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Sample records for elderly patients covered

  1. The elderly patients' dignity

    DEFF Research Database (Denmark)

    Høy, Bente; Hall, E.O.C.; Wagner, L.

    2007-01-01

    This study shows how care providers in hospital practice perceive the elderly patient's dignity as a core value in health promoting care towards the elderly. Fifteen focus group interviews were conducted with care providers who told about their nursing practice experience. The interviews were...... analysed using a phenomenological hermeneutical approach. The results disclose that when caring for the elderly patient's health potential, care providers saw dignity as the core value of health. Dignity was found to capture three themes: autonomy, identity, and worthiness. These themes reflect...

  2. [Surgical emergencies in elderly patients].

    Science.gov (United States)

    Cohen-Bittan, Judith; Lazareth, Helene; Zerah, Lorene; Forest, Anne; Boddaert, Jacques

    2011-01-01

    Surgical emergencies represent a diverse combination of common and particularly severe pathologies in elderly patients. This severity is due in part to concurrent comorbidities and sometimes atypical clinical presentations, causing delay in diagnosis and treatment.

  3. [Nutritional anemias in elderly patients].

    Science.gov (United States)

    Serraj, Khalid; Federici, Laure; Kaltenbach, Georges; Andrès, Emmanuel

    2008-09-01

    Nutritional deficiencies cause one third of the cases of anemia in the elderly. The urgency of anemia management in elderly patients depends on tolerance and repercussions, rather than only on the hemoglobin level. Iron, vitamin B12 and folate are the most common deficiencies, and their levels should be tested. Chronic gastrointestinal bleeding is the principal cause of iron-deficiency anemia. Management is based on supplementation combined with effective etiological treatment.

  4. Brief hospitalizations of elderly patients

    DEFF Research Database (Denmark)

    Strømgaard, Sofie; Rasmussen, Søren Wistisen; Schmidt, Thomas Andersen

    2014-01-01

    BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of les...... care sector, yet who do not belong at the emergency department. Further studies are needed to create a suitable service for these patients, and to improve the continuity of the treatment and the cooperation between hospitals and the primary health care sector.......BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less...... than 24 hours, as such short admissions could indicate that the patients had not been severely ill and that it might have been possible in these cases to avoid hospitalization. METHODS: Medical records were examined to determine the number of patients aged 75 or more who passed through the emergency...

  5. [Urinary diversion in elderly patients].

    Science.gov (United States)

    Spahn, M; Boxler, S

    2015-12-01

    Bladder cancer represents one of the ten most prevalent cancers worldwide. More than 400,000 people worldwide are newly diagnosed every year. Within 2 years after diagnosis, 80% of patients with muscle invasive bladder cancer without treatment die. The aggressive local surgical approach with a cystectomy is the therapy of choice. The median age of patients with de novo bladder cancer is 70 years. Thus bladder cancer is a cancer of the elderly. For demographical reasons, the number of eldery patients undergoing radical cystectomy will rise in the next few years. The type of urinary diversion is a major factor influencing perioperative morbidity and quality of life in these patients. Incontinent urinary diversions are preferentially used in daily practice. There are only a few contraindications for orthotopic neobladder; however, age alone is not a contraindication. Patient selection and a nerve sparing approach are crucial in men and women to achieve excellent functional results with orthotopic neobladder in elderly patients.

  6. Radiation therapy in elderly patients

    International Nuclear Information System (INIS)

    Terradas, M.; Santini, A.; Mara, C.

    2004-01-01

    Elderly patients, or those individuals over 65 or 70 depending on the different authors, represent the majority of cancer patients who treated with radiation therapy (RT), however there are very few publications that we provide information needed to evaluate the use of RT in the treatment elders regarding: indication of dose, tissue tolerance, toxicity and association with other therapeutic modalities. In the treatment process must take into account RT radiobiology Clinical applied to each patient and is more relevant in the elderly in which often are comorbid conditions and functional limitations normal tissues increases with age and disease coexisting vascular and connective influencing RT treatment. Chronological age does not correlate with the biological age for tolerance normal tissue, however frequently refers to healthy tissue in the elderly are less tolerant than healthy tissue RT adults young but no data in the literature to support it and perhaps those claims probably based on the presence of comorbid conditions or diseases associated or previous surgeries that influence the risk of tissue damage healthy. Studies conducted by the EORTC not show differences in toxicity acute and late age-related. Elderly patients tolerate RT like younger patients with comparable side effects. In the case of concurrent chronic diseases should take into account a possible modification of the dose and volume irradiated to prevent the risk develop permanent damage or sector body lest un irradiated able to compensate for the loss of function of the irradiated tissue; but we should always note that the dose reduction while reducing the risk of complications also decreases the chance of cure

  7. Respiratory failure in elderly patients.

    Science.gov (United States)

    Sevransky, Jonathan E; Haponik, Edward F

    2003-02-01

    Elderly individuals comprise an increasing proportion of the population and represent a progressively expanding number of patients admitted to the ICU. Because of underlying pulmonary disease, loss of muscle mass, and other comorbid conditions, older persons are at increased risk of developing respiratory failure. Recognition of this vulnerability and the adoption of proactive measures to prevent decompensation requiring intrusive support are major priorities together with clear delineation of patients' wishes regarding the extent of support desired should clinical deterioration occur. Further, the development of coordinated approaches to identify patients at risk for respiratory failure and strategies to prevent the need for intubation, such as the use of NIV in appropriate patients, are crucial. As soon as endotracheal intubation and mechanical ventilation are implemented strategies that facilitate the liberation of elderly patients from the ventilator are especially important. The emphasis on a team approach, which characterizes geriatric medicine, is essential in coordinating the skills of multiple health care professionals in this setting. Respiratory failure can neither be effectively diagnosed nor managed in isolation. Integration with all other aspects of care is essential. Patient vulnerability to nosocomial complications and the "cascade effect" of these problems such as the effects of medications and invasive supportive procedures all impact on respiratory care of elderly patients. For example, prolonged mechanical ventilation may be required long after resolution of the underlying cause of respiratory failure because of unrecognized and untreated delirium or residual effects of small doses of sedative and/or analgesic agents or other medications in elderly patients with altered drug metabolism. The deleterious impact of the foreign and sometimes threatening ICU environment and/or sleep deprivation on the patient's course are too often overlooked because

  8. DENGUE INFECTION IN ELDERLY PATIENTS.

    Science.gov (United States)

    Tiawilai, Thawat; Tiawilai, Anongrat; Nunthanid, Somboon

    2015-01-01

    From 2005 to 2013, there were 15 dengue patients aged over 60 years old who were admitted to Photharam Hospital, Ratchaburi, Thailand. Ten were females and five were males. Nine had dengue fever (DF), and 6 had dengue hemorrhagic fever (DHF). A trending shift in age group towards adults has been seen during the past decades. No deaths were seen in these elderly patients with dengue disease, indicating early recognition and effective management of these dengue patients. The trend towards higher age in dengue patients is a problem of concern, which needs further elaboration.

  9. [Acute abdomen in elderly patients].

    Science.gov (United States)

    Machado, M A; Pereira, E A; Lourenção, J L; Branco, P D

    1990-01-01

    Seventy nine elderly patients with acute abdominal conditions were operated on in the Emergency Service of the Hospital das Clinicas of the University of São Paulo from 1981 to 1985. Total mortality rate was 58.23%. In patients with acute vascular abdominal conditions it was 100%, in inflammatory conditions 55.17% and in intestinal obstruction 47.83%. The lowest mortality was observed in traumatic conditions (27.27%). Procrastination of operations was followed by higher mortality. In operations lasting more than three hours the mortality was significantly higher than in those lasting less than three hours. Associated diseases as well as reoperations increased the postoperative mortality.

  10. Perioperative renal failure in elderly patients.

    Science.gov (United States)

    Mårtensson, Johan; Bellomo, Rinaldo

    2015-04-01

    To describe the epidemiology, pathophysiology, diagnosis and management of perioperative acute kidney injury (AKI) in elderly patients. Elderly patients with a reduced renal reserve and multiple comorbidities have a higher risk of developing AKI after surgery. Postoperative AKI is diagnosed late and may even go undetected in immobilized elderly patients because of loss of muscle mass and reduced creatinine production. Panels of injury biomarkers could improve early risk stratification, but this approach needs further evaluation. The evidence for perioperative AKI prevention or treatment with renal vasodilators or remote ischaemic preconditioning is conflicting and needs further research. Avoiding hypotension, venous congestion and fluid overload appear important to protect elderly patients and their kidneys from harm. Continuous rather than intermittent renal replacement therapy should be considered early when the response to diuretics is insufficient to prevent fluid overload. Postoperative AKI incidence is expected to rise as the number of elderly patients undergoing surgery is increasing. Biomarkers of early AKI will likely be important for the future development and validation of novel treatment strategies. The haemodynamic management of the elderly surgical patient should focus on avoiding hypotension and high central venous pressures.

  11. Deinstitutionalizing Elderly Patients: A Program of Resocialization

    Science.gov (United States)

    Siegel, Barry; Lasker, Judith

    1978-01-01

    In a program of deinstitutionalization 61 elderly state hospital patients were successfully placed outside the institution. Changes in definition of the patients' situation, collective approach to resocialization, careful medical evaluation, and familiarity of patients with possible alternatives help reduce patients' commitment to the institution…

  12. Orthostatic hypotension in elderly patients.

    NARCIS (Netherlands)

    Hartog, Laura

    2017-01-01

    Orthostatic hypotension (OH) is defined as a decrease in blood pressure (BP) after changing from supine to standing position and is frequently diagnosed in the elderly population. Information is limited with regard to differences between the various methods to determine OH, and about the

  13. Sarcopenia and frailty in elderly trauma patients.

    Science.gov (United States)

    Fairchild, Berry; Webb, Travis P; Xiang, Qun; Tarima, Sergey; Brasel, Karen J

    2015-02-01

    Sarcopenia describes a loss of muscle mass and resultant decrease in strength, mobility, and function that can be quantified by CT. We hypothesized that sarcopenia and related frailty characteristics are related to discharge disposition after blunt traumatic injury in the elderly. We reviewed charts of 252 elderly blunt trauma patients who underwent abdominal CT prior to hospital admission. Data for thirteen frailty characteristics were abstracted. Sarcopenia was measured by obtaining skeletal muscle cross-sectional area (CSA) from each patient's psoas major muscle using Slice-O-Matic(®) software. Dispositions were grouped as dependent and independent based on discharge location. χ (2), Fisher's exact, and logistic regression were used to determine factors associated with discharge dependence. Mean age 76 years, 49 % male, median ISS 9.0 (IQR = 8.0-17.0). Discharge destination was independent in 61.5 %, dependent in 29 %, and 9.5 % of patients died. Each 1 cm(2) increase in psoas muscle CSA was associated with a 20 % decrease in dependent living (p psoas major muscle CSA is related to discharge destination in elderly trauma patients and can be obtained from the admission CT. Lower psoas muscle CSA is related to loss of independence upon discharge in the elderly. The early availability of this variable during the hospitalization of elderly trauma patients may aid in discharge planning and the transition to dependent living.

  14. Treatment of Elderly Patients With Mantle Cell Lymphoma

    NARCIS (Netherlands)

    Kluin-Nelemans, Hanneke C.; Doorduijn, Jeanette K.

    Treatment of elderly patients with a mantle cell lymphoma (MCL) is a challenge. High-dose cytarabine and autologous transplantation, both important components of the treatment in younger patients, are not feasible for most elderly patients. However, in fit elderly patients long progression-free

  15. Managing multiple myeloma in elderly patients.

    Science.gov (United States)

    Diamond, Evan; Lahoud, Oscar B; Landau, Heather

    2017-08-28

    Multiple myeloma (MM) is a plasma cell neoplasm that affects elderly individuals with two-thirds of patients over 65 years at diagnosis. However, data available are derived from clinical trials conducted in younger patients. Fewer studies investigated treatment options in the elderly. This review summarizes the clinical outcomes and toxicities associated with therapeutic regimens in older patients including doublet, triplet and high dose therapyin newly diagnosed patients and relapsed patients with MM. We highlight the importance of an approach tailored to individuals, incorporates the geriatric frailty assessment, considers comorbiditiess and commits to early recognition and management of toxicities ranging from myelosuppression to polypharmacy. To date, no trial has prospectively investigated a tailored treatment paradigm in older patients based on frailty and/or comorbidities. As the population ages, the proportion of MM patients with advanced age will grow. Studies are indicated to determine optimal treatment approaches in this increasingly heterogeneous geriatric population.

  16. Affective functioning after delirium in elderly hip fracture patients

    NARCIS (Netherlands)

    Slor, C.J.; Witlox, J.; Jansen, R.W.M.M.; Adamis, D.; Meagher, D.J.; Tieken, E.; Houdijk, A.P.J.; van Gool, W.A.; Eikelenboom, P.; de Jonghe, J.F.M.

    2013-01-01

    ABSTRACT Background: Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. Methods: For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline

  17. Gastric cancer surgery in elderly patients.

    Science.gov (United States)

    Gretschel, Stephen; Estevez-Schwarz, Lope; Hünerbein, Michael; Schneider, Ulrike; Schlag, Peter M

    2006-08-01

    To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer. All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival. There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; PPatient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.

  18. Managing myelodysplastic symptoms in elderly patients

    Directory of Open Access Journals (Sweden)

    R Ria

    2009-10-01

    Full Text Available R Ria, M Moschetta, A Reale, G Mangialardi, A Castrovilli, A Vacca, F DammaccoDepartment of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, ItalyAbstract: Most patients with myelodysplastic syndromes (MDS are elderly (median age range 65 to 70 years; as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone

  19. ANTIHYPERTENSIVE TREATMENT IN ELDERLY PATIENTS WITH DIHYDROPYRIDINE CALCIUM ANTAGONISTS

    Directory of Open Access Journals (Sweden)

    Y. A. Karpov

    2006-01-01

    Full Text Available The proofs of necessity of active arterial hypertension (AH treatment in elderly patients are given. Peculiarities of pathogenesis of AH in elderly patients, connected predominantly with loss of big arteries elasticity and reasoning widely spread of isolated systolic AH in these patients, are discussed. Advantages of dihydropyridine calcium antagonists (DPCA for AH treatment in elderly patients are proved, safety of treatment with DPCA is discussed. Data of clinical studies is analyzed. Analysis of target levels of blood pressure for antihypertensive treatment in elderly hypertensive patients is made. As a conclusion DPCA are the medicines of choice for AH treatment in elderly patients.

  20. Managing myelodysplastic symptoms in elderly patients.

    Science.gov (United States)

    Ria, R; Moschetta, M; Reale, A; Mangialardi, G; Castrovilli, A; Vacca, A; Dammacco, F

    2009-01-01

    Most patients with myelodysplastic syndromes (MDS) are elderly (median age range 65 to 70 years); as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone marrow function, including the diminished capacity of response to stressors such as infection or myelosuppressive treatments. Through the integration of geriatric and oncological strategies, a personalized approach toward this unique population may be applied. As

  1. Profile of Ear Diseases among Elderly Patients in Sagamu, South ...

    African Journals Online (AJOL)

    The importance of screening for hearing impairment in the elderly patients was also stressed. KEYWORDS: Cerumen, Ear disease, Elderly, Otitis, Presbycusis. Erratum Note: Olusola AS on the article “Profile of Ear Diseases among Elderly Patients in Sagamu, South-Western Nigeria” on Page Nig. J. Med 2013. 143-147.

  2. [Nutritional status of elderly surgical patients].

    Science.gov (United States)

    Damuleviciene, Gyte; Lesauskaite, Vita; Macijauskiene, Jūrate

    2008-01-01

    The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it. A total of 156 patients aged 45 years and more, treated at the Departments of Surgery and Urology of Kaunas 2nd Clinical Hospital, were enrolled in the study. Elderly group (aged 65 years and more) consisted of 99 patients, and middle-aged group (45 to 64 years old) of 57 patients. The following anthropometric measurements were performed: weight, height, mid-arm circumference; hemoglobin, serum albumin level, and total lymphocyte count were determined. Standard assessment scales included Instrumental Activities of Daily Living, Geriatric Depression Scale, and Mini Mental State Exam. Statistical analysis was performed with the help of SPSS 12.0. Malnutrition was diagnosed in 53.5% of older patients and in 15.8% of middle-aged patients (Pcognitive functions than among those without impaired cognitive functions (in 100% of patients with medium impaired cognitive function, in 59.3% of patients with mild impaired cognitive function, and in 44.4% of patients with unimpaired cognitive function, Pfunctional level than the remaining (IADL score of 3.97 and 4.75 for men, 5.38 and 6.89 for women, respectively; P0.05). Malnutrition was diagnosed more frequently in elderly surgical patients than in middle-aged patients. Obesity was more common in women than in men. The prevalence of obesity was not associated with age. Malnutrition in elderly surgical patients was associated with poor functional status, impaired cognitive function, and urgent operation.

  3. Outcome of Colonic Surgery in Elderly Patients with Colon Cancer

    OpenAIRE

    Hermans, E.; van Schaik, P. M.; Prins, H. A.; Ernst, M. F.; Dautzenberg, P. J. L.; Bosscha, K.

    2010-01-01

    Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly m...

  4. Indications for tube feedings in elderly patients.

    Science.gov (United States)

    Ciocon, J O

    1990-01-01

    Tube feedings are utilized in elderly patients with acute and chronic problems. Inadequate oral intake with malnutrition, comatose state, neurologic disorders with severe dysphagia, extensive burns, massive gastrointestinal resection, and oropharyngeal and upper gastrointestinal malignancies are the commonly encountered conditions requiring tube alimentation. Dysphagia with frequent aspiration is the most common indication for use of tube feedings in the elderly. Nasogastric tube is preferred for short-term feeding, while gastrostomy or jejunostomy is indicated for long-term or permanent nutritional support. Nutritional assessment should be done initially and on a regular basis. Specific formulas are available to calculate height, weight, and caloric needs of bedbound elderly patients. Various enteral feeding formulas are available for a specific clinical condition and are preferably administered by continuous drip using a pump. Parenteral nutrition is also indicated for certain situations in which enteral feeding cannot meet the patient's nutritional requirement, and in particular situations where enteral feeding is contraindicated and not feasible. Optimal patient care is dependent on adequate nutritional support.

  5. Pharmacological pain management in the elderly patient

    Directory of Open Access Journals (Sweden)

    Gary McCleane

    2008-01-01

    Full Text Available Gary McCleaneRampark Pain Centre, Lurgan, Northern Ireland, United KingdomAbstract: With the increasing number of elderly patients the issue of pain management for older people is of increasing relevance. The alterations with aging of the neurobiology of pain have impacts of pain threshold, tolerance and treatment. In this review the available evidence from animal and human experimentation is discussed to highlight the differences between young and older subjects along with consideration of how these changes have practical effect on drug treatment of pain. Cognitive impairment, physical disability and social isolation can also impact on the accessibility of treatment and have to be considered along with the biological changes with ageing. Conventional pain therapies, while verified in younger adults cannot be automatically applied to the elderly without consideration of all these factors and in no other group of patients is a holistic approach to treatment more important.Keywords: pain, analgesia, pain threshold, pain tolerance

  6. Constipation in elderly patients with psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Naresh Nebhinani

    2017-01-01

    Full Text Available Constipation is a common complaint among the elderly patients with psychiatric disorders because of age.related physiologic and anatomical changes, lifestyle factors, comorbid physical and surgical disorders, medications, including psychotropics, and polypharmacy. Lack of timely reporting by patients as well as inadequate expertise of physician may contribute to significant delay in treatment and poor quality of life. Primary constipation is amenable to lifestyle modification. (dietary changes, exercise, and physical activity, fiber intake, and laxatives when necessary. Secondary constipation should be treated with managing underlying pathology or predisposing factors, including effective treatment of psychiatric disorders and rationalizing psychotropic prescription. This review article focuses on the definition, etiology, assessment, treatment, and prevention of constipation in elderly population with mental illness.

  7. ANTIHYPERTENSIVE TREATMENT IN ELDERLY PATIENTS WITH DIHYDROPYRIDINE CALCIUM ANTAGONISTS

    OpenAIRE

    Y. A. Karpov; V. V. Buza

    2006-01-01

    The proofs of necessity of active arterial hypertension (AH) treatment in elderly patients are given. Peculiarities of pathogenesis of AH in elderly patients, connected predominantly with loss of big arteries elasticity and reasoning widely spread of isolated systolic AH in these patients, are discussed. Advantages of dihydropyridine calcium antagonists (DPCA) for AH treatment in elderly patients are proved, safety of treatment with DPCA is discussed. Data of clinical studies is analyzed. Ana...

  8. Impulse control disorders in elderly patients.

    Science.gov (United States)

    Tamam, Lut; Bican, Mehtap; Keskin, Necla

    2014-05-01

    There is no epidemiological study on the prevalence of impulse control disorders (ICDs) in the elderly population. The studies on ICDs in elderly patients are limited and some of them are case reports about pathological gambling and kleptomania. The comorbidity of other psychiatric disorders makes diagnosis difficult and has negative effects on both treatment and the prognosis of ICDs. The aim of this study was to determine the prevalence of ICDs among elderly patients and to evaluate the related sociodemographic and clinical features. A total of 76 patients aged 60 and over who have been referred to our outpatient clinics in a one-year period were included in the study. A demographic data form was completed. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) was used to determine axis I psychiatric disorders. The prevalence of ICDs was investigated by using the modified version of the Minnesota Impulse Disorders Interview (MIDI). Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). The Mini-Mental State Examination (MMSE) test was performed to evaluate the cognitive status of patients and to exclude the diagnosis of dementia. In addition, all patients completed Symptom Check List-90 (SCL-90). The prevalence rate of at least one comorbid ICD in our sample was 17%. When patients with a diagnosis of ICDs not otherwise specified (ICD-NOS) were included, the prevalence rate increased to 22.4%. The most common ICD was intermittent explosive disorder (15.8%), followed by pathological gambling (9.2%). The majority of the sample was men (54%), married (80%), had a high school education (51%), and mid-level socioeconomic status (79%). The only statistically significant difference between the sociodemographic characteristics of patients with or without ICDs was gender. The lifetime prevalence of ICDs was 34.1% in men and 8.6% in women. The prevalence of childhood conduct disorder

  9. Outcome of colonic surgery in elderly patients with colon cancer.

    Science.gov (United States)

    Hermans, E; van Schaik, P M; Prins, H A; Ernst, M F; Dautzenberg, P J L; Bosscha, K

    2010-01-01

    Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly more (P younger group was 62% compared with 36% in the elderly (P younger patients compared with 32% in the elderly (P < .05). Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative mortality and morbidity.

  10. [Nutrition for elderly acute stroke patients].

    Science.gov (United States)

    Ha, Lisa; Iversen, Per Ole; Hauge, Truls

    2008-09-11

    Elderly people have an increased risk of malnutrition due to biological and physiological changes and underlying disease. Almost 90% of the stroke patients are older than 65 years, and the consequences of acute stroke may lead to additional nutritional problems. This paper reviews nutritional therapy for stroke patients. PubMed was searched (non-systematically) for prospective cohort studies of occurrence, diagnostics and consequences of undernutrition in stroke patients. Randomized trials were examined to identify clinical effects of oral protein and energy supplements or tube feeding on nutritional status and intake, functional status, infections, length of stay, quality of life and mortality. 8-35% of stroke patients are undernourished. Body weight is one of the most important parameters for assessment of nutritional status. Dysphagia occurs in up to 80% of patients with acute stroke and increases the risk of undernutrition, which again leads to prolonged length of stay, reduced functional status and poorer survival. Early nasogastric tube feeding does not increase the risk of pneumonia and may improve survival after six months. Oral supplements lead to a significantly improved nutritional intake in undernourished stroke patients, as well as improved nutritional status and survival in undernourished elderly. Nutritional treatment can improve the clinical outcome after an acute stroke, provided that there are good procedures for follow-up and monitoring of the treatment.

  11. [Prescription drug abuse in elderly psychiatric patients].

    Science.gov (United States)

    Wetterling, Tilman; Schneider, Barbara

    2012-08-01

    Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Hepatocellular carcinoma in elderly patients: challenges and solutions.

    Science.gov (United States)

    Brunot, Angélique; Le Sourd, Samuel; Pracht, Marc; Edeline, Julien

    2016-01-01

    Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment. Unfit patients should be managed through a multidisciplinary team involving both oncological and geriatrician professionals. Specific studies and recommendations for HCC in the elderly should be encouraged.

  13. [Prevalence of metabolic syndrome in elderly patients].

    Science.gov (United States)

    Castro Vilela, María Elena; Quílez Pina, Raquel María; Bonafonte Marteles, José Luis; Morlanes Navarro, Teresa; Calvo Gracia, Fernando

    2014-01-01

    To determine the prevalence of metabolic syndrome (MS) according to the definitions of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF) and its relation to cardiovascular disease (CVD) in hospitalized elderly patients. This descriptive and prospective study (February-March 2011) included 200 consecutive patients hospitalized in a Geriatric Department. Sociodemographic, clinical and biochemical data was collected. The prevalence of MS was 65% (NCEP-ATP III) and 67.5% (IDF) and was greater in women (NCEP-ATP III=72.8%, IDF=73.6%) than in men (NCEP-ATP III=50.7%; IDF=56.3%). The mean age of patients diagnosed with MS by both diagnostic criteria were similar: 84.7 years. MS was not associated with an increased prevalence of CVD. MS is highly prevalent in elderly hospitalized patients, being higher in women, with both diagnostic criteria (NCEP- ATP III and IDF). In our population the MS was not associated with an increased prevalence of CVD. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

  14. [Treatment of hip fractures in elderly patients].

    Science.gov (United States)

    Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

    2015-04-01

    Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program. © Georg Thieme Verlag Stuttgart · New York.

  15. Cushing's disease in the elderly patient

    Directory of Open Access Journals (Sweden)

    Maritza Cardosa Samón

    2012-05-01

    Full Text Available Introduction: Cushing's disease arises from increased ACTH secretion from a pituitary tumor that stimulates the area fasciculata of the adrenal cortex and produces hypersecretion of glucocorticoids. Objectives: To explain the clinical and humoral manifestations of Cushing's disease in elderly adults. Methods: The article is a descriptive and retrospective study of a case report on a 62 year old patient that is admitted to our Center with manifestations of facial plethora and centripetal obesity. Onset was characterized by hypertension and diabetes mellitus. Definitive diagnosis was Cushing's disease from a macroadenoma with increased ACTH secretion.

  16. Descending necrotizing mediastinitis in the elderly patients

    Directory of Open Access Journals (Sweden)

    Mazzella Antonio

    2016-01-01

    Full Text Available Descending Necrotizing Mediastinitis (DNM is a polymicrobic, dangerous and often fatal process, arising from head or neck infections and spreading along the deep fascial cervical planes, descending into the mediastinum. It can rapidly progress to sepsis and can frequently lead to death. It has a high mortality rate, up to 40% in the different series, as described in the literature. Surgical and therapeutic management has been discussed for long time especially in an elderly patient population. The literature has been reviewed in order to evaluate different pathogenesis and evolution and to recognise a correct therapeutic management.

  17. Inguinal hernioraphy under local anesthesia in the elderly patients

    Directory of Open Access Journals (Sweden)

    Nurettin Kahramansoy

    2012-12-01

    Full Text Available Objectives: The incidence of inguinal hernia and the frequencyof comorbidity increase in the elderly. Therefore,in operations of these patients, anesthesia methods areimportant. The aim of our study was to investigate the feasibilityof local anesthesia in the operation of the elderly.Materials and methods: The patients operated for inguinalhernia were analyzed retrospectively. They weredivided into two groups: the elderly (>60 years and theyounger. Anesthesia methods, additional anesthesia requirementand complications were compared.Results: Of totally 177 patients, 30.5% were elderly.Operation type, anesthesia method and score of operationalrisk differed between groups. The percentage of comorbidity (55.6% in the elderly was significantly high (p<0.001. Among elderly, the frequency of co morbidity wasslightly higher in patients who had local anesthesia comparedto spinal and general anesthesia. Patients in youngand middle ages preferred to be operated less under localanesthesia (34.1% compared to elderly (70.4%. Therewas one case (2.6% converted to general anesthesiaas an additional anesthesia in the elderly group. Postoperativecomplications were slight more frequent in elderly.These cases were five in number (31.3% and were operatedunder spinal or general anesthesia (p=0.002.Conclusions: The frequency of co morbidity and riskscore of operation (ASA category rise in the elderly.However, inguinal hernioraphy can be performed underlocal anesthesia without complication and conversion togeneral anesthesia.Key words: Inguinal hernia; aged; comorbidity; local anesthesia

  18. [Pathophysiology of reflux esophagitis in the elderly patients].

    Science.gov (United States)

    Nakamura, Toshiya; Uetake, Tomoyoshi; Fujino, Masayuki A

    2002-08-01

    Recent reports indicate an increased prevalence of reflux esophagitis(RE) in Japan. There are many factors causing RE, and many kinds of changes associating aging are important in the causes of RE in the elderly patients. Characteristic features of the causes of RE in elderly patients are summarized here. Within the elderly patients, there are cases with persistent gastric acid secretion. Aging affections lead to esophageal motor dysfunctions and to failure of LES function(presbyesophagus). The elderly are complicated by orthopedic degenerative diseases with posture change due to osteoporosis; some pharmaceutical agents such as Ca-channel blockers or NSAIDs. Hiatal hernia is also an aggravating factor. In the future, elderly people with persistent gastric acid secretion will be increased based on declining prevalence of Helicobacter pylori. Therefore further increase in the prevalence and development of RE is foreseen in our country. Pathophysiology of RE in the elderly patients is expected to show various changes in the future.

  19. Risk Factors for Postoperative Cognitive Dysfunctions in Elderly Patients

    Directory of Open Access Journals (Sweden)

    N. Yu. Ibragimov

    2008-01-01

    Full Text Available Objective: to study the impact of a wide spectrum of factors on the development of postoperative delirium in elderly patients in relation to the changes in their cognitive functions depending on the type of anesthesia and period after surgery. Subjects and methods. The study covered 100 patients aged 65—90 years who had been electively operated on under general, regional, and combined anesthesia. Their cognitive status was elevated before and 1, 4, and 7 days after surgery, by using the Mini-Mental State Examination (MMSE schedule. The diagnosis was postoperatively established on the basis of interviews, by applying the diagnostic criteria of ICD-10 and DSM-IV (American Psychiatric Association, 1994 and verified by a psychiatrist’s consultation. Results. Seventeen patients developed delirium within the first two days following surgery. Elevated plasma sodium (p<0.000001, leukocytosis (p<0.00002, and postoperative analgesia mode (p<0.02 proved to be statistically significant risk factors for delirium. Worse results of MMSE tests at all postoperative stages than those obtained prior to surgery were significant (p<0.05. Comparing the results obtained on days 1, 4, and 7 showed a significant cognitive improvement. Analysis indicated no significant differences in MMSE changes between the groups of general, regional, and combined anesthesia at all study stages. Conclusion. In elderly patients, surgery and anesthesia lead to a considerable deterioration of cognitive functions even if the development of delirium can be avoided. There is a significant correlation of the development of delirium with leukocytosis, hypernatremia, and postoperative analgesia mode. Key words: anesthesia, postoperative delirium, cognitive status, MMSE, elderly age.

  20. Relative Risk of Deep Vein Thrombosis in Very Elderly Patients Compared With Elderly Patients.

    Science.gov (United States)

    Yayan, Josef; Bals, Robert

    2016-01-01

    Deep vein thrombosis (DVT) and pulmonary embolism are major causes of morbidity and mortality in patients during hospitalization; previous studies have proposed that an advanced age of more than 60 years is a risk factor for these conditions. This study analyzes the relative risk of DVT in very elderly patients older than 90 years of age compared with elderly patients aged 80 to 89 years. The study was performed at the Department of Internal Medicine, University Hospital of Saarland, Homburg/Saar, Germany, between 2004 and 2012. After completing ultrasound examinations, 20 (64.52%, 12 [60%] female patients, mean age 91.8 ± 1.83 years) of the 31 patients in the study group and 132 (62.26%, 87 [65.91%] female patients, mean age 83.84 ± 2.66 years) of the 212 patients in the control group were diagnosed with DVT. An increased relative risk of DVT was not discovered in the very elderly patients (relative risk, 1.04; P = .80). © The Author(s) 2014.

  1. Gerios: Recommending Drugs and Dosing for Elderly Patients

    OpenAIRE

    Peterson, Josh F.; Bates, David W.; Patel, Minal; Avorn, Jerry; Kuperman, Gilad J.

    2002-01-01

    Elderly patients are often exposed to inappropriate medications or overly high drug doses, often with adverse consequences. To assist providers with prescribing for the elderly, we designed a decision support system that delivers a recommended dose or suggests a medication substitution when medications are being ordered in hospitalized elderly patients. A baseline period of evaluation showed significant noncompliance with existing recommendations. We are currently assessing the impact of the ...

  2. Pulp sensibility test in elderly patients.

    Science.gov (United States)

    Farac, Roberta Vieira; Morgental, Renata Dornelles; Lima, Regina Karla de Pontes; Tiberio, Denise; dos Santos, Maria Teresa Botti Rodrigues

    2012-06-01

    The ageing process transforms the histological composition of the dental pulp and may affect the response to pulp sensibility tests. The aim of this study was to assess the influence of age on pulp response time and on pain intensity. Fifty elderly patients and 50 young patients were selected. Different classes of teeth were evaluated. The pulp sensibility test was performed with a refrigerant spray. The pulp response time was measured in seconds and the pain intensity was assessed by visual analogue scale. The Spearman coefficient was calculated and detect a positive correlation between age and pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). On the contrary, there was a negative correlation between age and pain intensity for maxillary incisors, mandibular incisors, and mean (p < 0.05). Also, the results of elderly and young groups were compared by Mann-Whitney test. Significant difference was noted regarding the pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). Significant difference was detected regarding the pain intensity for mandibular incisors only (p < 0.05). Pulp response time increases when people get older while pain intensity decreases. There were variations among the classes of teeth. © 2012 The Gerodontology Society and John Wiley & Sons A/S.

  3. Value of laparoscopic appendectomy in the elderly patient.

    Science.gov (United States)

    Kirshtein, Boris; Perry, Zvi Howard; Mizrahi, Solly; Lantsberg, Leonid

    2009-05-01

    Acute appendicitis (AA) in elderly patients (60 years of age and older) is a challenging problem associated with significant morbidity and mortality when perforation is present. We hypothesized that laparoscopic appendectomy (LA) would enable an earlier correct diagnosis and have advantages in elderly patients. We performed a retrospective review of patients who underwent laparoscopic appendectomy for suspected AA. Data of elderly patients were compared to data of younger patients (18 to <60 years of age). Fifty-four LA were performed in elderly patients and 423 in younger patients. Patients over the age of 60 years had more co-morbidities and required more frequent use of anticoagulants. Preoperative imaging (ultrasound or computerized tomography) was significantly more frequent in elderly patients (36% versus 15%), and was associated with a higher rate of confirmation of acute appendicitis (78% versus 55%), which allowed a decrease in the rate of negative surgical explorations to 4.1% in elderly patients compared to 10.2% in younger patients. Complicated appendicitis and conversions were more frequent in the elderly patients. This resulted in prolonged operative time and longer hospital stay for this group. The overall complication rate was equivalent in the two groups, without differences in the occurrence either of infectious complications or of complications related to surgical site. There were no deaths following appendectomy in our series. Laparoscopic appendectomy is safe in the elderly population and is not associated with any increase in morbidity. The high incidence of complicated appendicitis in elderly patients affects operative time and length of hospital stay following laparoscopic appendectomy, and it can also lead to an increased rate of conversion to an open procedure. Use of preoperative abdominal computerized tomography scan is mandatory in elderly patients to provide an early diagnosis and to decrease unnecessary surgical exploration when acute

  4. Communication in dental medicine: importance in motivating elderly dental patients.

    Science.gov (United States)

    Scutariu, Mihaela Monica; Forna, Norina

    2013-01-01

    Dental services for elderly patients are characterized by a series of particularities related to the vulnerability of this age group, which is affected by various co morbidities, and the diminished physical, cognitive and financial capacities. Finding ways to keep elderly patients coming to a dental office is possible by improving the dentist-patient relationship and implicitly the quality of care by increasing the self-esteem of the elderly and their place in society, by increasing the role of oral health in the quality of life, and here we refer to the pleasure of eating, the pleasant physical aspect and normal diction. The present paper presents the psychological aspects that interfere in the communication process between the dentist and the elderly patient and the changes motivation undergoes when people are in pain. These data can sometimes change the reticent attitude of the dentist towards the elderly patient which is often considered to be a risk patient.

  5. Comparison of safety and outcomes of shock wave lithotripsy between elderly and non-elderly patients

    Directory of Open Access Journals (Sweden)

    Chen YZ

    2017-04-01

    Full Text Available Yi-Zhong Chen,1 Wun-Rong Lin,1,2 Chih-Chiao Lee,1,2 Fang-Ju Sun,1,3 Yung-Chiong Chow,1,2 Wei-Kung Tsai,1,2 Pai-Kai Chiang,1,2 Ting-Po Lin,1,2 Marcelo Chen,1–3 Allen W Chiu1,4 1Department of Urology, MacKay Memorial Hospital, 2School of Medicine, MacKay Medical College, 3Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, 4School of Medicine, National Yang-Ming University, Taipei, Taiwan Background: This study compared the clinical outcomes of extracorporeal shock wave lithotripsy between elderly (aged ≥65 years and non-elderly (aged <65 years patients.Methods: A retrospective review of medical records was performed on 483 (non-elderly: 245, elderly: 238 patients with upper urinary tract stones who underwent shock wave lithotripsy between 2007 and 2015. The demographic data, stone parameters, stone-free rate, retreatment rate, and complication rate were analyzed in both elderly and non-elderly patient groups.Results: There was no significant difference between non-elderly and elderly patients in terms of stone-free rate (46.5% vs 41.1%, P>0.05 regardless of stone site or stone size and overall retreatment rate (41.6% vs 37.0%, P>0.05. Elderly patients had a higher complication rate than non-elderly patients (15.5% vs 23.5%, P=0.026. The most common complication was flank pain. Receiver operating characteristic curves predicted that elderly patients (cutoff value: 65 years of age had a higher risk of complications and that patients with smaller stones (cutoff value: 0.8 cm had a higher stone-free rate.Conclusion: This study showed that elderly patients with upper urinary tract stones undergoing shock wave lithotripsy had comparable efficacy for stone-free rates and retreatment rates, but higher complication rates. Keywords: elderly, shock wave lithotripsy, upper urinary tract stone, safety, outcome

  6. Elderly versus young patients with appendicitis 3 years experience

    African Journals Online (AJOL)

    Wagih Mommtaz Ghnnam

    2011-12-14

    Dec 14, 2011 ... Abstract Background: Appendicitis in the elderly continues to be a challenging surgical problem. Patients continued to present late with atypical presentations. Results might improve with earlier consideration of the diagnosis in elderly patients with abdominal pain, followed by prompt surgical operation.

  7. Trends of Polypharmacy Among Elderly Patients Attending An out ...

    African Journals Online (AJOL)

    Elderly patient often require multiple medications (polypharmacy (PP)) to adequately manage their co-morbidities. The objectives of this study were to analyze the number of medicines per prescription in elderly patients in terms of monopharmacy, minor and major polypharmacy, to identify the demographic trend of ...

  8. Non-verbal behaviour in nurse-elderly patient communication.

    NARCIS (Netherlands)

    Caris-Verhallen, W.M.C.M.; Kerkstra, A.; Bensing, J.M.

    1999-01-01

    This study explores the occurence of non-verbal communication in nurse-elderly patient interaction in two different care settings: home nursing and a home for the elderly. In a sample of 181 nursing encounters involving 47 nurses a study was made of videotaped nurse-patient communication. Six

  9. Radiotherapy of metastatic spinal cord compression in very elderly patients

    NARCIS (Netherlands)

    Rades, Dirk; Hoskin, Peter J.; Karstens, Johann H.; Rudat, Volker; Veninga, Theo; Stalpers, Lukas J. A.; Schild, Steven E.; Dunst, Juergen

    2007-01-01

    Owing to the aging of the population, the proportion of elderly patients receiving cancer treatment has increased. This study investigated the results of radiotherapy (RT) for metastatic spinal cord compression (MSCC) in the very elderly, because few data are available for these patients. The data

  10. Elderly versus young patients with appendicitis 3 years experience ...

    African Journals Online (AJOL)

    Elderly group of patients had perforated appendix in 16 cases (69.5%) while in group II patients eight cases (20%) had perforated appendix. Conclusion: Acute appendicitis in the elderly remains a challenge for practicing surgeons and continues to be associated with high morbidity and mortality. Results might improve with ...

  11. Affective functioning after delirium in elderly hip fracture patients

    NARCIS (Netherlands)

    Slor, Chantal J.; Witlox, Joost; Jansen, René W. M. M.; Adamis, Dimitrios; Meagher, David J.; Tieken, Esther; Houdijk, Alexander P. J.; van Gool, Willem A.; Eikelenboom, Piet; de Jonghe, Jos F. M.

    2013-01-01

    Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and

  12. APPROACHES TO ANTITHROMBOTIC THERAPY IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    E. A. Ushkalova

    2017-01-01

    Full Text Available Advanced age is the most important and independent risk factor for the development of atrial fibrillation (AF. The proportion of patients with AF at the age of 65-85 years reaches 70%, and average age of patients with AF is 75 years. Antithrombotic therapy of AF in the elderly is challenging for several reasons. On the one hand, elderly patients are at an increased risk of systemic embolism and stroke and fatal outcomes of stroke are higher in the elderly compared with these in the younger patients. On the other hand, elderlies are at an increased risk of bleeding. In addition, they have important comorbidities and are treated with drugs that can interact with antithrombotic agents. The article discusses tools used to assess risks of thromboembolic and hemorrhagic complications and general approaches to antithrombotic treatment of elderly patients.

  13. Dermatologic Analysis in Elderly Patients During Balneotherapy

    Directory of Open Access Journals (Sweden)

    Selçuk Özdogan

    2010-09-01

    Full Text Available  Aim: The aim of this study was to determine skin changes due to balneotherapy in elderly patients who were treated with termal therapy for rheumatismal pain. Material and Methods Older than 50 years old 51 patients with generalize ostoarthritis were treated with balneotherapy enrolled our study in October- November 2009. All patients treated 21 days with balneotherapy. Patient’s skin analyses were done twice, at first day and 19th day of the treatment. Skin analyses were done at face region and fore arm flexor region. Moisturing, elasticity, pigmentation, fat ratio assessed in skin analysis. Results: 20 male and 31 female, totally 51 patients were enrolled our study. Before balneotherapy, mean moisturing was %67, after balneotherapy mean moisturing decreased %47 at fore arm region. After balneotherapy, mean moisturing at face decreased from %54 to %45. Fat ratio decreased from %28 to %20 Before balneotherapy and after balneotherapy elasticity and pigmentation differences were not significant statistically. Conclusion: By aging, skin becomes sensitive to environmental factors. Dry skin is a usual problem during balneotherapy. Patients with dry skin have pruritus and discomfort. We suggest patients treated with balneotherapy to use moisturing cream for protecting dry skin problems during balneotherapy.

  14. Prostate cancer in the elderly patient.

    Science.gov (United States)

    Fung, Chunkit; Dale, William; Mohile, Supriya Gupta

    2014-08-20

    Treatment for prostate cancer (PCa) has evolved significantly over the last decade. PCa is the most prevalent non-skin cancer and the second leading cause of cancer death in men, and it has an increased incidence and prevalence in older men. As a result, physicians and patients are faced with the challenge of identifying optimal treatment strategies for localized, biochemical recurrent, and advanced PCa in the older population. When older patients are appropriately selected, treatment for PCa results in survival benefits and toxicity profiles similar to those experienced in younger patients. However, underlying health status and age-related changes can have an impact on tolerance of hormonal therapy and chemotherapy in men with advanced disease. Therefore, the heterogeneity of the elderly population necessitates a multidimensional assessment to maximize the benefit of medical and/or surgical options. Providing clinicians with the requisite health status data on which to base treatment decisions would help ensure that older patients with PCa receive optimal therapy if it will benefit them and/or active surveillance or best supportive care if it will not. We provide a review of the existing evidence to date on the management of PCa in the older population.

  15. Visual Morbidities among Elderly Patients Presenting at a Primary ...

    African Journals Online (AJOL)

    Background: Visual challenges compromise mobility, increase dependency on family members and constitute a major health problem mainly seen by the primary care physicians among the elderly. However, there is little information on the pattern of visual problems of elderly patients attending the primary care clinics in ...

  16. How long are elderly patients followed up with mammography after ...

    African Journals Online (AJOL)

    common cancer in women (20.62%), with an overall lifetime risk of developing ... Background. The effect of breast cancer on elderly South African (SA) patients is not well characterised. ... Objectives. To assess the effect of breast cancer and adherence to post-treatment surveillance programmes among the local elderly.

  17. Tegaserod for treating chronic constipation in elderly patients.

    Science.gov (United States)

    Baun, Ronald F; Levy, Hedva Barenholtz

    2007-02-01

    To evaluate data that address the safety and efficacy of tegaserod for the management of chronic constipation (CC) in elderly patients. Primary literature was identified through MEDLINE (1966-January 2007) and EMBASE (2002-January 2007) using the search terms tegaserod, elderly, and constipation. Additional information was requested from the pharmaceutical manufacturer. Clinical trials evaluating the efficacy and safety of tegaserod for treating CC were considered for inclusion. Emphasis was placed on data relevant to use of tegaserod in the elderly and on CC. Two efficacy trials evaluated tegaserod for treating constipation. They enrolled a total of 331 elderly patients, comprising approximately 13% of study patients. Tegaserod was effective for improving constipation in the overall study populations; no significant adverse events were noted. However, both studies lacked a subgroup analysis in the elderly. Diarrhea occurred more commonly with higher doses of tegaserod and may be a concern in older adults. A 13 month safety trial found tegaserod to be well tolerated for treatment of constipation, with similar adverse events seen as in the 12 week efficacy studies. Specific data were not provided for elderly patients. Tegaserod should not replace current therapies for treatment of CC in the elderly. The drug has been studied in a small number of older adults; thus, data are inconclusive about its use in this population. Older adults have a higher risk of diarrhea with tegaserod. Cautious use is warranted until further studies specifically address the elderly population.

  18. Chronic Constipation in the Elderly: An Unusual Presentation of Colonic Dysmotility in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    R. Peravali

    2013-01-01

    Full Text Available Introduction. Chronic constipation is common in the elderly, and often no underlying pathology is found. Primary colonic dysmotility has been described in children but is rare in the elderly. Case report. We present an 82-year-old female with long standing constipation presenting acutely with large bowel obstruction. Laparotomy and Hartman’s procedure was performed, and a grossly distended sigmoid colon was resected. Histology revealed a primary myopathic process. Conclusion. Primary colonic myopathy should be considered in elderly patients presenting with large bowel obstruction and a long preceding history of constipation, particularly when previous endoscopic examinations were normal.

  19. Factors Influencing Depression among Elderly Patients in Geriatric Hospitals

    OpenAIRE

    Jee, Young Ju; Lee, Yun Bok

    2013-01-01

    [Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem ...

  20. Digital pen-based telemonitoring of elderly heart failure patients

    OpenAIRE

    Lind, Leili; Karlsson, Daniel

    2013-01-01

    Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital p...

  1. MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

    OpenAIRE

    I. L. Chernikovskiy; V. M. Gelfond; A. S. Zagryadskikh; S. A. Savchuk

    2016-01-01

    Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were pres...

  2. PALLIATIVE CARE ELDERLY PATIENTS WITH SLEEPING DISORDERS ARE POORLY TREATED

    OpenAIRE

    Bellido-Estevez, Inmaculada

    2015-01-01

    Background: Sleep disorders are frequent in patients with advanced cancer receiving palliative-care, especially in elderly patients (1). Sleep disorders during palliative-care may be related with anxiety, opioids related central-sleep apnoea or corticoids therapy between others (2). Our aim was to quantify the effectiveness of hypnotic medication in the sleep quality in advanced cancer receiving palliative-care elderly patients. Material and methods: A descriptive cross-sectional study was...

  3. Geriatric evaluation of oncological elderly patients.

    Science.gov (United States)

    Malaguarnera, Michele; Frazzetto, Paola Mariangela; Erdogan, Ozyalcn; Cappellani, Alessandro; Cataudella, Emanuela; Berretta, Massimiliano

    2013-11-01

    Cancer has a high prevalence in older age. The management of cancer in the older aged person is an increasingly common problem. Age may be construed as a progressive loss of stress tolerance, due to decline in functional reserve of multiple organ systems, high prevalence of comorbid conditions, limited socioeconomic support, reduced cognition, and higher prevalence of depression. In the elderly, the comorbidities and physiological changes in the pharmacokinetics reduce the prospective for therapy and suggest the importance of a multidimensional assessment of cancer patients as well as the formulation of predictive models of risk, in order to estimate the life expectancy and tolerance to treatment. The pharmacological changes of age include decreased renal excretion of drugs and increased susceptibility to myelosuppression, mucositis, cardio toxicity and neurotoxicity. The chemotherapy in patients older than 75 years is very limited. The geriatric assessment is considered a valid tool in geriatric medical. It is important for two main reasons: first of all, for the need to distinguish the features linked to the geriatric syndromes from those ones which are strictly connected to the cancer pathology; secondly, for its potential prognostic value.

  4. Total knee arthroplasty in elderly osteoporotic patients.

    Science.gov (United States)

    Spinarelli, Antonio; Petrera, Massimo; Vicenti, Giovanni; Pesce, Vito; Patella, Vittorio

    2011-04-01

    Often in daily practice the choice of a prosthesis does not rise out of considerations about literature evidences, but it seems to be related to the personal experience and "surgical philosophy" of surgeon. The choice of prosthesis in total joint replacement is usually justified by biological and mechanical parameters that the surgeon considers before surgery. Osteoporosis is a disease characterized by a reduced bone mass and a degeneration of the bone tissue; it leads to bone fragility, so to a higher risk of fractures. Bone resistance, as all the changes in the microarchitecture of the bone tissue, is linked to bone density. Because of the bone density variation and/or the changes in the bone micro-architecture, as the bone strength decreases, the risk of fractures increases. It is important to understand all the factors taking part in both normal and abnormal bone remodelling. Osteoporosis does not imply a concrete bone loss, but a change of the bone micro-architecture itself. In these cases the choice of the patient and implant design are very important. In the period between March 1997-July 2002, we implanted 100 consecutive TKA (total knee arthroplasty) Genesis II in 97 subjects (79 female); mean age was 77.1 years old. All TKA were performed because of primary osteoarthritis of the knee. All patients had complete pain relief and excellent knee score. The surgical and medical complications were in accordance with the published literature. We must consider all existing medical conditions, the state of the knee and local needs of the elderly patient. Thus, within these limits, the total knee can improve the ability of patients to manage the activities of daily living and improve their quality of life.

  5. Inadequate pain relief and consequences in oncological elderly patients.

    Science.gov (United States)

    Caltagirone, Carlo; Spoletini, Ilaria; Gianni, Walter; Spalletta, Gianfranco

    2010-09-01

    Elderly patients with cancer are particularly burdened with pain, which has an impact on physical, psychological and cognitive symptoms, and consequently, on the overall quality of life. Here, the existing literature on pain and its consequences in elderly patients with cancer is reviewed, in order to understand the impact of cancer pain and its related symptoms, and the importance of its correct assessment and management, in the geriatric population. From the literature, it emerges that cancer pain has a complex and multidimensional phenomenology in this population, and it is often underestimated and consequently untreated. Furthermore, elderly cancer patients are at higher risk of suffering from pain. Aetiology of cancer pain in elderly patients is still an emergent issue, and immunological findings on the link between pain, cancer and aging may help enlighten the pathophysiological mechanisms underlying pain in elderly cancer patients. Particularly, immune dysfunction may represent a common pathogenic ground of pain and its more common related symptoms (i.e. depression and cognitive decline) in elderly cancer patients. Appropriate pain relief represents a challenge in oncological research, in order to improve patients' and caregivers' quality of life. Copyright 2009 Elsevier Ltd. All rights reserved.

  6. Pacemaker implantation complication rates in elderly and young patients

    Directory of Open Access Journals (Sweden)

    Özcan KS

    2013-08-01

    Full Text Available Kazim Serhan Özcan, Damirbek Osmonov, Servet Altay, Cevdet Dönmez, Ersin Yildirim, Ceyhan Türkkan, Baris Güngör, Ahmet Ekmekçi, Ahmet Taha Alper, Kadir Gürkan, İzzet ErdinlerDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, TurkeyAims: To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation.Methods: We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (<70 years old and elderly (≥70 years old patients.Results: Among 574 patients with a permanent pacemaker, 259 patients (45.1% were below and 315 patients (54.9% were above or at 70 years of age. There were 240 (92.7% and 19 (7.3% dual-chamber pacemaker (DDD and single-chamber pacemaker (VVI implanted patients in the younger group, and 291 (76.8% and 73 (23.2% DDD and VVI pacemaker implanted patients in the elderly group, respectively. The complication rate was 39 (15.1% out of 259 young patients and 24 (7.6% out of 315 elderly patients. Postprocedural complications were statistically lower in the elderly patients than in younger patients (P = 0.005.Conclusion: A pacemaker implantation performed by an experienced operator is a safe procedure for patients of advanced age. The patients who are above 70 years old may have less complication rates than the younger patients.Keywords: complications of pacemaker implantation, elderly patients, permanent pacemaker

  7. Current characteristics of dialysis therapy in Korea: 2015 registry data focusing on elderly patients

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    Dong-Chan Jin

    2016-12-01

    Full Text Available Because of increases in the elderly population and diabetic patients, the proportion of elderly among dialysis patients has rapidly increased during the last decades. The mortality and morbidity of these elderly dialysis patients are obviously much higher than those of young patients, but large analytic studies about elderly dialysis patients' characteristics have rarely been published. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an Internet online registry program and analyzed the characteristics. A survey on elderly dialysis patients showed that more than 50% of elderly (65 years and older patients had diabetic nephropathy as the cause of end-stage renal disease, and approximately 21% of elderly dialysis patients had hypertensive nephrosclerosis. The proportion of elderly hemodialysis (HD patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of young (under 65 years HD patients (69% vs. 80%. Although the vascular access was poor and small surface area dialyzers were used for the elderly HD patients, the dialysis adequacy data of elderly patients were better than those of young patients. The laboratory data of elderly dialysis patients were not very different from those of young patients, but poor nutrition factors were observed in the elderly dialysis patients. Although small surface area dialyzers were used for elderly HD patients, the urea reduction ratio and Kt/V were higher in elderly HD patients than in young patients.

  8. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    Science.gov (United States)

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, Ppneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (Ppneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (Ppneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with disease status remains a question for future research.

  9. Good patient and technique survival in elderly patients on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Li, Philip Kam-Tao; Law, Man Ching; Chow, Kai Ming; Leung, Chi-Bon; Kwan, Bonnie Ching-Ha; Chung, Kwok Yi; Szeto, Cheuk-Chun

    2007-06-01

    The aging population has significant implications for the community. The increasing number of elderly end-stage renal disease (ESRD) patients presses the renal team to find an appropriate management plan. We used a retrospective analysis to study the effectiveness of continuous ambulatory peritoneal dialysis (CAPD) in elderly ESRD patients. Of the 328 CAPD patients recruited for the study, 121 were in the elderly group (>or=65 years of age), and 207 were in the control group (under 65 years of age). Median age in the elderly group was 71 years, and in the control group, 51 years. The elderly group had a higher prevalence (54.5%) of diabetes mellitus. The 2-year and 5-year rates of patient survival were 89.3% and 54.8% respectively in the elderly group and 92.2% and 62.9% in the control group (p=0.19). The 2-year and 5-year rates of technique survival were 84.0% and 45.7% respectively in the elderly group and 80.9% and 49.1% in the control group (p=0.75). The probability of a 12-month peritonitis-free period was 76.6% in the elderly group and 76.5% in the control group (p=0.75). One hundred elderly patients (82.6% of the group) performed their CAPD exchanges by themselves. We observed no significant difference in clinical outcome-including patient survival, technique survival, and peritonitis-free period-between the elderly self-care CAPD and the elderly assisted CAPD groups. In elderly ESRD patients, CAPD is an effective dialysis modality. A slightly longer training time is to be expected for elderly patients. Self-care CAPD for elderly patients who are capable of performing their own exchanges provides them with an independent home life.

  10. Patient participation during oncological encounters: barriers and facilitators experienced by elderly cancer patients.

    OpenAIRE

    Noordman, J.; Driesenaar, J.A.; Henselmans, I.; Heijmans, M.; Verboom, J.; Dulmen, S. van

    2017-01-01

    Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data analysis) and qualitative (interviews) methods. Survey data were used to identify communication barriers and need for supportive interventions of elderly cancer patients, compared to younger patients. Nex...

  11. Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

    Science.gov (United States)

    Uno, Masaaki; Toi, Hiroyuki; Hirai, Satoshi

    2017-08-15

    As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH. The literature actually offers conflicting advice regarding CSDH treatment; however, burr hole surgery with drainage under local anesthesia is the most common surgical procedure, even in elderly patients. The recurrence rate of CSDH has not decreased over recent decades, and it has ranged from 0.36-33.3%. Outcomes in patients over 75 years old was significantly worse than for those younger than 75. Moreover, long-term outcomes for elderly patients with CSDH are poor. CSDH in the elderly is no longer a benign disease. In the future, it will be important for us to understand the mechanisms of onset and recurrence of CSDH and to develop more effective medical treatments and noninvasive surgical techniques for elderly patients.

  12. Electrocardiographic Changes in Elderly Patients During Endoscopic Retrograde Cholangiopancreatography

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    NG Kounis

    2003-01-01

    Full Text Available BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP via Holter monitoring in elderly patients older than 70 years of age.

  13. Evidence-based nutritional support of the elderly cancer patient.

    Science.gov (United States)

    Bozzetti, Federico

    2015-04-01

    The papers included in this section represent the effort of the Task Force on Nutrition of the International Society of Geriatric Oncology to synthetize the evidence-based concepts on nutritional support of the elderly cancer patients. In the attempt of presenting a comprehensive overview of the topic, the panel included experts from different specialties: basic researchers, nutritionists, geriatricians, nurses, dieticians, gastroenterologists, oncologists. Cancer in elderly people is a growing problem. Not only in almost every country, the proportion of people aged over 60 years is growing faster than any other age group, but cancer per se is also a disease of old adult-elderly people, hence the oncologists face an increasing number of these patients both now and in the next years. The are several studies on nutrition of elderly subjects and many other on nutrition of cancer patients but relatively few specifically devoted to the nutritional support of the elderly cancer patients. However, the awareness that elderly subjects account for a high proportion of the mixed cancer patients population, in some way legitimates us to extend some conclusions of the literature also to the elderly cancer patients. Although the topics of this Experts' Consensus have been written by specialists in different areas of nutrition, the final message is addressed to the oncologists. Not only they should be more directly involved in the simplest steps of the nutritional care (recognition of the potential existence of a "nutritional risk" which can compromise the planned oncologic program, use of some oral supplements, etc.) but, as the true experts of the natural history of their cancer patient, they should also coordinate the process of the nutritional support, integrating this approach in the overall multidisciplinary cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. The care needs of elderly patients with schizophrenia spectrum disorders

    NARCIS (Netherlands)

    Meesters, P.D.; Comijs, H.C.; Dröes, R.M.; de Haan, L.; Smit, J.H.; Eikelenboom, P.; Beekman, A.T.F.; Stek, M.L.

    2013-01-01

    Objective: Elderly patients constitute the fastest growing segment of the schizophrenia population. Still, their needs for care are poorly understood. This study aimed to gain insight into the care needs of older patients with schizophrenia spectrum disorders. Setting and Participants: Patients,

  15. Communication of the cancer diagnosis to an elderly patient

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    Lucélia Terra Jonas

    2015-05-01

    Full Text Available Objective: to collect evidence on matters which involve cancer diagnosis disclosure to an elderly patient. Methods: integrative revision made in five important data bases in the area of health with seven selected articles. Results: it was noticeable that there are conflicts between family members and health professionals concerning cancer diagnosis disclosure to an elderly patient and that the preferences of those people on the disclosure of the diagnosis are similar to other patients. Conclusion: health professionals, especially the nurses, need training in order to have a secure and clarifying communication, matching the information to the specific needs of each patient, considering their reality and type of confrontation..

