Intolerability to postoperative early oral nutrition in older patients (≥70 years) undergoing gastrectomy for gastric cancer: A case-control study

Background Postoperative early oral nutrition has increasingly been adopted for patients undergoing gastrectomy. However, intolerability to early oral nutrition remains a major concern, especially in older patients. This study aimed to investigate early oral nutrition intolerability in older patients who had undergone gastrectomy. Methods We retrospectively reviewed 825 patients who had undergone gastrectomy for gastric carcinoma between 2017 and 2019. All patients received an oral diet on postoperative day 1. Patients were divided into older (≥70 years) and younger (<70 years) adult groups, and short-term outcomes and intolerability to oral nutrition were compared. Intolerability to early oral nutrition was defined as oral diet cessation due to adverse gastrointestinal symptoms. Results Among the 825 patients (≥70 years, n = 286; <70 years, n = 539), 151 (18.3%) developed intolerability to early oral nutrition, of whom 100 patients were < 70 years old and 51 were ≥70 years old. The most common symptom causing intolerability was abdominal distension. The mean duration of fasting after developing intolerability was 2.8 ± 2.4 days. The incidence of intolerability in the older and younger adult groups was 17.8% and 18.6%, respectively (p = 0.799). In terms of sex, operative approach, gastric resection, lymph node dissection, reconstruction, and tumor stage subgroups, the older adult group did not exhibit a significant increase in intolerability. Postoperatively, the older adult group showed a higher incidence of systemic complications; however, anastomotic complications did not significantly differ between the two groups. Conclusions Postoperative early oral nutrition can safely be adopted for older patients undergoing gastrectomy, with acceptable intolerability and surgical outcomes.

Download Full-text

Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042351 ◽

2020 ◽

Vol 10 (11) ◽

pp. e042351

Author(s):

Kathryn Eastwood ◽

Dhanya Nambiar ◽

Rosamond Dwyer ◽

Judy A Lowthian ◽

Peter Cameron ◽

...

Keyword(s):

Cohort Study ◽

Older Adult ◽

Retrospective Cohort Study ◽

Older Patients ◽

Retrospective Cohort ◽

Vital Signs ◽

Telephone Triage ◽

Ambulance Dispatch ◽

Emergency Ambulance ◽

Primary Triage

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

Download Full-text

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052237 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2237

Author(s):

Youn-Jung Son ◽

Da-Young Kim ◽

Mi Hwa Won

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Older Adults ◽

Sex Differences ◽

Older Adult ◽

Hospital Readmission ◽

Older Patients ◽

Adverse Outcomes ◽

Prognostic Impact ◽

Male And Female

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

Download Full-text

Helicobacter pylori infection in Iran: demographic, endoscopic and pathological factors

BMC Gastroenterology ◽

10.1186/s12876-021-01931-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Seyedeh Amineh Hojati ◽

Sara Kokabpeyk ◽

Salma Yaghoubi ◽

Farahnaz Joukar ◽

Mehrnaz Asgharnezhad ◽

...

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Epigastric Pain ◽

Tap Water ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Common Symptom ◽

Pathological Findings ◽

Significant Difference ◽

H Pylori

Abstract Background Helicobacter pylori (H. pylori) infection is the most important risk factor for gastritis and peptic ulcer. However, factors other than H. pylori are involved in its pathogenesis. In the current study, we aimed to compare the clinical manifestations and endoscopic and histopathological findings of patients with and without H. pylori infection. Methods In this cross-sectional study, 233 patients with dyspepsia, referred for endoscopy, were examined regarding the presence of H. pylori infection. During an endoscopic exam, 5 biopsy specimens were taken from the stomach. The criteria for the presence of H. pylori infection was the presence and identification of bacteria in pathology. Two groups of H. pylori-positive and H. pylori-negative patients were compared regarding their demographic, endoscopic, and pathological findings. Results Of 233 patients, 154 (66.1%) were non-smokers, 201 (86.3%) were not alcohol users, and 153 (65.7%) used tap water. The most common symptom, reported in 157 (67.4%) patients, was epigastric pain. There was a significant difference between patients with and without H. pylori infection in terms of the educational status, occupational status, family history of gastrointestinal cancer, and some gastrointestinal symptoms. Also, there was a significant relationship between the endoscopic and pathological findings of patients with H. pylori. Conclusions The results of the present study revealed that H. pylori infection was not associated with sex, alcohol consumption, or non-steroidal anti-inflammatory drug use. The role of H. pylori in the pathophysiology of peptic ulcer was clarified. Also, there was a significant difference in the endoscopic and pathological findings of patients with H. pylori.

