Optimising glycaemic control to prevent diabetes-associated complications has received much attention. The associated risk of iatrogenic hypoglycaemia, however, is inevitable and can have a significant impact on health. The prevalence of iatrogenic hypoglycaemia tends to increase with advancing age. Elderly people are intrinsically prone to hypoglycaemia. Ageing attenuates the glucose counter-regulatory and symptomatic response to hypoglycaemia, particularly in the presence of a longer duration of diabetes. Multiple co-morbidities and polypharmacy correlated with advancing age also increase the hypoglycaemic risk. In addition to the acute adverse effects of hypoglycaemia, such as fall with injury, cardiovascular events and mortality, a hypoglycaemic episode can have long-term consequences. Repeated episodes may have a significant psychological impact and are also a risk factor for dementia. Because of the heterogeneous health status of the elderly, not all will benefit from optimal glycaemic control. Setting an individual glycaemic target and formulating a management plan that takes account of the patient's circumstances combined with balancing the benefit and risk of diabetes intervention to avoid hypoglycaemia is a more practical approach to the management of elderly diabetic patients.
A B S T R A C TFollowing a survey on the clinical practice of geriatricians in the management of older people with diabetes and a study of hypoglycaemia in diabetic patients, a round-table discussion with geriatricians and endocrinologists was held in January 2015. Consensus was reached for six domains specifically related to older diabetic people: (1) the considerations when setting an individualised diabetic management; (2) inclusion of geriatric syndrome screening in assessment; (3) glycaemic and blood pressure targets; (4) pharmacotherapy; (5) restrictive diabetic diet; and (6) management goals for nursing home residents.
options such as low-intensity warfarin and aspirin plus clopidogrel have been suggested but are inferior to dose-adjusted warfarin. Novel oral anticoagulants with promising efficacy and convenience hold great appeal. Optimal management of underlying medical conditions and modifiable stroke risk factors, together with intervention to improve the safe use of oral anticoagulants, are useful.
Background. During the fifth wave of the COVID-19 pandemic in Hong Kong, a geriatric team was established to provide interdisciplinary intervention and discharge planning for older patients in a community treatment facility (CTF) at the AsiaWorld-Expo. This study examined clinical outcomes among these older patients and identified key determinants of these outcomes.Methods. Medical records of patients aged ≥60 years who were admitted to the CTF for management of COVID-19 by a geriatric team between 24 March 2022 and 4 May 2022 were retrospectively reviewed. Baseline characteristics, geriatric syndrome statuses, laboratory results, treatments, and clinical outcomes were collected. Risk factors for transfer to an acute care hospital, 28-day mortality, and 28-day readmission were examined.Results. Among 257 patients admitted to the CTF, 29.6% had geriatric syndromes; poor oral feeding was most common. The proportion of patients with frailty increased by 14.4% upon discharge. The 28-day mortality rate was 12.5%; risk factors were dexamethasone use and transfer to an acute care hospital. The 28-day readmission rate was 33.9%; risk factors were higher Charlson Comorbidity Index, dementia, and moderate to severe hyponatraemia.Conclusions. Geriatric syndromes (particularly poor oral feeding) were common in older patients with COVID-19 who were associated with significant post-hospitalisation mortality, readmission, and worsened frailty with functional decline. These findings highlight the importance of a geriatric care model in the management of older patients with COVID-19.
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