  16. Acceptable long-term outcome in elderly intensive care unit patients

    DEFF Research Database (Denmark)

    Schrøder, Morten; Poulsen, Jesper Brøndum; Perner, Anders

    2011-01-01

    The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.......The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care....

  17. Incidence and cause of acute confusion in elderly patients

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    Rejeki A. Rahayu

    2002-03-01

    Full Text Available Acute confusion is a clinical syndrome in the elderly whose diagnosis is made by acute onset of disturbance of consciousness, impairment of cognition and fluctuating perception and has an underlying medical cause associated with usually serious medical illness. Acute confusion has a high morbidity and mortality, and patient need to stay longer in the hospital, have a higher risk for institutionalization and immobilization. The aim of this study is to recognize the incidence and most of medical illness, which cause acute confusion in elderly patients, a retrospective study based on medical record of elderly patients who were hospitalized in Dr Kariadi hospital since 1998 to 1999. 5407 elderly patients were hospitalized, but only 5191 were analyzed and included in this study. 35% (992 men and 846 women elderly patients had acute confusion on first arrival and 7% ( 197 men and 176 women acute confusion appears in the ward. Total acute confusion was 40.89%. The mortality rate was 29% (263 women and 381 men. Three most frequent cause of death were sepsis (10.04%; hemorrhagic stroke (5.11%; multifactor (4.16%. Top ten diseases, which cause acute confusion, were hepatic encephalopathy, hemorrhagic stroke, sepsis, moderate dehydration due to gastoenteritis, hyponatremia, acute myocardial infarction, pneumonia, urinary tract infection, congestive heart failure, and arrhythmia cordis. (Med J lndones 2002; 11: 30-35Keywords: acute confusional state, geriatric patients, hospital study

  18. Epidemiology and prognostic factors of candidemia in elderly patients.

    Science.gov (United States)

    Tang, Hung-Jen; Liu, Wei-Lun; Lin, Hsin-Lan; Lai, Chih-Cheng

    2015-06-01

    The present retrospective study was carried out to investigate the epidemiological characteristics and the prognostic factors of candidemia among elderly patients. From 2009 to 2012, elderly patients with candidemia were identified at the Chi Mei medical center, a 900-bed regional hospital in southern Taiwan, and their medical records retrospectively reviewed. During the 4-year period, a total of 175 episodes of candidemia among elderly patients were identified. The patients ranged in age from 65 to 98 years (mean 76.4 years) and the mean (±standard deviation) Charlson Comorbidity Index score was 7.6 (±2.7). Cancer was the most common underlying disease (n = 127, 72.6%), followed by diabetes mellitus (n = 69, 39.4%). Candida albicans (n = 96, 54.9%) was the most common pathogen, followed by C. tropicalis (n = 39, 22.3%), C. parapsilosis (n = 24, 13.7%), C. glabrata (n = 22, 12.6%), C. guilliermondii (n = 2, 1.1%) and Candida species (n = 3, 1.7%). The ratio of C. albicans causing candidemia was significantly higher in young-old than old-old patients (64.1% vs 47.4%, P = 0.027). The overall in-hospital mortality was 50.3%. Multivariate analysis showed that the in-hospital mortality was only significantly associated with jaundice (P = 0.004), no use of antifungal agent (P = 0.021) and intensive care unit admission (P Candidemia can develop in elderly patients, especially patients with cancer or other risk factors. C. albicans is the most common Candida species causing candidemia among elderly patients, followed by C. tropicalis. The mortality of candidemia among elderly patients remains high. © 2014 Japan Geriatrics Society.

  19. Treatment and Prevention of Oral Candidiasis in Elderly Patients.

    Science.gov (United States)

    Sakaguchi, Hideo

    2017-01-01

    The incidence of oral candidiasis has increased in the elderly in recent years. Although the increase of the elderly population plays a big role in this rise of oral candidiasis, the broader recognition that elderly people have higher infection rates for oral candidiasis is considered to be also an important factor. Oral candidiasis can be categorized into three types. Pseudomembranous oral candidiasis is characterized by the appearance of white moss, erythematous oral candidiasis by the eruption of erythema, and hyperplastic oral candidiasis by mucosal hyperplasia. Miconazole has been commonly used when treating oral candidiasis. Elderly patients, however, have a tendency to develop oral candidiasis repeatedly. It is therefore critical to take measures to prevent recurrence. We recommend the use an oral moisturizer containing hinokitiol, an antifungal substance, on a regular basis, to help prevent recurrence of oral candidiasis.

  20. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients

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    Nagashima Atsushi

    2011-09-01

    Full Text Available Abstract Background The elderly population has increased in many countries. Indications for cancer treatment in elderly patients have expanded, because surgical techniques and medical management have improved remarkably. Pancreaticoduodenectomy (PD requires high-quality techniques and perioperative management methods. If it is possible for elderly patients to withstand an aggressive surgery, age should not be considered a contraindication for PD. Appropriate preoperative evaluation of elderly patients will lead to their safer management. The purpose of the present study was to evaluate the safety of PD in patients older than 75 years and to show the influence of advanced age on the morbidity and mortality associated with this operation. Patients and methods Subjects were 98 patients who underwent PD during the time period from April 2005 to April 2011. During this study, 31 patients were 75 years of age or older (group A, and the other 67 patients were less than 75 years old (group B. Preoperative demographic and clinical data, surgical procedure, pathologic diagnosis, postoperative course and complication details were collected prospectively and they were analyzed in two group. Results There was no statistical difference between patient groups in terms of gender, comorbidity, preoperative drainage, diagnosis, or laboratory data. Preoperative albumin values were lower in group A (P = 0.04. The mean surgical time in group A was 408.1 ± 73.47 min. Blood loss and blood transfusion were not significantly different between both groups. There was no statistical differences in mortality rate (P = 0.14, morbidity rate (P = 0.43, and mean length of hospital stay (P = 0.22 between both groups. Long-term survival was also no statistically significant difference between the two groups using the log-rank test (P = 0.10. Conclusion It cannot be ignored that the elderly population is getting larger. We must investigate the management of elderly patients after

  1. Renal replacement therapy in elderly patients: peritoneal dialysis.

    Science.gov (United States)

    Catizone, Luigi; Malacarne, Franco; Bortot, Alessia; Annaloro, Mariangela; Russo, Giorgia; Barillà, Antonio; Storari, Alda

    2010-01-01

    Management of chronic uremia in elderly patients presents several clinic and organizational difficulties. Hemodialysis (HD) and chronic peritoneal dialysis (CPD) are both available for the elderly, and the choice depends on the individual, clinical and familial conditions. Several reports have compared the outcomes for older patients treated by HD or peritoneal dialysis, with those for younger or older patients undergoing peritoneal dialysis. CPD is a successful dialysis option for elderly patients, in both patient and technique survival terms. All nutritional parameters are of pivotal importance. Several barriers, such as medical and social factors, physician bias, late referral and education irrespective of the needs of older patients, influence the choice of CPD. The development of assisted peritoneal dialysis, using community-based nurses or health care assistants, can overcome some of the barriers and enable frail older patients to have home-based dialysis treatment. Increasing age is associated with higher peritonitis rates among patients who started CPD in the 1990s, while age is not associated with peritonitis in more recent CPD cohorts, and no greater frequency of adverse outcomes of peritonitis has been seen among those who began CPD after the year 2000. In elderly dialysis patients, the management of quality of life (QOL) is important as well as adequacy of dialysis, nutritional status and survival rate. To obtain a good standard of QOL, it is essential to select carers who are properly educated and who can access an adequate support system, both physical and psychological, to help them cope with their burden.

  2. Maintenance of continuous ambulatory peritoneal dialysis in elderly patients.

    Science.gov (United States)

    Ishida, Mari

    2012-01-01

    In Japan, peritoneal dialysis (PD) remains the principal modality of home dialysis for the elderly although PD patients accounted for only 3.3% (n = 9,728) of the overall dialysis patient population. One of the preventing factors for introduction of PD in elderly patients is the Japanese public nursing care system. Besides, difficulties in the continuation of dialysis therapy will arise because of the progression of dementia as well as the decline in muscular strength, vigor, and physical strength of patients. In spite of these difficulties, some local dialysis centers tried to maintain and manage elderly dialysis patients at home by utilizing diverse social resources, in addition to obtaining the cooperation of care givers such as family members. In our hospital, approximately 40% of patients who started dialysis therapy have selected PD. To support patients on PD, several special forms of care are prepared: utilization of visiting nurse care or home-visit nursing care services, supply of information on renal failure and education to home-care support providers and welfare service facility staff members. In addition, modulation of PD therapy such as automated PD and hemodialysis and PD in combination is also properly prepared. Lastly, the organization of a team, including physicians, nurses, social workers and dietitians, and the construction of a centralized patient information management system are important for elderly patients who need dialysis therapy. Copyright © 2012 S. Karger AG, Basel.

  3. Radiotherapy for head and neck cancer in elderly patients

    International Nuclear Information System (INIS)

    Schofield, Clare P.; Sykes, Andrew J.; Slevin, Nicholas J.; Rashid, Noor Z.Z.

    2003-01-01

    Background and purpose: Elderly patients with head and neck cancer may not be treated aggressively with radiotherapy, due to concerns regarding tolerance of treatment and toxicity. A retrospective study was undertaken of patients aged 80 years and over, treated by definitive radiotherapy for head and neck cancer. Material and methods: 98 patients aged 80-92 received radiotherapy for carcinoma of the head and neck between 1991 and 1995. All patients received beam directed radiotherapy with radical intent using an immobilisation shell. Results: Cancer specific survival was 59% and overall local control was 70% at 5 years. Both were significantly affected by T stage and site of disease. Cancer specific survival was comparable to that of patients aged below 80 years. Seven patients died within 6 months of the treatment. Three patients developed severe late toxicity. Metastatic disease occurred in eight patients. Conclusions: Radiotherapy is a beneficial and well tolerated treatment in elderly patients with carcinoma of the head and neck

  4. Frail elderly patients with dementia go too fast.

    NARCIS (Netherlands)

    Iersel, M.B. van; Verbeek, A.L.M.; Bloem, B.R.; Munneke, M.; Esselink, R.A.J.; Olde Rikkert, M.G.M.

    2006-01-01

    The reason why patients with dementia fall more often and sustain more fractures than patients without dementia remains unclear. Therefore, the relationship between dementia and gait velocity as a marker for mobility and falls in a cohort of frail elderly (mean age of 77.3 years) inpatients was

  5. Pharmacokinetic study of aniracetam in elderly patients with cerebrovascular disease.

    Science.gov (United States)

    Endo, H; Tajima, T; Yamada, H; Igata, A; Yamamoto, Y; Tsuchida, H; Nakashima, Y; Suzuki, Y; Ikari, H; Iguchi, A

    1997-02-01

    The clinical pharmacokinetics of the cognitive enhancer, aniracetam (200 mg), was studied in elderly patients with cerebrovascular disease (CVD) and compared with those of young healthy volunteers. Six female hospitalized patients (mean age 84.5 years) were used in this study. The serum level of anisic acid and p-methoxyhippuric acid, major metabolites of aniracetam, reached a peak at 2 h after oral administration, and returned to basal level by 6 h. Mean creatinine clearance was 20-30 ml/min. The t1/2 of metabolites was increased by 4- to 7-fold in the elderly patients compared with young volunteers. This study showed that tmax, t1/2, and AUC were enlarged in the elderly; however, no clinical side effects were observed.

  6. Antithrombotic treatment in elderly patients with atrial fibrillation.

    Science.gov (United States)

    Suárez Fernández, C; Camafort, M; Cepeda Rodrigo, J M; Díez-Manglano, J; Formiga, F; Pose Reino, A; Tiberio, G; Mostaza, J M

    2015-04-01

    Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Efficacy and safety of febuxostat in elderly female patients

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    Mizuno T

    2014-09-01

    Full Text Available Tomohiro Mizuno,1,2 Takahiro Hayashi,3 Sayo Hikosaka,1 Yuka Shimabukuro,1 Maho Murase,1 Kazuo Takahashi,2 Hiroki Hayashi,2 Yukio Yuzawa,2 Tadashi Nagamatsu,1 Shigeki Yamada3 1Department of Analytical Pharmacology, Graduate School of Pharmacy, Meijo University, Nagoya, Japan; 2Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Japan; 3Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Toyoake, Japan Background: Maintenance of low serum urate levels is important for the management of gout. Achieving the recommended serum urate levels of less than 6.0 mg/dL is difficult in elderly (65 years of age or older patients with renal impairment. Xanthine oxidase inhibitors allopurinol and febuxostat are used for this purpose. Although febuxostat had been shown to be efficacious in elderly patients, its safety and efficacy in elderly female patients with hyper­uricemia remain unclear.Objective: The aim of this study was to assess the efficacy and safety of febuxostat in elderly female patients.Methods: We studied a retrospective cohort study. The study included elderly Japanese patients (65 years of age or older who were treated with febuxostat at Fujita Health University Hospital from January 2012 to December 2013. The treatment goal was defined as achievement of serum urate levels of 6.0 mg/dL or lower within 16 weeks; this was the primary endpoint in the present study. Adverse events of febuxostat were defined as more than twofold increases in Common Terminology Criteria for adverse events scores from baseline. Results: We evaluated 82 patients treated with febuxostat during the observation period and classified them into male (n=53 and female (n=29 groups. The mean time to achievement of the treatment goal was significantly shorter in the female group (53 days than in the male group (71 days. There were no significant differences in adverse events between the 2 groups.Conclusion: Our

  8. Fospropofol Disodium for Sedation in Elderly Patients Undergoing Flexible Bronchoscopy.

    Science.gov (United States)

    Silvestri, Gerard A; Vincent, Brad D; Wahidi, Momen M

    2011-01-01

    BACKGROUND: Fospropofol disodium is a water-soluble prodrug of propofol. A subset analysis was undertaken of elderly patients (≥65 y) undergoing flexible bronchoscopy, who were part of a larger multicenter, randomized, double-blind study. METHODS: Patients received fentanyl citrate (50 mcg) followed by fospropofol at initial (4.88mg/kg) and supplemental (1.63mg/kg) doses. The primary end point was sedation success (3 consecutive Modified Observer's Assessment of Alertness/Sedation scores of ≤4 and procedure completion without alternative sedative or assisted ventilation). Treatment success, time to fully alert, patient and physician satisfaction, and safety/tolerability were also evaluated. RESULTS: In the elderly patients subset (n=61), sedation success was 92%, the mean time to fully alert was 8.0±10.9 min, and memory retention was 72% during recovery, and these were comparable with the younger patients subgroup (age, Sedation-related adverse events occurred in 23% of the elderly and 18% of the younger patients (age, sedation, rapid time to fully alert, and high satisfaction in this elderly subset undergoing flexible bronchoscopy, which was comparable with outcomes in younger patients.

  9. EVALUATION OF TREATMENT FOR ELDERLY PATIENTS WITH MULTIPLEMYELOMA

    Directory of Open Access Journals (Sweden)

    Amela Kobaklić

    2008-04-01

    The result of our study indicates that combination chemotherapy with thalidomide iseffective treatment for elderly patients with multiple myeloma. Thalidomide in combination with other medications significantly extended medial overall survival, thereforthalidomide should be the reference treatment for elderly patients with multiple myelomafor the time being.Compering overall survival among different treatment centers we observed better survivalin our clinic, nevertheless multiple myeloma is stil a disease with severe prognosis. Withthat in mind we have high hopes for treating multiple myeloma with introduction of newdrugs (bortezomib, lenalomid

  10. Factors associated with polypharmacy in elderly home-care patients.

    Science.gov (United States)

    Komiya, Hitoshi; Umegaki, Hiroyuki; Asai, Atsushi; Kanda, Shigeru; Maeda, Keiko; Shimojima, Takuya; Nomura, Hideki; Kuzuya, Masafumi

    2018-01-01

    Polypharmacy, which is often observed in elderly patients, has been associated with several unfavorable outcomes, including an increased risk of potentially inappropriate medications, medication non-adherence, drug duplication, drug-drug interactions, higher healthcare costs and adverse drug reactions. A significant association between polypharmacy and adverse outcomes among older people living in the community has also been confirmed. A reduction in the number of medications should thus be pursued for many older individuals. Nevertheless, the factors associated with polypharmacy in elderly home-care patients have not been reported. Here, we investigated those factors in elderly home-care patients in Japan. We used the data of the participants in the Observational Study of Nagoya Elderly with Home Medical investigation. Polypharmacy was defined as the current use of six or more different medications. We carried out univariate and multivariate logistic regression analyses to assess the associations between polypharmacy and each of several factors. A total of 153 home-care patients were registered. The mean number of medications used per patient was 5.9, and 51.5% of the patients belonged to the polypharmacy group. The multivariate model showed that the patients' scores on the Charlson Comorbidity Index and the Mini-Nutrition Assessment Short Form were inversely associated with polypharmacy, and potentially inappropriate medication was most strongly associated with polypharmacy (odds ratio 4.992). The present findings showed that polypharmacy was quite common among the elderly home-care patients, and they suggest that home-care physicians should prescribe fewer medications in accord with the deterioration of home-care patients' general condition. Geriatr Gerontol Int 2018; 18: 33-41. © 2017 Japan Geriatrics Society.

  11. Quality of Life in Elderly Cancer Patients Undergoing Chemotherapy.

    Science.gov (United States)

    Lavdaniti, Maria; Zyga, Sofia; Vlachou, Eugenia; Sapountzi-Krepia, Despina

    2017-01-01

    As life expectancy increases, it is expected that 60% of all cases of cancer will be detected in elderly patients in the next two decades. Cancer treatment for older persons is complicated by a number of factors, thus negatively affecting patients' quality of life. The purpose of this study is to investigate quality of life in elderly cancer patients undergoing chemotherapy. This study was descriptive and non-experimental. It was conducted in one large hospital in a major city of Northern Greece. The sample was convenience comprising 53 elderly cancer patients undergoing cycle 3 chemotherapy. The data was collected using the Functional Assessment of Cancer Therapy scale and included questions related to demographic and clinical characteristics. The majority of participants were men (n = 27, 50.9%) who were married (n = 32, 79.5%). Their mean age was 70.07 ± 3.60. Almost half of the sample (n = 30, 56.6%) had colon cancer. There was a statistical significant difference between men and women pertaining to physical wellbeing (p = 0.004) and overall quality of life (p quality of life (p quality of life (p quality of life and its related factors in elderly cancer patients. It is highly recommended to envisage measures for improving quality of life in this group of cancer patients.

  12. Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

    Directory of Open Access Journals (Sweden)

    Daiki Hira

    2016-10-01

    Conclusions: Elderly patients are apt to assume that they “understand well”, therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent instructions on inhalation therapy.

  13. Plasma Adiponectin Levels in Elderly Patients with Prediabetes

    Directory of Open Access Journals (Sweden)

    Si Eun Kong

    2015-09-01

    Full Text Available BackgroundThe significance of adiponectin levels in elderly individuals with prediabetes has yet to be determined. Thus, the present study was performed to evaluate the relationships between adiponectin levels and anthropometric variables, body composition parameters, insulin sensitivity, and lipid profiles in elderly prediabetic patients.MethodsThe present study included 120 subjects with prediabetes who were >65 years of age and were selected from among 1,993 subjects enrolled in the Korea Rural Genomic Cohort Study. All subjects underwent a 75 g oral glucose tolerance test and tests for measurement of insulin sensitivity. All diagnoses of prediabetes satisfied the criteria of the American Diabetes Association.ResultsPlasma adiponectin levels were lower in elderly prediabetic subjects than elderly subjects with normal glucose tolerance (P<0.01 as well as in elderly prediabetic patients with metabolic syndrome (MetS than in those without MetS (P<0.02. When the subjects were categorized into two groups according to plasma adiponectin levels, the waist-to-hip ratio and 2-hour insulin levels were significantly lower in individuals with high plasma adiponectin levels than in those with low plasma adiponectin levels. Additionally, the plasma adiponectin levels of elderly prediabetic subject were inversely correlated with body mass index (BMI, waist circumference (WC, waist-to-hip ratio, visceral fat, visceral fat ratio, and 2-hour insulin levels.ConclusionThe present findings demonstrated that the major factors correlated with adiponectin levels in elderly prediabetic subjects were BMI, WC, waist-to-hip ratio, visceral fat, visceral fat ratio, and 2-hour insulin levels.

  14. Hip Fracture in the Elderly Patients: A Sentinel Event.

    Science.gov (United States)

    Koso, Riikka E; Sheets, Charles; Richardson, William J; Galanos, Anthony N

    2018-04-01

    Hip fracture in the elderly patients is associated with increased morbidity and mortality. There is great need for advance care planning should a patient fail to rehabilitate or experience an adverse event during or after recovery. This study was performed to evaluate for palliative care consultation and changes in code status and/or advance directives in elderly patients with hip fracture. We performed a retrospective review of 186 consecutive patients aged 65 years and older with a hip fracture due to a low-energy fall who underwent surgery at a large academic institution between August 1, 2013, and September 1, 2014. Risk factors assessed were patient demographics, home status, mobility, code status, comorbidities, medications, and hospitalizations prior to injury. Outcomes of interest included palliative care consultation, complications, mortality, and most recent code status, mobility, and home. About 186 patients with hip fractures were included. Three patients died, and 12 (6.5%) sustained major complications during admission. Nearly one-third (51 patients) died upon final follow-up approximately 1.5 years after surgery. Of the patients who died, palliative care consulted on 6 (11.8%) during initial admission. Eleven (21.6%) were full code at death. Three patients underwent cardiopulmonary resuscitation (CPR) and 1 underwent massive transfusion and extracorporeal membrane oxygenation prior to changing their code status to do not attempt resuscitation. Hip fracture in elderly patients is an important opportunity to reassess the patient's personal health-care priorities. Advance directives, goals of care, and code status documentation should be updated in all elderly patients with hip fracture, should the patient's health decompensate.

  15. Serum Concentration of p-Cresol and Indoxyl Sulfate in Elderly Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Cheng-Jui Lin

    2011-06-01

    Conclusion: This study shows that the elderly hemodialysis patients do not have higher serum p-cresol and IS levels. Diabetes was associated with serum total p-cresol level in elderly dialysis patients.

  16. Knee osteoarthritis prevalence in hospitalized elderly patients: a retrospective study.

    Science.gov (United States)

    Huang, Ke Qiang; Li, Chuan Silvia; Lin, Zhong Qiu; Feng, Guo Fei; Wang, Xiao Hui; Fu, Wen Zhe; Xie, Zhi Quan

    2013-01-01

    This study aimed to determine the prevalence rate of knee osteoarthritis (OA) and the risk factors for OA in hospitalized elderly patients. We conducted this retrospective study in elderly patients (aged 65 years and older) who were hospitalized in the Geriatric Ward of General Hospital of Guangzhou Military Command of the People's Liberation Army between January 2011 and June 2013, including general condition, present history, past history, physical examination, X-ray results, and disease diagnosis. The prevalence, awareness, and treatment rates of knee OA in hospitalized elderly patients were calculated. Risk factors were computed using multiple logistic regression analysis. Of a total of 267 (17.4%) hospitalized elderly patients diagnosed with knee OA, the prevalence rate of OA was 9.95% in males and 37.76% in females. The rate of awareness among those with OA was 51.68%; the rate of treatment was 83.33%; and the rate of control was 77.39%. The medical expenses for both females (1143±315 yuan month-1) and males (1192±357 yuan month-1) in knee OA patients are higher than that of the non-knee OA group (989±274 yuan month-1, 1038±295 yuan month-1). The risk factors for knee OA include gender (OR=2.448), age (OR=1.124), transportation mode (OR= 8.972), exercise (OR=7.374), bowel evacuation position (OR=5.767), family history of knee OA (OR=2.195), and body mass index (OR=2.469). The prevalence of knee OA is unexpectedly high in hospitalized elderly patients, and the rates of awareness and treatment are less than desirable. Prevention and control measures should be taken in patients with concomitant risk factors.

  17. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

    Science.gov (United States)

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (Pelderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  18. Comparative study of trauma in the elderly and non-elderly patients in a University Hospital in Curitiba.

    Science.gov (United States)

    Broska, César Augusto; de Folchini, Augusto Bernardo; de Ruediger, Ricardo Rydygier

    2013-01-01

    To compare and identify differences in the profile of elderly and non-elderly patients with trauma. We conducted a comparative, cross-sectional, retrospective, quantitative study with 3112 patients between November, 25th 2010 and February, 25th 2011; patients were classified into GI: elderly (60 years or older) and GA: non-elderly (13-59 years). We collected information on the mechanism of trauma, injuries and factors associated with the event, which were compared between groups by using chi-square, Student t and proportions tests. Falls were more frequent in GI, mostly from the standing height, while violence and traffic accidents (especially with motorcycles) were the most important in GA. Both groups possessed mild trauma (bruises, sprains) as the most frequent, followed by traumatic brain injury (TBI) and fractures. Femur fractures were more common in the elderly, and hand and wrist fractures in the nonelderly. The elderly were hospitalized fewer days and there was no difference as for complications, need for intensive care unit (ICU), or mortality between groups. Falls from the standing height are more frequent in the elderly, and motorcycle accidents and interpersonal violence in the non-elderly. Both groups had superficial injuries, head trauma and fractures as major injuries. The elderly were hospitalized for less time. There was no difference in the need for ICU, complications and mortality.

  19. Fall Injuries and Related Factors of Elderly Patients at a Medical Center in Taiwan

    Directory of Open Access Journals (Sweden)

    Li-Yun Tsai

    2014-12-01

    Conclusion: Fall injuries have a negative and serious impact on elderly patients to their health condition and quality of life. Nursing staff need to instruct fall prevention measures at an early stage of elderly patient hospitalization. This study should provide a reference for nursing staff in assessing fall risks and reducing resultant falls and injuries among elderly patients.

  20. Dementia and delirium, the outcomes in elderly hip fracture patients

    NARCIS (Netherlands)

    Mosk, C.A. (Christina A.); Mus, M. (Marnix); Vroemen, J.P.A.M. (Jos P. A. M.); T. van der Ploeg (Tjeerd); D.I. Vos (Dagmar); Elmans, L.H.G.J. (Leon H. G. J.); L. van der Laan (Lyckle)

    2017-01-01

    textabstractBackground: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to

  1. Sub-clinical middle ear malfunctions in elderly patients; prevalence ...

    African Journals Online (AJOL)

    Abstract: Background: Little is known about functioning of the middle ear with advancing age. Objectives: To estimate the prevalence and describe tympanometric patterns of sub-clinical middle ear malfunctions,( S-MEM) in elderly patients. It also assessed clinical factors that could predict S-MEM. Methods: Cross-sectional ...

  2. Surgical operations in elderly patients | Njeze | Orient Journal of ...

    African Journals Online (AJOL)

    There were 12 deaths recorded in the major category, and none in the minor operations. Haemorrhage, infection and cancer were responsible for the deaths. Conclusion: Most of the patients who underwent these surgical operations derived benefits both for improved quality of life and increased life expectancy. The elderly ...

  3. Factors predicting mortality in elderly patients admitted to a ...

    African Journals Online (AJOL)

    Factors predicting mortality in elderly patients admitted to a Moroccan medical intensive care unit. Jihane Belayachi, Mina El khayari, Tarek Dendane, Naoufel Madani, Khalid Abidi, Redouane Abouqal, Amine Ali Zeggwagh. Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco. Jihane Belayachi, MD.

  4. Bone mineral density among elderly patients with chronic ...

    African Journals Online (AJOL)

    Background: Osteoporosis is one of the major extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), which limits the physical activity. The present study was undertaken to study the bone mineral density (BMD) and osteoporosis in the elderly COPD patients. Materials and Methods: This was a ...

  5. Treatment options and outcomes for glioblastoma in the elderly patient

    Directory of Open Access Journals (Sweden)

    Arvold ND

    2014-02-01

    Full Text Available Nils D Arvold,1 David A Reardon2 1Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA; 2Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA Abstract: Age remains the most powerful prognostic factor among glioblastoma (GBM patients. Half of all patients with GBM are aged 65 years or older at the time of diagnosis, and the incidence rate of GBM in patients aged over 65 years is increasing rapidly. Median survival for elderly GBM patients is less than 6 months and reflects less favorable tumor biologic factors, receipt of less aggressive care, and comorbid disease. The standard of care for elderly GBM patients remains controversial. Based on limited data, extensive resection appears to be more beneficial than biopsy. For patients with favorable Karnofsky performance status (KPS, adjuvant radiotherapy (RT has a demonstrated survival benefit with no observed decrement in quality of life. Concurrent and adjuvant temozolomide (TMZ along with RT to 60 Gy have not been prospectively studied among patients aged over 70 years but should be considered for patients aged 65–70 years with excellent KPS. Based on the recent NOA-08 and Nordic randomized trials, testing for O6-methylguanine-DNA-methyltransferase (MGMT promoter methylation should be performed routinely immediately after surgery to aid in adjuvant treatment decisions. Patients aged over 70 years with favorable KPS, or patients aged 60–70 years with borderline KPS, should be considered for monotherapy utilizing standard TMZ dosing for patients with MGMT-methylated tumors, and hypofractionated RT (34 Gy in ten fractions or 40 Gy in 15 fractions for patients with MGMT-unmethylated tumors. The ongoing European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada trial will help clarify the role for concurrent TMZ with hypofractionated RT. For elderly patients with poor KPS, reasonable

  6. Factors Affecting QOL of the Elderly Home-bound Patients

    OpenAIRE

    武政, 誠一; 嶋田, 智明; 日高, 正巳; 石川, 司; 池田, 亨; 河波, 恭弘; 末永, 英文

    1994-01-01

    The purpose of this study was to clarify the factors affecting the quali- ty of life (QOL) of the elderly home-bound patients. Data were collected from 56 chronically disabled elderly persons (mean age of 76.7 years) who need a long-term home-based care. They were assessed on health status, QOL, functional capacity, and family functioning as well as socio-economic condition. The QOL was evaluated by using Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The Activities of daily l...

  7. The Mystery of Increased Hospitalizations of Elderly Patients

    Centers for Disease Control (CDC) Podcasts

    2008-04-15

    Pneumonia is a common illness that affects millions of people in the United States every year. In some people, particularly the elderly and those who are ill from pre-existing conditions, bacterial pneumonia may follow influenza or even a common cold. Dr. Martin Meltzer, discusses two articles in the May 2008 issue of Emerging Infectious Diseases journal about increased pneumonia-related hospitalizations of elderly patients in England.  Created: 4/15/2008 by Emerging Infectious Diseases.   Date Released: 4/30/2008.

  8. Role of nutritional supplementation in elderly patients with hip fractures

    OpenAIRE

    Grigg, Megan; Arora, Manit; Diwan, Ashish D.

    2014-01-01

    Due to the ageing population there is an increasing incidence of hip fractures in the elderly. Oral nutritional supplements are being widely used to improve clinical outcomes and mortality post-hip fractures. The aim of this study was to review the available literature on the effects of oral nutritional supplements on elderly patients with hip fractures. A search of EMBASE (1988–present) and MEDLINE (1946–present) with the search terms: “nutritional supplement” AND “hip fracture”; “nutritiona...

  9. Patient participation during oncological encounters: Barriers and need for supportive interventions experienced by elderly cancer patients

    NARCIS (Netherlands)

    Noordman, Janneke; Driesenaar, Jeanine A.; Henselmans, Inge; Verboom, Jedidja; Heijmans, Monique; van Dulmen, Sandra

    2017-01-01

    Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data

  10. Patient participation during oncological encounters: barriers and facilitators experienced by elderly cancer patients.

    NARCIS (Netherlands)

    Noordman, J.; Driesenaar, J.A.; Henselmans, I.; Heijmans, M.; Verboom, J.; Dulmen, S. van

    2017-01-01

    Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data

  11. Visual impairment in elderly patients receiving long-term hemodialysis.

    Science.gov (United States)

    Chiu, Ernest; Markowitz, Samuel N; Cook, Wendy L; Jassal, Sarbjit V

    2008-12-01

    Visual impairments are associated with low quality of life, impairment of daily activities, and accidental falls. As dialysis patients are increasingly older and more disabled, we sought to assess visual impairments within an elderly dialysis population. Based on data from the general population, we hypothesized that more than 30% of dialysis patients 65 years or older would have visual impairment manifested by loss of visual acuity, depth perception, or contrast sensitivity. Single-center cross-sectional study. Patients established on hemodialysis therapy, age older than 65 years. The proportion of elderly hemodialysis patients with impairments in visual acuity, contrast sensitivity, and depth perception. Lighthouse Near Visual Acuity Test, Lea Screener contrast sensitivity test (Goodlite, MA, USA), Titmus Stereotest, Folstein Mini-Mental Status Examination. 152 of 159 patients (95.6%) had visual acuity levels less than age-expected values. Under North American (American Medical Association, edition 4) guidelines for disability compensation, 62 patients (39.0%) fulfilled criteria for legal blindness. Sixty patients (37.0%) had poor contrast sensitivity and 48 (30.6%) failed the Housefly component of the Titmus Stereotest. Failing the Housefly component was associated with a lower Folstein Mini-Mental Status Examination score (23.4 +/- 4.2 v 25.1 +/- 3.5; P = 0.01). This study is limited by the cross-sectional study design and abbreviated test protocol used for vision assessment. Results of this study suggest that elderly hemodialysis patients have a high frequency of visual impairment. Formal low vision assessment and low vision rehabilitation may be useful in elderly dialysis patients. Additional study is required to determine whether the absence of depth perception in this patient group is associated with deteriorating cognitive function.

  12. Use of anticoagulants in elderly patients: practical recommendations

    Directory of Open Access Journals (Sweden)

    Helia Robert-Ebadi

    2009-04-01

    Full Text Available Helia Robert-Ebadi, Grégoire Le Gal, Marc RighiniDivision of Angiology and Hemostasis (HRE, MR, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland, and Department of Internal Medicine and Chest Diseases, EA 3878 (GETBO, Brest University Hospital, Brest, France (GLGAbstract: Elderly people represent a patient population at high thromboembolic risk, but also at high hemorrhagic risk. There is a general tendency among physicians to underuse anticoagulants in the elderly, probably both because of underestimation of thromboembolic risk and overestimation of bleeding risk. The main indications for anticoagulation are venous thromboembolism (VTE prophylaxis in medical and surgical settings, VTE treatment, atrial fibrillation (AF and valvular heart disease. Available anticoagulants for VTE prophylaxis and initial treatment of VTE are low molecular weight heparins (LMWH, unfractionated heparin (UFH or synthetic anti-factor Xa pentasaccharide fondaparinux. For long-term anticoagulation vitamin K antagonists (VKA are the first choice and only available oral anticoagulants nowadays. Assessing the benefit-risk ratio of anticoagulation is one of the most challenging issues in the individual elderly patient, patients at highest hemorrhagic risk often being those who would have the greatest benefit from anticoagulants. Some specific considerations are of utmost importance when using anticoagulants in the elderly to maximize safety of these treatments, including decreased renal function, co-morbidities and risk of falls, altered pharmacodynamics of anticoagulants especially VKAs, association with antiplatelet agents, patient education. Newer anticoagulants that are currently under study could simplify the management and increase the safety of anticoagulation in the future.Keywords: anticoagulation, elderly patients, venous thromboembolism, hemorrhagic risk, atrial fibrillation, thrombin inhibitors, factor Xa

  13. Clinicopathological features and prognosis in elderly gastric cancer patients: a retrospective cohort study.

    Science.gov (United States)

    Xu, Guanghui; Feng, Fan; Liu, Shushang; Wang, Fei; Zheng, Gaozan; Wang, Qiao; Cai, Lei; Guo, Man; Lian, Xiao; Zhang, Hongwei

    2018-01-01

    Little is known about the clinicopathological features and prognosis in elderly gastric cancer (GC) patients aged 65-79 years. The aim of this study was to evaluate clinicopathological features and prognosis in elderly GC patients. From May 2008 to December 2014, a total of 5,282 GC patients were enrolled in our present study. Patients were divided into elderly and middle-aged groups. The clinicopathological features and clinical outcomes were analyzed. The proportion of dysphagia was significantly higher in elderly patients than that in middle-aged patients ( P =0.002), whereas the proportion of abdominal pain and heartburn was significantly lower in elderly patients than that in middle-aged patients ( P elderly patients than that in middle-aged patients ( P =0.009). There was no significant difference in clinicopathological features between elderly and middle-aged patients with D2 gastrectomy (all P >0.05). Age, tumor size, histological type, tumor depth, lymph node metastasis, carcinoembryonic antigen, alpha fetoprotein, CA19-9, and CA125 were independent risk factors for the prognosis of GC patients in univariate and multivariate analyses. Overall survival in elderly patients was significantly reduced compared with middle-aged patients ( P =0.001), especially in patients with tumor size >5 cm ( P =0.002), poorly differentiated tumor ( P elderly patients were different to those of middle-aged patients. The prognosis for elderly GC patients was significantly worse than for middle-aged patients.

  14. Epidemiology and management of chronic constipation in elderly patients.

    Science.gov (United States)

    Vazquez Roque, Maria; Bouras, Ernest P

    2015-01-01

    Constipation is a common functional gastrointestinal disorder, with prevalence in the general population of approximately 20%. In the elderly population the incidence of constipation is higher compared to the younger population, with elderly females suffering more often from severe constipation. Treatment options for chronic constipation (CC) include stool softeners, fiber supplements, osmotic and stimulant laxatives, and the secretagogues lubiprostone and linaclotide. Understanding the underlying etiology of CC is necessary to determine the most appropriate therapeutic option. Therefore, it is important to distinguish from pelvic floor dysfunction (PFD), slow and normal transit constipation. Evaluation of a patient with CC includes basic blood work, rectal examination, and appropriate testing to evaluate for PFD and slow transit constipation when indicated. Pelvic floor rehabilitation or biofeedback is the treatment of choice for PFD, and its efficacy has been proven in clinical trials. Surgery is rarely indicated in CC and can only be considered in cases of slow transit constipation when PFD has been properly excluded. Other treatment options such as sacral nerve stimulation seem to be helpful in patients with urinary dysfunction. Botulinum toxin injection for PFD cannot be recommended at this time with the available evidence. CC in the elderly is common, and it has a significant impact on quality of life and the use of health care resources. In the elderly, it is imperative to identify the etiology of CC, and treatment should be based on the patient's overall clinical status and capabilities.

  15. Role of nutritional supplementation in elderly patients with hip fractures

    Directory of Open Access Journals (Sweden)

    Megan Grigg

    2014-01-01

    Full Text Available Due to the ageing population there is an increasing incidence of hip fractures in the elderly. Oral nutritional supplements are being widely used to improve clinical outcomes and mortality post-hip fractures. The aim of this study was to review the available literature on the effects of oral nutritional supplements on elderly patients with hip fractures. A search of EMBASE (1988–present and MEDLINE (1946–present with the search terms: “nutritional supplement” AND “hip fracture”; “nutritional supplement” AND “femoral neck fracture”; “nutritional supplement” AND “intertrochanteric fracture”; “nutritional supplement” AND “subcapital fracture”; “hip fracture” AND “vitamin supplement”; “hip fracture” AND “protein supplement”; “hip fracture” AND “nutrient supplement” was carried out. Additionally, the reference lists of articles were searched for relevant areas of study. Few studies showed that oral nutritional supplementation led to a more positive clinical outcome amongst elderly patients suffering hip fractures. Most studies found little or nil positive results. Thus, the role of oral nutritional supplementation on post-hip fracture mortality, infection/complication rates, and hospitalisation/rehabilitation time amongst elderly patients is unclear. There is a need for a broader, randomised, placebo-controlled clinical trial on the effect of oral nutritional supplements and particularly on the supplements used commonly.

  16. Patient participation during oncological encounters: Barriers and need for supportive interventions experienced by elderly cancer patients.

    Science.gov (United States)

    Noordman, Janneke; Driesenaar, Jeanine A; Henselmans, Inge; Verboom, Jedidja; Heijmans, Monique; van Dulmen, Sandra

    2017-12-01

    To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. A mixed method design, including both quantitative (secondary survey data analysis) and qualitative (interviews) methods Survey data were used to identify communication barriers and need for supportive interventions of elderly cancer patients, compared to younger patients. Next, interviews provided in-depth insight into elderly patients' experiences and underlying mechanisms. A majority of the 70 participating elderly cancer patients (53%) felt confident in communicating and participating during medical encounters. However, 47% of patients experienced barriers to effectively communicate with their healthcare provider and felt the need for supportive interventions. The 14 interviewed patients mentioned barriers and facilitators related to attributes of themselves (e.g. feeling sick, self-efficacy), the provider (e.g. taking patient seriously) and the healthcare system (e.g. time constraints). Although many elderly cancer patients feel confident, offering support to patients who feel less confident in communicating with their provider is recommended. The outcomes of this study can be used as a first step for developing interventions for elderly cancer patients to overcome communication barriers, and help providers to facilitate this process. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Treatment decisions for elderly patients with haematological malignancies: a dilemma.

    Science.gov (United States)

    Peyrade, Frédéric; Gastaud, Lauris; Ré, Daniel; Pacquelet-Cheli, Sandrine; Thyss, Antoine

    2012-08-01

    Over the past decade, haematological malignant diseases have been diagnosed with increasing frequency in patients older than 65 years. The management of these diseases is particularly difficult in elderly patients, as non-tumour-related life expectancy is highly variable and the benefit-to-risk ratio for oncological treatments depends on comorbidities and pharmacological factors. Very few data are available in very old or frail patients, and management decisions are usually based on data obtained in younger patients. Patients might, therefore, be overtreated or undertreated without clear clinical or biological justification. In this Review we discuss the management of haematological malignant diseases in the elderly, with respect to biology or pharmacokinetic and pharmacodynamic features. We focus on acute myeloid leukaemia and aggressive lymphoma. Additionally, we discuss how the implementation of geriatric tools, such as comprehensive geriatric assessment scores, in the clinical management of elderly patients might help to adapt treatment to meet individual patients' needs. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Bariatric surgery in elderly patients: a systematic review.

    Science.gov (United States)

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I (2) test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone.

  19. Digital pen-based telemonitoring of elderly heart failure patients.

    Science.gov (United States)

    Lind, Leili; Karlsson, Daniel

    2013-01-01

    Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital pen and a Health Diary form. Via the system the clinicians detected all HF-related deteriorations at an early stage and thereby prevented hospital re-admissions for all patients during the study, implying improved symptom control and large cost savings.

  20. Elderly patients compliance and elderly patients and health professional's, views, and attitudes towards prescribed sip- feed supplements.

    Science.gov (United States)

    Lad, H; Gott, M; Gariballa, S

    2005-01-01

    Although nutritional supplements are widely prescribed in hospital and community settings compliance with supplements and factors affecting compliance are not well understood. The aims of this study were therefore to examine compliance, factors that influence compliance, views and attitudes of elderly patients and their health professionals on prescribed oral nutritional supplements. Forty medically stable hospitalised elderly patients prescribed nutritional supplements by a hospital dietician after nutritional screening had their compliance with supplement intake measured. Sixteen patients prescribed nutritional supplements and their health professionals had their views and attitudes on the factors that influence compliance with supplements intake explored using qualitative face-to- face interviews and postal questionnaires respectively. Qualitative data analysis adhered to the principles of grounded theory and followed the 'Framework' approach. Quantitative data were entered on to a standard spreadsheet and simple descriptive statistics was examined. A total of 40 hospitalised elderly patient (Age range 60-91 yrs; mean age 78 years; 20 female); 24 doctors, 13 dietician and 33 nurses were recruited. The main finding of this study was that compliance with prescribed nutritional supplements was low in hospital and in the community. Only 43% of the study population consumed more than 80% of the prescribed amount. Factors that affected compliance included flavour, taste, texture and predictability of the supplements as well as personal preferences and life style. Health professionals dealing with elderly patients have wide-range and different views on the criteria used to prescribe nutritional supplements and factors affecting their subsequent intake. Compliance with prescribed nutritional supplements was low in hospital and in the community. Elderly patients and their health professionals have wide-range and different views on factors that influence compliance with

  1. Bariatric surgery in elderly patients: a systematic review

    OpenAIRE

    Giordano S; Victorzon M

    2015-01-01

    Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and...

  2. Radiotherapy of brain metastases and glioblastomas in elderly patients

    International Nuclear Information System (INIS)

    Lauche, O.; Kerr, C.; Riou, O.; Dhermain, F.

    2011-01-01

    As the occurrence of malignant gliomas and brain metastases is increasing in elderly people, the authors report the definition of an optimal therapeutic strategy for these patients. For patients in good health condition, a prospective randomized showed a modest benefit of radiotherapy alone with respect to support cares in terms of survival. The radiotherapy scheme is discussed in terms of dose and number of fractions. It seems that the physiological age is a strong prognosis factor. Short communication

  3. Efficacy of radiotherapy for malignant gliomas in elderly patients

    International Nuclear Information System (INIS)

    Villa, Salvador; Vinolas, Nuria; Verger, Eugenia; Yaya, Ricard; Martinez, Antonio; Gil, Miquel; Moreno, Victor; Caral, Luis; Graus, Francesc

    1998-01-01

    Purpose: Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas. Methods and Materials: We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30-100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models. Results: Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31-6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years. Conclusions: The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter

  4. Efficacy of radiotherapy for malignant gliomas in elderly patients.

    Science.gov (United States)

    Villà, S; Viñolas, N; Verger, E; Yaya, R; Martínez, A; Gil, M; Moreno, V; Caral, L; Graus, F

    1998-12-01

    Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas. We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30-100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models. Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31-6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years. The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter.

  5. Differences in perceived communication barriers among nurses and elderly patients in China.

    Science.gov (United States)

    Ruan, Jing; Lambert, Vickie A

    2008-06-01

    In China, limited information exists about nurses' and elderly patients' perceptions of barriers to the communication process. Therefore, the purposes of this study were to identify the major communication barriers (nurse-related, patient-related, and environment-related) perceived both by nurses and elderly patients and to determine the perceived differences in the level of importance of the communication barriers between nurses and elderly patients. The sample consisted of 84 nurses and 75 elderly patients who completed a demographic questionnaire and a communication barriers questionnaire. The findings suggested that the nurses and elderly patients often selected similar barriers related to the communication process. The nurses tended to assign higher values to the communication barriers that were found to be significantly different from those of the elderly patients. The study findings provide information about which type of barriers nurses need to address so as to facilitate effective communication with elderly patients.

  6. Epidemiology and management of chronic constipation in elderly patients

    Science.gov (United States)

    Vazquez Roque, Maria; Bouras, Ernest P

    2015-01-01

    Constipation is a common functional gastrointestinal disorder, with prevalence in the general population of approximately 20%. In the elderly population the incidence of constipation is higher compared to the younger population, with elderly females suffering more often from severe constipation. Treatment options for chronic constipation (CC) include stool softeners, fiber supplements, osmotic and stimulant laxatives, and the secretagogues lubiprostone and linaclotide. Understanding the underlying etiology of CC is necessary to determine the most appropriate therapeutic option. Therefore, it is important to distinguish from pelvic floor dysfunction (PFD), slow and normal transit constipation. Evaluation of a patient with CC includes basic blood work, rectal examination, and appropriate testing to evaluate for PFD and slow transit constipation when indicated. Pelvic floor rehabilitation or biofeedback is the treatment of choice for PFD, and its efficacy has been proven in clinical trials. Surgery is rarely indicated in CC and can only be considered in cases of slow transit constipation when PFD has been properly excluded. Other treatment options such as sacral nerve stimulation seem to be helpful in patients with urinary dysfunction. Botulinum toxin injection for PFD cannot be recommended at this time with the available evidence. CC in the elderly is common, and it has a significant impact on quality of life and the use of health care resources. In the elderly, it is imperative to identify the etiology of CC, and treatment should be based on the patient’s overall clinical status and capabilities. PMID:26082622

  7. Bariatric surgery in elderly patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Giordano S

    2015-10-01

    Full Text Available Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (% with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. Keywords: morbid obesity, bariatric surgery, elderly, gastric bypass, weight loss, laparoscopy

  8. Treatment options and outcomes for glioblastoma in the elderly patient

    Science.gov (United States)

    Arvold, Nils D; Reardon, David A

    2014-01-01

    Age remains the most powerful prognostic factor among glioblastoma (GBM) patients. Half of all patients with GBM are aged 65 years or older at the time of diagnosis, and the incidence rate of GBM in patients aged over 65 years is increasing rapidly. Median survival for elderly GBM patients is less than 6 months and reflects less favorable tumor biologic factors, receipt of less aggressive care, and comorbid disease. The standard of care for elderly GBM patients remains controversial. Based on limited data, extensive resection appears to be more beneficial than biopsy. For patients with favorable Karnofsky performance status (KPS), adjuvant radiotherapy (RT) has a demonstrated survival benefit with no observed decrement in quality of life. Concurrent and adjuvant temozolomide (TMZ) along with RT to 60 Gy have not been prospectively studied among patients aged over 70 years but should be considered for patients aged 65–70 years with excellent KPS. Based on the recent NOA-08 and Nordic randomized trials, testing for O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation should be performed routinely immediately after surgery to aid in adjuvant treatment decisions. Patients aged over 70 years with favorable KPS, or patients aged 60–70 years with borderline KPS, should be considered for monotherapy utilizing standard TMZ dosing for patients with MGMT-methylated tumors, and hypofractionated RT (34 Gy in ten fractions or 40 Gy in 15 fractions) for patients with MGMT-unmethylated tumors. The ongoing European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada trial will help clarify the role for concurrent TMZ with hypofractionated RT. For elderly patients with poor KPS, reasonable options include best supportive care, TMZ alone, hypofractionated RT alone, or whole brain RT for symptomatic patients needing to start treatment urgently. Given the balance between short survival and quality of life in this patient population

  9. Quality of life of elderly cancer patients under radiotherapy

    International Nuclear Information System (INIS)

    Peres de Oliveira, Patricia; Corte Pereira, Beltrina da Purificacao

    2004-01-01

    This research analyzed the effects of radiotherapy in the quality of life of elderly patients suffering from prostatic cancer. Our aim was to verify the psychometric properties of the Quality of Life Index (QLI), by Ferrans and Powers, describing the social-demographic characteristics that affect the quality of life; and patients concept of quality of life and their perception of how radiotherapy interferes with the quality of life. Interviews were carried out with a sample of seven elderly patients suffering from prostatic cancer. Two different approaches were utilized: descriptive and qualitative statistics. The results show that the QLI may have useful application in our field in the identification of those aspects of quality of life affected by cancer. (author)

  10. Assessment and treatment relevance in elderly glioblastoma patients.

    Science.gov (United States)

    Bauchet, Luc; Zouaoui, Sonia; Darlix, Amélie; Menjot de Champfleur, Nicolas; Ferreira, Ernestine; Fabbro, Michel; Kerr, Christine; Taillandier, Luc

    2014-11-01

    Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and "standards of care" do not exist for GBM patients aged >70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS patients; and (v) the addition of concomitant temozolomide to radiotherapy has not yet been validated but shows promising results in some studies, yet the optimal schedule of radiotherapy remains to be determined. In the future, specific assessments (geriatric, imaging, biology) and use of new endpoints (quality of life and toxicity measures) will aid clinicians in determining the balance of potential benefits and risks of each oncological strategy. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. [Hospitality for elderly patients in the emergency department].

    Science.gov (United States)

    Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas

    2015-12-09

    Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective.

  12. Effectiveness of Radiotherapy for Elderly Patients With Glioblastoma

    International Nuclear Information System (INIS)

    Scott, Jacob; Tsai, Ya-Yu; Chinnaiyan, Prakash; Yu, Hsiang-Hsuan Michael

    2011-01-01

    Purpose: Radiotherapy plays a central role in the definitive treatment of glioblastoma. However, the optimal management of elderly patients with glioblastoma remains controversial, as the relative benefit in this patient population is unclear. To better understand the role that radiation plays in the treatment of glioblastoma in the elderly, we analyzed factors influencing patient survival using a large population-based registry. Methods and Materials: A total of 2,836 patients more than 70 years of age diagnosed with glioblastoma between 1993 and 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. Demographic and clinical variables used in the analysis included gender, ethnicity, tumor size, age at diagnosis, surgery, and radiotherapy. Cancer-specific survival and overall survival were evaluated using the Kaplan-Meier method. Univariate and multivariate analysis were performed using Cox regression. Results: Radiotherapy was administered in 64% of these patients, and surgery was performed in 68%. Among 2,836 patients, 46% received surgery and radiotherapy, 22% underwent surgery only, 18% underwent radiotherapy only, and 14% did not undergo either treatment. The median survival for patients who underwent surgery and radiotherapy was 8 months. The median survival for patients who underwent radiotherapy only was 4 months, and for patients who underwent surgery only was 3 months. Those who received neither surgery nor radiotherapy had a median survival of 2 months (p < 0.001). Multivariate analysis showed that radiotherapy significantly improved cancer-specific survival (hazard ratio [HR], 0.43, 95% confidence interval [CI] 0.38-0.49) after adjusting for surgery, tumor size, gender, ethnicity, and age at diagnosis. Other factors associated with Cancer-specific survival included surgery, tumor size, age at diagnosis, and ethnicity. Analysis using overall survival as the endpoint yielded very similar results. Conclusions: Elderly

  13. Epidemiology and management of chronic constipation in elderly patients

    Directory of Open Access Journals (Sweden)

    Vazquez Roque M

    2015-06-01

    Full Text Available Maria Vazquez Roque, Ernest P Bouras Gastroenterology and Hepatology Department, Mayo Clinic, Jacksonville, FL, USA Abstract: Constipation is a common functional gastrointestinal disorder, with prevalence in the general population of approximately 20%. In the elderly population the incidence of constipation is higher compared to the younger population, with elderly females suffering more often from severe constipation. Treatment options for chronic constipation (CC include stool softeners, fiber supplements, osmotic and stimulant laxatives, and the secretagogues lubiprostone and linaclotide. Understanding the underlying etiology of CC is necessary to determine the most appropriate therapeutic option. Therefore, it is important to distinguish from pelvic floor dysfunction (PFD, slow and normal transit constipation. Evaluation of a patient with CC includes basic blood work, rectal examination, and appropriate testing to evaluate for PFD and slow transit constipation when indicated. Pelvic floor rehabilitation or biofeedback is the treatment of choice for PFD, and its efficacy has been proven in clinical trials. Surgery is rarely indicated in CC and can only be considered in cases of slow transit constipation when PFD has been properly excluded. Other treatment options such as sacral nerve stimulation seem to be helpful in patients with urinary dysfunction. Botulinum toxin injection for PFD cannot be recommended at this time with the available evidence. CC in the elderly is common, and it has a significant impact on quality of life and the use of health care resources. In the elderly, it is imperative to identify the etiology of CC, and treatment should be based on the patient’s overall clinical status and capabilities. Keywords: pelvic floor dysfunction, constipation, elderly 

  14. [Predictive value of the VMS theme 'Frail elderly': delirium, falling and mortality in elderly hospital patients].

    Science.gov (United States)

    Oud, Frederike M M; de Rooij, Sophia E J A; Schuurman, Truus; Duijvelaar, Karlijn M; van Munster, Barbara C

    2015-01-01

    To determine the predictive value of safety management system (VMS) screening questions for falling, delirium, and mortality, as punt down in the VMS theme 'Frail elderly'. Retrospective observational study. We selected all patients ≥ 70 years who were admitted to non-ICU wards at the Deventer Hospital, the Netherlands, for at least 24 hours between 28 March 2011 and 10 June 2011. On admission, patients were screened with the VMS instrument by a researcher. Delirium and falls were recorded during hospitalisation. Six months after hospitalisation, data on mortality were collected. We included 688 patients with a median age of 78.7 (range: 70.0-97.1); 50.7% was male. The sensitivity of the screening for delirium risk was 82%, the specificity 62%. The sensitivity of the screening for risk of falling was 63%, the specificity 65%. Independent predictors for mortality within 6 months were delirium risk (odds ratio (OR): 2.3; 95% CI 1.1-3.2), malnutrition (OR: 2.1; 95% CI 1.3-3.5), admission to a non-surgical ward (OR: 3.0; 95% CI 1.8-5.1), and older age (OR: 1.1; 95%CI 1.0-1.1). Patients classified by the VMS theme 'Frail elderly' as having more risk factors had a higher risk of dying (p instrument for identifying those elderly people with a high risk of developing this condition; the VMS sensitivity for fall risk is moderate. The number of positive VMS risk factors correlates with mortality and may therefore be regarded as a measure of frailty.

  15. On the importance of multidimensional evaluation of elderly oncologic patients.

    Science.gov (United States)

    Di Mauro, S; Distefano, A; Di Fazio, I; Leotta, C; Malaguarnera, M

    2000-01-01

    The role of comorbidity and the psycho-affective attitudes have been studied in 108 elderly oncological patients, in comparison with 25 elderly subjects without tumor pathologies. The results have revealed positive correlations between the activity of daily living (ADL), as well as the instrumental activity of daily living (IADL) scales and the comorbidity both in the oncological subjects and the controls. The performance status defined by the eastern cooperative oncology group (ECOG-PS) positively correlated with the parameters of ADL and IADL scales, demonstrating an increased vulnerability and fragility of the oncological patients in their everyday activities. An increased psychological fragility of the oncological patients has also been revealed by the scores of the geriatric depression scale (GDS), which might be cause and consequence at the same time of the disease itself. In addition, the polypathologies are not associated with an increased gravity of the tumor stage, although there have been 2.5 accompanying pathologies, mainly diseases of osteoarticular and cardial character. The correction of functional damages of various organs due to aging or concomitant or previous diseases is a period of fundamental importance for an adequate oncological therapy. The principal goal of any intervention in the elderly oncological patient should certainly be an improvement of the quality of life, including an alleviation of the impact of the diagnostic and therapeutic procedures on it.

  16. Antipsychotic use in elderly patients and the risk of pneumonia.

    Science.gov (United States)

    Gambassi, Giovanni; Sultana, Janet; Trifirò, Gianluca

    2015-01-01

    Antipsychotics are frequently and increasingly prescribed off-label for the treatment of behavioral and psychological symptoms associated with dementia, despite their modest efficacy. Instead, the safety profile of antipsychotics has been questioned repeatedly in recent years with various concerns, including death. Meta-analyses of randomized controlled trials found that one of the major causes of death associated with atypical antipsychotics use was pneumonia. Only few observational studies, however, have investigated the risk of pneumonia in elderly patients, especially among those receiving conventional antipsychotics. The aim of this editorial is to synthesize the current evidence from observational studies regarding the risk of pneumonia in elderly patients receiving either conventional or atypical antipsychotics. The studies conducted so far document that the risk of pneumonia is two- to threefold increased in a dose-dependent fashion with both classes compared to nonuse, with a possibly higher risk attributable to atypical antipsychotics. The risk seems to peak at the beginning of treatment (e.g., 7 - 30 days), and dissipates over time for both conventional and atypical antipsychotics. The risk-benefit ratio suggests that there will be 1 excess hospitalization for pneumonia for every 2 - 5 patients receiving any clinical improvement in symptoms. Considering the modest improvement in terms of efficacy, the risks associated with antipsychotics in elderly patients may outweigh their benefit.

  17. Assessment of adherence in elderly patients in primary care.

    Science.gov (United States)

    Schmitt Júnior, Antônio Augusto; Lindner, Stéphanie; Helena, Ernani Tiaraju de Santa

    2013-01-01

    To identify the prevalence of non-adherence to drug therapy for elderly patients in primary care in Blumenau, SC, Brazil. This is a cross-sectional, population-based epidemiological study. A randomly selected sample of users who attended the pharmacies of 14 units of primary healthcare answered the questionnaire's study variables. The prevalence of non-adherence was measured using a self-reported questionnaire. A logistic regression model to calculate odds ratio was performed to estimate the association between risk factors and non-adherence. Of the 151 elderly individuals interviewed, 84.1% reported continuous use of their medicines. The average age of the participants was 69.04 years. Regarding the characteristics of the medications, an average of 4.3 medicines were used by the elderly, and diseases of the circulatory system were the most prominent (43.3%). The prevalence of non-adherence was 35.4%. Logistic regression showed an association between non-adherence and "prior stopping treatment because of lack of medication" and "inappropriately prescribed medication use" (p < 0.005). The results reinforce the need to improve public policy and management processes aimed at ensuring people's access to essential medicines and qualify the process of prescribing health professionals as a way to improve treatment adherence in the elderly. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  18. Affective functioning after delirium in elderly hip fracture patients.

