Older substance misusers still deserve better diagnosis – an update (Part 2)

2005 ◽  
Vol 15 (3-4) ◽  
pp. 255-262 ◽  
Author(s):  
Ilana Crome ◽  
Roger Bloor
Keyword(s):  
Elderly Population ◽  
Substance Misuse ◽  
Age Groups ◽  
The Elderly ◽  
Drug Misuse ◽  
Age Group ◽  
Age Related ◽  
Co Morbidity ◽  
Specialist Treatment ◽  
The Impact

Substance misuse in the elderly population has been referred to as a silent epidemic. One of the factors that contributes to the appropriateness of this description is the difficulty of diagnosis in this age group. There is abundant evidence that substance misuse is under-diagnosed in elderly people and that this applies to both alcohol and drug misuse, although the general principles of a diagnostic approach are not age-related. The increased incidence of anxiety, depression, dementing illness, and physical illness in this population, independent of substance misuse, means that diagnoses can often be missed. The impact of co-morbidity (Figure 1) in older age groups is such that it remains the most important confounding factor in diagnosis. In this second section of the review we explore the range of psychiatric and physical illnesses that can coexist with, or be caused by, substance misuse in the elderly population. The issue of assessment as part of a treatment framework is considered in the third section of the review. The risk of missed diagnosis in this age group was illustrated in a study of diagnosis of substance misuse problems in patients aged 65 and over who had been admitted to hospital. Only three out of a total of 88 patients using benzodiazepines, 29 out of 76 smokers, and 33 out of 99 problem drinkers were correctly identified. Of those who were identified only a small proportion were referred on for specialist treatment.

scholarly journals Age separation dramatically reduces COVID-19 mortality rate in a computational model of a large population

2020 ◽  
Author(s):  
Liron Mizrahi ◽  
Shani Stern
Keyword(s):  
Elderly Population ◽  
Large Population ◽  
Age Groups ◽  
The Elderly ◽  
Mortality Rates ◽  
Social Connections ◽  
Age Group ◽  
Efficient Treatment ◽  
Age Related ◽  
Total Death

AbstractCOVID-19 pandemic has caused a global lock down in many countries throughout the world. Faced with a new reality, and until a vaccine or efficient treatment is found, humanity must figure out ways to keep economy going on one hand, yet keep the population safe on the other hand, especially those that are susceptible to this virus. Here we use a network simulation, with parameters that were drawn from what is known about the virus, to explore 5 different scenarios of partial lock down release. We find that separating age groups by reducing interactions between age groups, protects the general population and reduces mortality rates. Furthermore, addition of new connections within the same age group to compensate for the lost connections outside the age group, still has a strong beneficial influence and reduces the total death toll by 66%. While complete isolation from society may be the most protective scenario for the elderly population, it would have an emotional and possibly cognitive impact that might outweigh its benefit. We therefore propose creating age-related social recommendations or even restrictions, thereby allowing social connections but still strong protection for the older population.

scholarly journals Age separation dramatically reduces COVID-19 mortality rate in a computational model of a large population

Open Biology ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 200213
Author(s):  
Liron Mizrahi ◽  
Huda Adwan Shekhidem ◽  
Shani Stern
Keyword(s):  
Elderly Population ◽  
Large Population ◽  
Age Groups ◽  
The Elderly ◽  
Social Connections ◽  
Age Group ◽  
Efficient Treatment ◽  
Age Related ◽  
Total Death ◽  
Geographical Locations

COVID-19 pandemic has caused a global lockdown in many countries throughout the world. Faced with a new reality, and until a vaccine or efficient treatment is found, humanity must figure out ways to keep the economy going, on one hand, while keeping the population safe, on the other hand, especially those that are susceptible to this virus. Here, we use a Watts–Strogatz network simulation, with parameters that were drawn from what is already known about the virus, to explore five different scenarios of partial lockdown release in two geographical locations with different age distributions. We find that separating age groups by reducing interactions between them protects the general population and reduces mortality rates. Furthermore, the addition of new connections within the same age group to compensate for the lost connections outside the age group still has a strong beneficial influence and reduces the total death toll by about 62%. While complete isolation from society may be the most protective scenario for the elderly population, it would have an emotional and possibly cognitive impact that might outweigh its benefit. Therefore, we propose creating age-related social recommendations or even restrictions, thereby allowing social connections while still offering strong protection for the older population.

