Geriatric syndromes in individuals admitted to vascular and urology surgical units

Abstract

Objectives: To document the incidence of geriatric syndromes (delirium, functional decline, falls, and pressure ulcers) in two surgical units and to determine the association between the occurrence of geriatric syndromes and admission type (elective vs nonelective), severity of surgery, and surgical subspecialty unit.

Design: Retrospective cohort study.

Setting: One vascular surgical unit and one urology surgical unit in an Australian tertiary teaching hospital.

Participants: Individuals aged 65 and older admitted to a study unit for 3 days or more (N = 112).

Measurements: Delirium was identified using a validated chart extraction tool. Functional decline from admission to discharge was identified from nursing documentation. Falls were identified according to documentation in the medical record cross-checked with the hospital incident reporting system. Pressure ulcers were identified according to documentation in the medical record.

Results: Geriatric syndromes were present in 32% of participants. Delirium was identified in 21%, functional decline in 14%, falls in 8%, and pressure ulcers in 5%. Individuals admitted directly from the emergency or outpatient department and interhospital transfers (nonelective) were significantly more likely to develop any geriatric syndrome than those on an elective surgery list before admission to the hospital (41% vs 18%, P = .01). In multivariable analysis, nonelective admission (odds ratio (OR) = 3.3, 95% confidence interval (CI) = 1.6-4.7, P = .005), major surgery (OR = 3.1, 95% CI = 1.7-3.7, P = .004) and preexisting impairment in activities of daily living (OR 2.9, 95% CI 1.5-3.6, P = .007) increased the likelihood of geriatric syndromes.

Conclusion: Geriatric syndromes are common in older adults undergoing surgery, and nonelective admission and major surgery increase the likelihood of geriatric syndromes occurring during hospitalization. Baseline dependency in ADLs is an important risk factor for the occurrence of these conditions.

Keywords: geriatric surgery; geriatric syndromes; predictor.