    Science.gov (United States)

    Slor, Chantal J; Witlox, Joost; Jansen, René W M M; Adamis, Dimitrios; Meagher, David J; Tieken, Esther; Houdijk, Alexander P J; van Gool, Willem A; Eikelenboom, Piet; de Jonghe, Jos F M

    2013-03-01

    Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge. Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups. This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

  19. [Treatment of infiltrating nonmetastatic bladder cancers in elderly patients].

    Science.gov (United States)

    Quintens, H; Guy, L; Mazerolles, C; Théodore, C; Amsellem, D; Roupret, M; Wallerand, H; Roy, C; Saint, F; Bernardini, S; Lebret, T; Soulié, M; Pfister, C

    2009-11-01

    Total cystectomy is the reference treatment for infiltrating nonmetastatic bladder cancers. With the progress in anesthesia and postoperative intensive care, this treatment can be applied to a population of elderly subjects provided there is a strict oncological and geriatric evaluation of the patient. Recent series reporting total cystectomies in subjects over 75 years of age report comparable morbidity and mortality rates to the general population. Strategies to preserve the vesical reservoir can be indicated in selected cases. Their objectives are to guarantee local control and follow-up identical to radical cystectomy, while preserving a functional bladder and good quality of life. The strategies including transurethral resection with radiochemotherapy are analyzed. Thus, with multidisciplinary consensus and adapted management, elderly patients with significant comorbidities should not be automatically excluded from access to effective treatment of these cancers. (c) 2009 Elsevier Masson SAS. All rights reserved.

  20. Nursing diagnosis "impaired walking" in elderly patients: integrative literature review

    Directory of Open Access Journals (Sweden)

    Cristina Maria Alves Marques-Vieira

    Full Text Available The impaired walking nursing diagnosis has been included in NANDA International classification taxonomy in 1998, and this review aims to identify the defining characteristics and related factors in elderly patients in recent literature. Integrative literature review based on the following guiding question: Are there more defining characteristics and factors related to the nursing diagnosis impaired walking than those included in NANDA International classification taxonomy in elderly patients? Search conducted in 2007-2013 on international and Portuguese databases. Sample composed of 15 papers. Among the 6 defining characteristics classified at NANDA International, 3 were identified in the search results, but 13 were not included in the classification. Regarding the 14 related factors that are classified, 9 were identified in the sample and 12 were not included in the NANDA International taxonomy. This review allowed the identification of new elements not included in NANDA International Taxonomy and may contribute to the development of taxonomy and nursing knowledge.

  1. Reasons for elderly patients GP visits: results of a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Frese T

    2016-02-01

    Full Text Available Thomas Frese, Jarmila Mahlmeister, Tobias Deutsch, Hagen Sandholzer Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany Objective: The aim of this study is to describe the frequency of reasons for elderly patients visits to a general practice (GP setting. Subjects and methods: Cross-sectional data from 8,877 randomly selected patients were assessed during a 1-year period by 209 GPs in the German federal state of Saxony. The reasons for visits, performed procedures, and results of visits were documented. In this study, the data of patients aged 65 years and older are analyzed and the procedural and nonprocedural reasons for visits are described. Results: In all, 2,866 patients aged 65 years and older were included. The majority of patients (1,807 were female. A total of 4,426 reasons for visits were found, distributed on 363 International Classification of Primary Care-2 codes. In the mean, there were 1.5 reasons for a GP visit from each patient. The top five nonprocedural reasons for visiting the GP were: cough (1.8%, back complaints (1.6%, shoulder complaints (1.3%, knee complaints (1.1%, and dyspnea (1.0% of all reasons for visit. The top five procedural reasons for visiting the GP included follow-up investigations of cardiovascular or endocrine disorders and immunizations. The top 30 nonprocedural reasons for visits covered 21.9% of all reasons for visiting. The top 30 procedural reasons covered 54.3% of all reasons for visits. Conclusion: The current work indicates that people aged 65 years and older consult the GP more frequently for procedural than for nonprocedural reasons. The top 30 procedural and nonprocedural reasons for visits cover ~75% of all reasons for visits in these patients. Keywords: elderly, geriatric, general practice, primary care, reason for visit, reason for consultation

  2. How well do nurses recognize malnutrition in elderly patients?

    Science.gov (United States)

    Suominen, M H; Sandelin, E; Soini, H; Pitkala, K H

    2009-02-01

    Malnutrition is a common and underrecognized clinical problem among aged institutionalized patients. The aim of this study was to investigate how well nurses recognize malnutrition in elderly patients in long-term care hospitals in Helsinki. In this descriptive, cross-sectional study, the nutritional status of 1043 elderly patients was assessed with the Mini Nutritional Assessment (MNA), their body mass indices (BMIs) (kg m(-2)) were counted, and factors related to their nutritional care were queried using a structured questionnaire. In addition, we asked the opinions of 53 nurses on whether they considered their patients to suffer from malnutrition. All the long-term care hospitals in Helsinki, Finland participated in this study. The mean age of the patients was 81 years. The nurses considered only 15.2% of the patients to be malnourished, although the MNA showed that 56.7% were malnourished (MNApatients having a BMI24 but MNApatients considered to be malnourished received snacks and nutritional supplements less than the patients that the nurses considered to have normal nutritional status. However, only one in six of the malnourished patients received oral nutritional supplements. The nurses recognized malnutrition in their aged patients poorly. Nutrition education for nurses is urgently needed, as malnutrition and weight loss have been considered significant problems, and the benefits of nutritional care are well established.

  3. Risk of rupture of unruptured cerebral aneurysms in elderly patients.

    Science.gov (United States)

    Hishikawa, Tomohito; Date, Isao; Tokunaga, Koji; Tominari, Shinjiro; Nozaki, Kazuhiko; Shiokawa, Yoshiaki; Houkin, Kiyohiro; Murayama, Yuichi; Ishibashi, Toshihiro; Takao, Hiroyuki; Kimura, Toshikazu; Nakayama, Takeo; Morita, Akio

    2015-11-24

    The aim of this study was to identify risk factors for rupture of unruptured cerebral aneurysms (UCAs) in elderly Japanese patients aged 70 years or older. The participants included all patients 70 years of age or older in 3 prospective studies in Japan (the Unruptured Cerebral Aneurysm Study of Japan [UCAS Japan], UCAS II, and the prospective study at the Jikei University School of Medicine). A total of 1,896 patients aged 70 years or older with 2,227 UCAs were investigated. The median and mean follow-up periods were 990 and 802.7 days, respectively. The mean aneurysm size was 6.2 ± 3.9 mm. Sixty-eight patients (3.6%) experienced subarachnoid hemorrhage during the follow-up period. Multivariable analysis per patient revealed that in patients aged 80 years or older (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.16-3.49, p = 0.012), aneurysms 7 mm or larger (HR, 3.08; 95% CI, 1.35-7.03, p = 0.007 for 7-9 mm; HR, 7.82; 95% CI, 3.60-16.98, p < 0.001 for 10-24 mm; and HR, 43.31; 95% CI, 12.55-149.42, p < 0.001 for ≥25 mm) and internal carotid-posterior communicating artery aneurysms (HR, 2.45; 95% CI, 1.23-4.88, p = 0.011) were independent predictors for UCA rupture in elderly patients. In our pooled analysis of prospective cohorts in Japan, patient age and aneurysm size and location were significant risk factors for UCA rupture in elderly patients. © 2015 American Academy of Neurology.

  4. Scabies Among Elderly Korean Patients with Histories of Leprosy.

    Science.gov (United States)

    Park, Hyungcheol; Lee, Chaeyoung; Park, Seungkyu; Kwon, Hyeon; Kweon, Sun-Seog

    2016-07-06

    A scabies epidemic, traced by the hospital-based surveillance system, was reported in a Korean leprosarium. A total of 200 symptomatic cases were found during 2012-2014 among 570 elderly former leprosy patients. Most of cases were classic type scabies (87%) and aged 75 years and older (72%). Surveillance system for early diagnosis and prompt intervention was applied and the scabies epidemic was controlled effectively in this long-term care facility. © The American Society of Tropical Medicine and Hygiene.

  5. Anemia in the frail, elderly patient

    Science.gov (United States)

    Röhrig, Gabriele

    2016-01-01

    Anemia and frailty are two common findings in geriatric patients and have been shown to be associated with poor outcomes in this patient group. Recent studies have contributed to the growing evidence of a possible association with the age-related chronic inflammatory status known as “inflammaging”. These findings do not only give a better insight into the pathogenesis of anemia in frailty, but also offer new treatment options. The present article focuses on this assumed association between anemia, frailty, and inflammaging and summarizes current management options for anemia in frail patients. PMID:27051279

  6. Treatment strategy for elderly patients with esophageal cancer

    International Nuclear Information System (INIS)

    Yamasaki, Makoto; Doki, Yuichiro; Miyata, Hiroshi; Takiguchi, Shuji; Fujiwara, Yoshiyuki; Monden, Morito

    2008-01-01

    Short- and long-term outcomes of patients at least 75 years undergoing esophagectomy from 1986 to 2005 for Stage I to III esophageal cancer were compared with findings in definitive chemo-radiotherapy. 47 patients in esophagectomy and 18 in definitive chemo-radiotherapy were analyzed. Clinical presentation and morbidity rate in the two groups was similar. The morbidity rate and overall survival at 3 years in Stage II, III was 50.0 and 50.3% for all patients, 100 and 25.0% for patients with multiple comorbidities in esophagectomy group; meanwhile, in definitive chemo-radiotherapy group was 50.0 and 29.4% for all patients, 50.0 and 25.0% for patients with multiple comorbidities, respectively. We recommended esophagectomy in patients with one and less comorbidity and definitive chemo-radiotherapy with multiple comorbidities as standard treatment for elderly patients with Stage II, III esophageal cancer. (author)

  7. Hemorrhagic Cholecystitis in an Elderly Patient Taking Aspirin and Cilostazol

    Directory of Open Access Journals (Sweden)

    David S. Morris

    2008-06-01

    Full Text Available Hemorrhage is a rare complication of acute cholecystitis. Patients who develop this complication often are receiving anticoagulation therapy or have a pathologic coagulopathy. We present a case of an elderly patient who developed hemorrhagic cholecystitis while taking aspirin and cilostazol, a phosphodiesterase inhibitor. The patient underwent an emergent abdominal exploration. A large, blood-filled gallbladder was found along with a large hematoma between the liver and gallbladder. We also briefly review the literature regarding hemorrhagic cholecystitis, hemorrhage into the biliary tree, and hemorrhage as a complication of aspirin and phosphodiesterase inhibitor therapy.

  8. The interuncal distance in elderly patients with dementia

    International Nuclear Information System (INIS)

    Hanyu, Haruo; Takasaki, Masaru; Sugiyama, Takeshi; Abe, Shinei; Kobayashi, Yasutaka; Maehata, Yukihiko; Katsunuma, Hidetaka.

    1993-01-01

    The interuncal distance between the unci of the temporal lobes was measured from axial MR images of the brain in elderly patients with dementia including dementia of the Alzheimer type (DAT), vascular dementia (VD), and others. The measured value of the interuncal distance completely separated patients with DAT from normal controls, and there was significant diference in the interuncal distance between patients with DAT and VD. This measurement is a practical method of assessing hippocampal atrophy and appears to be a useful adjunct in the clinical diagnosis of DAT. (author)

  9. Radiotherapy in the management of cervical cancer in elderly patients

    International Nuclear Information System (INIS)

    Lindegaard, J.C.; Thranov, I.R.; Engelholm, S.A.

    2000-01-01

    One hundred and fourteen elderly patients (median 75.5 years, range 70.0-85.9) consecutively referred for curative radiotherapy in the period 1987-1996 were prospectively followed with regard to tumour control and complications. The importance of age, stage (FIGO), tumour size, histology, tumour fixation, haemoglobin, concurrent disease, performance status (WHO) and type of radiotherapy were assessed using univariate and multivariate analyses. Treatment was completed as planned in 68%, delayed in 29% and stopped prematurely in 3%. The frequency of grade 3 late complications was 11% and the actuarial probability at 5 years was 20%. Overall 5-year survival according to FIGO was 61% (I), 34% (II) and 25% (III). Cox multivariate analysis identified tumour size as independent prognostic factor for tumour control, disease-free survival and overall survival. FIGO stage was predictive for late grade 2 complications. We were unable to identify significant factors with respect to grade 3 complications. Age was not a significant parameter for any of the investigated endpoints. Elderly patients in good performance status with advanced cancer of the uterine may tolerate radical radiotherapy with acceptable morbidity and reasonable survival. Radiotherapy may also be a good alternative in early stage disease for surgically unfit elderly patients. (author)

  10. Refusal of implant supported mandibular overdentures by elderly patients.

    Science.gov (United States)

    Ellis, Janice S; Levine, Alissa; Bedos, Christophe; Mojon, Phillippe; Rosberger, Zeer; Feine, Jocelyne; Thomason, J Mark

    2011-03-01

      The aim of this study was to gain greater in-depth understanding of why elderly patients who are currently dissatisfied with conventional dentures decline implant treatment.   There is strong evidence from high-quality randomised controlled trials to support the use of implant-supported overdentures for the restoration of the edentulous mandible. However, whilst recruiting for randomised clinical trials, researchers have found that a high proportion of potential subjects decline participation, despite the removal of financial constraints.   The study adopted a qualitative approach to provide a rich and deep understanding of people's reasons for refusal. Data were collected through focus group interviews in a two-centre study based in Montreal, Canada and Newcastle, UK. A semi-structured interview schedule was used and iteratively developed as analysis identified themes from previous focus groups. Transcripts of focus groups were coded and emergent themes determined.   Two main themes emerged; patients' fear and anxiety (relating to the pain of surgery, complications of the procedure and immediate post-surgical denture use), and the appropriateness of the procedure in an elderly person.   Fears of pain, complications and social embarrassment, exacerbated by age, are important factors that help explain refusal of implants by elderly patients. © 2010 The Gerodontology Society and John Wiley & Sons A/S.

  11. [Lumbar spinal surgery in elderly patients].

    Science.gov (United States)

    Pulido-Rivas, P; Sola, R G; Pallares-Fernández, J M; Pintor-Escobar, A

    In the geriatric population, pain with sciatic irradiation requires a differential diagnosis to enable a distinction to be made mainly between a herniated disc, lateral recess stenosis or lumbar stenosis. In addition, in many cases the degenerative problems are often associated with lumbar listhesis or instability. Furthermore, these patients present very diverse associated cardiovascular, pulmonary or metabolic pathologies which can make surgery complicated and, above all, prolong post-operative recovery, as well as increasing morbidity and mortality. We reviewed a group of 50 patients aged between 70 and 87 who had been submitted to surgery between 1997 and 2003; 27 were females and 23 males. 76% of them presented associated systemic pathologies and 22% had a history of previous spinal surgery. In 15 cases clinical symptoms were gait disorders involving claudication, there were three cases of paraparesis with cauda equina syndrome, 19 lumbagos with bilateral sciatica and 16 cases of lumbago with unilateral sciatica. Unilateral decompression hemilaminectomy was performed in 16 patients (group I) with microdiscectomy in 13 cases, laminectomy of one or several vertebrae (group II) was carried out in 17 patients and another 17 patients were submitted to decompression laminectomy plus arthrodesis with transpedicular instrumentation (group III). Overall a significant improvement was observed in 86% of patients. Detected complications involved two serious deep infections (4%), one of which was secondary to cerebrospinal fluid fistula, and the other occurred in an instrumented patient. No instabilities secondary to the laminectomy were observed in non-instrumented patients. No intraoperative anaesthetic or surgical complications were produced. Patients are followed up simultaneously during the post-operative period by both Internal Medicine and Neurosurgery. In the geriatric population there is a high incidence of degenerative problems, not only involving canal stenosis

  12. MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

    Directory of Open Access Journals (Sweden)

    I. L. Chernikovskiy

    2016-01-01

    Full Text Available Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min. Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml, but the differences were insignificant (р=0.36. No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43. Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %. The median follow-up time was 16 months (range, 6-30 months. The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of

  13. Conservation laryngeal surgery in the elderly patient.

    Science.gov (United States)

    Tucker, H M

    1977-12-01

    In the 100 years since Bilroth first undertook a total laryngectomy, general improvements in the prevention and management of childhood and adult disease have led to continuing increase in life expectancy to the point that, in many developed countries, 25% or more of the population is over the age of 65. Although many of these individuals are in otherwise reasonable health, major head and neck procedures are often not performed in favor of radiation therapy for cure, even for lesions that would otherwise be considered amenable to surgery in younger patients, on the grounds that the patient is too old to tolerate the necessary procedure. The same argument has been employed in favoring total laryngectomy over subtotal procedures in the older patient. Review of the author's experience (27 cases) with conservation laryngeal surgery in patients over the age of 65 at the time treatment was undertaken reveals that such procedures are well tolerated in this age group. There were no mortalities and an overall complication rate of 11.1% resulted. These findings compare favorably with complication rates reported for similar patients and surgery in the under 65 age group and strongly suggest that chronologic age alone need not be a contraindication to such surgery.

  14. Do psychosocial factors predict readmission among diabetic elderly patients?

    Directory of Open Access Journals (Sweden)

    Mousa Alavi

    2017-01-01

    Full Text Available Background: Despite advances in diabetes treatment, the rate of readmission is still relatively high among these patients, especially in older population. Various factors may predict readmission in these patients; hence, the aim of this study was to assess the role of psychosocial factors in predicting readmission among diabetic elderly hospitalized in selected hospitals of Isfahan. Materials and Methods: In this cross-sectional study conducted from January to September 2016, 150 diabetic elderly hospitalized in selected hospitals affiliated with Isfahan University of medical sciences were chosen using a convenient sampling method. The initial information was collected by a three-part questionnaire consisting of (a demographic characteristics, (b 21-item depression, anxiety, and stress scale (DASS-21, and (c multidimensional scale of perceived social support (MSPSS. Further information about readmission was gathered 3 months after completing the questionnaires through a phone call follow-up. Descriptive and inferential statistics (discriminant function analysis test were used to analyze the data. Results: During 3 months after discharge, 44% of hospitalized diabetic elderly were readmitted. Analytical model predicted the readmission status of 109 individuals (of total 150 persons in the studied units (success rate of 72.2%. Among predicting factors, depression and social support had the most and the least important roles in predicting readmission rate, respectively. Conclusions: Interventions to improve mental status (i.e., decreasing levels of depression, anxiety, and stress and develop social support are suggested to reduce the risk of readmission among diabetic elderly patients. Nevertheless, future studies are needed to verify the value of such interventions.

  15. Prospective comparison of outcomes of percutaneous nephrolithotomy in elderly patients versus younger patients

    DEFF Research Database (Denmark)

    Okeke, Zeph; Smith, Arthur D; Labate, Gaston

    2012-01-01

    Research Office of the Endourological Society (CROES) Global PCNL Study database were used. Elderly patients were defined as those aged 70 years and above, while younger patients were those between 18 and 70 years of age. Matched and unmatched group comparisons were performed based on imaging modality used...... for assessing stone-free status. Patient characteristics, operative data, and postoperative outcomes were compared. Results: The median age of the elderly group vs the young group was 74 years (range 70-93 years) vs 49 years. In the unmatched analysis, staghorn stones were seen at higher rates in the elderly...... group (27.8% vs 21.8%, P=0.014); however, the mean stone size was not significantly different (465.0 vs 422.8, P=0.063). The length of hospitalization was significantly longer in the elderly group compared with the young group in the unmatched analysis (5 days vs 4.1 days, P...

  16. Radiotherapy of metastatic spinal cord compression in very elderly patients

    International Nuclear Information System (INIS)

    Rades, Dirk; Hoskin, Peter J.; Karstens, Johann H.; Rudat, Volker; Veninga, Theo; Stalpers, Lukas J.A.; Schild, Steven E.; Dunst, Juergen

    2007-01-01

    Purpose: Owing to the aging of the population, the proportion of elderly patients receiving cancer treatment has increased. This study investigated the results of radiotherapy (RT) for metastatic spinal cord compression (MSCC) in the very elderly, because few data are available for these patients. Methods and Materials: The data from 308 patients aged ≥75 years who received short-course (treatment time 1-5 days) or long-course RT (2-4 weeks) for MSCC were retrospectively analyzed for functional outcome, local control, and survival. Furthermore, nine potential prognostic factors were investigated: gender, performance status, interval from tumor diagnosis to MSCC, tumor type, number of involved vertebrae, other bone or visceral metastases, ambulatory status, and speed at which motor deficits developed. Results: Improvement of motor deficits occurred in 25% of patients, with no further progression of MSCC in an additional 59%. The 1-year local control and survival rate was 92% and 43%, respectively. Improved functional outcomes were associated with ambulatory status and slower developing motor deficits. Improved local control resulted from long-course RT. Improved survival was associated with a longer interval from tumor diagnosis to MSCC, tumor type (breast/prostate cancer, myeloma/lymphoma), lack of visceral or other bone metastases, ambulatory status, and a slower development of motor deficits. Conclusion: Short- and long-course RT are similarly effective in patients aged ≥75 years regarding functional outcome and survival. Long-course RT provided better local control. Patients with better expected survival should receive long-course RT and others short-course RT. The criteria for selection of an appropriate regimen for MSCC in very elderly patients should be the same as for younger individuals

  17. Clinical and Radiographic Features of Knee Osteoarthritis of Elderly Patients.

    Science.gov (United States)

    Sahli, Hana; Tekaya, Aicha Ben; Daas, Selim; Mahmoud, Ines; Tekaya, Rawdha

    2017-04-25

    Knee osteoarthritis is a common pathology, characterized by a prevalence that increases with age. Absence of anatomo-clinical correlation its management complex, particularly in a geriatric setting where it is not well studied. The aim of the present study is to investigate the epidemio-clinical profile, functional impairment and radiographic features of knee osteoarthritis in the old patients versus younger patients (<65 years). Cross-sectional study including patients who were monitored for 6 months at a rheumatology department for knee osteoarthritis. Epidemio-clinical, anthropometric and radiographic data were gathered. A comparison was made of these various characteristics between patients of over 65 years of age (group1; n=56) and those under 65 (group2; n=56). The mean age of the group1's patients was 71±5 with a clear feminine predominance. Comorbidity was observed in two thirds of cases. More than half of them were overweight. Gonalgia had been evolving for approximately 8.4±9.2 years and was bilateral in 82.6% of the cases and of mechanical type in 94.6% of the cases. The patients experienced an average pain scale of 65.2mm. Pain had an anterior site in major of cases. An axial deviation of the lower limbs were observed in 60.7% of the cases and a limited mobility of the knees in 48.2% of the cases. The mean value of Lequesne index was 11.02±4.8. The walking distance was not limited in 37.5% of the cases. Radiographically, knee osteoarthritis was bilateral in all cases and stage4 was observed 50% of the cases. Comparative study showed that elderly patients had a smaller waist size (p=0.003), a longer course of gonalgia (p<0.0001), a widespread site of pain (p=0.004), and a more frequent limitation of walking distance (p<0.0001) as well as more axial deviation (p<0.0001) and joint mobility limitation (p=0.005). Gonalgia manifesting during rest was more frequent in elderly patients (p=0.001). In addition, impaired functioning (p=0.001) and the stage of

  18. Surgical palliation of unresectable pancreatic head cancer in elderly patients

    Science.gov (United States)

    Hwang, Sang Il; Kim, Hyung Ook; Son, Byung Ho; Yoo, Chang Hak; Kim, Hungdai; Shin, Jun Ho

    2009-01-01

    AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer. PMID:19248198

  19. The elderly patient with spinal injury: treat or transfer?

    Science.gov (United States)

    Barmparas, Galinos; Cooper, Zara; Haider, Adil H; Havens, Joaquim M; Askari, Reza; Salim, Ali

    2016-05-01

    The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P spinal cord injury (22.3% versus 21.0%, P elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Improvement in cognitive impairment after cataract surgery in elderly patients.

    Science.gov (United States)

    Tamura, Hiroki; Tsukamoto, Hidetoshi; Mukai, Satoshi; Kato, Tomoko; Minamoto, Atsushi; Ohno, Yuko; Yamashita, Hidetoshi; Mishima, Hiromu K

    2004-03-01

    To evaluate whether cognitive impairment improves in elderly patients who have cataract surgery with intraocular lens (IOL) implantation. Kouki Hospital, Yamaguchi, Japan. A prospective observational study evaluated patients' scores on the Revised Hasegawa Dementia Scale (HDS-R) and the HDS-R minus 1 item regarding immediate regeneration (ie, function of vision and memory). Twenty patients (6 men, 14 women) with cognitive impairment had cataract surgery in 1 eye between March 1996 and July 2001 at Kouki Hospital, Japan. The mean age of the patients was 81.8 years (range 61 to 90 years). Twenty patients (4 men, 16 women) with cognitive impairment who did not have cataract surgery were selected as a control. The mean age in the control group was 84.3 years (range 70 to 93 years). The HDS-R was administered twice between March 1996 and July 2001. The mean HDS-R scores in the cataract surgery group improved from 12.5 points +/- 5.3 (SD) preoperatively to 16.6 +/- 6.2 points postoperatively; the improvement was significant (t = -5.02; Pcognitive impairment improved in 12 patients (60%), was unchanged in 7 (35%), and was worse in 1 (5%). Cataract surgery improved cognitive impairment in elderly Japanese patients.

  1. Physical exercise modifies the functional capacity of elderly patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Moane Marchesan

    Full Text Available Abstract Introduction Patients on hemodialysis (HD improve functional capacity after physical training. However, little is discussed about these effects in elderly patients, since these are usually excluded of studies, due to their physical disabilities and other deficits. Objective To analyze the effects of aerobic and resistance training in the functional capacity of elderly patients submitted to HD. Methods Studied participants were 15 patients, of both genders, and aged over 60 years. Aerobic and resistance training was carried out during the hemodialysis session, three times per week, during four months. Patients were distributed into control (CG and experimental (EG groups. Functional capacity was assessed by six-minute walk (6MW, sit-to-stand (STS and respiratory muscle strength tests. Results After the physical training, EG presented a significant increase in the distance covered in 6MW (Z = 2.521, p < .012, respiratory muscle strength (inspiratory pressure: Z = 2.533, p < .011; expiratory pressure: Z = 2.536, p < .011; and in number of STS repetitions (2.54; p <.001. Conclusion The training modified the functional capacity of the HD patients, contributing to their rehabilitation.

  2. Safety and efficacy of ipragliflozin in elderly versus non-elderly Japanese patients with type 2 diabetes mellitus: a subgroup analysis of the STELLA-LONG TERM study.

    Science.gov (United States)

    Maegawa, Hiroshi; Tobe, Kazuyuki; Tabuchi, Hiromi; Nakamura, Ichiro; Uno, Satoshi

    2018-03-01

    This subgroup analysis of STELLA-LONG TERM interim data explored the long-term safety and efficacy of ipragliflozin in non-elderly vs. elderly Japanese type 2 diabetes mellitus (T2DM) patients. STELLA-LONG TERM is an ongoing 3-year prospective surveillance study of Japanese T2DM patients receiving ipragliflozin 50 mg once daily. In this subgroup analysis, patient characteristics, laboratory variables, and adverse drug reactions (ADRs) were compared between non-elderly (<65 years) and elderly (≥65 years) patients. Non-elderly patients had significantly higher body mass index and low-density lipoprotein cholesterol than elderly patients (P < 0.001). The proportion of patients with hemoglobin A1c (HbA1c) <8.0% was significantly higher among elderly patients (P < 0.001). HbA1c, fasting plasma glucose, and body weight significantly decreased from baseline to 3 and 12 months in both groups (all P < 0.05 vs. baseline). The ADR incidence was 10.83% vs. 10.42% in non-elderly and elderly patients. The incidence of skin complications was 0.98% vs. 1.65% and that of renal disorder was 0.47% vs. 0.95% in non-elderly and elderly patients (both P = 0.003). Ipragliflozin was effective in non-elderly and elderly Japanese T2DM patients in a real-world clinical setting. The incidence of renal disorder and skin complications was significantly higher in elderly vs. non-elderly patients.

  3. [Therapeutic massage on behavioral disturbances of elderly patients with dementia].

    Science.gov (United States)

    Barquilla Ávila, Carolina; Rodríguez-Mansilla, Juan

    2015-12-01

    To know the efficacy of therapeutic massage on behavioral disturbances of elderly patients with dementia. Literature review. The literature search was done in six scientific databases: PubMed, Cochrane Library Plus, PEDro, Dialnet, Scopus and CSIC, between 1983 and 2013. The search terms were "massage", "dementia", "therapy", "behavior disorders" and "Alzheimer". Of the 496 articles analyzed, 11 scientific articles have met the selection criteria. Inclusion criteria were: clinical trials, published in English or Spanish, which had analyzed the effects of massage therapy on altered behaviors in people with dementia. The variables were massage benefits, type of massage and massage lubricant. Their authors use different massage techniques (effleurage, pétrissage, pressures, frictions and kneading), obtain better conduct disorders (aggression, anxiety, agitation, and resistance to care) of elderly. The therapeutic massage can be a complementary treatment in the rehabilitation program for better behavior disorders. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. Relationship between central and peripheral corneal astigmatism in elderly patients

    Science.gov (United States)

    Kawamorita, Takushi; Shimizu, Kimiya; Hoshikawa, Rie; Kamiya, Kazutaka; Shoji, Nobuyuki

    2018-03-01

    Abstract Purpose We investigated the relationship between central and peripheral corneal astigmatism in elderly patients. Methods Seventy-six eyes of 76 elderly subjects (mean age = 72.6 ± 3.0 years) were included in the study. Corneal shape was evaluated using the Pentacam HR (Oculus, Wetzlark, Germany), which is comprised of a rotating Scheimpflug camera and a short-wavelength slit light. The power distribution map was selected and corneal astigmatism was calculated using front K-Readings in zones centered on the pupil. Analyzed zones were 2.0-6.0 mm in diameter. Results Corneal astigmatism decreased as diameter increased, similar to what was observed in eyes with with-the-rule astigmatism and against-the-rule astigmatism (ANOVA, p axis of corneal astigmatism (ANOVA, p = 0.98). Conclusion These results suggest that the relationship between central and peripheral corneal astigmatism should be taken into consideration to optimize vision when astigmatic correction is needed.

  5. Localized prostate cancer in elderly patients. Outcome after radiation therapy compared to matched younger patients

    International Nuclear Information System (INIS)

    Huguenin, P.U.; Bitterli, M.; Luetolf, U.M.; Glanzmann, C.; Bernhard, J.

    1999-01-01

    Purpose: To detect a difference in outcome (disease-specific survival, local tumor progression, late toxicity, quality of life) after curative radiotherapy for localized prostate cancer in elderly as compared to younger patients. Patients and methods: In a retrospective analysis 59 elderly patients (>74 years old) were matched 1:2 with younger patients from the data base according to tumor stage, grading, pre-treatment PSA values and year of radiotherapy. Surviving patients were contacted to fill in a validated questionnaire for quality of life measurement (EORTC QLQ-C30). Median follow-up for elderly and younger patients was 5.2 and 4.5 years, respectively. Results: Overall survival at 5 years was 66% for the elderly and 80% for younger patients. Intercurrent deaths were observed more frequently in the elderly population. There was no age-specific difference in disease-specific survival (78% vs 82%), late toxicity or quality of life. Clinically meaningful local tumor progression was observed in 15% and 14%, respectively, corresponding to data from the literature following hormonal ablation. Conclusions: There is no obvious difference in outcome including disease-specific survival, late toxicity and quality of life in elderly patients, compared to a matched younger population. A clinically meaningful local tumor progression following radiotherapy or hormonal ablation only is rare. Local radiotherapy or, alternatively, hormonal ablation is recommended to preserve local progression-free survival in elderly patients except for very early stage of disease (i.e. T1 G1-2 M0). (orig.) [de

  6. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

    Directory of Open Access Journals (Sweden)

    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  7. Narrative medicine and the personalisation of treatment for elderly patients.

    Science.gov (United States)

    Cenci, C

    2016-07-01

    Healthcare organisations, medical knowledge and clinical practice are among the contexts that have most strongly felt the impact of the over 75 population. This is a population of multimorbidity and polypharmacy patients. They are often seen as a conglomeration of juxtaposed guidelines resulting in the intake of more than 10 drugs a day, with absolutely no certainty of their efficacy. The scientific community is increasingly calling into question the current disease-focused approach. Narrative medicine can provide the tools for a treatment plan which is instead more patient-centred. Narrative medicine can promote the development of a systemic, integrated and multi-disciplinary approach to elderly patients. The stories of patients and caregivers, their representations, perceptions, experiences and preferences can reduce the risk of inappropriate tests and treatments. They can promote deprescribing procedures based on a careful analysis of a specific patient's needs. Narration time is treatment time which does not necessarily create a burden on organisations and caregivers. Quite the contrary since by facilitating adherence and team work, it can significantly reduce time and costs. Given their training and the importance of their relationship with elderly patients, internists, together with geriatricians, can play a key role in promoting and coordinating a narrative medicine approach. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  8. Characteristics and Outcomes of Elderly Patients Refused to ICU

    Directory of Open Access Journals (Sweden)

    María-Consuelo Pintado

    2013-01-01

    Full Text Available Background. There are few data regarding the process of deciding which elderly patients are refused to ICU admission, their characteristics, and outcome. Methods. Prospective longitudinal observational cohort study. We included all consecutive patients older than 75 years, who were evaluated for admission to but were refused to treatment in ICU, during 18 months, with 12-month followup. We collected demographic data, ICU admission/refusal reasons, previous functional and cognitive status, comorbidity, severity of illness, and hospital and 12-month mortality. Results. 338 elderly patients were evaluated for ICU admission and 88 were refused to ICU (26%. Patients refused because they were “too ill to benefit” had more comorbidity and worse functional and mental situation than those admitted to ICU; there were no differences in illness severity. Hospital mortality rate of the whole study cohort was 36.3%, higher in patients “too ill to benefit” (55.6% versus 35.8%, P<0.01, which also have higher 1-year mortality (73.7% versus 42.5%, P<0.01. High comorbidity, low functional status, unavailable ICU beds, and age were associated with refusal decision on multivariate analysis. Conclusions. Prior functional status and comorbidity, not only the age or severity of illness, can help us more to make the right decision of admitting or refusing to ICU patients older than 75 years.

  9. Primary Occipital Encephalocele in an Elderly Patient.

    Science.gov (United States)

    Barros, Fernanda Carvalho; Barros, Henrique Almeida; Júnior, Helvécio Marangon; Taitson, Paulo Franco

    2016-05-01

    The encephalocele is a condition characterized by the protrusion of the intracranial contents through a bone defect of the skull. The authors report a clinical case of an 80-year-old woman with primary occipital encephalocele on the right side and that was affected by trauma and presented liquor fistula and infection. Tomographic sections were obtained by injection intravenous of contrast. The images showed bone thickness thinning on the right occipital region and solution of continuity (encephalocele) with regular contours, reduction in brain volume, and hypodensity of the periventricular white substance were observed. The patient was successfully operated.

  10. Radiation therapy for elderly patients with limited non-small cell lung cancer

    International Nuclear Information System (INIS)

    Hayakawa, Kazushige; Mitsuhashi, Norio; Katano, Susumu

    1998-01-01

    The treatment results for 93 patients aged 75 years or older (elderly group) with limited non-small cell lung cancer (NSCLC) were retrospectively analyzed and compared with those for 193 patients younger than 75-years old (younger group). The elderly patients were classified into two groups: 64 patients aged 75-79 years (the elderly A) and 29 patients aged 80 years or older (the elderly B). All patients were treated with 10 MV X-rays using 2 Gy daily standard fractionation between 1976 and 1994. The total dose ranged from 60 Gy to 80 Gy. The overall two and five year survival rates were 31% and 12% for the elderly A group, and 28% and 6% for the elderly B group, respectively, compared with 34% and 12% for the younger group. In stage I-II NSCLC patients, the 2-year and 5-year disease-specific survival rates were 61% and 43% for the elderly A group, and 55% and 17% for the elderly B group, respectively, while the corresponding rates for younger group were 56% and 22%, respectively. In patients with stage III disease, however, the survival curves of the elderly B were inferior to those of the younger group and the elderly A group, although the difference was not statistically significant. Only two elderly patients died of late pulmonary insufficiency associated with high-dose irradiation of 80 Gy to the proximal bronchus. No other treatment-related event was observed except for mild acceptable acute complications in the elderly groups. The condition of two patients aged more than 80 years, however, deteriorated in mentality during hospitalization. Definitive radiation therapy is recommended to the elderly aged 75 years or older with limited NSCLC, especially early stage disease, as an acceptable choice or treatment. (K.H.)

  11. Dermatite de contato em idosos Contact dermatitis in elderly patients

    Directory of Open Access Journals (Sweden)

    Ida Duarte

    2007-04-01

    Full Text Available FUNDAMENTOS: A dermatite alérgica de contato é freqüente, com variações de acordo com o grupo estudado. OBJETIVOS: Verificar a freqüência da dermatite alérgica de contato em idosos; demonstrar os principais sensibilizantes nesse grupo; comparar os resultados dos testes epicutâneos com um grupo de adultos atendidos no mesmo período. PACIENTES: Durante o período 1998-2003, entre os pacientes submetidos aos testes de contato na Clínica de Dermatologia da Santa Casa de São Paulo, selecionaram-se idosos (>65 anos e adultos (20-65 anos. RESULTADOS: Foram avaliados 80 (9% idosos e 581 (63% adultos. Entre os idosos, 70 tiveram testes positivos, e 10, negativos. Nos adultos, 436 apresentaram testes positivos, e 145, negativos. A diferença entre os grupos em relação ao número de testes positivos e negativos foi estatisticamente significante (p= 0,02. Demonstrou-se maior freqüência de sensibilização nos idosos às seguintes substâncias - sulfato de níquel (p=0,001, perfume-mix (p=0,004, neomicina (p=0,0008, nitrofurazona (p=0,02, prometazina (p=0,03 e benzocaína (p=0,007. CONCLUSÕES: A dermatite alérgica de contato nos idosos é comum como em outras faixas etárias. As substâncias relacionadas aos medicamentos tópicos são importantes agentes etiológicos da dermatite alérgica de contato nesse grupo.BACKGROUND: Allergic contact dermatitis is a frequent condition and varies according to the population studied. OBJECTIVES: To verify the frequency of allergic contact dermatitis in elderly patients; to demonstrate the main sensitizers in this age group; to compare the results of the contact tests with those of a group of adults seen in the same period. Patients: From 1998 to 2003, elderly (over 65 years, and adults (aged 20-65 years were selected among patients submitted to contact tests at the Dermatology Clinic of [Hospital] Santa Casa de Sao Paulo. RESULTS: Eighty (9% elderly and 581(63% adult patients were assessed; 70 elderly

  12. [Special features of physical therapy for elderly rheumatic patients].

    Science.gov (United States)

    Hardt, R

    2012-07-01

    The demographic shift is leading to a rapid rise in the number of elderly citizens. Accordingly, the number of geriatric problems is also increasing within the population of rheumatic patients. Geriatric patients are characterized through the triad of high age, multimorbidity and functional deficits. Almost all will show signs of arthritis and other degenerative musculoskeletal illnesses. Inflammatory rheumatic diseases within the geriatric population are found to be mostly in the chronic stage or with defective conditions. Problems typical of this population, such as comorbidities especially in the cardiovascular sector, must be assessed prior to the application of therapeutic concepts. The focus is on activating therapies, such as physiotherapy and occupational therapy, where the functional usefulness is proven. The use of thermal therapy, especially applied in the form of heat, as well as electrotherapy and high frequency therapy are also useful when indicated. Balneotherapy and hydrotherapy, as well as massage therapy and lymphatic drainage, must be adapted to the cardiovascular function of geriatric patients; this applies especially to heart failure patients. Physical therapy concepts in elderly rheumatic patients should preferably be implemented and managed by a multidisciplinary geriatric team.

  13. Diagnosing delirium in very elderly intensive care patients.

    Science.gov (United States)

    Heriot, Natalie R; Levinson, Michele R; Mills, Amber C; Khine, Thinn Thinn; Gellie, Anthea L; Sritharan, Gaya

    2017-02-01

    To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10). Retrospective study. An ICU in a large metropolitan private hospital in Melbourne, Australia. English-speaking participants (n=348) 80+ years, admitted to ICU for >24 hours. Medical files of ICU patients admitted October 2009-October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data. General patient characteristics, first onset of delirium symptoms, source of delirium information, administration of delirium medication, hospital and ICU length of stay, 90 day mortality were documented. Delirium was found in 11-29% of patients, the highest incidence identified by chart review. Patients diagnosed with delirium had higher 90 day mortality, and those meeting criteria for all three methods had longer hospital and ICU length of stay. ICU delirium in the elderly is often under-reported and strategies are needed to improve staff education and diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Natural course of subarachnoid hemorrhage is worse in elderly patients

    Directory of Open Access Journals (Sweden)

    Felix Hendrik Pahl

    2014-11-01

    Full Text Available Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH patients according to age. Method Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.

  15. Dementia and delirium, the outcomes in elderly hip fracture patients

    Directory of Open Access Journals (Sweden)

    Mosk CA

    2017-03-01

    Full Text Available Christina A Mosk,1 Marnix Mus,1 Jos PAM Vroemen,1 Tjeerd van der Ploeg,2 Dagmar I Vos,1 Leon HGJ Elmans,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Public Health, Erasmus MC–University Medical Center, Rotterdam, 3Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands Background: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.Methods: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.Results: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9. Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001, increased association with complications (P<0.001, institutionalization (P<0.001, and 6-month mortality (P<0.001. Patients with dementia (N=168 had a

  16. Benefits of a low intensity exercise programme during haemodialysis sessions in elderly patients

    Directory of Open Access Journals (Sweden)

    Vicent Esteve Simo

    2015-07-01

    Conclusions: (1 An adapted low intensity exercise programme improved muscle strength, functional capacity and health-related quality of life in our elderly patients on HD. (2 Our results highlight the benefits from exercise in HD patients even in this elderly population. (3 In elderly patients on HD, it is worth considering an adapted low intensity intradialytic exercise programme as a part of a comprehensive care.

  17. Prevention and treatment of venous thromboembolism in the elderly patient

    Directory of Open Access Journals (Sweden)

    Enrico Tincani

    2007-07-01

    Full Text Available Enrico Tincani1, Mark A Crowther2, Fabrizio Turrini1, Domenico Prisco31Unità Operativa di Medicina Interna Cardiovascolare, Nuovo Ospedale Civile di Modena S.Agostino-Estense, Modena, Italy; 2McMaster University, St. Joseph’s Hospital and McMaster University, Hamilton, Canada; 3Dipartimento di Area Critica Medico Chirurgica, Universita’ di Firenze, Florence, ItalyAbstract: Venous thromboembolism (VTE is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both lowmolecular-weight heparins (LMWHs and unfractionated heparin (UFH, all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use.Keywords: venous thromboembolism, elderly patient, fondaparinux

  18. Headache Characteristics and Clinical Features of Elderly Migraine Patients.

    Science.gov (United States)

    de Rijk, Pablo; Resseguier, Noémie; Donnet, Anne

    2018-04-01

    To investigate the headache characteristics and clinical features of elderly migraine patients at a tertiary headache center. We retrospectively reviewed 239 records of migraine patients, over the age of 64 at the first visit, who had migraine as defined by the International Classification of Headache Disorders 3rd edition (beta version) from 2006 to 2015 based on the Marseille registry at Timone Hospital. 13.8% (33/239) patients had migraine with aura only, 13.0% (31/239) had both diagnoses. Of the patients who presented with migraine with aura, 13.4% (32/239) presented with aura without headache. Unilateral pain location was reported by 58.6% (140/239) of patients and the throbbing type of pain was present in 50.2% (120/239) of our study group. Photo- and phonophobia were observed in 77.4% (185/239) and 79.5% (190/239) of patients. Seventy-nine out of 239 (30.1%) patients were found to have probable medication overuse. Within this group, 31.65% (25/79) overused triptan and 70.9% (56/79) overused combination analgesics. We found higher frequencies of migraine for patients whose age at onset of migraine was younger than 18 years, and low frequency migraine was reported more frequently in the later onset group (P = .0357). We assess the headache characteristics of elderly migraine patients who were seen at our tertiary headache center and report the high frequency of probable medication overuse headache in this study group. Finally, we suggest that age of onset is an important factor in the clinical profile of these patients. © 2017 American Headache Society.

  19. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  20. Fractures of the acetabulum in elderly patients: an update.

    Science.gov (United States)

    Guerado, E; Cano, J R; Cruz, E

    2012-12-01

    The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Cardiac safety of donepezil in elderly patients with Alzheimer disease.

    Science.gov (United States)

    Isik, Ahmet Turan; Yildiz, Gulsen Babacan; Bozoglu, Ergun; Yay, Adnan; Aydemir, Emine

    2012-01-01

    Donepezil is a widely used cholinesterase inhibitor for the treatment of Alzheimer's disease (AD), however its cholinergic adverse side effects on the cardiovascular system are still unclear. In this study, we aimed to examine the adverse side effects caused by donepezil on cardiac rhythm and postural blood pressure changes in elderly patients with Alzheimer Disease. The ECG parameters including heart rate, PR, QT, QTc interval and QRS duration and postural blood pressure changes were recorded at the baseline and at each donepezil dose level (5 and 10 mg/d). Patients Seventy-one consecutive patients who were referred by primary care centers to a Geriatric Clinic were enrolled and underwent comprehensive geriatric assessment. Fifty-two subjects completed the study. There were no significant changes relative to the baseline in any of the ECG parameters or arterial blood pressure at any of the investigated dosages of donepezil. It was demonstrated that donepezil was not associated with increased negative chronotropic, arrhythmogenic or hypotensive effects for elderly patients with Alzheimer's disease.

  2. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-03-01

    To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

  3. Managing Syncope in the Elderly: The Not So Simple Faint in Aging Patients.

    Science.gov (United States)

    Solbiati, Monica; Sheldon, Robert; Seifer, Colette

    2016-09-01

    Providing care to the elderly patient with syncope poses problems that are unusual in their complexity. The differential diagnosis is broad, and sorting through it is made more difficult by the relative lack of symptoms surrounding the faint. Indeed, distinguishing faints from falls is often problematic. Many elderly patients are frail and are at risk of trauma if they should have an unprotected faint or fall to the ground. However, not all elderly patients are frail, and definitions of frailty vary. Providing accurate, effective, and appropriate care for the frail elderly patient who faints may require a multidisciplinary approach. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. Increased bone fractures among elderly United States hemodialysis patients.

    Science.gov (United States)

    Wagner, John; Jhaveri, Kenar D; Rosen, Lisa; Sunday, Suzanne; Mathew, Anna T; Fishbane, Steven

    2014-01-01

    Fractures are an important cause of morbidity in hemodialysis patients. Multiple advances in the treatment of mineral and bone disease in hemodialysis patients have occurred. The purpose of this study was to determine whether the rate of fractures in hemodialysis patients has changed over time. We studied US Renal Data System (USRDS) datasets to determine the rates of hospitalized fractures among hemodialysis patients. The primary outcome was incidence of fractures requiring hospitalization. The fracture rate per 1000 person-years was calculated by year from 1992 to 2009. The first 90 days after initiating dialysis were excluded from analysis. The incidence of hip and vertebral fractures increased from 12.5 fractures per 1000 patient-years in 1992 to 25.3 per 1000 patient-years in 2004 (P fractures increased from 3.2 per 1000 patient-years in 1992 to 7.7 per 1000 patient-years in 2009 (P fracture rate was seen in white patients >65 years of age. After 2004, the incidence rate of these fractures stabilized and subtly declined, but did not decrease significantly. Fracture rates increased significantly in hemodialysis patients from 1992 to 2004, with most of the increase occurring in elderly white patients. Assessment of fracture risk and management in dialysis patients at greatest risk requires greater emphasis and further study.

  5. [Home end-of-life care for advanced dementia vs advanced cancer elderly patients: dying elderly at home project].

    Science.gov (United States)

    Hirakawa, Yoshihisa; Masuda, Yuichiro; Kuzuya, Masafumi; Iguchi, Akihisa; Asahi, Takiko; Uemura, Kazumasa

    2006-05-01

    The aim of this study was to assess the frequency of symptoms and end-of-life care received in advanced dementia and advanced cancer elderly patients dying at home during the last two days of their lives and to evaluate the differences observed between the two groups. We used data from the Dying Elderly at Home (DEATH) project, which was a prospective study of home elderly patients dying with end-stage illness. Consecutive deceased subjects aged 65 or older who were seen at 16 study clinics belonging to the Japanese Society of Hospice and Home-care with diagnoses of all illnesses including advanced dementia and advanced cancer and died at home from October 2002 to September 2004 were included in the study. We evaluated 36 deceased subjects with advanced dementia and 116 with advanced cancer. We collected the following information: sociodemographics, ADLs, cognitive impairment, observed symptoms and end-of-life care provided during the last 48 hours of life. Deceased subjects with advanced dementia were less likely to show symptoms of pain, acute confusion, or nausea/vomiting and more likely to display fever or cough than advanced cancer patients. Also, those with advanced dementia were more likely to receive intravenous drip injection or narcotic analgesia and more likely to be given sputum suction, or antibiotics. We observed that the dying process and end-of-life care for advanced dementia elderly patients was different from that for advanced cancer elderly patients.

  6. [Cancer treatment in elderly patients: evidence and clinical research].

    Science.gov (United States)

    Repetto, Lazzaro; Luciani, Andrea

    2015-01-01

    In 2020 the percentage of patients with a diagnosis of cancer in people with more than 65 years will exceed 70% and 28% in ethnic minorities. The treatment of cancer in these populations is challenging for the oncologists due to socio-economic issues such as poverty, reduced access to the hospital care, level of education. The clinical pathway "diagnosis-treatment-cure", typical of the care of young patients has to be integrated in elderly patients with a more individualized treatment by means of comprehensive geriatric assessment (CGA). IADL (Instrumental Activities of Daily Living) have the best predictive role in oncological setting and their impairment significantly correlate with overall survival, chemotherapy toxicities and thirty days postoperative morbidities. The CGA is universally accepted as the most appropriate instrument to analitically evaluate the age related problems of elderly patients. The role of CGA is crucial to identify geriatric issues not easily diagnosed, to predict treatment toxicities, functional or cognitive decline, post operative complications and to estimate life expectancy. The CGA items are predictive of severe toxicity, however it is not clearly established which are the best performers and the best cut-offs points. Today CGA is integrated with physical performance tests (the most widely used is the "time up and go" test) and laboratory assay of Interleukin 6 and D-Dimer that correlate with mortality and physical decline. There are few prospective studies that evaluated the role of CGA in treatment choice. The first is a phase II study in solid tumors, the second is a haematological trial on non Hodgkin lymphoma. The largest trial is a 571 patients observational series that confirmed the role of CGA in decision making. The administration of CGA is time consuming and consequently some screening tools were developed. VES-13 is a 13 items tool that explores prevalently the functional status and the self reported health status. VES-13

  7. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, Peter Krogh; Husted, Steen; Damsgaard, Else Marie Skjøde

    2007-01-01

    , length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...... variables was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. CONCLUSION: 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables......INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...

  8. Postoperative Conversion Disorder in Elderly Oral Cancer Patient.

    Science.gov (United States)

    Yakushiji, Takashi; Hayashi, Kamichika; Morikawa, Takamichi; Migita, Masashi; Ogane, Satoru; Muramatsu, Kyotaro; Kamio, Takashi; Shibahara, Takahiko; Takano, Nobuo

    2016-01-01

    Conversion disorder is a condition in which psychological stress in response to difficult situations manifests as physical symptoms. Here, we report a case of postoperative coma due to conversion disorder in an elderly oral cancer patient. An 82-year-old woman was referred to Tokyo Dental College Chiba Hospital with a mass lesion on the tongue. A biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment was performed for the tongue carcinoma and tracheotomy for management of the airway. On postoperative day 5, the patient exhibited loss of consciousness (Glasgow Coma Scale: E1, VT, M1; Japan Coma Scale: III-300). The patient's vital signs were all normal, as were the results of a full blood count, brain-CT, MRI, and MRA. Only the arm dropping test was positive. Therefore, the cause of the coma was diagnosed as conversion disorder. Seven hours later, the patient showed a complete recovery.

  9. Short-term prognostic factors in the elderly patients seen in emergency departments due to infections.

    Science.gov (United States)

    Julián-Jiménez, Agustín; González-Del-Castillo, Juan; Martínez-Ortiz-de-Zárate, Mikel; Arranz-Nieto, María Jesús; González-Martínez, Félix; Piñera-Salmerón, Pascual; Navarro-Bustos, Carmen; Henríquez-Camacho, César; García-Lamberechts, Eric Jorge

    2017-04-01

    To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. A prospective, observational, multicentre, analytical study was carried out on patients aged 75years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. The study included 488 consecutive patients, 92 (18.9%) of whom died within 30days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure 4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  10. Development and application of measurement methods focusing on medication related problems in elderly hospitalised patients

    NARCIS (Netherlands)

    Wierenga, P.C.

    2013-01-01

    In conclusion, elderly hospitalised patients form a patient group that is at higher risk for medication related problems compared to younger patients. In order to measure medication related problems in hospitalised elderly and to ultimately improve their pharmaceutical care we examined three

  11. Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: outcomes in young, middle-aged, and elderly patients.

    Science.gov (United States)

    Leonardi, Robert A; Townsend, Jacob C; Patel, Chetan A; Wolf, Bethany J; Todoran, Thomas M; Powers, Eric R; Steinberg, Daniel H; Fernandes, Valerian L; Nielsen, Christopher D

    2013-11-01

    We compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle-aged, and elderly patients. Intersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA. Data for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age. Young (elderly (≥65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow-up (P elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P ≤ 0.016 for elderly vs. others). Mortality rates for young and middle-aged patients were lower than for elderly patients, but the differences were not statistically significant. Patients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates. Copyright © 2012 Wiley Periodicals, Inc.

  12. Treatment in elderly patients with head and neck cancer : A challenging dilemma

    NARCIS (Netherlands)

    Teymoortash, A; Ferlito, A; Halmos, G B

    Despite the increasing number of elderly patients requiring treatment for head and neck cancer, there is insufficient available evidence about the oncological results of treatment and its tolerability in such patients. Owing to comorbidities, elderly patients often need complex evaluation and

  13. Systemic therapy in younger and elderly patients with advanced biliary cancer

    DEFF Research Database (Denmark)

    McNamara, Mairéad Geraldine; Bridgewater, John; Lopes, Andre

    2017-01-01

    = 0.58, P = 0.66) or OS (P = 0.18, P = 0.75). CONCLUSIONS: In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should...

  14. Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

    Science.gov (United States)

    Polistena, Andrea; Sanguinetti, Alessandro; Lucchini, Roberta; Galasse, Segio; Avenia, Stefano; Monacelli, Massimo; Johnson, Louis Banka; Jeppsson, Bengt; Avenia, Nicola

    2017-02-01

    Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

  15. Aggressive primary thyroid lymphoma: imaging features of two elderly patients

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    Kim, Eu Hyun; Kim, Jee Young; Kim, Tae Jung [Yeouido St. Mary' s Hospital, The Catholic University College of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    We report two cases of aggressive thyroid lymphoma in elderly patients that presented as Epub ahead of print large infiltrative thyroid masses with extensive invasion to adjacent structures including trachea, esophagus, and common carotid artery. Ultrasonography displayed irregular shaped, heterogeneous hypoechoic mass, mimicking anaplastic carcinoma. Computed tomography showed heterogeneously enhancing mass compared to surrounding muscles without calcification and hemorrhage. After biopsy, the masses were histopathologically diagnosed as lymphoma. Aggressive primary thyroid lymphoma is rare; therefore, here we report its image features, with emphasis on ultrasonographic findings, and discuss its differential diagnosis.

  16. Survival Patterns in Elderly Head and Neck Squamous Cell Carcinoma Patients Treated With Definitive Radiation Therapy.

    Science.gov (United States)

    Sommers, Linda W; Steenbakkers, Roel J H M; Bijl, Henk P; Vemer-van den Hoek, Johanna G M; Roodenburg, Jan L N; Oosting, Sjoukje F; Halmos, Gyorgy B; de Rooij, Sophia E; Langendijk, Johannes A

    2017-07-15

    We sought to assess the effect of age on overall survival (OS), cancer-specific survival (CSS), and non-cancer-related death (NCRD) in elderly (aged ≥70 years) head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radiation therapy. The results were compared with those of younger patients, and the most important prognostic factors for survival endpoints were determined. Treatments may be better justified based on identification of the main differences in survival between young and elderly patients. Data were analyzed from all consecutive HNSCC patients treated with definitive radiation therapy (66-70 Gy) in our department between April 2007 and December 2014. A total of 674 patients, including 168 elderly patients (24.9%), were included in the study. Multivariate association models were constructed to assess the effect of age on survival endpoints. Multivariate analysis was performed to identify potential prognostic factors for survival in elderly patients. A total of 674 consecutive patients, including 168 elderly patients, were analyzed. The 5-year OS and NCRD rates were significantly worse for elderly patients than for young patients: 45.5% versus 58.2% (P=.007) and 39.0% versus 20.7% (Pelderly patient group. Of the elderly patients, 80 (47%) died during follow-up; 45% of these deaths were ascribed to the index tumor. For elderly patients, radiation therapy combined with systemic forms of treatment was significantly associated with adverse NCRD rate (hazard ratio, 8.02; 95% confidence interval, 2.36-27.2; P=.001) after we performed a multivariate association analysis. Elderly HNSCC patients have worse survival outcomes than young HNSCC patients. Age is an independent prognostic factor for OS, mainly due to an increase in non-cancer-related mortality and comorbid diseases. The differences in CSS between young and elderly patients are negligible. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. The nutritional status of Dutch elderly patients with Parkinson's disease.

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    van Steijn, J; van Harten, B; Flapper, E; Droogsma, E; van Walderveen, P; Blaauw, M; van Asselt, D

    2014-01-01

    To assess the prevalence of (risk of) undernutrition in Dutch elder Parkinson's disease patients as well as it's risk factors. Observational cross-sectional study. An outpatient clinic at the department Neurology of Medical Centre Leeuwarden, a large teaching hospital. 102 outpatients with Parkinson's disease aged 65 years and older were recruited. Data regarding various aspects of undernutrition including socio-demographic aspect, disease characterisitics, nutritional status, appetite and overall-physical and psychological functioning were collected. Undernutrition was diagnosed in 2.0% and 20.5% of the patients were categorized as being at risk of undernutrition. Care dependency and appetite were the two risk factors with the highest predictive value for an unfavorable nutritional status. Of Dutch elderly patients with Parkinson's Disease 22.5% had an unfavourable nutritional status. Dependency and appetite were the two risk factors with the highest predictive value fort his outcome. Because undernutrition can be regarded as a geriatric syndrome a comprehensive nutritional assessment should be done followed by nutritional interventions next to interventions focused on the risk factors. Further studies are needed to evaluate these interventions.

