European Journal of Internal Medicine

(The median citation count of European Journal of Internal Medicine is 1. The table below lists those papers that are above that threshold based on CrossRef citation counts [max. 250 papers]. The publications cover those that have been published in the past four years, i.e., from 2020-01-01 to 2024-01-01.)
The pivotal link between ACE2 deficiency and SARS-CoV-2 infection901
Efficacy and safety of tocilizumab in severe COVID-19 patients: a single-centre retrospective cohort study311
Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis283
Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)274
Impact of low dose tocilizumab on mortality rate in patients with COVID-19 related pneumonia203
Creatinine: From physiology to clinical application150
Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan, Italy144
Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease137
Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data126
Electrocardiographic features of patients with COVID-19 pneumonia102
Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.97
SARS-CoV-2 vaccines: Lights and shadows88
Mobile health technology-supported atrial fibrillation screening and integrated care: A report from the mAFA-II trial Long-term Extension Cohort85
Hepatic consequences of COVID-19 infection. Lapping or biting?78
Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study63
Anakinra for patients with COVID-19: a meta-analysis of non-randomized cohort studies.60
Protective role of chronic treatment with direct oral anticoagulants in elderly patients affected by interstitial pneumonia in COVID-19 era59
Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life55
Inhalation therapy devices for the treatment of obstructive lung diseases: the history of inhalers towards the ideal inhaler51
SARS-CoV-2 antibody kinetics eight months from COVID-19 onset: Persistence of spike antibodies but loss of neutralizing antibodies in 24% of convalescent plasma donors47
Factors associated with persistence of symptoms 1 year after COVID-19: A longitudinal, prospective phone-based interview follow-up cohort study47
The 2020 International Society of Hypertension global hypertension practice guidelines - key messages and clinical considerations45
Long-term efficacy of maintenance therapy with Rituximab for IgG4-related disease45
Prospective blinded Evaluation of the smartphone-based AliveCor Kardia ECG monitor for Atrial Fibrillation detection: The PEAK-AF study45
Bleeding in COVID-19 severe pneumonia: The other side of abnormal coagulation pattern?43
SARS-CoV-2 detection in the pericardial fluid of a patient with cardiac tamponade43
Mechanisms of weight regain.41
Low serum albumin: A neglected predictor in patients with cardiovascular disease40
The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: One year later40
The Brain-Gut-Microbiotal Axis: A framework for understanding functional GI illness and their therapeutic interventions39
Uric acid in metabolic syndrome: Does uric acid have a definitive role?39
Prognostic impact of coronary microvascular dysfunction in patients with myocardial infarction with non-obstructive coronary arteries39
Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine38
Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology38
Tocilizumab for the treatment of immune-related adverse events: a systematic literature review and a multicentre case series37
Blood pressure increase after Pfizer/BioNTech SARS-CoV-2 vaccine36
Consumer-led screening for atrial fibrillation using consumer-facing wearables, devices and apps: A survey of health care professionals by AF-SCREEN international collaboration35
Safety and Tolerability of Neurohormonal Antagonism in Cardiac Amyloidosis33
Optimizing antibiotic therapies to reduce the risk of bacterial resistance33
“Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations33
ANCA associated vasculitis32
How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity32
Management of hyperuricemia in asymptomatic patients: A critical appraisal32
Transthyretin amyloid cardiomyopathy: An uncharted territory awaiting discovery30
COVID-19, vaccines and deficiency of ACE2 and other angiotensinases. Closing the loop on the "Spike effect"30
Pneumothorax/pneumomediastinum in non-intubated COVID-19 patients: Differences between first and second Italian pandemic wave29
Screening for pulmonary arterial hypertension in systemic sclerosis: A systematic literature review.29
Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis29
Therapeutic strategies for virus-negative myocarditis: a comprehensive review29
Assessing the impact of COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study28
Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure27
Drug-induced liver injury: Pathogenesis, epidemiology, clinical features, and practical management27
