The Elderly ???Weekend Warrior??? and Risk of Mortality

2005 ◽  
Vol 15 (3) ◽  
pp. 201-202 ◽  
Author(s):  
Harold W Kohl
Keyword(s):  
The Elderly ◽  
Risk Of Mortality

scholarly journals Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

2021 ◽  
pp. 112972982198990
Author(s):  
Kulli Kuningas ◽  
Nicholas Inston
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Vascular Access ◽  
Clinical Condition ◽  
The Elderly ◽  
Dialysis Access ◽  
Adverse Health Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

scholarly journals Mortality Risk from Respiratory Diseases due to Non-Optimal Temperature among Brazilian Elderlies

2021 ◽  
Vol 18 (11) ◽  
pp. 5550
Author(s):  
Ludmilla da Silva Viana Jacobson ◽  
Beatriz Fátima Alves de Oliveira ◽  
Rochelle Schneider ◽  
Antonio Gasparrini ◽  
Sandra de Souza Hacon
Keyword(s):  
Time Series ◽  
Respiratory Diseases ◽  
Respiratory Health ◽  
The Elderly ◽  
Optimal Temperature ◽  
Average Temperature ◽  
Exposure Response ◽  
Mean Temperature ◽  
Risk Of Mortality ◽  
Exposure Variable

Over the past decade, Brazil has experienced and continues to be impacted by extreme climate events. This study aims to evaluate the association between daily average temperature and mortality from respiratory disease among Brazilian elderlies. A daily time-series study between 2000 and 2017 in 27 Brazilian cities was conducted. Data outcomes were daily counts of deaths due to respiratory diseases in the elderly aged 60 or more. The exposure variable was the daily mean temperature from Copernicus ERA5-Land reanalysis. The association was estimated from a two-stage time series analysis method. We also calculated deaths attributable to heat and cold. The pooled exposure–response curve presented a J-shaped format. The exposure to extreme heat increased the risk of mortality by 27% (95% CI: 15–39%), while the exposure to extreme cold increased the risk of mortality by 16% (95% CI: 8–24%). The heterogeneity between cities was explained by city-specific mean temperature and temperature range. The fractions of deaths attributable to cold and heat were 4.7% (95% CI: 2.94–6.17%) and 2.8% (95% CI: 1.45–3.95%), respectively. Our results show a significant impact of non-optimal temperature on the respiratory health of elderlies living in Brazil. It may support proactive action implementation in cities that have critical temperature variations.

Anaesthesia for major abdominal surgery in the elderly

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Abdominal Surgery ◽  
The Elderly ◽  
Major Abdominal Surgery ◽  
Bowel Distension ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Surgery In The Elderly ◽  
Fluid Losses ◽  
Effective Analgesia ◽  
Emergency Abdominal Surgery

Major abdominal surgery and laparotomy are common procedures that are associated with a high risk of mortality and morbidity, especially in the elderly. Outcomes can be improved by formal risk stratification, appropriate perioperative resuscitation and optimization, early surgery, senior anaesthetist involvement, and careful postoperative critical. Assessment of dehydration is imperative because fluid losses are very common and may be difficult to measure. Hypothermia is common, and measures should be instituted to conserve heat loss. Use of nitrous oxide can cause bowel distension and should be avoided. Elderly patients should receive postoperative care in an environment that is appropriate to the degree of comorbidity and the type of surgery. Effective analgesia is known to improve outcome. Only experienced anaesthetists should manage major and emergency abdominal surgery.

scholarly journals A Cohort Study on Dietary Habits, Lifestyles and the Risk of Mortality in the Elderly: the Latest Evidence From China Diet Cohort Study of Elderly Chinese

2020 ◽  
Author(s):  
Qianyu Zhou ◽  
Ying Qin ◽  
Yanru Zhang ◽  
Nan Sun ◽  
Shanqun Jia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Dietary Habits ◽  
Health Benefit ◽  
The Elderly ◽  
Lifestyle Factors ◽  
Cox Proportional Hazards Model ◽  
Risk Of Mortality ◽  
Elderly Chinese ◽  
Cooking Oils

