Abstract
Objectives
To investigate the current evidence on the use of point-of-care chest ultrasonography
in older patients and geriatric settings and present the current state of the art
of chest ultrasound applications.
Design
Special article based on a literature review with narrative analyses and expert clinical
knowledge.
Setting and participants
All studies performed in a geriatric setting were included. Observational and intervention
studies and meta-analyses including participants aged ≥70 years were also considered,
even if not specifically focused on a geriatric setting.
Measures
Data on participant characteristics, diagnostic accuracy of chest ultrasonography,
and outcomes were collected for each considered study. Data were analyzed and discussed
with a particular focus on the possible applications and advantages of chest ultrasonography
in geriatric medicine, underlining the possible areas of future research.
Results
We found only 5 studies on the diagnostic accuracy and prognostic relevance of chest
ultrasonography in geriatrics. However, several studies performed in emergency departments,
intensive care units, and internal medicine wards included a large number of participants
≥70 years old; they suggest that chest ultrasonography may represent a valid aid to
the diagnostics of acute dyspnea, pneumonia, acute heart failure, pneumothorax, and
pleural diseases, with an accuracy in some cases superior to standard x-rays, especially
when mobility limitation is present. Diaphragm ultrasonography may also represent
a valid tool to guide mechanical ventilation weaning in older patients with acute
respiratory failure.
Conclusions and implications
Chest ultrasonography may represent a valid bedside diagnostic aid to the management
of acute respiratory diseases in older patients. However, specific evidence is lacking
for geriatric patients. Future research will need to focus on defining the reference
standards and the diagnostic accuracy for older patients with frailty and multimorbidity,
cost-efficacy and cost-effectiveness of the technique, its impact for clinical outcomes,
and role for follow-up in the post-acute care.
Keywords
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Article info
Publication history
Published online: August 06, 2019
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