Impact of Tuberculosis in Elderly Population

2018 ◽  
pp. 326-338
Author(s):  
Gagan Chooramani ◽  
Pooja Singh
Keyword(s):  
Clinical Characteristics ◽  
Elderly Population ◽  
The Elderly ◽  
World Health ◽  
Tuberculosis Patients ◽  
Disease Outcomes ◽  
Age Related ◽  
Health Organization ◽  
The Impact ◽  
Poor Memory

The World Health Organization has declared that the spread of tuberculosis is a global emergency. Despite the implementation of strong tuberculosis-control initiatives by WHO, this highly infectious disease continues to affect all vulnerable populations, including the elderly population. Adverse social factors and poor living conditions also affect the elderly much more than the young. The clinical characteristics of tuberculosis in older adults can be unusual and may be confused with age-related illnesses. Various factors related to old age can also cause complications in the diagnosis, treatment, and disease outcomes for tuberculosis patients. The contributory factors may be poor memory, deafness, mental confusion, or impairment of speech. In addition, therapy for tuberculosis in elderly individuals is challenging because of the increased incidence of adverse drug reactions. Hence, understanding the impact of these substantial aspects will help to overcome the problem of tuberculosis in the elderly population.

scholarly journals Age-Related Changes in the 25-Hydroxyvitamin D Versus Parathyroid Hormone Relationship Suggest a Different Reason Why Older Adults Require More Vitamin D

2003 ◽  
Vol 88 (1) ◽  
pp. 185-191 ◽  
Author(s):  
Reinhold Vieth ◽  
Yasmin Ladak ◽  
Paul G. Walfish
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Secondary Hyperparathyroidism ◽  
Age Groups ◽  
The Elderly ◽  
Age Group ◽  
Hydroxyvitamin D ◽  
Age Related ◽  
25 Hydroxyvitamin D ◽  
The Relationship

Vitamin D requirements are thought to vary with age, but there is little comparative evidence for this. One goal in establishing a vitamin D requirement is to avoid secondary hyperparathyroidism. We studied 1741 euthyroid, thyroid clinic outpatients without evidence of calcium abnormalities, ranging in age from 19 to 97 yr, whose serum and urine had been analyzed for calcium, vitamin D, and parathyroid status. We found no effect of age on the 25-hydroxyvitamin D [25(OH)D] concentration associated with specific vitamin D intakes, and there was no relationship between 25(OH)D and 1,25hydroxyvitamin D [1,25(OH)2D]. In every age group, serum 1,25(OH)2D declined with increasing creatinine (P < 0.001). What changed with age included creatinine, which correlated with 25(OH)D (r = 0.146, P < 0.001) only in the youngest age group (19–50 yr) but not in the older age groups (P > 0.1). Creatinine did not correlate with PTH in the youngest age group, but the relationship became significant as age increased (e.g. for the elderly, r = 0.365, P < 0.001). Linear regression of log PTH vs. log 25(OH)D agreed with the natural shape of the relationship observed with scatterplot smoothing, and this showed no plateau in PTH as 25(OH)D increased. We compared PTH concentrations among age groups, based on 20 nmol/liter increments in 25(OH)D. Mean PTH in adults older than 70 yr was consistently higher than in adults younger than 50 yr (P < 0.05 by ANOVA and Dunnett’s t test). PTH levels of the elderly who had 25(OH)D concentrations greater than 100 nmol/liter matched PTH of younger adults having 25(OH)D concentrations near 70 nmol/liter. This study shows that all age groups exhibit a high prevalence of 25(OH)D insufficiency and secondary hyperparathyroidism. Older adults are just as efficient in maintaining 25(OH)D, but they need more vitamin D to produce the higher 25(OH)D concentrations required to overcome the hyperparathyroidism associated with their diminishing renal function.

scholarly journals Age and Gender Differences in Performance at Cross Triathlon World Championships

2018 ◽  
Vol 25 (3) ◽  
pp. 17-22 ◽  
Author(s):  
Oscar Romero-Ramos ◽  
Emilio Fernández-Rodríguez ◽  
Rafael Merino-Marbán ◽  
Daniel Mayorga-Vega ◽  
Robert Podstawski
Keyword(s):  
Age Groups ◽  
Performance Ratio ◽  
Age Group ◽  
Men And Women ◽  
Race Time ◽  
Age Related ◽  
And Performance ◽  
And Gender ◽  
High Level ◽  
The Impact