Abstract Aim: To examine the longitudinal relationship between dietary habits, lifestyle factors and the risk of mortality among the elderly Chinese. Methods: Four follow-up survey data of the Chinese Longitudinal Healthy Longevity Survey 2008-2018 were selected, and a total of 11899 elderly people were included. Food habits were assessed using an in-person interview. The frequency of consumption of each food item was recorded as “almost every day”, “occasionally” or “rarely or never”. After descriptive statistics of the data, the effects of dietary habits and lifestyle factors on all-cause mortality were analyzed using the Cox proportional hazards model and the adjusted model. Results: There were 9461 deaths during 55312 person-years of follow-up with an average age of 75 years (S.D. ±8.3) years for survivors and 91.09 (S.D. ±9.6) years for non-survivors. Type of staple food was associated with a reduced risk of mortality. Compared to those who rarely/never consumed fruit, vegetables, fish, tea, and nut products, participants consuming such products almost every day were associated with 3.7%, 20.9%, 10.8%, 0.1%, and 11.7% reductions in the risk of mortality, respectively. Compared with lard, long-term use of vegetable grease and gingili grease increased the risk of mortality by 10.5% and 11.6%, respectively. Conclusions: The Chinese elderly could gain health benefit from regular consumption of fruit, vegetables, fish, tea and nut products, and they should pay attention to the choice of cooking oils, reduce cooking oils frequency. Future research is warranted to establish the recommended daily nutrient allowances for the elderly and better address the nutritional needs of this vulnerable population.

Risks and outcomes of gastrointestinal malignancies in anticoagulated atrial fibrillation patients experiencing gastrointestinal bleeding

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.F Chao ◽  
G.Y.H Lip ◽  
S.A Chen
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
The Elderly ◽  
Prior History ◽  
Research Database ◽  
Gi Bleeding ◽  
Gi Tract ◽  
Gastrointestinal Malignancies ◽  
Risk Of Mortality ◽  
Gi Cancers

Abstract Background Oral anticoagulants (OACs) may serve as a type of “screening test” for the diagnosis of occult gastrointestinal (GI) tract malignancies through a clinical presentation with bleeding. Objective We aimed to investigate the 1-year incidence and predictors of GI cancers after GI bleeeding events among patients with atrial fibrillation (AF) treated with warfarin or NOACs. Second, we aimed to compare the risk of mortality after GI cancers between patients treated with warfarin or NOACs. Methods A total of 10,845 anticoagulated AF patients who experienced hospitalizations due to GI bleeding without prior history of GI cancers were identified from the Taiwan National Health Insurance Research Database. Patients were followed up for incident GI cancers for up to 1 year. Results Within 1 year after GI bleeding, 290 (2.67%) patients were diagnosed to have GI tract cancers. More patients treated with NOACs were diagnosed to have GI cancers than those receiving warfarin (68/1,759; 3.87% [NOACs] versus 222/9,086; 2.44% [warfarin], p<0.001) with an odds ratio (OR) 1.606 (95% CI: 1.208–2.117, p<0.001). Age (OR 1.025 [95% CI: 1.012–1.037] per 1 year increment) and male sex (1.356 [95% CI: 1.050–1.700]) were independently associated with the diagnosis of GI cancers within 1 year after GI bleeding. Among 290 patients diagnosed to have GI cancers, 131 (45.2%) experienced mortality within 1 year. The risk of mortality was lower for patients treated with NOACs compared to those receiving warfarin (23.5% versus 51.8%) with an adjusted hazard ratio (aHR) 0.441 (95% CI: 0.262–0.744, p<0.001) (Figure). Conclusions Incident GI cancers were diagnosed in 1 in 37 AF patients at 1 year after OAC-related GI bleeding, which were more common among patients treated with NOACs (1 in 26) compared to warfarin (1 in 41). Detailed surveys for occult GI cancers were necessary for these patients, especially for the elderly males. Survival curves Funding Acknowledgement Type of funding source: None

scholarly journals P.088 Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes

2018 ◽  
Vol 45 (s2) ◽  
pp. S39-S39
Author(s):  
P Scotti ◽  
J Troquet ◽  
C Seguin ◽  
B Lo ◽  
J Marcoux
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
Elderly Population ◽  
The Elderly ◽  
International Normalized Ratio ◽  
Trauma Patients ◽  
Surgical Interventions ◽  
Risk Of Mortality ◽  
Elderly Trauma Patients

