scholarly journals Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

2005 ◽  
Vol 153 (6) ◽  
pp. 723-735 ◽  
Author(s):  
Giuseppe Minniti ◽  
Vincenzo Esposito ◽  
Manolo Piccirilli ◽  
Amato Fratticci ◽  
Antonio Santoro ◽  
...  
Keyword(s):  
Side Effects ◽  
Replacement Therapy ◽  
Pituitary Adenomas ◽  
Bone Mineralization ◽  
The Elderly ◽  
Hormone Deficiency ◽  
Primary Therapy ◽  
Age Group ◽  
Diagnosis And Management ◽  
Age Related

An increasing proportion of pituitary adenomas are recognized in the elderly, raising the question of their optimal diagnosis and management. Age-related endocrine changes and associated diseases may significantly modify the clinical presentation and hormonal evaluation of these patients. About 80% of pituitary adenomas in this age group are non-secreting, requiring careful differential diagnosis with non-adenomatous sellar lesions. In this group, visual deterioration and hypopituitarism remain the leading symptoms. Recognized secreting tumours are mainly GH-secreting, most of them intrasellar, followed by prolactinomas, which present as clinically non-secreting and are usually invasive. Cushing’s disease appears as a very rare eventuality in the elderly. Optimal therapeutic management should aim to control the disease while preserving or improving patient’s quality of life. Transsphenoidal surgery has proved to be an efficient and well-tolerated option for non-secreting adenomas with visual defects and intrasellar GH-secreting adenomas, being able to improve metabolic and cardiovascular complications of acromegaly even in this age group. In contrast, dopamine-agonist drugs can be proposed as a primary therapy for prolactinomas even in the presence of severe neurological complications. Because the use of radiotherapy is hampered by its delay of action and potential neurological side effects, its indications should be better defined in this age group. The clinical importance of hypopituitarism should not be underestimated, and thyroid- and adrenal-replacement therapy are mandatory in the presence of documented hormone deficiency, carefully avoiding overtreatment in order to limit possible side effects on the cardiovascular system and bone mineralization. Indications for GH- and sex steroid-replacement therapy still await age-specific guidelines.

scholarly journals Gastrointestinal Tract Disorders in Older Age

2019 ◽  
Vol 2019 ◽  
pp. 1-19 ◽  
Author(s):  
Igor Dumic ◽  
Terri Nordin ◽  
Mladen Jecmenica ◽  
Milica Stojkovic Lalosevic ◽  
Tomica Milosavljevic ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Side Effects ◽  
Elderly Population ◽  
The Elderly ◽  
Daily Basis ◽  
Clinical Implications ◽  
Age Group ◽  
Gi Tract ◽  
Age Related ◽  
Age Related Changes

Considering an increase in the life expectancy leading to a rise in the elderly population, it is important to recognize the changes that occur along the process of aging. Gastrointestinal (GI) changes in the elderly are common, and despite some GI disorders being more prevalent in the elderly, there is no GI disease that is limited to this age group. While some changes associated with aging GI system are physiologic, others are pathological and particularly more prevalent among those above age 65 years. This article reviews the most important GI disorders in the elderly that clinicians encounter on a daily basis. We highlight age-related changes of the oral cavity, esophagus, stomach, small and large bowels, and the clinical implications of these changes. We review epidemiology and pathophysiology of common diseases, especially as they relate to clinical manifestation in elderly. Details regarding management of specific disease are discussed in detail if they significantly differ from the management for younger groups or if they are associated with significant challenges due to side effects or polypharmacy. Cancers of GI tract are not included in the scope of this article.