Abstract Introduction. Cross triathlon is a sport consisting of three segments: swimming, off-road cycling, and running. Our study analyses the differences in performance between genders and changes in performance in selected age categories at the ITU Cross World Championships held between 2011 and 2016. Material and methods. During this period, a total of 1,933 triathletes were analysed (1,472 men and 461 women). Two-way analyses of variance (ANOVA) were used to examine the impact of sex differences and age-related changes on performance (time, percentage of time, and performance ratio) in swimming, cycling, running, and total race. Results. The age groups with the highest level of participation were persons aged 40-44 and 45-49 years among men and women, respectively. With regards to performance in the different age groups, in men and women, its high level was maintained between 25 and 49 years, and it decreased significantly from the age of 50-54. In men, the best results in cycling and total race time were obtained in the 30-34 age group and in swimming and running in the 40-44 group. Women obtained the best results in running in the 25-29 age group, in cycling in the 30-34 group, and in swimming and total race time in the 35-39 group. Conclusions. The results of the study have confirmed that there is a demand for sports in 40+ age groups. As for performance in the different age groups, it was on a high level between 25 and 49 years and decreased significantly from the age of 50-54 onwards. According to these results, the sports training of these triathletes should be oriented so that they obtain their best results between 30 and 35 years of age.

scholarly journals The impact of age on outcome after surgery for colorectal adenocarcinoma

2011 ◽  
Vol 93 (6) ◽  
pp. 445-450 ◽  
Author(s):  
AL Widdison ◽  
S Wienand Barnett ◽  
N Betambeau
Keyword(s):  
Older Patients ◽  
Operative Mortality ◽  
Relative Proportion ◽  
The Elderly ◽  
Medical Complications ◽  
Related Factors ◽  
Percentage Points ◽  
Age Related ◽  
Co Morbidity ◽  
The Impact

INTRODUCTION The incidence of colorectal cancer (CRC) increases with age. The aim of this study was to investigate the impact of age and age-related factors on post-operative mortality and survival following CRC resections. METHODS A prospectively collected database of 459 CRC resections was analysed. RESULTS The mean age of the patients was 70 years (range: 25–95 years) and 54% were male. The relative proportion of female patients increased with age so that for patients aged over 77 more women were treated than men. The probability of undergoing an emergency resection (25%) did not change with age. In older patients the proportion of rectal cancers resected decreased and the proportion of hemicolectomies and Hartmann's operations performed increased. The 30-day mortality rate was 4% after elective and 11% after emergency resections. Most deaths were caused by medical complications, reflecting increased co-morbidity in the elderly. Post-operative mortality was 1% in patients under the age of 59. This increased by 3 percentage points every 10 years after elective resections and by 8 percentage points every 10 years after emergency resections. CRC-specific survival was independent of age whereas overall survival decreased so the likelihood of dying from CRC decreased with age: at age 50 half the deaths were from CRC, at age 70 a third and at age 80 a quarter. CONCLUSIONS CRC stage and the probability of presenting as an emergency did not change with age but older patients were more likely to be female and have colon cancer. Post-operative mortality progressively increased with age. Most deaths were caused by medical complications, reflecting increased co-morbidity. Older patients were less likely to die from CRC.

scholarly journals The Great Recession and the changing intergenerational distribution of economic stress across income classes in Ireland: A comparative perspective

2016 ◽  
Vol 25 (2) ◽  
pp. 105-127 ◽  
Author(s):  
Christopher T Whelan ◽  
Brian Nolan ◽  
Bertrand Maître
Keyword(s):  
Life Course ◽  
Great Recession ◽  
The Elderly ◽  
Economic Stress ◽  
Recent Analysis ◽  
Age Group ◽  
The Great Recession ◽  
Age Related ◽  
Starting Point ◽  
The Impact