Seventeen-year trend (2001–2017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: An analysis by age groups26
Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroente26
kinetics of anti-SARS-CoV-2 antibodies over time. Results of 10 month follow up in over 300 seropositive Health Care Workers25
Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation25
NAFLD and autoimmune hepatitis: Do not judge a book by its cover25
Comparing atrial fibrillation guidelines: Focus on stroke prevention, bleeding risk assessment and oral anticoagulant recommendations24
Interleukin-6 receptor blockade with subcutaneous tocilizumab improves coagulation activity in patients with COVID-1924
Left atrial diameter thresholds and new incident atrial fibrillation in embolic stroke of undetermined source24
Physical decline and cognitive impairment in frail hypertensive elders during COVID-1924
Effect of SGLT-2 inhibitors on cardiovascular outcomes in heart failure patients: A meta-analysis of randomized controlled trials23
Equity, diversity, and inclusion in academic internal medicine at US medical schools23
Smoking habit and hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia: The unsolved paradox behind the evidence.23
Incident atrial fibrillation and its risk prediction in patients developing COVID-19: A machine learning based algorithm approach23
The efficacies of entecavir and tenofovir in terms of enhancing prognosis after curative treatment of hepatitis B virus–related hepatocellular carcinoma23
Acidosis predicts mortality independently from hyperlactatemia in patients with sepsis23
Assessing the association between fluoroquinolones and emerging adverse drug reactions raised by regulatory agencies: An umbrella review23
Epidemiology of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis22
Speckle tracking echocardiography in patients with systemic lupus erythematosus: A meta-analysis22
Hyperhomocysteinemia in patients with acute porphyrias: A potentially dangerous metabolic crossroad?22
ChAdOx1 nCoV-19 effectiveness during an unprecedented surge in SARS COV-2 infections22
Comparative influence of Acute Illness Severity and comorbidity on mortality21
Diagnosis and treatment of hypertensive emergencies and urgencies among Italian emergency and intensive care departments. Results from an Italian survey: Progetto GEAR (Gestione dell'Emergenza e urgen21
No double-edged sword and no doubt about the relation between smoking and COVID-19 severity21
Active smoking and COVID-19: a double-edged sword21
Obesity as an adipose tissue dysfunction disease and a risk factor for infections – Covid-19 as a case study21
Management of chronic refractory cough in adults21
Physical activity in management of persons with obesity21
The power of choice: Experimental evidence that freedom to choose a vaccine against COVID-19 improves willingness to be vaccinated21
Treating periodontal disease in patients with myocardial infarction: A randomized clinical trial21
Primary adrenal insufficiency associated with Oxford-AstraZeneca ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia (VITT)21
Is low sodium intake a risk factor for severe and fatal COVID-19 infection?20
A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry20
Screening for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography - a prospective, cross sectional study20
Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome20
Monkeypox infection: An update for the practicing physician20
Effects of benzodiazepines on orthostatic blood pressure in older people20
COVID-19 vaccination and a severe pain in the neck20
Serum IgG4 level predicts COVID-19 related mortality19
The discriminatory power of bleeding assessment tools in adult patients with a mild to moderate bleeding tendency19
The age-adjusted Charlson comorbidity index: A significant predictor of clinical outcome in patients with heart failure18
Depression is independently associated with increased length of stay and readmissions in multimorbid inpatients18
Obesity and sleep disturbances: The “chicken or the egg” question18
Both lean and fat body mass associate with blood pressure18
Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values18
Standardizing PaO2 for PaCO2 in P/F ratio predicts in-hospital mortality in acute respiratory failure due to Covid-19: A pilot prospective study18
Long term clinical outcomes in survivors after out-of-hospital cardiac arrest18
The Atrial fibrillation Better Care (ABC) pathway and cardiac complications in atrial fibrillation: a potential sex-based difference. The ATHERO-AF study18
Rifabutin-Based Triple Therapy Or Bismuth-Based Quadruple Regimen As Rescue Therapies For Helicobacter pylori Infection17
Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy17
Knowing the new Omicron BA.2.75 variant (‘Centaurus’): A simulation study17
Inhaled long-acting muscarinic antagonists in asthma – A narrative review17