New Telerehabilitation Services for the Elderly

2013 ◽  
pp. 109-132 ◽  
Author(s):  
António Teixeira ◽  
Carlos Pereira ◽  
Miguel Oliveira e Silva ◽  
Joaquim Alvarelhão ◽  
Anabela G. Silva ◽  
...  
Keyword(s):  
Older People ◽  
User Interfaces ◽  
Multimodal Interaction ◽  
The Elderly ◽  
Ease Of Use ◽  
Preliminary Evaluation ◽  
Age Group ◽  
Additional Information ◽  
Age Related ◽  
First Results

The world’s population is getting older with the percentage of people over 60 increasing more rapidly than any other age group. Telerehabilitation may help minimise the pressure this puts on the traditional healthcare system, but recent studies showed ease of use, usability, and accessibility as unsolved problems, especially for older people who may have little experience or confidence in using technology. Current migration towards multimodal interaction has benefits for seniors, allowing hearing and vision problems to be addressed by exploring redundancy and complementarity of modalities. This chapter presents and contextualizes work in progress in a new telerehabilitation service targeting the combined needs of the elderly to have professionally monitored exercises without leaving their homes with their need regarding interaction, directly related to age-related effects on, for example, vision, hearing, and cognitive capabilities. After a brief general overview of the service, additional information on its two supporting applications are presented, including information on user interfaces. First results from a preliminary evaluation are also included.

QTc prolongation during the SARS-CoV-2 outbreak: clinical risk management through hospital training course, focus on elderly patients

2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Nicola Forni ◽  
Valentina Boasi ◽  
Katiuscia Sciole ◽  
Silvia Borile ◽  
Nicoletta Pingelli ◽  
...  
Keyword(s):  
Side Effects ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Age Group ◽  
Clinical Risk Management ◽  
Qtc Prolongation ◽  
Age Related ◽  
Recent Outbreak ◽  
Subsequent Modification ◽  
Related Mortality

The recent outbreak exposed doctors to a new challenge: treating people without any scientific evidence. All molecules combined in treatment schedules were merged on the basis of weak and anecdotal data so, the recommendations are constantly changing. In this context it is either mandatory for clinicians focusing on the different treatment options and on probable side effects of each molecules. It is well acquired that among elderly within same age group and strain, the outcome will differ according to each patient’s frailty. Moreover, old and frail people are particularly exposed to a double risk: the first one is the age-related mortality and the second one the susceptibility (also age related too) to side effects. Aim of our paper is reporting our experience in reducing toxicity with a constant action of scientific update and subsequent modification in clinical management protocols. Main focus was on frail patients and cardiologic risk-related to hydroxychloroquine.

scholarly journals Age-Related Changes in the 25-Hydroxyvitamin D Versus Parathyroid Hormone Relationship Suggest a Different Reason Why Older Adults Require More Vitamin D

2003 ◽  
Vol 88 (1) ◽  
pp. 185-191 ◽  
Author(s):  
Reinhold Vieth ◽  
Yasmin Ladak ◽  
Paul G. Walfish
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Secondary Hyperparathyroidism ◽  
Age Groups ◽  
The Elderly ◽  
Age Group ◽  
Hydroxyvitamin D ◽  
Age Related ◽  
25 Hydroxyvitamin D ◽  
The Relationship

Vitamin D requirements are thought to vary with age, but there is little comparative evidence for this. One goal in establishing a vitamin D requirement is to avoid secondary hyperparathyroidism. We studied 1741 euthyroid, thyroid clinic outpatients without evidence of calcium abnormalities, ranging in age from 19 to 97 yr, whose serum and urine had been analyzed for calcium, vitamin D, and parathyroid status. We found no effect of age on the 25-hydroxyvitamin D [25(OH)D] concentration associated with specific vitamin D intakes, and there was no relationship between 25(OH)D and 1,25hydroxyvitamin D [1,25(OH)2D]. In every age group, serum 1,25(OH)2D declined with increasing creatinine (P < 0.001). What changed with age included creatinine, which correlated with 25(OH)D (r = 0.146, P < 0.001) only in the youngest age group (19–50 yr) but not in the older age groups (P > 0.1). Creatinine did not correlate with PTH in the youngest age group, but the relationship became significant as age increased (e.g. for the elderly, r = 0.365, P < 0.001). Linear regression of log PTH vs. log 25(OH)D agreed with the natural shape of the relationship observed with scatterplot smoothing, and this showed no plateau in PTH as 25(OH)D increased. We compared PTH concentrations among age groups, based on 20 nmol/liter increments in 25(OH)D. Mean PTH in adults older than 70 yr was consistently higher than in adults younger than 50 yr (P < 0.05 by ANOVA and Dunnett’s t test). PTH levels of the elderly who had 25(OH)D concentrations greater than 100 nmol/liter matched PTH of younger adults having 25(OH)D concentrations near 70 nmol/liter. This study shows that all age groups exhibit a high prevalence of 25(OH)D insufficiency and secondary hyperparathyroidism. Older adults are just as efficient in maintaining 25(OH)D, but they need more vitamin D to produce the higher 25(OH)D concentrations required to overcome the hyperparathyroidism associated with their diminishing renal function.