In this paper we seek to bridge the gap between recent analysis relating to the distributional consequences of the Great Recession across the income distribution and more specific concerns relating to inter-generational outcomes. In Ireland in 2008 there was a clear age gradient in relation to economic stress. Over time the gradient became sharper with the relative position of younger groups deteriorating. The increased salience of age group differentiation in Ireland involved two components. The first related to variability in increases in stress across the age spectrum that was common across income class categories. In that respect children and the older middle age group suffered most. The second involves changes in the additional effects of poverty. While the variable impact of poverty increased the differentials between the elderly and all other groups, it reduced the degree of differentiation between the non-elderly groups. It is not possible to understand the impact of the Great Recession in Ireland by focusing only on changing relativities in relation to social class, unless one allows for the fact that the changing impact of life course stage varied across income classes and the scale of absolute increases in economic stress levels for the non-elderly groups experienced across all income classes. That the Irish pattern of change was not an inevitable outcome of the economic crisis is illustrated by the fact that in Iceland a similar starting point produced a quite different set of changes. Greece, on the other hand, provides an example of the emergence of significant age related differentiation where the pre-recession period was characterised by their absence. Clearly policy choices not only affect life course differentiation but the extent to which operates in a uniform or variable fashion across income classes.

scholarly journals Features of Cytokine Profile in Different Age Groups

2014 ◽  
Vol 3 ◽  
Author(s):  
Alikhan Shortanbayev ◽  
Beibitgul Bizhigitova ◽  
Anel Tarabayeva ◽  
Aliya Nurmuchanbetova
Keyword(s):  
Gradual Increase ◽  
Age Groups ◽  
The Elderly ◽  
Cytokine Profile ◽  
Age Group ◽  
Immune Parameters ◽  
Age Related ◽  
Cytokine Levels ◽  
Middle Aged Adults

Introduction. The study of the cytokine profile during aging is interesting because age-related changes of the immune status are usually correlate with the onset of specific diseases. Characteristics of cytokine activity in the elderly can not only detail the pathogenesis of the disease but also help to choose the appropriate therapeutic strategy, which in addition to the therapeutic effect could improve the quality of life of the elderly. The purpose of this study was to examine cytokine levels in older adults.Material and methods. We examined 268 people aged 45-80 years and older. All surveyed individuals were divided into 8 different age groups. All participants were tested for concentrations of IL-1β, IL-2, TNF-a and IFN-γ.Results. The study found that concentrations of TNF-a increased with age. For age group 45-49, the concentration of TNF-a was 5.94 pcg/ml. In older age groups, there was a gradual increase in cytokine concentration. In a group of centenarians, concentration of TNF-a  reached 20.55 pcg/ml, which is 3.4 times higher compared to the middle age group. Similar trends were found in the concentration of IL-1. For the age group of 45-49, the concentration of IL-1 b was 3.38 pcg/ml, and in the age group of 80 years and older, levels of this cytokine increased almost 5 times. It was found that with age-related there is a gradual decrease in the level of IL-2, and a gradual increase of IFN-γ. The decrease in IL-2 is due to the typical aging decrease in the amount of T-lymphocytes.Conclusion. Thus, our results indicate that there are significant deviations of immune parameters, particularly in cytokine concentrations, in older adults compared to middle aged adults. 

scholarly journals Age-Related Differences in Executive Functions Within High-Level Youth Soccer Players

2019 ◽  
Vol 13 (2) ◽  
pp. 64-75 ◽  
Author(s):  
Adam Francis Beavan ◽  
Jan Spielmann ◽  
Jan Mayer ◽  
Sabrina Skorski ◽  
Tim Meyer ◽  
...  
Keyword(s):  
Executive Functions ◽  
Response Times ◽  
Age Groups ◽  
Reaction Time Task ◽  
Soccer Players ◽  
Age Group ◽  
Sources Of Information ◽  
Age Related ◽  
The Impact ◽  
Effect Of Age

