Non-typhoidal Salmonella bacteraemia in elderly patients: an increased risk for endovascular infections, osteomyelitis and mortality

2012 ◽  
Vol 140 (11) ◽  
pp. 2037-2044 ◽  
Author(s):  
P. L. CHEN ◽  
H. C. LEE ◽  
N. Y. LEE ◽  
C. J. WU ◽  
S. H. LIN ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Odds Ratio ◽  
Mycotic Aneurysm ◽  
Young Patients ◽  
The Elderly ◽  
Solid Organ ◽  
Pulmonary Infections ◽  
Joint Infections ◽  
Increased Risk ◽  
Foodborne Infections

SUMMARYNon-typhoidal Salmonella (NTS) is a common pathogen causing foodborne infections, bacteraemia, and extra-intestinal focal infections (EFIs) in humans. The study compares the clinical characteristics of elderly patients with NTS bacteraemia with those of young adults. Of 272 adults with NTS bacteraemia identified in this study, 162 (59·6%) were aged ⩾55 years. EFIs were observed in 36% of the 162 patients. The most common EFIs in the elderly patients (⩾55 years) was mycotic aneurysm, followed by pulmonary infections and bone/joint infections. Elderly patients more often had chronic heart, lung, renal and malignant diseases, had more EFIs, and a higher 30-day mortality rate. Independent factors of 30-day mortality in elderly patients were solid-organ tumour [adjusted odds ratio (aOR) 4·4, P=0·003], mycotic aneurysm (aOR 3·7, P=0·023) and shock (aOR 12·1, P<0·0001). HIV infection, autoimmune diseases, and receipt of immunosuppressive therapy were more often observed in young patients.

scholarly journals Levothyroxine Therapy in Elderly Patients With Hypothyroidism

2021 ◽  
Vol 12 ◽  
Author(s):  
Grigoris Effraimidis ◽  
Torquil Watt ◽  
Ulla Feldt-Rasmussen
Keyword(s):  
Elderly Patients ◽  
Correct Diagnosis ◽  
Young Patients ◽  
The Elderly ◽  
Cardiovascular Complications ◽  
Cardiac Ischemia ◽  
Overt Hypothyroidism ◽  
Cardiac Morbidity ◽  
Background Population ◽  
Increased Risk

Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.

HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS

2021 ◽  
pp. 56-57
Author(s):  
Rohit Arora ◽  
D.K Sharma
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
The Elderly ◽  
Common Disease ◽  
Old Patients ◽  
Current Trends ◽  
Increased Risk ◽  
Individualized Approach ◽  
Risk Of Falls ◽  
Optimal Target

Hypertension is a common disease in the elderly associated with signicant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specically designed to study the efcacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benets in the positive studies were demonstrated even with a minimal BPcontrol (systolic BP[SBP] <150 mmHg) and continued to be reported for a SBP<120 mmHg. On the other hand, keeping SBP<140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BPtarget in very old patients or those with multiple comorbidities.

Abstract P329: White Matter Score Does Not Predict Post-tPA Hemorrhage in Elderly Patients Evaluated Acutely via Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Bilal Tariq ◽  
Shekhar Khanpara ◽  
Eliana Bonfante Mejia ◽  
Liang Zhu ◽  
Christy T Ankrom ◽  
...  
Keyword(s):  
White Matter ◽  
Elderly Patients ◽  
The Elderly ◽  
Periventricular White Matter ◽  
Severe Stroke ◽  
Age Related ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage ◽  
Relationship Of ◽  
Patient Presentation