Download Full-text

94 Association between Dual-Task Timed “UP and GO” Test and Occurrence of Falls According to Age Group (Young-Older or Old-Older Adults): A Longitudinal Observation Study

Age and Ageing ◽

10.1093/ageing/afz164.94 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Tsuyoshi Asai ◽

Kensuke Oshima ◽

Yoshihiro Fukumoto ◽

Shogo Misu

Keyword(s):

Older Adults ◽

Older Adult ◽

Dual Task ◽

Community Dwelling ◽

Age Group ◽

Adult Group ◽

Observation Study ◽

Timed Up And Go ◽

Community Dwelling Older Adults

Abstract Aim To elucidate the association between the occurrence of falls and timed “up and go” (TUG) test score in a dual-task condition among community-dwelling older adults by age group. Methods This longitudinal observation study included 987 community-dwelling older adults at baseline. A TUG test (single-TUG) and a TUG test while counting aloud backward from 100 (dual-TUG) were conducted at baseline. The dual-task cost (DTC) value was computed from these results. Data on fall history were obtained using a self-administered questionnaire at the 1-year follow-up. At follow-up, 322 participants had dropped out and six participants had missing data for falls. The final analysis included 658 individuals (follow-up rate: 658/987, 67%) divided into a young-older adult group (aged 60–74 years) and an old-older adult group (aged 75 years or older). Associations between the occurrence of falls and TUG-related values were analyzed by age group using multivariate logistic regression models. Results For old-older adults, there were significant associations between the occurrence of falls and DTC value (odds ratio [OR] 0.981, 95% confidence interval [CI]: 0.963–0.999, p = 0.040) and single-TUG score (OR 1.129, 95% CI: 1.006–1.268, p = 0.039). However, no significant associations were observed for young-older adults. Conclusions Slower single-TUG test score and lower DTC value are associated with the occurrence of falls among old-older adults but not among young-older adults. Dual task assessment is useful for predicting falls in TUG fall assessment for old-older adults.

Download Full-text

A case series study of hypopituitarism in older patients with and without gastrointestinal symptoms

Postgraduate Medicine ◽

10.1080/00325481.2018.1479612 ◽

2018 ◽

Vol 130 (5) ◽

pp. 501-506 ◽

Cited By ~ 1

Author(s):

Xiaowei Li ◽

Hang Yang ◽

Zhijun Duan ◽

Qingyong Chang ◽

Xiaoting Wei ◽

...

Keyword(s):

Older Patients ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Case Series Study ◽

Series Study

Download Full-text

Diabetic Gastroparesis

Endocrine Reviews ◽

10.1210/er.2018-00161 ◽

2019 ◽

Vol 40 (5) ◽

pp. 1318-1352 ◽

Cited By ~ 17

Author(s):

Adil E Bharucha ◽

Yogish C Kudva ◽

David O Prichard

Keyword(s):

Glycemic Control ◽

Gastrointestinal Symptoms ◽

Outlet Obstruction ◽

Diabetic Gastroparesis ◽

Oral Nutrition ◽

Ghrelin Receptor ◽

Receptor Agonists ◽

Wireless Motility Capsule ◽

Upper Gastrointestinal Symptoms

AbstractThis review covers the epidemiology, pathophysiology, clinical features, diagnosis, and management of diabetic gastroparesis, and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus. Up to 50% of patients with type 1 and type 2 DM and suboptimal glycemic control have delayed gastric emptying (GE), which can be documented with scintigraphy, 13C breath tests, or a wireless motility capsule; the remainder have normal or rapid GE. Many patients with delayed GE are asymptomatic; others have dyspepsia (i.e., mild to moderate indigestion, with or without a mild delay in GE) or gastroparesis, which is a syndrome characterized by moderate to severe upper gastrointestinal symptoms and delayed GE that suggest, but are not accompanied by, gastric outlet obstruction. Gastroparesis can markedly impair quality of life, and up to 50% of patients have significant anxiety and/or depression. Often the distinction between dyspepsia and gastroparesis is based on clinical judgement rather than established criteria. Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed GE. Alternatively, there are limited data to suggest that delayed GE may affect glycemic control. The management of diabetic gastroparesis is guided by the severity of symptoms, the magnitude of delayed GE, and the nutritional status. Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation. Promising newer therapeutic approaches include ghrelin receptor agonists and selective 5-hydroxytryptamine receptor agonists.

