2058
GERIATRICS
Geriatrics Re: Are High-Care Nursing Home Residents at Greater Risk of Unplanned Hospital Admission than Other Elderly Patients when Exposed to Beers Potentially Inappropriate Medications? S. D. Price, C. D. Holman, F. M. Sanfilippo and J. D. Emery School of Population Health, University of Western Australia, Crawley, Western Australia, Australia Geriatr Gerontol Int 2014; 14: 934e941.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.047 available at http://jurology.com/ Editorial Comment: Compared to younger patients, older adults are at increased risk for adverse events from many medications due to underlying comorbidities, polypharmacy, age related changes in pharmacokinetics and pharmacodynamics, and other factors. The American Geriatrics Society recently updated the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, a set of recommendations for potentially inappropriate medications (PIMs) to be avoided for use in geriatric patients.1 Prescription of PIMs is associated with potential risks of adverse outcomes in the elderly population. These authors sought to identify whether use of PIMs was linked to an increased risk of unplanned hospitalizations for more than 245,000 older adults living in nursing homes in Australia. Because they examined data spanning 12 years, information on many subjects could be tracked through time from when they were younger and healthier to older age with more comorbidity. Elderly nursing home residents, defined as requiring “high care,” had higher rates of unplanned hospitalizations related to PIM prescriptions compared to other elderly subjects. However, the relative risk of hospitalization due to PIM use was statistically similar between the groups. A wide variety of different medications were prescribed in this large cohort. Due to study design, it was difficult to determine specific timing or dosages for many medications. Nonetheless, these data provide additional support for recommendations to avoid PIMs in older adults if possible. Tomas L. Griebling, MD, MPH 1. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel: American Geriatrics Society updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2012; 60: 616.
Re: Ambulatory Surgery Centers and Outpatient Urologic Surgery among Medicare Beneficiaries A. M. Suskind, R. L. Dunn, Y. Zhang, J. M. Hollingsworth and B. K. Hollenbeck Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan Urology 2014; 84: 57e61.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.048 available at http://jurology.com/ Editorial Comment: Models of health care delivery continue to evolve, with overarching goals of decreased cost and increased efficiency and safety. Surgical care has changed markedly in the last several decades, with an increased emphasis on minimally invasive procedures and outpatient surgery. Urology has been at the forefront of this movement, with reductions in hospital length of stay for many procedures and maintenance of or improvements in other quality outcome measures. This study examined trends in hospital vs ambulatory surgery center (ASC) procedure use among Medicare beneficiaries. Introduction of an ASC into a health care market area was associated with decreased rates of outpatient surgery in traditional hospital settings. No significant changes in quality outcomes were observed.
GERIATRICS
2059
Many urological surgical procedures performed in geriatric patients are amenable to being done in the outpatient clinical setting. Approximately a third of all surgeries in the United States are performed in people older than 65 years. This continued emphasis on outpatient surgery, particularly at ASCs and similar facilities, may help to continue to decrease costs but still maintain quality for these procedures in this population. Tomas L. Griebling, MD, MPH
Suggested Reading Strope SA, Daignault S, Hollingsworth JM et al: Medicare reimbursement changes for ambulatory surgery centers and remuneration to urological physicianowners. J Urol 2008; 180: 1070.
Re: Geriatric Syndromes in Individuals Admitted to Vascular and Urology Surgical Units P. J. McRae, N. M. Peel, P. J. Walker, J. W. de Looze and A. M. Mudge Royal Brisbane and Women’s Hospital, and School of Medicine, University of Queensland, Brisbane, Queensland, Australia J Am Geriatr Soc 2014; 62: 1105e1109.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.049 available at http://jurology.com/ Editorial Comment: Geriatric syndromes are complex clinical conditions that are characterized by multifactorial etiologies and predominantly affect older adults. Examples include delirium, falls, functional decline, pressure ulcers and urinary incontinence. The authors of this retrospective cohort study examined rates of geriatric syndromes in 1 vascular and 1 urological surgery unit at a tertiary teaching hospital in Australia. A total of 112 individuals were included who were 65 years or older and were hospitalized for at least 3 days on either unit. Overall prevalence of geriatric syndromes in this cohort was 32%. Emergency admissions and inter-hospital transfers were strongly associated with increased rates of geriatric syndromes. On multivariable analysis nonelective hospitalization, major surgery and prior impairments in activities of daily living were strong independent predictors of associated geriatric syndromes. The rate of geriatric syndromes was higher than many common postoperative complications. Urologists and other surgeons caring for geriatric patients need to be aware of the major geriatric syndromes and implications for clinical outcomes. Future work will help to provide better insight into how different treatments may influence geriatric syndromes and other outcomes in this older, more vulnerable population. Tomas L. Griebling, MD, MPH
