Infection and immunity

2012 ◽  
pp. 605-626
Author(s):  
Lesley K Bowker ◽  
James D Price ◽  
Sarah C Smith
Keyword(s):  
Staphylococcus Aureus ◽  
Immune System ◽  
Clostridium Difficile ◽  
Older People ◽  
Older Patients ◽  
Antibiotic Use ◽  
Older Patient

The ageing immune system 606 Overview of infection in older people 608 HOW TO . . . Accurately diagnose infection in an older patient 609 Antibiotic use in older patients 610 Meticillin-resistant Staphylococcus aureus 611 Disease caused by MRSA 612 HOW TO . . . Control MRSA 613 Clostridium difficile-associated diarrhoea ...

scholarly journals The efficacy and safety of intravenous lidocaine for analgesia in the older adult: a literature review

2016 ◽  
Vol 11 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Harriet Daykin
Keyword(s):  
Neuropathic Pain ◽  
Literature Review ◽  
Older People ◽  
Respiratory Depression ◽  
Acute Pain ◽  
Older Patients ◽  
Critical Limb Ischaemia ◽  
Efficacy And Safety ◽  
Intravenous Lidocaine ◽  
Older Patient

Opioids remain the mainstay of analgesia for the treatment of moderate to severe acute pain. Even in the young, the use of opioids can be associated with an increased incidence of post-operative complications such as respiratory depression, vomiting, pruritus, excessive sedation, slowing of gastrointestinal function, and urinary retention. The need to manage acute pain in the older patient is becoming more common as the population ages, and increasingly older patients are undergoing more major surgery. Medical conditions are more common in older people and can result in the requirement of systemic analgesia for fractures, malignancy, nociceptive or neuropathic pain and peripheral vascular disease. Effective pain control can be difficult in older patients as there is a higher incidence of coexistent diseases, polypharmacy and age-related changes in physiology, pharmacodynamics and pharmacokinetics. Consequently, due to the fear of respiratory depression in older people, this leads to inadequate doses of opioid being given for the treatment of their pain. Lidocaine has analgesic, anti-hyperalgesic and anti-inflammatory properties and is metabolized by the liver which is limited by perfusion, and heart failure or drugs can alter this, affecting its clearance. Therefore, there are concerns regarding safety in older patients as plasma concentrations have both intersubject and intrasubject variability. The aim of this literature review is to assess the efficacy and safety of intravenous lidocaine as an adjuvant in pain management for the older patient. In total, 12 studies fulfilled the criteria. Lidocaine infusions were found to reduce pain scores and be opioid sparing in abdominal and urological surgery, in patients with opioid-refractory malignancy pain, neuropathic pain and critical limb ischaemia. Patients with malignancy were more likely to develop adverse effects, but no patients required treatment for lidocaine toxicity.

Malabsorption

2017 ◽  
pp. 1115-1122
Author(s):  
Philippe Ducrotté ◽  
Philippe Chassagne
Keyword(s):  
Weight Loss ◽  
Older People ◽  
Older Patients ◽  
Clinical Presentation ◽  
Older Patient ◽  
Substantial Evidence ◽  
Old Patients ◽  
Younger Patients ◽  
Clinical Challenge ◽  
Atypical Clinical Presentation

The clinical challenge of recognizing then treating malabsorption is crucial in older patients, in whom the consequences in terms of both morbidity and mortality are more severe. This challenge is reinforced by a frequent atypical clinical presentation delaying the diagnosis in many cases. Indeed, as in many diseases that occur in old patients, symptoms such as weight loss are often considered to be related to altered appetite or increased catabolism rather than to malabsorption. We now have substantial evidence that malabsorption in older people should not be ascribed to the ageing process and should be evaluated in the same way as malabsorption occurring in younger patients. In an older patient, there may be several contributory causes.

