Modelling of Temperature-Attributable Mortality among the Elderly in Lisbon Metropolitan Area, Portugal: A Contribution to Local Strategy for Effective Prevention Plans

Abstract Background Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.

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Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases

Nutrients ◽

10.3390/nu13124337 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4337

Author(s):

Neri Maria Cristina ◽

d’Alba Lucia

Keyword(s):

Quality Of Life ◽

Elderly People ◽

Healthy Aging ◽

Well Being ◽

The Elderly ◽

Gastrointestinal Diseases ◽

The Body ◽

Fundamental Aspect ◽

Effective Prevention

Nutritional well-being is a fundamental aspect for the health, autonomy and, therefore, the quality of life of all people, but especially of the elderly. It is estimated that at least half of non-institutionalized elderly people need nutritional intervention to improve their health and that 85% have one or more chronic diseases that could improve with correct nutrition. Although prevalence estimates are highly variable, depending on the population considered and the tool used for its assessment, malnutrition in the elderly has been reported up to 50%. Older patients are particularly at risk of malnutrition, due to multiple etiopathogenetic factors which can lead to a reduction or utilization in the intake of nutrients, a progressive loss of functional autonomy with dependence on food, and psychological problems related to economic or social isolation, e.g., linked to poverty or loneliness. Changes in the aging gut involve the mechanical disintegration of food, gastrointestinal motor function, food transit, intestinal wall function, and chemical digestion of food. These alterations progressively lead to the reduced ability to supply the body with adequate levels of nutrients, with the consequent development of malnutrition. Furthermore, studies have shown that the quality of life is impaired both in gastrointestinal diseases, but especially in malnutrition. A better understanding of the pathophysiology of malnutrition in elderly people is necessary to promote the knowledge of age-related changes in appetite, food intake, homeostasis, and body composition in order to better develop effective prevention and intervention strategies to achieve healthy aging.

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Characteristic of the Elderly Acute Heart Failure Patient: Data form Multicenter AHF Registry in Tokyo Metropolitan Area

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2013.08.426 ◽

2013 ◽

Vol 19 (10) ◽

pp. S162

Author(s):

Sayaka Funabashi ◽

Ayumi Goda ◽

Taku Inohara ◽

Mayuko Yagawa ◽

Keitaro Mahara ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Metropolitan Area ◽

Heart Failure Patient ◽

The Elderly ◽

Patient Data ◽

Tokyo Metropolitan ◽

Tokyo Metropolitan Area ◽

Data Form

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Statistical Modelling of Temperature-Attributable Deaths in Portuguese Metropolitan Areas under Climate Change: Who Is at Risk?

Atmosphere ◽

10.3390/atmos11020159 ◽

2020 ◽

Vol 11 (2) ◽

pp. 159

Author(s):

Mónica Rodrigues ◽

Paula Santana ◽

Alfredo Rocha

Keyword(s):

Climate Change ◽

Metropolitan Area ◽

Age Groups ◽

Circulatory System ◽

Statistical Modelling ◽

Attributable Mortality ◽

Historical Period ◽

Age Group ◽

Circulatory System Diseases ◽

Related Mortality

Several studies emphasize that temperature-related mortality can be expected to have differential effects on different subpopulations, particularly in the context of climate change. This study aims to evaluate and quantify the future temperature-attributable mortality due to circulatory system diseases by age groups (under 65 and 65+ years), in Lisbon metropolitan area (LMA) and Porto metropolitan area (PMA), over the 2051–2065 and 2085–2099 time horizons, considering the greenhouse gas emissions scenario RCP8.5, in relation to a historical period (1991–2005). We found a decrease in extreme cold-related deaths of 0.55% and 0.45% in LMA, for 2051–2065 and 2085–2099, respectively. In PMA, there was a decrease in cold-related deaths of 0.31% and 0.49% for 2051–2065 and 2085–2099, respectively, compared to 1991–2005. In LMA, the burden of extreme heat-related mortality in age group 65+ years is slightly higher than in age group <65 years, at 2.22% vs. 1.38%, for 2085–2099. In PMA, only people aged 65+ years showed significant temperature-related burden of deaths that can be attributable to hot temperatures. The heat-related excess deaths increased from 0.23% for 2051–2065 to 1.37% for 2085–2099, compared to the historical period.

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Functional fitness normative values for elderly polish population

BMC Geriatrics ◽

10.1186/s12877-020-01787-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zofia Ignasiak ◽

Anna Sebastjan ◽

Teresa Sławińska ◽

Anna Skrzek ◽

Wojciech Czarny ◽

...