GERIATRICS
Geriatrics Re: Are High-Care Nursing Home Residents at Greater Risk of Unplanned Hospital Admission than Other Elderly Patients when Exposed to Beers Potentially Inappropriate Medications? S. D. Price, C. D. Holman, F. M. Sanfilippo and J. D. Emery School of Population Health, University of Western Australia, Crawley, Western Australia, Australia Geriatr Gerontol Int 2014; 14: 934e941.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.047 available at http://jurology.com/ Editorial Comment: Compared to younger patients, older adults are at increased risk for adverse events from many medications due to underlying comorbidities, polypharmacy, age related changes in pharmacokinetics and pharmacodynamics, and other factors. The American Geriatrics Society recently updated the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, a set of recommendations for potentially inappropriate medications (PIMs) to be avoided for use in geriatric patients.1 Prescription of PIMs is associated with potential risks of adverse outcomes in the elderly population. These authors sought to identify whether use of PIMs was linked to an increased risk of unplanned hospitalizations for more than 245,000 older adults living in nursing homes in Australia. Because they examined data spanning 12 years, information on many subjects could be tracked through time from when they were younger and healthier to older age with more comorbidity. Elderly nursing home residents, defined as requiring “high care,” had higher rates of unplanned hospitalizations related to PIM prescriptions compared to other elderly subjects. However, the relative risk of hospitalization due to PIM use was statistically similar between the groups. A wide variety of different medications were prescribed in this large cohort. Due to study design, it was difficult to determine specific timing or dosages for many medications. Nonetheless, these data provide additional support for recommendations to avoid PIMs in older adults if possible. Tomas L. Griebling, MD, MPH 1. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel: American Geriatrics Society updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2012; 60: 616.
Re: Ambulatory Surgery Centers and Outpatient Urologic Surgery among Medicare Beneficiaries A. M. Suskind, R. L. Dunn, Y. Zhang, J. M. Hollingsworth and B. K. Hollenbeck Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan Urology 2014; 84: 57e61.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.048 available at http://jurology.com/ Editorial Comment: Models of health care delivery continue to evolve, with overarching goals of decreased cost and increased efficiency and safety. Surgical care has changed markedly in the last several decades, with an increased emphasis on minimally invasive procedures and outpatient surgery. Urology has been at the forefront of this movement, with reductions in hospital length of stay for many procedures and maintenance of or improvements in other quality outcome measures. This study examined trends in hospital vs ambulatory surgery center (ASC) procedure use among Medicare beneficiaries. Introduction of an ASC into a health care market area was associated with decreased rates of outpatient surgery in traditional hospital settings. No significant changes in quality outcomes were observed.
GERIATRICS
2059
Many urological surgical procedures performed in geriatric patients are amenable to being done in the outpatient clinical setting. Approximately a third of all surgeries in the United States are performed in people older than 65 years. This continued emphasis on outpatient surgery, particularly at ASCs and similar facilities, may help to continue to decrease costs but still maintain quality for these procedures in this population. Tomas L. Griebling, MD, MPH
Suggested Reading Strope SA, Daignault S, Hollingsworth JM et al: Medicare reimbursement changes for ambulatory surgery centers and remuneration to urological physicianowners. J Urol 2008; 180: 1070.
Re: Geriatric Syndromes in Individuals Admitted to Vascular and Urology Surgical Units P. J. McRae, N. M. Peel, P. J. Walker, J. W. de Looze and A. M. Mudge Royal Brisbane and Women’s Hospital, and School of Medicine, University of Queensland, Brisbane, Queensland, Australia J Am Geriatr Soc 2014; 62: 1105e1109.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.049 available at http://jurology.com/ Editorial Comment: Geriatric syndromes are complex clinical conditions that are characterized by multifactorial etiologies and predominantly affect older adults. Examples include delirium, falls, functional decline, pressure ulcers and urinary incontinence. The authors of this retrospective cohort study examined rates of geriatric syndromes in 1 vascular and 1 urological surgery unit at a tertiary teaching hospital in Australia. A total of 112 individuals were included who were 65 years or older and were hospitalized for at least 3 days on either unit. Overall prevalence of geriatric syndromes in this cohort was 32%. Emergency admissions and inter-hospital transfers were strongly associated with increased rates of geriatric syndromes. On multivariable analysis nonelective hospitalization, major surgery and prior impairments in activities of daily living were strong independent predictors of associated geriatric syndromes. The rate of geriatric syndromes was higher than many common postoperative complications. Urologists and other surgeons caring for geriatric patients need to be aware of the major geriatric syndromes and implications for clinical outcomes. Future work will help to provide better insight into how different treatments may influence geriatric syndromes and other outcomes in this older, more vulnerable population. Tomas L. Griebling, MD, MPH