Covid-19 cases in a no-Covid-19 geriatric acute care setting. A sporadic occurrence?17
Long-term outcomes of postoperative atrial fibrillation following non cardiac surgery: A systematic review and metanalysis17
Sarcopenia measurement in research and clinical practice17
Efficacy and safety of rituximab biosimilar (CT-P10) in IgG4-related disease: an observational prospective open-label cohort study17
Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study17
Acute kidney injury associated with non-steroidal anti-inflammatory drugs17
Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy17
Varicella-Zoster virus reactivation following severe acute respiratory syndrome coronavirus 2 vaccination or infection: New insights17
Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis17
Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-1917
Efficacy and safety of molnupiravir for COVID-19 patients17
Age-Related Changes in Clinical Presentation of Covid-19: the EPICOVID19 Web-Based Survey17
Thrombosis with Thrombocytopenia Syndrome associated with viral vector COVID-19 vaccines17
Management and outcomes of post-acute COVID-19 patients in Northern Italy16
Acute hemolysis by hydroxycloroquine was observed in G6PD-deficient patient with severe COVD-19 related lung injury16
Multimorbidity in COPD, does sleep matter?16
Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients16
Serum uric acid and outcomes in patients with chronic heart failure through the whole spectrum of ejection fraction phenotypes: Analysis of the ESC-EORP Heart Failure Long-Term (HF LT) Registry16
Practical use of Direct Oral Anti Coagulants (DOACs) in the older persons with atrial fibrillation.16
Treat-to-target in systemic lupus erythematosus: Where are we?16
Serum uric acid and mortality thresholds among men and women in the Irish health system: A cohort study16
Erectile dysfunction and adherence to antihypertensive therapy: Focus on β-blockers16
The impact of nutrition and lifestyle modification on health16
Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment16
Neurological diseases of unknown etiology: Brain-biopsy diagnostic yields and safety16
Serial investigation of Angiotensin-Converting Enzyme in sarcoidosis patients treated with Angiotensin-Converting Enzyme Inhibitor16
Sweet taste and obesity15
Recent advances in pericarditis15
Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave15
Hyperhomocysteinemia in patients with acute porphyrias: a possible effect of ALAS1 modulation by siRNAm therapy and its control by vitamin supplementation15
COVID-19: Timing is Important15
Coffee Consumption is Associated with a Decreased Risk of Incident Chronic Kidney Disease: A Systematic Review and Meta-analysis of Cohort Studies15
Spirometry: A practical lifespan predictor of global health and chronic respiratory and non-respiratory diseases15
Direct oral anticoagulants versus vitamin K antagonists in antiphospholipid syndrome: A meta-analysis.15
Chronic cough in adults15
Hypernatremia and moderate-to-severe hyponatremia are independent predictors of mortality in septic patients at emergency department presentation: A sub-group analysis of the need-speed trial15
Proton pump inhibitors and cardiovascular adverse effects: Real or surreal worries?15
“Let me choose my COVID-19 vaccine”15
The importance of recognizing cerebral venous thrombosis following anti-COVID-19 vaccination15
Increased serum uric acid level predicts poor prognosis in mildly severe chronic heart failure with reduced ejection fraction. An analysis from the MECKI score research group14
Alcohol consumption and risk of incident atrial fibrillation: A population-based cohort study14
A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score14
Clinical phenotypes and prediction of chronicity in sarcoidosis using cluster analysis in a prospective cohort of 694 patients14
Sympathetic activation and outcomes in chronic heart failure: Does the neurohormonal hypothesis apply to mid-range and preserved ejection fraction patients?14
Identification of chronic thromboembolic pulmonary hypertension on CTPAs performed for diagnosing acute pulmonary embolism depending on level of expertise14
Covid-19 in Italy: Lesson from the Veneto Region14
The coupling between sarcopenia and COVID-19 is the real problem14
Humoral SARS-COV-2 IgG decay within 6 months in COVID-19 healthy vaccinees: The need for a booster vaccine dose?14
Lung ultrasonography: A prognostic tool in non-ICU hospitalized patients with COVID-19 pneumonia14
Tocilizumab for severe COVID-19: A promising intervention affecting inflammation and coagulation14
The yield of F18 FDG PET-CT for the investigation of fever of unknown origin, compared with diagnostic CT14
Surveillance and management of colorectal dysplasia and cancer in inflammatory bowel disease: Current practice and future perspectives13
COVID-19 randomized controlled trials in medRxiv and PubMed13
SARS-CoV-2 infection among asymptomatic homebound subjects in Milan, Italy13
