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Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ≥65 years, with cancer diagnoses and if the study assessed patients' acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability.

Background To identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery. Methods This prospective study recruited patients aged ≥ 60 years who were scheduled to undergo noncardiac surgery at Siriraj Hospital (Bangkok, Thailand). Functional and cognitive statuses were assessed preoperatively using Barthel Index (BI) and the modified Informant Questionnaire on Cognitive Decline in the Elderly, respectively. POD was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria. Incidence of POD was reported. Univariate and multivariate analyses were used to identify risk factors for POD. Results Of the 249 included patients, 29 (11.6%) developed POD. Most patients (61.3%) developed delirium on postoperative day 1. Univariate analysis showed age ≥ 75 years, BI score ≤ 70, pre-existing dementia, preoperative use of opioid or benzodiazepine, preoperative infection, and hematocrit < 30% to be significantly associated with POD. Multivariate logistic analysis revealed pre-existing dementia (adjusted risk ratio [RR]: 3.95, 95% confidence interval [CI]: 1.91–8.17; p  < 0.001) and age ≥ 75 years (adjusted RR: 2.54, 95% CI: 1.11–5.80; p  = 0.027) to be independent risk factors for POD. Median length of hospital stay was 10 (range: 3–36) days for patients with POD versus 6 (range: 2–76) days for those without delirium ( p <  0.001). Conclusions POD remains a common surgical complication, with an incidence of 11.6%. Patients with pre-existing dementia and age ≥ 75 years are the most vulnerable high-risk group. A multidisciplinary team consisting of anesthesiologists and geriatricians should implement perioperative care to prevent and manage POD.

Background This study compared the perceived social support of young and older adult cancer patients, examining possible influencing factors as well as associations with health-related quality of life. Methods A total of 179 young patients (18–39 years) and 200 older adult patients (> 70 years) with haematological malignancies completed questionnaires on their perceived social support (ISSS-8, scales: Positive Support and Detrimental Interactions, range 0–16) and health-related quality of life (EORTC QLQ-C30). Tests for mean differences, correlations and regression analyses to determine associated variables of social support were performed. Results No difference was reported between young (M = 13.40, SD = 2.81) and older adult patients (M = 13.04, SD = 3.82; p  = .313) for Positive Support. However, young patients (M = 4.16, SD = 3.10) reported having had more Detrimental Interactions than older patients did (M = 1.63, SD = 2.42; p  < .001, Cohen’s d = .910). Comparison of the EORTC QLQ-C30 Function scales showed poorer outcomes for young patients on Emotional, Cognitive and Social Functions and a higher outcome on Physical Function compared with older adult patients. Regression analyses indicated that age (young vs. older adult patients) significantly explained proportions of variance in all models, with young age having a negative impact on Emotional, Cognitive and Social Functions and a positive impact on Physical and Role Functions compared with old age. Significant associations between Detrimental Interactions and all the scales examined except Cognitive Function were found. Conclusions The difference in negative perceptions of social support in young vs. older adult patients and its impact on health-related quality of life emphasises the necessity of differentiating between positive and negative social support. Negative interactions should be addressed through psychosocial care, particularly with young cancer patients.

Carbapenem-resistant (CRKP) infection has recently gained worldwide interest due to limited treatment options and high morbidity and mortality rates. The aim of this study was to determine the risk factors of carbapenem-resistant (CRKP) infection in older adult patients. This retrospective, single-center study included 132 patients with healthcare-associated CRKP infection (case group) and 150 patients with healthcare-associated carbapenem-susceptible (CSKP) infection (control group), aged > 65 years. In the CRKP and CSKP groups, 79 (59.8%) and 80 (53.3%) patients were males, and the mean ages were 77.8 ± 7.8 and 76.6 ± 7.7 years, respectively. Diabetes mellitus (DM), malignancy, cardiovascular diseases (CVDs), surgical intervention, invasive mechanical ventilation, central venous catheter insertion, parenteral nutrition, hospitalization in the previous 6 months, antibiotic use in the previous 3 months, and exposure to cephalosporins, fluoroquinolones, and carbapenems were significantly more common in the CRKP than the CSKP group (all p < 0.05). The multivariate logistic regression analysis identified malignancy, CVDs, DM, invasive mechanical ventilation, hospitalization in the previous 6 months, ICU admission, and exposure to cephalosporins, quinolones, and carbapenems as independent risk factors for CRKP infection in older adult patients. DM, malignancy, CVDs, ICU admission, invasive mechanical ventilation, and exposure to ceftriaxone, fluoroquinolones, and carbapenems were independent risk factors for CRKP infection in older adult patients. The identification of risk factors for CRKP infection can help to prevent and treat CRKP infection.