Background: While tPA may be safe in the elderly, increasing age appears to augment risk of post-tPA symptomatic intracranial hemorrhage (sICH). Age-related white matter changes (ARWMC) are associated with increased sICH. Patients evaluated for acute ischemic stroke (AIS) via telestroke (TS) may not have access to MRI to allow incorporation of microbleeds in tPA decisions. We assessed if increased CT-based ARWMC was associated with increased sICH in elderly patients. Methods: Patients 80 years and older who received tPA for AIS at spoke hospitals were selected from our TS network registry from 9/2015 to 12/2018. TS spoke CT scans from patient presentation were reviewed by three of the authors for periventricular white matter (PWMC) and deep white matter (DWMC) changes. Total ARWMC score, based on the Fazekas score, was collected. Total ARWMC score was either mild (0-2), moderate (3-4), or severe (5-6). PWMC and DWMC were either mild (0-1) or moderate-severe (2-3). Logistic regression adjusted for age, sex, race, ethnicity, NIHSS and premorbid mRS was used to analyze relationship of ARWMC scores with sICH and patient-outcomes. Results: Of 241 patients, median age overall was 86 years (IQR 83-90), and 66% were female. The overall median ARWMC score was 3 (IQR 2-5). Regression analysis showed that more severe ARWMC scores did not lead to higher frequency of post-tPA ICH (moderate OR 0.57, CI 0.19-1.71; severe OR 1.32, CI 0.48-3.65) including sICH (moderate OR 0.78, CI 0.21-2.94; severe OR 2.09, CI 0.62-7.02). Similarly, severe PWMC and DWMC were not associated with increased risk of post-tPA ICH (PWMC OR 1.31, CI 0.51-3.38; DWMC OR 1.25, CI 0.52-3.01), including sICH (PWMC OR 1.61, CI 0.51-5.08; DWMC OR 1.81, CI 0.65-5.01). In our cohort, older patients had no difference in hemorrhage (ICH OR 0.93 CI 0.85-1.00: sICH OR 0.95 CI 0.86-1.04), and patients with less severe stroke were more likely to have hemorrhage (ICH OR 1.06 CI 1.02-1.10; sICH OR 1.08 CI 1.03-1.13). IRR among the CT scan readers was moderate (k=0.504). Conclusions: ARWMC scores were not associated with post-tPA ICH in the elderly. Our analysis lends support for the use of tPA despite severity of white matter disease. ARWMC should not be used to assist in tPA decision-making in elderly patients via telestroke.

scholarly journals Целевой уровень артериального давления при лечении артериальной гипертензии у пациентов пожилого возраста с хронической сердечной недостаточностью

2019 ◽  
pp. 8-16
Author(s):  
M.S. CHERNIAEVA ◽  
O.D. OSTROUMOVA
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Target Blood Pressure ◽  
Lower Systolic Blood Pressure ◽  
Reduced Ejection Fraction ◽  
Increased Risk

Высокая распространенность хронической сердечной недостаточности (ХСН) в популяции пожилых пациентов наряду с устойчивым ро- стом численности пожилого населения как в России, так и в западных странах все больше привлекает внимание врачей к проблеме, связан- ной с ведением данного заболевания. Известно, что ведущим фактором риска развития ХСН является повышенное артериальное давление (АД) и большинство пациентов с ХСН имеют в анамнезе артериальную гипертонию (АГ), поэтому лечение пациентов пожилого возраста c АГ и ХСН является одним из важных направлений в профилактике прогрессирования ХСН, снижения количества госпитализаций и смерт- ности. Лечение АГ у пожилых имеет свои особенности, связанные с функциональным статусом пациентов и их способностью переносить лечение. В европейских рекомендациях (2018) пересмотрены целевые цифры АД при лечении АГ у пожилых, однако данные по целевым цифрам АД для лечения АГ у пациентов с ХСН опираются лишь на исследования, проводившиеся у больных без ХСН. Данные об оптималь- ном целевом уровне у пациентов с АГ и ХСН представлены в единичных исследованиях. В настоящей статье проанализирована взаимосвязь уровня АД и сердечно-сосудистых событий и смертности отдельно для пациентов с АГ и сердечной недостаточностью с низкой фракцией выброса левого желудочка и с сохраненной фракцией выброса левого желудочка. Результаты многих исследований показывают, что более низкий уровень систолического АД (120 мм рт. ст.) и диастолического АД (80 мм рт. ст.) ассоциирован с развитием неблагоприятных сердечно-сосудистых событий, особенно у пациентов с сердечной недостаточностью с низкой фракцией выброса левого желудочка.The high prevalence of chronic heart failure (CHF) in the elderly patients, along with the steady growth of the elderly population, both in Russia and in Western countries, is increasingly attracting the attention of doctors to the problem associated with the management of this disease. It is known that the leading risk factor for CHF is high blood pressure (BP) and most patients with CHF have a history of hypertension (H), so the treatment of elderly patients with H and CHF is the major focus in the slowing CHF progression, reducing the heart failure hospitalisation and mortality. Treatment of hypertension in the elderly has some specific features associated with the functional status of patients and their ability to tolerate treatment. The European recommendations (2018) revised target blood pressure levels in the elderly patients, however, data on target blood pressure levels in patients with CHF are based only on studies conducted in patients without CHF, data on the optimal target blood pressure levels in patients with hypertension and CHF are presented in single studies. In this article we analyze the relationship between blood pressure levels and cardiovascular events and mortality separately for patients with hypertension and heart failure with reduced ejection fraction and with preserved ejection fraction. Several studies show that lower systolic blood pressure (120 mm Hg) and diastolic blood pressure (80 mm Hg) is associated with the increased risk of cardiovascular events, especially in patients with heart failure with reduced ejection fraction.

