scholarly journals Assessment of Functions of the Autonomic Nervous System in the Elderly with Different Comorbid Factors

2020 ◽  
Author(s):  
Sushma S. ◽  
Medha Y Rao ◽  
Shaikh Mohammed Aslam
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
The Elderly ◽  
Common Symptom ◽  
Deep Breathing ◽  
Isometric Handgrip ◽  
Male Predominance ◽  
Healthy Elderly ◽  
Sensitivity Specificity ◽  
Deep Breathing Test

Abstract Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing’s battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients (n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs (p < 0.05). AFTs were highly significant with respect to the results obtained (p < 0.001). Deep breathing test, abnormal in majority of study patients, has a sensitivity of 93.3% and OHR has a specificity of 81.1% to determine AD. Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

scholarly journals Energy Requirement Equations in Elderly Patients: A Systematic Review (P01-002-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Dario Gregori ◽  
Honoria Ocagli ◽  
Corrado Lanera ◽  
Giulia Lorenzoni
Keyword(s):  
Systematic Review ◽  
Elderly Patients ◽  
Indirect Calorimetry ◽  
Gold Standard ◽  
Web Application ◽  
The Elderly ◽  
Energy Requirements ◽  
Elderly Subjects ◽  
Predictive Equation ◽  
Healthy Elderly

Abstract Objectives Elderly patients are at risk of malnutrition and need an appropriate assessment of energy requirements. In the clinical setting, predictive equations are widely used to estimate the Resting Energy Expenditure (REE). Although easy to use, these equations are not always validated for the elderly and, even if validated, they often provide different outputs of energy requirements for the same subject. This study aimed at doing a systematic review of the equations for the estimation of REE in the elderly with the final aim of developing a web-based application helping clinicians in finding out the most appropriate equation for estimating the REE for each subject. Methods The systematic review was carried out using PubMed and Scopus following PRISMA guidelines. Studies in subjects older than 65 years of age, testing the performance of a predictive equation for the estimation of REE vs. a gold standard (indirect calorimetry or doubly labeled water) were included in the review. Studies performed in critically ill elderly patients were excluded. Results The initial search identified 2035 studies. The final review included 50 studies. Included studies were mainly observational, conducted in healthy elderly subjects enrolled in the outpatient setting, and using indirect calorimetry as gold standard. The 50 studies included in the review corresponded to 189 different equations. Several parameters were included in the equations and they can be divided as following: anthropometric characteristics, body composition parameters, environmental measures, laboratory tests, presence of comorbidities, and physical activity frequency. Conclusions The assessment of the energy requirements in the elderly is crucial for the management of nutritional problems in this population group since nutritional problems are related to worse health outcomes. The present study showed a wide use of different type of equations for the estimation of REE in the elderly highlighting the need of choosing the most appropriate predictive equation according to the subject characteristics and health status. The web application that is currently under development will help clinicians in doing that. Funding Sources Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.

scholarly journals Immune response during disease and recovery in the elderly

1999 ◽  
Vol 58 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Bruno Lesourd
Keyword(s):  
Immune Responses ◽  
Elderly Patients ◽  
Acute Phase ◽  
Protein Energy Malnutrition ◽  
The Elderly ◽  
T Helper ◽  
Aged Patients ◽  
Healthy Elderly ◽  
Protein Energy ◽  
Apparently Healthy

The present article reviews immune ageing and its relationship with nutritional ageing, with a particular insight into the influences of disease on both ageing processes. Immune ageing can be described primarily as the progressive appearance of immune dysregulations, mainly acquired immunity (mature: immature, naive: memory T lymphocyte subset decreases) leading to gradual increases in T-helper 2: T-helper 1 cells. This change is due initially to decreased thymic function, and later to accumulative antigen pressure over the lifespan. In contrast, innate immunity (macrophage functions) is preserved during the ageing process and in the elderly this leads to macrophage–lymphocyte dysequilibrium, which is particularly critical during on-going disease. Indeed, any disease induces long-lasting acute-phase reactions in aged patients and leads to body nutritional reserve (mainly protein) losses. Episodes of disease in the aged patient progressively deplete body nutritional reserves and lead to protein–energy malnutrition, undernutrition-associated immunodeficiency, and finally cachexia. Undernutrition is a common symptom in the elderly; protein-energy malnutrition is found in more than 50 % of hospitalized elderly patients and in most elderly diseased subjects. In addition, micronutrient deficit or low levels are common in home-living self-sufficient apparently-healthy elderly subjects. All these nutritional deficits induce decreased immune responses, and micronutrient deficits are now thought to be partly responsible for the decreased immune responses (immune ageing?) observed in the apparently-healthy elderly. Indeed, several studies have shown that micronutrient supplements induce increased immune responses in the healthy elderly. The progression of infectious diseases depends on immune responses and on nutritional status before the onset of illness in aged subjects. In addition, recovery depends on the intensity of acute-phase responses in the undernourished elderly. In fact, chronic acute-phase responses, commonly associated with diseases in aged patients, lead to progressive lowering of metabolic responses in the undernourished elderly. This can be quantified by increased production of free radicals during treatment and these increases may explain the difficulty in successfully treating aged patients. Nutritive therapy in order to improve metabolic processes and also to maintain body reserves should be considered as a necessary adjuvant therapy in the treatment of elderly patients.