Keyword(s):

Physical Fitness ◽

Independent Living ◽

Dynamic Balance ◽

Elderly Person ◽

Clinical Importance ◽

The Elderly ◽

Functional Independence ◽

Upper Body ◽

Normative Values ◽

Effective Prevention

Abstract Background It’s really important to measure the actual functional physical fitness of elderly independent living persons from different environments to know the level and rate of decrease may inform about the threat of loss of functional independence, hence the need to monitor and assess the senior’s motor realm and adapt to it the appropriate programs and treatments in the care for the elderly person. Methods The study involved 5367 people (mean age 69,63 ± 7,06), including 4164 women (mean age 69,55 ± 7,11) and 1203 men (mean age 69,91 ± 6,86) aged 60 to 93 years old. We have measured basic anthropometric features and physical fitness (by using Senior Fitness Test). Results The average values in individual SFT tests significantly decrease along with age. After age of 80 and 85 there were no sex differences in SFT. The largest deficits concern the dynamic balance and the decrease reaches 69% in men and 62% in women A significantly higher rate of decline in aerobic capacity concerns men (43%) than women (36.9%). A clearly lower rate of loss occurs in the muscular strength of the lower and upper body and does not exceed 30%. Conclusions The results are of great clinical importance for the development of effective prevention and gerontological education programs in terms of promoting active lifestyle and successful ageing, at the same time limiting the economic consequences of treatment and hospitalisation.

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Prävention des Delirs auf der Intensivstation

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0666-3947 ◽

2019 ◽

Vol 144 (23) ◽

pp. 1611-1618

Author(s):

Stephan Braune ◽

Simone Gurlit

Keyword(s):

Risk Factors ◽

The Elderly ◽

Effective Prevention ◽

Interprofessional Cooperation ◽

High Prevalence ◽

Risk Patients ◽

The Brain ◽

Improve Clinical Outcome ◽

Effective Analgesia

AbstractA delirium in patients in the intensive care unit (ICU) is a manifestation of a severe acute dysfunction of the brain. It has a high prevalence and is associated with a relevant increase in morbidity and mortality. A cholinergic deficit and dopaminergic overactivity are considered to be a cause of delirium. Polypharmacy, which is often present before admission to the ICU, especially in the elderly, plays a key role as a trigger. The knowledge and identification of risk factors for delirium is a precondition for the early and effective prevention of delirium. The aim is the pre-operative or pre-interventional optimization of modifiable risk factors. Early and effective prevention of delirium can improve clinical outcome, reduce mortality, and positively impact long-term functional outcome. Non-pharmacological measures are always the basis for the prevention of delirium: maintenance of the day-night rhythm, sleep promotion at night and stimulation during the day, involvement of relatives, the avoidance of dehydration and malnutrition, and others more. They are pharmacologically accompanied by an effective analgesia and a target and symptom-oriented sedation with well controllable, as little as possible delirogenic substances. Interdisciplinary and interprofessional cooperation is essential so that preventive concepts significantly reduce the risk of delirium, even in high-risk patients.

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Modeling Annual Poverty In A Metropolitan Area

Journal of Applied Business Research (JABR) ◽

10.19030/jabr.v18i1.2100 ◽

2011 ◽

Vol 18 (1) ◽

Author(s):

Robert G. Mogull

Keyword(s):

Los Angeles ◽

Metropolitan Area ◽

The Elderly ◽

Metropolitan Region ◽

Long Beach ◽

Font Size

This study establishes a methodology to create annual rates of poverty within a metropolitan region.  The site selected is Los Angeles/Long Beach, where trend lines are separately calculated for all residents, whites, blacks, Hispanics, female family heads, the elderly and children.  The most striking evidence is the surge in poverty among Hispanics and children, which pulls up the overall rate for the region.  The trends foretell the formation of an immense impoverished Hispanic underclass.

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Preventing the Risk of Hospitalization for Respiratory Complications of Influenza among the Elderly: Is There a Better Influenza Vaccination Strategy? A Retrospective Population Study

Vaccines ◽

10.3390/vaccines8030344 ◽

2020 ◽

Vol 8 (3) ◽

pp. 344

Author(s):

Silvia Cocchio ◽

Tolinda Gallo ◽

Stefania Del Zotto ◽

Elena Clagnan ◽

Andrea Iob ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccination Strategy ◽