scholarly journals Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study

2018 ◽  
Vol 9 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Ayodele Sasegbon ◽  
Laura O’Shea ◽  
Shaheen Hamdy
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Elderly Person ◽  
Oropharyngeal Dysphagia ◽  
The Elderly ◽  
Common Source ◽  
Increased Risk ◽  
The Mean ◽  
The Relationship ◽  
New Onset

IntroductionElderly people are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are multifactorial. Our aim was to identify if sepsis is associated with OPD in the elderly during hospitalisation in the absence of known other risk factors for OPD.MethodsA hospital electronic database was searched for elderly patients (≥65 years) referred for assessment for suspected dysphagia between March 2013 and 2014. Exclusion criteria were age <65 years, pre-existing OPD or acute OPD secondary to acute intracranial event, space-occupying lesion or trauma. Data were collected on factors including age, sex, comorbidities, existing OPD, sepsis, microbiology, recovery of OPD and medication. Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.ResultsA total of 301 of 1761 screened patients referred for dysphagia assessment met the inclusion criteria. The prevalence of sepsis and subsequent OPD was 16% (51/301). The mean age was 83 years (median 81 years). The most common comorbidity was dementia (31%). The majority (84%) failed to recover swallowing during their hospital stay, 12% had complications of aspiration and 35% died. The most common source of sepsis was from the chest (55%). Other factors contributing to the risk for dysphagia included delirium (22%) and neuroactive medication (41%). However, 10% of patients had sepsis and subsequent OPD without other identified risk factors.ConclusionThe prevalence of sepsis and subsequent dysphagia is significant and should be taken into account in any elderly person in hospital with new-onset OPD without other predisposing risk factors.

scholarly journals Elevated Procalcitonin as a Risk Factor for Postoperative Delirium in the Elderly after Cardiac Surgery—A Prospective Observational Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3837
Author(s):  
Anna Kupiec ◽  
Barbara Adamik ◽  
Natalia Kozera ◽  
Waldemar Gozdzik
Keyword(s):  
Cardiac Surgery ◽  
Depressive Symptoms ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Reference Range ◽  
The Elderly ◽  
Daily Functioning ◽  
Multivariable Logistic Regression Model

One of the most common complications after cardiac surgery with cardiopulmonary bypass (CBP) is delirium. The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative and intraoperative risk factors. A total of 149 elderly patients were included. Thirty patients (20%) developed post-operative delirium. Preoperative procalcitonin (PCT) above the reference range (>0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p = 0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL vs. 0.05 ng/mL p = 0.011), and for consecutive days (day 1: 0.59 ng/mL vs. 0.25 ng/mL, p = 0.003; day 2: 1.21 ng/mL vs. 0.36 ng/mL, p = 0.006; day 3: 0.76 ng/mL vs. 0.34 ng/mL, p = 0.001). Patients with delirium were older (74 vs. 69 years, p = 0.038), more often had impaired daily functioning (47% vs. 28%, p = 0.041), depressive symptoms (40% vs. 17%, p = 0.005), and anemia (43% vs. 19%, p = 0.006). In a multivariable logistic regression model, preoperative procalcitonin (odds ratio (OR) = 3.05), depressive symptoms (OR = 5.02), age (OR = 1.14), impaired daily functioning (OR = 0.76) along with CPB time (OR = 1.04) were significant predictors of postoperative delirium.

