الفهرس 
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Abstract
The current study concluded that:
The most commonly affected age group were the group of young elderly with number of males higher than females.
Accidental intoxication and suicidal attempts were equally represented.
Most of the elderly patients with acute poisoning had one or more underlying chronic comorbidities and the oral route (ingestion) was more common.
CVS drugs, CNS drugs and pesticides were the major causes of poisoning in elderly patients.
CVS complications were the commonest cause of ICU admission in elderly.
High APACHE II score was associated with long hospitalization.
Presence of respiratory manifestations, the need for mechanical ventilation, PSS and APACHE II score were the prognostic factors in elderly patients with acute poisoning.
RECOMMENDATIONS
The current study highlights the great importance of studying the poisoning in the elderly, especially with the increasing of population ages.
The study recommends the following:
Special attention should be paid for elderly toxicity as presence of special habits, prolonged delay time and presence of medical comorbidities which may aggravate the course of poisoning among them.
It also recommends that predictors of outcome outlined in this study (respiratory manifestations, need for mechanical ventilation, PSS score and APACHE II score) should be assessed routinely and as early as possible to evaluate the severity, improve the course of management and deciding the pathway of care.
Severity scoring systems better to be applied in all poison control centers to help evaluating ICU performance and outcome, treatment effectiveness, the risk of hospital mortality and allocating resources.
Further studies are needed to provide a more comprehensive picture of risk factors influencing acute poisoning in the elderly, including larger sample size for more extended period than one year.
Further studies are needed to compare the pattern of poisoning in geriatrics with that in younger population and to compare each risk factor in each group.
SUMMARY
Acute poisoning is a major public health problem all over the world, it causes significant mortality and morbidity. It primarily involves young populations, with less than 3% of the affected cases being in people aged 60 years or older in most studies. Majority of the intoxication events in the elderly over 65 years old were accidental.
There are several classifications about the beginning of elderly, but according to common definitions, it usually begins at the age of 60 years. The world’s population has experienced a significant growth in the number of the elderly. During 2015, 10% of population is 60 years or above; by 2050, 20% of population will be 60 years or older.
The elderly are different from younger adults in many aspects. There are age related physiological changes. They have a higher incidence of comorbidities and use of many medications for chronic conditions, both of which make the elderly more susceptible to acute poisoning and its related consequences.
Although the elderly form a relatively small proportion of those admitted to hospital for acute self-poisoning, the poisoning in them is often more serious, complications are more frequent and a fatal outcome is more common.
The presence of multiple physical, social, and psychiatric problems, with possible difficulties in the diagnosis of poisoning make the management of the elderly more complicated than that of younger poisoned patients.
There are three main difficulties in diagnosing acute poisoning in the elderly. At first, it may not be easily obvious that the patient has taken an overdose. Secondly, the presence of pre‐existing diseases may obscure the clinical picture and finally, the drug may cause physical signs that similar to common problems of old age.
This study aimed to explore the risk factors affecting the prognosis of elderly patients with acute poisoning.
The present study was a prospective hospital-based observational study carried out at PCC of Ain Shams University Hospitals, in one-year duration starting from 1st of January 2022 and ending in 31th of December 2022.
Acutely intoxicated patients aged 60 years and older of both sexes, and admitted in the inpatient and ICU, were included in the present study.
All patients received routine and medical care. Diagnosis and treatment were provided according to treatment protocols of PCC of Ain Shams university hospitals.
For every patient, the following parameters were studied:
I. Sociodemographic data:
It included data regarding age, sex, residence and marital status.
II. Clinical evaluation:
Medical history:
It included:
Type of toxic agents, route of exposure, mode of intoxication, delay time, prehospital treatment, presence of comorbidities and Special habits.
Physical examination:
It included vital data as pulse, blood pressure, temperature, respiratory rate.
Investigations.
Poisoning Severity and APACHE II scores.
Treatment.
Outcome.
The results were tabulated and statistically analyzed and revealed the following:
The total number of acutely intoxicated elderly patients presented to the PCC during the studied year was 280 out of 21847 representing 1.28% of the total number of cases presented to the PCC.
