F010 Role of advanced age and hypertension in the elderly patients ≥ 85 years old with hypertrophic cardiomyopathy

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

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Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea

Journal of Clinical Medicine ◽

10.3390/jcm9020546 ◽

2020 ◽

Vol 9 (2) ◽

pp. 546 ◽

Cited By ~ 1

Author(s):

Tomas Posadas ◽

Grace Oscullo ◽

Enrique Zaldívar ◽

Alberto Garcia-Ortega ◽

José Daniel Gómez-Olivas ◽

...

Keyword(s):

Clinical Trials ◽

Elderly Patients ◽

Obstructive Sleep Apnoea ◽

The Elderly ◽

Sleep Apnoea ◽

Age Group ◽

Obstructive Sleep ◽

Receive Treatment ◽

Therapeutic Tools

The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

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Associate Members: A Life Worth Living

British Journal of Occupational Therapy ◽

10.1177/030802268604901108 ◽

1986 ◽

Vol 49 (11) ◽

pp. 362-364 ◽

Cited By ~ 1

Author(s):

Jean Parker

Keyword(s):

Elderly Patients ◽

Long Term Care ◽

The Elderly ◽

Worth Living ◽

Term Care ◽

Life Worth Living ◽

Meaningful Existence ◽

Time And Energy

Long-term care patients need a meaningful existence. It is our responsibility to ensure that time and energy are channelled into purposeful solutions for the disease of ‘time with nothing to do’. The author has taken up this challenge. Working as an activities organizer with the elderly for 11 years, she was determined never to take the role of a baby-sitter. The recreation unit has grown from its first eight guests to a purpose-built unit with approximately 1,500 attendances per month. A busy happy atmosphere now prevails where once there was a sea of dead faces. The choice to retain a sense of dignity and purpose should be available to all elderly patients who require long-term care.

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The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

Global Spine Journal ◽

10.1177/2192568220948036 ◽

2020 ◽

pp. 219256822094803

Author(s):

Barry Ting Sheen Kweh ◽

Hui Qing Lee ◽

Terence Tan ◽

Joost Rutges ◽

Travis Marion ◽

...

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Vertebral Fractures ◽

Postural Stability ◽

Elderly Population ◽

The Elderly ◽

Functional Improvement ◽

Osteoporotic Vertebral Fractures ◽

Spinal Orthoses

Study Design: Systematic review. Objective: Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. Methods: A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. Results: Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. Conclusion: The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.

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Balancing the Efficacy and Tolerability of First-line Treatment in Elderly Myeloma Patients

European Oncology & Haematology ◽

10.17925/eoh.2010.04.0.85 ◽

2010 ◽

Vol 00 (04) ◽

pp. 85

Author(s):

Valeria Magarotto ◽

Antonio Palumbo ◽

◽

Keyword(s):

Elderly Patients ◽

Elderly Population ◽

The Elderly ◽

New Drugs ◽

High Dose ◽

Standard Drug ◽

High Dose Dexamethasone ◽

Life Threatening ◽

Choice Of Therapy

Multiple myeloma (MM) is the second most frequent malignancy of the blood. It is more common among the elderly population, with <28% of patients 65–74 years of age and 37% >75 years of age. Before the introduction of novel agents, melphalan and prednisone (MP) was the best treatment for patients not eligible for autologous stem cell transplantation (ASCT). Steroids provide other options but with a higher toxicity, especially in elderly patients. Currently, the association of thalidomide with MP (MPT) represents the gold standard of treatment for patients ineligible for ASCT. Bortezomib and lenalidomide associated with MP provided effective and safe alternatives. High-dose dexamethasone combined with the new drugs is effective, but very toxic for elderly patients. Trials that combine low-dose dexamethasone with thalidomide, lenalidomide and bortezomib plus other agents such as doxorubicin and cyclophosphamide are ongoing. The role of transplantation is controversial in myeloma patients >65 years of age because elderly patients are fragile and the choice of therapy must take into account the likelihood of co-morbidities. Reducing the dose of the standard drug – eventually prolonging the duration of the treatment and administering prophylaxis – allows effective treatment of MM, without important or life-threatening toxicities.

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Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20181616 ◽

2018 ◽

Vol 45 (2) ◽

Cited By ~ 3

Author(s):

WALTER KOITI MATSUMOTO ◽

ALEXANDRE MENDONÇA MUNHOZ ◽

ALBERTO OKADA ◽

EDUARDO MONTAG ◽

EDUARDO GUSTAVO ARRUDA ◽

...

Keyword(s):

Postoperative Complications ◽

Breast Reconstruction ◽

The Elderly ◽

Advanced Age ◽

World Health ◽

Elderly Age ◽

Significant Difference ◽

Health Organization

ABSTRACT Objective: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. Methods: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age <60 years) and elderly (60 years or more). We also grouped them according to the World Health Organization classification: young people (age <44 years), middle age (45-59 years); elderly (age 60-89 years) and extreme advanced age (90 years or older). We applied the surgical risk classification of the American Society of Anesthesiologists to investigate the role of the preoperative physical state as a possible predictor of complications. Results: of the 560 patients operated on, 94 (16.8%) were 60 years of age or older. We observed a local complication rate of 49.8%, the majority being self-limited. The incidences of necrosis, infection and dehiscence were 15.5%, 10.9% and 9.3%, respectively. Patients older than 60 years presented a chance of complication 1.606 times greater than the younger ones. Forty-five (8%) patients had loss of the reconstruction; there was no statistically significant difference in the mean age of the patients who presented this result or not (p=0.321). Conclusion: in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.