Background: In the elderly population, use of antithrombotic therapy (AT), antiplatelets (AP – aspirin, clopidogrel) and/or anticoagulants (AC – warfarin, DoAC – Dabigatran, Rivaroxaban, Apixaban), to prevent thrombo-embolic events must be carefully weighed against the risk of intracranial hemorrhage (ICH) with trauma. We hypothesize that for all patients 65yro+ with head trauma, those on AT will be more likely to sustain a traumatic brain injury, ICH, and poorer outcomes. Methods: Data was collected from all head trauma patients 65yo+ presenting to our tertiary trauma center (level 1) over a 24-month period; age, gender, injury mechanism, medications, International Normalized Ratio, reversal therapy, Glasgow Coma Scale (GCS), ICH, surgery, Extended Glasgow Outcome Scale score (GOSE) and mortality. Results: 1365 patients were identified; 724 on AT (413 AP, 151 AC, 59 DoAC, 48 2AP, 38 AP+AC, 15 AP+DoAC) and 474 not (non-AT). When adjusted for covariates, AT patients were more likely to have ICH (p=0.0004), more invasive surgical interventions (p=0.0188), functional dependency (GOSE≤4; p<0.0001) and mortality (p<0.0001). Risk of mortality is notably high with 2AP (OR 5.74; p=0.0003) and AC+AP (OR 4.12; p=0.0118). Conclusions: Elderly trauma patients on AT, especially combination therapy, have higher risks of ICH and poorer outcomes compared to those who are not.

scholarly journals Gender and Age of Migration Differences in Mortality Among Older Mexican Americans

2019 ◽  
Vol 75 (8) ◽  
pp. 1707-1718 ◽  
Author(s):  
Adriana M Reyes ◽  
Marc A Garcia
Keyword(s):  
Life Course ◽  
Mexican Americans ◽  
Lower Risk ◽  
The Elderly ◽  
Life Course Perspective ◽  
Mortality Data ◽  
Lifestyle Risk Factors ◽  
Risk Of Mortality ◽  
Lifestyle Risk ◽  
The Relationship

Abstract Objectives Using a gendered life course perspective, we examine whether the relationship between age of migration and mortality is moderated by gender among a cohort of older Mexican Americans. Methods Data from the Hispanic Established Populations for the Epidemiological Study of the Elderly and recently matched mortality data are used to estimate Cox proportional hazard models. Results Our findings indicate that the relationship between age of migration and mortality is moderated by gender, suggesting a more nuanced perspective of the immigrant mortality paradox. Among men, midlife migrants exhibit an 18% lower risk of mortality compared to their U.S.-born co-ethnics, possibly due to immigrant selectivity at the time of migration. Conversely, late-life migrant women exhibit a 17% lower risk of mortality relative to U.S.-born women, attributed in part to socio-cultural characteristics that influence lifestyle risk factors across the life course. Discussion Selection mechanisms and acculturation processes associated with the immigrant experience are contingent on both age and gender, suggesting the utility of an integrated life course approach to contextualize the mortality profiles of older immigrants. These findings demonstrate the heterogeneity among immigrants and highlight the need to understand gender differences in the migration process when assessing the immigrant mortality paradox.

