Gastrointestinal Complications Associated with Intramuscular Ketorolac Tromethamine Therapy in the Elderly

1995 ◽  
Vol 29 (7-8) ◽  
pp. 698-701 ◽  
Author(s):  
James Maliekal ◽  
Charles M Elboim
Keyword(s):  
Gastric Ulcer ◽  
Elderly Patients ◽  
Stable Condition ◽  
The Elderly ◽  
Antiinflammatory Drug ◽  
Ketorolac Tromethamine ◽  
Gastrointestinal Complications ◽  
Ulcer Disease ◽  
History Of ◽  
Intramuscular Ketorolac

Objective: To report 3 cases of gastrointestinal (GI) complications associated with the use of intramuscular ketorolac tromethamine therapy in elderly patients. Case Summaries: In case 1, an 88-year-old woman was taken to surgery for the management of an acute abdomen and repair of a 2+ cm perforated prepyloric gastric ulcer. The patient had received a total 16 doses of ketorolac 30 mg im. The patient died after surgery from complications associated with bacterial and candidal sepsis, as well as acute renal failure. In case 2, an 80-year-old woman with no known history of GI problems developed a prepyloric gastric ulcer, which perforated and penetrated into the pancreas after the patient received 13 doses of ketorolac 30 mg im. The patient died from complications associated with candidal sepsis, peritonitis, and cardiopulmonary collapse. In case 3, an 85-year-old man with a history of a gastric ulcer developed GI bleeding after receiving a total of 9 doses of ketorolac 30 mg im. The bleeding was stabilized and the patient was discharged 12 days later in stable condition. Discussion: Ketorolac tromethamine is a nonsteroidal antiinflammatory drug with potent analgesic properties. We report 3 cases of GI complications associated with intramuscular ketorolac therapy in the elderly. A temporal relationship was established with the development of gastric ulceration in 2 patients and the recurrence of a gastric ulcer in the third patient. Conclusions: We recommend that the manufacturer's guidelines be followed when ketorolac is used in elderly patients, and the drug should not be used in patients with a history of gastric ulcer disease. The use of misoprostol may be warranted as prophylactic therapy in high-risk patients who are receiving ketorolac.

Gastric Ulcer Perforation Associated with the Use of Injectable Ketorolac

1993 ◽  
Vol 27 (1) ◽  
pp. 42-43 ◽  
Author(s):  
Lynn L. Estes ◽  
David W. Fuhs ◽  
Alan H. Heaton ◽  
Conrad S. Butwinick
Keyword(s):  
Peptic Ulcer ◽  
Gastric Ulcer ◽  
Previous History ◽  
Ketorolac Tromethamine ◽  
Antiinflammatory Agent ◽  
Data Synthesis ◽  
Ulcer Disease ◽  
Perforated Gastric Ulcer ◽  
History Of ◽  
Nonsteroidal Antiinflammatory Agent

OBJECTIVE: To report a case of a perforated gastric ulcer associated with the use of injectable ketorolac tromethamine. DATA SYNTHESIS: A 77-year-old woman with no previous history of peptic ulcer disease developed a perforated gastric ulcer after four days of treatment with ketorolac. To date, six other cases of gastrointestinal (GI) perforation associated with the use of ketorolac have been reported to the manufacturer. CONCLUSIONS: Although ketorolac is an effective analgesic, it is a nonsteroidal antiinflammatory agent and thus has the propensity for causing GI ulceration. Caution should be used when administering this drug and patients should be monitored for GI adverse effects.

scholarly journals Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

2021 ◽  
Author(s):  
frédérick rault ◽  
Anaïs R Briant ◽  
Thomas Gaberel ◽  
Hervé Kamga ◽  
Evelyne Emery
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Heart Diseases ◽  
The Elderly ◽  
Lumbar Spine Surgery ◽  
Increased Risk ◽  
History Of ◽  
Lumbar Spinal

Abstract Introduction:Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to find confounding factors.Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded.Results996 patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC.ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

Iron Deficiency Is Common in Anemic Elderly Patients: Results with sTfr Index.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3763-3763
Author(s):  
Mindy M. Yang ◽  
Mary Ann ◽  
Dawn E. Riordan ◽  
Min Fu ◽  
Victor Moyo ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Elderly Patients ◽  
Serum Iron ◽  
The Elderly ◽  
Community Dwelling ◽  
Deficiency Anemia ◽  
Chronic Anemia ◽  
Functional Iron Deficiency ◽  
Conventional Tests ◽  
History Of

