Geriatric conditions such as frailty and cognitive impairments may inadvertently worsen when older patients are treated in cardiac intensive care units, according to a new scientific statement from the American Heart Association.

In addition to their cardiovascular conditions, many older patients often have additional health conditions, take multiple medications for these conditions, may be frail or have cognitive impairment. 

"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 disease," said Abdulla A. Damluji, chair of the writing group for the statement, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland, and interventional cardiologist at the Inova Heart and Vascular Institute, Falls Church, Virginia.

Deterioration in muscle strength occurs with prolonged immobility

While in a cardiac intensive care unit, older patients often experience factors that are emotionally and physically disorienting - such as bright lights, excessive noise, new medications, urinary catheters, dietary shifts, sleep disruptions and toileting challenges. 

Delirium also commonly occurs during critical illness, and it contributes to a higher risk of dying in the hospital. "Reducing the level of sedation used in older patients may help mitigate delirium, however, more research needs to be done to fully understand how best to treat this condition in the context of acute cardiovascular illness," said Damluji.

Extended bedrest, often necessary in an intensive care unit, is detrimental to patients of all ages. For older, critically ill patients, who are often frail when admitted to the cardiac intensive care unit, bedrest can significantly worsen their frailty. Further deterioration in muscle strength and bone density often occurs with prolonged immobility, which can also lead to poor medication tolerance, an increased risk of falling, weakened heart function and pressure ulcers.

Early mobilisation - getting the patient out of bed as soon as appropriate, may be helpful for some patients to address frailty. Encouraging appropriate physical movement may result in less weakness, an improved ability to walk and less time in the cardiac intensive care unit, among other benefits.

Another issue faced by older adults admitted to the cardiac intensive care unit is that they take an average of 12 different prescription medications, raising the risk of adverse side effects, drug-to-drug and drug-to-disease interactions. Patients may benefit by having some of their medications discontinued or deprescribed, if appropriate.