scholarly journals Evaluation of modified Alvarado scoring system in acute appendicitis at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India

2017 ◽  
Vol 4 (7) ◽  
pp. 2118
Author(s):  
Punjala Sai Rithin ◽  
Aman Agarwal ◽  
Bhavana Budigi
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Scoring System ◽  
Iliac Fossa ◽  
Research Centre ◽  
Negative Appendectomy ◽  
Common Symptom ◽  
Complication Rates ◽  
Medical Sciences ◽  
Male Predominance

Background: Despite of much advancement in modern diagnostic technology, decision making in patients with acute appendicitis is still a challenge worldwide. Many diagnostic scoring systems have been developed. Of them modified Alvarado scoring system (MASS) has been reported to be a cheap and quick diagnostic tool which minimizes negative appendectomy rate. The present study was aimed to evaluate the efficacy of MASS in diagnosing acute appendicitis and correlating the same with histopathological results.Methods: This prospective cohort study conducted from November 2012 to April 2014, over a period of 18 months at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. 100 patients with symptoms of acute appendicitis were enrolled in the study. They were diagnosed using MASS. Patients with a score of 7 to 10 were taken up for surgery. Patients with a score below 7, but with high suspicion of acute appendicitis by the surgeon were taken up for surgery. Following surgery all appendix specimens were sent for histopathologic examination.Results: A total number of 100 patients were participated in the study. Of them patients under the age group of 21-30 years were more affected with acute appendicitis (51%). Male predominance was observed in the study (74%). The common symptom observed in all patients (100%) was tenderness in right Iliac fossa (RIF). Out of 100 patients, 79% of the patients were presented with a modified Alvarado score of ≥7 and 21% presented with a score of <7. The sensitivity and specificity of the MASS in this study was 89.66% and 92.31% in both males and females respectively. The positive predictive value was 98.73%, negative predictive value was 57.41% and the NAR was 6.75% and 30.76% in male and female patients respectively.Conclusions: The observations of the study confirm that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and subsequently reduces the negative appendicectomy and complication rates.

scholarly journals Tuberculosis in the elderly: Epidemiology and outcomes at JAMOT Hospital of Yaounde

2019 ◽  
Vol 5 (2) ◽  
pp. 65-68
Author(s):  
Bitchong Ekono Claire Francoise ◽  
◽  
Azoumbou Méfant Thérese ◽  
Ze Jean Jacques ◽  
Olinga Medjo Ubald ◽  
...  
Keyword(s):  
Developing Countries ◽  
Pulmonary Tuberculosis ◽  
Elderly Patients ◽  
The Elderly ◽  
Treatment Center ◽  
Therapeutic Success ◽  
Exact Probability ◽  
Male Predominance ◽  
Lost To Follow Up

Background: Tuberculosis in the elderly (TBES) compared to adult TB (TBA) has been poorly published in developing countries (developing countries).Aim and Objective: The objective of this study is to present the epidemiology of TBES and the outcome of TB patients aged 65 years or older compared to TBA. Methodology: Our study is retrospective and comparative for the period of activity from January 2008 to December 2013 at the Diagnostic and Treatment Center (CDT) at the Jamot Hospital in Yaoundé (HJY). It is compared between subjects aged 65 years and older and subjects aged 15 to 64 who have been diagnosed with tuberculosis (TB) Statiscal analysis: The Khi-2 test and the exact probability of Ficher were used for the comparison of proportions. A difference was considered significant if p <0.05. Results: Of the 10909 TB cases, the proportion of TBES is 2.93%. The sex ratio is 1.7 in case of TBES versus 1.5 in the TBA. The prevalence of TB-HIV co-infection is estimated at 11.3% versus 37.3% for TBA (p˂ 0000). The location is pulmonary in 76.4% of cases in TBES against 78.1% in the subject aged less than 65 years. Elderly patients developed more pulmonary tuberculosis with negative microscopy (TPM-) 12.9% versus 11.3% and extra-pulmonary tuberculosis (PET) (23.6% versus 21.9%). The therapeutic success rate in subjects aged 65 and over is 61.6% versus 70.3% in subjects under 65 years of age. The proportion of patients lost to follow-up and the rate of transfer are higher in case of TBES. Elderly patients died more frequently than young adults in the first two months of treatment. Conclusion: Tuberculosis of the elderly is rare with male predominance. The proportion of deaths is greater. The follow-up of elderly patients must integrate the therapeutic management of comorbidities

scholarly journals Analysis of clinical manifestations and diagnosis of late-onset myasthenia gravis

