Frailty and cognitive decline may cause geriatric patients to fare worse in a traditional cardiac ICU than expected, according to a Dec. 9 scientific statement from the American Heart Association.
The statement, penned by writing chair Abdulla A. Damluji, MD, MPH, and colleagues, explored multiple facets of the ICU that could adversely affect geriatric patients, many of whom present with multiple comorbidities, are cognitively impaired and are subject to polypharmacy. Damluji et al. said caring for older people in the cardiac ICU is very different than caring for your average adult.
“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 diseases,” Damluji, an interventional cardiologist at the Inova Heart and Vascular Institute in Virginia, said in a release. “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 common during critical illness, he said, and can increase a person’s risk of dying in the hospital. He said reducing the level of sedation used in older patients might reduce their odds of delirium, but those patients are exposed to so much emotional and physical disorientation—bright lights, loud noises, catheters, dietary changes, sleep disruptions and new medications, to name a few—that more likely needs to be done.
The authors of the AHA statement also pointed out that extended bedrest, which is detrimental to patients of any age, could especially harm those who are critically ill and frail. Bedrest is often necessary in the ICU, but in people whose muscle and bone strength is already deteriorating, prolonged immobility could contribute to an increased risk of falling, worse heart function and pressure ulcers.
The team suggested early mobilization to combat frailty, and also suggested discontinuing or deprescribing medications in older patients when possible. Geriatric patients admitted to the cardiac ICU take an average of 12 different prescription drugs, hiking their risk of adverse side effects and medication interactions.
“In recent years, there has been a strong emphasis by the American Heart Association and other organizations to integrate geriatric syndromes into cardiovascular care for older patients, although implementation is slow,” Damluji said. “Strategies to achieve a holistic care approach for each patient remains an important goal to improve care of older patients in the cardiac intensive care unit.”
Find the full scientific statement online here.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.