Prevalence of opioid dispensings and concurrent gastrointestinal medications in an elderly population from Ontario, Canada

2018 ◽  
Vol 4 (4) ◽  
pp. 193 ◽  
Author(s):  
Rachel Williams, PhD, MS ◽  
Nevzeta Bosnic, BA ◽  
Ashlee W. Duncan, PhD, MS ◽  
Michael Brogan, BA ◽  
Suzanne F. Cook, PhD
Keyword(s):  
Side Effects ◽  
Elderly Population ◽  
Prophylactic Treatment ◽  
Opioid Analgesics ◽  
The Elderly ◽  
Therapeutic Agents ◽  
Drug Benefit ◽  
Cohort Design ◽  
Age Related ◽  
Prophylactic Use

Background: Although opioid analgesics are effective therapeutic agents, gastrointestinal (GI) side effects represent a challenging consequence of treatment. In an elderly population, age-related physiological changes, such as decreased GI functioning and dehydration, may compound the adverse effects of opioids; therefore, appropriate prophylactic treatment, utilizing laxatives and/or acid suppressants, is particularly important in an elderly population.Aim: This study describes the prevalence of outpatient opioid dispensings and the concomitant dispensing of opioids and GI medications in a population 65 years or older enrolled in the Ontario Drug Benefit Program in 2005.Methods: Using a retrospective cohort design, dispensings of opioids, laxatives, and acid suppressants were identified using claims reimbursement data. Concurrent dispensings were defined as having at least one “GI medication-dispensed day” overlapping an “opioid-dispensed day.”Results: More than 18 percent of the elderly, drug plan population was dispensed an opioid in 2005. Women had more opioid dispensings and were dispensed opioids for extended periods of time as compared with men. Approximately half of patients with an opioid dispensing were concomitantly dispensed a GI medication; these medications were dispensed nearly twice as frequently among people with chronic opioid dispensings when compared with people with nonchronic opioid dispensings.Conclusions: Although laxatives are commonly recommended in patients taking opioids, only half of the older adults in Ontario who were dispensed an opioid also received a concomitant GI medication dispensing. As the elderly are more likely to develop opioid-induced constipation, the prophylactic use of laxatives and/or acid suppressant medications is often necessary to mitigate the side effects associated with their pain management.

Growth Hormone: Myths and Misconceptions

1996 ◽  
Vol 5 (3) ◽  
pp. 244-250
Author(s):  
Valerie J. Wirth ◽  
Joe Gieck
Keyword(s):  
Growth Hormone ◽  
Adipose Tissue ◽  
Side Effects ◽  
Elderly Population ◽  
The Elderly ◽  
Fat Free Mass ◽  
Hormone Deficiency ◽  
Adipose Tissue Volume ◽  
The Many ◽  
Positive Results

Growth hormone is one of the many dangerous and illegal ergogenic aids currently used by athletes. In those who suffer from a growth hormone deficiency, supplementation does produce positive results: Muscle volume increases while adipose tissue volume is significantly reduced. Growth hormone supplementation can also lead to strength increases in the deficient population (2, 6, 13) as well as in the elderly population (16, 18, 25). In healthy young men, growth hormone supplementation has been shown to increase fat-free mass and to decrease fat mass. However, these changes are not accompanied by strength gains (5, 7, 23, 24). This finding, coupled with the numerous side effects associated with the drug, presents a strong case for athletes to abandon its use as an ergogenic aid.

scholarly journals Age separation dramatically reduces COVID-19 mortality rate in a computational model of a large population

2020 ◽  
Author(s):  
Liron Mizrahi ◽  
Shani Stern
Keyword(s):  
Elderly Population ◽  
Large Population ◽  
Age Groups ◽  
The Elderly ◽  
Mortality Rates ◽  
Social Connections ◽  
Age Group ◽  
Efficient Treatment ◽  
Age Related ◽  
Total Death

