Delirium Duration Predicts 1-Month And 6-Month Mortality In Septic Patients From an Acute Geriatrics Unit

Abstract Sepsis is highly prevalent in the older population compared to younger age groups. We showed that the SOFA score predicts the risk of death at 30 days in patients discharged from an acute geriatrics unit (AGU). We aim at comparing the ability of both delirium duration and SOFA to predict 1-month and 6-month mortality among septic patients. We performed an observational cohort study recruiting all patients consecutively admitted to San Gerardo hospital AGU (Italy) between March 2017 and January 2020, aged ≥70, who were diagnosed with sepsis according to 2016 Sepsis-3 criteria. All patients underwent a comprehensive geriatric assessment, including delirium twice a day with the 4AT. Outcomes were 1- and 6-month mortality rates. From 3,326 hospitalized patients, 235 were included in the study (median age 84 years, 42% females). Delirium accounted for 71.9% (169 patients, median duration 3 days). One-month and 6-month mortality rates were 32.3% and 55.3%, respectively. Age, albumin, hemoglobin, and PCR levels were associated with mortality and included as covariates in our Base Model. We performed pairwise comparison between c-indexes of the Base Model vs. Base+delirium duration (days) vs. Base+SOFA. The increment of predictive performance of model including delirium duration was statistically significant (c-index: 0.67 vs. 0.75 when considering 1-month mortality; 0.70 vs. 0.75 for 6-month mortality). Base+delirium duration performed better than Base+SOFA, but the difference not significant. Delirium duration performs as well as SOFA score in predicting 1- and 6-month mortality, with practical implications for the management of these patients in the continuum of care.

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Inequalities and Impact of Socioeconomic-Cultural Factors in Suicide Rates Across Italy

Crisis ◽

10.1027/0227-5910/a000084 ◽

2011 ◽

Vol 32 (4) ◽

pp. 178-185 ◽

Cited By ~ 15

Author(s):

Maurizio Pompili ◽

Marco Innamorati ◽

Monica Vichi ◽

Maria Masocco ◽

Nicola Vanacore ◽

...

Keyword(s):

Suicide Rate ◽

Age Groups ◽

Premature Death ◽

Mortality Rates ◽

Mortality Data ◽

Italian Population ◽

Comprehensive Overview ◽

Suicide Rates ◽

Younger Age ◽

Age And Sex

Background: Suicide is a major cause of premature death in Italy and occurs at different rates in the various regions. Aims: The aim of the present study was to provide a comprehensive overview of suicide in the Italian population aged 15 years and older for the years 1980–2006. Methods: Mortality data were extracted from the Italian Mortality Database. Results: Mortality rates for suicide in Italy reached a peak in 1985 and declined thereafter. The different patterns observed by age and sex indicated that the decrease in the suicide rate in Italy was initially the result of declining rates in those aged 45+ while, from 1997 on, the decrease was attributable principally to a reduction in suicide rates among the younger age groups. It was found that socioeconomic factors underlined major differences in the suicide rate across regions. Conclusions: The present study confirmed that suicide is a multifaceted phenomenon that may be determined by an array of factors. Suicide prevention should, therefore, be targeted to identifiable high-risk sociocultural groups in each country.

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Housing Transitions and Recovery of Older Adults Following Hurricane Sandy

The Journals of Gerontology Series B ◽

10.1093/geronb/gby126 ◽

2018 ◽

Vol 74 (6) ◽

pp. 1041-1052 ◽

Cited By ~ 2

Author(s):

Alexis A Merdjanoff ◽

Rachael Piltch-Loeb ◽

Sarah Friedman ◽

David M Abramson

Keyword(s):

Older Adults ◽

Age Groups ◽

Family Health ◽

Hurricane Sandy ◽

Younger Adults ◽

Younger Age ◽

Observational Cohort ◽

Emergency Housing ◽

Young Old ◽

Post Disaster

Abstract Objectives This study explores the effects of social and environmental disruption on emergency housing transitions among older adults following Hurricane Sandy. It is based upon the Sandy Child and Family Health (S-CAFH) Study, an observational cohort of 1,000 randomly sampled New Jersey residents living in the nine counties most affected by Sandy. Methods This analysis examines the post-Sandy housing transitions and recovery of the young-old (55–64), mid-old (65–74), and old-old (75+) compared with younger adults (19–54). We consider length of displacement, number of places stayed after Sandy, the housing host (i.e., family only, friends only, or multi-host), and self-reported recovery. Results Among all age groups, the old-old (75+) reported the highest rates of housing damage and were more likely to stay in one place besides their home, as well as stay with family rather than by themselves after the storm. Despite this disruption, the old-old were most likely to have recovered from Hurricane Sandy. Discussion Findings suggest that the old-old were more resilient to Hurricane Sandy than younger age groups. Understanding the unique post-disaster housing needs of older adults can help identify critical points of intervention for their post-disaster recovery.