  18. Elderly patients with community-acquired pneumonia: optimal treatment strategies.

    Science.gov (United States)

    Thiem, Ulrich; Heppner, Hans-Jürgen; Pientka, Ludger

    2011-07-01

    Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP. The most common pathogen in CAP is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species. Antimicrobial resistance is an increasing problem, especially with regard to macrolide-resistant S. pneumoniae and fluoroquinolone-resistant strains. With regard to β-lactam antibacterials, resistance by H. influenzae and Moraxella catarrhalis is important, as is the emergence of multidrug-resistant Staphylococcus aureus. The main management decisions should be guided by the severity of disease, which can be assessed by validated clinical risk scores such as CURB-65, a tool for measuring the severity of pneumonia based on assessment of confusion, serum urea, respiratory rate and blood pressure in patients aged ≥65 years. For the treatment of low-risk pneumonia, an aminopenicillin such as amoxicillin with or without a β-lactamase inhibitor is frequently recommended. Monotherapy with macrolides is also possible, although macrolide resistance is of concern. When predisposing factors for special pathogens are present, a β-lactam antibacterial combined with a β-lactamase inhibitor, or the combination of a β-lactam antibacterial, a β-lactamase inhibitor and a macrolide, may be warranted. If possible, patients who have undergone previous antibacterial therapy should receive drug classes not previously used. For hospitalized patients with non-severe pneumonia, a common recommendation is empirical antibacterial therapy with an aminopenicillin in combination with a β-lactamase inhibitor, or

  19. Temporal Patterns of In-Hospital Falls of Elderly Patients.

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    López-Soto, Pablo J; Smolensky, Michael H; Sackett-Lundeen, Linda L; De Giorgi, Alfredo; Rodríguez-Borrego, María A; Manfredini, Roberto; Pelati, Cristiano; Fabbian, Fabio

    A potentially important factor yet to receive adequate study is the time when hospital falls occur. A prior study conducted before the system-wide introduction of preventive measures revealed a biphasic 24-hour pattern of hospital falls with major peak in the morning. The purpose was to identify the temporal patterning of falls among elderly patients in hospitals with comprehensive fall prevention programs in place. A 4-year observational study was conducted by the local health authority in the five nonteaching public hospitals located in the province of Ferrara, Italy. Fall records involving patients of ages ≥65 years hospitalized in the general medical departments were used. Single- and multiple-component cosinor (time series) analyses were used to explore 24-hour, weekly, and annual patterns of falls. A total of 763 falls were experienced by 709 different elderly hospitalized patients. Falls typically took place in the patient's hospital room (72%) and bathroom (23%). Major causes were patient instability (32%) and accident (13%), and most occurred when not wearing footwear (45%) or wearing inappropriate sling-back open-toe shoes (39%). Falls happened while standing (39%), while seated (21%), and while getting into, out of, or laying in bed (32%)-either with the bed rails raised or lowered. Fall outcome usually involved no injury (58%) or slight injury (35%), but some (7%) were disabling. Fall occurrence was higher during the night (46%) compared to either the morning (30%) or afternoon (24%) shift. Patterns across 24 hours were characterized by a single major and one or more minor peaks that seemed to be associated with a variety of scheduled patient, hospital, and nursing activities. Multiple-component cosinor analysis identified significant (p footwear. Falls were more frequent, but not significantly so, on Fridays, Sundays, and Mondays compared with Tuesdays, and were more frequent in winter and spring (p = .003). Documentation by cause and circumstance of

  20. [Elder].

    Science.gov (United States)

    Arroyo, Pedro; Gutiérrez-Robledo, Luis Miguel

    2016-09-01

    The aim of this review is to present scientific evidence on the biological, dietary, cultural and economic advantages of cow´s milk and dairy products intake in adults, with emphasis on the elderly. The role of milk and dairy products as part of the regular diet, as well as their contribution to a healthy diet for the aged population is described. The updated scientific references on the importance of milk and dairy products on the dietary management of the most prevalent diseases of the eldery -among these energy-protein malnutrition, sarcopenia, obesity, sarcopenic obesity, osteoporosis, diabetes and cardiovascular diseases- are presented.

  1. RELATIONSHIP BETWEEN SALT INTAKE AND GNRI IN ELDERLY DIALYSIS PATIENTS

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    Takaya Ozeki

    2012-06-01

    Full Text Available While the recommended salt intake in dialysis patients is no more than 5 g/day in the KDOQI guideline, and 6 g/day in the JSH 2009 guideline, reducing salt consumption is difficult on the traditional Japanese diet. If a patient is malnourished, a low-salt diet poses a risk of aggravating the nutritional deficiency. Since elderly dialysis patients have nutritional deficiencies underlying their condition, the recommended low-salt diet may prevent these patients from receiving adequate nutrition. In the present study, factors associated with nutritional status in the elderly were assessed using the Geriatric Nutritional Risk Index (GNRI, which is considered to correlate with predictor of mortality among dialysis patients. Participating patients were anuric, had been maintained on dialysis for at least 2 years, and were 65 years of age or older. Factors assessed for their possible correlations with GNRI were primary disease, presence of spouse, presence of cohabiting family, weight gain, and estimated salt intake. We analyzed 36 patients (age 74.3±5.4 years, 50% males. GNRI was 90.9±7.7, and salt intake (8.02±1.94 correlated with GNRI (r=0.41, P=0.02. No correlations were detected for the presence of spouse or cohabiting family, which would have contributed to nutrition. In conclusion, the higher the salt intake, the better GNRI tended to be. This raised the possibility that it would be advantageous to avoid excessive salt restriction in nutritional training.

  2. Detection of Right Heart Emboli by Transesophageal Echocardiography in Cement Implantation Syndrome in an Elderly Patient

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    Ching-Hung Chen

    2008-09-01

    Full Text Available Femoral fractures are common and lethal among elderly patients. The elderly suffer more perioperative risks because of their complicated medical conditions and poor physical reserves. During cemented arthroplasty surgery in the elderly, unstable hemodynamic changes are frequently noted when the cement and prosthesis are inserted. Transesophageal echocardiography (TEE allows rapid perioperative diagnosis and management of hemodynamic changes. We report an elderly patient with paroxysmal atrial fibrillation, in whom a huge serpentine embolus was noted by TEE. Although cardiovascular collapse was encountered during cemented hip arthroplasty surgery, the patient was successfully resuscitated and the related perioperative risk was managed by TEE application.

  3. Angiodysplasia and lower gastrointestinal tract bleeding in elderly patients.

    Science.gov (United States)

    Sharma, R; Gorbien, M J

    1995-04-24

    Angiodysplasia of the colon is one of the most common causes of major lower intestinal tract bleeding in the elderly; it occurs predominantly in the cecum and on the right side of the colon and is thought to result from degenerative changes associated with aging. The clinical presentation is varied, ranging from hematochezia or melena to iron-deficiency anemia resulting from long-term blood loss. Accurate diagnosis may require a combination of diagnostic techniques, such as angiography, nuclear scanning, and colonoscopy. The management plan should be individualized for each patient depending on severity, rate of rebleeding, and issues of comorbidity. Although conservative medical management is a reasonable option for many patients, endoscopic treatment has generally replaced surgery as the first line of definitive treatment for angiodysplasias in most of these patients. The risk of rebleeding is a considerable problem, and surgical therapy yields better results in this aspect. The role of hormonal therapy is not clearly established.

  4. [The Ogilvie syndrome in elderly patients with multimorbidity].

    Science.gov (United States)

    Tan, A C K; Olde Rikkert, M G M; Groenen, M J

    2014-06-01

    Two patients presented with the Ogilvie syndrome which is an acute colonic pseudo-obstruction without any mechanical obstruction. Both patients suffered from multiple medical conditions such as infections, electrolyte disturbances and functional decline.The Ogilvie syndrome is particularly seen in patients with multimorbidity who stay in the hospital or nursing home. The incidence of the Ogilvie syndrome will probably increase because of ageing of our population and will be most prevalent in the frail elderly. The precise mechanism of this disease is still unclear, but there is evidence in the literature that the aetiology is multifactorial and runs via autonomic dysregulation of the colon.Early recognition and appropriate treatment may reduce the risk of complications and limit mortality, also depending on the related comorbidity.

  5. Altered aiming movements in Parkinson's disease patients and elderly adults as a function of delays in movement onset.

    Science.gov (United States)

    Romero, Diana H; Van Gemmert, Arend W A; Adler, Charles H; Bekkering, Harold; Stelmach, George E

    2003-07-01

    This study investigated the effect of lengthening the time the hand remains immobilized on an aiming movement performed by Parkinson's disease (PD) patients and elderly adults, and whether visual information could compensate for the effects of delay. In Experiment One, PD patients and elderly adults kept the limb in a static position for 1, 6, or 10 s prior to movement initiation, both with and without vision of the initial limb position and the movement trajectory. Compared to elderly adults, PD patients had increased movement times and jerk scores, and exhibited shorter primary submovements that erred in initial movement direction. Lengthening the time delay increased movement time, decreased mean acceleration, and decreased the distance covered in the primary submovement for both groups. Parkinsonian patients, however, exhibited reduced length of the primary submovement across delay compared to elderly adults. Occluding vision caused the movements of PD patients to deteriorate on all measures. Although the performance of both groups was enhanced when vision was available, vision was not able to fully counteract the effects of delay in either group. In Experiment Two, participants moved to a previously viewed target to examine movement accuracy. Systematic undershooting of the target as a function of delay was found for both groups. Parkinsonian patients exhibited greater undershooting of the target after the primary submovement both with and without vision. Visual feedback reduced the effects of delay for both the elderly and PD patients. It can be inferred from the results that the decay in position sense as a function of time produces impairments in incorporating the initial limb position in motor planning process.

  6. Current status of treatment of metastatic colorectal cancer with special reference to cetuximab and elderly patients

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    Per Pfeiffer

    2008-12-01

    Full Text Available Per Pfeiffer, Camilla Qvortrup, Jon K BjerregaardDepartment of Oncology, Odense University Hospital. Institute of Clinical Research, University of Southern Denmark. Odense C, DenmarkPurpose: Elderly cancer patients often have co-morbidities and other characteristics that make the selection of optimal treatment more complex. The introduction of targeted therapies in colorectal cancer has further complicated this problem. This review will focus on the role of the EGFR antibody cetuximab in elderly patients.Methods: We have reviewed the available evidence in the literature to evaluate the results of therapy with cetuximab, alone or in combination with chemotherapy, with a focus on elderly patients with metastatic colorectal cancer (mCRC.Results: In patients with mCRC, combination chemotherapy prolongs median survival to more than 18 months and even around 24 months in combination with cetuximab in selected patients. No prospective studies have evaluated cetuximab in elderly patients. However, subgroup analyses from randomized trials and retrospective analysis suggest that the efficacy of chemotherapy and cetuximab is maintained in fit elderly patients, but with slightly increased but acceptable toxicity.Conclusion: No prospective cetuximab studies have been conducted solely in a population of elderly patients. However, available data suggest that outcomes in the fit elderly mirror results observed in younger patients.Keywords: metastatic colorectal cancer, cetuximab, elderly patients

  7. Safety of robotic general surgery in elderly patients.

    Science.gov (United States)

    Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Ayloo, Subhashini; Elli, Enrique F; Giulianotti, Pier C

    2010-08-01

    As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70-88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15-560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0-30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

  8. Oligometastatic cancer in elderly patients: the "blitzkrieg" radiotherapy approach

    Science.gov (United States)

    Lancia, Andrea; Ingrosso, Gianluca; Carosi, Alessandra; Bottero, Marta; Cancelli, Alessandro; Turturici, Irene; Ponti, Elisabetta; Santoni, Riccardo

    2018-03-29

    To retrospectively evaluate the outcome of stereotactic body radiation therapy (SBRT) in the treatment of elderly patients affected by isolated body metastasis from different primitive tumors. 70 patients with isolated body metastasis were treated. Median age at diagnosis was 75 years (IQR 69-80). The most common SBRT fractionation scheme was 5 × 7 Gy (total dose 35 Gy). The primary endpoints were Local Control (LC) and Toxicity. Secondary endpoints were Overall Survival (OS) and Disease-Specific Survival (DSS). Response to radiotherapy was assessed according to RECIST criteria v1.1. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. We performed survival analysis with the Kaplan-Meier method. The correlation between time actuarial incidence and clinical parameters was studied. Median follow-up was 26.5 months. 44 patients (62.8%) were alive at the time of analysis, while 22 (31.4%) died because of the disease. Local control at 2 and 3 years was 87%. The 2-year OS and DSS were 84 and 71%, respectively, while the 3-year values were 57 and 62%. PFS at 2 and 3 years was 41 and 25%, respectively. On univariate analysis, KPS ≥ 90 is statistically correlated with improved OS and DSS (p < 0.05). Acute toxicity of grade ≥ 2 occurred in 4 (5.7%) patients, while late toxicity ≥ 2 was recorded in 6 (8.6%) patients. Ablative Radiotherapy represents a safe, effective, and minimally invasive treatment modality for elderly oligometastatic patients who are judged unfit for systemic therapy.

  9. Prevalence and mechanisms of hyperhomocysteinemia in elderly hospitalized patients.

    Science.gov (United States)

    Salles-Montaudon, N; Parrot, F; Balas, D; Bouzigon, E; Rainfray, M; Emeriau, J-P

    2003-01-01

    Plasma homocysteine concentrations increase with age and remain an independent risk factor for vascular disease in the elderly. There are negative correlations between plasma homocysteine and serum folate and vitamin B12 concentrations. Two mechanisms, poor nutritional status, and chronic atrophic gastritis, could explain hyperhomocysteinemia. The purpose of the study was to determine prevalence and mechanisms of hyperhomocysteinemia in older hospitalized patients. During a 12-month period, all the consecutive hospitalized patients who underwent gastric endoscopy were recruited in this observational prospective study. Clinical, histological, and biological data concerning nutritional status, gastric analysis, homocysteine, vitamin B12, and folate concentrations were collected during the study for each included patient. One hundred and ninety six patients (132 women and 64 men, mean age: 85.3 5.7 years) were included. Hyperhomocysteinemia (>or= 18 mmol/l) was diagnosed in 45.4 %, cobalamin deficiency in 13.3 %, and folate deficiency in 11.7 % patients. Hyperhomocysteinemia was significantly correlated to cobalamin deficiency (r = - 0.21; p = 0.005). In a sub group of patients without hypothyroidism, or chronic renal impairment, univariate and multivariate analysis showed a significant association between hyper homocysteinemia and low MNA (OR: 0.92; 95% CI 0.85-0.99), and low albumin (OR: 0.92; 95% IC: 0.83-0.99; p = 0.04). No correlation was found between homocysteine concentrations and chronic atrophic gastritis or Helicobacter pylori infection. Hyperhomocysteinemia seems to be frequent in the elderly and is associated with poor nutritional status rather than chronic atrophic gastritis.

  10. [Full attention to several key issues in surgical treatment for the elderly patients with gastrointestinal cancer].

    Science.gov (United States)

    Zhu, Zhenggang

    2016-05-01

    With the development of population aging in our country, the incidence of gastrointestinal cancer is increasing. The risk of developing gastrointestinal cancer in elderly over 75 years was 5-6 times and the risk of death of gastrointestinal cancer was 7-8 times of the general population. As compared to non-elderly, the incidence of gastric cancer was not decreased obviously but the total incidence of colorectal cancer was increased more quickly. Therefore, screening of gastrointestinal cancer should be performed in the elderly for early discovery, diagnosis and treatment. Because of the insidious onset of the illness in elderly patients, gastrointestinal cancers are mostly diagnosed at advanced or late stage (stage III or IV). Well differentiated cancer is more common, such as papillary or tubular adenocarcinoma. Lauren type, Borrmann II or III are more common in gastric cancer, which are relatively favorable. Compared with non-elderly patients, many elderly patients also suffer from comorbid diseases with higher operation risk and postoperative complication rates. Therefore, we must pay great attention to the perioperative management and the surgical operation for the elderly patients. In this paper, several key issues involved the development trend of incidence and mortality of gastrointestinal cancer, the clinicopathological characteristics, the comorbidity and surgical treatment in the elderly patients with gastrointestinal cancer will be elaborated, aiming at promoting further attention to the clinical therapeutic strategies, management measures and prognostic factors for the elderly patients with gastrointestinal cancer.

  11. Factors Related with Handgrip Strength in Elderly Patients

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    Nur Riviati

    2017-11-01

    Full Text Available Background: the aging process causes decreasing in the function of various organs. Skletal muscle is one of the organs affected by aging process. It is known as sarcopenia. Sarcopenia is defined as a syndrome characterized by progressive loss of muscle mass and strength. The handgrip strength examination is often applied as a sarcopenia filtering technique. This study aimed to determine the relationship between age, nutritional status, and chronic diseases such as stroke, hypertension (HT, diabetes mellitus (DM, coronary heart disease (CHD, and chronic obstructive pulmonary disease (COPD with handgrip strength. Methods: a cross-sectional study to determine factors related to the handgrip strength in elderly patients was conducted in Geriatric outpatient clinic of Cipto Mangunkusumo Hospital and Mohammad Hoesin Hospital from August to October 2015. There were 352 eligible subjects in this study recruited with consecutive sampling. The independent variables in the study consisted of age, sex, nutritional status, chronic disease (stroke, hypertension (HT, diabetes mellitus (DM, coronary heart disease (CHD and chronic obstructive pulmonary disease (COPD, waist circumference while the dependent variable was handgrip strength. Results: age of more than 75 years old and malnutriton were risk factors that affected hangrip strength. Age of >75 years increase the risk for having low handgrip strength by 2,3-fold. Malnutrition increased risk for low handgrip strength for 1,9-fold. Conclusion: ages of >75 years old and malnutrition will increase the risk of low handgrip strength in elderly patients.

  12. Management of elderly patients with prostate cancer without metastatic lesions

    International Nuclear Information System (INIS)

    Sakamoto, Naotaka; Akitake, Masakazu; Ikoma, Saya; Ri, Ken; Masuda, Katsuaki; Yoshikawa, Masahiro; Iguchi, Atsushi

    2010-01-01

    In order to assess the optimal management for elderly patients with localized and locally advanced prostate cancer (clinical stage: T1-T4N0M0), we reviewed the prognoses. From April 2000 to December 2008, we treated and followed up 175 patients aged 75 years, or older. In almost all of the patients above 79 years of age, endocrine therapy was selected. Among the 75 to 79-year-old patients, the proportion of radiation therapy, including external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDR-brachytherapy), as well as radical prostatectomy increased. The follow-up period for all the patients was 0 to 106 months (median, 32 months). In the low- and intermediate-risk group, the actuarial biochemical control rate at 60 months for radical prostatectomy and endocrine therapy was 100% and 90%, respectively, and no patients with EBRT combined with endocrine therapy, and HDR-brachytherapy had biochemical failure at 34 and 46 months, respectively. In the high-risk group with 75 to 79-year-old patients, the actuarial biochemical control rate at 60 months for EBRT combined with endocrine therapy, radical prostatectomy and endocrine therapy was 71.4%, 69.0% and 55.7%, respectively, while the actuarial biochemical control rate at 48 months for HDR-brachytherapy was 40.9%. In the high-risk group with patients above 79 years of age, the actuarial biochemical control rate at 60 months for endocrine therapy was 64.5%. Prostate cancer death was recognized only in 1 patient within the high-risk group, treated by endocrine therapy. In all the patients, the overall survival rate at 60 months for EBRT combined with endocrine therapy, HDR-brachytherapy, radical prostatectomy and endocrine therapy was 100%, 100%, 76.4% and 89.5%, respectively. The actuarial biochemical control rate and overall survival rate were not significant among the management options in each risk group. However, the 75 to 79-year-old patients within the high-risk group, who were treated with

  13. Delirium in elderly patients: association with educational attainment.

    Science.gov (United States)

    Martins, Sónia; Paiva, José Artur; Simões, Mário R; Fernandes, Lia

    2017-04-01

    Among cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium. The study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service. Exclusion criteria were as follows: Glasgow Coma Scale (total≤11), blindness/deafness, inability to communicate or to speak Portuguese. The European Portuguese Version of the Confusion Assessment Method (CAM) was used for delirium assessment. The final sample (n=157) had a mean age of 78.8 (SD=7.6) the majority being female (52.2%), married (51.5%) and with low educational level (49%). According to CAM, 21% of the patients had delirium. The delirium group presented the fewest years of education (median 1 vs. 4), with statistical significance (p=0.003). Delirium was more frequent among male patients [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.12-0.86; p=0.023], as well as those patients with lower education (OR 0.76; 95% CI 0.62-0.95; p=0.016), and with respiratory disease (OR 3.35; 95% CI 1.20-9.33; p=0.020), after controlling for age and medication. Similar to previous studies, these findings point to a negative correlation between education and delirium. This study appears as an attempt to contribute to the knowledge about the role of cognitive reserve in risk of delirium, particularly because is the first one that has been carried out in an IMCU, with lower educated elderly patients. Further studies are needed to clarify this relationship considering other markers (e.g. cognitive activities), which can contribute to the definition of preventive strategies.

  14. Difference between elderly and non-elderly patients in using serum lactate level to predict mortality caused by sepsis in the emergency department.

    Science.gov (United States)

    Cheng, Hsien-Hung; Chen, Fu-Cheng; Change, Meng-Wei; Kung, Chia-Te; Cheng, Chi-Yung; Tsai, Tsung-Cheng; Hsiao, Sheng-Yuan; Su, Chih-Min

    2018-03-01

    Elderly people are more susceptible to sepsis and experience more comorbidities and complications than young adults. Serum lactate is a useful biomarker to predict mortality in patients with sepsis. Lactate production is affected by the severity of sepsis, organ dysfunction, and adrenergic stimulation. Whether the predictive ability of serum lactate will be different between non-elderly and elderly patients is unknown.A retrospective cohort study was conducted to compare the prognostic value of hyperlactatemia in predicting the mortality between elderly (≥65 years) and non-elderly (sepsis.This is a single-center retrospective observational cohort study conducted from January 2007 to December 2013 in southern Taiwan. All patients with sepsis, who used antibiotics, with blood culture collected, and with available serum lactate levels in the emergency department, were included in the analysis. We evaluated the difference in serum lactate level between the elderly and non-elderly septic patients by using multiple regression models.A total of 7087 patients were enrolled in the study. Elderly and non-elderly patients accounted for 62.3% (4414) and 40.2% (2673) of all patients, respectively. Statistically significant difference of serum lactate levels was not observed between elderly and non-elderly survivors (2.9 vs 3.0 mmol/L; P = .57); however, elderly patients had lower lactate levels than those within the 28-day in-hospital mortality (5.5 vs 6.6 mmol/L, P 2 mmol/L still could provide enough sensitivity in predicting sepsis mortality in elder patients.

  15. Comparative study of systemic early postoperative inflammatory response among elderly and non-elderly patients undergoing laparoscopic cholecystectomy

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    LUCIANA FIALHO

    2018-03-01

    Full Text Available ABSTRACT Objective: to evaluate and compare the early postoperative period systemic inflammatory response between elderly and non-elderly patients submitted to laparoscopic cholecystectomy, mainly performing a quantitative analysis of interleukin-6 (IL-6, a marker of inflammatory activity systemic. Methods: we compared a series of cases over a period of six months at the Gaffrée and Guinle University Hospital of the Federal University of the State of Rio de Janeiro, involving 60 patients submitted to elective laparoscopic cholecystectomy. We used non-probabilistic sampling for convenience, selecting, from the inclusion criteria, the first 30 patients aged 18-60 years, who comprised group I, and 30 patients with age equal to or greater than 60 years, who formed group II. Results: the 60 patients involved were followed for at least 30 days after surgery and there were no complications. There was no conversion to open surgery. The values of the medians found in the IL-6 dosages for the preoperative period, three hours after the procedure and 24 hours after surgery were, respectively, 3.1 vs. 4.7 pg/ml, 7.3 vs. 14.1 pg/ml and 4.4 vs 13.3 pg/ml. Conclusion: Elderly patients were more responsive to surgical trauma and had elevated IL-6 levels for a longer period than the non-elderly group.

  16. Improvement of cognitive function after cochlear implantation in elderly patients.

    Science.gov (United States)

    Mosnier, Isabelle; Bebear, Jean-Pierre; Marx, Mathieu; Fraysse, Bernard; Truy, Eric; Lina-Granade, Geneviève; Mondain, Michel; Sterkers-Artières, Françoise; Bordure, Philippe; Robier, Alain; Godey, Benoit; Meyer, Bernard; Frachet, Bruno; Poncet-Wallet, Christine; Bouccara, Didier; Sterkers, Olivier

    2015-05-01

    The association between hearing impairment and cognitive decline has been established; however, the effect of cochlear implantation on cognition in profoundly deaf elderly patients is not known. To analyze the relationship between cognitive function and hearing restoration with a cochlear implant in elderly patients. Prospective longitudinal study performed in 10 tertiary referral centers between September 1, 2006, and June 30, 2009. The participants included 94 patients aged 65 to 85 years with profound, postlingual hearing loss who were evaluated before, 6 months after, and 12 months after cochlear implantation. Cochlear implantation and aural rehabilitation program. Speech perception was measured using disyllabic word recognition tests in quiet and in noise settings. Cognitive function was assessed using a battery of 6 tests evaluating attention, memory, orientation, executive function, mental flexibility, and fluency (Mini-Mental State Examination, 5-word test, clock-drawing test, verbal fluency test, d2 test of attention, and Trail Making test parts A and B). Quality of life and depression were evaluated using the Nijmegen Cochlear Implant Questionnaire and the Geriatric Depression Scale-4. Cochlear implantation led to improvements in speech perception in quiet and in noise (at 6 months: in quiet, 42% score increase [95% CI, 35%-49%; P tests. One year after implant, 81% of the subgroup (30 of 37) showed improved global cognitive function (no or 1 abnormal test score). Improved mean scores in all cognitive domains were observed as early as 6 months after cochlear implantation. Cognitive performance remained stable in the remaining 19% of the participants (7 of 37). Among patients with the best cognitive performance before implantation (ie, no or 1 abnormal cognitive test score), 24% (12 of 50) displayed a slight decline in cognitive performance. Multivariate analysis to examine the association between cognitive abilities before implantation and the

  17. Geriatric Intervention in Elderly Patients with Hip Fracture in an Orthopaedic Ward

    DEFF Research Database (Denmark)

    Gregersen, Merete; Damsgaard, Else Marie Skjøde; Hougaard, Kjeld

    2012-01-01

    Introduction: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic col-laboration (orthogeriatrics) has been organized in different ways. The aim of this study is to eva-...... patient outcomes. The concept should be further developed particularly among the frail elderly....

  18. Cost-effectiveness of interpersonal psychoterapy for elderly primary care patients with major depression

    NARCIS (Netherlands)

    Bosmans, J.E.; van Schaik, D.J.; Heijmans, M.W.; van Marwijk, H.W.J.; Hout, H.P. van; de Bruijne, M.C.

    2007-01-01

    Objectives: Major depression is common in elderly patients. Interpersonal psychotherapy (IPT) is a potentially effective treatment for depressed elderly patients. The objective of this study was to evaluate the cost-effectiveness of IPT delivered by mental health workers in primary care practices,

  19. [Modern tactics of the dystrophic retina disease treatment of patients of the elder age group].

    Science.gov (United States)

    Gorbunov, A V; Osokina, Iu Iu

    2010-01-01

    One of the problems of elderly and senile patients is the reduction of visual acuity. Primarily this is due to AREDS as the most frequent cause of loss of visual acuity in people over 60 years. Therefore, the search for ways to protect and maintain visual function of elderly and senile patients is an important task both for ophthalmology and geriatrics.

  20. Bowel preparation in CT colonography: electrolyte and renal function disturbances in the frail and elderly patient.

    LENUS (Irish Health Repository)

    Mc Laughlin, Patrick

    2010-03-01

    Elderly patients are at increased risk of biochemical disturbances secondary to cathartic medications. This study investigates the renal function, electrolyte and clinical disturbances associated with CT colonography (CTC) with sodium picosulphate-magnesium citrate (SPS-MC) in a subgroup of frail, elderly patients.

  1. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial

    NARCIS (Netherlands)

    van Stijn, Mireille F. M.; Bruins, Arnoud A.; Vermeulen, Mechteld A. R.; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G.; de Bandt, Jean Pascal; Twisk, Jos W. R.; van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2015-01-01

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect

  2. Perioperative Complications of Liver Resection in the Elderly with Hepatocellular Carcinoma: A Comparison with Younger Patients

    Directory of Open Access Journals (Sweden)

    Ruey-Horng Rau

    2009-06-01

    Conclusion: In contrast to some surgeries for emergency conditions such as long bone fracture or acute abdomen, the perioperative complications in the elderly receiving elective liver resection surgery did not differ markedly from those of younger patients. However, elderly patients would benefit even more if comprehensive postoperative care or newly improved therapies can be provided to lessen the incidence of perioperative respiratory complications.

  3. Limited-preparation CT colonography in frail elderly patients: a feasibility study.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2010-05-01

    Full colonic preparation can be onerous and may be poorly tolerated in frail elderly patients. The purpose of this study was to prospectively assess the image quality and diagnostic yield of limited-preparation CT colonography (CTC) in elderly patients with suspected colorectal cancer who were deemed medically unfit or unsuitable for colonoscopy.

  4. Chronic Kidney Disease-Mineral Bone Disorder in the Elderly Peritoneal Dialysis Patient

    DEFF Research Database (Denmark)

    Heaf, James Goya

    2015-01-01

    PURPOSE: The purpose of this paper was to review the literature concerning the treatment of chronic kidney disease-mineral bone disorder (CKD-MBD) in the elderly peritoneal dialysis (PD) patient. ♦ RESULTS: Chronic kidney disease-mineral bone disorder is a major problem in the elderly PD patient...

  5. Effect of Administration Route on the Pharmacokinetics of Cobalamin in Elderly Patients: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Monique P.H. Tillemans, PharmD

    2014-12-01

    Conclusions: The pharmacokinetics of intranasal and intramuscular cobalamin administration in elderly, cobalamin-deficient patients differ significantly. However, the estimated 2% bioavailability of cobalamin after intranasal administration makes intranasal cobalamin administration a potentially interesting administration route for elderly patients. Netherlands Trial Registry identifier: NTR 3005.

  6. Admission of elderly medical patients to fast track or standard hospitalisation

    DEFF Research Database (Denmark)

    Strøm, Camilla; Rasmussen, Lars Simon; Rasmussen, Søren Wistisen

    2016-01-01

    patients. An interim safety analysis is scheduled. CONCLUSION: In the ELDER trial, we explore benefits and harms related to treatment in an SSU for elderly medical patients compared with standard hospitalisation. FUNDING: Region Zealand's Forskningsfond, the Tryg Foundation and University of Copenhagen...

  7. Cognitive Profile of Elderly Patients with Mild Stroke

    Directory of Open Access Journals (Sweden)

    Arne Gramstad

    2011-11-01

    Full Text Available Background: A pattern characterizing cognitive deficits in mild stroke could help in differential diagnosis and rehabilitation planning. Methods: Fifty patients with mild stroke (modified Rankin scale ≤2 at discharge aged >60 years were given the Mini Mental State Examination (MMSE, the Hopkins Verbal Learning Test-Revised (HVLT-R and the Stroop test. Results: On HVLT-R, significant impairments were found in learning and recall, but not in delayed recall. The Stroop test revealed significant impairments in reading speed, but not in color-word interference. Using the MMSE, significant deficits were only found in the youngest age group. Conclusion: Elderly patients with mild stroke show deficits in verbal learning/recall and in reading speed, but not in the MMSE, delayed recall or color-word interference. The deficits are consistent with a mild-to-moderate brain dysfunction, with relative sparing of medial brain structures.

  8. Community-Acquired Pneumonia: a Comparison between elderly and nonelderly patients

    Directory of Open Access Journals (Sweden)

    S. Jafari

    2006-08-01

    Full Text Available Background: Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias. Methods: In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed; and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist. Results: The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly (group I, age ≥65years and 38 young (group II, age<65years subjects. Delirium was seen more in elderly group (p=0.05. The average body temperature and pulse rate were significantly higher in nonelderly group. Sixty one percent of elderly patients and 21% of young patients have Po2 less than 60 (p=0.02. Smoking (29.1%, neurological disturbances (19%, congestive heart failure (15.2%, chronic obstructive pulmonary disease and diabetes mellitus (13.9% were associated comorbidities in both groups. In non elderly group, immune compromise and IV drug use were more common as underlying comorbid conditions. Two of three mortalities were due to elder patients. Conclusion: Community acquired pneumonia could have more serious clinical and abnormal laboratory features in the elderly than younger patients. Mortality rate may be higher in older patients. Comorbid conditions are frequently seen in both elderly and nonelderly patients with community acquired pneumonia, but IV drug use and immune compromise are more frequent in nonelderly patients.

  9. Indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients with peritoneal malignancy.

    Science.gov (United States)

    Kitai, Toshiyuki; Yamanaka, Kenya; Miyauchi, Yuya; Kawashima, Masahiro

    2017-06-01

    A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is effective for some peritoneal malignancies. However, the indications for elderly patients remain unclear, with substantial postoperative morbidity and mortality being problematic. Clinical data were analyzed in 42 patients undergoing CRS + HIPEC for peritoneal malignancy. The primary tumor was located in the appendix in 32 cases and elsewhere in 10 cases. Operative results and survival data were compared between patients aged ≥70 and Elderly patients had a higher peritoneal cancer index (32.0 vs. 21.5), higher CA19-9 level (189.0 vs. 28.1), and higher frequency of grade 4-5 complications (5/9 vs. 2/26) than the younger patients. Grade 4-5 respiratory failure occurred in three elderly patients. There was a significant difference of postoperative survival between the elderly patients and younger patients, with 5-year survival rates being 41.3 and 74.2%, respectively (p = 0.0166). The poor prognosis of elderly patients was related to the higher frequency of grade 4-5 complications. Elderly patients were referred for treatment with more advanced disease than younger patients. An age ≥70 years was associated with more frequent grade 4-5 complications and worse survival. Performing CRS + HIPEC in elderly patients should be considered carefully due to the risk of severe complications, especially respiratory failure.

  10. Symptom assessment in elderly cancer patients receiving palliative care.

    Science.gov (United States)

    Pautex, Sophie; Berger, André; Chatelain, Catherine; Herrmann, François; Zulian, Gilbert B

    2003-09-01

    The purpose of this study is to examine the concordance of symptom assessment among the multiple raters in French-speaking elderly patients with an advanced cancer benefiting from palliative care. This study was conducted in a geriatric hospital with palliative care specificity. During 6 months, patient, nurse and physician completed the Edmonton symptom assessment system on two consecutive days. 42 patients with an advanced oncological disease were included. Mean age was 72+/-9.04 (range 52-88) and 23 were females. Mean mini mental status examination (MMSE) was 27.5+/-1.6. First assessment was completed at a median of day 8 after admission. Nurses, physicians and patients assessments were reproducible between days 1 and 2 (P>0.05). Pearson correlation coefficient significantly associated nurse assessment with patient assessment for pain, depression, anxiety, drowsiness, appetite and wellbeing (Ppatient assessment for pain, depression, drowsiness, appetite, wellbeing and shortness of breath (Ppatient score from both physicians and nurses scores weakly correlated all these factors (R2patients without cognitive failure and in stable general condition are consistent in their symptom assessment, and they have to be considered as the gold standard. Nevertheless, interdisciplinary assessment is probably a valid surrogate to self-assessment by the patient but only when the latter is truly impossible.

  11. Education of Elderly Patients Within Nursing Care in Slovakia

    Directory of Open Access Journals (Sweden)

    Kaduchová Petra

    2017-08-01

    Full Text Available Introduction: The paper deals with the issues of the education of senior patients within nursing care. The aim of the paper is to find out the level of nurses’ knowledge and skills in educating elderly patients and to discover how these are reflected in the reality of clinical practice. It is a case study focused on showing the current real state of clinical practice related to the given topic. Methods: This paper will introduce the outcomes of a qualitative research (semistructured interview, semi-structured observation, documents analysis based on theoretical background. The research was carried out during the survey fellowship in the Slovak Republic and the respondents were nurses working in standard hospital departments. Certain phenomena, relations and influencing factors were clarified through the follow-up analysis. The gathered data were processed by using qualitative methods in the form of case studies. Results: The qualitative survey has revealed certain deficiencies in nurses’ knowledge and in the reality of the education of elderly patients in clinical practice. Discussion: The deficiencies in knowledge and skills are essential in the reality of clinical practice. Limitations: The research sample was made up of educating nurse/nurses working in geriatrics, in long-term care departments or internal departments. It included a total of 16 respondents. Conclusions: Sufficient attention should be paid to the training of nurses which should be focused on the specificities of educating seniors/senior patients as well as on the reality of education that is performed. It is necessary to provide training for working with this specific age group even in pre-gradual nursing education.

  12. Effects of Music Therapy on Heart Rate Variability in Elderly Patients with Cerebral Vascular Disease and Dementia

    Directory of Open Access Journals (Sweden)

    Akira Kurita, MD

    2006-01-01

    Conclusions: Music therapy enhanced parasympathetic activity and decreased sympathetic activity in elderly patients with CVD and dementia. These findings suggest that music therapy is useful for alleviating anxiety, increasing comfort and facilitating relaxation for elderly patients with CVD and dementia.

  13. Impact of Therapeutic Interventions on Survival of Elderly Patients with Gallbladder Carcinoma: A 10-year Single Center Experience

    Directory of Open Access Journals (Sweden)

    Ching-Wei Chang

    2015-12-01

    Conclusion: Most elderly patients at the time of diagnosis of GBC were in TNM Stage IV. Surgery was the predominant treatment at our hospital. Surgical interventions might be associated with better survival for elderly patients with GBC.

  14. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study

    NARCIS (Netherlands)

    Durante-Mangoni, Emanuele; Bradley, Suzanne; Selton-Suty, Christine; Tripodi, Marie-Françoise; Barsic, Bruno; Bouza, Emilio; Cabell, Christopher H.; Ramos, Auristela Isabel de Oliveira; Fowler, Vance; Hoen, Bruno; Koneçny, Pam; Moreno, Asuncion; Murdoch, David; Pappas, Paul; Sexton, Daniel J.; Spelman, Denis; Tattevin, Pierre; Miró, José M.; van der Meer, Jan T. M.; Utili, Riccardo; Gordon, David; Devi, Uma; Kauffman, Carol; Armstrong, William; Giannitsioti, Efthymia; Giamarellou, Helen; Lerakis, Stamatios; del Rio, Ana; Mestres, Carlos A.; Paré, Carlos; Garcia de la Maria, Cristina; de Lazzario, Elisa; Marco, Francesc; Gatell, Jose M.; Miró, José M.; Almela, Manel; Azqueta, Manuel; Jiménez-Expósito, Maria Jesús; de Benito, Natividad; Perez, Noel; Almirante, Benito; Fernandez-Hidalgo, Nuria; Rodriguez de Vera, Pablo; Tornos, Pilar; Falcó, Vicente; Claramonte, Xavier; Armero, Yolanda; Sidani, Nisreen; Kanj-Sharara, Souha; Kanafani, Zeina; Raglio, Annibale; Goglio, Antonio; Gnecchi, Fabrizio; Suter, Fredy; Valsecchi, Grazia; Rizzi, Marco; Ravasio, Veronica; Chirouze, Catherine; Leroy, Joel; Plesiat, Patrick; Bernard, Yvette; Casey, Anna; Lambert, Peter; Watkin, Richard; Elliott, Tom; Patel, Mukesh; Dismukes, William; Pan, Angelo; Caros, Giampiero; Tribouilloy, Amel Brahim Mathiron Christophe; Goissen, Thomas; Delahaye, Armelle; Delahaye, Francois; Vandenesch, Francois; Vizzotti, Carla; Nacinovich, Francisco M.; Marin, Marcelo; Trivi, Marcelo; Lombardero, Martin; Cortes, Claudia; Horacio Casabe, José; Altclas, Javier; Kogan, Silvia; Clara, Liliana; Sanchez, Marisa; Commerford, Anita; Hansa, Cass; Deetlefs, Eduan; Ntsekhe, Mpiko; Commerford, Patrick; Wray, Dannah; Steed, Lisa L.; Church, Preston; Cantey, Robert; Morris, Arthur; Read, Kerry; Raymond, Nigel; Lang, Selwyn; Chambers, Stephen; Kotsanas, Despina; Korman, Tony M.; Peterson, Gail; Purcell, Jon; Southern, Paul M.; Shah, Manisha; Bedimo, Roger; Reddy, Arjun; Levine, Donald; Dhar, Gaurav; Hanlon-Feeney, Alanna; Hannan, Margaret; Kelly, Sinead; Wang, Andrew; Cabell, Christopher H.; Woods, Christopher W.; Benjamin, Danny; Corey, G. Ralph; McDonald, Jay R.; Federspiel, Jeff; Engemann, John J.; Reller, L. Barth; Drew, Laura; Caram, Lauren B.; Stryjewski, Martin; Morpeth, Susan; Lalani, Tahaniyat; Chu, Vivian; Mazaheri, Bahram; Neuerburg, Carl; Naber, Christoph; Athan, Eugene; Henry, Margaret; Harris, Owen; Alestig, Eric; Olaison, Lars; Wikstrom, Lotta; Snygg-Martin, Ulrika; Francis, Johnson; Venugopal, K.; Nair, Lathi; Thomas, Vinod; Chaiworramukkun, Jaruwan; Pachirat, Orathai; Chetchotisakd, Ploenchan; Suwanich, Tewan; Kamarulzaman, Adeeba; Tamin, Syahidah Syed; Premru, Manica Mueller; Logar, Mateja; Lejko-Zupanc, Tatjana; Orezzi, Christina; Klein, John; Moreno, Mar; Rodríguez-Créixems, Marta; Fernández, Miguel; Muñoz, Patricia; Fernández, Rocío; Ramallo, Victor; Raoult, Didier; Thuny, Franck; Habib, Gilbert; Casalta, Jean-Paul; Fournier, Pierre-Edouard; Chipigina, Natalia; Kirill, Ozerecky; Vinogradova, Tatiana; Kulichenko, Vadim P.; Butkevich, O. M.; Lion, Christine; Alla, Francois; Coyard, Hélène; Doco-Lecompte, Thanh; Iarussi, Diana; Ragone, Enrico; Dialetto, Giovanni; Tripodi, Marie Françoise; Casillo, Roberta; Kumar, A. Sampath; Sharma, Gautam; Dickerman, Stuart A.; Street, Alan; Eisen, Damon Peter; McBryde, Emma Sue; Grigg, Leeanne; Abrutyn, Elias; Michelet, Christian; Donnio, Pierre Yves; Fortes, Claudio Querido; Edathodu, Jameela; Al-Hegelan, Mashael; Font, Bernat; Anguera, Ignasi; Raimon Guma, Joan; Cereceda, M.; Oyonarte, Miguel J.; Montagna Mella, Rodrigo; Garcia, Patricia; Braun Jones, Sandra; de Oliveira Ramos, Auristela Isabel; Paiva, Marcelo Goulart; de Medeiros, Regina Aparecida; Woon, Lok Ley; Lum, Luh-Nah; Tan, Ru-San; Rees, David; Lawrence, Richard; Dever, Robyn; Post, Jeffrey; Jones, Phillip; Ryan, Suzanne; Harkness, John; Feneley, Michael; Rubinstein, Ethan; Strahilewitz, Jacob; Ionac, Adina; Mornos, Cristian; Dragulescu, Stefan; Forno, Davide; Cecchi, Enrico; de Rosa, Francesco; Imazio, Massimo; Trinchero, Rita; Wiesbauer, Franz; Gattringer, Rainer; Deans, Greg; Andrasevic, Arjana Tambic; Klinar, Igor; Vincelj, Josip; Bukovski, Suzana; Krajinovic, Vladimir; Cabell, Christopher; Stafford, Judy; Baloch, Khaula; Redick, Thomas; Harding, Tina; Karchmer, Adolf W.; Bayer, Arnie; Durack, David T.; Corey, Ralph; Moreillon, Phillipe; Eykynm, Susannah

    2008-01-01

    BACKGROUND: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. METHODS: In this multinational, prospective, observational cohort study within the

  15. Management of Suspected Pemphigus Vulgaris in Elderly Patient with Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Ayu M. Prihanti

    2013-07-01

    Full Text Available 72 1024x768 Pemphigus vulgaris (PV is a group of vesicobullous disease affecting skin and mucous membranes. PV is associated with autoimmune diseases, characterized by binding of IgG autoantibodies to desmoglein 3. PV lesion is a thin-walled bulla arising on the skin or mucosa. Oral mucous bulla are fragile and easily breakdown, forming irreguler ulcers. There are several factors that trigger PV, including genetic factors, age, drugs and food. This paper aimed to report treatment of suspected pemphigus vulgaris in elderly patient with history of chronic diseases. A 75-year-old woman with 2 months history of bulla formation on skin and history of persistent oral ulceration. Ulcers were covered with fibrin and erosive erythematous on labial, buccal and gingival mucosa. History of hypertension, diabetes mellitus and hepatitis was revealed. Routine complete blood count showed thrombocytopenia. Diagnosis was confirmed by anamnesis, clinical examination and complete blood investigation. PV should be distinguished from other vesicobullous disease. Systemic corticosteroid was given concurrently with hepato-protector, mouthwash, supportive therapy and topical lip cream. Bulla on skin and persistent erosive ulcers of the oral mucosa are the manifestations of PV. Elderly patient with history of chronic diseases showed a complex care of PV requiring more intensive and comprehensive treatment.DOI: 10.14693/jdi.v20i1.129

  16. NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer.

    Science.gov (United States)

    Lacau St Guily, Jean; Bouvard, Éric; Raynard, Bruno; Goldwasser, François; Maget, Brigitte; Prevost, Alain; Seguy, David; Romano, Olivier; Narciso, Bérengère; Couet, Charles; Balon, Jean-Michel; Vansteene, Damien; Salas, Sébastien; Grandval, Philippe; Gyan, Emmanuel; Hebuterne, Xavier

    2018-01-01

    To compare the prevalence of malnutrition and nutritional management between elderly (≥70years old) and younger patients (malnutrition in adult patients with cancer in France. Patients diagnosed with cancer at the study date in both inpatient and outpatient settings were included. Data collection was performed by means of questionnaires completed by the physician, the patient and the caregiver. This post-hoc analysis compared 578 elderly patients (27.6%) vs. 1517 younger patients (72.4%). There were significant differences in cancer localization between the groups particularly in gastrointestinal cancer (27% in younger patients vs. 42% in elderly), breast cancer (17% vs 8% in elderly) and oropharyngeal (15% vs. 9% in elderly). Weight loss was significantly more reported in the elderly than in younger patients (73.6% vs. 67.6%, p=0.009). Elderly patients were more frequently malnourished than younger patients (44.9% vs. 36.7%, p=0.0006). Food intake was comparable between the groups; however, physicians overestimated the food intake, particularly in the elderly. The malnutrition management was more frequently proposed in elderly, as dietary advice and oral nutritional supplements, than in younger patients; however, enteral nutrition was significantly less undertaken in the elderly. Malnutrition is prevalent in elderly patients with cancer, and more frequent than in younger patients. There is a need for an early integration of the nutritional counselling in patients with cancer, and particularly in the elderly. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Compliance with Guidelines of Enhanced Recovery After Surgery in Elderly Patients Undergoing Gastrectomy.

    Science.gov (United States)

    Jeong, Oh; Park, Young Kyu; Jung, Mi Ran; Ryu, Seong Yeob

    2017-04-01

    Enhanced recovery after surgery (ERAS) aims at expediting postoperative recovery by implementing specific strategies in perioperative management. However, the tolerance to such fast-tracking protocols is under debate, especially in elderly patients. We aimed to investigate rate of compliance with the main ERAS guidelines in elderly gastrectomy patients. Using data for 168 gastric cancer patients who underwent ERAS after gastrectomy as part of Clinical Trial NCT01653496, we calculated the rates of compliance with nine main ERAS guidelines and compared the compliance rates of elderly (≥70 years) and non-elderly (90%) for every ERAS guideline. Notably, the overall compliance rates did not differ significantly between the groups. Postoperatively, the mean time to fulfillment of discharge criteria was slightly longer for elderly patients (4.7 vs. 4.2 days, p = 0.005), but there were no significant differences between the groups with respect to the incidence of postoperative complications, length of hospitalization, and readmission rate. Compliance of the medically and physically fit elderly patients with the main ERAS guidelines is comparable to that of non-elderly patients, and such protocols can be safely applied to elderly patients without significant modification.

  18. Comprehensive geriatric assessment in elderly patients with dementia.

    Science.gov (United States)

    Namioka, Nayuta; Hanyu, Haruo; Hatanaka, Hirokuni; Fukasawa, Raita; Sakurai, Hirofumi; Iwamoto, Toshihiko

    2015-01-01

    We have recently developed and validated a screening test for comprehensive geriatric assessment (CGA) named "Dr. SUPERMAN". We compared the results obtained by the CGA of patients with Alzheimer's disease (AD), vascular dementia (VaD) and dementia with Lewy bodies (DLB), and determined the relationship between functional deficits and clinical characteristics in each type of dementia. We used Dr. SUPERMAN to examine patients with AD (24 men and 53 women, mean age 83.0 ± 5.1 years), VaD (10 men and 12 women, mean age 80.4 ± 5.0 years) and DLB (28 men and 20 women, mean age 81.2 ± 5.5 years). Patients with DLB or VaD had functional deficits more frequently than those with AD in many fields. Significant correlations between functional impairments and clinical characteristics, such as age, sex and Mini-Mental State Examination scores, in the non-AD group (including DLB and VaD) were found in more extensive fields than those in the AD group. Patients with dementia, particularly DLB, have several geriatric problems. Correlations between functional deficits and clinical characteristics differ between the AD group and the non-AD group. Non-AD patients of older age who are male and have advanced dementia are more likely have several functional deficits. In addition to age and severity of dementia, the type of dementia should be considered in the treatments and interventions of elderly patients with dementia. © 2014 Japan Geriatrics Society.

  19. Iatrogenia em pacientes idosos hospitalizados Iatrogeny in hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Eurico T. Carvalho-Filho

    1998-02-01

    Full Text Available Analisar as complicações iatrogênicas apresentadas por idosos hospitalizados. Estudo retrospectivo dos prontuários de 96 pacientes, 48 do sexo masculino e 48 do feminino, com idades variando de 60 a 93 anos (média: 75,7 anos, hospitalizados durante o ano de 1995 em enfermaria geriátrica. A análise da evolução dos pacientes durante o período de hospitalização permitiu evidenciar: 1 em 42 (43,7% pacientes ocorreram uma ou mais complicações iatrogênicas, num total de 56 episódios; 2 manifestações relacionadas aos procedimentos diagnósticos corresponderam a 17,9% das iatrogenias; 3 alterações relacionadas às medidas terapêuticas corresponderam a 58,9%, sendo 32,1% referentes à terapêutica farmacológica e 26,8% a outros procedimentos terapêuticos; 4 manifestações iatrogênicas não relacionadas diretamente às afecções (úlceras de decúbito, quedas e fraturas corresponderam a 23,2%; 5 a presença de manifestações iatrogênicas correlacionou-se com período mais prolongado de internação; 6 cinco pacientes faleceram em conseqüência direta de complicações iatrogênicas. A iatrogenia é freqüente em pacientes idosos hospitalizados, podendo determinar manifestações graves e mesmo fatais. Como uma significativa proporção dessas complicações pode ser evitada através de medidas adequadas, deve-se procurar identificar suas causas e desenvolver métodos para previni-la ou reduzir seus efeitos.PURPOSE: To evaluate the iatrogenic complications in hospitalized elderly patients. MATERIAL AND METHOD: Review of the medical records of 96 patients, 48 men and 48 women, aged 60 to 93 years (75.7 years on average, hospitalized in a geriatric ward during 1995. RESULTS: The study of the medical records of the patients showed: 1 forty-two (43.7% of the elderly had one or more iatrogenic illnesses, with a total of 56 occurrences; 2 complications due to diagnostic tests corresponded to 17.9% of the iatrogenic disorders; 3

  20. Risk Factors of the Hip Fractures in Elderly Patients

    Directory of Open Access Journals (Sweden)

    Ali Reza Nik-Tab'e

    2001-12-01

    Full Text Available Objective: The hip fractures are the most frequent cause of traumatic death after the age of 75 years, occurring more frequently in women that will make a negative impact of the patient's life style. The purpose of this research was to evaluate the risk factors of the hip fractures in elderly hospitalized in centers of education and treatment of Kerman and Rafsanjan cities in 1998-2000. Methods and Materials & Methods: This study was a descriptive method of sampling during 27 months (from 19 April 1998 to 21 July 2000 in hospitalized patients of orthopedic wards of Ali ebne Abitaleb hospital of Rafsanjan and Shahid bahonar hospital of Kerman. 257 patients who were afflicted with hip fracture were evaluated by a questionnaire with 20 statements (risk factors of hip fractures that was used to recorded information about this study: This risk factors were including age, sex, type of fracture, osteoporosis, milk consumption, muscle atrophy, environmental hazards, body mass index diseases, diabetes, previous fracture, smoking, antidepressant and anti convulsion drugs, heart disease, low mobility and activity perception disorders, age of menopause, impaired visual and nonuse external hip protector (padding. Results: The results of this study showed that many of above risk factors were effective (>50% than others. These factors were including environmental hazards (81.7%, muscle atrophy (72.8%, previous fractures (52.1%, low mobility and activity (70.8%, low milk consumption (100%, low BMI (79.8%, osteoporosis (52.1% and nonuse external hip protector (100%. Conclusion: The results of this study recommend that environmental hazards of elderly should be modified (e.g. well lighted, stair case with secure hand rail to prevent from falling Exercise and faradic current prevent muscle atrophy and improve physical fitness, muscle strength, balance and coordination. Treatment of impaired visual is important because risk of falling is decreased. Regular load

  1. Multiprofessional Treatment of High Blood Pressure in Very Elderly Patients

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    Luciana Muniz Sanches Siqueira Veiga Jardim

    Full Text Available Abstract Background: As the world population ages, patients older than 80 years, known as very elderly, are more frequently found. There are no studies in this age group aimed at analyzing the multidisciplinary intervention in the treatment of systemic arterial hypertension (SAH and some comorbidities. Objectives: To assess the effect of a multidisciplinary approach in very elderly hypertensives cared for at a specialized service. Methods: Longitudinal retrospective cohort study in a multidisciplinary service specialized in the SAH treatment in the Brazilian West-Central region. Patients aged 80 years and older by June 2015 were included. Data from the first (V1 and last visit (Vf were assessed. Anthropometric variables, blood pressure (BP, renal function, pharmacological treatment, lifestyle, comorbidities and cardiovascular events were studied, comparing data from V1 and Vf. Controlled BP was defined as systolic blood pressure (SBP lower than 140 mm Hg and diastolic blood pressure (DBP lower than 90 mm Hg. Statistical analyses were performed with SPSSR software, version 21.0. Values of p<0,05 were considered significant. Results: Data of 71 patients were assessed with a mean follow-up time of 15,22 years. Their mean age at V1 was 69.2 years, and, at Vf, 84.53 years, and 26.8% of them were males. There was a significant reduction in mean SBP (157.3 x 142.1 mm Hg; p<0.001 and DBP (95.1 x 77.8 mm Hg; p<0.001, with an increase in BP control rates from V1 to Vf (36.6 x 83.1%; p<0.001. The number of antihypertensive drugs used increased (1.49 x 2.85; p<0.001, with an increase in the use of angiotensin-converting enzyme inhibitors (22.5 x 46.5%; p=0.004, angiotensin II receptor blockers (4.2 x 35.2%; p<0.001 and calcium-channel blockers (18.3 x 67.6%; p<0.001. There was a reduction in total cholesterol (217.9 x 191 mg/dL; p<0.001 and LDL-cholesterol (139.6 x 119.0 mg/dL; p<0.001, but worsening of the glomerular filtration rate (62.5 x 45.4 mL/min; p

  2. [Assisted peritoneal dialysis: home-based renal replacement therapy for the elderly patient].

    Science.gov (United States)

    Wiesholzer, Martin

    2013-06-01

    The number of elderly patients with end stage renal disease is constantly increasing. Conventional hämodiaylsis as the mainstay of renal replacement therapy is often poorly tolerated by frail eldery patients with multiple comorbidities. Although many of these patients would prefer a home based dialysis treatment, the number of elderly patients using peritoneal dialysis (PD) is still low. Impaired physical and cognitive function often generates insurmountable barriers for self care peritoneal dialysis. Assisted peritoneal dialysis can overcome many of these barriers and give elderly patients the ability of a renal replacement therapy in their own homes respecting their needs.

  3. Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance.

    Science.gov (United States)

    Cho, Kyu-Jung; Kim, Ki-Tack; Kim, Whoan-Jeang; Lee, Sang-Hoon; Jung, Jae-Hoon; Kim, Young-Tae; Park, Hae-Bong

    2013-11-15

    Retrospective, radiographical analysis. To evaluate pedicle subtraction osteotomy (PSO) as a means of correcting severe degenerative sagittal imbalance in elderly patients. PSO in patients with degenerative sagittal imbalance is likely to cause more complications than in patients with iatrogenic flatback deformity. This study analyzed 34 patients who underwent fusion to the sacrum, with a minimum 2-year follow-up. Age of the patients were in the range from 58 to 73 with the mean at 65.5 years. PSO was performed at one segment in all cases, consisting of L3 (n = 26), L4 (n = 4), L2 (n = 3), and L1 (n = 1). The average number of levels fused was 8.15. Ten patients had structural interbody fusion at the lumbosacral junction. Applying PSO at one segment, the mean correction of the lordotic angle at the osteotomy site was 33.3°, of which the loss of correction (LOC) was 4.0° at the last visit. The correction of lumbar lordosis was 33.7° and the LOC was 8.5°. The sagittal C7 plumb was 215.9 mm before surgery, corrected to 35.1 mm after surgery, and changed to 95.9 mm by the last visit. The correction of the sagittal C7 plumb was 119.9 mm and the LOC was 60.9 mm. There was substantial LOC in lumbar lordosis and sagittal C7 plumb. In 10 patients with addition of posterior lumbar interbody fusion, the LOC of lumbar lordosis was 7.4°, which was less than 9° in those without it. PSO for the correction of degenerative sagittal imbalance in elderly patients resulted in correction of sagittal alignment with a significant LOC of lumbar lordosis and sagittal C7 plumb. The LOC of lumbar lordosis occurred at both the osteotomy and non-osteotomy site. The addition of anterior column support is helpful to maintain correction and reduce complications. N/A.

  4. IgE-mediated allergy in elderly patients with asthma

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    Fumihiro Mitsunobu

    1997-01-01

    Full Text Available The incidence of a positive family history with asthma and levels of serum IgE and IgE antibodies were examined in 136 patients with asthma in relation to age at onset of the disease. The frequency of subjects with a family history of asthma ranged from 37.9 to 75.0% in all groups classified by age at onset. The frequency of patients with a high serum IgE level (≥ 150 IU/mL was higher (51.7–63.2% in all groups than the frequency of patients with a low serum level (< 150 IU/mL. The mean level of serum IgE was significantly higher in patients with a family history than in those without a family history, in subjects between the ages of 50 and 59 years at onset (mean age 63.4 years; P < 0.02 and in those over the age of 60 years at onset (74.0 years; P < 0.01. The number of patients with a positive RAST score either to house dust mite (HDM, cockroach, and Candida tended to decrease as the age at onset increased. However, the frequency of positive RAST to HDM was higher in patients with a family history and who were over the age of 50 years at onset compared with those patients between the ages of 40 and 49 years at onset, although the frequency was significantly higher in patients with family history than in those without family history (P < 0.02. These results suggest that IgE-mediated allergic reactions are significant not only in those patients who are younger, but also in elderly patients with asthma.

  5. Left ventricular diastolic filling in elder patients with systemic hypertension

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    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Kameoka, Masakuni (Sumitomo Hospital, Osaka (Japan))

    1990-07-01

    To study the significance of left ventricular (LV) diastolic filling in elderly patients with hypertension (HT), cardiac blood pool imagings with Tc-99m were obtained at rest in 17 normal subjects and 28 patients with systemic HT. HT patients did not show any evidence of coronary heart disease, renal insufficiency or other diseases. They showed normal LV ejection fraction (LVEF) and normal LV wall motion. From the LV volume curve and its first differentiation curve, LVEF, mean first third ejection rate (ERm) and peak ejection rate (PER) were obtained as LV systolic function indices; and LV diastolic filling rate during the first third of diastole (FRm) and peak filling rate (PFR) were obtained as LV diastolic function indices. All indices of LV systolic function were similar in all groups. In contrast, LV diastolic indices (FRm and PFR) of older groups were significantly lower than those of young HT and normal groups. LV diastolic indices in HT groups decreased significantly compared with normal groups of the same age. FRm could distinguish HT patients from normal subjects of the same age more accurately than PFR. In normal subjects, FRm correlated with age (r=-0.490) and ERm (r=-0.489). In addition to age ERm, FRm correlated with LV wall thickness measured by M-mode ecocardiography (r=-0.566) in HT patients. In the HT old group, the correlations between FRm and LV wall thickness and between FRm and ERm were more significant than those in the HT young group. The impairment of early diastolic filling of LV was more prominent in older HT patients than younger HT patients. LV diastolic abnormality was influenced more highly by the degree of LV hypertrophy in older HT patients than younger HT patients. These diastolic abnormalities may cause systolic dysfunction in older HT patients. (J.P.N.).