Download Full-text

The evaluation of flaxseed for hot flashes: Results of a randomized, controlled trial, NCCTG study N08C7.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.18_suppl.cra9015 ◽

2011 ◽

Vol 29 (18_suppl) ◽

pp. CRA9015-CRA9015 ◽

Cited By ~ 1

Author(s):

S. Pruthi ◽

R. Qin ◽

S. A. Terstriep ◽

H. Liu ◽

C. L. Loprinzi ◽

...

Keyword(s):

Placebo Group ◽

Side Effects ◽

Controlled Trial ◽

Hot Flashes ◽

Group Versus ◽

Abdominal Distension ◽

Self Report ◽

Phase Iii ◽

Common Symptom ◽

Hot Flash

CRA9015 Background: Hot flashes are a common symptom during the menopause transition or following breast cancer treatment that can negatively impact the quality of life for many women. Preliminary data have suggested that flaxseed, a rich source of dietary lignans, may be a potentially effective treatment for hot flashes. Methods: A phase III randomized, placebo controlled trial was conducted to evaluate the efficacy of flaxseed in reducing hot flashes. Postmenopausal women were randomly assigned to a flaxseed bar (providing 410 mg of lignans) for 6 weeks vs a placebo bar. Participants completed daily prospective, self report hot flash diaries during the baseline week and then began eating one study bar per day for 6 weeks, while continuing to record their daily hot flashes. The intra-patient difference in hot flash activity between baseline and the last treatment week was the primary endpoint. Side effects of the bars were evaluated through self report and CTC assessment. Results: Between October and December 2009, 188 women were enrolled onto this trial. Mean hot flash scores were reduced by 4.9 units in the flaxseed group and 3.5 in the placebo group (p=0.29). In both groups, a little over a third of the women received a 50% reduction in their hot flash scores. Only one side effect was significantly different between groups, that being grade 1 pruritis, which was more common (7%) in the placebo group versus 1% in the flaxseed group. Both groups reported increased abdominal distension, flatulence, diarrhea and nausea. Adherence and ability to detect treatment assignment did not differ between groups. Conclusions: The results of this trial do not support the use of 410 mg of flaxseed lignans for the reduction of hot flashes. The gastrointestinal side effects seen in both groups were likely due to the fiber content in the flaxseed and placebo bars.

Download Full-text

Defining undertreatment and overtreatment in older patients with cancer: A scoping review of the literature.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23020 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23020-e23020

Author(s):

Clark DuMontier ◽

Kah Poh Loh ◽

Paul A Bain ◽

Rebecca A Silliman ◽

Gregory A. Abel ◽

...

Keyword(s):

Older Adults ◽

Older Adult ◽

Scoping Review ◽

Standard Therapy ◽

Older Patients ◽

Review Of The Literature ◽

Substantial Agreement ◽

Explicit Definition ◽

Patients With Cancer ◽

Implicit Definitions

e23020 Background: The terms “undertreatment” and “overtreatment” are often used to describe the management of older adults with cancer. The aim of this scoping review was to explore the explicit and implicit definitions associated with the use of these terms. Methods: We searched PubMed (NCBI), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms "undertreatment" or "overtreatment" (overtreat OR undertreat OR over treat OR under treat) of older adults with cancer. We included all types of articles, cancers, and treatments. We excluded studies that only included patients younger than 60 years old or studies without a defined focus on older adults. CD and KL independently reviewed a subset of included articles to assess for inter-reviewer reliability. Results: We identified 224 primary and secondary research articles that used the terms “undertreatment” (192), “overtreatment” (72), or both (45) regarding the management of older adults with cancer. Only 14 (6.3%) articles provided an explicit definition; for the remaining articles, we derived the implicit definitions from the terms’ surrounding context. There was substantial agreement between CD and KL in their interpretation of definitions of these terms (kappa 0.81). “Undertreatment” was commonly used to imply less than “standard” therapy (130 articles, 67.7%), or less than “standard” therapy that contributed to worse outcomes (62, 32.3%). Many articles did not account for the underrepresentation of older adults in trials leading to “standard” therapy, and 24 primary studies performed no or limited adjustment for geriatric domains (e.g., function) in their analyses that suggested worse survival in older adults treated with substandard therapy. “Overtreatment” was commonly used to imply cancer treatment in an older adult whose cancer would not have caused symptoms in his/her remaining lifetime (31, 43.1%), or aggressive treatment in whom the harms of treatment outweigh its benefits (41, 56.9%). Conclusions: Nearly all articles used the terms “undertreatment” and/or “overtreatment” without an explicit definition, and we identified variability and limitations in the meanings implied by these terms.