Abstract Chronic anemia is common in the elderly (≥65) with a prevalence often exceeding 10%. Multiple comorbidities and multiple causes of anemia complicate anemia diagnosis in the elderly. Iron deficiency anemia (IDA) and anemia of chronic inflammation (ACI) both commonly occur in the elderly. Distinguishing ACI from the combination of IDA and ACI is difficult with conventional tests (serum iron, TIBC, TSAT, and ferritin), especially in elderly patients or those with multiple comorbidities. Recently, the serum transferrin receptor (sTfr) has been recommended to assess iron stores, although there is limited data in the elderly. Unlike ferritin, TIBC, or TSAT, sTfr Index (sTfr(mg/L)/[log10ferritin]) is not influenced by pro-inflammatory cytokines and may provide a more precise classification of iron status. Purpose: To determine the occurrence of iron deficiency alone or in combination with ACI in the elderly using the sTfr Index. Methods: The results of the sTfr Index were compared to ferritin, as well as serum iron, TIBC, and TSAT to determine the presence of iron deficiency alone or in combination with ACI. An sTfr Index of ≥2.0 was used to define iron deficiency. Data were obtained from ambulatory, community-dwelling elderly screened for three clinical trials for treatment of chronic anemia (Hb≤11g/dL x >3 months) using epoetin alfa. No patients had a history of GI bleeding, active cancer, or recent infections. At the time of evaluation, no patients were receiving iron therapy. GFR was calculated using the Modification of Diet for Renal Disease (MDRD) Equation. Results: A total of 81 patients (mean age 75±6, range 66–89 years; 68 women and 13 men) were studied. Of these patients, 43 patients had a history of rheumatoid arthritis. 32% were African-American, 64% Caucasian, and 4% Hispanic/American-Indian. For the entire cohort, mean Hb was 10.3±0.9 g/dL; ferritin 148.0±180.9ng/mL; iron 61±33mcg/mL; TIBC 311±69mcg/dL (n=80); TSAT 19.7±11.0%; GFR 59.2±28.0mL/min/1.73m2 (n=78); sTfr Index was 3.02±3.16. There was no statistically significant difference in the severity of anemia between patients with and without iron deficiency (sTfr Index ≥2.0, Hb 10.3±0.8 vs. sTfr Index <2.0, Hb 10.4±1.0g/dL). The following table summarizes the distribution of sTfr Index stratified by ferritin concentration. Twenty-six of 35 (74%) patients with a ferritin 30–100 ng/mL had sTfr Index ≥2.0 consistent with iron deficiency. However, using conventional iron tests (meeting 2 of 3 criteria: TIBC >450mcg/dL, iron <60mcg/dL, TSAT <15%), only 19 of the 26 patients would have been identified as having IDA. Surprisingly, 9 of 33 (27%) patients with ferritin >100ng/mL also had sTfr Index ≥2.0 suggesting functional iron deficiency in combination with ACI. Among all patients included in this analysis, compared to conventional iron tests, an univariate logistic regression analysis showed that with each unit increase in sTfr Index, the odds of being iron deficient, identified by conventional tests, significantly increased 3.4-fold (p<0.0001, 95% CI: 1.8–6.1). Conclusions: Results with the sTfr Index suggest that iron deficiency in the elderly may be more common than reported with conventional iron tests. In community-dwelling elderly patients with ferritin levels consistent with ACI (>100ng/mL) may have concomitant functional iron deficiency. The use of sTfr in older adults with milder anemia (Hb>11g/dL) should also be evaluated. Ferritin (ng/mL) sTfr Index < 30 30–100 > 100 < 2.0 0 9 24 2.0 – 3.0 1 17 5 >3.0 12 9 4 Total 13 35 33

К ВОПРОСУ ВЫЯВЛЕНИЙ РАЗЛИЧИЙ В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ПАЦИЕНТОВ РАЗНЫХ ВОЗРАСТНЫХ ГРУПП, ХИРУРГИЧЕСКОГО ПРОФИЛЯ

Innova ◽  
2020 ◽  
Vol 20 (3) ◽  
pp. 14-17
Author(s):  
Александр Александрович Барабанщиков ◽  
◽  
Горелик Светлана Гиршевна ◽  
Милютина Елена Валерьевна ◽  
Ищенко Карина Александровна
Keyword(s):  
Elderly Patients ◽  
District Hospital ◽  
The Elderly ◽  
Modern World ◽  
Frailty Syndrome ◽  
Distinctive Features ◽  
Surgical Department ◽  
History Of ◽  
The Difference ◽  
Special Approach