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Age and sex variation in visceral adipose tissue

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20190113 ◽

2019 ◽

Vol 6 (1) ◽

pp. 101

Author(s):

Pallavi Panchu ◽

Biju Bahuleyan ◽

Rose Babu ◽

Vineetha Vijayan

Keyword(s):

Adipose Tissue ◽

Visceral Fat ◽

Metabolic Disorders ◽

Age Groups ◽

Fat Distribution ◽

Age Group ◽

Cross Sectional ◽

Younger Age ◽

The Difference ◽

Gender Pattern

Background: Adipose tissue mainly visceral fat is said to be harmful and acts as a harbinger of metabolic disorders. A changing trend is seen in the recent decades with decreasing incidence of metabolic disorders in men even though visceral fat is said to be higher in them. Sex hormones may influence the deposition pattern of adipose tissue. The aim of this study was to observe effects of age on visceral fat and to know if the difference in gender pattern of fat distribution is maintained throughout life or disappears after menopause.Methods: This cross-sectional observational study was conducted in Thrissur on 385 apparently healthy subjects using Omron body composition analyser. Data was analysed using SPSS 20.0 version. The tests employed were NOVA, independent samples t-test.Results: In each age group, men had significantly higher visceral fat than females. As age increased, visceral fat increased significantly in both genders. In each group, except for younger age groups, VF levels were equal in men and women.Conclusions: Visceral fat is higher in men and this difference is seen in all age groups. As age increases, visceral fat levels also increased in men and women. The distribution of visceral fat is such that a greater number of men have high to very high levels at a younger age group, a feature observed in women only in the peri and post-menopausal age. Adoption of an active lifestyle coupled with healthy diet should protect against onset of metabolic disorders.

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Epidemiology of Childhood Cancer in Piemonte and Valle d'Aosta during 1965-69.

Tumori Journal ◽

10.1177/030089167506100307 ◽

1975 ◽

Vol 61 (3) ◽

pp. 291-304 ◽

Cited By ~ 4

Author(s):

Guido Pastore ◽

Benedetto Terracini

Keyword(s):

Age Groups ◽

Soft Tissue Sarcomas ◽

Cancer Registries ◽

Mortality Rates ◽

Number Of Children ◽

Incidence And Mortality ◽

The Central Nervous System ◽

The Difference ◽

Hodgkin's Lymphomas ◽

The U.S

Piemonte and Valle d'Aosta are in the NW part of Italy. In 1967 total population and population aged 0-14 were respectively 4.338.000 and 841.000. During the period 1965-69 a total of 688 cases of cancer (including leukemia) were diagnosed in children under 15 years of age resident in this area. The Cancer Registry of Piedmont and Valle d'Aosta (RTP) provided information on 465 children; the other 223 were collected through additional investigation in the files of 31 university or hospital departments of the region and 5 extraregional hospitals. Distribution through the 5 years covered by the investigation is shown in Table 1. Histological or hematological confirmation of the diagnosis was available in 499 cases (73%). The 688 cases included 216 leukemias, 131 tumors of the central nervous system, 40 neuroblastomas, 82 lymphomas (including 34 cases of Hodgkin's disease), 46 nephroblastomas, 32 soft-tissue sarcomas, 29 bone sarcomas (including 5 cases of Ewing's disease), 25 retinoblastomas, 12 thyroid tumors, 10 extragenital teratomas, 5 ovarian dysgerminomas, 4 tumours of the testes, 4 hepatoblastomas and 52 other tumours (Table 2). The number of children under 15 years of age dying of cancer during 1965-69 was 341 (Table 2). Incidence and mortality rates by age groups are given in Tables 3 and 4. The rates were of the same order as those observed in the U.S. and in other European cancer registries during the same period (Tables 4, 5 and 6). The mortality rate for nephroblastomas at age 0-4 was 1,09/100.000/year, i.e. slightly higher than that observed in the U.S. in 1960 but about twice as high as that observed in the U.S. in 1967 (14). Incidence and mortality rates for both Hodgkin's and non-Hodgkin's lymphomas were about 3 times higher in males than in females (Table 3). The difference was less obvious during the first five years of life, in which the total number of diagnosed lymphomas was 16.