Background: When measuring executive functions (EF), it is common for athletes to be assessed on their ability to detect and process explicit sources of information. Yet not all of the information is perceived explicitly in an environment. Aim: This study aimed to include a new assessment that measures the impact of implicitly perceived congruent and incongruent visual precues on response times. Method: Seventy-four male soccer players: U12 (n=15), U13 (n=17), U17 (n=21) and U19 (n=21) representing a German 1st league club were assessed on four cognitive tasks. Results: The MANOVAs revealed a multivariate effect of age group on a reactive stress tolerance task (F(6,140)=11.670, p<0.001, ES=0.38) and a Stop Signal Reaction Time task (F(6,144)=6.142, p<0.001, ES=0.20). A one-way ANOVA revealed an age group effect for response accuracy in a multiple-object-tracking task (F(3,74)=4.05, p=0.01, ES=0.14). Lastly, a within-subjects effect of congruency on the implicit precued task (F(1,74)=51.32, p<0.001, ES=0.41) and a between-subjects effect of age group (F(3,74)=4.30, p=0.008, ES=0.15) was observed. Interpretation: The results provided support for including an implicit precueing task, while the overall testing demonstrated that the magnitude of the increase in EF performance between ages was greater across the younger age groups compared to the older age groups.  

scholarly journals Impact of Age on Treatment and Outcome in Newly Diagnosed DLBCL (Diffuse Large B-cell Lymphoma) Patients in the United States Veteran Population (2011-2017)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 1-1
Author(s):  
Snegha Ananth ◽  
Madison H. Williams ◽  
Ryan A. Williams ◽  
Jean Pierre Blaize ◽  
David Gregorio ◽  
...  
Keyword(s):  
Elderly Population ◽  
Cell Lymphoma ◽  
Age Groups ◽  
B Cell Lymphoma ◽  
The Elderly ◽  
The United States ◽  
Age Group ◽  
Inclusion Criteria ◽  
Large B Cell Lymphoma

Introduction: Diffuse large B-cell lymphoma (DLBCL), is predominantly diagnosed in the elderly with a median age of diagnosis approaching the seventh decade of life. The prognosis for DLBCL has improved for all age groups, but less so for those over 75 years of age. The VHA (Veterans Health Administration) is one of the largest integrated provider of cancer care in the United States and its population, on average, is older than the general US population, giving us an unique advantage in exploring outcomes in elderly population. Methods: We reviewed 2036 medical records on patients that had a diagnosis code of some form of lymphoma between 2011 to 2017. Patients were randomly selected. Inclusion criteria was any veteran with atleast one entry in their records of selected ICD-9 and ICD-10 codes for lymphoma. Exclusion criteria included primary CNS lymphoma, other low grade variant lymphomas, diagnosis and treatment outside VHA, inability to determine if patient record met study criteria or inability to fill in critical fields of interest for the study. 971 patients were included. Data was manually abstracted by trained researchers. The Wilcoxon-Mann-Whitney test was used to compare median Overall Survival (OS) between two groups. All statistical comparisons were made using the R statistical analysis package. A level of significance of 0.05 was used for all the tests. Results: Of the 971 patients that met the inclusion criteria, 739 (76.1%) were &lt;75 years and 232 (23.9%) were ≥75 years. Larger number of veterans were diagnosed at Stage III-IV (67% in &lt;75 years and 67.7% in ≥75 years, p=0.76) with higher IPI score &gt;3 (50.1 % in &lt;75 years and 60.4% in ≥75 years, p=0.0005). Further descriptive comparison is outlined in Table 1. Patients in the &lt;75 years age group received more lines of chemotherapy (p&lt;0.0001). The ≥75 years older age group was more likely to have no treatment or non-chemo treatment (15.5% vs 3.9%) and the under 75 group was more likely to have 2 or more lines of treatment (8.9% vs 2.6%). For those who received chemotherapy, 82.4% in &lt;75 years vs 76.3% in ≥75 years completed at least 4 cycles of therapy (p=0.07). However, 1 year, 2 years and median OS, was statistically different between the two age groups for all three measurements (p&lt;0.0001) and survival decreases as age at diagnosis increases. (Table 2, Figure 1). Conclusions: Nearly 1/4th of the patient population were older than 75 years, and despite receiving comparable lines of chemotherapy, had lower survival when compared to patients who were &lt;75 years. Previous studies (Lee et al, Cancer 2003 & Kenneth R.Carson et al, Blood 2012) have reported the role of an anthracycline or treatment related mortality contributing to inferior outcomes in the elderly population. While historical data supports CHOP at maximal doses in elderly, a re-assessment of dose intensity, role of anthracyclines and finding a balance between short-term efficacy and safety is a priority for this age group given increasing human longevity. Disclosures No relevant conflicts of interest to declare.

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