In a new paper, researchers report that frailty and cognitive impairments may become worse when older patients are treated in cardiac intensive care units – even as they receive excellent care for their heart attack, heart failure, valvular heart disease or other heart problems.
This is from a new scientific statement from the American Heart Association.
In addition to their heart conditions, many older patients often have additional health conditions, take multiple medications for these conditions, maybe frail or have cognitive impairment.
Caring for older adults in the cardiac intensive care unit is markedly different than caring for younger patients, according to the statement.
It provides an overview of how geriatric conditions may influence acute cardiovascular care.
The team says 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 older patients with acute cardiovascular disease.
While in a cardiac intensive care unit, older patients often experience factors that are emotionally and physically disorienting – such as bright lights, excessive noise, new medications, urinary catheters, dietary shifts, sleep disruptions, and toileting challenges.
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 and could lead to delirium.
Delirium is a state of an acute disturbance in awareness and attention. It commonly occurs during critical illness, and it contributes to a higher risk of dying in the hospital.
According to the team, reducing the level of sedation used in older patients may help mitigate delirium, however, more research needs to be done to fully understand how best to treat this condition in the context of acute cardiovascular illness.
Extended bedrest, often necessary in an intensive care unit, is detrimental to patients of all ages.
For older, critically ill patients, who are often frail when admitted to the cardiac intensive care unit, bedrest can significantly worsen their frailty.
Further deterioration in muscle strength and bone density often occurs with prolonged immobility, which can also lead to poor medication tolerance, an increased risk of falling, weakened heart function and pressure ulcers (bed sores).
The team also mentions that early mobilization – getting the patient out of bed as soon as appropriate, may be helpful for some patients to address frailty.
Encouraging appropriate physical movement may result in less weakness, an improved ability to walk and less time in the cardiac intensive care unit, among other benefits.
Another issue faced by older adults admitted to the cardiac intensive care unit is that they take an average of 12 different prescription medications, raising the risk of adverse side effects, drug-to-drug, and drug-to-disease interactions.
Patients may benefit by having some of their medications discontinued or deprescribed, if appropriate.
One author of the study is Abdulla A. Damluji, M.D., M.P.H., chair of the writing group for the statement.
The study is published in Circulation.
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