Background: Malnutrition is a prevalent and hard-to-treat condition in older adults. enteral feeding is common in acute and long-term care. Data regarding the prognosis of patients receiving enteral feeding in geriatric medical settings is lacking. Such data is important for decision-making and preliminary instructions for patients, caregivers, and physicians. This study aimed to evaluate the prognosis and risk factors for mortality among older adults admitted to a geriatric medical center receiving or starting enteral nutrition (EN). Methods: A cohort retrospective study, conducted from 2019 to 2021. Patients admitted to our geriatric medical center who received EN were included. Data was collected from electronic medical records including demographic, clinical, and blood tests, duration of enteral feeding, Norton scale, and Short Nutritional Assessment Questionnaire score. Mortality was assessed during and after hospitalization. Data were compared between survivors and non-survivors. Multivariate logistic regressions were performed to identify the variables most significantly associated with in-hospital mortality. Results: Of 9169 patients admitted, 124 (1.35%) received enteral feeding tubes. More than half of the patients (50.8%) had polypharmacy (over 8 medications), 62% suffered from more than 10 chronic illnesses and the majority of patients (122/124) had a Norton scale under 14. Most of the patients had a nasogastric tube (NGT) (95/124) and 29 had percutaneous endoscopic gastrostomies (PEGs). Ninety patients (72%) died during the trial period with a median follow-up of 12.7 months (0.1–62.9 months) and one-year mortality was 16% (20/124). Associations to mortality were found for marital status, oxygen use, and Red Cell Distribution Width (RDW). Age and poly-morbidity were not associated with mortality. Conclusion: In patients receiving EN at a geriatric medical center mortality was lower than in a general hospital. The prognosis remained grim with high mortality rates and low quality of life. This data should aid decision-making and promote preliminary instructions.

Background: Systemic inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with severe COVID-19, but their role in mild disease among frail older adults remains unclear. Early Israeli admission policies enabled hematologic profiling of asymptomatic and mild cases. Methods: Retrospective cohort of adults ≥65 years admitted to a geriatric center (March 2020–March 2021). Patients with Mild/asymptomatic COVID-19 cases were compared with patients hospitalized for other infections (pneumonia, urinary tract infection, cellulitis). Admission indices such as NLR, derived neutrophil-to-lymphocyte ratio (dNLR), PLR, hemoglobin-to-lymphocyte ratio (HLR), red cell distribution width (RDW), and C-reactive protein (CRP) were analyzed using receiver operating characteristic (ROC) curves. Sensitivity analyses compared COVID-19 with bacterial pneumonia and assessed one-week changes. Results: Among 450 patients (177 COVID-19 and 273 non-COVID; median age 85–86), COVID-19 cases showed lower white blood cell counts (WBC), neutrophils, and CRP but more marked lymphopenia. The most discriminative indices were dNLR, PLR, HLR, and RDW, which differed most (all p < 0.001), while NLR and systemic immune-inflammation index (SII) showed limited discrimination. The best AUC was 0.69. dNLR, PLR, and HLR remained elevated after one week. Conclusions: In frail older adults with early or mild COVID-19, modest but consistent hematologic patterns, including lymphopenia with elevated dNLR, PLR, and HLR, and lower RDW, were distinguished COVID-19 from other infections, although single-marker accuracy was limited. These routine indices may assist early differentiation when virologic testing is delayed or unavailable.

Background: Chest pain is one of the most common reasons for emergency department (ED) visits. Patients presenting with inconclusive symptoms complicate the diagnostic process and add to the burden upon the ED. This study aimed to determine factors possibly influencing ED decisions on hospitalization versus discharge for patients with the diagnosis of chest pain. Methods: In the cohort study including 400 patients admitted to the emergency unit with a working diagnosis of chest pain, data on demographics, medical history, symptoms, lab results, and risk scores were collected from the medical records of patients admitted to the ED with a working diagnosis of chest pain. To reduce potential bias, the analysis was restricted to 330 patients who were referred to the ED by a primary care provider or clinic for chest pain. Results: Of 330 patients admitted to the ED, 58.5% were discharged, and 41.5% were hospitalized. Hospitalized patients were significantly older, with a median age of 70 versus 57 years for those discharged (p < 0.001). A higher proportion of hospitalizations occurred during the late-night shift. Significant predictors of hospitalization included hyperlipidemia (OR 3.246), diaphoresis (OR 8.525), dyspnea (OR 2.897), and hypertension (OR 1.959). Nursing home residents had a lower risk of hospitalization (OR 0.381). The area under the ROC curve for this model was 0.801 (95% CI: 0.753–0.848), indicating the predictive accuracy of the model in estimating the probability of admission. The HEART (history, ECG, age, risk factors, and troponin level) score was more effective than the TIMI (Thrombolysis in Myocardial Infarction) score in predicting the need for hospitalization, with an area under the curve (AUC) of 0.807 compared to 0.742 for TIMI. Conclusions: The HEART score in comparison with TIMI score proved especially valuable for quick risk assessment for hospitalization. The model that included hyperlipidemia, diaphoresis, dyspnea, and hypertension was the most predictive for the risk of hospitalization. Further research with larger populations is needed to validate these findings.

