scholarly journals Review: Delirium in the Elderly: A Comprehensive Review

2011 ◽  
Vol 26 (2) ◽  
pp. 97-109 ◽  
Author(s):  
Vikrant Mittal ◽  
Sunanda Muralee ◽  
Deena Williamson ◽  
Nicole McEnerney ◽  
Jennifer Thomas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Detection ◽  
Elderly Patients ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Comprehensive Review ◽  
Medication Effect ◽  
And Behaviors

Delirium is a common neuropsychiatric syndrome in the elderly characterized by concurrent impairments in cognition and behaviors. The etiologies for delirium are often multifactorial and are due to underlying medical illnesses and/or due to medication effect. The diagnosis of delirium is often missed in elderly patients and this condition may be mislabeled as depression or dementia. Untreated, delirium can have devastating consequences in the elderly with high rates of morbidity and mortality. Available evidence indicates that early detection, reduction of risk factors, and better management of this condition can decrease its morbidity rates. In this review, we discuss the etiology, neurobiology, diagnosis, prevention, and treatments for this potentially lethal condition in the elderly.

scholarly journals Appendicular perforation and its contributing factors

2017 ◽  
Vol 4 (6) ◽  
pp. 2007
Author(s):  
Anandaravi B. N. ◽  
Ramaswami B.
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Perforated Appendicitis ◽  
Clinical History ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Delayed Presentation ◽  
Contributing Factors ◽  
Steroid Dependent

Background: The objective was to study of different risk factors contributing in appendicular perforation and effective management of patients by knowing risk factors.Methods: This study was conducted in the department of general surgery K. R. Hospital Mysore medical college and research institute, Mysore, Karnataka, India from January 2015 to June 2016. Patients of age above 18 years and both sexes operated for acute appendicitis were included in present study. The clinical history, clinical features, investigations, intraoperative findings, were noted and surgical procedure done and all perforated appendicitis cases were operated lower midline incision, through wash given with normal saline drain in situ. Post operatively antibiotics were given and all patients follow up done for one month.Results: Present study duration is one and half year we operated total 100 patients for acute appendicitis. In this study 55 patients were male (55%) and 45 patients were females (45%). According to our study acute appendicitis is more common in males. Appendicular perforation has noticed in 23 female patients. The incidence of perforated appendicitis is low in males 12 out of 35 as compared to females 23 out of 35. The incidence of appendicular perforation is higher in the extreme of ages. In the elderly patients it is 58.33%. Thus, according to present study findings age above (>40 years) is strongly associated with the perforated appendicitis (p<0.001 chi squared test). Delayed presentation shows 77.41% appendicular perforation and faecolith associated with 64.51%.Conclusions: The morbidity and mortality rates are higher in elderly patients, diabetics, steroid dependent and immunocompromised patients. We should be aggressive in the treatment of acute appendicitis associated with high risk factors. So once acute appendicitis is diagnosed, the expedient surgery and appropriate use of perioperative antibiotics can help in reducing the morbidity and mortality.

scholarly journals Prognosis and risk factors of ERCP pancreatitis in elderly

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Erhan Ergin ◽  
Nevin Oruç ◽  
Galip Ersöz ◽  
Oktay Tekeşin ◽  
Ömer Özütemiz
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Elderly Patients ◽  
Biochemical Analysis ◽  
Female Gender ◽  
The Elderly ◽  
Imaging Findings ◽  
Endoscopic Retrograde ◽  
Sphincter Oddi ◽  
Oddi Dysfunction

AbstractPost Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

Surgical risk factors, morbidity, and mortality in elderly patients

2008 ◽  
Vol 68 ◽  
pp. S13 ◽  
Author(s):  
F.E. Turrentine ◽  
H. Wang ◽  
V.B. Simpson ◽  
R.S. Jones
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Morbidity And Mortality ◽  
Surgical Risk

scholarly journals Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jinzeng Zuo ◽  
Yongcheng Hu
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Intertrochanteric Fracture ◽  
Lower Extremities ◽  
The Elderly ◽  
Intertrochanteric Fractures ◽  
Targeted Interventions ◽  
Laboratory Test Results

Abstract Objective The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions.

scholarly journals Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study

2018 ◽  
Vol 9 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Ayodele Sasegbon ◽  
Laura O’Shea ◽  
Shaheen Hamdy
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Elderly Person ◽  
Oropharyngeal Dysphagia ◽  
The Elderly ◽  
Common Source ◽  
Increased Risk ◽  
The Mean ◽  
The Relationship ◽  
New Onset

IntroductionElderly people are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are multifactorial. Our aim was to identify if sepsis is associated with OPD in the elderly during hospitalisation in the absence of known other risk factors for OPD.MethodsA hospital electronic database was searched for elderly patients (≥65 years) referred for assessment for suspected dysphagia between March 2013 and 2014. Exclusion criteria were age <65 years, pre-existing OPD or acute OPD secondary to acute intracranial event, space-occupying lesion or trauma. Data were collected on factors including age, sex, comorbidities, existing OPD, sepsis, microbiology, recovery of OPD and medication. Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.ResultsA total of 301 of 1761 screened patients referred for dysphagia assessment met the inclusion criteria. The prevalence of sepsis and subsequent OPD was 16% (51/301). The mean age was 83 years (median 81 years). The most common comorbidity was dementia (31%). The majority (84%) failed to recover swallowing during their hospital stay, 12% had complications of aspiration and 35% died. The most common source of sepsis was from the chest (55%). Other factors contributing to the risk for dysphagia included delirium (22%) and neuroactive medication (41%). However, 10% of patients had sepsis and subsequent OPD without other identified risk factors.ConclusionThe prevalence of sepsis and subsequent dysphagia is significant and should be taken into account in any elderly person in hospital with new-onset OPD without other predisposing risk factors.