  6. Clinical characteristics and prognosis of acute bacterial meningitis in elderly patients over 65: a hospital-based study

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    Lai Wei-An

    2011-12-01

    Full Text Available Abstract Background To examine the clinical characteristics of bacterial meningitis in elderly patients. Methods 261 patients with adult bacterial meningitis (ABM, collected during a study period of 11 years (2000-2010, were included for study. Among them, 87 patients aged ≥ 65 years and were classified as the elderly group. The clinical and laboratory characteristics and prognostic factors were analyzed, and a clinical comparison with those of non-elderly ABM patients was also made. Results The 87 elderly ABM patients were composed of 53 males and 34 females, aged 65-87 years old (median = 71 years. Diabetes mellitus (DM was the most common underlying condition (34%, followed by end stage renal disease (7%, alcoholism (4% and malignancies (4%. Fever was the most common clinical manifestation (86%, followed by altered consciousness (62%, leukocytosis (53%, hydrocephalus (38%, seizure (30%, bacteremia (21% and shock (11%. Thirty-nine of these 87 elderly ABM patients had spontaneous infection, while the other 48 had post-neurosurgical infection. Forty-four patients contracted ABM in a community-acquired state, while the other 43, a nosocomial state. The therapeutic results of the 87 elderly ABM patients were that 34 patients expired and 53 patients survived. The comparative results of the clinical and laboratory characteristics between the elderly and non-elderly ABM patients showed that only peripheral blood leukocytosis was significant. Presence of shock and seizure were significant prognostic factors of elderly ABM patients. Conclusions Elderly ABM patients accounted for 34.8% of the overall ABM cases, and this relatively high incidence rate may signify the future burden of ABM in the elderly population in Taiwan. The relative frequency of implicated pathogens of elderly ABM is similar to that of non-elderly ABM. Compared with non-elderly patients, the elderly ABM patients have a significantly lower incidence of peripheral blood leukocytosis

  7. What is The Utility of Electrophysiological Study in Elderly Patients with Syncope and Heart Disease?

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    Rumas Aslam

    2015-01-01

    Conclusion: Complete EPS allows the identification of treatable causes in a high proportion of elderly patients with syncope and heart disease. Yet, the prognosis of these patients is mainly related to LVEF and age.

  8. Measuring elderly dysphagic patients' performance in eating--a review

    DEFF Research Database (Denmark)

    Hansen, Tina; Kjaersgaard, Annette; Faber, Jens

    2011-01-01

    Purpose. This review aims to identify psychometrically robust assessment tools suitable for measuring elderly dysphagic patients' performance in eating for use in clinical practice and research. Method. Electronic databases, related citations and references were searched to identify assessment...... tools integrating the complexity of the eating process. Papers were selected according to criteria defined a priori. Data were extracted regarding characteristics of the assessment tools and the evidence of reliability, validity and responsiveness. Quality appraisal was undertaken using developed...... of neurological and geriatric conditions. The rigor of the assessment tools' psychometric properties varied from no evidence available to excellent evidence. Only two assessment tools were rated adequate to excellent. Conclusion. ‘The Minimal Eating Observation Form-Version II’ to be used for screening and ‘The...

  9. Elderly patients with colorectal cancer are oncologically undertreated

    DEFF Research Database (Denmark)

    Bojer, A. S.; Roikjær, Ole

    2015-01-01

    Aims:Colorectal cancer (CRC) is mainly a disease of the elderly. Our primary aim was to investigate if age had influence on treatment decisions in regards to surgery, referral to an oncologist and treatment by an oncologist. Method:We identified patients with CRC in our department from 2004 through...... 2011 in the Danish Colorectal Cancer Group (DCCG) database. According to age ≤75 and >75 years multivariate logistic regression analysis was used on treatment decisions: surgery, referral to an oncologist and oncologic treatment. Independent variables were age, ASA score, tumorlocation, stage, gender...... ratio for referral to an oncologist (OR 0.624, p treatment if referred (OR 0.218, p treatment by an oncologist OR was 0.210 (p

  10. Immuno senescence: implications for cancer immunotherapy in elderly patients

    International Nuclear Information System (INIS)

    Garcia, Beatriz; Lage, Agustin

    2006-01-01

    The aging process produces functional and developmental changes in the immune system. Those changes may occur at different levels or at different moments, from lymphopoiesis up to the final response of the immune system facing a certain disease. The response of the adaptive immune system is most strongly affected by the aging process, particularly at the level of the effector T-cells. These changes can have a negative impact on the immune response of elderly patients during cancer immunotherapy. The present paper is an updated review of the bibliography on the most important modifications produced in the immune system during aging, as well as on the relevance of these modifications for the design of new strategies for cancer immunotherapy. (Author)

  11. Adjuvant radiotherapy on older and oldest elderly rectal cancer patients.

    Science.gov (United States)

    Fiorica, F; Cartei, F; Carau, B; Berretta, S; Spartà, D; Tirelli, U; Santangelo, A; Maugeri, D; Luca, S; Leotta, C; Sorace, R; Berretta, M

    2009-01-01

    The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity in the patients aged > or = 75 with advanced rectal cancer. From January 2002 to December 2006, 41 consecutive patients (27 men and 14 women) aged > or = 75 received radiotherapy for local advanced rectal cancer, 9 in a pre-operative and 22 in a post-operative setting. Sixteen patients received concomitant chemotherapy. Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluation index (ACE-27), surgery versus no surgery, and timing of radiotherapy. The median age was 80.5 years (range 75-90). A total of 19.5% of the patients had no co-morbidity, 48.8% mild, 17.1% moderate, and 14.6% had severe co-morbidities. Thirty-nine subjects (95.1%) were submitted to surgery. All patients but one completed the planned radiation schedule. At a median follow-up of 23.1 months, the 2- and 4-year overall survival rates were 71.8% and 61.6%, respectively. There was a better survival for patients with no or mild co-morbidities (p=0.002) and a good performance status (p=0.003). The cancer-free survival at 2 and 4 years was 78.9% and 26.4%, respectively. No difference in acute and late toxicity rates was found between patients with different ACE-27 indexes. We conclude that compliance with radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results.

  12. Losartan/hydrochlorothiazide combination is safe and effective for morning hypertension in Very-Elderly patients.

    Science.gov (United States)

    Uchiwa, Hiroki; Kai, Hisashi; Iwamoto, Yoshiko; Anegawa, Takahiro; Kajimoto, Hidemi; Fukuda, Kenji; Imaizumi, Tsutomu; Fukumoto, Yoshihiro

    2018-01-01

    Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the prevalence of morning hypertension increases with age, treatment of morning hypertension has not been established, particularly in Very-Elderly patients. We compared the safety and efficacy of a losartan/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension between Very-Elderly (≥75 years) and Young/Elderly patients (Morning Hypertension and Angiotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy study, in which patients with morning hypertension (≥135/85 mmHg) received a 50-mg losartan/12.5-mg HCTZ combination tablet (combination therapy) or 100-mg losartan (high-dose therapy) for 3 months. High adherence rates and few adverse effects were observed in Very-Elderly patients receiving combination (n = 32) and high-dose (n = 34) therapies and in Young/Elderly patients receiving combination (n = 69) and high-dose (n = 66) therapies. Baseline morning systolic BP (SBP) was similar in both age groups receiving either therapy. Morning SBP was reduced by 20.2 and 18.1 mmHg with combination therapy and by 7.1 and 9.1 mmHg with high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Morning BP target (morning hypertension in Very-Elderly as well as Young/Elderly patients. In addition, combination therapy was also superior to high-dose therapy for lowering morning SBP in Very-Elderly patients.

  13. Current and emerging treatment options for the elderly patient with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Fassett RG

    2014-01-01

    Full Text Available Robert G Fassett The University of Queensland School of Human Movement Studies, Brisbane, Queensland, Australia Abstract: The objective of this article is to review the current and emerging treatments of CKD prior to dialysis in the elderly. Worldwide, there are increasing numbers of people who are aged over 65 years. In parallel, there are increasing numbers of elderly patients presenting with chronic kidney disease (CKD, particularly in the more advanced stages. The elderly have quite different health care needs related to their associated comorbidity, frailty, social isolation, poor functional status, and cognitive decline. Clinical trials assessing treatments for CKD have usually excluded patients older than 70–75 years; therefore, it is difficult to translate current therapies recommended for younger patients with CKD across to the elderly. Many elderly people with CKD progress to end-stage kidney disease and face the dilemma of whether to undertake dialysis or accept a conservative approach supported by palliative care. This places pressure on the patient, their family, and on health care resources. The clinical trajectory of elderly CKD patients has in the past been unclear, but recent evidence suggests that many patients over 75 years of age with multiple comorbidities have greatly reduced life expectancies and quality of life, even if they choose dialysis treatment. Offering a conservative pathway supported by palliative care is a reasonable option for some patients under these circumstances. The elderly person who chooses to have dialysis will frequently have different requirements than younger patients. Kidney transplantation can still result in improved life expectancy and quality of life in the elderly, in carefully selected people. There is a genuine need for the inclusion of the elderly in CKD clinical trials in the future so we can produce evidence-based therapies for this group. In addition, new therapies to treat and slow CKD

  14. Correlates of Prevalent Disability Among HIV-Infected Elderly Patients.

    Science.gov (United States)

    Ávila-Funes, José Alberto; Belaunzarán-Zamudio, Pablo Francisco; Tamez-Rivera, Oscar; Crabtree-Ramírez, Brenda; Navarrete-Reyes, Ana Patricia; Cuellar-Rodríguez, Jennifer; Sierra-Madero, Juan; Amieva, Hélène

    2016-02-01

    The growing elderly population of HIV-infected patients is leading to a significant epidemiological transition and HIV infection has been proposed as a premature and accelerated aging model rending the individual more susceptible to premature disability. However, the determinants of disability among this emergent population are still lacking. Therefore, the aim of this study is to determine the correlates of prevalent disability in adults ≥50 years with HIV infection. A cross-sectional study of 184 HIV-infected adults receiving ambulatory care in an HIV clinic of a tertiary care, university-affiliated hospital in Mexico City was conducted. Disability for instrumental (IADL) and basic activities of daily living (ADL) was established. Sociodemographic factors, clinical variables, current CD4(+) cell count, and HIV viral load (VL) were tested as potential determinants of disability. Multivariate logistic regression analyses were used to identify the correlates of both types of disability. The mean age was 59.3 years. All participants were receiving highly active antiretroviral therapy. Of participants 17.9% had disability for IADL and 26.1% for ADL. Multivariate logistic regression analyses indicated that being older; having a lower CD4(+) cell count, and having a detectable HIV VL were independently associated with both types of disability. In addition, educational level was also independently associated with ADL disability. Age, educational level, low CD4(+) cell count, and detectable HIV VL were independently associated with disability. Whether effective and timely antiretroviral therapy will reduce the risk of disability in HIV-infected elderly patients needs to be evaluated.

  15. Thyroid Surgery for Elderly Patients: Are They at Increased Operative Risks?

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    Sze-How Ng

    2012-01-01

    Full Text Available An increasing elderly population, a rising incidence of differentiated thyroid carcinoma (DTC, and a rising incidence of benign nodular disease with age are all contributing to a rise in thyroid operations for the elderly. Literature review on the outcome and safety of thyroid surgery in elderly patients has been filled with conflicting results and this subject remains controversial. Although most single-institution studies conducted by high-volume surgeons did not find significant differences of complication rates in elderly when compared with younger cohorts, they often lacked the power necessary to identify subtle differences and suffered from various selection and referral biases. Recent evidence from large population-based studies concluded that thyroid surgery in the elderly was associated with higher complication rates. One of the major contributing factors for the increased complication rate was because most elderly patients suffered from many preexisting comorbidities. Therefore, elderly patients who have abnormal thyroid findings should complete a thorough preoperative workup and better postoperative care after undergoing any thyroid surgery. Furthermore, these high-risk patients would benefit if they could be referred to high-volume, specialized surgical units early. In this systemic review, we aimed to evaluate different issues and controversies in thyroidectomy for elderly patients.

  16. The role of perioperative oral nutritional supplementation in elderly patients after hip surgery.

    Science.gov (United States)

    Liu, Ming; Yang, Jing; Yu, Xi; Huang, Xiao; Vaidya, Sushan; Huang, Fuguo; Xiang, Zhou

    2015-01-01

    The effect of perioperative oral nutritional supplementation (ONS) on elderly patients after hip surgery remains controversial. This study intended to ascertain whether perioperative ONS is beneficial for the rehabilitation of elderly patients after hip surgery. We searched databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials for articles published up to May 2014. Randomized controlled trials of ONS for elderly patients after hip surgery were included. The combined trials showed that ONS had a positive effect on the serum total protein (Pelderly patients recover after hip surgery and reduce complications.

  17. Radiotherapy of elderly patients with non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Nakano, Kikuo; Hiramoto, Takehiko; Kumagai, Kazuhiko; Tukamoto, Yuji; Furonaka, Makoto; Hayakawa, Masanobu; Nakamura, Kenji

    1996-01-01

    Treatment results of patients aged 75 years or older (elderly group) with non-small-cell lung cancer were compared with those of patients aged 74 years or younger (younger group). In patients with stage III disease, radiotherapy alone resulted in a median survival of 11.5 months in the younger group and 5.5 months in the elderly group. There was a significant difference in survival rate between the two groups (P=0.0008). Moreover, the elderly group patients more frequently died of pneumonia and radiation pneumonitis than the younger group patients. However, results of radiotherapy were similar in the two groups of patients with stage I and II disease. Accordingly, these findings suggested that radiotherapy is an appropriate treatment modality for elderly lung cancer patients, but that individualized radiotherapy is needed for those with locally advanced stage. (author)

  18. Viability of gait speed test in hospitalized elderly patients.

    Science.gov (United States)

    Martinez, Bruno Prata; Batista, Anne Karine Menezes Santos; Ramos, Isis Resende; Dantas, Júlio Cesar; Gomes, Isabela Barboza; Forgiarini, Luiz Alberto; Camelier, Fernanda Rosa Warken; Camelier, Aquiles Assunção

    2016-01-01

    The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = -0.27 to 0.15). The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance. O teste de velocidade de marcha (TVM) é um teste físico que pode predizer quedas e auxiliar no diagnóstico de sarcopenia em idosos da comunidade. Entretanto, pelo que sabemos, não há estudos que avaliaram sua reprodutibilidade em idosos hospitalizados. O objetivo deste estudo foi avaliar a segurança e a reprodutibilidade do TVM de seis

  19. Bridging Community Generational Gaps through Experiential Learning: A College Nursing Student Practicum for Elderly Patients

    Science.gov (United States)

    Pate, Jane D.

    2013-01-01

    At the study site, an elder care practicum was adopted after nursing students demonstrated a lack of interest in the well-being of elderly patients. The purpose of the study was to determine if there was a change in college nursing students' attitudes toward nursing home residents as a result of increased intergenerational exposure following an…

  20. The characteristics of walking strategy in elderly patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Xi Pan

    2016-06-01

    Conclusions: It highlights to put forward the walking strategy according to the abnormal COP trajectory. Due to the elderly diabetics with high risks of falling, the rehabilitation nursing should be strengthened mainly including the training of enhancing proprioception to prevent the elderly patients with type2 diabetes from falling.

  1. Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper

    DEFF Research Database (Denmark)

    Aapro, M; Bernard-Marty, C; Brain, E G C

    2011-01-01

    BACKGROUND: Comorbidities and risk factors likely to complicate treatment are common in elderly cancer patients. Anthracyclines remain the cornerstone of first-line therapy for non-Hodgkin's lymphoma (NHL) and metastatic and early breast cancer but can cause congestive heart failure. Elderly pati...

  2. Quality of Life Is Related to Social Support in Elderly Osteoporosis Patients in a Chinese Population.

    Science.gov (United States)

    Ma, Lina; Li, Yun; Wang, Jieyu; Zhu, Hong; Yang, Wei; Cao, Ruojin; Qian, Yuying; Feng, Ming

    2015-01-01

    To explore the association between quality of life and social support in elderly osteoporosis patients in a Chinese population. A total of 214 elderly patients who underwent bone mineral density screening were divided into two groups: elderly patients with primary osteoporosis (case group, n = 112) and normal elderly patients (control group, n = 102). Quality of life and social support were compared between the two groups. Quality of life and social support were significantly different between the case and control groups. The physical function, role-physical, bodily pain, general health, vitality, social-functioning, role-emotional and mental health scores in case group were significantly lower than those in the control group (P Quality of life and social support were positively correlated in the case group (r = 0.672, P Quality of life and social support in elderly patients with osteoporosis in China were poorer than in elderly patients without osteoporosis and were positively correlated. Our findings indicate that increased efforts to improve the social support and quality of life in elderly osteoporosis patients are urgently needed in China. Further longitudinal studies should be conducted to provide more clinical evidence to determine causative factors for the observed association between risk factors and outcomes.

  3. Observation the swallowing mechanism in elderly patients with pharyngeal dysphagia

    Directory of Open Access Journals (Sweden)

    Claudia Ximena Campo-Cañar

    2010-09-01

    Full Text Available Observation of the swallowing dynamics is an issue that demands close attention by the health professionals involved in the diagnosis and management of patients with dysphagia. This article is a review of the literature aimed to enhance the knowledge regarding the speech therapy assessment of pharyngeal dysphagia in elder adults. The disorder of the swallowing is called dysphagia and it is defined as difficulty swallowing. The dysphagia is often caused by affectation of mechanical or neuromuscular components of the swallowing mechanism. This type of disorder is likely to impact the the oral, pharyngeal and esophageal phases of the swallowing. The speech therapist should take into account assessing aspects such as level of consciousness, vital signs, whether or not the patient is ventilator dependent, means of feeding, if intubated what type of cannula, whether or not the patient uses a speaking valve (if a trach tube is present, nutritional status, the patient’s expressive and receptive language, the anatomical and physiological state of the oral motor structures. When assessing swallowing clinicians should also make sure to develop an adequate beside clinical, voice assessment and videofluoroscopy.

  4. Hypoperfusion in baseline and cognitively activated brain SPECT imaging of adult and elderly patients with depression

    International Nuclear Information System (INIS)

    Zhao Jinhua; Lin Xiangtong; Jiang Kaida; Ang Qiuqing; Shi Shenxun; Xue Fangping

    2000-01-01

    Objective: To evaluate the rCBF abnormalities of the baseline and cognitively activated rCBF imaging in unmedicated adult and elderly patients with depression. Methods: The subjects were divided into four groups: depressed adults, normal adult controls, depressed elders and normal elderly controls. All depressed patients were unmedicated and the diagnoses (depression of moderate degree with accompanying somatization) were confirmed by the ICD-10 criteria. Age range of the 39 depressed adult patients was 17 - 55 years. 17 age-matched normal adult controls (age range 21 - 50 years) were studied under identical conditions. The age range of 18 depressed elderly patients was 62 - 76 years. 21 age-matched normal elderly controls (age range 60 - 72 years) were studied under identical conditions. Baseline and cognitively activated 99 Tc m -ECD SPECT were performed on 25 of the 39 adult patients with depression and 17 normal adult controls. Baseline 99 Tc m -ECD SPECT only was performed on the remaining 14 patients with depression. Baseline and cognitively activated 99 Tc m -ECD SPECT were performed on 12 of the 18 elderly patients with depression and 18 of the 21 normal elderly controls. Baseline 99 Tc m -ECD SPECT only was performed on the remaining elderly patients and 3 normal elderly controls. Results: 1) The characteristic abnormalities of baseline and cognitively activated brain SPECT imaging of depression in adults: the baseline rCBF values of frontal and temporal lobe decreased significantly and the activated rCBF values of frontal, temporal lobe decreased more evidently than that in the baseline imaging and additionally decreased activated rCBF values in parietal lobe were found. 2) The characteristic abnormalities of baseline and cognitively activated brain SPECT imaging of elderly patients with depression: the baseline rCBF values of frontal, temporal lobe and right basal ganglia decreased significantly and the activated rCBF values of frontal, temporal, right

  5. Clinical characteristics and prognosis of heart failure in elderly patients.

    Science.gov (United States)

    Martínez-Braña, Lucía; Mateo-Mosquera, Lara; Bermúdez-Ramos, María; Valcárcel García, María de los Ángeles; Fernández Hernández, Lorena; Hermida Ameijeiras, Álvaro; Lado Lado, Francisco Luis

    2015-01-01

    The aim of this study was to assess prevalence, clinical characteristics, and prognosis in elderly patients with heart failure with preserved ejection fraction (HFPEF) compared to patients with heart failure with reduced ejection fraction (HFREF) who were followed in an internal medicine unit. In this retrospective observational study, the sample consisted of 301 patients followed in an internal medicine referral unit between January 2007 and December 2010. All patients were checked to determine their vital status on 31 December 2012. Survival was analyzed using Kaplan-Meier curves, and compared using the log-rank test. Of the 301 patients, 165 (54.8%) were women. In the 263 cases (87.4%) who underwent echocardiographic assessment, 190 (72.2%) had HFPEF and 73 (27.8%) had HFREF. Mean age was similar in the two groups (80.1 and 79.9 years; p=0.905), with a predominance of women in the HFPEF group (60.5% women, 42.5% men; p=0.025). The main etiology was hypertensive heart disease in the HFPEF group. Regarding treatment, more beta-blockers were administered in the HFREF group. No statistically significant differences were observed between the groups in terms of cardiovascular risk factors, comorbidities, NYHA functional class, or mortality. Clinical characteristics were similar for both HFPEF and HFREF patients. Women were predominant in the HFPEF group, as was hypertensive etiology. No significant differences in mortality were observed between the groups. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. Experiences and learnings of the elderly patients in the hemodialisis routine

    Directory of Open Access Journals (Sweden)

    Nadia Dumara Ruiz Silveira

    2012-01-01

    Full Text Available The present study results from the observation of the experience of elderly patients that were submitted to hemodialysis treatment, trying to find out their new learning during the period of treatment. The interviews were conducted with 08 elderly patients who took the treatment in a private hospital in the city of Teresina-PI. The results showed us that their changes of habits in daily routine may become a challenge for them. At the same time, those elderly patients acquired new knowledge resulting a new vision of the world.

  7. [Modern aspects of diagnosis of presbycusis and its treatment in elderly patients].

    Science.gov (United States)

    Boboshko, M Iu; Efimova, M V; Savenko, I V

    2011-01-01

    This study was designed to evaluate the efficacy of tanakan used to treat tympanophonia in elderly women. The entire spectrum of modern audiological technique was employed to examine the patients. It was shown that tanakan therapy decreases intensity of typmanytis and improves speech hearing in aged patients. The results of the study give reason to recommend the treatment with tanakan for the elderly patients presenting with either presbiacusis or normal tonal hearing.

  8. Bevacizumab plus chemotherapy in elderly patients with previously untreated metastatic colorectal cancer: single center experience

    Directory of Open Access Journals (Sweden)

    Ocvirk Janja

    2016-06-01

    Full Text Available Metastatic colorectal cancer (mCRC is mainly a disease of elderly, however, geriatric population is underrepresented in clinical trials. Patient registries represent a tool to assess and follow treatment outcomes in this patient population. The aim of the study was with the help of the patients’ register to determine the safety and efficacy of bevacizumab plus chemotherapy in elderly patients who had previously untreated metastatic colorectal cancer.

  9. Current and emerging treatment options for the elderly patient with chronic kidney disease

    Science.gov (United States)

    Fassett, Robert G

    2014-01-01

    The objective of this article is to review the current and emerging treatments of CKD prior to dialysis in the elderly. Worldwide, there are increasing numbers of people who are aged over 65 years. In parallel, there are increasing numbers of elderly patients presenting with chronic kidney disease (CKD), particularly in the more advanced stages. The elderly have quite different health care needs related to their associated comorbidity, frailty, social isolation, poor functional status, and cognitive decline. Clinical trials assessing treatments for CKD have usually excluded patients older than 70–75 years; therefore, it is difficult to translate current therapies recommended for younger patients with CKD across to the elderly. Many elderly people with CKD progress to end-stage kidney disease and face the dilemma of whether to undertake dialysis or accept a conservative approach supported by palliative care. This places pressure on the patient, their family, and on health care resources. The clinical trajectory of elderly CKD patients has in the past been unclear, but recent evidence suggests that many patients over 75 years of age with multiple comorbidities have greatly reduced life expectancies and quality of life, even if they choose dialysis treatment. Offering a conservative pathway supported by palliative care is a reasonable option for some patients under these circumstances. The elderly person who chooses to have dialysis will frequently have different requirements than younger patients. Kidney transplantation can still result in improved life expectancy and quality of life in the elderly, in carefully selected people. There is a genuine need for the inclusion of the elderly in CKD clinical trials in the future so we can produce evidence-based therapies for this group. In addition, new therapies to treat and slow CKD progression are needed for all age groups. PMID:24477220

  10. Constipation in elderly patients attending a polyclinic | Meiring ...

    African Journals Online (AJOL)

    Objective. Tb determine the prevalence of and risk factors for constipation in the elderly. Differences between the white and black elderly populations in this regard were examined. Design. Cross-section hospital-based study. Setting. The family medicine cliriics at National and Pelonomi hospitals in greater Bloemfontein.

  11. Effect of Chronic Total Occlusion Percutaneous Coronary Intervention on Clinical Outcomes in Elderly Patients.

    Science.gov (United States)

    Zhang, Hui-Ping; Ai, Hu; Zhao, Ying; Li, Hui; Tang, Guo-Dong; Zheng, Nai-Xin; Sun, Fu-Cheng; Liu, Jing-Hua

    2018-02-01

    There are little published data reporting the effect of coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on the prognosis of elderly patients with identified CTOs. We sought to evaluate the clinical effect of CTO PCI on the prognosis of elderly patients with CTOs. A total of 445 consecutive patients diagnosed with a CTO by angiography from January 2011 to December 2013 were enrolled. We compared long-term clinical outcomes between the elderly group (≥75 years; n = 120, 27.0%), and the nonelderly group (elderly CTO patients had left main (LM) disease (25.0 versus 15.1%, P = 0.015), 3-vessel disease (96.4% versus 73.8%, P elderly patients had a higher syntax score than nonelderly patients (27.0 [25.0, 30.0] versus 26.0 [23.0, 30.0], P = 0.006). PCI was attempted for 33 out of 135 CTO lesions (24.4%) in the elderly group, and 127 out of 378 lesions (33.6%) in the nonelderly group (P = 0.049); however, there were no statistically significant differences in the CTO PCI success rates between the 2 groups (69.7% versus 82.7%, P = 0.097). The 3-year cardiac mortality rate was 15.0% and 4.6% (P elderly and nonelderly groups, respectively. Elderly patients with CTOs who were recanalized by PCI and those with unopened CTOs exhibited comparable 3-year cardiac mortality rates (15.0% versus 16.0%, P = 1.000). There was no significant difference in primary endpoint incidence (25.0% versus 33.0%, P = 0.486). Multivariate analysis revealed that after corrections for baseline and procedural differences, right coronary artery CTO (odds ratio = 4.600, 95% CI: 1.320-16.031; P = 0.017) and LM disease combined with 3-vessel disease (odds ratio = 4.296, 95% CI: 1.166-15.831; P = 0.028) were independent predictors of 3-year cardiac mortality among elderly patients with CTOs. Elderly patients with CTOs presented with seriously diseased coronary arteries and poor prognoses. CTO PCI did not seem to significantly improve long-term clinical outcomes among

  12. Persistent Q fever and ischaemic stroke in elderly patients.

    Science.gov (United States)

    González-Quijada, S; Salazar-Thieroldt, E; Mora-Simón, M J

    2015-04-01

    Whether persistent or chronic Q fever may act as a risk factor for stroke is unknown. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and December 2012. A total of 803 samples from 634 consecutive hospitalized patients ≥65 years old were tested, of whom 111 were cases (patients with prevalent or incident ischaemic stroke and/or transient ischaemic attack) and 523 were controls (patients without ischaemic stroke and/or transient ischaemic attack). Immunoglobulin G (IgG) antibody titres phase I and II against Q fever, and IgG antibodies levels against Chlamydia pneumoniae and cytomegalovirus (CMV), were determined using immunofluorescence assay and ELISA methods, respectively. Phase I IgG titres against Coxiella burnetii ≥1:256 (compatible with chronic or persistent Q fever) were detected in 16 of 110 (14.5%) cases and in 32 of 524 (6.1%) controls; P = .004, odds ratio (OR) 2.6, 95% confidence interval (CI) 1.3 to 4.9. This ratio was maintained after adjusting for age, sex, hypertension, dyslipidaemia, cardioembolic focus, smoking, diabetes, other cardiovascular diseases, C-reactive protein, and leukocyte count (OR 2.6, 95% CI 1.3 to 5.3). High-titre IgG antibodies (top quartile) against CMV (OR 2.1, 95% CI 1.3 to 3.5), but not against C. pneumoniae (OR 0.9, 95% CI 0.5 to 1.6), also were associated with ischaemic stroke after adjustment for risk factors. In conclusion, serology compatible with persistent or chronic Q fever is associated with ischaemic stroke in elderly patients. High levels of IgG antibodies against CMV, but not against C. pneumoniae, also are associated with ischaemic stroke in these patients. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  13. [Role of surgery for lung cancer in elderly patients].

    Science.gov (United States)

    Benko, István; Horváth, Ors Péter; Nagy, Klára; Sárosi, Veronika; Balikó, Zoltán; Potó, László; Molnár, F Tamás

    2008-02-01

    Lung cancer is a leading cause of death in the civilised world. Surgical resection, which play a crucial role in the complex oncological treatment, has to be offered in older ages than it was done before, due to an ageing population. Results of surgical treatment of patients older than 75 years are investigated retrospectively in the present paper. A retrospectively analysis was carried out of 54 from a total of 884 lung resections for primary lung cancer performed for patients older than 75 years between 1995-2005. Twelve of these patients were above 80 years. Kaplan-Meier analysis was performed to calculate survival and multifactor analysis for the risk factors. Average age was 77.5 years (75-85). Two pneumonectomies, two bilobectomies, 41 lobectomies, seven sublobar resections and two lobectomies with chest wall resections were performed. The average hospital stay was 11.4 days (8-36). Mortality: 7.4% (n = 4), morbidity: 52% (n = 28) including: sputum retention: 43%, arrhythmia 33%, atelectasia: 15%. There were two bronchial stump insufficiencies (4%) and three reoperations were performed (5%). The average follow up was: 32 months and the five year survival 33.7% (median 43 months). Multifactorial analysis show that extended resection, male gender, age above 80 years are risk factors for adverse outcome. Female gender, stage Ia and lobectomy are considered as predictive factors for long survival. We conclude, that with proper patient selection (below ASA3, early stage) and with carefully conducted postoperative care (physiotherapy, monitoring) surgical resection should be offered to elderly lung cancer patients as well.

  14. Retrograde femoral nailing in elderly patients: outcome and functional results.

    Science.gov (United States)

    Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael

    2012-06-01

    Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures. Copyright 2012, SLACK Incorporated.

  15. [SURGICAL TREATMENT OF THYROID GLAND IN ELDERLY PATIENTS: OUR EXPERIENCES].

    Science.gov (United States)

    Kovačić, I; Kovačić, M

    2016-09-01

    The share of elderly persons in the population is growing rapidly and continuously. Requirements for their surgical treatment are increasing and so is the number of published papers on the safety and success of some surgical procedures performed in these patients. The present study included 183 patients aged ≥65 out of 897 patients surgically treated for thyroid gland diseases. They were divided into two groups (group 1 aged 65-69 and group 2 aged ≥70) in order to determine between-group differences in the indications, surgical strategy, final histopathologic analysis, preoperative physical status, number of comorbid diseases and postoperative complications. Analysis of the results justified our decision to divide our patients into two groups of younger and older ones. In group 1, the indications for surgery were mostly benign changes (93.2%), whereas malignant, verified and suspected disease was considerably more frequent in group 2 (21.8%), with a significantly higher percentage of compressive syndrome. Significant between-group differences were recorded in the preoperative physical status (group 2: ASA III and IV, 73.8% and 5%, respectively), number of thyroidectomies performed (group 1, 56.2% vs. group 2, 77.3%) and secondary hemithyroidectomy. A difference was also found in the number of surgical and non surgical complications. The absence of a higher percentage of permanent complications, hypocalcemia and recurrent laryngeal nerve paralysis, in total and by groups, confirmed that surgical treatment of thyroid gland diseases can be considered safe and successful in older age groups, regardless of the between-group differences observed.

  16. A family involvement and patient-tailored health management program in elderly Korean stroke patients' day care centers.

    Science.gov (United States)

    Chang, Ae Kyung; Park, Yeon-Hwan; Fritschi, Cynthia; Kim, Mi Ja

    2015-01-01

    This study aimed to examine the effects of a family involvement and functional rehabilitation program in an adult day care center on elderly Korean stroke patients' perceived health, activities of daily living, instrumental activities of daily living, and cost of health services, and on family caregivers' satisfaction. Using one-group pre- and posttest design, dyads consisting of 19 elderly stroke patients and family caregivers participated in 12-week intervention, including involvement of family caregivers in day care services and patient-tailored health management. Outcomes of patients and caregivers were significantly improved (all p health services did not decrease significantly. This program improved functional levels and health perception of elderly stroke patients and caregivers' satisfaction. However, results must be interpreted with caution, because this was only a small, single-group pilot study. This program may be effective for elderly stroke patients and their caregivers. © 2013 Association of Rehabilitation Nurses.

  17. [Factors affecting the quality of life of elderly diabetic patients: survey in north and south Wanjiang river regions].

    Science.gov (United States)

    Jin, Yuelong; Ding, Lingling; Wang, Quanhai; He, Lianping; Nie, Miao; Song, Xiuli; Tang, Hui; Guo, Daoxia; Chen, Yan; Yao, Yingshui

    2014-02-01

    To investigate the quality of life of elderly diabetic patients and its influencing factors. By randomized cluster sampling, we conducted a survey in 1450 elderly residents (over 60 years old) living in urban, suburban and rural areas in south and north Anhui province. We evaluated the quality of life of the elderly diabetic patients using a demographic information questionnaire and full items on Short Form (36) Health Survey (SF-36). The elderly diabetic patients had lower scores in all dimensions of quality of life than the elderly without diabetes. Multiple linear regression analysis showed a linear regression in the quality of life among the elderly diabetic patients in terms of geographic regions, education, personality, sleep quality, and age. Elderly diabetic patients have generally poor quality of life, which was subjected to the influences by geographic regions, education, personality, sleep quality, and age, suggesting the necessity of corresponding interventions to improve the quality of life of these patients.

  18. White Matter Hyperintensities and Cognitive Impairment During Electroconvulsive Therapy in Severely Depressed Elderly Patients

    NARCIS (Netherlands)

    Oudega, M.L.; van Exel, E.; Wattjes, M.P.; Comijs, H.C.; Scheltens, P.; Barkhof, F.; Eikelenboom, P.; Craen, A.J.M.; Beekman, A.T.F.; Stek, M.L.

    2014-01-01

    Objective: Transient cognitive impairment during electroconvulsive therapy (ECT) can be a reason to discontinue ECT in depressed elderly patients. We hypothesized that both white matter hyperintensities and medial temporal lobe atrophy contribute to transient cognitive impairment during ECT.

  19. Effect of strength training on muscle function in elderly hospitalized patients

    DEFF Research Database (Denmark)

    Suetta, C; Magnusson, S P; Beyer, N

    2007-01-01

    Immobilization due to hospitalization and major surgery leads to an increased risk of morbidity, disability and a decline in muscle function especially in frail elderly individuals. In fact, many elderly patients fail to regain their level of function and self-care before admission to hospital...... to induce muscle hypertrophy and increase muscle strength and functional performance in frail elderly individuals. Furthermore, there is increasing evidence that strength training is an effective method to restore muscle function in post-operative patients and in patients with chronic diseases. Despite this......, strength training is rarely used in the rehabilitation of hospitalized elderly patients. The current knowledge on this topic will be the focus of this review....

  20. How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ebrahim Hasankhani

    2014-09-01

     Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates. 

  1. Pattern of pulmonary tuberculosis in elderly patients in Sohag Governorate: Hospital based study

    Directory of Open Access Journals (Sweden)

    Mona T. Hussein

    2013-04-01

    Conclusion: This study showed that elderly pulmonary TB patients had higher frequencies of atypically clinical, radiological presentations, co-morbidities, anti-tuberculosis drug adverse reactions and TB related mortality.

  2. Tacrolimus Therapy for Three Patients with Elderly-Onset Ulcerative Colitis: Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Rumiko Kobayashi

    2016-07-01

    Full Text Available In recent years, cases of elderly-onset ulcerative colitis (UC have been increasing in number and are currently reported to account for 10–15% of all cases of UC. Although the treatment of UC is essentially similar between older and younger patients, evidence of the therapeutic efficacy of tacrolimus in elderly-onset UC patients is still limited. Herein, we report our attempt to induce remission using tacrolimus in three patients with elderly-onset UC. A 75-year-old Japanese woman, a 71-year-old Japanese man and a 76-year-old Japanese woman with severe elderly-onset UC of the pancolitis type were treated with tacrolimus. Although all three patients showed response to the drug, the eventual outcome was poor in the first patient, who developed toxic megacolon, underwent surgery, and suffered from recurrent infections and hemorrhage after the surgery. However, clinical remission was successfully achieved in the second and third patient. Tacrolimus shows some indication of effectiveness in the treatment of elderly-onset UC. However, in elderly-onset UC patients, it is necessary to keep in mind the higher risk of adverse effects of medical therapy and postoperative complications because of the high comorbidity rates. Moreover, in situations where surgery needs to be considered, it is important to ensure appropriate timing of the surgery.

  3. Cerebral hemodynamics in elderly patients with subarachnoid hemorrhage. Using serial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Hideo; Fukushima, Takeo; Hirakawa, Katsuyuki; Sakamoto, Seizaburou; Tsuchimochi, Hirohito; Tomonaga, Masamichi [Fukuoka Univ. (Japan). Faculty of Medicine

    1995-05-01

    To define characteristics of cerebral vasospasm in elderly patients with subarachnoid hemorrhage, changes in cerebral hemodynamics were serially determined by single photon emission computed tomography (SPECT) with {sup 99m}Tc-hexamethylpropylene-amino-oxime (HMPAO). The subjects were 8 elderly patients with an average age of 65 years (one men and 7 women). The findings were compared with those from 28 younger patients with an average age of 49 years (9 men and 19 women). The common site of aneurysms was the internal carotid artery (37.5%) in the elderly group. The frequency of delayed ischemic neurologic dysfunction after cerebral vasospasm was 50.0% in the elderly group and 39.3% in the younger group. There was no significant difference in the frequency of cerebral infarction between the two groups (25.0% vs 28.6%); however, the rate of persistent delayed ischemic neurologic dysfunction was higher in the elderly group (50.0%) than the younger group (36.4%). The frequency of hydrocephalus was higher in the elderly group (50.0%) than the younger group (21.4%). In the elderly group, the recovery from decreased cerebral blood flow was poor even in patients with mild subarachnoid hemorrhage. All patients with severe subarachnoid hemorrhage developed delayed ischemic neurologic dysfunction. Even if the degree of subarachnoid hemorrhage was the same in both groups, the recovery from decreased blood flow was poorer in the elderly group than the younger group. There was no decrease in cerebral blood flow in the stage of vasospasm, which may be attributed to the relief of intracranial pressure due to cerebral atrophy. Even in subacute stage, blood flow was more diffusely decreased in the elderly group than the younger group. (N.K.).

  4. Alternative to the bentall procedure for elderly patients with aortic root aneurysms.

    Science.gov (United States)

    Bical, Olivier M; Deleuze, Philippe

    2013-09-01

    We describe an alternative technique to the Bentall procedure for elderly patients with aortic root aneurysms. It is the subcoronary implantation of a Freestyle (Medtronic, Minneapolis, MN) aortic bioprosthesis with interposition of a graft material between the upper part of the Freestyle bioprosthesis and the distal aorta. The technique described avoids the proximal anastomosis of the graft and avoids the coronary reimplantations of the Bentall procedure which are still a potential risk of bleeding particularly in elderly patients. © 2013 Wiley Periodicals, Inc.

  5. EFFECT OF DANCE EXERCISE ON COGNITIVE FUNCTION IN ELDERLY PATIENTS WITH METABOLIC SYNDROME: A PILOT STUDY

    OpenAIRE

    Sang-Wook Song; Seo-Jin Park; Jung-hyoun Cho; Sung-Goo Kang; Hyun-Kook Lim; Yu-Bae Ahn; Minjeong Kim; Se-Hong Kim

    2011-01-01

    Metabolic syndrome is associated with an increased risk of cognitive impairment. The purpose of this prospective pilot study was to examine the effects of dance exercise on cognitive function in elderly patients with metabolic syndrome. The participants included 38 elderly metabolic syndrome patients with normal cognitive function (26 exercise group and 12 control group). The exercise group performed dance exercise twice a week for 6 months. Cognitive function was assessed in all participants...

  6. Effect of Internet technology on extended care in elderly patients with diabetic feet

    OpenAIRE

    Xian Zang; Jiao-Jiao Bai; Jiao Sun; Yue Ming; Li Ji

    2017-01-01

    Objective: To evaluate the effect of Internet technology on continuing nursing in elderly patients with diabetic feet. Method: From January 2015 to July 2016, 12 elderly patients with diabetic foot ulcers were enrolled from the Endocrinology Department in our hospital. We used “WeChat”, “E nursing” and other Internet technologies to perform remote extended care and to observe the foot ulcer outcomes. Results: All foot ulcers healed with a wound healing time between 38 and 73 days (avera...

  7. Elderly patients with an atypical presentation of illness in the emergency department.

    Science.gov (United States)

    Hofman, M R; van den Hanenberg, F; Sierevelt, I N; Tulner, C R

    2017-07-01

    Very little information is available on the prevalence and clinical outcome of elderly patients with atypical presentations of illness in the emergency department. The objective was to determine the prevalence and clinical outcome of elderly patients seen in the emergency department with an atypical presentation. A monocentric retrospective observational study on 355 elderly patients presenting to the emergency department. Patients of 80 years and older were included. Data were extracted from the electronic medical file. A total of 355 patients were included, with a mean age of 86 years; 53% of these elderly patients had an atypical presentation of illness. Mostly this was due to a fall (71%). A total of 15% of the patients with an atypical presentation reported no specific symptoms of the underlying disease. Patients with atypical presentation were more likely to have a longer stay in hospital (p presentation of illness in elderly patients is highly prevalent in the emergency department. Falling accidents are the most important reason for this. Patients with an atypical presentation have a worse clinical outcome. Accurate training of emergency staff is necessary to recognise this group of patients to ensure proper clinical monitoring and timely treatment.

  8. Bevacizumab plus chemotherapy in elderly patients with previously untreated metastatic colorectal cancer: single center experience

    International Nuclear Information System (INIS)

    Ocvirk, Janja; Moltara, Maja Ebert; Mesti, Tanja; Boc, Marko; Rebersek, Martina; Volk, Neva; Benedik, Jernej; Hlebanja, Zvezdana

    2016-01-01

    Metastatic colorectal cancer (mCRC) is mainly a disease of elderly, however, geriatric population is underrepresented in clinical trials. Patient registries represent a tool to assess and follow treatment outcomes in this patient population. The aim of the study was with the help of the patients’ register to determine the safety and efficacy of bevacizumab plus chemotherapy in elderly patients who had previously untreated metastatic colorectal cancer. The registry of patients with mCRC was designed to prospectively evaluate the safety and efficacy of bevacizumab-containing chemotherapy as well as selection of patients in routine clinical practice. Patient baseline clinical characteristics, pre-specified bevacizumab-related adverse events, and efficacy data were collected, evaluated and compared according to the age categories. Between January 2008 and December 2010, 210 patients with mCRC (median age 63, male 61.4%) started bevacizumab-containing therapy in the 1 st line setting. Majority of the 210 patients received irinotecan-based chemotherapy (68%) as 1 st line treatment and 105 patients (50%) received bevacizumab maintenance therapy. Elderly (≥ 70 years) patients presented 22.9% of all patients and they had worse performance status (PS 1/2, 62.4%) than patients in < 70 years group (PS 1/2, 35.8%). Difference in disease control rate was mainly due to inability to assess response in elderly group (64.6% in elderly and 77.8% in < 70 years group, p = 0.066). The median progression free survival was 10.2 (95% CI, 6.7–16.2) and 11.3 (95% CI, 10.2–12.6) months in elderly and < 70 years group, respectively (p = 0.58). The median overall survival was 18.5 (95% CI, 12.4–28.9) and 27.4 (95% CI, 22.7–31.9) months for elderly and < 70 years group, respectively (p = 0.03). Three-year survival rate was 26% and 37.6% in elderly vs. < 70 years group (p = 0.03). Overall rates of bevacizumab-related adverse events were similar in both groups: proteinuria 21

  9. Epidemiology and management of chronic constipation in elderly patients

    OpenAIRE

    Bouras, Ernest; Vazquez-Roque,Maria

    2015-01-01

    Maria Vazquez Roque, Ernest P Bouras Gastroenterology and Hepatology Department, Mayo Clinic, Jacksonville, FL, USA Abstract: Constipation is a common functional gastrointestinal disorder, with prevalence in the general population of approximately 20%. In the elderly population the incidence of constipation is higher compared to the younger population, with elderly females suffering more often from severe constipation. Treatment options for chronic constipation (CC) include stool softeners,...

  10. Elderly patients' and GPs' perspectives of patient-GP communication concerning polypharmacy: a qualitative interview study.

    Science.gov (United States)

    Schöpf, Andrea C; von Hirschhausen, Maike; Farin, Erik; Maun, Andy

    2017-12-26

    Aim The aim of this study was to explore elderly patients' and general practitioners' (GPs') perceptions of communication about polypharmacy, medication safety and approaches for empowerment. To manage polypharmacy, GPs need to know patients' real medication consumption. However, previous research has shown that patients do not always volunteer all information about their medication regimen, for example, such as the intake of over-the-counter medication or the alteration or discontinuation of prescribed medication. A qualitative interview study including patients of at least 65 years old with polypharmacy (⩾5 medications) and their GPs in a German Primary Healthcare Centre. The transcripts from the semi-structured interviews (n=6 with patients; n=3 with GPs) were analysed using a framework analytical approach. Findings We identified three themes: differing medication plans: causes?; dialogue concerning medication: whose responsibility?; supporting patients' engagement: how? While GPs stated that patients do not always report or might even conceal information, all patients reported that they could speak openly about everything with their GPs. In this context, trust might act as a double-edged sword, as it can promote open communication but also prevent patients from asking questions. Both GPs and patients could name very few ways in which patients could be supported to become more informed and active in communication concerning polypharmacy and medication safety. This study shows that patients' awareness of the significance of their active role in addressing polypharmacy needs to be increased. This includes understanding that trusting the doctor does not preclude asking questions or seeking more information. Thus, interventions which improve patients' communication skills and address specific issues of polypharmacy, particularly in elderly patients, should be designed. GPs might support patients by 'inviting' their contribution.

  11. Fraction of exhaled nitric oxide measurements in the diagnoses of asthma in elderly patients

    Directory of Open Access Journals (Sweden)

    Godinho Netto AC

    2016-05-01

    Full Text Available Antonio Carlos Maneira Godinho Netto,1,2 Túlio Gonçalves dos Reis,1,2 Cássia Franco Matheus,1,2 Beatriz Julião Vieira Aarestrup,3,4 Fernando Monteiro Aarestrup1,2,4 1School of Medical and Health Sciences – SUPREMA, 2Maternity Hospital Terezinha de Jesus, 3Morphology Department, Federal University of Juiz de Fora, Institute of Biological Sciences, 4Laboratory of Immunopathology and Experimental Pathology, Federal University of Juiz de Fora, Reproductive Biology Center (CBR, Juiz de Fora, Brazil Objective: To assess the value of fraction of exhaled nitric oxide (FeNO measurements in the diagnosis of asthma in elderly patients. Methods: The clinical symptoms of 202 elderly patients were assessed with the asthma module of the International Study of Asthma and Allergies in Childhood test, which had been modified for the elderly patients, and the diagnostic routine for chronic obstructive pulmonary disease (COPD, which was based on the Global initiative for chronic Obstructive Lung Disease criteria. Of the 202 patients assessed, 43 were subjected to pulmonary function evaluations (spirometry and FeNO measurements. Results: Of the 202 elderly patients, 34 had asthma (23 definite and eleven probable, 20 met COPD criteria, 13 presented with an overlap of asthma and COPD, and 135 did not fit the criteria for obstructive pulmonary disease. Among the 43 elderly patients who were subjected to FeNO measurements, ten showed altered results (23.2% and 33 had normal results (76.7%. The average value of FeNO in patients with definite and probable asthma undergoing this procedure was 29.2 parts per billion whereas that in nonasthmatic patients was 17.5 parts per billion (P=0.0002. Conclusion: We show a clear relationship between FeNO levels and asthma symptoms and previous asthma diagnoses in elderly patients. Keywords: asthma, chronic obstructive pulmonary disease, elderly patients, nitric oxide

  12. Optimal timing of aortic valve replacement in elderly patients with severe aortic stenosis.

    Science.gov (United States)

    Marumoto, Akira; Nakamura, Yoshinobu; Kishimoto, Yuichiro; Saiki, Munehiro; Nishimura, Motonobu

    2014-01-01

    The elderly population with severe aortic stenosis (AS) requiring aortic valve replacement (AVR) is increasing. The optimal timing of AVR in these patients has been under discussion. We retrospectively reviewed the data from severe AS patients (n = 84) who underwent AVR with/without concomitant procedures from 2005 to 2010. The symptom status, preoperative data, operative outcome, late survival and freedom from cardiac events were compared between elderly patients (age ≥80 years [n = 31]) and younger patients (age <80 years [n = 53]). The operative mortality in elderly patients (3.2 %) and younger patients (3.8 %) was comparable. The symptoms in elderly patients were more severe and hospitalized heart failure (HF) was more frequently noted as the primary symptom (p = 0.017). Patients with and without hospitalized HF differed significantly in late survival and freedom from cardiac events (p = 0.001), but advanced age had no significant effect. The results of a Cox proportional hazards analysis revealed that hospitalized HF was a significant predictor for cardiac events after AVR, irrespective of age (hazard ratio 6.93, 95 % confidence interval 1.83-26.26, p < 0.004). In elderly patients with severe AS, surgery should be recommended even in the presence of minimal symptoms and should be performed before the onset of life-threatening HF.

  13. Cognitive performance of long-term institutionalized elderly patients with schizophrenia: A case control study

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    Alexandre Paim Diaz

    Full Text Available Abstract Cognitive impairment is inherent to the ageing process. Several studies suggest that patients with late-life schizophrenia have more marked cognitive impairment. Objective: The aim of this study was to compare the cognitive performance of elderly institutionalized patients with schizophrenia and institutionalized elderly control patients without neurological or psychiatric diseases, matched for age, educational level and institutionalization time. Methods: The Cambridge Examination for Mental Disorders of the Elderly (CAMCOG was used to test 10 institutionalized elderly patients with schizophrenia. Results were compared with those of 10 institutionalized control patients with history of Hansen's disease. Results: Patients with schizophrenia showed a worse performance in terms of total CAMCOG score and on its subtests of orientation, language, abstraction, and memory (p≤0.05. Patients with schizophrenia also disclosed a non-significant trend toward lower scores on the MMSE and on calculus. Conclusion: Findings demonstrated that schizophrenia was associated to worse cognitive impairment in long-term institutionalized elderly patients compared with institutionalized patients without neurological or psychiatric diseases.

  14. Vulnerable Elderly Survey 13 as a screening method for frailty in Polish elderly surgical patient--prospective study.

    Science.gov (United States)

    Kenig, Jakub; Richter, Piotr; Zychiewicz, Beata; Olszewska, Urszula

    2014-03-01

    The Vulnerable Elders Survey (VES-13) is a simple function based frailty screening tool that can be also administered by the nonclinical personnel within 5 minutes and has been validated in the out- and in patient clinic and acute medical care settings. The aim of the study was to validate the accuracy of the VES-13 screening method for predicting the frailty syndrome based on a CGA in polish surgical patients. We included prospectively 106 consecutive patients ≥65, that qualify for abdominal surgery (both due to oncological and benign reasons), at the tertiary referral hospital.We evaluated the diagnostic performance of VES-13 score comparing to the results from the CGA, accepted as the gold standard for identifying at risk frail elderly patients. The prevalence of frailty as diagnosed by CGA was 59.4%. There was significantly higher number of frail patients in the oncological group (78% vs. 31%; ppatients cannot replace the comprehensive geriatric assessment; this is due to the insufficient discriminative power to select patients for further assessment. It might be helpful in a busy clinical practice and in facilities that do not have trained personal for geriatric assessment.

  15. Nutritional Assessment in Elderly Hospitalized Patients in Qazvin Teaching Hospitals in 2011

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    Azam Ghorbani

    2013-04-01

    Full Text Available Objectives: Nutritional status in the elderly is an important issue in developing countries has been little attention to it. It results from complex interaction between personal and environmental factors that have a considerable effect on mortality, morbidity and quality of life of elderly people especially the hospitalized ones. The aim of this study was to investigate nutritional status in elderly hospitalized patients in Qazvin Teaching Hospitals and know Influential factors to plan appropriate programs for improving their health. Methods & Materials: In this cross-sectional study 233 elderly (151 women and 171 men aging more than 60 years, hospitalized in two hospitals in Qazvin city were studied. Nutritional status were evaluated using Mini Nutritional Assessment, The nutritional status was classified into: malnourished, risk of malnutrition and without malnutrition (adequate. Results: Among the assessed elderly 29.8% were well nourish, 13.4% malnourished and 42.95 at risk of malnutrition. There was more malnutrition in females compared to males (25.8% vs 7.2 P=23(62.5% vs. 12.6% P<0.001, Statistical analysis of the studied variables showed that nutritional status were significantly associated with Age, BMI, WC and WHR Conclusion: This study confirms a high prevalence of malnutrition risk in hospitalized elderly patients. The assessment of nutritional status with MNA that can facilitate evaluation of the nutritional status of elderly individuals in hospitals

  16. Sex differences in use of inhalants by elderly patients with asthma

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    Hirose M

    2015-08-01

    Full Text Available Masahiro Hirose, Rieko Kondo, Naoaki Ban, Kazunobu Kuwabara, Mamoru Shiga, Takahiko Horiguchi Department of Respiratory Medicine II, Fujita Health University School of Medicine, Nagoya, Aichi, Japan Background: The number of elderly patients with asthma has been increasing in Japan. Treatment for these patients should be provided based on the condition of individual patients. This study was performed to clarify the relationship between inhalation procedure and sex difference in elderly patients with asthma.Methods: The inhalation procedure was examined in 155 elderly patients with asthma (male: n=66, average age ± standard deviation: 75.5±5.65 years old; female: n=89, average age ± standard deviation: 78.7±6.87 years old during a medical examination.Results: For the three items that were common to all devices, the percentages of the 155 patients who could/could not perform the actions were examined by separate Fisher’s exact tests for males and females. A statistically significant difference (P=0.007 was observed for “breath holding”, and more females than males were not able to hold their breath. Although no significant difference was seen in the “accurate number of times of inhalation”, females tended to not be able to inhale accurately compared to males (P=0.072.Conclusion: Our results suggest that elderly female patients with asthma have less understanding of inhaled steroid therapy, compared to elderly male patients. Therefore, it is particularly important to confirm that the correct inhalation procedure is used by elderly female patients with asthma. Keywords: asthma, elderly, sex, inhalation, therapyA Letter to the Editor has been received and published for this article.

  17. Transfer of anterolateral thigh flaps in elderly oral cancer patients: complications in oral and maxillofacial reconstruction.

    Science.gov (United States)

    Ren, Zhen-Hu; Wu, Han-Jiang; Tan, Hong-Yu; Wang, Kai; Zhang, Sheng

    2015-03-01

    Although a promising approach, the use of anterolateral thigh (ALT) free flaps has been limited in the reconstruction of oral and maxillofacial defects in elderly patients. The aim of this study was to estimate the frequency of postoperative complications and identify factors associated with complications. The authors designed and implemented a retrospective study on the frequency of postoperative complications in elderly patients. They enrolled a sample composed of patients who underwent ALT free flap transfers for the repair of defects created during oral and maxillofacial cancer surgery from February 2002 to March 2013. The χ(2) test, t test, and multivariate regression model were used. A total of 1,100 patients were studied (859 men and 241 women). One hundred four patients (9.5%) were at least 70 years old (elderly group) at the time of surgery; the other 996 patients were younger than 70 years (younger group). The overall success rate of ALT free flap transfer was 97.2% (97.0% in the younger group, 99.0% in the elderly group; P > .05). The overall complication rate was 27.5% (27.2% in the younger group, 29.8% in the elderly group; P = .572). Multivariate analysis showed that operation time, American Society of Anesthesiologists class, and comorbidity were independent risk factors for postoperative complications in elderly patients. Oral and maxillofacial reconstruction using ALT free flaps in elderly patients can achieve outcomes similar to those obtained in younger patients. Limiting the operation time is important for improving surgical outcomes. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  18. P17.70CAN ELDERLY PATIENTS WITH GLIOBLASTOMA BENEFIT FROM CONVENTIONAL CHEMO-RADIOTHERAPY TREATMENT?

    Science.gov (United States)

    Pineda, E.; Valduvieco, I.; Pujol, T.; Oleaga, L.; Ribalta, T.; Caral, L.; Gonzalez, J.; Boget, T.; Graus, F.; Verger, E.

    2014-01-01

    BACKGROUND: Glioblastoma (GBM) is the most life-threatening primary brain tumor, especially in elderly. Despite aggressive treatment, median survival among all GBM patients is only 12-15 months and is worse in elderly (6-9 months). The standard of care for elderly remains controversial. The purpose of this study is to assess the benefit of conventional treatment (Stupp regimen) in elderly patients. METHOD: We retrospectively reviewed a prospective database of 209 patients who were diagnosed with GBM at a single center from January 2005 to March 2013. All patients were divided into younger and elderly groups based on the cut-off age of 65 years. RESULTS: Of 209 patients diagnosed with GBM, 122 (58%) patients were younger than 65 years, and 87 (42%) patients were 65 years old or older. No differences were found in basal patient characteristics and neither in grade of resection between age subgroups. However elderly received less active treatment, radio-chemotherapy was less frequent in elderly (51% vs 73%) but radiotherapy alone (18% vs 8%) and non-oncological treatment after surgery was more frequent in elderly (31% vs 18%) (p = 0.002). No differences in median survival were found in elderly patients who received the same approach treatment than young patients. Median OS was 10.8 months in all GBM patients, 8.7 months in older and 13.6 months in younger patients (p = 0.019). Of all, 106 (51%) patients received Stupp regimen, 41 (47%) elderly and 65 (53%) young. Median OS in patients treated with conventional treatment was 18 months, without differences by age, 15.3 months in older and 18 months in younger (p = 0.228), neither differences were found in PFS (global of 8.2 months, 9.7 and 8.2 months, p = 0.307). MGMT status information was available only for 45.5% of patients that received Stupp regimen, 23 MGMT methylated, 25 MGMT unmethylated and 58 patients with MGMT not evaluable or not done. Surprisingly, no differences in OS were found between groups by MGMT

  19. Quality of Life in the Elderly People Covered by Health Centers in the Urban Areas of Markazi Province, Iran

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    Ali Agha nouri

    2012-01-01

    Full Text Available Objectives: To improve quality of life in the elderly through proper plans and active involvement of elderly in their family and community, we should get a lot of information about health-related quality of life because the composition of our population has changed. Infact, the aged population is increasingly growing, that this will, in turn, have an effect on economic progression and well-being in the country. Thus, this study assessed quality of life and its determinants in the people aged 60 years and over living in the urban areas of Central Province. Methods & Materials: This study was a cross-sectional descriptive-analytic survey that included 165 elderly peoples in the urban areas of Markazi Province. Data was obtained via a general and a quality of life (using SF-36 questionnaire. The results were analyzed by Chi-Square, Fisher, independent T-test, ANOVA, Regression, and Pearson correlation coefficient. Results: The average age of the subjects was 70.7 years (men 44.8% and women 55.2%. The mean of total SF-36, physical and mental components' scores were 55.66±22, 51.32±21 and 57.30±25 respectively. Additionally, the mean scores of eight health-related dimensions were as follows: physical functions 56.26±45, role limitations due to physical problems 50.60±27, body pain 51.26±38, general health 45.26±53, vitality 53.24±09, social functioning 67.85±27, role limitations due to mental problems 57.14±45 and mental health 62.88±25. Also, the quality of life scores were significantly associated with sex, previous employment, leisure activities, income, current exercising, present disease and drug consumption (P<0.05. Conclusion: Results showed that the elderly's quality of life in the urban areas in Markazi province is in the middle level and the individuals have better mental health compared to physical health. Moreover, various factors are associated with the elderly’s quality of life, which require comprehensive planning for

  20. Ceftaroline fosamil for the treatment of community-acquired bacterial pneumonia in elderly patients.

    Science.gov (United States)

    Udeani, George; Evans, John; Cole, Phillip; Friedland, H David

    2014-08-01

    The Clinical Assessment Program and Teflaro Utilization Registry (CAPTURE) is a multicenter study, assessing the contemporary use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP) or acute bacterial skin and skin structure infection. This article discusses the data collected from 528 evaluable patients with CABP, from 39 sites in the United States, between August 2011 and April 2013. The majority of patients (51%) were elderly (aged ≥ 65 years), most of whom were treated in general hospital wards (70%). Approximately one quarter of elderly patients had ≥ 2 comorbidities (26%), the most common of which was structural lung disease (51%). The majority of elderly patients received ceftaroline fosamil as second-line therapy (85%), concurrently with other antibiotics (61%). Similar patterns of ceftaroline fosamil usage were noted in younger patients (aged ceftaroline fosamil was 81% for elderly patients with CABP and 82% for younger patients. These data suggest that ceftaroline fosamil is a potentially effective treatment option for CABP in the elderly.

