correlation with sodium (r = - 0.53), potassium (r = - 0.34), and chloride (r = - 0.30) levels. Likewise, the length of hospital stay of the geriatrics with severe hyponatremia was prolonged (19 days), which contributed to the deterioration of health status; thereby, better healthcare follow-up is encouraged.  Conclusion Hyponatremia is a critical alert analyte that is common in hospitalized geriatric patients. The ISAR score system points towards the individuals who are at risk and need immediate correction. Thereby, correction of sodium levels and close monitoring of the elderly patient enables quick recovery, and the consequences of hyponatremia are circumvented.

Anesthesia and perioperative pain relief in the frail elderly patient

Demand for anesthesia and analgesia for the frail elderly is continuously increasing as the likelihood of encountering very elderly, very vulnerable, and very compromised patients has, ever so subtly, increased over the last three decades. The anesthesiologist has, increasingly, been obliged to offer professional services to frail patients. Fortunately, there has been a dramatic improvement in medications, methods of drug delivery, critical monitoring, and anesthesia techniques. Specific methodologies peculiar to the frail are now taught and practiced across all anesthesia subspecialties. However, administering anesthesia for the frail elderly is vastly different to giving an anesthetic to the older patient. Frail patients are increasingly cared for in specialized units-geriatric intensive therapy units, post-acute care services, palliative, hospices, and supportive care and aged care facilities. Several medications (e.g., morphine-sparing analgesics) more suited to the frail have become universally available in most centers worldwide so that best-practice, evidence-based anesthesia combinations of drugs and techniques are now increasingly employed. Every anesthetic and pain management techniques in the frail elderly patient are going to be discussed in this review.

Identification of Seniors at Risk Score to Determine Geriatric Evaluations on Trauma Patients With Hip Fractures

BACKGROUND

Trauma centers are confronted with rising numbers of geriatric trauma patients at high risk for adverse outcomes. Geriatric screening is advocated but not standardized within trauma centers.

OBJECTIVE

This study aims to describe the impact of Identification of Seniors at Risk (ISAR) screening on patient outcomes and geriatric evaluations.

METHODS

This study used a pre-/postdesign to assess the impact of ISAR screening on patient outcomes and geriatric evaluations in trauma patients 60 years and older, comparing the periods before (2014-2016) and after (2017-2019) screening implementation.

RESULTS

Charts for 1,142 patients were reviewed. Comparing pre- to post-ISAR groups, the post-ISAR group with geriatric evaluations were older (M = 82.06, SD = 9.51 vs. M = 83.64, SD = 8.69; p = .026) with higher Injury Severity Scores (M = 9.22, SD = 0.69 vs. M = 9.38, SD = 0.92; p = .001). There was no significant difference in length of stay, intensive care unit length of stay, readmission rate, hospice consults, or inhospital mortality. Inhospital mortality (n = 8/380, 2.11% vs. n = 4/434, 0.92%) and length of stay in hours (M = 136.49, SD = 67.09 vs. M = 132.53, SD = 69.06) down-trended in the postgroup with geriatric evaluation.

CONCLUSION

Resources and care coordination efforts can be directed toward specific geriatric screening scores to achieve optimal outcomes. Varying results were found related to outcomes of geriatric evaluations prompting future research.