scholarly journals Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Chen-guang Wang ◽  
Ya-fei Qin ◽  
Xin Wan ◽  
Li-cheng Song ◽  
Zhi-jun Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
The Elderly

Anaesthesia in the elderly

2017 ◽  
Author(s):  
Bernadette Veering ◽  
Chris Dodds
Keyword(s):  
Elderly Patients ◽  
Postoperative Morbidity ◽  
Medical Condition ◽  
Clinical Care ◽  
The Elderly ◽  
Individual Variability ◽  
Morbidity And Mortality ◽  
Clear Understanding ◽  
Organ Systems ◽  
Specific Organ

The elderly population continues to grow. As surgical intervention in disease processes becomes more aggressive, the anaesthetist is faced with an increasing number of elderly patients. Elderly patients should be approached with a clear understanding of ageing, how it occurs, how it affects specific organ systems, and how it may influence clinical care, when a patient is subjected to an operation. The ageing process is a multifactorial process, resulting in a decreased capacity for adaptation and producing a gradual decrease in functional reserve of many organ systems. This has significant effects on the physiological responses to surgical and pharmacological trespass faced during anaesthesia. Increasing age is associated with changes in the response to a wide variety of drugs. Changes in dose–response relationships may be as a result of changes in pharmacokinetics, pharmacodynamics, or a combination of both. One should realize that increasing age is associated with a large inter-individual variability in dose requirements. As such, it is important to carefully titrate the dose against the desired clinical effect in an older patient. Preoperative physical and mental state are the most important determinants of per- and postoperative morbidity and mortality. The number of co-morbidities increases with advanced age and as such, optimization of the medical condition is essential to reduce the morbidity and mortality.

scholarly journals Neurosarcoidosis Presenting With Recurrent Strokes

2016 ◽  
Vol 7 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Naheed Raza ◽  
Karisa C. Schreck
Keyword(s):  
Risk Factors ◽  
Young People ◽  
Elderly Patients ◽  
Classification Scheme ◽  
The Elderly ◽  
Secondary Stroke Prevention ◽  
High Grade ◽  
Age Group ◽  
Vascular Risk ◽  
Recurrent Strokes

Neurosarcoidosis is a rare but important cause of stroke as it is treatable. Cases reported thus far have primarily been in young people who are relatively healthy. Here we report the case of a 73-year-old woman presenting with recurrent strokes and high-grade intracranial stenosis caused by probable neurosarcoidosis. This is unique as neurosarcoidosis is not usually considered as an etiology for recurrent strokes in our patient’s age-group. We review and categorize published cases of neurosarcoidosis causing stroke and describe a classification scheme for certainty of diagnosis. Given the implications of this diagnosis for secondary stroke prevention, we recommend that neurosarcoidosis be considered in the differential for patients with few vascular risk factors, recurrent strokes refractory to medical treatment, or possible vasculitis even in the elderly patients.

Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1055-1059 ◽  
Author(s):  
Yi-Ren Chen ◽  
Maxwell Boakye ◽  
Robert T. Arrigo ◽  
Paul S. A. Kalanithi ◽  
Ivan Cheng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Treatment Modality ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Complication Rates ◽  
Term Survival ◽  
Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

scholarly journals CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Rajesh Kumar Singhal ◽  
Harsha Kumar Gowardhan
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Elderly Patients ◽  
The Elderly ◽  
Shortness Of Breath ◽  
Cross Sectional ◽  
Clinical Presentations ◽  
Myocardial Infraction

Background: The cardiovascular diseases (CVDs) have become the leading cause of mortality worldwide. There is an increasing burden on health care systems associated with MIs in the elderly, differences in clinical picture, and difficulties in dealing with elderly patients with myocardial infraction (MI). Aim: The aim of study is to evaluate the different clinical presentations, risk factors and complications of elderly patients presenting with acute myocardial infarction. Methods: This is a retrospective, cross sectional study done over a period of 1 year. A total of 100 elderly patients who were diagnosed as AMI were included in the study. We studied Demographic features, cardiovascular risk factors, varied clinical presentations Electrocardiogram (ECG) findings from the history proformas and documented. Results: A total of 100 patients diagnosed with MI were studied. Mean age of the study population was 69.41 years and were predominantly male (84%). The most common presenting symptom was chest pain (79%) followed by sweating (7%), followed by shortness of breath (5%), giddiness (4%) vomiting (3%) and palpitations (2%). hypertension was commonly seen in elderly (56%) followed by diabetes (39%), smoking (28%), dyslipidaemias (12%), history of CAD (9%) and obesity (6%).  Mortality rate was 26% and maximum (11%) patients belonged to age group >80 years. Conclusion: We conclude that chest pain is the most common presentation in elderly AMI patients, but other atypical symptoms such as shortness of breath, giddiness, vomiting, without chest pain can also be the common presenting signs. Early and prompt management as appropriate should be provided to avoid morbidity and mortality in elderly. Keywords: Clinical Profile, Mortality, Myocardial Infarction, Risk Factors.

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