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Association Between Salivary Flow Rate and the Use of Systemic Medication Among 76-, 81-, and 86-year-old Inhabitants in Helsinki, Finland

Journal of Dental Research ◽

10.1177/00220345920710120401 ◽

1992 ◽

Vol 71 (12) ◽

pp. 1875-1880 ◽

Cited By ~ 116

Author(s):

T.O. Narhi ◽

J.H. Meurman ◽

A. Ainamo ◽

J.M. Nevalainen ◽

K.G. Schmidt-Kaunisaho ◽

...

Keyword(s):

Flow Rate ◽

Age Groups ◽

Salivary Flow ◽

Salivary Flow Rate ◽

Flow Rates ◽

Systemic Medication ◽

Younger Age ◽

Significant Difference ◽

The Difference ◽

Saliva Flow

The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368. In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p < 0.01). No significant differences in this respect were found between genders. Among the unmedicated subjects, 76-year-olds had significantly higher stimulated salivary flow rates than did the 81-year-olds (p < 0.05). Unmedicated women showed significantly lower unstimulated (p < 0.01) and stimulated flow rates than did men (p < 0.05). Stimulated salivary flow rate was also significantly higher in the 76-year-old medicated subjects than in the medicated 86-year-old subjects (p < 0.05). No statistically significant differences were found in unstimulated salivary flow rates among the three age groups. Medicated women showed significantly lower unstimulated salivary flow rates than men (p < 0.001), although the difference in stimulated saliva flow was not significant. A statistically significant difference in unstimulated and stimulated salivary flow rates was found between unmedicated persons and those who took from four to six, or more than seven, prescribed medications daily.

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Higher Incidence of Chronic Myeloid Leukemia (CML) Among Blacks Compared to Whites in the Post-Imatinib Period (2002–2009) Corresponds with Worse Survival Observed within the Surveillance, Epidemiology and End Results 18 Registries

Blood ◽

10.1182/blood.v120.21.3773.3773 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3773-3773

Author(s):

Adam Mendizabal ◽

Paul H Levine

Keyword(s):