Download Full-text

Multidimensional Motor Sequence Learning Is Impaired in Older But Not Younger or Middle-Aged Adults

Physical Therapy ◽

10.2522/ptj.20070131 ◽

2008 ◽

Vol 88 (3) ◽

pp. 351-362 ◽

Cited By ~ 22

Author(s):

Lara A Boyd ◽

Eric D Vidoni ◽

Catherine F Siengsukon

Keyword(s):

Motor Learning ◽

Older Adult ◽

Sequence Learning ◽

Motor Sequence Learning ◽

Motor Sequence ◽

Adult Group ◽

Middle Aged ◽

Retention Testing ◽

Interference Tests ◽

Middle Aged Adults

Background and Purpose The purpose of this study was to identify which characteristics of a multidimensional sequence containing motor, spatial, and temporal elements would be most salient for motor sequence learning and whether age might differentially affect this learning. Subjects Younger (n=11, mean age=26.0 years), middle-aged (n=13, mean age=50.7 years), and older (n=11, mean age=77.5 years) adults who were neurologically intact participated in the study. Methods Participants practiced a sequencing task with repeated motor, spatial, and temporal dimensions for 2 days; on a separate third day, participants completed retention and interference tests designed to assess sequence learning and which elements of the sequence were learned. The mean median response time for each block of responses was used to assess motor sequence learning. Results Younger and middle-aged adults demonstrated sequence-specific motor learning at retention testing via faster response times for repeated sequences than random sequences; both of these groups showed interference for the motor dimension. In contrast, older adults demonstrated nonspecific learning (ie, similar improvements in response time for both random and repeated sequences). These findings were shown by a lack of difference between random and repeated sequence performance in the older adult group both at retention testing and during interference tests. Conclusion and Discussion Our data suggest that, when younger and middle-aged adults practice sequences containing multiple dimensions of movement, the motor element is most important for motor learning. The absence of sequence-specific change demonstrated by an older adult group that was healthy suggests an age-related impairment in motor learning that may have profound implications for rehabilitation.

Download Full-text

Validating SPICES as a Screening Tool for Frailty Risks among Hospitalized Older Adults

Nursing Research and Practice ◽

10.1155/2014/846759 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Harriet Udin Aronow ◽

Jeff Borenstein ◽

Flora Haus ◽

Glenn D. Braunstein ◽

Linda Burnes Bolton

Keyword(s):

Older Adult ◽

Older Patients ◽

Screening Tool ◽

Adverse Outcomes ◽

Patient Harm ◽

Comorbid Conditions ◽

Care Plans ◽

Screening Protocol ◽

Hospitalized Older Adults ◽

Almost All

Older patients are vulnerable to adverse hospital events related to frailty. SPICES, a common screening protocol to identify risk factors in older patients, alerts nurses to initiate care plans to reduce the probability of patient harm. However, there is little published validating the association between SPICES and measures of frailty and adverse outcomes. This paper used data from a prospective cohort study on frailty among 174 older adult inpatients to validate SPICES. Almost all patients met one or more SPICES criteria. The sum of SPICES was significantly correlated with age and other well-validated assessments for vulnerability, comorbid conditions, and depression. Individuals meeting two or more SPICES criteria had a risk of adverse hospital events three times greater than individuals with either no or one criterion. Results suggest that as a screening tool used within 24 hours of admission, SPICES is both valid and predictive of adverse events.

Download Full-text