  1. Application of Dorothea Orem's Theory of Self-Care to the Elderly Patient on Peritoneal Dialysis.

    Science.gov (United States)

    O'Shaughnessy, Maria

    2014-01-01

    Due to improvements in health care and increasing life expectancy, a greater number of elderly patients need renal replacement therapy. Dorothea Orem's Theory of Self-Care is an appropriate model to guide healthcare providers addressing the unique capabilities of this generation. The utilization and promotion of peritoneal dialysis as a therapy option offers the elderly an improved quality of life with a greater sense of self-worth. Literature has shown the elderly have superior technique and similar peritonitis-free survival rates as the younger population.

  2. Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures.

    Science.gov (United States)

    Lau, Tak-wing; Leung, Frankie

    2010-08-01

    To evaluate postoperative walking status of elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. 33 women and 4 men aged 66 to 95 (mean, 85) years presented with osteoporotic pubic rami fractures after a fall. 22 (59%) of the patients had additional posterior pelvic ring fractures (9 had lateral compression type-II fractures involving the ilium and 13 had lateral compression type-I fractures involving the sacroalar region). Seven of the 9 patients with lateral compression type-II fractures underwent open reduction and internal fixation using plates and/ or screws. The remaining 30 patients were treated conservatively. Postoperative walking status was similar in elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Posterior pelvic ring fractures are easily missed in elderly patients with pubic rami fractures. Routine computed tomography of the pelvis is useful in making the diagnosis.

  3. Factors affecting the quality of life of homebound elderly hemiparetic stroke patients with cognitive impairment.

    Science.gov (United States)

    Takemasa, Seiichi; Nakagoshi, Ryoma; Uesugi, Masayuki; Inoue, Yuri; Gotou, Makoto; Koeda, Hideki; Naruse, Susumu

    2016-12-01

    [Purpose] This study examined the quality of life of homebound elderly hemiparetic stroke patients with cognitive impairment and the factors affecting their quality of life. [Subjects and Methods] The subjects of the study were 17 home-based elderly hemiparetic stroke patients with cognitive impairment (8 males and 9 females, average age: 76.3 ± 10.5 years old). Their physical and psychological conditions, quality of life and other items were investigated. Nishimura's Mental State Scale for the Elderly was used for the cognitive impairment assessment. The Functional Independence Measure was used to assess activities of daily living, and the Japanese Quality of Life Inventory for the Elderly with Dementia was used to assess quality of life. [Results] The subjects' quality of life was affected by their cognitive impairment level and independence of activities of daily living. However, no correlations were observed between the quality of life of the homebound elderly hemiparetic stroke patients with cognitive impairment, age, gender or care-need level. [Conclusion] In order to improve the quality of life of homebound elderly hemiparetic stroke patients with cognitive impairment, assistance helping them to maintain their cognitive abilities and on-going rehabilitation for improving activities of daily living independence are required.

  4. Safety profile of gadoxetate disodium in elderly patients (≥65 years).

    Science.gov (United States)

    Endrikat, Jan; Schwenke, Carsten; Vogtlaender, Kai; Dohannish, Susan; Breuer, Josy

    2018-01-01

    Background Safety data on routine clinical use of gadoxetate disodium in elderly patients is not reported yet. Purpose To assess the safety of liver specific gadoxetate disodium in contrast enhanced magnetic resonance imaging in elderly patients (≥65 years) in comparison to adults (18-64 years). Material and Methods Safety data on gadoxetate disodium were analyzed from 12 clinical phase II-III studies and from our pharmacovigilance database. A comparison between elderly (≥65 years) versus adults (18-64 years) was performed with respect to the frequency of drug-related adverse events (AEs) in clinical phase II-III studies and adverse drug reactions (ADRs) in the pharmacovigilance database. Results In clinical studies, 1989 patients were enrolled: 675 elderly and 1314 adults. Twenty-three elderly patients (3.4%) suffered at least one drug-related AE in contrast to 58 patients (4.4%) in the group of adults (odds ratio = 0.76; 95% confidence interval = 0.45-1.27). Since marketing authorization in 2004, more than 3.5 million patients have been exposed to gadoxetate disodium worldwide: 1.7 million (48.6%) in elderly and 1.8 million (51.4%) in adults. The number of patients with post-marketing ADRs (total n = 793) was 354 (0.021%) in the elderly group and 439 (0.024%) in the adult group. Thus, there were significantly fewer patients with ADRs reported in the group of elderly versus adults ( P = 0.028). Hypersensitivity/immune system disorders, gastrointestinal disorders, and respiratory disorders were the most frequent ADRs in both groups, elderly and adults. Conclusion The incidence of drug-related AEs in clinical studies was similar and that of patients with ADRs in the post-marketing setting was lower in elderly (≥65 years) compared with younger adults aged 18-64 years. Overall, gadoxetate disodium shows a favorable safety profile in both age groups.

  5. HIPAA-protecting patient confidentiality or covering something else?

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    Robbins RA

    2013-10-01

    Full Text Available No abstract available. Article truncated at 150 words. A case of a physician fired from the Veterans Administration (VA for violation of the Health Care Portability and Accountability Act of 1996 (HIPAA illustrates a problem with both the law and the VA. Anil Parikh, a VA physician at the Jesse Brown VA in Chicago, was dismissed on a charge of making unauthorized disclosures of confidential patient information on October 19, 2007. On January 3, 2011 the Merit Systems Protection Board (MSPB reversed Dr. Parikh’s removal. Dr. Parikh's initially made disclosures to the VA Office of Inspector General and to Senator Barack Obama and Congressman Luis Gutierrez, in whose district the Jesse Brown VA lies. Dr. Parikh alleged that there were systematic problems within the Jesse Brown VA that resulted in untimely and inadequate patient care. The confidential patient information Parikh disclosed included examples of the misdiagnoses and misdirection of patients within the hospital. Specifically, Dr. Parikh alleged that …

  6. Clinical features of type 1 autoimmune hepatitis in elderly Italian patients.

    Science.gov (United States)

    Granito, A; Muratori, L; Pappas, G; Muratori, P; Ferri, S; Cassani, F; Lenzi, M; Bianchi, F B

    2005-05-15

    The usual onset of type 1 autoimmune hepatitis occurs at puberty or around menopause, whereas disease presentation in the advanced age is less often reported. To assess the clinical, immunological and histological features of Type 1 autoimmune hepatitis in elderly Italian patients. We assessed, at diagnosis, the clinical and immunological features of 76 consecutive Italian patients with type 1 autoimmune hepatitis, focusing particularly on a subgroup of 20 patients presenting at > or = 65 years (females 95%, median age 72 years, range 65-82). In comparison with the younger group, at the time of autoimmune hepatitis diagnosis, elderly Italian patients are more often asymptomatic (25% vs. 7%; P = 0.04), are more frequently positive for antinuclear autoantibodies (95% vs. 52%; P = 0.0004) and HLA-DR4 (45% vs. 18%; P = 0.03); among the extra-hepatic manifestations, autoimmune thyroid disorders are prevalent in the elderly group (25% vs. 5%; P = 0.02). However, no difference was observed in the histological/biochemical expression of the liver disease and response to immunosuppression. In elderly Italian patients, autoimmune hepatitis has typical serological and genetic characteristics, is more frequently asymptomatic, although prognosis and response to therapy is similar to that of younger patients. As a concomitant autoimmune thyroid disorder is common, autoimmune hepatitis should be suspected and investigated in elderly patients with autoimmune thyroid disorder and abnormal liver function tests.

  7. Inadequate treatment for elderly patients: professional norms and tight budgets could cause "ageism" in hospitals.

    Science.gov (United States)

    Skirbekk, Helge; Nortvedt, Per

    2014-06-01

    We have studied ethical considerations of care among health professionals when treating and setting priorities for elderly patients in Norway. The views of medical doctors and nurses were analysed using qualitative methods. We conducted 21 in depth interviews and 3 focus group interviews in hospitals and general practices. Both doctors and nurses said they treated elderly patients different from younger patients, and often they were given lower priorities. Too little or too much treatment, in the sense of too many interventions and too much drugs, combined with too little care and comfort, was admitted as a relatively frequent yet unwanted consequence of the way clinical priorities were set for elderly patients. This was explained in terms of elderly patients not tolerating the same treatment as younger patients, and questions were raised about the quality of life of many elderly patients after treatment. These explanations were frequently referred to as medically sound decision making. Other explanations had little to do with medically sound decisions. These often included deep frustration with executive guidelines and budget constraints.

  8. Radiotherapy alone for elderly patients with stage III non-small cell lung cancer

    International Nuclear Information System (INIS)

    Nakano, Kikuo; Hiramoto, Takehiko; Kanehara, Masasi; Doi, Mihoko; Furonaka, Osamu; Miyazu, Yuka; Hada, Yosihiro

    1999-01-01

    We undertook a retrospective study of elderly patients with stage III non-small cell lung cancer who had been treated solely with radiotherapy during the period 1986 to 1995. Our study was designed to assess the influence of age on survival and malnutrition in patients aged 75 years or older (elderly group) and patients aged 74 years or younger (younger group). Radiotherapy alone resulted in a median survival period of 11.5 months in the younger group and 6.3 months in the elderly group (p=0.0043). With the Cox multivariate model, good performance status, age less than 75 years, and good response were significant favorable independent predictors. Furthermore, the elderly group patients more frequently died of respiratory infections and had lower prognostic nutritional indexes than the younger group patients before and after radiotherapy. These findings suggested elderly patients with stage III non-small cell lung cancer who had been treated with radiotherapy alone had a poor prognosis and that malnutrition caused by radiotherapy was a factor contributing to the risk of death from respiratory infection in such patients. (author)

  9. Factors Associated with Insomnia among Elderly Patients Attending a Geriatric Centre in Nigeria

    OpenAIRE

    Ogunbode, Adetola M.; Adebusoye, Lawrence A.; Olowookere, Olufemi O.; Owolabi, Mayowa; Ogunniyi, Adesola

    2014-01-01

    Background. Insomnia is a form of chronic sleep problem of public health importance which impacts the life of elderly people negatively. Methods. Cross-sectional study of 843 elderly patients aged 60 years and above who presented consecutively at Geriatric Centre, University College Hospital, Ibadan, Nigeria. The World Health Organization Composite International Diagnostic Interview was used to diagnose insomnia. We assessed the following candidate variables which may be associated with insom...

  10. Treatment of Malignant Gliomas in Elderly Patients: A Concise Overview of the Literature

    Directory of Open Access Journals (Sweden)

    Patrizia Farina

    2014-01-01

    Full Text Available Gliomas are the most frequent primary brain tumors and the incidence data has increased in the elderly population. Unfortunately, prospective studies on this population are few and so the right treatment is unknown. In the elderly patients no standard treatment has been established and therefore the optimal treatment should be individualized. We performed a review analyzing the prognostic and predictive factors, the clinical studies, and the correct management of this population.

  11. Elderly patients with community-acquired pneumonia are not treated according to current guidelines

    DEFF Research Database (Denmark)

    Lindhardt Damsgaard, Tove; Klausen, Henrik Hedegaard; Christiansen, Christina

    2013-01-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance...... with guidelines for treatment and care of patients with CAP....

  12. The level of ethylene biomarker in the renal failure of elderly patients analyzed by photoacoustic spectroscopy

    Science.gov (United States)

    Popa, C.; Patachia, M.; Banita, S.; Matei, C.; Bratu, A. M.; Dumitras, D. C.

    2013-12-01

    In recent years there has been a large increase in the areas related to developments in the prevention of diseases, especially in explaining the role of oxidative stress. Lipid peroxidation and oxidative stress contributes to morbidity in hemodialysis (HD) patients. It is therefore relevant to analyze the impact of oxidative stress and its related species (ethylene) immediately after dialysis treatment in order to prevent trauma in the renal failure of elderly patients. In this paper we describe recent progress in laser photoacoustic spectroscopy detection of ethylene in renal failure patients. We have found that HD treatment increases ethylene concentration in the exhaled breath of elderly patients and may intensify oxidative stress.

  13. The level of ethylene biomarker in the renal failure of elderly patients analyzed by photoacoustic spectroscopy

    International Nuclear Information System (INIS)

    Popa, C; Patachia, M; Banita, S; Matei, C; Bratu, A M; Dumitras, D C

    2013-01-01

    In recent years there has been a large increase in the areas related to developments in the prevention of diseases, especially in explaining the role of oxidative stress. Lipid peroxidation and oxidative stress contributes to morbidity in hemodialysis (HD) patients. It is therefore relevant to analyze the impact of oxidative stress and its related species (ethylene) immediately after dialysis treatment in order to prevent trauma in the renal failure of elderly patients. In this paper we describe recent progress in laser photoacoustic spectroscopy detection of ethylene in renal failure patients. We have found that HD treatment increases ethylene concentration in the exhaled breath of elderly patients and may intensify oxidative stress. (paper)

  14. Adjuvant Chemoradiation Therapy After Pancreaticoduodenectomy in Elderly Patients With Pancreatic Adenocarcinoma

    International Nuclear Information System (INIS)

    Horowitz, David P.; Hsu, Charles C.; Wang Jingya; Makary, Martin A.; Winter, Jordan M.; Robinson, Ray; Schulick, Richard D.; Cameron, John L.; Pawlik, Timothy M.; Herman, Joseph M.

    2011-01-01

    Purpose: To evaluate the efficacy of adjuvant chemoradiation therapy (CRT) for pancreatic adenocarcinoma patients ≥75 years of age. Methods: The study group of 655 patients underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma at the Johns Hopkins Hospital over a 12-year period (8/30/1993 to 2/28/2005). Demographic characteristics, comorbidities, intraoperative data, pathology data, and patient outcomes were collected and analyzed by adjuvant treatment status and age ≥75 years. Cox proportional hazards analysis determined clinical predictors of mortality and morbidity. Results: We identified 166 of 655 (25.3%) patients were ≥75 years of age and 489 of 655 patients (74.7%) were <75 years of age. Forty-nine patients in the elderly group (29.5%) received adjuvant CRT. For elderly patients, node-positive metastases (p = 0.008), poor/anaplastic differentiation (p = 0.012), and undergoing a total pancreatectomy (p = 0.010) predicted poor survival. The 2-year survival for elderly patients receiving adjuvant therapy was improved compared with surgery alone (49.0% vs. 31.6%, p = 0.013); however, 5-year survival was similar (11.7% vs. 19.8%, respectively, p = 0.310). After adjusting for major confounders, adjuvant therapy in elderly patients had a protective effect with respect to 2-year survival (relative risk [RR] 0.58, p = 0.044), but not 5-year survival (RR 0.80, p = 0.258). Among the nonelderly, CRT was significantly associated with 2-year survival (RR 0.60, p < 0.001) and 5-year survival (RR 0.69, p < 0.001), after adjusting for confounders. Conclusions: Adjuvant therapy after PD is significantly associated with increased 2-year but not 5-year survival in elderly patients. Additional studies are needed to select which elderly patients are likely to benefit from adjuvant CRT.

  15. Laparoscopic gastrectomy for elderly patients with gastric cancer: A systematic review with meta-analysis.

    Science.gov (United States)

    Pan, Yu; Chen, Ke; Yu, Wei-Hua; Maher, Hendi; Wang, Sui-Han; Zhao, Hang-Fen; Zheng, Xue-Yong

    2018-02-01

    Laparoscopic gastrectomy (LG) has been widely applied in patients with gastric cancer (GC). However, the safety and application value of LG in elderly patients with GC was still unclear. In this study, we aimed to evaluate the feasibility and safety of LG for elderly patients with GC using the meta-analysis. Studies comparing elderly patients and nonelderly patients who underwent LG for GC were reviewed and collected from the PubMed, EBSCO, Cochrane Library, and EMBASE. Outcomes such as operative results, postoperative recovery, and morbidity were compared and analyzed. The Review Manager 5.3 was used to portray the weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI). Eleven observational studies with a total of 3275 patients were included. Compared with nonelderly patients, elderly patients had shorter operation time (WMD -10.46; 95% CI -17.06 to -3.86; P = .002), less retrieved lymph nodes (WMD -2.34; 95% CI -3.77 to -0.92; P = .001), delayed time to first flatus (WMD 0.31; 95% CI 0.10-0.51; P = .003), longer postoperative hospital stays (WMD 1.06; 95% CI 0.07-2.05; P = .04), higher risk for overall postoperative complication (OR 1.34; 95% CI 1.08-1.67; P = .009), nonsurgical postoperative complication (OR 1.98; 95% CI 1.24-3.15; P = .004), and postoperative pulmonary complication (OR: 3.09; 95% CI 1.68-5.68; P  .05). Outcomes of LG for elderly patients were comparable to those in nonelderly patients. Age alone should not preclude LG in elderly patients.

  16. Frailty is associated with a history with more falls in elderly hospitalised patients

    DEFF Research Database (Denmark)

    Schultz, Martin; Rosted, Elizabeth; Sanders, Suzanne

    2015-01-01

    INTRODUCTION: When elderly people are admitted to hospital, their risk of falling may often not be recognised. The risk of falling in the elderly is linked to frailty. In a Danish study, it was found that the "Identification of Seniors at Risk" screen (ISAR) predicted the patients' amount of health...... problems, days in hospital and readmission. It may therefore also be a predictor of frailty. This study aimed to evaluate how many elderly patients were admitted to an emergency department (ED) because of a fall and to examine if there was a correlation between these patients and their ISAR score. METHODS...... experienced a fall. Of those, 67% were not referred for further fall assessment. Patients who had experienced falls had more health problems than patients without falls (mean 5.7 versus mean 4.4 (p = 0.00)) and more had cognitive impairment (31% versus 14% (p = 0.00)). A positive correlation was found between...

  17. [Effects of carbonated water intake on constipation in elderly patients following a cerebrovascular accident].

    Science.gov (United States)

    Mun, Jae-Hee; Jun, Seong Sook

    2011-04-01

    This study was done to identify effects of carbonated water intake on constipation in elders who have experienced a cerebrovascular accident (CVA) and are bed-ridden. Forty elderly patients with CVA were randomly assigned to one of two groups in a double-blind study. Patients in the experimental group drank carbonated water and those in the control group drank tap water for two weeks. Six patients dropped out during the study period. Data were analyzed by repeated measured ANCOVA and the covariance was the dose of laxatives used for the two weeks. Frequency of defecation increased significantly and symptoms of constipation decreased significantly for patients in the experimental group. The study results suggest that the intake of carbonated water is an effective method for the intervention of constipation in elderly patients with CVA.

  18. Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

    OpenAIRE

    Pesonen, Anne

    2011-01-01

    The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was t...

  19. [Urogenital atrophy and recurrent urinary tract infection in elderly patients].

    Science.gov (United States)

    Salvat, J; Capilna, M; Schmidt, M H

    1997-08-13

    Postmenopausal lower urinary tract atrophy and its relations to recurrent urinary infections in elderly women are studied. Clinical aspects, functional and histological aspects and hypothetic mechanisms of atrophy are reported, epidemiologic data, mechanisms of urinary infections and of estrogen effects are reviewed and reports on the results of local or systemic use of drugs from the literature are presented. Local administration of estrogen seems to be efficient on the urinary tract. Local treatment is less dangerous and cheaper than systemic treatment. Hormonal treatment is one of the preventive measures against recurrent urinary infections in elderly women.

  20. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  1. The Effect of Cognitive Remediation Therapy on Social Skills in Institutionalized Elderly Patients with Schizophrenia.

    Science.gov (United States)

    Mohammadi, Fatemeh; Momtaz, Yadollah Abolfathi; Motallebi, Seyedeh Ameneh; Boosepasi, Shahnaz

    2017-01-01

    There are limited scientific investigations on cognitive remediation in elderly patients with schizophrenia. The present study was aimed to examine the efficacy of cognitive remediation therapy on social skills in institutionalized elderly patients with schizophrenia. The study employed a randomized clinical trial. A total of 60 institutionalized elderly patients with schizophrenia from Razi Psychiatric Hospital, Tehran were selected and randomly allocated into two equal groups (control and intervention). The intervention group attended to cognitive remediation therapy for 8 weeks. The Evaluation of Living Skills Scale for psychiatric patients was used for data collection. The Chi Square, independent and paired t-tests using SPSS, version 22, were employed to analyze the data. The mean age of 60 elderly patients participated in the study was 65.25 ± 4.19 years. No significant differences were found between two groups at baseline. However, independent t-tests showed significant differences between the intervention and the control group in social skills after implementation of intervention. Additionally, the results of paired t-tests revealed significant improvements in intervention group on communication skills (t=5.50, psocial skills of elderly patients with schizophrenia. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  2. Methods to reduce prescribing errors in elderly patients with multimorbidity

    Directory of Open Access Journals (Sweden)

    Lavan AH

    2016-06-01

    Full Text Available Amanda H Lavan, Paul F Gallagher, Denis O’Mahony Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland Abstract: The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers’ lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people’s prescriptions/screening tool to alert to right treatment criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another

  3. Use of Stereotactic Radiosurgery in Elderly and Very Elderly Patients With Brain Metastases to Limit Toxicity Associated With Whole Brain Radiation Therapy.

    Science.gov (United States)

    Chen, Linda; Shen, Colette; Redmond, Kristin J; Page, Brandi R; Kummerlowe, Megan; Mcnutt, Todd; Bettegowda, Chetan; Rigamonti, Daniele; Lim, Michael; Kleinberg, Lawrence

    2017-07-15

    We evaluated the toxicity associated with stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) in elderly and very elderly patients with brain metastases, as the role of SRS in geriatric patients who would traditionally receive WBRT is unclear. We conducted a retrospective review of elderly patients (aged 70-79 years) and very elderly patients (aged ≥80 years) with brain metastases who underwent RT from 2010 to 2015 at Johns Hopkins Hospital. Patients received either upfront WBRT or SRS for metastatic solid malignancies, excluding small cell lung cancer. Acute central nervous system toxicity within 3 months of RT was graded using the Radiation Therapy Oncology Group acute radiation central nervous system morbidity scale. The toxicity data between age groups and treatment modalities were analyzed using Fisher's exact test and multivariate logistic regression analysis. Kaplan-Meier curves were used to estimate the median overall survival, and the Cox proportion hazard model was used for multivariate analysis. A total of 811 brain metastases received RT in 119 geriatric patients. The median overall survival from the diagnosis of brain metastases was 4.3 months for the patients undergoing WBRT and 14.4 months for the patients undergoing SRS. On multivariate analysis, WBRT was associated with worse overall survival in this cohort of geriatric patients (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.9-7.0, PElderly and very elderly patients did not have significantly different statistically acute toxicity rates when stratified by age. WBRT was associated with increased toxicity compared with SRS in elderly and very elderly patients with brain metastases. SRS, rather than WBRT, should be prospectively evaluated in geriatric patients with the goal of minimizing treatment-related toxicity. Copyright © 2017. Published by Elsevier Inc.

  4. Attitudes towards medication non-adherence in elderly kidney transplant patients: a Q methodology study.

    Science.gov (United States)

    Tielen, Mirjam; van Exel, N Job A; van Buren, Marleen C; Maasdam, Louise; Weimar, Willem

    2011-05-01

    Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing population of elderly kidney recipients. Q methodology was used to explore attitude profiles. Participants (> 65 years) were asked to rank-order opinion statements on issues associated with (non-)adherence. The rankings were subject to by-person factor analysis, and the resulting factors were interpreted and described as attitudes. Twenty-six elderly renal transplant recipients participated in the study. All passed the Mini-Mental State Examination. Two attitude profiles were found: (i) satisfied and easy-going (attitude A), and (ii) reserved and concerned (attitude B). Elderly patients with attitude A want to enjoy the new life following their kidney transplant, are not very concerned about having to recommence dialysis, now and then even forget their regime, and do not really worry about it. Elderly patients with attitude B feel more insecure about their kidney transplant, are fairly concerned over issues like rejection or going back on dialysis, and try to adapt their way of life to the regime. One-third of these elderly patients forget their medication at least once a month, but there was no difference between attitude groups. Attitudes about the post-transplant regime differ among elderly patients, implying different needs for assistance, monitoring and risk of non-adherence to the regime. The proportion of elderly patients who forget their medication is considerable, but may be much higher among those with mild and severe cognitive limitations.

  5. A cerebrovascular stroke following endoscopy for an elderly patient ...

    African Journals Online (AJOL)

    Ahmed Gado

    2015-02-02

    Feb 2, 2015 ... Abstract Elderly people constitute an increasing proportion of those presenting with acute upper gastrointestinal bleeding. Not only in upper gastrointestinal bleeding is advanced age a risk of death, but also exceeding 60 years of age results in an increased risk of cerebrovascular and cardio- vascular ...

  6. A cerebrovascular stroke following endoscopy for an elderly patient ...

    African Journals Online (AJOL)

    Elderly people constitute an increasing proportion of those presenting with acute upper gastrointestinal bleeding. Not only in upper gastrointestinal bleeding is advanced age a risk of death, but also exceeding 60 years of age results in an increased risk of cerebrovascular and cardiovascular events. Factors likely to ...

  7. Visual Morbidities among Elderly Patients Presenting at a Primary ...

    African Journals Online (AJOL)

    Assessment of binocular acuity revealed blindness in 109 (21.8%) and low-vision in 68 (13.6%). The prevalence of visual impairment increased significantly with age. Conclusion: Visual impairment is a common problem of the elderly people in the hospital setting, with cataract being the main cause. Efforts should be made ...

  8. Clinical features of diabetes retinopathy in elderly patients with type ...

    African Journals Online (AJOL)

    Objective: The objective was to estimate the prevalence and clinical characteristics of diabetes retinopathy (DR) in elderly individuals with type 2 diabetes mellitus in Northern Chinese. Materials and Methods: 595 eligible subjects (263 men, 332 women) assisted by the community health service center in Beijing, China ...

  9. Intervention of Collective Exercise on the Mental Health of Elderly Hypertensive Patients.

    Science.gov (United States)

    Xu, Wenxin; Li, Menglong; Yao, Jiwei

    2016-03-01

    Anxiety, depression, and other adverse psychological reactions are often observed in elderly hypertensive patients. Appropriate exercise is a safe form of adjuvant therapy without causing side effects among these patients, with consistent effects on patients' mental health. In this study, a collective exercise intervention experiment was conducted to evaluate the mental health of elderly hypertensive patients and to verify the effect of the psychological intervention of collective exercise. A total of 115 elderly hypertensive patients aged 60-70 years old were selected as study subjects from May 2012 to January 2015 in Fuzhou City, Fujian Province, China. A total of 57 patients were included in the control group and 58 patients were assigned in the experimental group. Patients in the experimental group participated in a 12 weeks exercise intervention, while patients in the control group didn't participate in any regular physical exercise. After intervention, the Symptom Checklist-90 (SCL-90), total score, somatization, obsessive-compulsive symptom, interpersonal sensitivity, depression, anxiety, hostility, and paranoia scores of the experimental group were significantly lower than those of the control group (P mental health level and coping ability of elderly hypertensive patients can be effectively improved with the proposed treatment.

  10. The hidden curriculum of the medical care for elderly patients in medical education: a qualitative study.

    Science.gov (United States)

    Meiboom, Ariadne; Diedrich, Chantal; Vries, Henk De; Hertogh, Cees; Scheele, Fedde

    2015-01-01

    Despite more attention being given to geriatrics in medical curricula, few new physicians are seeking training in this field. So far, there has been no exploration of factors in the hidden curriculum that could potentially influence the persisting lack of interest in this field of medicine. To study this hidden curriculum in medical education in relation to medical care of elderly patients, the authors used a qualitative research design including participant observations on two internal medicine wards in a teaching hospital and semistructured interviews. The results showed that elderly patients with multiple problems are seen as frustrating and not interesting. Medical students were not stimulated to go into the totality of medical problems of elderly patients. They picked up a lot of disparaging remarks about these patients. The mainly negative attitudes demonstrated by role models, in particular the residents, may potentially influence the development of future doctors and their choice of career.

  11. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Mireille F. M. Van Stijn

    2015-05-01

    Full Text Available Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE analysis average difference over time; regression coefficient (Beta: −0.54; 95% CI: −1.08–−0.01; p = 0.04, blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00–3.15; p = 0.05 and a trend towards lower lactate to pyruvate ratio (Beta: −1.10; 95% CI: −2.33–0.12; p = 0.08. We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality.

  12. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial.

    Science.gov (United States)

    Van Stijn, Mireille F M; Bruins, Arnoud A; Vermeulen, Mechteld A R; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G; De Bandt, Jean Pascal; Twisk, Jos W R; Van Leeuwen, Paul A M; Houdijk, Alexander P J

    2015-05-29

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): -0.54; 95% CI: -1.08--0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00-3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: -1.10; 95% CI: -2.33-0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality.

  13. Upper GI endoscopy in elderly patients: predictive factors of relevant endoscopic findings.

    Science.gov (United States)

    Buri, Luigi; Zullo, Angelo; Hassan, Cesare; Bersani, Gianluca; Anti, Marcello; Bianco, Maria A; Cipolletta, Livio; Giulio, Emilio Di; Matteo, Giovanni Di; Familiari, Luigi; Ficano, Leonardo; Loriga, Piero; Morini, Sergio; Pietropaolo, Vincenzo; Zambelli, Alessandro; Grossi, Enzo; Tessari, Francesco; Intraligi, Marco; Buscema, Massimo

    2013-03-01

    Elderly patients are at increased risk for peptic ulcer and cancer. Predictive factors of relevant endoscopic findings at upper endoscopy in the elderly are unknown. This was a post hoc analysis of a nationwide, endoscopic study. A total of 3,147 elderly patients were selected. Demographic, clinical, and endoscopic data were systematically collected. Relevant findings and new diagnoses of peptic ulcer and malignancy were computed. Both univariate and multivariate analyses were performed. A total of 1,559 (49.5%), 213 (6.8%), 93 (3%) relevant findings, peptic ulcers, and malignancies were detected. Peptic ulcers and malignancies were more frequent in >85-year-old patients (OR 3.1, 95% CI = 2.0-4.7, p = 0.001). The presence of dysphagia (OR = 5.15), weight loss (OR = 4.77), persistent vomiting (OR = 3.68), anaemia (OR = 1.83), and male gender (OR = 1.9) were significantly associated with a malignancy, whilst overt bleeding (OR = 6.66), NSAIDs use (OR = 2.23), and epigastric pain (OR = 1.90) were associated with the presence of peptic ulcer. Peptic ulcer or malignancies were detected in 10% of elderly patients, supporting the use of endoscopy in this age group. Very elderly patients appear to be at higher risk of such lesions.

  14. Use of geriatric assessment and screening tools of frailty in elderly patients with prostate cancer. Review.

    Science.gov (United States)

    Molina-Garrido, Maria-José; Guillén-Ponce, Carmen

    2017-06-01

    The management of prostate cancer in the elderly is a major public health concern in most countries. Currently, most prostate cancers are diagnosed in elderly males. The elderly population is very heterogeneous. Thus, the current challenge is to identify better those individuals for whom specific screening tools and a Comprehensive Geriatric Assessment (CGA) would be beneficial. On the basis of the recommendations of the Prostate Cancer Working Group in the International Society of Geriatric Oncology, older patients with prostate cancer should be managed according to their individual health status and not by their age. CGA is the best tool for determining the health status of an older patient. In this article, we sought to assemble all available evidence on the models of CGA and the prevalence of geriatric conditions in older patients with prostate cancer. We also discuss the feasibility of the most used screening tools in elderly patients, that is, the Vulnerable Elders Survey-13 (VES-13) and G-8 as screening tools in this group of patients.

  15. The safety and prognostic factors for mortality in extremely elderly patients undergoing an emergency operation.

    Science.gov (United States)

    Park, Seon-Young; Chung, Jae Sik; Kim, Sung Hoon; Kim, Young Wan; Ryu, Hoon; Kim, Dong Hyun

    2016-02-01

    As the number of elderly people has increased, the number of elderly patients who need emergency operations has also increased. Although there are many models to evaluate the risk of surgery in elderly patients, they all are associated with limitations. We herein evaluated the prognostic factors for surgical mortality in elderly patients more than 80 years old who needed emergency operations. A total of 171 patients more than 80 years old underwent emergency operations from January 2001 to December 2012. Among them, 79 patients with acute cholecystitis, panperitonitis and intestinal obstruction with strangulation, which included mortality cases, were included. We retrospectively reviewed the medical records of the patients and analyzed the prognostic factors for surgical mortality. Forty-eight patients had a co-morbidity. Thirty-one patients initially had systemic inflammatory response syndrome. There were 27 surgical mortality cases. A univariate analysis revealed that panperitonitis, a positive blood culture and the level of albumin were significant prognostic factors predicting a worse prognosis. However, a multivariate analysis revealed that a serum albumin level more than 3.5 g/dL was the only significant prognostic factor (p = 0.037). Surgeons cannot fully evaluate the risk of emergency operation cases. However, our data indicate that if patients do not show hypoalbuminemia, the surgeon may be able to perform an emergency operation without a high risk of surgical mortality.

  16. Early Peritonitis is an Independent Risk Factor for Mortality in Elderly Peritoneal Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Zhi Wang

    2015-05-01

    Full Text Available Background/Aims: The impact of early peritonitis on the outcome of elderly peritoneal dialysis (PD patients has not been studied. We aimed to research the influence of early peritonitis on patient outcomes in elderly PD patients. Methods: This study involved elderly PD patients (age ≥65 who underwent PD between Jan 1, 2004 and Jul 31, 2013. Patient characteristics were collected in our database. Early peritonitis was defined as peritonitis within 6 months after the initiation of PD. Patient survival and technique were compared among the non-peritonitis, early peritonitis and late peritonitis groups using Cox regression analysis. Results: There were 155 subjects involved in this study. The patients were divided among a non-peritonitis group (n=78, early peritonitis group (n=32 and late peritonitis group (n=45. The organisms causing first peritonitis in the two groups did not differ significantly. After adjustment for age, diabetes, serum albumin and residual renal function, multivariable Cox regression model revealed that compared with the early peritonitis group, both the non-peritonitis group (HR 0.57, RI 0.32-0.99, p=0.046 and the late peritonitis group (HR 0.37, RI 0.16-0.75, p=0.004 exhibited a lower patient mortality rate. Conclusions: Early peritonitis is an independent risk factor for mortality in elderly peritoneal dialysis patients.

  17. Body composition, muscle strength and quality of active elderly women according to the distance covered in the 6-minute walk test

    Directory of Open Access Journals (Sweden)

    Karla H. C. Vilaca

    2013-06-01

    Full Text Available BACKGROUND: Changes arising from the aging process, particularly changes in body composition, contribute to the functional decline of the elderly. OBJECTIVE: To compare the body composition and muscle strength, mobility and quality in active elderly women according to the distance walked during the 6-minute walk test (6MWT. METHOD: The study included 77 active elderly women aged 65 to 80 years, who were divided into tertiles (A, B and C according to the distance covered in the 6MWT. We performed anthropometric and clinical evaluations. Body composition was determined by dual energy X-ray absorptiometry (DXA. Handgrip strength (HGS was measured with a portable dynamometer (Saehan, and knee extension strength (KES was measured with the one repetition maximum test (1-RM. Functional mobility was assessed by the Timed Up and Go (TUG test, and body balance was assessed by the Berg Balance Scale (BBS. Muscle quality was defined by the ratio between muscle strength (kgf and muscle mass (kg. RESULTS: The group that walked the shortest distance in the 6MWT had a higher BMI (A=30.8±7.0, B=27.2±4.2 and C=25.9±3.5 kg/m2, greater amount of fat mass (A=31.3±10.7, B=25.9±6.7 and C=23.81±6.46 kg lower HGS (A=21.8±5.1, B=22.1±3.5 and C=25.5±5.1 kgf, lower knee extension strength (A=30.6±10.9, B=40.4±12.5 and C=47.2±10.1 kgf, lower arm muscle quality (A=10.1±3.7, B=11.6±2 and C=12.7±2.2 kg and lower leg muscle quality (A=1.78±1, B=2.84±0.98 and C=3.31±0.77 kg. There was no significant difference between muscle mass (p=0.25 and lean mass (p=0.26. CONCLUSION: Body fat has a negative influence on functional performance, even among active elderly women.

  18. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    Science.gov (United States)

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  19. Pain in the Frail or Elderly Patient: Does Tapentadol Have a Role?

    Science.gov (United States)

    Veal, Felicity C; Peterson, Gregory M

    2015-06-01

    Persistent pain affects the elderly disproportionally, occurring in 50% of elderly community-dwelling patients and 80% of aged care residents. The management of pain in the elderly and frail patient is complicated because of the risks posed by changes in pharmacokinetics and pharmacodynamics, polypharmacy, and drug-disease interactions. Trials evaluating the efficacy of analgesics have often excluded elderly patients and universally excluded frail patients; therefore, the true efficacy and side-effect profiles in these population groups are largely unknown, especially for long-term use. A stepwise approach is recommended to managing pain, commencing with paracetamol and adding on opioids when needed to manage pain. However, because of the short duration of clinical trials, exclusion of frail patients, and minimal inclusion of elderly patients, the decision as to which opioid should be added on to paracetamol is a difficult one. This article reviews the evidence surrounding a newer opioid, tapentadol. Tapentadol acts on both the mu receptors and on neuronal reuptake of noradrenaline, and has no significant analgesically active metabolites, which theoretically presents some advantages, particularly in comparison with tramadol. However, the evidence to support tapentadol is weak and the trials were often methodologically poor and sponsored almost universally by the drug company. Currently, there is insufficient evidence to support the use of tapentadol over other opioids, which have been on the market longer, are less expensive, and have better established safety profiles. As a first-line agent after the failure of paracetamol alone, morphine, oxycodone, fentanyl, or buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for elderly or frail patients.

  20. Pulsatile cardiopulmonary bypass and renal function in elderly patients undergoing aortic valve surgery

    NARCIS (Netherlands)

    Milano, Aldo Domenico; Dodonov, Mikhail; Van Oeveren, Willem; Onorati, Francesco; Gu, Y. John; Tessari, Maddalena; Menon, Tiziano; Gottin, Leonardo; Faggian, Giuseppe

    OBJECTIVES: To evaluate if pulsatile cardiopulmonary bypass (CPB) has any protective influence on renal function in elderly patients undergoing aortic valve replacement (AVR). METHODS: Forty-six patients (>= 75 years old) with aortic valve stenosis underwent AVR with either pulsatile perfusion (PP)

  1. Identification of Drug Therapy Problems among Elderly in-patients of ...

    African Journals Online (AJOL)

    A two-fold study combining retrospective and prospective was carried out in a teaching hospital using elderly inpatients prescriptions and self assessment questionnaires. Ninety in-patient prescriptions (from case notes) were randomly selected for the retrospective study. Majority of the patients were males 54(60%).

  2. On-pump versus off-pump coronary artery bypass surgery in elderly patients

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard

    2012-01-01

    Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially...... in elderly patients....

  3. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients

    Directory of Open Access Journals (Sweden)

    Bhava RJ Satish

    2013-01-01

    Conclusion: Closed reduction and cannulated cancellous screw fixation gives satisfactory functional results in large group of elderly patients. The four quadrant parallel peripheral (FQPP screw fixation technique gives good stability, allows controlled collapse, avoids fixation failure and achieves predictable bone healing in displaced femoral neck fracture in patients ≥50 years of age.

  4. Impact of renal function on cardiovascular events in elderly hypertensive patients treated with efonidipine.

    Science.gov (United States)

    Hayashi, Koichi; Saruta, Takao; Goto, Yoshio; Ishii, Masao

    2010-11-01

    This study evaluated the impact of renal function on cardiovascular outcomes in elderly hypertensive patients enrolled in the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive patients. The patients were randomly assigned to either a strict-treatment group (target systolic blood pressure (BP) stroke, cardiovascular disease and renal disease) were evaluated during the 2-year follow-up period following the prospective randomized open-blinded end-point method. Estimated glomerular filtration rate (eGFR) was elevated throughout the trial period in both the strict-treatment (59.4-62 ml min⁻¹ per 1.73 m²) and the mild-treatment group (58.8-61.4 ml min⁻¹ per 1.73 m²). This tendency was also observed in diabetic patients and patients aged ≥75 years, with baseline eGFRrelationship with the incidence of cardiovascular events, nor did the level of BP control. Proteinuria at the time of entry into the study, however, was significantly correlated with cardiovascular event rates (7.1%), an association that was more apparent in patients with eGFRfunction and proteinuria constitute critical risk factors for cardiovascular events in elderly hypertensive patients, trends that are enhanced when baseline eGFR is diminished. Furthermore, the fact that efonidipine-based regimens ameliorate renal function in elderly hypertensive patients with chronic kidney disease may offer novel information on the mechanisms of cardiovascular protection.

  5. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

    Directory of Open Access Journals (Sweden)

    Mosam Phirke

    2015-01-01

    Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

  6. Predicting prosthetic use in elderly patients after major lower limb amputation.

    NARCIS (Netherlands)

    Eijk, M.S. van; Linde, H. van der; Buijck, B.I.; Geurts, A.C.H.; Zuidema, S.U.; Koopmans, R.T.

    2012-01-01

    BACKGROUND: The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities

  7. Elderly patients with community-acquired pneumonia are not treated according to current guidelines

    DEFF Research Database (Denmark)

    Lindhardt Damsgaard, Tove; Klausen, Henrik Hedegaard; Christiansen, Christina

    2013-01-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance...

  8. Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients

    NARCIS (Netherlands)

    Ocak, Gürbey; Halbesma, Nynke; le Cessie, Saskia; Hoogeveen, Ellen K.; van Dijk, Sandra; Kooman, Jeroen; Dekker, Friedo W.; Krediet, Raymond T.; Boeschoten, Elisabeth W.; Verduijn, Marion

    2011-01-01

    Catheter use has been associated with an increased mortality risk in haemodialysis patients. However, differences in the all-cause and cause-specific mortality risk between catheter use and arteriovenous access use in young and elderly haemodialysis patients have not yet been investigated. In this

  9. What Should Be the Target Blood Pressure in Elderly Patients With Diabetes?

    Science.gov (United States)

    Solini, Anna; Grossman, Ehud

    2016-08-01

    Hypertension is very common in elderly subjects with type 2 diabetes. The coexistence of hypertension and diabetes can be devastating to the cardiovascular system, and in these patients, tight blood pressure (BP) control is particularly beneficial. Little information is available regarding the target BP levels in elderly hypertensive patients with type 2 diabetes, and therefore extrapolation from data in the general population should be done. However, it is difficult to extrapolate from the general population to these frail individuals, who usually have isolated systolic hypertension, comorbidities, organ damage, cardiovascular disease, and renal failure and have a high rate of orthostatic and postprandial hypotension. On the basis of the available evidence, we provide arguments supporting the individualized approach in these patients. Target BP should be based on concomitant diseases, orthostatic BP changes, and the general condition of the patients. It is recommended to lower BP in the elderly patient with diabetes to 60 mmHg. In patients with coronary artery disease and in patients with orthostatic hypotension, excessive BP lowering should be avoided. In elderly hypertensive patients with diabetes, BP levels should be monitored closely in the sitting and the standing position, and the treatment should be tailored to prevent excessive fall in BP. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  10. Medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis.

    Science.gov (United States)

    Kim, Gang Deuk; Chae, Soo Uk; Cha, Myoung Soo

    2013-11-01

    Insufficiency fracture is a type of stress fracture, which is the result of normal stresses on abnormal bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. An early diagnosis is best made with a bone scan or magnetic resonance imaging, as radiographs may initially appear normal. Insufficiency fractures of the lower leg and ankle are less common. Furthermore, reports of medial malleolar insufficiency fracture without any history of trauma in elderly patients are extremely rare. Thus, we report a case with a medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis. This case shows that we should be aware of the possibility of encountering an uncommon medial malleolar insufficiency fracture as a cause of pain in the ankle region of an elderly patient with osteoporosis.

  11. The impact of acute high-risk abdominal surgery on quality of life in elderly patients

    DEFF Research Database (Denmark)

    Tengberg, Line Toft; Foss, Nicolai Bang; Lauritsen, Morten Laksafoss

    2017-01-01

    surgery. METHODS: From 1 November 2014 to 30 April 2015, consecutive patients (≥ 75 years) undergoing AHA surgery were included for follow-up after six months. The patients included answered a health-related quality-of-life questionnaire and a supplemental questionnaire regarding residential status...... and they were willing to undergo surgery again, if necessary. All study participants were admitted from their own home, and 95% had no change in residential status after six months. CONCLUSIONS: The self-reported quality of life in elderly survivors six months after AHA surgery was surprisingly good in a small......INTRODUCTION: Undergoing acute high-risk abdominal (AHA) surgery is associated with reduced survival and a great risk of an adverse outcome, especially in the elderly. The primary aim of this study was to investigate the residential status and quality of life in elderly patients undergoing AHA...

  12. Discrimination of elderly patients in the health care system of Lithuania

    Directory of Open Access Journals (Sweden)

    Kristina Selli

    2016-07-01

    Full Text Available Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015. Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results:  This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii the lack of information for complaining and the fear of consequences of complaining; iii the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv the high level of burden of proof in court cases and lack of good practices; v the lack of a patient (human rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions:  This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care;  encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the

  13. Factors influencing general practitioners in the referral of elderly cancer patients

    Directory of Open Access Journals (Sweden)

    Demeaux Jean-Louis

    2011-01-01

    Full Text Available Abstract Background A number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France. Methods This is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients. Results The response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy, by cancer-related elements (severity of symptoms, expected side-effects and an organisational element (whether the general practitioner was used to collaborating with oncologists. Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients. Conclusions Cancer-linked factors and organisational difficulties have been highlighted as influencing the

  14. Cobalamin Deficiency in Elderly Patients: A Personal View

    Directory of Open Access Journals (Sweden)

    Emmanuel Andrès

    2008-01-01

    Full Text Available Cobalamin (vitamin B12 deficiency is particularly common in the elderly (>65 years of age but is often unrecognized because its clinical manifestations are subtle; however, they are also potentially serious, particularly from a neuropsychiatric and hematological perspective. In the elderly, the main causes of cobalamin deficiency are pernicious anemia and food-cobalamin malabsorption. Food-cobalamin malabsorption syndrome is a disorder characterized by the inability to release cobalamin from food or its binding proteins. This syndrome is usually caused by atrophic gastritis, related or unrelated to Helicobacter pylori infection, and long-term ingestion of antacids and biguanides. Management of cobalamin deficiency with cobalamin injections is currently well documented but new routes of cobalamin administration (oral and nasal are being studied, especially oral cobalamin therapy for food-cobalamin malabsorption.

  15. Quality of life of elderly patients with leg ulcers

    Directory of Open Access Journals (Sweden)

    Ana Paula Cardoso Tavares

    2017-10-01

    Full Text Available Abstract Objectives: To identify compromised domains of the 36-Item Short Form Survey (SF-36 for elderly individuals with leg ulcers and correlate their clinical and sociodemographic variables with the SF-36's components. Method: Exploratory and cross-sectional study conducted with 50 elderly individuals with leg ulcers. The instruments were the sociodemographic and clinical form and the SF-36. The Statistical Package for the Social Sciences was used to analyze data. Results: Most were married, retired, and received one times the minimum wage, were Caucasians or of mixed race, and had hypertension. In regard to the SF-36, the most compromised domain was physical limitations, while social aspects and general health status were the less compromised domains. The SF-36 domains were not correlated with age, income, duration or size of the lesion or pain. Conclusion: The ulcer-related biopsychosocial aspects need to be considered in order to devise more effective nursing interventions.

  16. Spine Surgery Outcomes in Elderly Patients Versus General Adult Patients in the United States: A MarketScan Analysis.

    Science.gov (United States)

    Lagman, Carlito; Ugiliweneza, Beatrice; Boakye, Maxwell; Drazin, Doniel

    2017-07-01

    To compare spine surgery outcomes in elderly patients (80-103 years old) versus general adult patients (18-79 years-old) in the United States. Truven Health Analytics MarketScan Research Databases (2000-2012) were queried. Patients with a diagnosis of degenerative disease of the spine without concurrent spinal stenosis, spinal stenosis without concurrent degenerative disease, or degenerative disease with concurrent spinal stenosis and who had undergone decompression without fusion, fusion without decompression, or decompression with fusion procedures were included. Indirect outcome measures included length of stay, in-hospital mortality, in-hospital and 30-day complications, and discharge disposition. Patients (N = 155,720) were divided into elderly (n = 10,232; 6.57%) and general adult (n = 145,488; 93.4%) populations. Mean length of stay was longer in elderly patients versus general adult patients (3.62 days vs. 3.11 days; P adult patients (0.31% vs. 0.06%; P adult patients (11.3% vs. 7.15% and 17.8% vs. 12.6%; P adult patients (33.7% vs. 16.2%; P < 0.0001). Our results revealed significantly longer hospital stays, more in-hospital mortalities, and more in-hospital and 30-day complications after decompression without fusion, fusion without decompression, or decompression with fusion procedures in elderly patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. STEP; A Service Evaluation of Footwear in Elderly Patients

    OpenAIRE

    Bacon, Emma

    2013-01-01

    Background - Falls are a major issue in hospital. One third of people aged over 65 falls each year (Masud & Morris, 2001). Footwear and falls is under researched and not documented, even though it has a big impact on falls risks. Objectives - To observe, document and describe the types, characteristics and source of footwear worn by inpatients on three health care of the elderly wards. Interviews will examine staff knowledge and perception of footwear and its links to falls, and comment on...

  18. Standard Enucleation with Aluminium Oxide Implant (Bioceramic) Covered with Patient's Sclera

    Science.gov (United States)

    Zigiotti, Gian Luigi; Cavarretta, Sonia; Morara, Mariachiara; Nam, Sang Min; Ranno, Stefano; Pichi, Francesco; Lembo, Andrea; Lupo, Stefano; Nucci, Paolo; Meduri, Alessandro

    2012-01-01

    Purpose. We describe in our study a modified standard enucleation, using sclera harvested from the enucleated eye to cover the prosthesis in order to insert a large porous implant and to reduce postoperative complication rates in a phthisis globe. Methods. We perform initially a standard enucleation. The porous implant (Bioceramic) is then covered only partially by the patient's sclera. The implant is inserted in the posterior Tenon's space with the scleral covering looking at front. All patients were followed at least for twelve months (average followup 16 months). Results. We performed nineteen primary procedures (19 patients, 19 eyes, x M; x F) and secondary, to fill the orbital cavity in patients already operated by standard evisceration (7 patients, 7 eyes). There were no cases of implant extrusion. The orbital volume was well reintegrated. Conclusion. Our procedure was safe and effective. All patients had a good cosmetic result after final prosthetic fitting and we also achieved good prothesis mobility. PMID:22654614

  19. Standard Enucleation with Aluminium Oxide Implant (Bioceramic Covered with Patient's Sclera

    Directory of Open Access Journals (Sweden)

    Gian Luigi Zigiotti

    2012-01-01

    Full Text Available Purpose. We describe in our study a modified standard enucleation, using sclera harvested from the enucleated eye to cover the prosthesis in order to insert a large porous implant and to reduce postoperative complication rates in a phthisis globe. Methods. We perform initially a standard enucleation. The porous implant (Bioceramic is then covered only partially by the patient's sclera. The implant is inserted in the posterior Tenon's space with the scleral covering looking at front. All patients were followed at least for twelve months (average followup 16 months. Results. We performed nineteen primary procedures (19 patients, 19 eyes, M; F and secondary, to fill the orbital cavity in patients already operated by standard evisceration (7 patients, 7 eyes. There were no cases of implant extrusion. The orbital volume was well reintegrated. Conclusion. Our procedure was safe and effective. All patients had a good cosmetic result after final prosthetic fitting and we also achieved good prothesis mobility.

  20. Gait speed predicts post-operative medical complications in elderly gastric cancer patients undergoing gastrectomy.

    Science.gov (United States)

    Chandoo, Arvine; Chi, Chu-Huai; Ji, Weiping; Huang, Yingpeng; Chen, Xiao-Dong; Zhang, Wei-Teng; Wu, Rui-Sen; Shen, Xian

    2017-12-11

    Gait speed is a clinical outcome that can measure the physical performance of elderly gastric patients. The purpose of this study was to determine the importance of gait speed in predicting post-operative morbidities in elderly patients undergoing curative gastrectomy. We conducted a prospective study of 357 elderly patients (≥65 years old) undergoing curative gastrectomy. Preoperative gait speed was measured in a 6-m well-lit and unobstructed hallway. Patients were followed up for the post-operative clinical outcomes. Factors contributing to the post-operative morbidities were analysed using univariate and multivariate analyses. Slow gait speed was present in 95 out of 357 patients (26.61%) which was significantly associated with age (P gait speed (P = 0.029) were risk factors of post-operative complications. In multivariate analysis, we found that age (P gait speed (P = 0.029) were independent predictors of post-operative medical complications. Slow gait speed is an independent predictor of post-operative medical complications in elderly patients undergoing curative gastrectomy. Those patients should be managed with appropriate perioperative nutritional support and physical exercise which can improve gait speed and reduce the risk of post-operative medical complications. © 2017 Royal Australasian College of Surgeons.

  1. Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis.

    Science.gov (United States)

    Lee, Jung Eun; Jo, In Young; Lee, Song Mi; Kim, Woo Jeong; Choi, Hoon Young; Ha, Sung Kyu; Kim, Hyung Jong; Park, Hyeong Cheon

    2015-01-01

    The number of elderly people on dialysis is increasing rapidly. Fluid overload and malnutrition status are serious problems in elderly dialysis patients. We aimed to compare the hydration and nutritional status through bioimpedance analysis (BIA) between young and elderly hemodialysis (HD) patients and to analyze risk factors related to fluid overload and malnutrition status in these patients. We conducted a cross-sectional study, in which 82 HD (males 42, mean age 58.7±12.9 years) patients were enrolled. We collected different types of data: laboratory data, such as serum creatinine, albumin, total iron-binding capacity, hemoglobin, total cholesterol; anthropometric data, such as hand grip strength (HGS); BIA data, such as intracellular water, skeletal muscle mass, body cell mass, bone mineral content, phase angle (PhA), extra cellular water (ECW)/total body water (TBW) ratio; and malnutrition-inflammation score (MIS), which is a traditional nutritional parameter for dialysis patients. All patients were stratified into two groups according to their age: young (hydration status in elderly HD patients.

  2. Website design: technical, social and medical issues for self-reporting by elderly patients.

    Science.gov (United States)

    Taylor, Mark J; Stables, Rod; Matata, Bashir; Lisboa, Paulo J G; Laws, Andy; Almond, Peter

    2014-06-01

    There is growing interest in the use of the Internet for interacting with patients, both in terms of healthcare information provision and information gathering. In this article, we examine the issues in designing healthcare websites for elderly users. In particular, this article uses a year-long case study of the development of a web-based system for self-reporting of symptoms and quality of life with a view to examine the issues relating to website design for elderly users. The issues identified included the technical, social and medical aspects of website design for elderly users. The web-based system developed was based on the European Quality of Life 5-Dimensions health-status questionnaire, a commonly used tool for patient self-reporting of quality of life, and the more specific coronary revascularisation outcome questionnaire. Currently, self-reporting is generally administered in the form of paper-based questionnaires to be completed in the outpatient clinic or at home. There are a variety of issues relating to elderly users, which imply that websites for elderly patients may involve different design considerations to other types of websites.

  3. Changes in Renal Function in Elderly Patients Following Intravenous Iodinated Contrast Administration: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ali Alsafi

    2014-01-01

    Full Text Available Background. Contrast-induced nephropathy (CIN is a recognised complication of intravascular administration of iodinated contrast media (ICM. Previous studies suggest a higher incidence in the elderly, but no large study has assessed this to date. We set out to assess changes in creatinine in elderly inpatients following computed tomography (CT examination and compare those who received intravenous contrast to those who did not. Methods. Using the Radiology Information System in two teaching hospitals, inpatients over the age of seventy who had a CT examination and a baseline creatinine were identified and their follow-up creatinine levels were analysed. Elderly inpatients who underwent a noncontrast CT over the same period were used as controls. Results. 677 elderly inpatients who received ICM were compared with 487 controls. 9.2% of patients who received ICM developed acute kidney injury (AKI compared to 3.5% of inpatient controls (P<0.0001. Patients with higher baseline eGFR had a higher incidence of post-CT AKI. Conclusions. The incidence of post-CT AKI is higher in patients who received IV ICM compared to those who did not; the difference may be partly attributable to contrast-induced nephropathy. This suggests that the incidence of CIN in the elderly may not be as high as previously thought.

  4. Constipation in Elderly Patients with Noncancer Pain: Focus on Opioid-Induced Constipation.

    Science.gov (United States)

    Chokhavatia, Sita; John, Elizabeth S; Bridgeman, Mary Barna; Dixit, Deepali

    2016-08-01

    Constipation is a common and often debilitating condition in the elderly, which may be caused by underlying disease conditions, structural abnormalities in the bowel, and a variety of medications such as anticholinergics, antidepressants, and opiates. In this review, we focus on opioid-induced constipation (OIC), which is often underrecognized and undertreated in the elderly. When opioid therapy is initiated, healthcare providers are encouraged to evaluate risk factors for the development of constipation as part of a thorough patient history. To this end, the patient assessment should include the use of validated instruments, such as the Bristol Stool Scale and Bowel Function Index, to confirm the diagnosis and provide a basis for evaluating treatment outcomes. Healthcare providers should use a stepwise approach to the treatment of OIC in the elderly. Conventional laxatives are a first-line option and considered well tolerated with short-term use as needed; however, evidence is lacking to support their effectiveness in OIC. Moreover, because of the risk of adverse events and other considerations, such as chewing difficulties and swallowing disorders, conventional oral laxatives may be inappropriate for the treatment of OIC in the elderly. Thus, the availability of new pharmacologic agents such as the peripherally acting µ-opioid receptor antagonists methylnaltrexone and naloxegol, which target the underlying causes of OIC, and the secretagogue lubiprostone may provide more effective treatment options for elderly patients with OIC.

  5. Literature Review of Gastrointestinal Physiology in the Elderly, in Pediatric Patients, and in Patients with Gastrointestinal Diseases.

    Science.gov (United States)

    Bai, Jane P F; Burckart, Gilbert J; Mulberg, Andrew E

    2016-02-01

    Oral bioavailability studies during the development of new medical entities or generic drugs are typically performed in healthy volunteers. Approved drug products are, however, used by patients with diverse disease backgrounds, and by pediatric and elderly patients. To provide the knowledge base for assessing the potential effects of age or co-morbidity on the in vivo performance of an orally absorbed, systemically active drug product, the literature regarding the gastrointestinal (GI) physiological characteristics (pH, permeability, and transit time) in children, in the elderly, and in patients with GI diseases (irritable bowel syndrome, ulcerative colitis, and Crohn's disease) is reviewed herein, with the knowledge gaps highlighted. Published by Elsevier Inc.

