Seniors in cardiac intensive care units may suffer delirium and other problems if doctors only focus on their heart, a new American Heart Association (AHA) scientific statement says.
Older adults in cardiac ICU require different care from younger patients, according to the statement. They're likely to be frail, have other medical conditions and use multiple medications.
"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," statement writing group chair Dr. Abdulla Damluji said in an AHA news release.
Damluji, a cardiologist, is an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Seniors in a cardiac ICU often struggle emotionally and physically due to bright lights, noise, new medications, urinary catheters, dietary changes and sleep disruptions.
"For vulnerable older adults who may already be experiencing cognitive decline, the environment in the cardiac intensive care unit may deplete already limited coping skills and could lead to delirium," Damluji said.
Delirium is common in critically ill patients and increases the 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," Damluji said.
Many older patients are frail when admitted to the cardiac ICU, and extended bed rest can worsen their frailty. This can lead to poor medication tolerance, an increased risk of falling, weakened heart function and bedsores.
Getting older heart patients out of bed as soon as appropriate and encouraging movement may preserve strength, improve the ability to walk and result in less time in the cardiac intensive care unit, according to the AHA.
Another potential problem for older cardiac ICU patients is that they take an average of 12 prescription medications. This increases the risk of harmful side effects and detrimental interactions. Older patients may benefit by being taken off some of their medications if appropriate, according to the statement.
"Strategies to achieve a holistic care approach for each patient remains an important goal to improve care of older patients in the cardiac intensive care unit," Damluji said.
The statement was published Dec. 9 in the journal Circulation.