The total number of studied patients were divided into two groups: 56 survivors representing 77.78% and 16 non-survivors representing 22.22%.
The majority of patients (83.33%) were between 60 and 74 years and showing a decline in number with increasing age.
Male intoxicated patients were represented at a higher rate than females with a male to female ratio 1.32: 1.
As regard residence distribution, 91.67% of patients came from urban areas while 8.33% of patients came from rural ones.
The majority of patients were married (91.67%).
There was no significant statistical difference as regard age, sex, residence and marital status between survivors and non-survivors.
CVS drugs, CNS drugs and pesticides were the major causes of toxicity in elderly patients representing 25% equally followed by corrosive exposure (6.94%).
Single agent toxicity was more prevalent by 91.67%.
There was no significant statistical difference as regard toxic agent and co-ingestion in survivors and non-survivors.
Accidental intoxication and suicidal attempts were equally represented. The majority of patients (90.28%) exposed to the toxic agent through oral route. The mean value of delay time was 10.86 hour and the majority of patients (89.06%) were presented within the first 24 hours of poisoning.
No pre-hospital treatment was offered to the majority of patients (95.83%) before arrival to the PCC, 2.78% of the studied patients received faulty treatment while proper treatment occurred in only 1.39% of them.
There was significant statistical difference between survivors and non-survivors as regard mode of intoxication. It was found that 42.86% of survivors and 75% of non-survivors were suicidal, however there was no significant statistical difference between survivors and non-survivors as regard delay time, route of exposure and pre-hospital ttt.
As regard medical comorbidities, hypertension (44.44%) came at the top of diseases affecting the elderly followed by diabetes mellitus and cardiac diseases. Psychiatric problems were present in 9 patients representing 12.50% of all patients, no significant statistical difference between survivors and non-survivors as regard medical and psychiatric comorbidities.
The majority of patients (84.72%) did not have any special habits. Presence of special habits was significantly higher among non-survivors.
Regarding vital signs, extremities of vital signs including respiratory rate, blood pressure and pulse rate had significant effect on outcome.
The majority of patients had no cyanosis and only four patients had cyanosis representing 5.56% of all patients. Cyanosis was highly significantly higher in non-survivors.
The majority of patients had normal reactive pupil, constricted pupil up to pinpoint pupil was present in 25 patients representing 34.72% of all patients but only one case had dilated fixed pupil.
Regarding clinical manifestations, gastrointestinal symptoms (in the form of vomiting, diarrhea, dysphagia and abdominal pain) were the commonest manifestations representing 54.17% of all patients. There was highly significant statistical difference between survivors and non-survivors as regard nervous manifestations, cardiovascular manifestations and respiratory manifestations.
It was observed that the range of PSS among studied patients on hospital admission was 0 - 3. Most of patients (40.28%) presented to the PCC with score II while two patients were completely asymptomatic (score 0) and admitted for follow up. There was no correlation between PSS and hospital admission duration in the studied patients.
There was highly significant statistical difference between survivors and non-survivors as regard PSS on admission, where all non-survivors were classified as severe.
There was highly significant statistical difference between survivors and non-survivors as regard APACHE II score. It was found that APACHE II score was high among non-survivors. High APACHE II score was associated with long hospitalization.
Activated charcoal was given to 19.44% and intravenous fluids were used in 80.56% of all patients, the majority of patients received symptomatic and supportive treatment representing 98.61% and 100% respectively.
Hospital admission duration ranged from 3 hours up to 28 days with the majority of patients stayed in PCC for more than one day (52.78%).
The majority of studied patients admitted in PCC in ICU representing 58.33%.
CVS complications including severe hypotension, bradycardia and heart block was the commonest cause of admission occurring in 18 patients representing 25% of totally admitted intoxicated patients. Other complications like deep coma, seizures, metabolic acidosis and hematemesis also occurred.
Presence of respiratory manifestations, the need for mechanical ventilation, PSS score and APACHE II score could be used as predictors of outcome and severity.