  6. Prevention of chemotherapy-induced nausea and vomiting in elderly cancer patients

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Herrstedt, Jørn

    2009-01-01

    There is a global and continuing increase in the population of elderly people. This is particularly true among patients with cancer including those receiving chemotherapy. There are no guidelines that in particular address prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in the elde......, use of poly-pharmacy with increased risk of drug-drug interactions and due to co-morbidity. Compliance needs to be carefully evaluated, particularly in patients with high risk of non-compliance, such as elderly with dementia and impaired vision....

  7. [FRancilian Oncogeriatric Group (FROG)'s focus on management of elderly patients with bladder cancer].

    Science.gov (United States)

    Ghebriou, Djamel; Avenin, Danièle; Caillet, Philippe; Mongiat-Artus, Pierre; Durdux, Catherine; Massard, Christophe; Culine, Stéphane

    2014-09-01

    Bladder cancer is diagnosed more often in the elderly. The most effective treatment strategies are mostly very aggressive and are not applicable to all patients in a very heterogeneous population. However, effective options exist to treat the most vulnerable subjects. A multidisciplinary approach including a geriatric assessment is essential for optimal adaptation of treatment. The FRancilian Oncogeriatric Group (FROG) conducted a comprehensive literature search in order to review the applicable therapeutic options according to oncological and geriatric settings. International recommendations are essential to harmonize the management of elderly patients with bladder cancer.

  8. Quality of life of elderly patients on peritoneal dialysis versus hemodialysis: a single-center study.

    Science.gov (United States)

    Saka, Yosuke; Naruse, Tomohiko; Tawada, Naoto; Tokomoto, Mitsuhiro; Noda, Yuhei; Taniguchi, Yohei; Nagahara, Yasuko; Yamashita, Ryoko; Karasawa, Munetoshi; Watanabe, Yuzo; Ito, Yasuhiko

    2017-10-01

    The number of elderly dialysis patients in Japan is dramatically increasing. Receiving therapy with better satisfaction through home care is one of the important factors in their daily lives. Thus, the quality of life of elderly patients on hemodialysis (HD) or peritoneal dialysis (PD) was evaluated. Clinical information of patients aged ≥80 years who started dialysis at our hospital between January 2013 and December 2015 was retrospectively collected. The mortality rate, length of hospitalization, and place of death were identified to evaluate patient quality of life. In total, 56 patients (14 PD and 42 HD) were enrolled. The mean age of study subjects was 85.2 ± 4.0 years. The proportion of PD patients who lived with their family or have professional caregivers who could assist them in their daily life was higher than that of HD patients (100 vs. 76.2%, respectively; p = 0.044). Mortality rate was higher in PD patients than in HD patients (p = 0.003), but long-term hospitalization of >180 days was observed only in HD patients (PD vs. HD: 0.0 vs. 16.7%; p = 0.102). In patients with Barthel index scores home (p = 0.002). PD is a desirable home care therapy for elderly patients, but the burden on caregivers should be considered.

  9. Invasive strategy and frailty in very elderly patients with acute coronary syndromes.

    Science.gov (United States)

    Llaó, Isaac; Ariza-Solé, Albert; Sanchis, Juan; Alegre, Oriol; López-Palop, Ramon; Formiga, Francesc; Marín, Francisco; Vidán, María T; Martínez-Sellés, Manuel; Sionis, Alessandro; Vives-Borrás, Miguel; Gómez-Hospital, Joan Antoni; Gómez-Lara, Josep; Roura, Gerard; Díez-Villanueva, Pablo; Núñez-Gil, Iván; Maristany, Jaume; Asmarats, Lluis; Bueno, Héctor; Abu-Assi, Emad; Cequier, Àngel

    2018-04-03

    Current guidelines recommend an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment was performed during hospitalization, including frailty. We evaluated the impact of an invasive strategy during the admission on the incidence of cardiac death, reinfarction or new revascularisation at 6-months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had lower proportion of frailty (23.3% vs 40.3%, pstrategy-frailty was significant (p=0.032) Conclusions: An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.

  10. Effect of nebivolol on outcome in elderly patients with heart failure and atrial fibrillation : insights from SENIORS

    NARCIS (Netherlands)

    Mulder, Bart A.; van Veldhuisen, Dirk J.; Crijns, Harry J. G. M.; Boehm, Michael; Cohen-Solal, Alain; Babalis, Daphne; Roughton, Michael; Flather, Marcus D.; Coats, Andrew J. S.; Van Gelder, Isabelle C.

    2012-01-01

    Beneficial effects of beta-blockade remain unclear in heart failure patients who have atrial fibrillation (AF), especially in the elderly. We evaluated the effect of nebivolol on cardiovascular outcomes in elderly patients with heart failure and AF. The SENIORS trial showed an overall benefit of

  11. Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients.

    NARCIS (Netherlands)

    Iersel, M.B. van; Munneke, M.; Esselink, R.A.J.; Benraad, C.E.; Olde Rikkert, M.G.M.

    2008-01-01

    OBJECTIVE: To estimate clinically relevant changes in functional mobility tests and quantitative gait measures at group and individual level in frail elderly patients. STUDY DESIGN AND SETTING: This study was a cohort study of consecutively admitted frail elderly patients. Gait velocity,

  12. Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department

    DEFF Research Database (Denmark)

    Nielsen, Louise M.; Kirkegaard, Hans; Østergaard, Lisa Gregersen

    2016-01-01

    Background Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED)...

  13. Altered aiming movements in Parkinson's disease patients and elderly adults as a function of delays in movement onset

    NARCIS (Netherlands)

    Romero, D.H.; Gemmert, A.W.A. van; Adler, C.H.; Bekkering, H.; Stelmach, G.E.

    2003-01-01

    This study investigated the effect of lengthening the time the hand remains immobilized on an aiming movement performed by Parkinson's disease (PD) patients and elderly adults, and whether visual information could compensate for the effects of delay. In Experiment One, PD patients and elderly adults

  14. Factors predicting the outcomes of elderly hospitalized myasthenia gravis patients: a national database study

    Directory of Open Access Journals (Sweden)

    Tiamkao S

    2017-04-01

    Full Text Available Somsak Tiamkao,1,2 Sineenard Pranboon,3 Kaewjai Thepsuthammarat,4 Kittisak Sawanyawisuth1,5,6 1Department of Medicine, Faculty of Medicine, 2The Neuroscience Research and Development Group, 3Nursing Division, Srinagarind Hospital, 4Clinical Epidemiology Unit, Faculty of Medicine, 5Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, 6Ambulatory Medicine Research Group, Khon Kaen University, Khon Kaen, Thailand Background: Myasthenia gravis (MG in elderly populations is increasing. This study aimed to evaluate predictors for treatment outcomes in elderly hospitalized MG patients using the national database. Methods: We collected data of elderly hospitalized MG patients from the National Health Security Office from October 2009 to September 2010. Predictors for treatment outcomes were examined. Results: During the study period, 1,948 identified MG patients were admitted to hospitals throughout Thailand. Of those, 441 patients (22.64% were aged ≥ 60 years. There were 66 patients (14.97% who had poor outcomes. There were only three significant factors in the final model. Presence of pneumonia, use of mechanical ventilators, and septicemia had adjusted odds ratios (95% confidence interval of 2.83 (1.03, 7.75, 5.33 (2.24, 12.72, and 4.47 (1.86, 10.75, respectively. Conclusion: Pneumonia, being on a mechanical ventilator, and septicemia were independent factors associated with poor treatment outcomes in elderly hospitalized MG patients according to national data. Keywords: pneumonia, ventilator, mortality, predictor 

  15. Middle ear impedance studies in elderly patients implications on age-related hearing loss

    Directory of Open Access Journals (Sweden)

    Olusola Ayodele Sogebi

    2015-04-01

    Full Text Available INTRODUCTION: Controversies arise with respect to functioning of the middle ear over time.OBJECTIVE: To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients.METHODS: Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes.RESULTS: One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0 ± 6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex.CONCLUSION: Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss.

  16. Middle ear impedance studies in elderly patients implications on age-related hearing loss.

    Science.gov (United States)

    Sogebi, Olusola Ayodele

    2015-01-01

    Controversies arise with respect to functioning of the middle ear over time. To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients. Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes. One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0±6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex. Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  17. Elderly patients with gastrointestinal stromal tumour (GIST) receive less treatment irrespective of performance score or comorbidity - A retrospective multicentre study in a large cohort of GIST patients.

    Science.gov (United States)

    Farag, Sheima; van Coevorden, Frits; Sneekes, Esther; Grunhagen, Dirk J; Reyners, Anna K L; Boonstra, Pieter A; van der Graaf, Winette T; Gelderblom, Hans J; Steeghs, Neeltje

    2017-11-01

    Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce. Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression. Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11-0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23-0.95). Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8-65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01). Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Effect of aromatherapy massage on elderly patients under long-term hospitalization in Japan.

    Science.gov (United States)

    Satou, Tadaaki; Chikama, Mizuki; Chikama, Yoshiko; Hachigo, Masato; Urayama, Haruna; Murakami, Shio; Hayashi, Shinichiro; Koikem, Kazuo

    2013-03-01

    To verify the effectiveness of aromatherapy massage on elderly patients under long-term hospitalization. Aromatherapy massage was performed twice a week for a total of eight times. Nursing home. Elderly women under long-term hospitalization. Questionnaire and measurement of stress marker levels (salivary amylase activity) before and after the first, fifth, and eighth aromatherapy massages. Questionnaire (Face scale, General Health Questionnaire-12 [GHQ-12]), measurement of salivary amylase activity. A decrease in stress after aromatherapy massage compared to before each massage was confirmed at all measurement times and with the stress marker. No marked reduction was observed in Face scale or saliva amylase activity as a whole over the long term, although decreasing tendencies were seen. Marked reductions in GHQ-12 were observed over the long term. Aroma massage appears likely to prove effective in reducing psychological stress among elderly patients under long-term hospitalization.

  19. STUDY OF THYROID DYSFUNCTION IN ELDERLY PATIENTS AND ITS CLINICAL CORRELATION IN TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Vidyasagar

    2016-03-01

    Full Text Available INTRODUCTION Thyroid dysfunction in elderly is not uncommon. Thyroid abnormalities were more among females than in males. Clinical diagnosis is difficult to make but Thyroid Function Tests always help in diagnosing the disease. Subclinical state is equally common as clinical state in elderly population. As the age advances the incidence of thyroid disorders increase. The study was undertaken with an objective to study the spectrum of thyroid dysfunction in elderly and to correlate clinical symptoms with abnormal thyroid function. Thyroid disorders were present in 26%, overt hypothyroidism in 12%, subclinical hypothyroidism in 8% cases, hyperthyroidism in 3% and subclinical hyperthyroidism in 3% patients was noted. In this study, 36 patients were males and 64 were females. Females (20% had high incidence of thyroid disorders than males (6%.

  20. Prospective analysis of quality of life in elderly patients treated with adjuvant chemotherapy for non-small-cell lung cancer.

    Science.gov (United States)

    Park, S; Kim, I R; Baek, K K; Lee, S J; Chang, W J; Maeng, C H; Hong, J Y; Choi, M K; Kim, Y S; Sun, J M; Ahn, J S; Park, K; Jo, J; Jung, S H; Ahn, M J

    2013-06-01

    Given the more comorbidities with a decline in physiologic reserve, it can be challenging to make appropriate treatment decisions in the elderly. Here, we prospectively evaluated and compared the health-related quality of life (HRQOL) of patients aged ≥ 65 with aged quality of life (QOL) in elderly patients did not significantly deteriorate with adjuvant chemotherapy and the time trend of QOL in elderly patients was similar to that of younger patients. Although the elderly suffered from increased treatment-related adverse events involving sore mouth, peripheral neuropathy and alopecia compared with the baseline, the same time trends were also observed in younger group. The mean dose intensities (MDIs) for PC and NP regimen were not significantly different between the two age groups. Postoperative chemotherapy did not substantially reduce HRQOL in elderly NSCLC patients, and HRQOL during and after adjuvant chemotherapy did not significantly differ by age.

  1. Factors associated with reported snoring among elderly patients attending the geriatric centre in Nigeria.

    Science.gov (United States)

    Adebusoye, Lawrence Adekunle; Ogunbode, Adetola Morenikeji; Olowookere, Olufemi Oluwole

    2014-01-01

    Snoring is the major symptom of sleep disordered breathing (SDB) which is of immense public health importance. It is associated with some morbidities and mortality in the elderly. Few studies have addressed this problem in the elderly Nigerians. Cross-sectional study of 843 elderly patients at the Geriatric Centre, University College Hospital, Ibadan, Nigeria. Data were collected on the following candidate variables which may be associated with snoring such as socio-demographic characteristics, morbidities, lifestyle habits and functional disability using Katz index. Anthropometric measurements such as body mass index and neck, waist and hip circumferences were taken. Statistical analysis was done with SPSS 17. The point prevalence of reported snoring was 31.2%. Habitual snoring was reported by 24.8%. Snoring was significantly associated with obesity, moderate to severe oropharyngeal crowding, wide neck and waist circumferences in both sexes. Logistic regression analysis showed wide neck circumference (OR = 6.005; 95%CI= 2.150-16.770) among the males and obesity (OR = 2.028; 95%CI= 1.344-3.061) and moderate to severe oropharyngeal crowding (OR = 1.639; 95%CI= 1.057-2.543) in the females to be the most significant factors associated with snoring. The high prevalence of snoring among elderly patients in Nigeria calls for concerted effort by healthcare workers to educate the elderly.

  2. [Risk scores for community acquired pneumonia in elderly and geriatric patients].

    Science.gov (United States)

    Pflug, M A; Wesemann, T; Heppner, H J; Thiem, U

    2015-10-01

    Community-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients. For epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users. Since the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients. At present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults. For treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.

  3. Are Nutritional Care Adequate for Elderly Hospitalized Patients? A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Helene Kjøllesdal Eide

    2016-12-01

    Full Text Available This article assesses nutritional care in identifying and treating nutritional risk in elderly hospitalized patients. A cross-sectional study was conducted at a large Norwegian University hospital in the period 2011 to 2013. Data on nutritional risk and care for elderly patients (≥70 years without dementia were collected at 20 wards by 173 second-year nursing students in acute-care clinical studies. A stratified sampling technique was utilized to improve the representativeness of the sample. In total, 508 patients (48.8% women with a mean age of 79.6 years participated. The internationally and nationally recommended nutritional care was not implemented at the hospital, suggesting that nutritional care for elderly hospitalized patients was not adequate. This implies that the majority of the elderly patients nutritionally at risk are neither identified nor treated according to their needs. The article highlights the importance of having systematic nutritional care practices to make it possible for the hospital ward staff to routinely identify nutritional risk and initiate appropriate nutritional treatment measures.

  4. Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases.

    Science.gov (United States)

    Pérez-Jover, Virtudes; Mira, José J; Carratala-Munuera, Concepción; Gil-Guillen, Vicente F; Basora, Josep; López-Pineda, Adriana; Orozco-Beltrán, Domingo

    2018-02-10

    The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

  5. Risk factors and bacterial spectrum for pneumonia after abdominal surgery in elderly Chinese patients.

    Science.gov (United States)

    Chen, Peng; A, Yongjun; Hu, Zongqiang; Cun, Dongyun; Liu, Feng; Li, Wen; Hu, Mingdao

    2014-01-01

    Postoperative pneumonia is a common complication of abdominal surgery in the elderly. The aim of this study was to determine risk factors and bacterial spectrum for pneumonia after abdominal surgery in elderly Chinese patients. We performed a case-control study in a total of 5431 patients aged 65 years and over who had undergone abdominal surgery at the 2nd affiliated hospital of Kunming medical college between June 2003 and June 2011. Postoperative pneumonia developed in 86 patients (1.58%). Gram-negative bacilli were the principal microorganisms (82.86%) isolated from patients. The most common organisms isolated were Klebsiella spp. (28.57%), Acinetobacter spp. (17.14%) and Pseudomonas aeruginosa (17.14%). Multivariate analysis confirmed the following to be independent risk factors for postoperative pneumonia in the elderly after abdominal surgery: age ≥70 (OR 1.93, 95% CI 1.16-3.22, p=0.01), upper abdominal surgery (OR 2.07, 95% CI 1.18-3.64, p=0.01) and duration of operation >3 h (OR 2.48, 95% CI 1.49-4.15, p=0.00). Identifying these risk factors may help achieve better prevention and treatment for postoperative pneumonia in elderly patients after abdominal surgery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Telehealth for "the digital illiterate"--elderly heart failure patients experiences.

    Science.gov (United States)

    Lind, Leili; Karlsson, Daniel

    2014-01-01

    Telehealth solutions should be available also for elderly patients with no interest in using, or capacity to use, computers and smartphones. Fourteen elderly, severely ill heart failure patients in home care participated in a telehealth study and used digital pens for daily reporting of their health state--a technology never used before by this patient group. After the study seven patients and two spouses were interviewed face-to-face. A qualitative content analysis of the interview material was performed. The informants had no experience of computers or the Internet and no interest in learning. Still, patients found the digital pen and the health diary form easy to use, thus effortlessly adopting to changes in care provision. They experienced an improved contact with the caregivers and had a sense of increased security despite a multimorbid state. Our study shows that, given that technologies are tailored to specific patient groups, even "the digital illiterate" may use the Internet.

  7. Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients.

    Science.gov (United States)

    Gómez-Cerquera, Juan Manuel; Daroca-Pérez, Rafael; Baeza-Trinidad, Ramón; Casañas-Martinez, Marta; Mosquera-Lozano, Jose Daniel; Ramalle-Gómara, Enrique

    2015-10-01

    PCT has been consolidated as a key tool in the diagnosis of bacterial infections in general population. Few studies have been conducted to determine the applicability of this test in elderly patients. Study of validity of PCT on elderly patients. Two groups were formed; the first group was formed by patients aged 75 years or older, under bacterial infection criteria and PCT on the initial Lab test. The second group was formed by patients aged 75 years or older with any noninfectious disease; these patients were asked PCT in the initial Lab test. Sensitivity, specificity, positive and negative likelihood ratio were calculated. 161 patients were included, 95 with probable bacterial infection and 66 without infection. Patients with probable bacterial infection criteria, 72% of them had PCT >0.5 ng/mL. Patients without infection, 8% of the patients had PCT >0.5 ng/mL. Sensitivity and specificity of PCT to bacterial infection with the cutoff value of 0.5 ng/mL was 72% and 92%, respectively. PCT can be used in elderly patients to diagnose bacterial infections because it has proved good sensitivity and high specificity. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  8. Bevacizumab treatment in the elderly patient with metastatic colorectal cancer

    Directory of Open Access Journals (Sweden)

    Di Bartolomeo M

    2015-01-01

    Full Text Available Maria Di Bartolomeo,1 Claudia Maggi,1 Francesca Ricchini,1 Filippo Pietrantonio,1 Roberto Iacovelli,1 Filippo de Braud,1 Alessandro Inno2 1Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, 2Department of Medical Oncology, Sacro Cuore-Don Calabria Hospital, Negrar, Italy Abstract: Metastatic colorectal cancer (mCRC, like many cancers, is primarily a disease of elderly people. Despite this prevalence, such patients are often excluded from randomized trials or represent a minority of enrolled patients. Moreover, the criteria for establishing benefit or side effects of treatment strategies in this population are uncertain and not well recognized. Bevacizumab improves the outcome of mCRC when used in combination with standard first-line and second-line chemotherapy and beyond the first disease progression when given with a chemotherapy backbone different from that used in the precedent line. The particular toxicity profile of this antiangiogenesis agent (in particular hypertension, thromboembolic events, hemorrhage, and renal failure may discourage its use in elderly patients with comorbidities. Data from subgroup analyses of randomized trials and the results of recent cohort studies suggest a significant benefit from the addition of bevacizumab to standard chemotherapy for elderly patients comparable with that observed in younger patients, except for the increased risk for thromboembolic events. Age alone should not be a barrier to use of bevacizumab, and further research with a more complete geriatric assessment should investigate the role of bevacizumab in elderly patients with mCRC to avoid undertreatment of this patient population due to a ­historical conservative approach. Keywords: bevacizumab, elderly, metastatic colorectal cancer, antivascular treatment, review

  9. Comparison of Pulmonary Embolism and Subsequent Cardiovascular Events Between Elderly and Young Patients in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Yen-Yi Feng

    2012-06-01

    Conclusion: Diagnosis intervals in the elderly were widely variable. Rapid and precise diagnosis of PE in the emergency department remains a challenge. Clinical presentations gave less useful information to make a correct diagnosis of PE, especially in the elderly. There are more new episodes of ischemic heart disease in the elderly followed by PE, but no significant difference in the overall SCVE between the two groups. The relationship between SCVE and age in patients with PE may need further evaluation.

  10. Compliance and toxicity of adjuvant CMF in elderly breast cancer patients: a single-center experience

    International Nuclear Information System (INIS)

    De Maio, Ermelinda; Capasso, Immacolata; Rinaldo, Massimo; Morrica, Brunello; Elmo, Massimo; Di Maio, Massimo; Perrone, Francesco; Matteis, Andrea de; Gravina, Adriano; Pacilio, Carmen; Amabile, Gerardo; Labonia, Vincenzo; Landi, Gabriella; Nuzzo, Francesco; Rossi, Emanuela; D'Aiuto, Giuseppe

    2005-01-01

    Few data are available on compliance and safety of adjuvant chemotherapy when indicated in elderly breast cancer patients; CMF (cyclophosphamide, methotrexate, fluorouracil) can be reasonably considered the most widely accepted standard of treatment. We retrospectively reviewed compliance and safety of adjuvant CMF in patients older than 60. The treatment was indicated if patients had no severe comorbidity, a high-risk of recurrence, and were younger than 75. Toxicity was coded by NCI-CTC. Toxicity and compliance were compared between two age subgroups (<65, ≥ 65) by Fisher exact test and exact Wilcoxon rank-sum test. From March 1991 to March 2002, 180 patients were identified, 100 older than 60 and younger than 65, and 80 aged 65 or older. Febrile neutropenia was more frequent among older patients (p = 0.05). Leukopenia, neutropenia, nausea, cardiac toxicity and thrombophlebitis tended to be more frequent or severe among elderlies, while mucositis tended to be more evident among younger patients, all not significantly. Almost one half (47%) of the older patients receiving concomitant radiotherapy experienced grade 3–4 haematological toxicity. Compliance was similar in the two groups, with 6 cycles administered in 86% and 79%, day-8 chemotherapy omitted at least once in 36% and 39%, dose reduction in 27% and 38%, prolonged treatment duration (≥ 29 weeks) in 10% and 11% and need of G-CSF in 9% and 18%, among younger and older patients, respectively. Our data show that, in a highly selected population of patients 65 or more years old, CMF is as feasible as in patients older than 60 and younger than 65, but with a relevant burden of toxicity. We suggest that prospective trials in elderly patients testing less toxic treatment schemes are mandatory before indicating adjuvant chemotherapy to all elderly patients with significant risk of breast cancer recurrence

  11. Compliance and toxicity of adjuvant CMF in elderly breast cancer patients: a single-center experience

    Science.gov (United States)

    De Maio, Ermelinda; Gravina, Adriano; Pacilio, Carmen; Amabile, Gerardo; Labonia, Vincenzo; Landi, Gabriella; Nuzzo, Francesco; Rossi, Emanuela; D'Aiuto, Giuseppe; Capasso, Immacolata; Rinaldo, Massimo; Morrica, Brunello; Elmo, Massimo; Di Maio, Massimo; Perrone, Francesco; de Matteis, Andrea

    2005-01-01

    Background Few data are available on compliance and safety of adjuvant chemotherapy when indicated in elderly breast cancer patients; CMF (cyclophosphamide, methotrexate, fluorouracil) can be reasonably considered the most widely accepted standard of treatment. Methods We retrospectively reviewed compliance and safety of adjuvant CMF in patients older than 60. The treatment was indicated if patients had no severe comorbidity, a high-risk of recurrence, and were younger than 75. Toxicity was coded by NCI-CTC. Toxicity and compliance were compared between two age subgroups (<65, ≥ 65) by Fisher exact test and exact Wilcoxon rank-sum test. Results From March 1991 to March 2002, 180 patients were identified, 100 older than 60 and younger than 65, and 80 aged 65 or older. Febrile neutropenia was more frequent among older patients (p = 0.05). Leukopenia, neutropenia, nausea, cardiac toxicity and thrombophlebitis tended to be more frequent or severe among elderlies, while mucositis tended to be more evident among younger patients, all not significantly. Almost one half (47%) of the older patients receiving concomitant radiotherapy experienced grade 3–4 haematological toxicity. Compliance was similar in the two groups, with 6 cycles administered in 86% and 79%, day-8 chemotherapy omitted at least once in 36% and 39%, dose reduction in 27% and 38%, prolonged treatment duration (≥ 29 weeks) in 10% and 11% and need of G-CSF in 9% and 18%, among younger and older patients, respectively. Conclusion Our data show that, in a highly selected population of patients 65 or more years old, CMF is as feasible as in patients older than 60 and younger than 65, but with a relevant burden of toxicity. We suggest that prospective trials in elderly patients testing less toxic treatment schemes are mandatory before indicating adjuvant chemotherapy to all elderly patients with significant risk of breast cancer recurrence. PMID:15790416

  12. Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome

    OpenAIRE

    Holtkamp, M; Buchheim, K; Unterberg, A; Hoffmann, O; Schielke, E; Weber, J; Masuhr, F

    2001-01-01

    OBJECTIVE—To assess the survival rate and functional outcome in elderly patients with space occupying supratentorial infarction who underwent hemicraniectomy compared with those who received medical treatment alone.
METHODS—All patients older than 55 years with space occupying middle cerebral artery (MCA) infarction treated in our clinic between January 1998 and July 1999 were included in this retrospective analysis. Patients were eligible for decompressive surgery if they w...

  13. Compliance and toxicity of adjuvant CMF in elderly breast cancer patients: a single-center experience

    Directory of Open Access Journals (Sweden)

    Rinaldo Massimo

    2005-03-01

    Full Text Available Abstract Background Few data are available on compliance and safety of adjuvant chemotherapy when indicated in elderly breast cancer patients; CMF (cyclophosphamide, methotrexate, fluorouracil can be reasonably considered the most widely accepted standard of treatment. Methods We retrospectively reviewed compliance and safety of adjuvant CMF in patients older than 60. The treatment was indicated if patients had no severe comorbidity, a high-risk of recurrence, and were younger than 75. Toxicity was coded by NCI-CTC. Toxicity and compliance were compared between two age subgroups ( Results From March 1991 to March 2002, 180 patients were identified, 100 older than 60 and younger than 65, and 80 aged 65 or older. Febrile neutropenia was more frequent among older patients (p = 0.05. Leukopenia, neutropenia, nausea, cardiac toxicity and thrombophlebitis tended to be more frequent or severe among elderlies, while mucositis tended to be more evident among younger patients, all not significantly. Almost one half (47% of the older patients receiving concomitant radiotherapy experienced grade 3–4 haematological toxicity. Compliance was similar in the two groups, with 6 cycles administered in 86% and 79%, day-8 chemotherapy omitted at least once in 36% and 39%, dose reduction in 27% and 38%, prolonged treatment duration (≥ 29 weeks in 10% and 11% and need of G-CSF in 9% and 18%, among younger and older patients, respectively. Conclusion Our data show that, in a highly selected population of patients 65 or more years old, CMF is as feasible as in patients older than 60 and younger than 65, but with a relevant burden of toxicity. We suggest that prospective trials in elderly patients testing less toxic treatment schemes are mandatory before indicating adjuvant chemotherapy to all elderly patients with significant risk of breast cancer recurrence.

  14. The orodental status of a group of elderly in-patients: a preliminary assessment.

    Science.gov (United States)

    McNally, L; Gosney, M A; Doherty, U; Field, E A

    1999-12-01

    To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients. Cross-sectional. Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside. 150 patients aged 58 to 94 years, in which a history could be validated at interview. Questionnaire administered by dentist and clinical examination. Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology. Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61% had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology. The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.

  15. Patterns of Care in Elderly Head-and-Neck Cancer Radiation Oncology Patients: A Single-Center Cohort Study

    International Nuclear Information System (INIS)

    Huang Shaohui; O'Sullivan, Brian; Waldron, John; Lockwood, Gina; Bayley, Andrew; Kim, John; Cummings, Bernard; Dawson, Laura A.; Hope, Andrew; Cho, John; Witterick, Ian; Chen, Eric X.; Ringash, Jolie

    2011-01-01

    Purpose: To compare the patterns of care for elderly head-and-neck cancer patients with those of younger patients. Methods and Materials: A retrospective review was conducted of all new mucosal head-and-neck cancer referrals to radiation oncology between July 1, 2003 and December 31, 2007 at our institution. The clinical characteristics, treatment pattern, tolerance, and outcomes were compared between the elderly (aged ≥75 years) and younger (aged <75 years) cohorts. Results: A total of 2,312 patients, including 452 (20%) elderly and 1,860 (80%) younger patients, were studied. The elderly patients were more likely to be women (36% vs. 27%, p <.01) and to have other malignancies (23% vs. 13%, p <.01), Stage I or II disease (38% vs. 32%, p <.01), and N0 status (56% vs. 42%, p <.01). Treatment was less often curative in intent (79% vs. 93%, p <.01). For the 1,487 patients who received definitive radiotherapy (RT), no differences were found between the elderly (n = 238) and younger (n = 1,249) patients in treatment interruption, completion, or treatment-related death. Within the subset of 760 patients who received intensified treatment (concurrent chemoradiotherapy or hyperfractionated accelerated RT), no difference was seen between the elderly (n = 46) and younger (n = 714) patients in treatment interruption, completion, or treatment-related death. After a median follow-up of 2.5 years, the 2-year cause-specific survival rate after definitive RT was 72% (range, 65-78%) for the elderly vs. 86% (range, 84-88%) for the younger patients (p <.01). Conclusion: Elderly head-and-neck cancer patients exhibited different clinical characteristics and experienced different patterns of care from younger patients. Although age itself was an adverse predictor of cause-specific survival, its effect was modest. Elderly patients selected for definitive RT or intensified RT showed no evidence of impaired treatment tolerance.

  16. Serum interleukin-6 is related to lower cognitive functioning in elderly patients with major depression.

    Science.gov (United States)

    Ali, Nehad Samir; Hashem, Abdel Hamid Hashem; Hassan, Akmal Mostafa; Saleh, Alia Adel; El-Baz, Heba Nabil

    2017-03-24

    There is an increased evidence of an association between inflammatory mediators, particularly serum IL-6, depression and cognitive impairment in the elderly. This study aims at exploring the relation of peripheral IL-6 to cognitive functions in elderly patients with major depressive disorder (MDD). (1) Assessment of serum IL-6 levels and cognitive functions in elderly patients suffering from major depression and comparing them to healthy age-matched control subjects; (2) correlation between serum IL-6 levels and clinical characteristics of depression and cognitive functions in these patients. The study is an observational, case-control study. It consisted of 80 subjects, 40 with the diagnosis of MDD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) with early onset (first episode before the age of 60) and 40 community-dwelling subjects. They were subjected to the Structured Clinical Interview according to DSM-IV, Montreal Cognitive Assessment, Montgomery Asberg Depression Rating Scale, and serum IL-6 assay using ELISA. In the depression group, subjects had lower scores in cognitive testing, than the control group (p = 0.001). Serum IL-6 was found to have a negative correlation with cognitive testing in these patients even after controlling for the severity of depressive status and Body Mass Index (BMI) (p = 0.025). MDD in elderly subjects is associated with decline in cognitive functions that may be related to peripheral IL-6 levels.

  17. The Course of Adverse Effects of Nortriptyline and Venlafaxine in Elderly Patients with Major Depression

    NARCIS (Netherlands)

    Kok, Rob M.; Aartsen, Marja; Nolen, Willem A.; Heeren, Thea J.

    2009-01-01

    OBJECTIVES To evaluate tolerability and course of adverse effects of antidepressants in elderly patients and to study the association between number and severity of adverse effects and age, physical comorbidity, antidepressant dose. and depression severity. DESIGN Double-blind, randomized controlled

  18. Efficacy, safety and tolerability of rasagiline as adjunctive therapy in elderly patients with Parkinson's disease.

    Science.gov (United States)

    Tolosa, E; Stern, M B

    2012-02-01

    Rasagiline, an MAO-B inhibitor, is indicated for the treatment of Parkinson's disease (PD). In this post hoc analysis, the efficacy, safety and tolerability of rasagiline as an adjunct to levodopa were compared with placebo in elderly (≥70 years) and younger (Rasagiline: Efficacy and Safety on the Treatment of 'OFF' and Lasting effect in Adjunct therapy with Rasagiline Given Once daily randomized, double-blind, placebo-controlled trials with the primary efficacy end-point being the reduction from baseline in daily OFF time. Secondary efficacy end-points included scores for Clinical Global Improvement (CGI)-Examiner during ON time, Unified Parkinson's Disease Rating Scale (UPDRS)-ADL during OFF time, UPDRS-Motor during ON time and total daily ON time with and without troublesome dyskinesia. Tolerability was evaluated from adverse events (AEs) in the two age groups. Rasagiline decreased daily OFF time versus placebo (Prasagiline but were not significant. Between-group comparisons (≥70 vs. 0.1), and rasagiline was well tolerated amongst both groups of patients with a comparable incidence of total and dopaminergic AEs (P>0.1). Adjunct rasagiline is efficacious and well tolerated in elderly non-demented patients (≥70 years) with moderate to advanced PD. Confirmation of the efficacy and safety of rasagiline in the elderly patient subgroup is especially relevant because of the increasing number of elderly patients with PD. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

  19. Preoperative Nutrition Status and Postoperative Outcome in Elderly General Surgery Patients: A Systematic Review

    NARCIS (Netherlands)

    van Stijn, Mireille F. M.; Korkic-Halilovic, Ines; Bakker, Marjan S. M.; van der Ploeg, Tjeerd; van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2013-01-01

    Background: Poor nutrition status is considered a risk factor for postoperative complications in the adult population. In elderly patients, who often have a poor nutrition status, this relationship has not been substantiated. Thus, the aim of this systematic review was to assess the merit of

  20. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients – focus on esomeprazole

    Directory of Open Access Journals (Sweden)

    Tang RS

    2013-10-01

    Full Text Available Raymond SY Tang, Justin CY Wu Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Abstract: Peptic ulcer disease (PUD and gastroesophageal reflux disease (GERD are not uncommon in elderly patients. Clinical presentations of these acid-related disorders may be atypical in the geriatric population. Older individuals are at increased risk for poor outcomes in complicated PUD and for development of GERD complications. Multiple risk factors (eg, Helicobacter pylori [HP], use of nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin contribute to the development of PUD. Recent data has shown that HP-negative, NSAID-negative idiopathic peptic ulcers are on the rise and carry a higher risk of recurrent ulcer bleeding and mortality. Effective management of PUD in the geriatric population relies on identification and modification of treatable risk factors. Elderly patients with GERD often require long-term acid suppressive therapy. Proton pump inhibitors (PPI including esomeprazole are effective in the treatment of reflux esophagitis, maintenance of GERD symptomatic control, and management of PUD as well as its complications. Potential safety concerns of long-term PPI use have been reported in the literature. Clinicians should balance the risks and benefits before committing elderly patients to long-term PPI therapy. Keywords: elderly patients, peptic ulcer disease, gastroesophageal reflux disease, proton pump inhibitor, esomeprazole

  1. An Unusual Foreign Body in the Ear of an Elderly Nigerian Patient ...

    African Journals Online (AJOL)

    This was a case of an incidental finding of an unusual foreign body in the right ear of an elderly Nigerian patient. The mode of presentation, the manner of discovery and how it was managed successfully were highlighted. We reported this case to create awareness, and encourage physicians to always observe effluents ...

  2. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

    International Nuclear Information System (INIS)

    Franca, Manuela; Certo, Manuela; Varzim, Pedro; Silva, Donzilia; Peixoto, Carlos

    2010-01-01

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  3. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

    Energy Technology Data Exchange (ETDEWEB)

    Franca, Manuela; Certo, Manuela; Varzim, Pedro [Centro Hospitalar do Porto, Radiology Department, Porto (Portugal); Silva, Donzilia [Centro Hospitalar do Porto, Surgery Department, Porto (Portugal); Peixoto, Carlos [Centro Hospitalar do Porto, Pathology Department, Porto (Portugal)

    2010-10-15

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  4. The prevalence of bipolar spectrum disorder in elderly patients with recurrent depression

    Science.gov (United States)

    Lee, Chang-In; Jung, Young-Eun; Kim, Moon-Doo; Hong, Seong-Chul; Bahk, Won-Myong; Yoon, Bo-Hyun

    2014-01-01

    Purpose Despite a growing body of knowledge on bipolar spectrum disorder (BSD), relatively little is known about the clinical characteristics of BSD in elderly people. We investigated the prevalence of BSD in elderly patients with recurrent depression. Patients and methods A total of 65 elderly outpatients (≥60 years of age) who met the Diagnostic and Statistical Manual of Mental Disorders IV criteria for recurrent major depressive disorder participated in the study. BSD was diagnosed according to the criteria developed by Ghaemi et al and the Mood Disorder Questionnaire (MDQ) was used to assess bipolarity. Results Of 65 subjects, eleven (16.9%) and 54 (83.1%) were diagnosed with BSD and unipolar depression, respectively. A total of 32.3% (n=22) had a positive screen for bipolar disorder, and we found a significant association between the BSD criteria and the criteria for a positive MDQ (Ppersonality (P=0.001), and atypical depression (P=0.030) were highly associated with MDQ-positive patients. Conclusion Our results indicate that many depressed elderly patients have bipolar-related illness; moreover, some features of the depression are associated with bipolarity. PMID:24855364

  5. Vitamin Status and the Development of Postoperative Cognitive Decline in Elderly Surgical Oncologic Patients

    NARCIS (Netherlands)

    Weerink, Linda B. M.; van Leeuwen, Barbara L.; Gernaat, Sofie A. M.; Absalom, Anthony R.; Huisman, Monique G.; van der Wal-Huisman, Hanneke; Izaks, Gerbrand J.; de Bock, Geertruida H.

    Background. This study aimed to evaluate the influence that serum levels of vitamin B12, folate, and homocysteine have on the development of short-term postoperative cognitive decline in the elderly surgical oncology patient. Methods. This study was part of a prospective cohort study focused on

  6. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics

    NARCIS (Netherlands)

    Maarsingh, Otto R.; Dros, Jacquelien; Schellevis, François G.; van Weert, Henk C.; Bindels, Patrick J.; Horst, Henriette E. van der

    2010-01-01

    Although dizziness in elderly patients is very common in family practice, most prevalence studies on dizziness are community-based and include a study population that is not representative of family practice. The aim of this study was to investigate the prevalence and incidence of dizziness reported

  7. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics

    NARCIS (Netherlands)

    Maarsingh, O.R.; Dros, J.; Schellevis, F.G.; van Weert, H.C.; Bindels, P.J.; van der Horst, H.E.

    2010-01-01

    Background: Although dizziness in elderly patients is very common in family practice, most prevalence studies on dizziness are community-based and include a study population that is not representative of family practice. The aim of this study was to investigate the prevalence and incidence of

  8. Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation

    DEFF Research Database (Denmark)

    Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa

    2018-01-01

    BACKGROUND: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. DESIGN: We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling el...

  9. Profile and causes of mortality among elderly patients seen in a ...

    African Journals Online (AJOL)

    Ramakantb

    aim of this study was to examine causes and pattern of death among elderly patients managed in a tertiary care hospital in Nigeria with ... to University of Ilorin Teaching Hospital (UITH), Ilorin, between January 2005 and June 2007. Excluded were all ..... Part of the limitations of this study is its hospital- based nature and lack ...

  10. Is Routine Preoperative Chest X-ray Indicated in Elderly Patients ...

    African Journals Online (AJOL)

    Background: In our hospital pre-operative chest x-ray (CXR) are routinely requested without prior establishment of any medical indication for patients of 70 or more years of age who are undergoing elective surgery. The aim of this study was to determine if routine preoperative chest x-rays are justifiably indicated for elderly ...

  11. Survival Patterns in Elderly Head and Neck Squamous Cell Carcinoma Patients Treated With Definitive Radiation Therapy

    NARCIS (Netherlands)

    Sommers, Linda W.; Steenbakkers, Roel J. H. M.; Bijl, Henk P.; Vemer-van den Hoek, Johanna G. M.; Roodenburg, Jan L. N.; Oosting, Sjoukje F.; Halmos, Gyorgy B.; de Rooij, Sophia E.; Langendijk, Johannes A.

    2017-01-01

    PURPOSE: We sought to assess the effect of age on overall survival (OS), cancer-specific survival (CSS), and non-cancer-related death (NCRD) in elderly (aged ≥70 years) head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radiation therapy. The results were compared with

  12. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: An International Myeloma Working Group report

    NARCIS (Netherlands)

    A. Palumbo (Antonio); S. Bringhen (Sara); M.V. Mateos; A. Larocca (Alessandra); T. Facon (Thierry); S. Kumar (Shaji); M. Offidani (Massimo); P.L. McCarthy (Philip); A. Evangelista (Arturo); S. Lonial (Sagar); S. Zweegman (Sonja); P. Musto (Pellegrino); E. Terpos (Evangelos); A. Belch (Andrew); R. Hàjek (Roman); H. Ludwig (Heinz); A.K. Stewart (Keith); P. Moreau; K.C. Anderson (Kenneth); H. Einsele (Hermann); B.G.M. Durie (Brian); M.A. Dimopoulos (Meletios A.); O. Landgren; J.F.S. Miguel (Jesus F. San); P.G. Richardson (P.); P. Sonneveld (Pieter); S.V. Rajkumar (Vincent)

    2015-01-01

    textabstractWe conducted a pooled analysis of 869 individual newly diagnosed elderly patient data from 3 prospective trials. At diagnosis, a geriatric assessment had been performed. An additive scoring system (range 0-5), based on age, comorbidities, and cognitive and physical conditions, was

  13. Effects of Attention on Dichotic Listening in Elderly and Patients with Dementia of the Alzheimer Type

    Science.gov (United States)

    Bouma, Anke; Gootjes, Liselotte

    2011-01-01

    This article presents an overview of our studies in elderly and Alzheimer patients employing Kimura's dichotic digits paradigm as a measure for left hemispheric predominance for processing language stimuli. In addition to structural brain mechanisms, we demonstrated that attention modulates the direction and degree of ear asymmetry in dichotic…

  14. Symptoms and aetiology of delirium: a comparison of elderly and adult patients.

    Science.gov (United States)

    Grover, S; Agarwal, M; Sharma, A; Mattoo, S K; Avasthi, A; Chakrabarti, S; Malhotra, S; Kulhara, P; Bas, D

    2013-06-01

    OBJECTIVE. To compare the symptoms of delirium as assessed by the Delirium Rating Scale-Revised-98 (DRS-R-98) and associated aetiologies in adult and elderly patients seen in a consultation-liaison service. METHODS. A total of 321 consecutive patients with a DSM-IV-TR diagnosis of delirium were assessed on the DRS-R-98 and a study-specific aetiology checklist. RESULTS. Of the 321 patients, 245 (76%) aged 18 to 64 years formed the adult group, while 76 (24%) formed the elderly group (≥ 65 years). The prevalence and severity of various symptoms of delirium as assessed using the DRS-R-98 were similar across the 2 groups, except for the adult group having statistically higher prevalence and severity scores for thought process abnormalities and lability of affect. For both groups and the whole sample, factor analysis yielded a 3-factor model for the phenomenology. In the 2 groups, the DRS-R-98 item loadings showed subtle differences across various factors. The 2 groups were similar for the mean number of aetiologies associated with delirium, the mean number being 3. However, the 2 groups differed with respect to hepatic derangement, substance intoxication, withdrawal, and postpartum causes being more common in the adult group, in contrast lung disease and cardiac abnormalities were more common in the elderly group. CONCLUSION. Adult and elderly patients with delirium are similar with respect to the distribution of various symptoms, motor subtypes, and associated aetiologies.

  15. Preoperative strength training for elderly patients awaiting total knee arthroplasty.

    NARCIS (Netherlands)

    C.J. de Ruiter; Dr. D.M. van Leeuwen; P.A. Nolte; A. de Haan

    2014-01-01

    Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA). Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard

  16. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients

    Directory of Open Access Journals (Sweden)

    Karla Diaz

    2014-01-01

    Full Text Available Background: Obstructive sleep apnea (OSA is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA. Materials and Methods: This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA. Results: Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4% were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF, pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05. The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05. Conclusion: Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA

  17. Constipation prophylaxis reduces length of stay in elderly hospitalized heart failure patients with home laxative use.

    Science.gov (United States)

    Staller, Kyle; Khalili, Hamed; Kuo, Braden

    2015-11-01

    Elderly, hospitalized patients suffer disproportionately from constipation; however, little data suggest that constipation prophylaxis reduces length of stay (LOS). We performed a retrospective analysis of elderly patients admitted to our hospital with congestive heart failure (CHF) to determine the effects of constipation prophylaxis on LOS. Patients ≥ 65 years old admitted with the diagnosis of CHF in 2012 were evaluated for home and hospital laxative use on admission. Our primary outcome was LOS. We used linear regression modeling to independently evaluate the impact of constipation prophylaxis on LOS. Among 618 patients who were eligible for our study, 201 (32.5%) were using laxatives at home, whereas 254 (41.1%) were started on a prophylactic laxative on admission. There was no significant difference in LOS between patients receiving prophylaxis versus those who did not (P = 0.32). Patients with home laxative use had a 1 day longer LOS compared to those without laxative use (6 vs 5, P = 0.03). Among patients with home laxative use, there were 2 days longer LOS in those who were not given constipation prophylaxis on admission (8 vs 6, P = 0.002). After multivariate adjustment, failure to use constipation prophylaxis in patients with home laxative use was the only independent predictor of increased LOS (P = 0.03). Among elderly patients admitted for CHF exacerbations, failure to use constipation prophylaxis in patients with home laxative use is associated with a significantly longer LOS. Our data suggest that routine use of bowel prophylaxis for elderly CHF patients with preexisting constipation may reduce LOS. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  18. Evaluation of Pain Intensity Assessment Tools Among Elderly Patients With Cancer in Taiwan.

    Science.gov (United States)

    Chang, Hsien-Chen; Lai, Yeur-Hur; Lin, Kuan-Chia; Lee, Tzu-Ying; Lin, Hung-Ru

    Effective pain management requires careful assessment of pain. Auditory, visual, cognitive, and motor impairments in elderly people may affect their ability to use pain assessment tools. The aim of this study was to evaluate the reliability, validity, and no-response rate of pain scales among elderly patients with cancer pain, as well as patient preference for the scales. A cross-sectional correlational design was used with a convenience sample of 73 elderly cancer patients recruited at a cancer-based hospital in southern Taiwan. Participants were asked to rate their pain by using a numeric rating scale (NRS-11), a facial pain scale (FPS), a verbal descriptor scale (VDS), and a mixed scale (consisting of NRS-11, FPS, and VDS) on 2 consecutive days. Test-retest reliability, as indicated by Spearman rank correlation coefficients for the 24-hour interval pain ratings, ranged from 0.426 to 0.683. The criterion-related validity of the scales was supported by significant Spearman rank-order correlation. The time taken to respond to the scales ranged from 40.3 to 16.2 seconds. The no-response rates for the scales decreased in the order NRS-11 > FPS > mixed scale > VDS. Patient preference for the scales decreased in the order mixed scale > VDS > NRS-11 > FPS. All 4 scales were reliable and valid for assessing cancer pain among elderly patients. Because the no-response rates for the scales depended on educational level and cognitive function, nurses should exercise good judgment in choosing pain intensity assessment tools for use with elderly patients.

  19. Sleep EEG Characteristics in Young and Elderly Patients with Obstructive Sleep Apnea Syndrome.

    Science.gov (United States)

    Lee, Yu Jin; Kim, Jong Won; Lee, Yu-Jin G; Jeong, Do-Un

    2016-03-01

    In the present study, it was hypothesized that the sleep electroencephalogram (EEG) characteristics of young (55 yrs) OSAS patients would differ. We analyzed 76 sleep EEG recordings from OSAS patients (young group: n=40, mean age: 24.3±4.9 yrs; elderly group: n=36, mean age: 59.1±4.9 yrs), which were obtained during nocturnal polysomnography. The recordings were assessed via spectral analysis in the delta (0.5-4.5 Hz), theta (4.5-8 Hz), alpha (8-12 Hz), beta (12-32 Hz), slow sigma (11-13 Hz), and fast sigma (13-17 Hz) frequency bands. Apnea Hypopnea Index (AHI) and sleep efficiency (%) did not differ significantly between the two groups (19.8±14.4 vs. 25.9±16.0, p=0.085; 84.4±12.6 vs. 80.9±11.0, p=0.198, respectively). After adjusting for gender, the slow/fast sigma ratio was not significantly correlated with AHI in the elderly group (r=-0.047, p=0.790) but AHI was inversely correlated with the slow/fast sigma ratio in the young group (r=-0.423, p=0.007). A multiple linear regression analysis revealed that a higher AHI was related with a lower slow/fast sigma ratio in the young group (β=-0.392, p=0.028) but not the elderly. In the present study, sleep EEG activity differed between young and elderly OSAS patients. The slow/fast sigma ratio was associated with OSAS severity only in young patients, suggesting that young OSAS patients may have a distinctive brain plasticity compared with elderly patients.

  20. Patterns Of Antimicrobial Use For Respiratory Tract Infections In Elderly Patients

    International Nuclear Information System (INIS)

    Taha, H.M.; Rasheedy, D.; Mahmoud, A.H.

    2013-01-01

    Background: Elderly patients are prone to respiratory tract infections (RTIs) both; acute bronchitis and pneumonia. A large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. There is an increased need to decrease excess antibiotic use in elderly to minimize antibiotic resistance. Objective: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) among elderly Patients and methods: A cross sectional study was conducted on one hundred elderly patients, aged > 60 years, both males and females to describe patterns of antimicrobial use for respiratory tract infections (RTIs) among elderly patients. RTIs, categorized as acute bronchitis, and pneumonia, were studied for appropriateness of antimicrobial use, type of antibiotics used, and factors associated with their use. We rated antibiotic use as appropriate (when an effective drug was used), inappropriate (when a more effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). Results: Of 100 patients with RTI, overall treatment was appropriate in 79% of episodes, inappropriate in 9%, and unjustified in 12%. For acute bronchitis, treatment was appropriate in 85% and unjustified in 15% of cases. For pneumonia, treatment was appropriate in 55% of episodes. Among the most commonly used antimicrobials, B.Lactam + macrolides their use were unjustified in 41% of cases. There were statistical significant differences in the patterns of antibiotic use when stratified by age, gender, and co- morbid conditions including chronic obstructive pulmonary disease. Conclusion: Antimicrobials are unjustifiably used for 12% of RTIs and 15% of cases of acute bronchitis, thus suggesting a need for programs to improve antibiotic prescribing at hospitals.

  1. Chemotherapy in frail elderly patients with hormone-refractory prostate cancer: A “real world” experience

    Directory of Open Access Journals (Sweden)

    Paolo Tralongo

    2016-03-01

    Conclusion: Weekly docetaxel and oral metronomic vinorelbine are equally effective and well tolerated in elderly unfit and frail patients affected by mCRPC. Metronomic vinorelbine treatment is associated with higher patient compliance and satisfaction.

  2. Using Balanced Scorecard on Reducing Fall Incidents and Injuries Among Elderly Cancer Patients in a Medical Center in Taiwan

    Directory of Open Access Journals (Sweden)

    Jung-Mei Tsai

    2017-12-01

    Conclusion: The results of present study provided references to healthcare institutes using balanced scorecard management strategies as intervention to reduce to fall incidents and injuries in elderly cancer patients and to prompt patient safety and quality of care.

  3. Cutaneous Type of Nocardiosis Caused by Nocardia brasiliensis in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    Chen-Yi Su

    2012-06-01

    Full Text Available Acute soft tissue infection with Nocardia brasiliensis is an uncommon manifestation in the elderly. A case of cellulitis and an abscess on the foot due to N. brasiliensis in a 77-year-old man with chronic obstructive pulmonary disease is reported. N. brasiliensis was isolated from fluid from the bulla. Treatment with trimethoprim–sulfamethoxazole for 6 months led to complete resolution and no evidence of recurrence was noted. Nocardia infection must be considered in the differential diagnosis for elderly patients with soft tissue infection, especially in those with severe underlying diseases, and we suggest that trimethoprim–sulfamethoxazole is an effective and safe treatment.

  4. Benefits of Minimal Access Surgery in Elderly Patients with Pelvic Cancer

    Directory of Open Access Journals (Sweden)

    Vincent Lavoué

    2016-01-01

    Full Text Available An increasing proportion of patients requiring treatment for malignancy are elderly, which has created new challenges for oncologic surgeons. Aging is associated with an increasing prevalence of frailty and comorbidities that may affect the outcome of surgical procedures. By decreasing complications and shortening length of hospital stay without affecting oncologic safety, surgery performed using the robot, rather than traditional laparotomy, improves the chances of a better outcome in our growing elderly populations. In addition to age, surgeons should take into account factors, such as frailty and comorbidities that correlate with outcome.

  5. The effect of geriatric intervention in frail elderly patients receiving chemotherapy for colorectal cancer

    DEFF Research Database (Denmark)

    Lund, C M; Vistisen, K K; Dehlendorff, C

    2017-01-01

    BACKGROUND: Better surgical techniques, chemotherapy and biological therapy have improved survival in patients with colorectal cancer (CRC), most markedly in younger patients. About half of patients over 70 years receive dose reductions or early treatment discontinuation of the planned adjuvant...... or first-line treatment due to side effects. The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary evaluation of an elderly individual's health status. This assessment in older patients with cancer can predict survival, chemotherapy toxicity and morbidity. METHODS: This randomized phase II....... Secondary outcomes are dose reductions, treatment delays, toxicity, time to recurrence, survival, cancer-related mortality and quality of life. DISCUSSION: This ongoing trial is one of the first to evaluate the effect of geriatric intervention in frail elderly patients with CRC. The trial will provide new...

  6. Treatment of Myasthenia Gravis in Patients with Elderly Onset at Advanced Age

    Directory of Open Access Journals (Sweden)

    Noriko Nishikawa

    2015-01-01

    Full Text Available The number of patients with late-onset myasthenia gravis (MG among patients ≥50 years has been increasing recently. We encountered three patients who developed elderly-onset MG at a particularly advanced age (≥80 years. All were female and positive for anti-acetylcholine receptor antibodies. About 4 years have passed since MG onset in all three patients and symptoms have been controlled without recurrence using a combination of oral low-dose prednisolone and tacrolimus. As many cases of elderly-onset MG do not require strong immunosuppression, we recommend minimum immunosuppressive treatment to avoid adverse events, particularly in patients at an advanced age of ≥80 years.

  7. Blood transfusion and overall quality of life after hip fracture in frail elderly patients--the transfusion requirements in frail elderly randomized controlled trial.

    Science.gov (United States)

    Gregersen, Merete; Borris, Lars Carl; Damsgaard, Else Marie

    2015-09-01

    We examined possible associations between different red blood cell (RBC) transfusion strategies, overall quality of life (OQoL), and recovery of activities of daily living (ADL) in operated frail elderly hip fracture patients, and the possibility that OQoL was related to ADL recovery. A prospective, assessor-blinded, randomized controlled trial was carried out among 157 elderly residents (≥65 years) from nursing homes and sheltered housing facilities with Mini-Mental State Examination scores ≥5 points. Patients were assigned to either a restrictive RBC transfusion strategy [hemoglobin (Hb) elderly hip fracture patients are not associated. However, for survivors with less severe dementia, ADL recovery after 1 year is greater following a liberal transfusion strategy than a restrictive strategy. OQoL progress and ADL recovery were associated. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  8. Geographical variation in antipsychotic drug use in elderly patients with dementia

    DEFF Research Database (Denmark)

    Zakarias, Johanne Købstrup; Jensen-Dahm, Christina; Nørgaard, Ane

    2016-01-01

    BACKGROUND: Use of antipsychotics in elderly patients with dementia has decreased in the past decade due to safety regulations; however use is still high. Geographical variation may indicate discrepancies in clinical practice and lack of adherence to evidence-based guidelines for the management...... of behavioral symptoms. OBJECTIVE: To investigate potential geographical variances in use of antipsychotic drugs in dementia care. METHODS: A registry-based cross-sectional study in the entire elderly population of Denmark (≥65 years) conducted in 2012. Data included place of residence, prescriptions filled......, and hospital discharge diagnoses. Antipsychotic drug use among elderly with (n = 34,536) and without (n = 931,203) a dementia diagnosis was compared across the five regions and 98 municipalities in Denmark, adjusted for age and sex. RESULTS: In 2012, the national prevalence of antipsychotic drug use was 20...

  9. Geographical Variation in Antipsychotic Drug Use in Elderly Patients with Dementia

    DEFF Research Database (Denmark)

    Zakarias, Johanne Købstrup; Jensen-Dahm, Christina; Nørgaard, Ane

    2016-01-01

    BACKGROUND: Use of antipsychotics in elderly patients with dementia has decreased in the past decade due to safety regulations; however use is still high. Geographical variation may indicate discrepancies in clinical practice and lack of adherence to evidence-based guidelines for the management...... of behavioral symptoms. OBJECTIVE: To investigate potential geographical variances in use of antipsychotic drugs in dementia care. METHODS: A registry-based cross-sectional study in the entire elderly population of Denmark (≥65 years) conducted in 2012. Data included place of residence, prescriptions filled......, and hospital discharge diagnoses. Antipsychotic drug use among elderly with (n = 34,536) and without (n = 931,203) a dementia diagnosis was compared across the five regions and 98 municipalities in Denmark, adjusted for age and sex. RESULTS: In 2012, the national prevalence of antipsychotic drug use was 20...

  10. A modified total colonic exclusion for elderly patients with severe slow transit constipation.

    Science.gov (United States)

    Qian, Q; Jiang, C; Chen, Y; Ding, Z; Wu, Y; Zheng, K; Qin, Q; Liu, Z

    2014-07-01

    The aim of this study was to evaluate outcomes of total colonic exclusion with antiperistaltic ileorectal anastomosis (TCE-AIA) for elderly patients with slow transit constipation (STC). Elderly patients (defined as age >65) who underwent TCE-AIA for severe idiopathic STC between 2009 and 2012 at our institution were identified. Postoperative outcomes and routine follow-up were assessed using the Wexner constipation score (WCS), gastrointestinal quality of life index (GIQLI) and four-point postoperative satisfaction scales. A total of 13 elderly patients were met the inclusion criteria. Five patients (38.5%) were male, and eight patients (61.5%) were female. The mean age of this population was 74 years (range 63-82 years). The mean operative time was 55 min (range 28-32), and blood loss was minimal. The mean postoperative hospital stay was 6.7 days (range 5-12 days). The mean time until the first postoperative bowel movement was 4 days (range 2-8 days). There was no procedure-related mortality and no major in-hospital complications. The median duration of follow-up was 12.4 months (range 6-29 months). None of the 13 patients had fecal incontinence or recurrence of constipation at the follow-up end point. However, eight patients underwent colonoscopy during follow-up, and four patients presented with diversion colitis. The patients' preoperative WCS was 22.8 ± 3.3, and it had significantly improved to 5.4 ± 2.1 on 6 months after operation (p elderly patients with STC.

  11. Bowel preparation in CT colonography: electrolyte and renal function disturbances in the frail and elderly patient

    Energy Technology Data Exchange (ETDEWEB)

    Mc Laughlin, Patrick; Mc Sweeney, Sean; Mc Williams, Sebastian; O' Regan, Kevin; Kelly, Denis; Maher, Michael M. [Cork University Hospital, Department of Radiology, Cork (Ireland); Eustace, Joseph; O' Connor, Michael [Cork University Hospital, Department of Medicine, Cork (Ireland)

    2010-03-15

    Elderly patients are at increased risk of biochemical disturbances secondary to cathartic medications. This study investigates the renal function, electrolyte and clinical disturbances associated with CT colonography (CTC) with sodium picosulphate-magnesium citrate (SPS-MC) in a subgroup of frail, elderly patients. Patients aged over 70 years considered at risk of complication during SPS-MC administration by a physician specialised in care of the elderly were included in this retrospective study. Biochemical parameters pre- and post-CTC and the presence of co-morbidities were recorded. Imaging findings and quality of bowel preparation at CTC were graded by consensus by two radiologists. Of the 72 patients 56% had co-morbidities that caution the use of SPS-MC. No significant changes in serum urea, sodium, potassium or estimated glomerular filtration rate (eGFR) occurred post-CTC (p > 0.10). Serum magnesium increased by 0.11 mmol/L in 14 patients (p = 0.03) without clinical sequelae. Good overall preparation was achieved in 88% of patients, allowing confident identification of signs of colonic neoplasia in 20 patients (27%). A mild increase in serum magnesium but no other significant biochemical disturbance was observed. In our group CTC with SPS-MC was safe and effective; however, we advise an alternate preparation be considered in patients with decreased renal function due to decreased magnesium clearance. (orig.)