2020 ◽  
Vol 10 (1) ◽  
pp. 53-63
Author(s):  
A. N. Khalmurzina ◽  
T. M. Alekseeva ◽  
S. V. Lobzin ◽  
D. I. Rudenko ◽  
V. V. Kryuchkova
Keyword(s):  
Elderly Patients ◽  
Myasthenia Gravis ◽  
Late Onset ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Neuromuscular Diseases ◽  
The Elderly ◽  
Vascular Pathology ◽  
Common Symptom ◽  
Diagnostic Features

Introduction. Myasthenia gravis is one of the most common autoimmune neuromuscular diseases, the peak incidence is in the age of 20–40 years. However, studies show that throughout the world in recent decades there has been an increase in the prevalence and incidence of myasthenia gravis among older people.Purpose of the study – to evaluate the clinical manifestations and diagnostic features of myasthenia gravis in patients with an onset of diseases in the elderly.Materials and methods. The retrospective, non-interventional study included 315 patients over 18 years old with a reliable (3 out of 4 criteria) and an undoubted (4 out of 4 criteria) diagnosis of myasthenia gravis, the duration of the disease for up to 5 years, undergoing inpatient treatment from 2001 to 2017 years. The severity of the clinical manifestations of myasthenia gravis was assessed using the Myasthenia Gravis Foundation of America scale. We were taken into account the information about the first symptoms, duration of the period from the onset of the disease to the verification of the diagnosis, results of the examinations, the presence of concomitant diseases and treatment methods.Results. The most common symptom of myasthenia gravis in the group of patients with debut disease aged 60 years and older was ptosis (p <0.001). The crises and pathology of the thymus were less common in elderly patients (p <0.0001). The concentration of antibodies to acetylcholine receptors was the same (p = 0.05) among all patients. The level of antibodies to titin was increased in patients with lateonset (p = 0.0014). The presence of bronchopulmonary pathology made worse the course of myasthenia gravis in elderly people (p = 0.01), while cardiovascular and cerebrovascular diseases, as well as diabetes mellitus, did not occur (p >0.005). At the first examination in the group of elderly patients among the incorrectly diagnoses prevailed: stroke or decompensation of chronic cerebral ischemia (p = 0.0002). With a comparable duration and severity of myasthenia gravis in different age groups, the combination of anticholinesterase drugs, glucocorticosteroids and azathioprine (p = 0.01) at a lower daily dose (100 mg) was more often used for the treatment of elderly patients compared with young and middle-aged groups (150 mg) (p = 0.03).Conclusion. Diagnosis of myasthenia gravis in elderly patients presents the greatest difficulties, and symptoms of manifestation during initial treatment are often regarded as a manifestation of vascular pathology. Despite the presence of concomitant diseases characteristic of this age group, myasthenia gravis does not differ in the severity of the course. To achieve remission and compensation of symptoms, elderly patients do not need large doses of symptomatic and pathogenetic drugs.

scholarly journals Radiotherapy for Elderly Patients Aged ≥75 Years with Clinically Localized Prostate Cancer—Is There a Role of Brachytherapy?

2018 ◽  
Vol 7 (11) ◽  
pp. 424 ◽  
Author(s):  
Hideya Yamazaki ◽  
Koji Masui ◽  
Gen Suzuki ◽  
Satoaki Nakamura ◽  
Norihiro Aibe ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Elderly Patients ◽  
Risk Group ◽  
The Elderly ◽  
Elderly Group ◽  
Localized Prostate Cancer ◽  
Control Group ◽  
Healthy Elderly ◽  
Gu Toxicity

We compared radiotherapy outcomes between 241 elderly patients aged ≥75 years and 867 younger controls (age <75 years) with clinically localized prostate cancer. The elderly group showed an equivalent actuarial seven-year biochemical failure-free survival rate (7y-bNED) (94.9%) to the younger control group (96.4%, p = 0.593). The incidence of late genitourinary (GU) and gastrointestinal (GI) toxicities grade ≥2 was also similar between the elderly and younger cohorts, while no grade ≥4 adverse events occurred. We also examined the role of brachytherapy (BT) in the elderly group, in comparison with image-guided intensity-modulated radiotherapy (IG-IMRT). BT showed superior 7y-bNED (94.1%) than IG-IMRT (84.6%, p = 0.0183) in elderly patients, which was 100% (100% for BT and 100% for IG-IMRT, p > 0.999) for the low-risk group, 94.6% (92.8% and 100%, p = 0.203) for the intermediate-risk group, and 80.5% (91.2% and 73.6%, p = 0.0195) for the high-risk group. BT showed higher GU toxicity and equivalent GI toxicity to IG-IMRT. In conclusion, elderly patients showed bNED and toxicity that were equivalent to those observed in younger controls, and BT is a plausible option also for healthy elderly with potential to improve bNED, with higher but acceptable GU toxicity.

