Geriatric impairments, medication and interventions in older persons: With focus on patients with cardiovascular disease

Abstract

The number of patients with cardiovascular disease (CVD) is increasing worldwide. Many patients with CVD are 75 years of age or older. Frailty and geriatric impairments such as problems with thinking (cognitive impairment), concomitant use of several medications (polypharmacy), falls and reduced self-reliance are particularly common in the older patient. In recent years, frailty and geriatric impairments have been demonstrated to play a role in recognizing patients at increased risk of adverse outcomes from treatments. In this thesis, we investigated the occurrence of geriatric impairments in different patient groups with CVD, by means of a geriatric investigation (known as comprehensive geriatric assessment). We concluded that geriatric impairments and frailty are common in patients with CVD, especially in those screened for an implanted mechanical heart pump (left ventricular assist device), heart transplantation or aortic valve implantation through the groin (transcatheter aortic valve implantation). Geriatric impairments (including cognitive impairment and hyperpolypharmacy (≥10 medications)) and frailty were associated with adverse outcomes in patients with CVD. Knowledge of the predictive value of these conditions provides a better understanding of the potential risks of a treatment and may therefore improve shared decision-making. Several recommendations for treatments to reduce the risk of geriatric impairments and complications follow from the geriatric assessment which includes a medication review. Geriatric impairments often have several causes. In line with this, two literature reviews we conducted showed that treatments with multiple components in particular are effective in preventing falls and hospital readmissions.