Background Malnutrition is a common geriatric syndrome and can be targeted preoperatively to decrease the risk of postoperative delirium (POD) in older adult patients. To analyze the value of the prognostic nutritional index (PNI) to predict the incidence of POD in older adult patients with hip fractures. Methods This was a prospective, observational, cohort study of older adult patients with hip fractures. Preoperative PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/μL) using preoperative laboratory results. Patients were divided into POD and non-POD groups using the Confusion Assessment Method (CAM). The risk factors associated with POD as well as the relationship between PNI values and the incidence of POD were analyzed using univariate and multivariate logistic regression analyses. The predictive value of PNI for POD was assessed using receiver operating characteristic curve analysis. Results In this cohort of 369 patients who underwent hip fracture surgery, 67 patients (18.2%) were diagnosed with POD by the CAM results. Low PNI increased the risk of POD (odds ratio (OR) = 0.928, 95% confidence interval (CI): 0.864–0.997). General anesthesia (OR = 2.307, 95% CI: 1.279–4.162) and Mini-Mental State Examination (MMSE) score (OR = 0.956, 95% CI: 0.920–0.994) were also identified as risk factors for POD. Receiver operating characteristic curve analysis suggested that PNI combined with the anesthetic method and MMSE score may be used as a potential predictive indicator of POD after hip fracture surgery. Conclusion Preoperative PNI value is related to POD in older adult patients with hip fractures. Trial registration This secondary analysis study was approved by the Peking University Third Hospital Medical Science Research Ethics Committee (approval No. M2022578) and registered in the Chinese Clinical Trial Registry (ChiCTR2300070569).

Systemic inflammatory response syndrome (SIRS) is a serious postoperative complication among older adult surgical patients that frequently develops into sepsis or even death. Notably, the incidences of SIRS and sepsis steadily increase with age. It is important to identify the risk of postoperative SIRS for older adult patients at a sufficiently early stage, which would allow preemptive individualized enhanced therapy to be conducted to improve the prognosis of older adult patients. In recent years, machine learning (ML) models have been deployed by researchers for many tasks, including disease prediction and risk stratification, exhibiting good application potential. We aimed to develop and validate an individualized predictive model to identify susceptible and high-risk populations for SIRS in older adult patients to instruct appropriate early interventions. Data for surgical patients aged ≥65 years from September 2015 to September 2020 in 3 independent medical centers were retrieved and analyzed. The eligible patient cohort in the Third Affiliated Hospital of Sun Yat-sen University was randomly separated into an 80% training set (2882 patients) and a 20% internal validation set (720 patients). We developed 4 ML models to predict postoperative SIRS. The area under the receiver operating curve (AUC), F score, Brier score, and calibration curve were used to evaluate the model performance. The model with the best performance was further validated in the other 2 independent data sets involving 844 and 307 cases, respectively. The incidences of SIRS in the 3 medical centers were 24.3% (876/3602), 29.6% (250/844), and 6.5% (20/307), respectively. We identified 15 variables that were significantly associated with postoperative SIRS and used in 4 ML models to predict postoperative SIRS. A balanced cutoff between sensitivity and specificity was chosen to ensure as high a true positive as possible. The random forest classifier (RF) model showed the best overall performance to predict postoperative SIRS, with an AUC of 0.751 (95% CI 0.709-0.793), sensitivity of 0.682, specificity of 0.681, and F score of 0.508 in the internal validation set and higher AUCs in the external validation-1 set (0.759, 95% CI 0.723-0.795) and external validation-2 set (0.804, 95% CI 0.746-0.863). We developed and validated a generalizable RF model to predict postoperative SIRS in older adult patients, enabling clinicians to screen susceptible and high-risk patients and implement early individualized interventions. An online risk calculator to make the RF model accessible to anesthesiologists and peers around the world was developed.

Decision-making regarding adjuvant chemotherapy for older adults with breast cancer is a challenge because older adult patients often have poor physical health, frailty, and age-related comorbidities, which can compromise treatment outcome. Due to these considerations, doctors tend to use less chemotherapy for breast cancer in older adults. However, older patients in good general health could still benefit from chemotherapy. Careful benefit-risk assessment is essential to provide best care for each older adult patient. Due to a rapidly aging population, breast cancer in older adults is becoming a serious public health issue in China. In this mini review, we discuss the need, means, and tools to assess the benefits and risks of adjuvant chemotherapy in older adults with breast cancer. The contents of this review may drive decision-making with regard to the use and selection of adjuvant chemotherapy for older adult patients in China who are fit for the treatment.