In the modern world, life expectancy is increasing, which means an increase in the number of elderly patients with "frailty" syndrome. This group of patients requires a special approach to treatment. Identifying the distinctive features of elderly patients in comparison with young ones will allow us to approach the treatment of these patients according to their characteristics. This study showed the difference between the elderly and senile group of patients in comparison with the average age. The material is the history of diseases of patients in 2018 who were treated in the surgical Department No. 1 of the St. Luke of Crimea Stary Oskol district hospital. Statistical analysis of medical history data was performed.

scholarly journals Two-year outcomes of more than 30 000 elderly patients with atrial fibrillation: results from the All Nippon AF In the Elderly (ANAFIE) Registry

2021 ◽  
Author(s):  
Takeshi Yamashita ◽  
Shinya Suzuki ◽  
Hiroshi Inoue ◽  
Masaharu Akao ◽  
Hirotsugu Atarashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Clinical Status ◽  
The Elderly ◽  
Very Elderly ◽  
History Of ◽  
Bleeding History

Abstract Aims To clarify the real-world clinical status and prognosis of elderly and very elderly non-valvular atrial fibrillation (NVAF) patients, more than 30 000 elderly patients with NVAF aged ≥75 years were enrolled in the ANAFIE Registry. Methods and Results This multicentre, prospective, observational study followed elderly NVAF patients in Japan for ∼2 years. Among 32 275 patients (mean age 81.5 years; men, 57.3%; mean CHA2DS2-VASc score 4.5), 2445 (7.6%) were not receiving oral anticoagulants (OACs) and 29 830 (92.4%) were given OACs. Of these, 21 585 (66.9%) were receiving direct OACs (DOACs) and 8233 (25.5%), warfarin (mean time in therapeutic range: ∼75%). In total, the 2-year incidence rate was 3.01% for stroke/systemic embolic events (SEE); 2.00%, major bleeding; and 6.95%, all-cause death. As compared with the warfarin group, the DOAC group had a lower hazard ratio (HR) for stroke/SEE, major bleeding, and all-cause death after adjusting for confounders. The group without OACs had a higher HR for stroke/SEE and all-cause death, with a lower HR for major bleeding. History of falls within 1 year at enrolment and of catheter ablation were positive and negative independent risk factors, respectively, for stroke/SEE, major bleeding and all-cause death. Conclusion In Japan, a large proportion of elderly and very elderly NVAF patients were receiving DOACs, which was significantly associated with lower rate of stroke/SEE, major bleeding, and all-cause death vs well-controlled warfarin. History of falls and of catheter ablation were independently associated with stroke/SEE, major bleeding, and all-cause death.

P001: Do the elderly patients with medical history of dementia receive a different antihypertensive treatment in comparison with the ones without dementia?

2014 ◽  
Vol 5 ◽  
pp. S83
Author(s):  
P.H. Ponte Márquez ◽  
O. Torres Bonafonte ◽  
J. Garcia Moreno ◽  
A. López Soto ◽  
N. Ramirez Duque ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Medical History ◽  
Antihypertensive Treatment ◽  
The Elderly ◽  
History Of

scholarly journals Cognitive performance of long-term institutionalized elderly patients with schizophrenia: A case control study

2011 ◽  
Vol 5 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Alexandre Paim Diaz ◽  
Monica Zavaloni Scalco ◽  
Marcelo Libório Schwarzbold ◽  
Douglas Affonso Formolo ◽  
Alberto Stoppe Júnior
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Cognitive Performance ◽  
The Elderly ◽  
Psychiatric Diseases ◽  
Institutionalized Elderly ◽  
History Of ◽  
Language Abstraction ◽  
Institutionalized Patients

Abstract Cognitive impairment is inherent to the ageing process. Several studies suggest that patients with late-life schizophrenia have more marked cognitive impairment. Objective: The aim of this study was to compare the cognitive performance of elderly institutionalized patients with schizophrenia and institutionalized elderly control patients without neurological or psychiatric diseases, matched for age, educational level and institutionalization time. Methods: The Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) was used to test 10 institutionalized elderly patients with schizophrenia. Results were compared with those of 10 institutionalized control patients with history of Hansen's disease. Results: Patients with schizophrenia showed a worse performance in terms of total CAMCOG score and on its subtests of orientation, language, abstraction, and memory (p≤0.05). Patients with schizophrenia also disclosed a non-significant trend toward lower scores on the MMSE and on calculus. Conclusion: Findings demonstrated that schizophrenia was associated to worse cognitive impairment in long-term institutionalized elderly patients compared with institutionalized patients without neurological or psychiatric diseases.