Tyrosine Kinase ◽

Incidence Rate ◽

Kinase Inhibitors ◽

Age Groups ◽

Incidence Rates ◽

Age At Diagnosis ◽

Age Group ◽

Risk Of Death ◽

Younger Age ◽

Adjusted Incidence

Abstract Abstract 3773 Background: Age at diagnosis of CML varies by race in the United States with median occurring around ages 54 and 63 among Black and White patients, respectively. The treatment paradigm shifted when Imatinib was approved in 2001 for treatment of CML. More recently, second generation tyrosine kinase inhibitors (TKI) have also been used for treatment of CML. Differences in outcomes by race have been previously reported prior to the TKI treatment period. We aimed to assess whether the earlier age at diagnosis resulted in differential trends in age-adjusted incidence rates and survival outcomes by race in the post-Imatinib treatment period. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries were extracted for diagnoses between 2002 and 2009 based on the assumption that cases diagnosed after 2002 would be treated with TKI's. CML was defined according to the International Classification of Diseases for Oncology 3rd edition code 9863 (CML-NOS) and 9875 (CML-Philadelphia Chromosome Positive). Cases diagnosed by autopsy or death certificate only were excluded. Incidence rates are expressed per 100,000 person-years and age-adjusted to the 2000 US Standard Population. Black/White incidence rate ratios (IRRBW) are shown with corresponding 95% confidence intervals (CI). Kaplan-Meier estimates of CML-specific survival (CPS) and overall survival (OS) were estimated at 5-years post-diagnosis with the event being time to CML-specific death or any death, respectively. Stratified Cox proportional hazards models were constructed to assess the impact of age and race on the risk of death expressed as a hazard ratio (HR). Results: Since 2002, 6,632 patients diagnosed with CML were reported to the SEER 18 registries including 5,829 White patients (87.9%) and 803 Black patients (12.1%) with 57% being male. The age-adjusted incidence rate for Blacks was 1.18 (95% CI, 1.10–1.27) per 100,000 and 1.12 (95% CI, 1.09–1.27) per 100,000 for Whites. The corresponding IRRBW was 1.06 (95% CI, 0.98– 1.14). When considering 20-year age-groups, Blacks had higher incidence rates in the 20–39 and 40–59 age groups; IRRBW of 1.26 (95% CI, 1.06–1.49; p=0.0073) and 1.23 (95% CI, 1.09–1.39; p=0.0007), respectively. No statistically significant differences in IRRBW were seen within the 0–19, 60–79 and 80+ age-groupings although Whites have higher non-significant incidence rates in the latter 2 age-groups. Differences in IRRBW prompted an assessment of survival to determine if the excess incidence observed in the younger age groups corresponded with a worse survival. CPS at 5-years was 85.5% (95% CI, 84.3–86.6). In univariate analysis, age was an important predictor of outcome (p<0.0001) with patients diagnosed after age 80 having the worse outcomes (OS: 58.3%), followed by patients diagnosed between 60 and 79 years (OS 84.7%), 0–19 years (OS: 87.1%), 40–59 years (OS: 90.2%), and 20–39 years (OS: 92.6%). When considering all age-groups, race was not a significant predictor of death (HR 0.91; 95% CI, 0.72–1.15). However, in a stratified analysis with 20-year age groups, Blacks had an increased risk of death as compared to Whites (Figure 1) in the 20–39 age group (HR: 2.94; 95% CI, 1.72–5.26; p<0.0001) and the 40–59 age group (HR: 1.67; 95% CI, 1.22–2.27; p=0.0069) while no differences were seen within the 0–19, 60–79 and 80+ age groups. Conclusions from OS models were similar to that of the CPS models. Conclusions: Through this analysis of population-based cancer registry data collected in the US between 2002 and 2009, we show that Blacks have a younger age at diagnosis with higher incidence rates observed in the 20–39 and 40–59 age-groups as compared to Whites. Both CPS and OS outcomes differed by race and age. Similar to the differences observed with the incidence rates, survival was worse in Blacks diagnosed within the 20–39 and 40–59 age-groups as compared to Whites. Although outcomes have globally improved in patients with CML since the advent of tyrosine kinase inhibitors, the persistence of incidence heterogeneity and poorer survival among Blacks warrants further attention. Access to care may be a possible reason for the differences observed but further studies are warranted to rule out biological differences which may be causing an earlier age at onset and poorer survival. Disclosures: No relevant conflicts of interest to declare.

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Covid-19: Comparisons by Country and Implications for Future Pandemics

10.1101/2021.05.29.21258056 ◽

2021 ◽

Author(s):

Lewis E. Mehl-Madrona ◽

Francois Bricaire ◽

Adrian Cuyugan ◽

J. Barac ◽

Asadullah Parvaiz ◽

...

Keyword(s):

The United States ◽

Mortality Rates ◽

Social Structures ◽

Lower Mortality ◽

Vitamin D Status ◽

Northern European ◽

The Usa ◽

The Difference ◽

Very High ◽

Better Than

Background. We set out in this paper to compare Covid-19 results by country to better understand the factors leading to the differing results found internationally. Methods. We used publicly available large datasets to explore differences by the country for Covid-19 mortality statistics. We continuously challenged our projections with reality and numbers from countries around the world, allowing us to refine our models and better understand the progression of the epidemic. All our predictions and findings were discussed and validated from a clinical viewpoint. Results. While no lockdown resulted in higher mortality, the difference between strict lock-down and a lax lockdown was not terribly different and favored lax lockdown. Only one of the top 44 countries had long and strict restrictions. Strict restrictions were more common in the worst-performing countries in terms of Covid mortality. The United States had the largest economic growth coupled with the largest rate of mortality. Those who did well economically had lower mortality and less pressure on their population. Yet they had less mortality than average and less than their neighbors. Conclusions. Countries with the least restrictions fared best economically. Some of them fared well in terms of mortality, even better than neighboring countries with similar social structures and more severe restrictions. The mortality rates in the USA, however, appeared to suffer from very high obesity rates. Norway and the northern European countries have less strict restrictions from the rest of Europe and had lower mortality rates. COVID-19 mortality was associated with vitamin D status.