scholarly journals Comparison of Six Decision Aid Rules For Diagnosis of Acute Myocardial Infarction In Elderly Patients Presenting To The Emergency Department With Acute Chest Pain

2021 ◽  
Author(s):  
Juraj Hrečko ◽  
Jiří Dokoupil ◽  
Radek Pudil
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Elderly Patients ◽  
Predictive Value ◽  
Decision Aid ◽  
Real Life ◽  
The Elderly ◽  
Coronary Syndrome

Abstract Background: Using decision aid rules for diagnosis of acute myocardial infarction (AMI) is not common practice in our region. Elderly patients are often neglected in clinical trials, and the proper diagnostics of acute myocardial infarction in this group remains problematic. The objective of this study was to evaluate the accuracy and effectiveness of different strategies for the diagnosis of AMI in the elderly in real-life clinical practice. Methods: In a retrospective single-center study, we included patients older than 70 years presenting to the emergency department with chest pain as a dominant symptom. The performance of six decision aid rules (T-MACS, HEART, EDACS, TIMI, GRACE, and ADAPT) and solo troponin T strategy for diagnosing acute myocardial infarction was evaluated by calculating sensitivity, specificity, odds ratios, negative and positive predictive values.Results: A total of 250 patients, with a mean age of 78.5 years, were enrolled. Forty-eight patients (19.2%) had an acute myocardial infarction in a 30 day follow-up period. The sensitivity for ruling-out AMI was 100% for T-MACS, HEART, and ADAPT; 97.9% for EDACS, 93.8% for TIMI, and 81.3% for GRACE and solo TnT strategy. For ruling-in AMI, the specificity was 97.5% for T-MACS, 95% for TIMI, 83.2% for HEART, 81.7% for GRACE, and 46% for ADAPT. C-statistics were 0.52 for T-MACS, 0.51 for ADAPT, 0.47 for EDACS and GRACE, 0.46 for HEART and TIMI, and 0.33 for solo TnT strategy.Conclusion: T-MACS decision aid had the best performance with 100% sensitivity and 100% negative predictive value for rule-out AMI; 97.5% specificity and 64.3% positive predictive value for rule-in AMI. Other evaluated protocols were less accurate. Risk stratification of patients with suspected acute coronary syndrome based on decision aid rules can be used in real-life practice, even in the population of the elderly.

scholarly journals Pattern of anemia in elderly patients

2019 ◽  
Vol 7 (7) ◽  
pp. 2524
Author(s):  
Vibhuti Jain
Keyword(s):  
Elderly Patients ◽  
Prospective Observational Study ◽  
The Elderly ◽  
Common Symptom ◽  
Medical College ◽  
Increase Risk ◽  
Study Population ◽  
The Common ◽  
Jawaharlal Nehru ◽  
Significant Factors

Background: Anemia is one of the common significant factors responsible for the morbidity and mortality in elderly patients of age 60 years and above. The present was done with the aim to assess the consequences of anemia, and potential etiologies that increase risk of adverse events in geriatric population.Methods: This was a prospective observational study conducted at the department of pathology at Pt. Jawaharlal Nehru Medical College and associated Dr. B. R. A. M. Hospital, Raipur, Chhattisgarh, during the period from December 2011 to December 2012. A total of 150 patients with hemoglobin <12 gm% in female and <13 gm% in male satisfying the WHO criteria of anemia (hemoglobin (Hb) were included in the study. Detailed laboratory investigation of haemoglobin and relevant diagnostic tests were done in all the patients to identify the etiology.Results: The prevalence rate of anemia was 68.67%. Proportion of anemia in males was 56.6% and in females it was 43.4%.Fatigue was the most common symptom found in 87.88 % of patients. Overall mean MCV values in the study population were 80.12±10.71 (fL). Most of the patients were mild anaemic (45.3%). Normocytic-normochromic type of anemia was the most common type constituting 64%.Conclusions: There are no specific clinical guidelines to manage geriatric anemia at present. It is clear that anemia in the elderly should be evaluated, and the underlying cause should be identified at the earliest and treated whenever possible.

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