The Elderly ◽

Protective Role ◽

The Body ◽

Health Concern ◽

Respiratory Complications ◽

Effective Prevention ◽

Vaccination Strategies ◽

The Impact

Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact of different influenza vaccination strategies in preventing hospitalizations for influenza and its related respiratory complications. A retrospective cohort study was conducted on data routinely collected by the health services for six consecutive influenza seasons, considering the population aged 65 years or more at the time of their vaccination and living in northeastern Italy. Our analysis concerns 987,266 individuals vaccinated against influenza during the study period. The sample was a mean 78.0 ± 7.7 years old, and 5681 individuals (0.58%) were hospitalized for potentially influenza-related reasons. The hospitalization rate tended to increase over the years, not-significantly peaking in the 2016–2017 flu season (0.8%). Our main findings revealed that hospitalizations related to seasonal respiratory diseases were reduced as the use of the enhanced vaccine increased (R2 = 0.5234; p < 0.001). Multivariate analysis confirmed the significantly greater protective role of the enhanced vaccine over the conventional vaccination strategy, with adjusted Odds Ratio (adj OR) = 0.62 (95% CI: 0.59–0.66). A prior flu vaccination also had a protective role (adj OR: 0.752 (95% CI: 0.70–0.81)). Age, male sex, and H3N2 mismatch were directly associated with a higher risk of hospitalization for pneumonia. In the second part of our analysis, comparing MF59-adjuvanted trivalent inactivated vaccine (MF59-TIV) with conventional vaccines, we considered 479,397 individuals, of which 3176 (0.66%) were admitted to a hospital. The results show that using the former vaccine reduced the risk of hospitalization by 33% (adj OR: 0.67 (95% CI: 0.59–0.75)). This study contributes to the body of evidence of a greater efficacy of enhanced vaccines, and MF59-adjuvanted TIV in particular, over conventional vaccination strategies in the elderly.

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A Study of Elderly Suicides in Hong Kong

Crisis ◽

10.1027/0227-5910.19.1.35 ◽

1998 ◽

Vol 19 (1) ◽

pp. 35-46 ◽

Cited By ~ 11

Author(s):

Iris Chi ◽

Paul SF Yip ◽

Gabriel KK Yu ◽

Peter Halliday

Keyword(s):

Hong Kong ◽

High Risk ◽

Secondary Data ◽

The Elderly ◽

High Risk Group ◽

Policy And Practice ◽

Effective Prevention ◽

Medical Practitioners ◽

Police Records ◽

Elderly Suicide

Hong Kong has one of the highest rates of suicide among the elderly in the world. Most of the existing suicide prevention programs have had very little effect on the elderly, who rarely utilize these programs. This study aims to help in understanding the problem, so that effective prevention can be provided to this high-risk group of suicidal people. Specifically, the study (1) describes the characteristics of the suicidal elderly, (2) investigates the reason(s) why the elderly are in distress and become suicidal, and (3) formulates a policy and service model to reach the elderly high-risk group.This research project involves secondary data analysis. Police records on elderly suicide cases in 1992 were scrutinized to find out the major reason(s) for fatal death in the elderly. Our study points out those districts that are more crowded and have fewer medical and social facilities tended to have higher suicide rates. Most of the deaths occurred at home or nearby, and the suicidal elderly were alone before their death. The majority of elderly suicide victims suffered from chronic diseases. Very few of them, however, were totally dependent: About 40% of the cases had consulted medical practitioners, and 27% had consulted psychiatrists within one month before their deaths. Close to 70% of the cases had indicated to family members or others their suicidal thoughts, and many of them had revealed numerous suicidal indications. Both policy and practice issues are discussed in light of the findings.

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Self-injury and suicide attempt among the elderly population in the city of São Paulo

Jornal Brasileiro de Psiquiatria ◽

10.1590/0047-2085000000154 ◽

2017 ◽

Vol 66 (2) ◽

pp. 83-88 ◽

Cited By ~ 1

Author(s):

Jane de Eston Armond ◽

Rodrigo de Eston Armond ◽

Tatiana Cristina Pereira ◽

Cléo Chinaia ◽

Thiago Leão Vendramini ◽

...

Keyword(s):

Suicide Attempt ◽

Elderly Population ◽

Attempted Suicide ◽

Risk Groups ◽

The Elderly ◽

Sao Paulo ◽

São Paulo ◽

Effective Prevention ◽

Self Injury ◽

The City

ABSTRACT Objective In this perspective, the present research aims to describe the reports of self-injury and suicide attempt among the elderly population living in the city of São Paulo. Methods This is a descriptive, quantitative approach based on Violence and Accidents Surveillance Information System (SIVVA) of the city of São Paulo. In the selection of notifications, it was included the ones related to self-injury and attempted suicide against men and women, with age group between 60 and over, from January to December 2014 in the city of São Paulo, Southeastern Region of Brazil. Results During 2014, 93 cases of self-injury and attempted suicide were reported among elderly people living in the city of São Paulo. The main instruments used by the elderly population in the analyzed period were poisoning (41.9%), other means (34.4%), cold weapon (15.1%), high precipitation places (4.3%), hanging or suffocation (3.2%), and firearm (1.1%). Conclusion From the results of this study it was possible to characterize some specific aspects related to self-injury and suicide attempt among elderly in the evaluated population. Therefore, developing a strategy to promote effective prevention actions and offer specialized services to most risk groups (brown races, people with lower levels of education, and males).

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