AbstractCOVID-19 pandemic has caused a global lock down in many countries throughout the world. Faced with a new reality, and until a vaccine or efficient treatment is found, humanity must figure out ways to keep economy going on one hand, yet keep the population safe on the other hand, especially those that are susceptible to this virus. Here we use a network simulation, with parameters that were drawn from what is known about the virus, to explore 5 different scenarios of partial lock down release. We find that separating age groups by reducing interactions between age groups, protects the general population and reduces mortality rates. Furthermore, addition of new connections within the same age group to compensate for the lost connections outside the age group, still has a strong beneficial influence and reduces the total death toll by 66%. While complete isolation from society may be the most protective scenario for the elderly population, it would have an emotional and possibly cognitive impact that might outweigh its benefit. We therefore propose creating age-related social recommendations or even restrictions, thereby allowing social connections but still strong protection for the older population.

scholarly journals Asthma in the elderly: a different disease?

Breathe ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Salvatore Battaglia ◽  
Alida Benfante ◽  
Mario Spatafora ◽  
Nicola Scichilone
Keyword(s):  
Side Effects ◽  
The Elderly ◽  
Epidemiological Studies ◽  
Older Age ◽  
Exclusion Criterion ◽  
Diagnostic Process ◽  
List Type ◽  
Older Individuals ◽  
Public Health Perspective ◽  
Age Related

Key pointsAsthma in the elderly can be difficult to identify due to modifications of its clinical features and functional characteristics.Several comorbidities are associated with asthma in the elderly, and this association differs from that observed in younger patients.In clinical practice, physicians should treat comorbidities that are correlated with asthma (i.e. rhinitis or gastro-oesophageal reflux), assess comorbidities that may influence asthma outcomes (i.e. depression or cognitive impairment) and try to prevent comorbidities related to ­‘drug-associated side-effects (i.e. cataracts, arrhythmias or osteoporosis).“Geriatric asthma” should be the preferred term because it implies the comprehensive and multidimensional approach to the disease in the older populations, whereas “asthma in the elderly” is only descriptive of the occurrence of the disease in this age range.Educational aimsTo present critical issues in performing differential diagnosis of asthma in the elderly.To offer the instrument to implement the management of asthma in the most advanced ages.Asthma is a chronic airway disease that affects all ages, but does this definition also include the elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological studies and clinical experience support the concept that asthma is as prevalent in older age as it is in the young. With the ever-increasing elderly population worldwide, the detection and proper management of the disease in old age may have a great impact from the public health perspective. Whether asthma in the elderly maintains the same characteristics as in young populations is an interesting matter. The diagnostic process in older individuals with suspected asthma follows the same steps, namely a detailed history supported by clinical examination and laboratory investigations; however, it should be recognised that elderly patients may partially lose reversibility of airway obstruction. The correct interpretation of spirometric curves in the elderly should take into account the physiological changes in the respiratory system. Several factors contribute to delaying the diagnosis of asthma in the elderly, including the age-related impairment in perception of breathlessness. The management of asthma in advanced age is complicated by the comorbidities and polypharmacotherapy, which advocate for a comprehensive approach with a multidimensional assessment. It should be emphasised that older age frequently represents an exclusion criterion for eligibility in clinical trials, and current asthma medications have rarely been tested in elderly asthmatics. Ageing is associated with pharmacokinetic changes of the medications. As a consequence, absorption, distribution, metabolism and excretion of antiasthmatic medications can be variably affected. Similarly, drug-to-drug interactions may reduce the effectiveness of inhaled medications and increase the risk of side-effects. For this reason, we propose the term “geriatric asthma” be preferred to the more generic “asthma in the elderly”.

Dysphonia in the Elderly: Diagnosis and Management of Age-Related Voice Changes

1996 ◽  
Vol 89 (2) ◽  
pp. 204-207 ◽  
Author(s):  
PATRICK HAGEN ◽  
GEORGE D. LYONS ◽  
DANIEL W. NUSS
Keyword(s):  
The Elderly ◽  
Diagnosis And Management ◽  
Age Related ◽  
Voice Changes
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