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Mortality of the population of the Komi Region at the end of the – XIX beginning of the XX century: age composition

Historical demography ◽

10.19110/2304-5922-2021-1-11-14 ◽

2021 ◽

Vol 1 ◽

pp. 11-14

Author(s):

D.V. Vishnyakova ◽

Keyword(s):

Mortality Rate ◽

Age Groups ◽

Mortality Rates ◽

Age Composition ◽

Younger Age ◽

Significant Concentration

The article describes some mortality rates of the population of the Komi Region in the late XIX-early XX century. The age composition of the deceased is revealed, with a distribution by gender. During the studied time, mortality was characterized by a significant concentration in younger age groups. The mortality rate of children under the age of five years averaged 55–70 % of the total number of deaths in the region.

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Systemic Lupus Erythematosus in the First Decade of Life

PEDIATRICS ◽

10.1542/peds.83.2.235 ◽

1989 ◽

Vol 83 (2) ◽

pp. 235-239

Author(s):

Thomas J. A. Lehman ◽

Deborah K. McCurdy ◽

Bram H. Bernstein ◽

Karen K. King ◽

Virgil Hanson

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Medical Records ◽

Age Groups ◽

Mortality Rates ◽

Sex Distribution ◽

Systemic Lupus ◽

Younger Age ◽

Racial Ethnic ◽

Two Age Groups

To evaluate whether the onset of systemic lupus erythematosus in the first decade of life was Associated with a unique pattern of racial preponderance, sexual preponderance, genetic predisposition, or disease expression, the medical records of 23 children with systemic lupus erythematosus prior to their tenth birthdays were compared with the medical records of 82 children in whom lupus was diagnosed between their tenth and 20th birthdays. No statistically significant differences in sex distribution, racial (ethnic) background, family history, mode of onset, morbidity, or mortality rates were found between the two age groups. The frequently held view that children with early-onset lupus do worse probably relates to the fact that even though they survive as long as children with the older-onset disease, they die younger because they have the onset of their lupus at a younger age.

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SAT0252 INCREASED MORTALITY FOR INDIVIDUALS WITH GIANT CELL ARTERITIS: A POPULATION-BASED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1879 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1069.1-1069

Author(s):

L. Barra ◽

J. Pope ◽

P. Pequeno ◽

J. Gatley ◽

J. Widdifield

Keyword(s):

General Population ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Age Groups ◽

Mortality Rates ◽

Population Based ◽

Population Based Study ◽

Risk Of Mortality ◽

Younger Age ◽

Over Time

Background:Individuals with giant cell arteritis (GCA) are at increased risk of serious morbidity including cardiovascular disease and stroke. Yet the risk of mortality among individuals with GCA have produced conflicting reports1.Objectives:Our aim was to evaluate excess all-cause mortality among individuals with GCA relative to the general population over time.Methods:We performed a population-based study in Ontario, Canada, using health administrative data among all individuals 50 years and older. Individuals with GCA were identified using a validated case definition (81% PPV, 100% specificity). All Ontario residents aged 50 and above who do not have GCA served as the General Population comparators. Deaths occurring in each cohort each year were ascertained from vital statistics. Annual crude and age/sex standardized all-cause mortality rates were determined for individuals with and without GCA between 2000 and 2018. Standardized mortality ratios (SMRs) were calculated to measure relative excess mortality over time. Differences in mortality between sexes and ages were also evaluated.Results:Population denominators among individuals 50 years and older with GCA and the General Population increased over time with 12,792 GCA patients and 5,456,966 comparators by 2018. Annual standardized mortality rates among the comparators steadily declined over time and were significantly lower than GCA morality rates (Figure). Annual GCA mortality rates fluctuated between 42-61 deaths per 1000 population (with overlapping confidence intervals) during the same time period. SMRs for GCA ranged from 1.28 (95% CI 1.08,1.47) at the lowest in 2002 to 1.96 (95% CI 1.84, 2.07) at the highest in 2018. GCA mortality rates and SMRs were highest among males and younger age groups.Conclusion:Over a 19-year period, mortality has remained increased among GCA patients relative to the general population. GCA mortality rates were higher among males and more premature deaths were occurring at younger age groups. In our study, improvements to the relative excess mortality for GCA patients over time (mortality gap) did not occur. Understanding cause-specific mortality and other factors are necessary to inform contributors to premature mortality among GCA patients.References:[1]Hill CL, et al. Risk of mortality in patients with giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2017;46(4):513-9.Figure.Acknowledgments: :This study was supported by a CIORA grantDisclosure of Interests:Lillian Barra: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Priscila Pequeno: None declared, Jodi Gatley: None declared, Jessica Widdifield: None declared

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