Sarcopenic obesity in ageing: cardiovascular outcomes and mortality

2020 ◽  
Vol 124 (10) ◽  
pp. 1102-1113 ◽  
Author(s):  
Janice L. Atkins ◽  
S. Goya Wannamathee
Keyword(s):  
Older Adults ◽  
Muscle Mass ◽  
The Elderly ◽  
Obesity Paradox ◽  
Overweight And Obesity ◽  
Sarcopenic Obesity ◽  
Public Health Issue ◽  
Established Risk Factor ◽  
Risk Of Mortality ◽  
The Impact

AbstractObesity is a major public health issue with prevalence increasing worldwide. Obesity is a well-established risk factor for CVD and mortality in adult populations. However, the impact of being overweight or obese in the elderly on CVD and mortality is controversial. Some studies even suggest that overweight and obesity, measured by BMI, are apparently associated with a decreased mortality risk (known as the obesity paradox). Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass. Fat mass is positively associated and lean mass is negatively associated with risk of mortality. Therefore, in older adults BMI is not a good indicator of obesity. Sarcopenia has been defined as the degenerative loss of muscle mass, quality and strength with age and is of major concern in ageing populations. Sarcopenia has previously been associated with increased risks of metabolic impairment, cardiovascular risk factors, physical disability and mortality. It is possible for sarcopenia to co-exist with obesity, and sarcopenic obesity is a new class of obesity in older adults who have high adiposity levels together with low muscle mass, quality or strength. Therefore, sarcopenia with obesity may act together to increase their effect on metabolic disorders, CVD and mortality. This review will discuss the available evidence for the health implications of sarcopenic obesity on CVD and mortality in older adults.

scholarly journals Optimal SARS-CoV-2 vaccine allocation using real-time attack-rate estimates in Rhode Island and Massachusetts

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Thu Nguyen-Anh Tran ◽  
Nathan B. Wikle ◽  
Emmy Albert ◽  
Haider Inam ◽  
Emily Strong ◽  
...  
Keyword(s):  
Rhode Island ◽  
The Elderly ◽  
Distribution Networks ◽  
Population Immunity ◽  
Risk Of Mortality ◽  
Care Workers ◽  
Elderly Health ◽  
Near Term ◽  
Vaccination Campaigns ◽  
Induced Immunity

Abstract Background When three SARS-CoV-2 vaccines came to market in Europe and North America in the winter of 2020–2021, distribution networks were in a race against a major epidemiological wave of SARS-CoV-2 that began in autumn 2020. Rapid and optimized vaccine allocation was critical during this time. With 95% efficacy reported for two of the vaccines, near-term public health needs likely require that distribution is prioritized to the elderly, health care workers, teachers, essential workers, and individuals with comorbidities putting them at risk of severe clinical progression. Methods We evaluate various age-based vaccine distributions using a validated mathematical model based on current epidemic trends in Rhode Island and Massachusetts. We allow for varying waning efficacy of vaccine-induced immunity, as this has not yet been measured. We account for the fact that known COVID-positive cases may not have been included in the first round of vaccination. And, we account for age-specific immune patterns in both states at the time of the start of the vaccination program. Our analysis assumes that health systems during winter 2020–2021 had equal staffing and capacity to previous phases of the SARS-CoV-2 epidemic; we do not consider the effects of understaffed hospitals or unvaccinated medical staff. Results We find that allocating a substantial proportion (>75%) of vaccine supply to individuals over the age of 70 is optimal in terms of reducing total cumulative deaths through mid-2021. This result is robust to different profiles of waning vaccine efficacy and several different assumptions on age mixing during and after lockdown periods. As we do not explicitly model other high-mortality groups, our results on vaccine allocation apply to all groups at high risk of mortality if infected. A median of 327 to 340 deaths can be avoided in Rhode Island (3444 to 3647 in Massachusetts) by optimizing vaccine allocation and vaccinating the elderly first. The vaccination campaigns are expected to save a median of 639 to 664 lives in Rhode Island and 6278 to 6618 lives in Massachusetts in the first half of 2021 when compared to a scenario with no vaccine. A policy of vaccinating only seronegative individuals avoids redundancy in vaccine use on individuals that may already be immune, and would result in 0.5% to 1% reductions in cumulative hospitalizations and deaths by mid-2021. Conclusions Assuming high vaccination coverage (>28%) and no major changes in distancing, masking, gathering size, hygiene guidelines, and virus transmissibility between 1 January 2021 and 1 July 2021 a combination of vaccination and population immunity may lead to low or near-zero transmission levels by the second quarter of 2021.

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