scholarly journals Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257561
Author(s):  
Pieternella C. Bots-VantSpijker ◽  
Claar D. van der Maarel-Wierink ◽  
Jos M. G. A. Schols ◽  
Josef J. M. Bruers
Keyword(s):  
Oral Health ◽  
Older People ◽  
Older Patients ◽  
Cross Sectional Study ◽  
Treatment Intensity ◽  
Dental Practice ◽  
Sectional Study ◽  
Older Patient ◽  
Cross Sectional ◽  
High Treatment

Objectives To assess the oral health of older people who visit the community dental practice from both the dentists’ and the patients’ perspective. Materials and methods In this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI]. Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman’s rank correlation coefficient (rho) and an ordinal regression model. Results In total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis. Older people’s assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication. Conclusions and clinical relevance Chronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health. Older patients themselves assess their oral health differently, mostly more positive, than their dentist.

scholarly journals Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience

Pharmaceutics ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 32
Author(s):  
Nélio Drumond ◽  
Sven Stegemann
Keyword(s):  
Patient Population ◽  
Older Patients ◽  
Negative Impact ◽  
Water Soluble ◽  
Oral Dosage ◽  
Oral Drug ◽  
Older Patient ◽  
Coating Materials ◽  
Esophageal Transit ◽  
Patient Centric

Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

Caractéristiques des diarrhées post-antibiotiques à Clostridium difficile et à Staphylococcus aureus

2004 ◽  
Vol 33 (4) ◽  
pp. 253
Author(s):  
Georges Kaltenbach ◽  
Alain Gravet ◽  
Damien Heitz ◽  
Marie Noblet-Dick ◽  
Gilles Prévost ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clostridium Difficile

scholarly journals Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027

2008 ◽  
Vol 57 (6) ◽  
pp. 709-716 ◽  
Author(s):  
T. I. I. van der Kooi ◽  
M. Koningstein ◽  
A. Lindemans ◽  
D. W. Notermans ◽  
E. Kuijper ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Use ◽  
Study Groups ◽  
Ribotype 027 ◽  
Defined Daily Doses ◽  
Hygiene Measures ◽  
Epidemic Period ◽  
Group A ◽  
Group B ◽  
The Relationship

The first Dutch outbreak due to Clostridium difficile ribotype 027 was observed in mid-2005; by the end of that year, eight hospitals were affected. To study the relationship between hospital-wide antibiotic use and the incidence of 027-linked C. difficile-associated disease (CDAD) three study groups were made: group A, all eight hospitals with an 027-associated epidemic; group B, five of a total of six hospitals with occasional 027 cases, without an increase in CDAD; and group C, ten randomly selected hospitals with no reported 027 epidemics or isolated 027 cases. Quarterly data on CDAD incidences, hygiene measures and the use of fluoroquinolones, second- and third-generation cephalosporins, extended-spectrum penicillins, penicillins with beta-lactamase inhibitors, carbapenems, lincomycins and macrolides were collected for 2004 and 2005, and divided into pre-epidemic and epidemic periods. Using a multilevel Poisson regression analysis, CDAD incidence was linked to antibiotic use in the previous quarter and to certain hygiene measures. In the pre-epidemic period, the total use of the studied antibiotics was comparable between affected and unaffected hospitals. Higher use of second-generation cephalosporins, macrolides and all of the studied antibiotics were independently associated with a small increase in CDAD incidence [relative risk (95 % confidence interval): 1.14 per increase of 100 defined daily doses per 10 000 bed days (1.06–1.23), 1.10 (1.01–1.19) and 1.02 (1.01–1.03), respectively]. However the effect was too small to predict which hospitals might be more prone to 027-associated outbreaks.

Older people's satisfaction with intermediate care: a systematic review

2007 ◽  
Vol 17 (3) ◽  
pp. 199-218 ◽  
Author(s):  
Andrew Wilson ◽  
Suzanne Richards ◽  
Janette Camosso-Stefinovic
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Older Patients ◽  
Hospital Care ◽  
Patient Choice ◽  
Intermediate Care ◽  
Care Services ◽  
The Relationship

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

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