scholarly journals Prevalence of Gastric and Small-Intestinal Mucosal Injury in Elderly Patients Taking Enteric-Coated Aspirin by Magnetically Controlled Capsule Endoscopy

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Feng Gao ◽  
Xue Chen ◽  
Jie Zhang
Keyword(s):  
Elderly Patients ◽  
Capsule Endoscopy ◽  
The Elderly ◽  
Mucosal Injury ◽  
Middle Aged ◽  
Enteric Coated Aspirin ◽  
History Of ◽  
Intestinal Mucosal Injury ◽  
Small Intestinal ◽  
Enteric Coated

Objective. To investigate aspirin-related gastric and small-intestinal mucosal injury in elderly patients by magnetically controlled capsule endoscopy (MCCE). Methods. Patients taking enteric-coated aspirin attending the outpatient department of Beijing Anzhen Hospital, Capital Medical University, from September 2017 to July 2019 underwent MCCE to assess injury to the gastric and small-intestinal mucosa. The patients were divided into the elderly group (age≥60 years) and middle-aged group (45 years≤age<60 years), and their clinical data were evaluated. Results. Sixty-eight patients (34 per group) taking enteric-coated aspirin were recruited, and the elderly and middle-aged groups did not differ significantly in sex, history of smoking, history of alcohol consumption, body mass index, or accompanying diseases. In the elderly and middle-aged groups, the gastric Lanza scores were 2.0 (2.0, 3.0) and 2.0 (1.0, 3.0; P=0.192), the numbers of patients with small-intestinal mucosal injuries (at least one erosion and/or ulcer) were 30 (88.2%) and 15 (44.1%; P<0.001), the numbers of patients with more severe small-intestinal mucosal injuries (larger erosion and/or ulcer) were 11 (32.4%) and 3 (8.8%; P=0.033), the numbers of patients with ileal erosion were 22 (64.7%) and 8 (23.5%; P=0.001), and the durations of aspirin use were 30.0 (12.0, 120.0) and 10.5 (2.0–48.0) months (P=0.007), respectively. Conclusions. The rate of small-intestinal mucosal injury was significantly higher in elderly than in middle-aged patients taking enteric-coated aspirin, especially the rate of ileal erosion. MCCE enables the monitoring of aspirin-related gastric and small-intestinal mucosal injury in elderly patients, which can guide treatment decision making.

scholarly journals Physical illness and dementia among the elderly patients in a tertiary care hospital: a cross sectional study

2020 ◽  
Vol 31 (1) ◽  
pp. 20-23
Author(s):  
Arman Ibne Haq ◽  
Mekhala Sarkar ◽  
Susmita Roy ◽  
Ahsan Uddin Ahmed
Keyword(s):  
Elderly Patients ◽  
Health Care Professionals ◽  
Past History ◽  
Tertiary Care ◽  
The Elderly ◽  
Physical Illness ◽  
Dementia Patient ◽  
Care Hospital ◽  
Cross Sectional ◽  
History Of

The elder people are rapidly increasing throughout the world and dementia has become the important point of interest of health care professionals. The objective of the study was to find out the physical illness and dementia as well as their association among the elderly patients. This was a cross sectional and analytical study conducted in National Institute of Mental Health (NIMH) at Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from 1st November 2014 to 30th April 2015. For this purpose 78 elderly patients aged e”60 years attending both in outpatient and inpatient department of NIMH satisfying inclusion and exclusion criteria, irrespective of age and gender were selected as study population by convenient sampling technique. The result showed that majority (59%) had co-morbid physical illness. Common co-morbid physical illness was hypertension (26.9%). Among the respondants, 5 (6.4%) were current smokers and 12 (15.38%) had past history of smoking for more than five years. In the study, 50% of the respondents diagnosed with dementia had hypertension (c2 = 3.8808, P= 0.04884), 25% dementia patient had co-morbid diabetes mellitus (c2 = 2.4287, P= 0.11913), history of cerebro vascular accident (CVA) was present in 25% of patient and 25% patient had history of smoking (c2 = 0.0088, P= 0.92533). This study provided baseline information about clinical factors associated with dementic patients in Bangladesh which could be used in future studies. Bang J Psychiatry June 2017; 31(1): 20-23

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