Objective Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it. Methods This mixed-methods observational study nested within LEARNING WISDOM included caregivers of older patients who experienced an ED care transition. Burden was collected with the brief Zarit Burden Interview (ZBI-12), and caregivers also commented on the care transition. A qualitative coding scheme of patient care transitions was created to reflect themes important to caregivers. Comments were randomly analyzed until saturation and themes were extracted from the data. We followed both the SRQR and STROBE checklists. Results Comments from 581 caregivers (mean age (SD) 64.5 (12.3), 68% women) caring for patients (mean age (SD) 77.2 (7.54), 48% women) were analyzed. Caregivers overwhelmingly reported dissatisfaction and unmet service expectations, particularly with home care and domestic help. Communication and follow-up from the ED emerged as an area for improvement. Caregivers who reported an increased level of burden following a patient’s care transition had significantly higher ZBI scores than caregivers who self-reported stable burden levels. Conclusion Caregivers with increasing, stable, and improved levels of subjective burden all reported areas for improvement in the care transition process. Themes centering on the capacity to live at home and inadequate communication were most frequently mentioned and may represent serious challenges to caregivers. Addressing these challenges could improve both caregiver burden and ED care transitions. Key points 1. We analyzed caregivers’ thoughts about emergency department care transitions using both qualitative and quantitative tools. 2. Caregivers reported dissatisfaction and unmet service expectations with home care, domestic help, and coordinating follow-ups. 3. Variance in self-reported subjective caregiver burden corresponds to Zarit Burden Interview (ZBI) scores.

Background Ciprofol, a novel intravenous anesthetic, exhibits similar sedation mechanisms and pharmacokinetic properties to propofol. However, ciprofol demonstrates greater potency and is associated with reduced injection pain compared to propofol. Given the varying sensitivities to anesthetic agents across different age groups, this study aims to determine the median effective dose (ED 50 ) of ciprofol required to suppress the laryngeal mask airway (LMA) insertion response in both young and older adult patients, as well as to assess its potential adverse reactions. Methods In this study, 46 patients scheduled for surgery under general anesthesia with LMA insertion were recruited. Upon entering the operating room, patients were intravenously administered ciprofol (0.4 mg·kg − 1 ) and sufentanil (0.3 µg·kg − 1 ), followed by LMA insertion after three minutes. To derive robust confidence intervals for both ED 50 and ED 95 , we performed an analysis using a logistic regression model combined with bootstrap resampling. Results In the young adult group, the ED 50 and ED 95 of ciprofol for suppressing the LMA insertion response were 0.38 mg·kg − 1 (95% CI, 0.35–0.41) and 0.46 mg·kg − 1 (95%CI, 0.40–0.56), respectively. In the older adult group, the respective ED 50 and ED 95 were 0.29 mg·kg − 1 (95% CI, 0.26–0.32) and 0.37 mg·kg − 1 (95% CI, 0.30–0.78). Regarding adverse reactions, although there were differences in the incidence of injection pain, hypotension, and bradycardia between the young and older groups, no statistically significant differences were observed between the two groups. Conclusion In this study, significant differences were observed in the ED 50 of ciprofol for suppressing the LMA insertion response between young and older adult patients. The ED 50 of ciprofol for young adult patients was 0.38 mg·kg − 1 (95% CI, 0.35–0.41), while for older adult patients it was0.29 mg·kg − 1 (95% CI, 0.26–0.32). Trial registration This study was registered on February 17, 2024, with the China Clinical Trial Registration Center ( www.chictr.org.cn ; Registration Number: ChiCTR2400080891).

Purpose This study aimed to identify knowledge, attitudes, and behaviors regarding older adult patients’ mobilization from the perspectives of critical care nurses (CCNs) and physicians. Methods The researchers employed a cross-sectional study design following the STROBE guidelines. A total of 136 CCNs and 64 physicians completed an online electronic survey. This single-center study utilized the PMABS-ICU questionnaire and adopted a convenience sampling method. Results Two hundred voluntary participants were involved in our study. The mean (SD) of the overall barrier score for CCNs was 113.16(16.7), significantly higher than the 107.75(10.9) reported by physicians ( P  = 0.007). The mean (SD) attitude in CCNs was 26.75(5.00), which was of higher significance ( p  = 0.000) than physicians at 23.56(4.78). CCNs had a higher total mean (SD) behavior subscale, 45.22(11.20), than physicians, 44.39(4.79), with no statistically significant differences between them ( p  = 0.461). There was a moderate positive correlation between the overall score and subscale knowledge ( p  = 0.000), attitude ( p  = 0.000), and behavior ( p  = 0.000). Conclusion CCNs reported that barriers to older adult patients’ mobility were perceived as higher than physicians. Safety fears and anticipation regarding falling can hinder CCNs’ initial attempts to promote the mobility of older adult patients, while physicians perceive time constraints as a hurdle. Implications for practice Mobility barriers among older adult patients in ICUs were reported to be higher among CCNs than physicians, with fear of injury and safety concerns being the most significant barriers. Clinical trial number Not applicable.