Background: Evidence regarding optimal reperfusion strategies in older patients with acute ischemic stroke remains inconsistent, particularly in real-world settings where patient selection and comorbidity burden differ from randomized trials. Objective: This study evaluates real-world outcomes of ischemic stroke interventions among older adults in a tertiary medical center. Methods: This single-center retrospective cohort study included patients aged ≥ 65 years with acute ischemic stroke admitted between August 2022 and December 2023. Mortality follow-up continued until September 2024. Patients were categorized according to treatment: intravenous thrombolysis (tPA) alone, endovascular thrombectomy (EVT) alone, or combined (tPA + EVT) therapy. Data included demographics, comorbidities, stroke severity (NIHSS), imaging, treatment timing, and mortality outcomes. Results: Among 200 patients (mean age 77.5 years), 66 received tPA, 86 underwent EVT, and 48 received tPA + EVT therapy. Patients treated with tPA alone presented with milder strokes and had low in-hospital and six-month mortality (1.5% and 6.1%, respectively). In contrast, EVT-only patients had substantially higher in-hospital and six-month mortality (21% and 43%, respectively). Patients receiving tPA + EVT therapy had low mortality rates comparable to the tPA group (2.1% and 6.3%, respectively), despite greater stroke severity at presentation. Conclusions: Despite greater stroke severity, patients receiving tPA + EVT therapy had outcomes comparable to those treated with tPA alone, while EVT-only patients experienced substantially higher mortality. These findings underscore the importance of patient selection and suggest that treatment allocation may strongly influence real-world outcomes in older adults.

Background and Objectives: Older nursing-care patients are a clinically complex population with marked functional dependence, cognitive impairment, nutritional vulnerability, and multimorbidity. Although nursing-home residents are often considered at higher risk for adverse outcomes, many highly dependent older adults receive nursing care at home. Materials and Methods: This single-center retrospective cohort study included 501 nursing-care patients hospitalized between December 2022 and December 2023, of whom 334 were admitted from home and 167 from nursing homes. The primary outcome was in-hospital mortality; secondary outcomes included length of hospital stay, discharge destination, and 90-day post-discharge mortality among patients discharged alive. Longer-term survival analyses were exploratory. Demographic, clinical, functional, nutritional, laboratory, hospitalization, and mortality data were evaluated. Results: The median age was 85 years (IQR, 11), and 63.1% of patients were women. Patients admitted from home were older than those admitted from nursing homes (median 86 vs. 84 years; p = 0.036). Nursing-home patients more frequently presented with fever and infection-related diagnoses and had a higher prevalence of dementia (85.0% vs. 58.1%; p < 0.001), greater pressure-ulcer risk according to the Norton scale (p < 0.001), and greater nutritional vulnerability according to the MNA-mini (p = 0.007). Median length of stay did not differ significantly between groups (p = 0.755). In-hospital mortality was 23.7% in patients admitted from home and 18.6% in those admitted from nursing homes (p = 0.194). Among patients discharged alive, 90-day post-discharge mortality was 24.3% and 28.7%, respectively (p = 0.348). In the extended Cox model for 90-day post-discharge mortality, neither source of admission nor its time-dependent interaction was significantly associated with mortality (source of admission: HR, 0.831; 95% CI, 0.097–7.096; p = 0.865; time-dependent interaction: HR, 1.036; 95% CI, 0.573–1.873; p = 0.907). Conclusions: No statistically significant difference in in-hospital mortality was detected according to source of admission. Nursing-home patients had greater cognitive, nutritional, pressure-ulcer-risk, and infection-related vulnerability. These findings do not establish equivalence between groups and should be interpreted together with individual clinical characteristics.