scholarly journals Spread of odontogenic infections in the elderly: Prevalence and characteristic multidetector CT findings

2017 ◽  
Vol 4 (1) ◽  
pp. 28 ◽  
Author(s):  
Ichiro Ogura ◽  
Norihito Iizuka ◽  
Marie Ishida ◽  
Eri Sawada ◽  
Takashi Kaneda
Keyword(s):  
Elderly Patients ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Multidetector Ct ◽  
The Elderly ◽  
Multivariate Regression Analysis ◽  
Masticator Space ◽  
Odontogenic Infections ◽  
Submandibular Space ◽  
Buccal Space

Purpose: To analyze spread of odontogenic infections in the elderly, especially the prevalence and characteristic multidetectorcomputed tomography (MDCT) findings.Materials and methods: Ninety-seven patients with odontogenic infection who underwent 64-row MDCT were evaluated inthis study. The study patients comprised 31 elderly patients (60 years) and 66 adults (< 60 years). Age, gender, location ofcausal tooth, and spread of odontogenic infections with MDCT were analyzed.Results: The elderly patients (74.2%) had higher ratio with female compared to the adults (57.6%). The buccal space (93.5%)was the most common spread of odontogenic infections for the elderly patients, followed by the masticator space (54.8%) andsubmandibular space (45.2%), whereas the buccal space (97.0%) was the most common spread of odontogenic infections for theadults, followed by submandibular space (65.2%) and masticator space (51.5%). Logistic multivariate regression analysis forodontogenic infections in the elderly demonstrated that the gender (odds ratio = 3.462, P = .024) and submandibular space (oddsratio = 0.168, P = .013) were significant variable.Conclusions: The study showed the prevalence and characteristic MDCT findings of spread of odontogenic infections in theelderly.

scholarly journals Cisplatin-induced renal toxicity in elderly people

2020 ◽  
Vol 12 ◽  
pp. 175883592092343 ◽  
Author(s):  
ZhiYu Duan ◽  
GuangYan Cai ◽  
JiJun Li ◽  
XiangMei Chen
Keyword(s):  
Elderly Patients ◽  
Elderly People ◽  
Renal Toxicity ◽  
Enzyme Inhibitor ◽  
Interstitial Fibrosis ◽  
Angiotensin Receptor Blockers ◽  
Young Patients ◽  
Kidney Injury ◽  
The Elderly ◽  
Tubular Atrophy

Despite available prevention and treatment measures, such as hydration, diuresis, magnesium supplementation, and amifostine, renal toxicity is still one of the major dose-limiting side effects of cisplatin. The aim of this review is to discuss the issue of cisplatin-induced nephrotoxicity in the elderly. Compared with young patients, the incidences of cisplatin-induced nephrotoxicity and acute kidney injury (AKI) in elderly patients are significantly increased, and survival time may be decreased. Following cisplatin treatment of elderly patients, tubulointerstitial injuries will be significantly aggravated based on their original age, both for acute injuries due to cell necrosis and exfoliation and chronic injuries due to interstitial fibrosis, tubular atrophy, and dilatation. The high incidence of cisplatin-induced nephrotoxicity in elderly patients may be associated with renal hypoperfusion; increased comorbidities, such as chronic kidney disease (CKD), cardiovascular disease, and diabetes mellitus; increased use of combined drugs [especially non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor and angiotensin receptor blockers (ACEI/ARB), and antibiotics]; decreased clearance of cisplatin; and high plasma ultrafilterable cisplatin. Considering hemodynamic stability and water balance, short duration and low volume hydration may be more suitable for treating elderly people. With the increasing popularity of low-dose daily/weekly regimens, we do not recommend routine diuretic treatment for elderly patients. We recommend using a less nephrotoxic platinum if large doses of cisplatin (100mg/m2) are needed.