Cardiac involvement in eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome): Prospective evaluation at a tertiary referral centre13
Future directions in obesity pharmacotherapy13
High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis13
THE role of metabolic syndrome in blood pressure control and pulse wave velocity progression over a 3.5 years in treated hypertensive PATIENTS.13
High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study13
Lessons from pathophysiology: Use of individualized combination treatments with immune interventional agents to tackle severe respiratory failure in patients with COVID-1913
The association between education level and chronic liver disease of any etiology13
Adherence to the “Atrial fibrillation Better Care” (ABC) pathway in patients with atrial fibrillation and cancer: A report from the ESC-EHRA EURObservational Research Programme in atrial fibrillation 13
Non-alcoholic fatty liver disease: identical etiologic factors in patients with type 1 and type 2 diabetes13
Detection of subclinical atrial fibrillation after cryptogenic stroke using implantable cardiac monitors13
Prevalence and risk factors for pulmonary embolism in patients with suspected acute exacerbation of COPD: a multi-center study.13
Longitudinal changes of left and right cardiac structure and function in patients with end-stage renal disease on replacement therapy13
Waste in COVID-19 clinical trials conducted in western Europe12
Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry12
Refining age stratum of the C2HEST score for predicting incident atrial fibrillation in a hospital-based Chinese population12
Atrial cardiomyopathy markers and new-onset atrial fibrillation risk in patients with acute myocardial infarction12
Venous thromboembolism during pregnancy and postpartum period12
Early osteopontin levels predict mortality in patients with septic shock12
The challenge of implementing Less is More medicine: A European perspective12
Pre-operative physical performance as a predictor of in-hospital outcomes in older patients undergoing elective cardiac surgery12
Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism12
The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues12
Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort.12
Pre-transplant diabetes predicts atherosclerotic vascular events and cardiovascular mortality in liver transplant recipients: a long-term follow-up study12
Impact of point of care ultrasound on the number of diagnostic examinations in elderly patients admitted to an internal medicine ward12
Negligible HCC risk during stringently defined untreated immune-tolerant phase of chronic hepatitis B12
Active smoking and severity of coronavirus disease 2019 (COVID-19): The use of significance testing leads to an erroneous conclusion12
The link between nutritional status and outcomes in COVID-19 patients in ICU: Is obesity or sarcopenia the real problem?12
The COVID-19 burden for health care professionals: Results of a global survey12
Blood pressure increase during hospitalization for COVID-1912
Thrombocytopenia in primary antiphospholipid syndrome, a marker of high-risk patients?12
Prognostic impact of Vitamin D deficiency in patients with coronary artery disease undergoing percutaneous coronary intervention11
Adiponectin involved in portal flow hepatic extraction of 13C-methacetin in obesity and non-alcoholic fatty liver11
C-reactive protein and 10-year cardiovascular risk in rheumatoid arthritis11
Point of care ultrasound for rapid assessment and treatment of palliative care patients in acute medical settings11
The prognostic effect of left ventricular thrombus formation after acute myocardial infarction in the contemporary era of primary percutaneous coronary intervention: A meta-analysis11
Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: Insights from the iCOR randomised controlled trial11
Inappropriate use of carbapenems in an internal medicine ward: Impact of a carbapenem-focused antimicrobial stewardship program11
Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: A systematic review and meta-regression11
Heart failure etiologies and clinical factors precipitating for worsening heart failure: Findings from BIOSTAT-CHF11
Light anti-thrombotic regimen for prevention of device thrombosis and/or thrombotic complications after interatrial shunts device-based closure11
Identification and management of acute alcohol intoxication11
Predictive value of the Canada Acute Coronary Syndrome risk score for post-acute myocardial infarction infection11
Autologous fecal microbiota transplantation can retain the metabolic achievements of dietary interventions11
Embolic risk stratification and prognostic impact of early surgery in left-sided infective endocarditis11
Quality of care after AKI development in the hospital: Consensus from the 22nd Acute Disease Quality Initiative (ADQI) conference11
