Geriatric conditions pose added danger for older heart patients in ICU

Dec. 9 (UPI) — Many older people undergoing treatment in hospital cardiac intensive care units have other health problems, take multiple medications for these conditions and may be frail or have cognitive impairment.

The American Heart Association, in a scientific statement published Monday in the journal Circulation, is urging clinicians to “treat the whole patient” when providing care to these patients.

The statement offers guidance on the management of common geriatric conditions such as frailty and cognitive impairment in patients undergoing treatment for a variety of heart conditions, including heart attack, heart failure and pulmonary embolism.

It notes that many other health problems plaguing older people may inadvertently worsen while in the cardiac ICU.

“Treating the whole patient — considering their entire health profile, rather than focusing only on their acute cardiovascular event — is essential for achieving the best possible outcomes among geriatric patients with acute cardiovascular disease,” Abdulla A. Damluji, chair of the writing group for the statement and interventional cardiologist at the Inova Heart and Vascular Institute, Falls Church, Va., said in an AHA press release. “Strategies to achieve a wholistic care approach for each patient remains an important goal.”

The statement emphasizes that caring for older adults in cardiac ICUs is “markedly different” than caring for younger patients.

Older adults admitted to the cardiac ICU take an average of 12 prescription medications, per AHA data, raising the risk of side effects and drug interactions when they are in the hospital. These patients, the statement advises, may benefit by having some of their medications discontinued while in the ICU, if possible.

Older patients may also experience emotionally and physically disorienting scenarios while in ICU — bright lights, excessive noise, new medications, dietary changes, sleep disruptions — that may exacerbate pre-existing problems, such as dementia.

“For vulnerable older adults who may already be experiencing cognitive decline, the environment in the cardiac intensive care unit may deplete already limited coping skills,” Damluji said.

The ICU may induce delirium, a state of acute confusion. Delirium is common in older hospitalized people receiving treatment for a critical illness, and it may increase risk for death.

“Reducing the level of sedation used in older patients may help mitigate delirium,” Damluji noted.

Extended bedrest, while necessary in some cases, can also be detrimental to patients of all ages. For older, critically ill people, who are often frail, it can significantly worsen weakness and mobility issues.

According to AHA, further deterioration in muscle strength and bone density often occurs after prolonged bedrest, which can also increase risk for falling when people are ready to move around.

Encouraging appropriate physical movement may result in less weakness, an improved ability to walk and less time in the cardiac ICU, the organization said.

Damluji said there has been an emphasis in recent years to integrate geriatric conditions into standard care but “implementation is slow.”

“Strategies to achieve a wholistic care approach for each patient remains an important goal to improve care of older patients in the cardiac intensive care unit,” he said.


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