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The Role of Psychotherapy and Humor for Death Anxiety, Death Wishes, and Aging

OMEGA - Journal of Death and Dying ◽

10.2190/d0nx-7v03-w1h0-4614 ◽

2007 ◽

Vol 54 (1) ◽

pp. 41-51 ◽

Cited By ~ 15

Author(s):

Joseph Richman

Keyword(s):

Elderly Patients ◽

Death Anxiety ◽

The Elderly ◽

Social Attitudes ◽

Problems In Living ◽

Death Wishes ◽

Anxiety Depression

This article is part of a series of humor on social attitudes (Richmen, 1977), humor by the elderly (Richman, 1989), assessment (Richman, 1996a), and psychotherapy (Richman, 1996b). The present study is based on the topics of humor related to death anxiety and wishes, and aging that emerged during psychotherapy with elderly patients. The healing qualities of laughter and humor have been observed since Biblical times to the present, however the applications of humor to professional psychotherapy is still in its infancy. The examples in this study spell out how humor in therapy can bring people together, and help them affirm life and laugh at anxiety, depression, and their problems in living.

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Effectiveness of Family Function in Quality of Life in Elderly Patients: An Evidence Based Case Report

Muhammadiyah Journal of Geriatric ◽

10.24853/mujg.1.2.52-57 ◽

2021 ◽

Vol 1 (2) ◽

pp. 52

Author(s):

Muhammad Sobri Maulana

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Chronically Ill ◽

The Elderly ◽

Evidence Based ◽

Literature Searching ◽

Family Function ◽

Based Medicine

Background: Geriatric care is an important part in healthcare and are sometimes neglected. Family caregivers figures assume a key role in postponing and potentially forestalling standardization of chronically ill elderly patients. The role of family function in depression has been demonstrated from earlier studies, however, the part of family function in quality of life the elderly has not concentrated widely. Objective: To evaluate the connection between family function and quality of life. Methods: Literature searching was conducted through PubMed, Science Direct and Embase. Critical appraisal using appraisal sheet for prognosis from Oxford Center for Evidence Based Medicine in 2011. Results: One article was found with good validity showed that direct relationship between family function and quality of life is not associated. However, if depression is present it plays as a strong mediator between family function and quality of life. Conclusion: Family function mediated with depression plays an important role in quality of life in elderly patients.

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Role of Early Low-Molecular-Weight Heparin Prophylaxis in the Surgical Treatment of Degenerative Spinal Diseases in the Elderly Patients

Surgical Science ◽

10.4236/ss.2016.79054 ◽

2016 ◽

Vol 07 (09) ◽

pp. 375-380

Author(s):

Carlo Doria ◽

Gianfilippo Caggiari ◽

Giulia Raffaella Mosele ◽

Leonardo Puddu ◽

Paolo Tranquilli Leali

Keyword(s):

Molecular Weight ◽

Surgical Treatment ◽

Elderly Patients ◽

Low Molecular Weight Heparin ◽

The Elderly ◽

Low Molecular Weight ◽

Spinal Diseases ◽

Heparin Prophylaxis

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The role of primary cemented total hip arthroplasty in the management of fractures of the neck of femur in the elderly population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175066 ◽

2017 ◽

Vol 4 (1) ◽

pp. 8

Author(s):

Yeshwanth Subash ◽

Jagadeesh B. ◽

Ravikrishna R. ◽

Prabhu Manickam

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Elderly Patients ◽

Hip Arthroplasty ◽

Elderly Population ◽

The Elderly ◽

Femoral Neck Fractures ◽

Total Hip ◽

Cemented Total Hip Arthroplasty

Background: Femoral neck fractures are common injuries in the elderly population and are associated with high rates of morbidity and mortality. The aim of surgical intervention in these elderly patients is to restore them to the pre-fracture status as rapidly as possible. The aim of this study was to evaluate the role of total hip arthroplasty as a primary option in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 45 patients with femoral neck fractures treated with cemented total hip arthroplasty were studied from January 2011 to January 2013 and were followed up for a minimum period of two years.Results: There were 18 males and 27 females ranging from 60 to 75 years of age. Mean age was 64.6 years. Majority (80%) of the fractures were completely displaced, Garden type 4 fractures followed by type 3 in 20% of cases. The most common mode of injury was a simple slip and fall. Excellent results were seen in 17 patients, good results in 24 patients and fair results in 4 patients. No poor results were seen. Conclusions: Cemented total hip arthroplasty is a very useful procedure for the primary treatment of femoral neck fractures in elderly patients. This procedure markedly improves the functional status of the patients and gives good functional results.

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