  12. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  13. Chemotherapy options for the elderly patient with advanced non-small cell lung cancer.

    LENUS (Irish Health Repository)

    Hennessy, B T

    2012-02-03

    Combination chemotherapy has been shown to improve overall survival compared with best supportive care in patients with advanced non-small cell lung cancer (NSCLC). The survival advantage is modest and was initially demonstrated with cisplatin-containing regimens in a large meta-analysis of randomized trials reported in 1995. Newer chemotherapy combinations have been shown to be better tolerated than older cisplatin-based combinations, and some trials have also shown greater efficacy and survival benefits with these newer combinations. Combination chemotherapy is, therefore, the currently accepted standard of care for patients with good performance statuses aged less than 70 years with advanced NSCLC. However, there are limited data from clinical trials to support the use of combination chemotherapy in elderly patients over 70 years of age with advanced NSCLC. Subgroup analyses of large randomized phase III trials suggest that elderly patients with good performance statuses do as well as younger patients treated with combination chemotherapy. There are few randomized trials reported that evaluate chemotherapy in patients aged greater than 70 years only. Based on data from trials performed by an Italian group, single-agent vinorelbine has been shown to have significant activity in elderly patients with advanced NSCLC and to be well tolerated by those patients with Eastern Cooperative Oncology Group performance statuses of two or less, with associated improvements in measures of global health.

  14. Serum growth hormone and insulin levels in elderly patients with essential hypertension

    International Nuclear Information System (INIS)

    Cai Jianlin; Ji Naijun; Mei Yibin; Fan Bifu; Wang Chengyao; Li Fuyuan; Tong Lijun; Chen Donghai; Guan Lihua

    2004-01-01

    Objective: To investigate the changes of serum growth hormone (GH) and insulin (IS) levels in elderly patients with essential hypertension (EH). Methods: Serum GH and IS levels were measured with RIA in 88 elderly patients (age 60-88) with EH and 40 normotensive controls. Results: Serum levels of GH were significantly lower and serum IS levels significantly higher in EH patients than those in the controls (t=3.769, p 0.05) . GH levels were most markedly decreased in stage III hypertensives and the differences in GH levels among patients of different stages (stage I, II, III) were significant (F=8.182, p 0.05). Both the differences of GH levels and IS levels among different grades (grade 1, 2, 3) patients were not significant, For different rick groups (low, moderate, high, very high), the differences in GH levels were significant (F=3.918, p 0.05). In EH patients with heart and/ or brain complications, GH levels were significantly lower than those in patients without complications (t=3.396, p<0.01). However, IS levels in two groups were about the same. Conclusion: In elderly EH patient, the serum levels of GH were significantly lower than those in the controls. The levels dropped continuously as the disease process worsened. For IS, the serum levels were higher than those in controls, but did not increase along with the disease process

  15. Potential drug-drug interactions with direct oral anticoagulants in elderly hospitalized patients.

    Science.gov (United States)

    Forbes, Heather L; Polasek, Thomas M

    2017-10-01

    To determine the prevalence and nature of potential drug-drug interactions (DDIs) with direct oral anticoagulants (DOACs) in elderly hospitalized patients. This was a retrospective observational study. Inclusion criteria were: aged over 65 years; taking apixaban, rivaroxaban or dabigatran; and admitted to the Repatriation General Hospital between April 2014 and July 2015. A list of clinically relevant 'perpetrator' drugs was compiled from product information, the Australian Medicines Handbook, the Australian National Prescribing Service resources, and local health network guidelines. The prevalence and nature of potential DDIs with DOACs was determined by comparing inpatient drug charts with the list of perpetrator drugs. There were 122 patients in the study with a mean age of 82 years. Most patients had nonvalvular atrial fibrillation and were taking DOACs to prevent thrombotic stroke (83%). Overall, 45 patients (37%) had a total of 54 potential DDIs. Thirty-five patients had potential pharmacodynamic DDIs with antidepressants, nonsteroidal anti-inflammatory drugs and antiplatelets (35/122, 29%). Nineteen patients had potential pharmacokinetic DDIs (19/122, 16%). Of these, 68% (13/19) were taking drugs that increase DOAC plasma concentrations (amiodarone, erythromycin, diltiazem or verapamil) and 32% (6/19) were taking drugs that decrease DOAC plasma concentrations (carbamazepine, primidone or phenytoin). There were no cases of patients taking contraindicated interacting drugs. Potential DDIs with DOACs in elderly hospital inpatients are relatively common, particularly interactions that may increase the risk of bleeding. The risk-benefit ratio of DOACs in elderly patients on polypharmacy should always be carefully considered.

  16. Functional outcomes of inpatient rehabilitation in very elderly patients with stroke: differences across three age groups.

    Science.gov (United States)

    Mutai, Hitoshi; Furukawa, Tomomi; Wakabayashi, Ayumi; Suzuki, Akihito; Hanihara, Tokiji

    2018-05-01

    Background As the population continues to age rapidly, clarifying the factors affecting the prognosis in very elderly stroke patients is essential to enhance the quality of their rehabilitation. Objectives To compare the functional recovery of elderly stroke patients classified into three age groups and to identify the predictors of functional recovery in the very elderly following acute inpatient rehabilitation. Methods Observational study: We collected data on 461 stroke patients in the neurology and neurosurgery ward and classified them into three age groups (65-74, 75-84, and ≥ 85 years). Functional recovery was compared among groups using the functional independence measure (FIM) at discharge and ADL recovery rate was compared using the Montebello rehabilitation factor score (MRFS). Multiple regression analysis was used to identify and compare the factors associated with functional recovery in each age group. Results Functional recovery in the ≥ 85 years group was lower than that in other age groups. Factors associated with activities of daily living (ADL) status (FIM at discharge) in the ≥ 85 years group were premorbid dependence (β = -0.183, p = 0.011), motor paralysis (β = -0.238, p = 0.001), and cognitive function (β = 0.586, p age increased. Factors associated with ADL recovery rates (MRFS) in the ≥ 85 years group were non-paretic limb function (β = -0.294, p = 0.004) and cognitive function (β = 0.201, p = 0.047). Conclusions This study identified the factors associated with functional recovery among very elderly stroke patients. Effective forms of rehabilitation for very elderly stroke patients that take these factors into consideration need to be investigated.

  17. Risk of Malignancy in a Nationwide Cohort of Elderly Inflammatory Bowel Disease Patients.

    Science.gov (United States)

    Khan, Nabeel; Vallarino, Carlos; Lissoos, Trevor; Darr, Umar; Luo, Michelle

    2017-11-01

    Management of elderly inflammatory bowel disease (IBD) patients (≥ 65 years of age) is complicated due to many factors, including a higher risk of cancer, which may impact therapeutic decisions. The aim of this study was to determine the risk of cancer among elderly IBD patients compared with younger IBD patients. Additionally, the absolute risk of malignancy and factors contributing to it were evaluated, and therapeutic patterns among the elderly were assessed. This retrospective cohort study extracted data from the Truven Health Analytics MarketScan ® database. Among adult IBD patients who were free of cancer before starting on corticosteroids, immunomodulators, or biologics, a Cox model for time to cancer was fitted that adjusted for several covariates, including time-dependent treatment. Baseline results were evaluated by age group, as were the incidence of cancer and the distribution of cancer subtypes. The elderly IBD cohort (n = 8788) had a higher prevalence of cancer and several other ailments before starting treatment, relative to the younger IBD cohort aged 18-64 years (n = 54,971). During follow-up, the elderly IBD cohort experienced a higher incidence of malignancy, confirmed by a hazard ratio (HR) of 3.04 (95% confidence interval [CI] 2.71-3.41) from the Cox model fit. The risk of cancer was also significantly associated with male sex (HR 0.82 female), duration of disease (HR 1.08), several comorbidities and corticosteroid use (HR 1.35), but not with the use of immunomodulators or biologics. Non-Hodgkin's lymphoma, urinary tract malignancy, and prostate, lung, and female breast cancers were observed more commonly in this elderly IBD cohort when compared with the same age group in the Surveillance, Epidemiology, and End Results (SEER) database. The elderly with IBD have a higher risk of malignancy when compared with younger IBD patients and the general age-matched population, with certain cancers being more common among these patients.

  18. Unsuspected Small-Bowel Crohn’s Disease in Elderly Patients Diagnosed by Video Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    Che-Yung Chao

    2018-01-01

    Full Text Available Background. Video capsule endoscopy (VCE is increasingly performed among the elderly for obscure bleeding. Our aim was to report on the utility of VCE to uncover unsuspected Crohn’s disease (CD in elderly patients. Methods. Retrospective review of VCE performed in elderly patients (≥70 y at a tertiary hospital (2010–2015. All underwent prior negative bidirectional endoscopies. CD diagnosis was based on consistent endoscopic findings, exclusion of other causes, and a Lewis endoscopic score (LS > 790 (moderate-to-severe inflammation. Those with lower LS (350–790 required histological confirmation. Known IBD cases were excluded. Results. 197 VCE were performed (mean age 78; range 70–93. Main indications were iron deficiency anemia (IDA, occult GI bleeding (OGIB, chronic abdominal pain, or diarrhea. Eight (4.1% were diagnosed as CD based on the aforementioned criteria. Fecal calprotectin (FCP was elevated in 7/8 (mean 580 μg/g. Mean LS was 1824. Small-bowel CD detected by VCE led to a change in management in 4/8. One patient had capsule retention secondary to NSAID induced stricture, requiring surgical retrieval. Conclusions. VCE can be safely performed in the elderly. A proportion of cases may have unsuspected small-bowel CD despite negative endoscopies. FCP was the best screening test. Diagnosis frequently changed management.

  19. Supra-Epiglottic Upper Airway Volume in Elderly Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

    Science.gov (United States)

    Boutet, Claire; Abdirahman Mohamed Moussa, Syad; Celle, Sébastien; Laurent, Bernard; Barthélémy, Jean-Claude; Barral, Fabrice-Guy; Roche, Frédéric

    2016-01-01

    Small upper airway measurements areas and high body mass index are recognized risk factors for obstructive sleep apnea syndrome (OSAS) in non-elderly populations; however, there is limited information regarding elderly patients. We evaluated whether upper airway volume is associated with OSAS and OSAS treated with continuous positive airway pressure (CPAP) treatment and whether BMI is correlated with upper airway volume and measurements in elderly subjects. In 60 volunteers aged 75.58±0.9 years: 20 OSAS, 20 OSAS chronically treated with CPAP, and 20 controls, semi-automatic segmentation, retropalatal distance and transverse diameter of the supra-epiglottic upper airway were evaluated using 3DT1-weighted magnetic resonance imaging. Anteroposterior to transverse diameter ratio was defined as retropalatar diameter/transverse diameter. There were no significant differences in supra-epiglottic upper airway volume between OSAS, CPAP treated patients, and controls. There were significant differences in retropalatal distance and anteroposterior to transverse diameter ratio between OSAS, CPAP treated patients, and controls (P = 0.008 and Psupra-epiglottic upper airway volume. In elderly subjects, OSAS and body mass index are not associated with changes in supra-epiglottic upper airway volume but are associated with modification of pharynx shape.

  20. Determinants of poor sleep quality in elderly patients with diabetes mellitus, hyperlipidemia and hypertension in Singapore.

    Science.gov (United States)

    Chiang, Grace S H; Sim, Brenda L H; Lee, Jeannette J M; Quah, Joanne H M

    2018-03-27

    AimThe objective of this study was to assess determinants of poor sleep quality which is an under-diagnosed and under-treated problem in elderly patients with diabetes mellitus, hyperlipidemia and hypertension. Poor sleep quality is linked to decreased quality of life, increased morbidity and mortality. Poor sleep quality is common in the elderly population with associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension. This is a cross-sectional study undertaken in the primary healthcare setting (Singhealth Polyclinics-Outram) in Singapore. Singaporeans aged 65 years and above who had at least one of the three cardiometabolic risk factors (diabetes, hypertension and hyperlipidemia) were identified. Responders' sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and were divided into those with good quality sleep and those with poor quality sleep, based on the PSQI score. Information on demographics, co-morbidities and lifestyle practices were collected. Descriptive and multivariate analyses of determinants of poor sleep were determined.FindingsThere were 199 responders (response rate 88.1%). Nocturia (adjusted prevalence rate ratio 1.54, 95% confidence interval 1.06-2.26) was found to be associated with an increased risk of poor sleep quality in elderly patients with diabetes mellitus, hypertension and hyperlipidaemia. Nocturia, a prevalent problem in the Asian elderly population, has been found to be associated with poor sleep quality in our study. Hence, it is imperative to identify and treat patients with nocturia to improve sleep quality among them.

  1. Partial pleural covering for intractable pneumothorax in patients with Birt-Hogg-Dubé Syndrome.

    Science.gov (United States)

    Okada, Akira; Hirono, Tatsuhiko; Watanabe, Takehiro; Hasegawa, Go; Tanaka, Reiko; Furuya, Mitsuko

    2017-03-01

    Birt-Hogg-Dubé syndrome (BHD) is an inherited disorder associated with a germline mutation of the folliculin (FLCN) gene. Most patients with BHD have multiple pulmonary cysts, and are at high risk of repeated pneumothorax. Although an increasing number of patients are diagnosed with BHD by genetic testing, therapeutic approaches for intractable pneumothorax have not yet been described. We treated three patients who had repeated episodes of pneumothorax. All had multiple pulmonary cysts in the lower lobes, and two had a family history of pneumothorax. Video-assisted thoracic surgery was used to perform wedge resections and partial pleural covering of the cystic lesions. The partial pleural covering technique used sheets of polyglycolic acid felt or regenerative oxidized cellulose mesh. The resected tissues underwent histopathological evaluation, and peripheral blood leukocytes were tested for FLCN mutations. The operative times were less than 2 h, and there were no complications. The resected cysts had histopathological features characteristic of BHD lung. All patients were found to have FLCN germline mutations; thus their repeated pneumothoraces were a manifestation of BHD. None of the patients developed respiratory problems after undergoing the partial pleural covering procedure, and they have all been well without pneumothorax for 30 months or more. Partial pleural covering combined with resection of protruding cysts should be a safe and effective therapeutic approach for BHD patients with intractable pneumothorax. Further investigation is needed to establish a detailed protocol for treatment of pneumothorax that results in minimal functional impairment. © 2015 John Wiley & Sons Ltd.

  2. Sensitivity of the dipstick in detecting bacteremic urinary tract infections in elderly hospitalized patients.

    Directory of Open Access Journals (Sweden)

    Zvi Shimoni

    Full Text Available The sensitivity of the dipstick in elderly patients with a suspected urinary tract infection (UTI is unclear because of the inclusion of patients with urine contamination or asymptomatic bacteriuria in previous studies.We selected consecutive patients aged 65 years or older hospitalized in internal medicine departments with bacteremic UTI (same organism in blood and urine cultures minimizing misclassifications. The false positive rate was determined in consecutive patients with negative culture results. A positive dipstick was a test result with a trace leukocyte esterase and/or nitrite positivity. Bacteriuria was the growth of at least 105 colony-forming units per milliliter of urine.Of 20,555 consecutive patients, 228 had a bacteremic UTI, and 4069 a negative culture result. The sensitivity of the dipstick was 96.9% (95% CI-93.7-98.6 with a false positive rate of 42.4% (95% CI, 41.0-43.8 in those with a negative culture result.In elderly hospitalized patients with a bacteremic UTI, the dipstick urinalysis is highly sensitive, much higher than reported previously in studies of UTIs in the elderly. It is unclear whether the observed high sensitivity of the dipstick was due to the exclusion of patients with asymptomatic bacteriuria or to spectrum bias. Studies of the clinical utility/disutility of using a negative dipstick to rule out a urinary tract infection are warranted.

  3. Side-to-Side Ileosigmoidostomy Shunting Surgery for the Treatment of Elderly Patients With Chronic Constipation.

    Science.gov (United States)

    Handaya, Yuda; Maryanto, Agung; Marijata

    2017-12-01

    Constipation is a digestive disorder that often occurs in the elderly; its main cause is bowel motility disorder. Treatments for patients with chronic constipation include pharmacotherapy, diet changes, and surgery if other therapies do not offer satisfactory results. We describe 4 patients, 2 men (70 and 65 years old) and 2 women (75 and 66 years old), who were diagnosed with chronic constipation (slow transit constipation) and treated with conventional therapy, but did not improve. For that reason, side-to-side ileosigmoidostomy shunting surgery was performed. After the surgery, the average time until normal defecation was 16 days, and the defecation frequency was 3 to 4 times a day with no need for a laxative. No patient had a recurrence of constipation. Based on these results, side-to-side ileosigmoidostomy shunting surgery is expected to restore digestive function and can be considered as an alternative therapy for elderly patients with chronic constipation.

  4. Admission of elderly medical patients to fast track or standard hospitalisation

    DEFF Research Database (Denmark)

    Strøm, Camilla; Rasmussen, Lars Simon; Rasmussen, Søren Wistisen

    2016-01-01

    patients. An interim safety analysis is scheduled. CONCLUSION: In the ELDER trial, we explore benefits and harms related to treatment in an SSU for elderly medical patients compared with standard hospitalisation. FUNDING: Region Zealand's Forskningsfond, the Tryg Foundation and University of Copenhagen...... are patients aged ≥ 75 years needing in-hospital treatment of an acute medical problem and who are stable upon admission. The primary outcome is 90-day all-cause mortality. Secondary outcomes include: length of stay in hospital, incidence of complications during hospitalisation, rate of unplanned readmissions...... and change in instrumental activities of daily living. We aim at recruiting 430 patients based on an estimated effects size of reducing mortality by 10%. All outcome measures will be assessed in an intention-to-treat analysis. Recruitment started on 5 January 2015. By 16 October 2015, we have enrolled 203...

  5. Observational cross-sectional study revealing less aggressive treatment in Japanese elderly than nonelderly patients with rheumatoid arthritis.

    Science.gov (United States)

    Ogasawara, Michihiro; Tamura, Naoto; Onuma, Shin; Kusaoi, Makio; Sekiya, Fumio; Matsudaira, Ran; Kempe, Kazuo; Yamaji, Ken; Takasaki, Yoshinari

    2010-12-01

    Elderly patients with rheumatoid arthritis (RA) have more aging-related complications than nonelderly patients with RA. The objective of the study was to investigate the treatment status of elderly patients with RA. Between January and March 2008, 969 patients with RA were enrolled in this observational cross-sectional study. Prescription of disease-modifying antirheumatic drugs (DMARDs) and corticosteroids and laboratory data related to RA, including matrix metalloproteinase 3, rheumatoid factor, and anti-cyclic citrullinated peptide antibody levels, were compared between the elderly and the nonelderly patients. Fewer DMARDs were prescribed to the elderly patients (1.40 [SD, 0.57] vs. 1.51 [SD, 0.61]; P = 0.029). Furthermore, a lower percentage of patients received methotrexate (MTX) (47.2% vs. 56.9%; P = 0.0001), a lower average dosage of MTX was administered (5.46 [SD, 1.66] mg/wk vs. 5.96 [SD, 1.77] mg/wk; P = 0.0001), and fewer biologic DMARDs were used (1.46% vs. 5.59% for infliximab, P = 0.0008; 0.58% vs. 3.19% for etanercept, P = 0.0038) in the elderly group. The laboratory data suggested that the disease status was uncontrolled to a greater extent, and complications were more common in the elderly group. Elderly patients with RA receive less aggressive treatment than nonelderly patients with RA, despite laboratory evidence for poorly controlled disease status among the elderly. The use of a less aggressive regimen could be attributed to the higher prevalence of complications and problems. Therefore, the elderly with RA should be considered a different patient population from the viewpoint of treatment and be administered specialized medical care.

  6. Cognitive and psychomotor effects of three months of escitalopram treatment in elderly patients with major depressive disorder

    NARCIS (Netherlands)

    Beheydt, L.L.; Schrijvers, D.L.; Docx, L.; Bouckaert, F.; Hulstijn, W.; Sabbe, B.G.C.

    2015-01-01

    Background Although psychomotor retardation (PR) and cognitive disfunctioning are essential symptoms of elderly depressed patients, the differential effect of treatment with an SSRI in the elderly on these symptoms has hardly got any attention in studies with objective experimental measures. Since

  7. Caregiver Objective Burden and Assessments of Patient-Centered, Family-Focused Care for Frail Elderly Veterans

    Science.gov (United States)

    Rose, Julia Hannum; Bowman, Karen F.; O'Toole, Elizabeth E.; Abbott, Katherine; Love, Thomas E.; Thomas, Charles; Dawson, Neal V.

    2007-01-01

    Purpose: There is a growing consensus that quality of care for frail elders should include family and be evaluated in terms of patient-centered, family-focused care (PCFFC). Family caregivers are in a unique and sometimes sole position to evaluate such care. In the context of caring for physically frail elders, this study examined the extent to…

  8. The impact of type of assistance on characteristics of peritonitis in elderly peritoneal dialysis patients.

    Science.gov (United States)

    Hsieh, Chun-Yih; Fang, Ji-Tseng; Yang, Chih-Wei; Lai, Ping-Chin; Hu, Sau-An; Chen, Yu-Ming; Yu, Chun-Chen; Tian, Ya-Chung; Chien, Chu-Chun; Hung, Cheng-Chieh

    2010-12-01

    The elderly patients are the fastest-growing end-stage renal disease (ESRD) population in Taiwan. Assisted peritoneal dialysis (PD) has been employed to overcome the barriers to PD. The aim of this retrospective, single-center study was to describe the status of assisted PD and the impact of type of assistance on peritonitis in elderly patients in Taiwan. One hundred and two patients initiated PD at the age of 65 or older between 2000 and 2008; 79 episodes of peritonitis occurred during the follow-ups. The patients and episodes of peritonitis were divided into three groups based on the type of assistance: (1) self-care: patients performing dialysis independently, (2) family: patients whose dialysis was performed by family, (3) caregiver: patients whose dialysis was performed by a private caregiver. Patient characteristics and incidence, etiology and outcomes of peritonitis were compared. There were 26 (25.5%), 44 (43.1%), and 32 (31.4%) patients in the self-care, family, and caregiver groups, respectively. The overall peritonitis rate was 1/33 patient-months. Patients in the caregiver group were older and had more comorbidities than the self-care group. They had a trend of higher overall peritonitis rate (1/24 patient-months, P = 0.077) and fungal peritonitis rate (P = 0.060) compared to the self-care and family groups, but this was statistically non-significant. Three-fourths of elderly PD patients in the present study required assistance from family members or private caregivers. Caregiver-assisted patients were significantly older and had more comorbidities. Also, a non-significant trend of higher peritonitis incidence was observed in these patients.

  9. A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients.

    Science.gov (United States)

    Yazar, Emine; Yılmaz, Canan; Bilgin, Hülya; Karasu, Derya; Bayraktar, Selcan; Apaydın, Yılmaz; Sayan, Halil Erkan

    2016-03-01

    The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Prospective clinical trial study. Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505).

  10. Pharmacokinetic and pharmacodynamic study of dexmedetomidine in elderly patients during spinal anesthesia.

    Science.gov (United States)

    Kuang, Yun; Zhang, Ran-Ran; Pei, Qi; Tan, Hong-Yi; Guo, Cheng-Xian; Huang, Jie; Xiang, Yu-Xia; Ouyang, Wen; Duan, Kai-Ming; Wang, Sai-Ying; Yang, Guo-Ping

    2015-12-01

    The application of dexmedetomidine in patient sedation is generally accepted, though its clinical application is limited because of the lack of information detailing the specific properties among diverse populations of patients. The aim of this study was to compare the pharmacokinetic and pharmacodynamic characteristics of dexmedetomidine between elderly and young patients during spinal anesthesia. 34 subjects (elderly group: n = 15; young group: n = 19) with spinal anesthesia were enrolled in the present study following the inclusion/exclusion criteria detailed below. All subjects received intravenous infusion of dexmedetomidine with a loading dose of 0.5 µg x kg⁻¹ for 10 minutes and a maintenance dose of 0.5 µg x kg⁻¹ x h⁻¹ for 50 minutes. Plasma concentrations of dexmedetomidine were detected by the HPLC-MS/MS method and pharmacokinetic parameters were calculated using WinNolin software. There was no significant difference between the elderly and young subjects in major pharmacokinetic parameters. There was a marked gender difference in the Cmax (peak plasma concentration) and tmax (time to reach Cmax) between genders in elderly subjects, though in this cohort the other pharmacokinetic parameters were not significantly different. In the young subjects there were no noteworthy variations between genders in pharmacokinetic parameters. There was no significant difference between the two groups in BISAUC(0-t) (the area under the bispectral index-time curve from time 0 to t hours), BISmin (the minimum value of the bispectral index after drug delivery), and or tmin-BIS (bispectral index for the minimum value of time). SBP (systolic blood pressure), DBP (diastolic blood pressure), HR (heart rate), and SpO₂(pulse oxygen saturation) developed substantive differences in a time-dependent manner, but there were no statistically significant differences in these four indicators in the time*group at three time points (1 hour, 2 hours, and 3 hours after drug

  11. Epidemiology of fractures of the proximal third of the femur in elderly patients

    OpenAIRE

    Daniachi, Daniel; Santos Netto, Alfredo dos; Ono, Nelson Keiske; Guimarães, Rodrigo Pereira; Polesello, Giancarlo Cavalli; Honda, Emerson Kiyoshi

    2015-01-01

    ABSTRACTOBJECTIVE: This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo. METHODS: The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the tre...

  12. Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis.

    Directory of Open Access Journals (Sweden)

    Seon Ha Baek

    Full Text Available The proportion of elderly patients beginning to undergo dialysis is increasing globally. Whether early referral (ER of elderly patients is associated with favorable outcomes remains under debate. We investigated the influence of referral timing on the mortality of elderly patients.We retrospectively assessed mortality in 820 patients aged ≥70 years with end-stage renal disease (ESRD who initiated hemodialysis at a tertiary university hospital between 2000 and 2010. Mortality data was obtained from the time of dialysis initiation until December 2010. We assigned patients to one of two groups according to the time of their first encounters with nephrologists: ER (≥ 3 months and late referral (LR; < 3 months.During a mean follow-up period of 25.1 months, the ER group showed a 24% reduced risk of long-term mortality relative to the LR group (HR = 0.760, P = 0.009. Rate of reduction in 90-day mortality for ER patients was 58% (HR = 0.422, P=0.012. However, the statistical significance of the difference in mortality rates between ER and LR group was not observed across age groups after 90 days. Old age, LR, central venous catheter, high white blood cell count and corrected Ca level, and lower levels of albumin, creatinine, hemoglobin, and sodium were significantly associated with increased risk of mortality.Timely referral was also associated with reduced mortality in elderly ESRD patients who initiated hemodialysis. In particular, the initial 90-day mortality reduction in ER patients contributed to mortality differences during the follow-up period.

  13. Risk factors of outcomes in elderly patients with acute ischemic stroke in China.

    Science.gov (United States)

    Wu, Qi; Zou, Chunying; Wu, Chengji; Zhang, Shuping; Huang, Zuoyi

    2016-08-01

    Stroke results in poor outcomes among elderly patients. However, the factors associated with outcome over different follow-up periods in this population are unknown. To evaluate the outcomes and risk factors of outcomes in elderly patients after stroke. Outcomes, including mortality, dependency (defined as a mRS >2), and recurrence rates, and associated risk factors were assessed at 3 and 12 months after stroke in patients aged ≥80 years. There were 419 acute ischemic stroke patients aged ≥80 years at 3 months, and 309 patients at 12 months; outcomes and relevant risk factors were assessed in these patients. Hypertension was more prevalent in women than in men. At 3 months, the mortality, dependency, and recurrence rates were 13.8, 54.2, and 18.1 %, respectively; the corresponding rates at 12 months were 26.9, 58.0, and 32.6 %, respectively. In the multivariate analysis, after adjusting by confounding factors, TOAST classification and stroke severity were associated with mortality and recurrence, while stroke severity was associated with dependency at 3 months. The mortality and dependency rates at 12 months were significantly associated with moderate and severe stroke, but severe stroke was an independent factor associated with recurrence. Stroke subtype and severity were associated with stroke outcomes among elderly patients in northern China. These findings suggest that it is crucial to highlight the affected factors of stroke outcome among elderly patients for reduce the burden of stroke in China.

  14. Effect of endovascular treatment on headache in elderly patients with unruptured intracranial aneurysms.

    Science.gov (United States)

    Gu, D-Q; Duan, C-Z; Li, X-F; He, X-Y; Lai, L-F; Su, S-X

    2013-01-01

    The incidence of unruptured intracranial aneurysms is increasing in the elderly population as life expectancy increases, and patients often present with headache. The goal of this study was to determine the effect of endovascular treatment on headache and identify factors associated with headache outcome in elderly patients with unruptured intracranial aneurysms. A retrospective study was conducted for elderly patients (≥ 65 years old) being treated for unruptured intracranial aneurysms. Headache assessment was performed by a quantitative 11-point headache scale in all patients before and after endovascular treatment. Factors associated with headache outcome were investigated by univariate analyses. A total of 72 patients (mean age, 70.0 years; age range, 65-80 years; 41 women) fulfilled the inclusion criteria. There were 52 patients (72.2%) who presented with preoperative headache (headache score ≥ 1). Among them, 40 (76.9%) reported that headache score had an improvement according to their self-reported quantitative headache score after endovascular treatment. The average headache score was 5.63 preoperatively vs 2.50 postoperatively (P = .000). Twenty patients (27.8%) had no headache before treatment (headache score = 0), of whom 2 (10.0%) reported new onset of headache postoperatively. Only a preoperative headache score was associated with treatment outcome of headache, and a higher headache score predicted a lack of headache relief after endovascular treatment (P = .003). Endovascular coiling of unruptured intracranial aneurysms resulted in relief of headache in most of the elderly patients. Preoperative headache score was the only statistically significant predictor of headache outcome.

  15. Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Johansson, M.; Cesarini, K.G.; Ronne-Engstroem, E.; Enblad, P.; Norbaeck, O.; Gal, G.; Tovi, M.; Solander, S.; Contant, C.F.

    2004-01-01

    Subarachnoid hemorrhage (SAH) is not an unusual disease in an elderly population. The clinical outcome has improved over time. It has been suggested that elderly SAH patients would benefit from endovascular aneurysm treatment. The aim of this study was to evaluate technical results and clinical outcome in a series of elderly SAH-patients treated with endovascular coil embolization. Sixty-two patients (≥ 65 years) presenting with aneurysmal SAH underwent early endovascular coil embolization at Uppsala University Hospital between September 1996 and December 2000. In all 62 cases included in the study, endovascular coil embolization was considered the first line of treatment. Admission variables, specific information on technical success, degree of occlusion and procedural complications, and outcome figures were recorded. Clinical grade on admission was Hunt and Hess (H and H) I-II in 39%, H and H III in 27% and H and H IV-V in 34% of the patients. The proportion of posterior circulation aneurysms was 24%. Coil embolization was successfully completed in 94%. The degree of occlusion of the treated aneurysm was complete occlusion in 56%, neck remnant in 21%, residual filling in 11%, other remnant in 5% and not treated in 6%. The rate of procedural complications was 11%. Outcome after 6 months was favorable in 41%, severe disability in 36% and poor in 22%. Favorable outcome was achieved in 57% of the H and H I-II patients, 47% of the H and H III patients and 17% of the H and H IV-V patients. Endovascular aneurysm treatment can be performed in elderly patients with SAH with a high level of technical success, acceptable aneurysm occlusion results, an acceptable rate of procedural complications and fair outcome results. (orig.)

  16. Shorter-Course Whole-Brain Radiotherapy for Brain Metastases in Elderly Patients

    International Nuclear Information System (INIS)

    Rades, Dirk; Evers, Jasmin N.; Veninga, Theo; Stalpers, Lukas J.A.; Lohynska, Radka; Schild, Steven E.

    2011-01-01

    Purpose: Many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone. Using 10 × 3 Gy in 2 weeks is the standard regimen in most centers. Regarding the extraordinarily poor survival prognosis of elderly patients with multiple brain metastases, a shorter WBRT regimen would be preferable. This study compared 10 × 3 Gy with 5 × 4 Gy in elderly patients (≥65 years). Methods and Materials: Data from 455 elderly patients who received WBRT alone for brain metastases were retrospectively analyzed. Survival and local (= intracerebral) control of 293 patients receiving 10 × 3 Gy were compared with 162 patients receiving 5 × 4 Gy. Eight additional potential prognostic factors were investigated including age, gender, Karnofsky performance score (KPS), primary tumor, number of brain metastases, interval from tumor diagnosis to WBRT, extracerebral metastases, and recursive partitioning analysis (RPA) class. Results: The 6-month overall survival rates were 29% after 5 × 4 Gy and 21% after 10 × 3 Gy (p = 0.020). The 6-month local control rates were 12% and 10%, respectively (p = 0.32). On multivariate analysis, improved overall survival was associated with KPS ≥ 70 (p < 0.001), only one to three brain metastases (p = 0.029), no extracerebral metastasis (p = 0.012), and lower RPA class (p < 0.001). Improved local control was associated with KPS ≥ 70 (p < 0.001), breast cancer (p = 0.029), and lower RPA class (p < 0.001). Conclusions: Shorter-course WBRT with 5 × 4 Gy was not inferior to 10 × 3 Gy with respect to overall survival or local control in elderly patients. 5 × 4 Gy appears preferable for the majority of these patients.

  17. Postprandial hypotension in clinical geriatric patients and healthy elderly: prevalence related to patient selection and diagnostic criteria.

    NARCIS (Netherlands)

    Orshoven, N.P. Van; Jansen, P.A.M.; Oudejans, I.; Schoon, Y.; Oey, P.L.

    2010-01-01

    The aims of this study were to find out whether Postprandial hypotension (PPH) occurs more frequently in patients admitted to a geriatric ward than in healthy elderly individuals, what the optimal interval between blood pressure measurements is in order to diagnose PPH and how often it is associated

  18. Characteristics of elderly cancer patients' concerns and their quality of life in Japan: a Web-based survey.

    Science.gov (United States)

    Nakanotani, Takako; Akechi, Tatsuo; Takayama, Tomoko; Karato, Atsuya; Kikuuchi, Yuki; Okamoto, Naoyuki; Katayama, Kayoko; Yokoo, Minori; Ogawa, Asao

    2014-05-01

    Cancer incidence and the number of cancer patients are increasing in today's aging society. The purpose of this study was to investigate the characteristics of elderly cancer patients' concerns and examine the association between their concerns and quality of life. This was a cross-sectional web-based survey completed by ambulatory cancer patients aged 20 years or older. The questionnaire on cancer patients' concerns, comprehensive concerns assessment tool and the European Organization for Research and Treatment of Cancer QLQ-C30 were distributed to the subjects. Multiple regression analysis was conducted to determine which patients' concerns significantly contributed to their quality of life. The final study population consisted of 807 cancer patients, among whom 243 (30%) were elderly (65 years or older). Elderly cancer patients had particular difficulty with self-management, psychological symptoms and medical information, and the prevalence of their concerns was generally lower than that of younger patients, with the exception of physical symptoms. Multiple types of elderly patients' concerns were independently associated with quality of life. We found that elderly cancer patients suffered from various concerns, thus multidisciplinary intervention is important for providing them with optimal care. The results of this study suggest that elderly cancer patients' quality of life will improve if their concerns are properly handled.

  19. Sleep quality, depression, and quality of life in elderly hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Turkmen K

    2012-10-01

    Full Text Available Kultigin Turkmen,1 Fatih Mehmet Erdur,1 Ibrahim Guney,2 Abduzhappar Gaipov,1 Faruk Turgut,3 Lutfullah Altintepe,2 Mustafa Saglam,1 Halil Zeki Tonbul,1 Emaad M Abdel-Rahman41Division of Nephrology, Meram School of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey; 2Division of Nephrology, Meram Research and Training Hospital, Meram, Konya, Turkey; 3Division of Nephrology, Iskenderun State Hospital, Iskenderun, Hatay, Turkey; 4Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USAObjective: Both the incidence and the prevalence of end-stage renal disease (ESRD in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ, depression, and health related quality of life (HRQoL in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients.Patients and methods: Sixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI, the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI were applied.Results: The prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher was 71% (45/63, and the prevalence of depression was 25% (16/63. Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03, significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = −0.500, P < 0.001 and Mental Component Scale

  20. Knowledge about and attitude toward electroconvulsive therapy of elderly patients with severe mental disorders

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2014-01-01

    Full Text Available Background: Electroconvulsive therapy (ECT is quite often used in elderly patients with severe mental disorders. One of the important factors which determine the acceptance of ECT among patients is the knowledge and attitude toward ECT. Aim: The present study attempted to assess the knowledge about and attitude toward ECT among elderly patients with severe mental disorders who had never received ECT. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using ECT knowledge and attitude questionnaires, among 102 clinically stable elderly patients with severe mental disorders. Results: Majority (n = 62; 60.8% of the patients obtained information mostly from "general word of mouth" or media (n = 23; 22.6%. None of the patients had full knowledge about ECT. Majority of the patients were not aware of the basic facts about ECT. Except for the fact that ECT involves use of electric current and can be given by a doctor, more than two-third of the patients were unaware of the basic facts about the procedure of ECT. Less than half of the patients were aware of the need for informed consent. Knowledge about indications, efficacy, and side effects of ECT was also very poor. In terms of attitude toward ECT, on most (15 out of 16 of the items, positive attitudes toward ECT were found in less than half of the patients (8.8-44.1%. In addition, significant proportions of patients were uncertain about their attitudes to ECT (35.3-66.7% or had a negative attitude toward ECT (4.9-32.4%. There was significant positive correlation between the total knowledge and attitude score, suggesting that higher knowledge was associated with more positive attitude and vice versa. There was no relationship of total knowledge and total attitude score with demographic and clinical variables. Conclusions: Elderly patients with severe mental disorders have poor knowledge, and a significant proportion of them have a negative attitude toward ECT. Accordingly, it is

  1. Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients: A Systematic Review.

    Science.gov (United States)

    Ge, Lixia; Mordiffi, Siti Zubaidah

    Caring for elderly cancer patients may cause multidimensional burden on family caregivers. Recognition of factors associated with caregiver burden is important for providing proactive support to caregivers at risk. The aim of this study was to identify factors associated with high caregiver burden among family caregivers of elderly cancer patients. A systematic search of 7 electronic databases was conducted from database inception to October 2014. The identified studies were screened, and full text was further assessed. The quality of included studies was assessed using a checklist, and relevant data were extracted using a predeveloped data extraction form. Best-evidence synthesis model was used for data synthesis. The search yielded a total of 3339 studies, and 7 studies involving 1233 family caregivers were included after screening and full assessment of 116 studies. Moderate evidence supported that younger caregivers, solid tumors, and assistance with patient's activities of daily living were significantly associated with high caregiver burden. Eighteen factors were supported by limited evidence, and 1 was a conflicting factor. The scientific literature to date proved that caregiver burden was commonly experienced by family caregivers of elderly cancer patients. The evidence indicated that family caregivers who were at younger age, caring for solid tumor patients, and providing assistance with patient's activities of daily living reported high caregiver burden. The data provide evidence in identifying family caregivers at high risk of high caregiver burden. More high-quality studies are needed to clarify and determine the estimates of the effects of individual factors.

  2. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Sah

    2017-03-01

    Full Text Available Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%, amlodipine (23.16%, paracetamol (17.6%, salbutamol (15.72% and vitamin B complex (13.26%. The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  4. In vivo biofilm formation on a soft denture liner in elderly patients with controlled diabetes.

    Science.gov (United States)

    Faccio, Daniela R; Pereira-Cenci, Tatiana; Cenci, Maximiliano S; Demarco, Flávio F; Moraes, Rafael R; Boscato, Noéli

    2012-06-01

    This in vivo study evaluated the influence of controlled diabetes on biofilm formation on a soft denture liner in elderly patients. Soft denture lining materials are more susceptible to microbial colonisation than denture base acrylic resins. Especially in the elderly, several predisposing factors may accumulate leading to an increased probability of biofilm development that may result in candidiasis, a significant clinical oral disease. Volunteers wearing complete dentures were divided into two groups (n = 20): diabetic patients with controlled glycaemia, and healthy patients. In both groups, a silicone-based soft liner was placed in a recess created at the base of the maxillary dentures. Subjects cleaned the prosthesis three times a day. Biofilm formed on the liner was quantified at various time points (baseline, two, four and six weeks). Data were analysed by two-way repeated measures ANOVA and Tukey's test (α = 0.05). There was no statistical difference in biofilm formation for any of the time points between controlled diabetes patients and healthy patients. The results suggest that the control of diabetes in elderly patients provides the same levels of biofilm formation when compared to healthy individuals. © 2010 The Gerodontology Society and John Wiley & Sons A/S.

  5. Impact of robotics on the outcome of elderly patients with endometrial cancer.

    Science.gov (United States)

    Lavoue, Vincent; Zeng, Xing; Lau, Susie; Press, Joshua Z; Abitbol, Jeremie; Gotlieb, Raphael; How, Jeffrey; Wang, Yifan; Gotlieb, Walter H

    2014-06-01

    To evaluate the impact of introducing a robotics program on clinical outcome of elderly patients with endometrial cancer. Evaluation and comparison of peri-operative morbidity and disease-free interval in 163 consecutive elderly patients (≥70years) with endometrial cancer undergoing staging procedure with traditional open surgery compared to robotic surgery. All consecutive patients ≥70years of age with endometrial cancer who underwent robotic surgery (n=113) were compared with all consecutive patients ≥70years of age (n=50) before the introduction of a robotic program in December 2007. Baseline patient characteristics were similar in both eras. Patients undergoing robotic surgery had longer mean operating times (244 compared with 217minutes, p=0.009) but fewer minor adverse events (17% compared with 60%, probotics cohort had less estimated mean blood loss (75 vs 334mL, probotics program for the treatment of endometrial cancer in the elderly has significant benefits, including lower minor complication rate, less operative blood loss and shorter hospitalization without compromising 2-year disease-free survival. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Intracranial traumatic lesion risk factors in elderly patients with minor head injury

    International Nuclear Information System (INIS)

    Kochi, Masato; Hori, Shigeaki

    2011-01-01

    The authors conducted a retrospective analysis of the risk factors of intracranial traumatic lesions in elderly patients with minor head injury. Sixty-nine elderly patients with Glasgow Coma Scale (GCS) scores of 13-15 after head injury who had presented within 24 hours of trauma and admitted to hospital were included in this study. The indications for admission were a GCS score of 13 or 14 on presentation, loss of consciousness, retrograde or posttraumatic amnesia, local neurological deficit, severe headache and vomiting, dangerous mechanism of injury, skull fracture and abnormal CT findings. The relationship between the clinical findings and intracranial traumatic lesions was analized by univariate and multivariate analysis. The relationship between the clinical findings and surgical intervention was also analized by the same methods in those who had intracranial traumatic lesions. The mean and median age of patients were 81.1 and 83 years, respectively. Of 69 patients, 41 had intracranial traumatic lesions present on their CT scan. Of these, 6 needed surgical intervention. Multivariable logistic regression analysis showed that a Glasgow Coma Scale score of 13 and a loss of consciousness at injury were identified as independent risk factors of intracranial traumatic lesions in elderly patients with minor head injury and a dangerous mechanism of injury was identified as an independent risk factor of surgical intervention in those who had traumatic intracranial lesions. Our results offer useful information for evaluating patients with minor head injury in Japan's aging society. (author)

  7. Rosuvastatin effect on intima media thickness in adult vs elderly patients.

    Science.gov (United States)

    Riccioni, Graziano; Scotti, Luca; Di Ilio, Emanuala; Bucciarelli, Valentina; D'Orazio, Nicolantonio; Aceto, Antonio; Bucciarelli, Tonino

    2012-06-01

    The benefits of cardiovascular therapies such as statins for the treatment of atherosclerosis have been well documented. Many studies have demonstrated important benefits in patients with asymptomatic carotid atherosclerosis. We have evaluated the effect of low dose of rosuvastatin on asymptomatic carotid atherosclerosis in elderly versus adult subjects. Among 640 participants in the Asymptomatic Carotid Atherosclerotic Disease In Manfredonia Study (ACADIM Study) forty-five patients (21 adults, 24 elderly) with hypercholesterolemia and asymptomatic carotid atherosclerosis on baseline carotid ultrasound investigation (CUI) were examined with repeat CUI after one treatment year with rosuvastatin (ROS) (10 mg/day). Total and low density lipoprotein cholesterol decreased significantly (p<0.001) while high density lipoprotein cholesterol increased significantly (p<0.001) during the intervention. Mean decrease in carotid intima media thickness (CIMT) of the right and left common carotid arteries were higher in adult versus elderly subjects (p<0.04 for each), even if in both group there was a significant regression in carotid atherosclerosis respect to baseline values (P<0.001). These results confirm the reduction in IMT of the CCAs in response to ROS at a low dose in a one-year treatment period, even if in elderly subjects this effect is lower respect to adult. The treatment of asymptomatic carotid atherosclerosis defined by CIMT started in the adult age is more effective.

  8. Factors Associated with Insomnia among Elderly Patients Attending a Geriatric Centre in Nigeria

    Directory of Open Access Journals (Sweden)

    Adetola M. Ogunbode

    2014-01-01

    Full Text Available Background. Insomnia is a form of chronic sleep problem of public health importance which impacts the life of elderly people negatively. Methods. Cross-sectional study of 843 elderly patients aged 60 years and above who presented consecutively at Geriatric Centre, University College Hospital, Ibadan, Nigeria. The World Health Organization Composite International Diagnostic Interview was used to diagnose insomnia. We assessed the following candidate variables which may be associated with insomnia such as socidemographic characteristics, morbidities, and lifestyle habits. Statistical analysis was done with SPSS 17. Results. The point prevalence of insomnia was 27.5%. Insomnia was significantly associated with being female, not being currently married, having formal education, living below the poverty line, and not being physically active. Health complaints of abdominal pain, generalized body pain, and persistent headaches were significantly associated with insomnia. Conclusion. The high prevalence of insomnia among elderly patients in this setting calls for concerted effort by healthcare workers to educate the elderly on lifestyle modification.

  9. A clinical study in elderly patients with Parkinson's disease using MRI and SPECT

    International Nuclear Information System (INIS)

    Umahara, Takahiko; Iwamoto, Toshihiko; Takasaki, Masaru; Katsunuma, Hideyo

    1991-01-01

    Parkinson's disease (PD) is often associated with dementia in elderly patients, and sometimes PD coexists with senile dementia of the Alzheimer type (SDAT) or cerebrovascular disease (CVD) in the elderly. However, since there are few previous clinical studies on the coincidence of, or relationship between PD and CVD, the authors evaluated these aspects in 34 elderly patients with PD using MRI and SPECT. All the patients were over 70 years old. The diagnosis of PD was based on the presence of three symptons (resting tremor, cogwheel rigidity and bradikinesia) which are characteristic of PD, and the effectiveness of L-DOPA therapy. We therefore believe that patients with vascular Parkinsonism were excluded from our study. In 34 cases, 24 (71%) had MRI evidence of CVD (mainly the lacunar state). In the 10 cases who had no CVD, 2 (20%) had severe dementia and the decrease of regional cerebral blood flow (rCBF) in the temporal and parietal lobes bilaterally correlated with the SPECT findings commonly found in SDAT. A comparison of the rCBF and the results of Hasegawa's dementia score (HDS) (verbal intelligence score) was made between the patients with PD associated with CVD and the patients with PD who had no CVD and no SPECT findings which correlated with SDAT. The rCBF in the frontal lobes and the results of the HDS of the former group were significantly lower than those of the latter. As mentioned above, elderly patients with PD often had CVD, leading to dementia. We also pointed out the difficulty in making a differential diagnosis between PD with CVD and vascular Parkinsonism, and the necessity of whether or not the concept of 'mixed type Parkinsonism' should be considered. (author)

  10. Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients.

    Science.gov (United States)

    Oishi, Hidenori; Yamamoto, Munetaka; Nonaka, Senshu; Shimizu, Takashi; Yoshida, Kensaku; Mitsuhashi, Takashi; Arai, Hajime

    2015-09-01

    We report the results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms (UIAs) in elderly patients (≥65 years). There were 375 elderly patients with 400 asymptomatic UIAs. Patients were divided into two groups: group A included patients aged 65-74 years and group B patients aged ≥75 years. Endovascular procedures were completed in 97.8% of patients. Immediate anatomical outcomes showed complete occlusion in 53.7%, residual neck in 18.9%, and residual aneurysm in 27.4%. Anatomical follow-ups (mean 36.3±28.1 months) were unchanged in 55.7%, improved in 22.6%, minor recurrence in 11.5%, and major recurrence in 10.2%. Procedure related complications occurred in 31 patients (8.3%). 15 patients had ischemic and 10 hemorrhagic complications. Retreatments were performed in 16 patients (4.3%). Among 366 patients technically completed, 363 (99.2%) showed a favorable clinical outcome (modified Rankin Scale (mRS) score 0 at 30 days. The latest clinical follow-up outcomes showed: mRS score 0 in 362 patients; mRS score 1 in one; mRS score 3 in one; mRS score 4 in one; and mRS score 5 in one patient. Permanent morbidity and mortality rates were 1.1% and 0%, respectively. There were no statistically significant differences in gender, comorbidities, aneurysm size, neck width, dome-to-neck ratio, immediate anatomical outcomes, anatomical follow-up outcomes, or procedure related complications between the groups. Endosaccular coil embolization is safe and feasible for elderly patients with asymptomatic UIAs. Old age itself should not be a contraindication. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. The Needs of Hospitalized Elderly Patients: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Nahid Rejeh

    2010-04-01

    Full Text Available Objectives: The aim of this study was to describe and explain older adults' perspectives on the experience of their hospitalization. Methods & Materials: This qualitative research adopted a content analysis approach. Twenty seven participants (65-81 years selected through a purposel sampling from three university hospitals in Tehran went through open in depth interviews. All the interviwes were taped, then transcribed verbatim and undertook content analysis using the method described by Kvale. Results: Six main contributing categories were emerged: Access to basic resources, participation in the process of care, empathy, respect and dignity, providing information, inducing hope and optimism Conclusion: These findings may help professionals to better understand the problems concerning the experience of hospitalization, to identify factors which decrease the stresses arising from the hospitalization and to find the ways to smooth the impact of the situation on the older people. The findings also emphasized the necessity of designing and implementing the nursing trainings in a way to better responds to the needs of elderly.

  12. Health Effect of Forest Bathing Trip on Elderly Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Jia, Bing Bing; Yang, Zhou Xin; Mao, Gen Xiang; Lyu, Yuan Dong; Wen, Xiao Lin; Xu, Wei Hong; Lyu, Xiao Ling; Cao, Yong Bao; Wang, Guo Fu

    2016-03-01

    Forest bathing trip is a short, leisurely visit to forest. In this study we determined the health effects of forest bathing trip on elderly patients with chronic obstructive pulmonary disease (COPD). The patients were randomly divided into two groups. One group was sent to forest, and the other was sent to an urban area as control. Flow cytometry, ELISA, and profile of mood states (POMS) evaluation were performed. In the forest group, we found a significant decrease of perforin and granzyme B expressions, accompanied by decreased levels of pro-inflammatory cytokines and stress hormones. Meanwhile, the scores in the negative subscales of POMS decreased after forest bathing trip. These results indicate that forest bathing trip has health effect on elderly COPD patients by reducing inflammation and stress level. Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  13. [Clinical thinking and decision making in practice. An elderly patient with vertigo and high sedimentation rate].

    Science.gov (United States)

    van Laar, J M; verschuuren, J J; de Meijer, P H

    1999-10-30

    A 77-year-old woman was admitted because of progressive vertigo, nausea and a dysarthric speech disorder. The patient's history of diabetes mellitus, hypertension and hypercholesterolaemia, and the finding of murmurs over peripheral arteries at physical examination led to a presumptive diagnosis of cerebellar ischaemia in the context of generalized atherosclerosis. However, the diagnosis was revised when bilateral cerebellar infarction was demonstrated radiologically, and a biopsy of a temporal artery revealed giant cell arteritis. Despite treatment with prednisone (60 mg daily) the patient's neurological condition deteriorated, and she succumbed several months later to pneumonia. The case illustrates the pitfalls in the diagnostic approach of elderly patients with multiple pathology and it also emphasizes that in an elderly person with high erythrocyte sedimentation rate (> 100 mm in the first hour) temporal arteritis should be ruled out as soon as possible to prevent further neurological damage.

  14. Balance in elderly patients: the "get-up and go" test.

    Science.gov (United States)

    Mathias, S; Nayak, U S; Isaacs, B

    1986-06-01

    The "get-up and go test" requires patients to stand up from a chair, walk a short distance, turn around, return, and sit down again. This test was conducted in 40 elderly patients with a range of balance function. Tests were recorded on video tapes, which were viewed by groups of observers from different medical backgrounds. Balance function was scored on a five-point scale. The same patients underwent laboratory tests of gait and balance. There was agreement among observers on the subjective scoring of the clinical test, and good correlation with laboratory tests. The get-up and go test proved to be a satisfactory clinical measure of balance in elderly people.

  15. Persistent thrombocytosis in elderly patients with rare hyposplenias that mimic essential thrombocythemia.

    Science.gov (United States)

    Imashuku, Shinsaku; Kudo, Naoko; Kubo, Kagekatsu; Takahashi, Naoto; Tohyama, Kaoru

    2012-06-01

    When elderly patients present with persistent thrombocytosis, myeloproliferative disease, iron-deficiency anemia or post-splenectomy status are suspected along with autoimmune diseases. Reported here are the cases of two elderly patients with persistent thrombocytosis due to hyposplenia, which is very rarely diagnosed in old age. Case 1 was a 72-year-old man whose thrombocytosis was due to non-familial type isolated congenital asplenia. Case 2 was a 74-year-old man whose thrombocytosis was caused by an atrophied spleen resulting from perforated stomach ulcer-related panperitonitis that had been treated 20 years previously. Both patients had thrombocyte counts exceeding >500,000/μl in association with small vestigial spleen tissue on a computed tomography scan and positive Howell-Jolly bodies on the blood smear. A correct diagnosis is essential for the management of persistent thrombocytosis.

  16. [Percutaneous nephrolithotomy for kidney stones in elderly patients: Meta-analysis of results and complications].

    Science.gov (United States)

    Haider, R; Regnier, P; Roustan, F-R; Séverac, F; Treacy, P-J; Mendel, L; Bodokh, Y; Tibi, B; Prader, R; Traxer, O; Chevallier, D; Amiel, J; Durand, M

    2017-02-01

    Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for kidney stones regardless of age. Elderly patients (EP)≥65years old, in growing numbers, have more comorbidities than the general population, may alter results of PCNL. The aim of this meta-analysis was to compare efficacy and complications of this procedure between EP and young patients (YP). Original studies of prospective and historical cohorts, in English or French, presenting PCNL series published on PubMed until 2015 were identified using the keywords percutaneous nephrolithotomy, elderly patients, kidney stones and staghorn calculi. Our analysis focused on therapeutic efficacy, defined by absence of residual fragment or the presence of residual fragmentskidney stones n EP is effective with a significantly increase the risk of postoperative blood transfusions compared to YP. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. A prospective analysis of urinary tract infections among elderly trauma patients.

    Science.gov (United States)

    Zielinski, Martin D; Kuntz, Melissa M; Polites, Stephanie F; Boggust, Andy; Nelson, Heidi; Khasawneh, Mohammad A; Jenkins, Donald H; Harmsen, Scott; Ballman, Karla V; Pieper, Rembert

    2015-10-01

    Catheter-associated urinary tract infections (CAUTIs) have been deemed "reasonably preventable" by the Centers for Medicare and Medicaid, thereby eliminating reimbursement. Elderly trauma patients, however, are at high risk for developing urinary tract infections (UTIs) given their extensive comorbidities, immobilization, and environmental changes in the urine, which provide the ideal environment for bacterial overgrowth. Whether these patients develop CAUTI as a complication of their hospitalization or have asymptomatic bacteriuria (ASB) or UTI at admission must be determined to justify the "reasonably preventable" classification. We hypothesize that a significant proportion of elderly patients will present with ASB or UTI at admission. Institutional review board permission was obtained to perform a prospective, observational clinical trial of all elderly (≥65 years) patients admitted to our Level I trauma center as a result of injury. Urinalysis (UA) and culture (UCx) were obtained at admission, 72 hours, and, if diagnosed with UTI, at 2 weeks after injury. Mean cost of UTI was calculated based on Centers for Disease Control and Prevention estimates of $862 to $1,007 per UTI. Of 201 eligible patients, 129 agreed to participate (64%). Mean (SD) age was 81 (8.6) years. All patients had a blunt mechanism of injury (76% falls), with a mean Injury Severity Score (ISS) of 13.8 (7.6). Of the 18 patients (14%) diagnosed with CAUTI, 14 (78%) were present at admission. In addition, there were 18 patients (14%) with ASB at admission. The most common bacterial species present at admission urine culture were Escherichia coli (24%) and Enterococcus (16%). Clinical features associated with bacteriuria at admission included a history of UTI, positive Gram stain result, abnormal microscopy, and pyuria. The estimated loss of reimbursement for 18 UTIs at admission was $15,516 to $18,126; however, given an estimated cost of $1,981 to screen all patients with UA and UCx at

  18. The influence of new scientific information on the treatment of elderly patients in general practice.

    Science.gov (United States)

    Kubesová, H; Holik, J; Bogrova, I

    2001-01-01

    It has been proven that with an increasing number of diseases elderly patients are treated by an increasing number of drugs despite the fact that treatment of elderly persons should be as simple as possible. Simpler dosage of (fewer?) drugs may contribute to a good cooperation on the part of patients, as well as to a lower incidence of undesirable effects and drug interactions. Sticking to established medication schemes is another feature observed in practice, which interferes with the introduction of novelties. The aim of this study was to investigate the actual situation of medication of elderly patients treated by general practitioners in this country. Between 1996 and 1998, a random group of 1481 patients aged older than 75 was studied in cooperation with general practitioners. A detailed history was obtained and physical examination was performed, signs of depression were assessed, Barthel's test of everyday activities, and IADL (activities of daily living) and MMSE (Mini Mental State Examination) tests were applied. A unified "Protocol on Examination" was used in which three questions were concerned with medication--the kinds of drugs taken by the patient, their names and dosage, and whether any hypnotics were taken. The five most frequently prescribed groups include vasodilators (62% patients), cardiotonics (39%), analgetics (41%) and Ca-antagonists (25%). The dynamics of the prescription were remarkable--a significant decrease of the use of analgetics and cardiotonics was observed in comparison with a significant increase in the use of ACE inhibitors. The number of drugs administered is as follows: while only 1.3% patients took no drugs, 1.6% patients took more than 13 drugs. 61% patients rank among the categories taking 4-5 or 6-8 kinds of drugs. On the whole, general practitioners tend to prescribe medicaments in doses one tablet per day. The results suggest that, even nowadays, elderly patients are treated with a rather high number of medicaments. In

  19. Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients.

    Science.gov (United States)

    Sahin, Abdurrahman; Tunc, Nurettin; Demirel, Ulvi; Kursat Poyrazoglu, Orhan; Yalniz, Mehmet; Halil Bahcecioglu, Ibrahim

    2018-04-01

    Objective To compare clinical and laboratory features of elderly patients with and without diverticulosis and assess factors related to hepatosteatosis. Method This retrospective case-control study analysed the clinical and laboratory data, colonoscopy and abdominal ultrasonography records of patients >65 years who underwent colonoscopies. Subjects were categorized according to the presence and absence of colonic diverticulosis. Univariate/multivariate logistic regression a