scholarly journals The impact of age on approach-related complications with navigated lateral lumbar interbody fusion

2020 ◽  
Vol 49 (3) ◽  
pp. E8
Author(s):  
Yamaan S. Saadeh ◽  
Clay M. Elswick ◽  
Eleanor Smith ◽  
Timothy J. Yee ◽  
Michael J. Strong ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Interbody Fusion ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Lumbar Interbody Fusion ◽  
Related Complication ◽  
Lateral Lumbar Interbody Fusion ◽  
Increased Risk ◽  
The Impact

OBJECTIVEAge is known to be a risk factor for increased complications due to surgery. However, elderly patients can gain significant quality-of-life benefits from surgery. Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure that is commonly used to treat degenerative spine disease. Recently, 3D navigation has been applied to LLIF. The purpose of this study was to determine whether there is an increased complication risk in the elderly with navigated LLIF.METHODSPatients who underwent 3D-navigated LLIF for degenerative disease from 2014 to 2019 were included in the analysis. Patients were divided into elderly and nonelderly groups, with those 65 years and older categorized as elderly. Ninety-day medical and surgical complications were recorded. Patient and surgical characteristics were compared between groups, and multivariate regression analysis was used to determine independent risk factors for complication.RESULTSOf the 115 patients included, 56 were elderly and 59 were nonelderly. There were 15 complications (25.4%) in the nonelderly group and 10 (17.9%) in the elderly group, which was not significantly different (p = 0.44). On multivariable analysis, age was not a risk factor for complication (p = 0.52). However, multiple-level LLIF was associated with an increased risk of approach-related complication (OR 3.58, p = 0.02).CONCLUSIONSElderly patients do not appear to experience higher rates of approach-related complications compared with nonelderly patients undergoing 3D navigated LLIF. Rather, multilevel surgery is a predictor for approach-related complication.

scholarly journals EPIDEMIOLOGY OF ZOONOTIC Cryptosporidium spp. ISOLATES IN NJORO SUB_COUNTY NAKURU COUNTY, KENYA

2021 ◽  
Vol 15 (2) ◽  
pp. 3-9
Author(s):  
Essendi Miding'a Walter ◽  
Muleke Charles ◽  
Otachi Elick ◽  
Miheso Manfred ◽  
Kyule Domitila
Keyword(s):  
Odds Ratio ◽  
The Elderly ◽  
Domestic Animals ◽  
Risk Of Infection ◽  
Multivariate Logistic Regression ◽  
Chi Square ◽  
Cryptosporidium Spp ◽  
Potential Source ◽  
Increased Risk ◽  
Adolescents And Adults

Background: There is no information on human and animal Cryptosporidium spp. in Njoro sub- county. The risk posed to humans and animals within the sub-county is therefore unknown. Materials and Methods: A total of 1476 animal and 378 human fecal samples were evaluated. Multivariate logistic regression was used to evaluate association between infection status and the predisposing factors. Results were expressed as odds ratio (OR) with a 95% confidence interval. Chi-square and Maentel–Haenszel tests were used to quantify relationships among variables. Results: Prevalence of Cryptosporidium spp. was 9.8% in humans, 10.8% in cows, 19.6% in sheep and 4.5% in goats. Prevalence in humans was significantly higher in females 12/37. Infection was highest in the elderly (27.27%), and significantly lower in adolescents and adults at 8.66% and 9.59%, respectively. Goats had lowest overall parasitization at all levels, while sheep had the highest parasitization at levels (+1 and +2). Relatively, humans had the highest parasite counts +3 cases (1.5%). Conclusion: Cryptosporidium spp. is prevalent in Njoro sub-county and domestic animals are important reservoirs and a potential source of zoonosis in humans. Children, elderly and females are at increased risk of infection, especially during rainy season. The study recommends maintenance of proper sanitation when handling domestic animals, treatment of drinking water and use of alternative safer sources of water in order to reduce infection.

Sign in / Sign up

Export Citation Format

Share Document