Validation of the AF-ESUS score to identify patients with embolic stroke of undetermined source and low risk of device-detected atrial fibrillation11
Effects of non-invasive respiratory supports on inspiratory effort in moderate-severe COVID-19 patients. A randomized physiological study10
Why should we use convalescent plasma for COVID-19?10
Alcoholic liver disease and autoimmune hepatitis: Sometimes a closer look under the surface is needed10
Why optional inferior vena cava filters are not always retrieved? A real world 19 years experience in a Swiss tertiary care university hospital.10
POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence10
Sex-specific outcomes and management in critically ill septic patients10
The ISTH DIC score predicts outcome in non-septic patients admitted to a cardiovascular intensive care unit10
Phenotyping congestion in patients with acutely decompensated heart failure with preserved and reduced ejection fraction: The Decongestion duRing therapY for acute decOmpensated heart failure in HFpEF10
Timeline analysis of clinical severity of COVID-19 in the general population10
Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohort10
Management of venous thromboembolism in cancer patients: Considerations about the clinical practice guideline update of the American society of clinical oncology10
COVID-19 and hydroxychloroquine: Is the wonder drug failing?10
Prevalence, risk factors and proteomic bioprofiles associated with heart failure in rheumatoid arthritis: The RA-HF study10
Risk of stroke in CYP2C19 LoF polymorphism carrier coronary artery disease patients undergoing clopidogrel therapy: An ethnicity-based updated meta-analysis10
Diagnostic accuracy of D-Dimer testing for recurrent venous thromboembolism: A systematic review with meta-analysis.10
SARS-CoV-2 vaccine-induced cerebral venous thrombosis10
Response to mepolizumab according to disease manifestations in patients with eosinophilic granulomatosis with polyangiitis10
Cardiopulmonary exercise test with stress echocardiography in COVID-19 survivors at 6 months follow-up10
Estimated 10-year cardiovascular risk in a large Italian cohort of rheumatoid arthritis patients: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group10
Definition of tachycardia for risk stratification of pulmonary embolism10
Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia10
Sex-specific differences in the presentation, clinical course, and quality of life of patients with acute venous thromboembolism according to baseline risk factors. Insights from the PREFER in VTE10
Interstitial pneumonia with autoimmune features: Evaluation of connective tissue disease incidence during follow-up10
Interleukin-6 inhibitors reduce mortality in coronavirus disease-2019: An individual patient data meta-analysis from randomized controlled trials10
Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C?10
Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases9
A systematic bias assessment of top-cited full-length original clinical investigations related to COVID-199
Efficacy and safety of steroid-sparing treatments in giant cell arteritis according to the glucocorticoids tapering regimen: A systematic review and meta-analysis9
Influence of BMI and geographical region on prescription of oral anticoagulants in newly diagnosed atrial fibrillation: The GLORIA-AF Registry Program9
Exploring the possible link between myocarditis and mRNA COVID-19 vaccines9
Long term consequences of COVID-199
Neuraminidase inhibitors are effective and safe in reducing influenza complications: meta-analysis of randomized controlled trials.9
Is the 2020 Sampson equation the best formula for LDL-C estimation?9
Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation?9
NEWS2 is a valuable tool for appropriate clinical management of COVID-19 patients9
Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure9
Exploring the recovery curve for long-term post-COVID dyspnea and fatigue9
Infective endocarditis in patients with solid organ transplantation. A nationwide descriptive study9
A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows9
Temporal changes in co-morbidities and mortality in patients hospitalized for COVID-19 in Italy9
Renin-angiotensin-aldosterone system inhibition in patients affected by heart failure: efficacy, mechanistic effects and practical use of sacubitril/valsartan. Position Paper of the Italian Society of9
Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations9
Fibroblast growth factor 23 predicts carotid atherosclerosis in individuals without kidney disease. The CORDIOPREV study9
Sustainable and personalized nutrition: From earth health to public health9
Clinical significance of anti-Ro52 (TRIM21) antibodies in adult patients with connective tissue diseases9
Non-classical clinical presentation at diagnosis by male celiac disease patients of older age9