Clinical Approach to Confusion and Delirium in the Elderly

2014 ◽  
Vol 15 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Dong-Kuck Lee
Keyword(s):  
The Elderly ◽  
Clinical Approach

How I treat elderly patients with myeloma

Blood ◽  
2010 ◽  
Vol 116 (13) ◽  
pp. 2215-2223 ◽  
Author(s):  
Jayesh Mehta ◽  
Michele Cavo ◽  
Seema Singhal
Keyword(s):  
Adverse Effects ◽  
Older Patients ◽  
Supportive Therapy ◽  
The Elderly ◽  
High Dose Chemotherapy ◽  
Cytotoxic Agents ◽  
High Dose ◽  
Clinical Approach ◽  
Younger Patients ◽  
Best Response

Abstract The clinical approach to older patients with myeloma has to be modified to take into account comorbidities and the likelihood of higher treatment-related toxicity. Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects. Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently. The sequential use of active agents singly and in different combinations has improved response rates and survival of all patients with myeloma, including the elderly.

Sleep-related behaviors in Alzheimer’s disease and dementia with Lewy bodies

2015 ◽  
Vol 26 (1) ◽  
Author(s):  
Alberto Raggi ◽  
Walter Neri ◽  
Raffaele Ferri
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Circadian Rhythm ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
The Elderly ◽  
Narrative Review ◽  
Clinical Approach ◽  
Prevalence Studies

AbstractPrevalence studies suggest that Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) are the most common dementing illnesses in the elderly. The aim of this narrative review was to provide data on sleep-related behaviors in AD and DLB. This paper contains arguments, with a clinical approach, on both circadian rhythm changes and dissociated states of wakefulness and sleep in these two conditions.

scholarly journals 509 A biochemical approach to atrial fibrillation in older patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giulia Ricciardi ◽  
Giuseppe Pieraccini ◽  
Claudia Di Serio ◽  
Giancarlo La Marca ◽  
Stefano Fumagalli
Keyword(s):  
Atrial Fibrillation ◽  
Amino Acids ◽  
Healthy Subjects ◽  
Older Patients ◽  
Metabolic Diseases ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Untargeted Metabolomics ◽  
Clinical Approach ◽  
Laboratory Activity

Abstract Aims Atrial fibrillation (AF) is the most common arrhythmia among the elderly. It is characterized by a disordered electrical activity of the atria and is associated with increased morbidity and mortality. The pathogenesis of AF is not completely understood as it depends on a multifactorial combination of electrical and structural remodelling and inflammation. Metabolomics is the study of the small molecules present in a given biological sample and it has been widely used to determine the metabolic signatures of certain diseases. Untargeted metabolomics consists of a comprehensive screening of all measurable metabolites to identify patterns related to a certain disease, while targeted metabolomics aims at analysing a defined group of metabolites belonging to a specific metabolic pathway or class of compounds. Mass spectrometry (MS), coupled with gas chromatography (GC) and liquid chromatography (LC) offers the possibility of performing quantitative analyses with high selectivity and sensitivity. Aims of this project were to understand the biomolecular mechanisms underlying the onset of AF. Methods We compared plasma samples of older patients with AF with those of healthy subjects. We started from untargeted metabolomics to explore the whole metabolome; then we focused on the lipidomic profile, and, finally, we measured the plasma concentration of acylcarnitines and some amino acids, known to be diagnostic markers of certain metabolic diseases. Fifty patients (age: 76 ± 6 years) and 26 healthy subjects (age: 65 ±19 years) were recruited for the study. A blood sample was drawn by each patient. Samples for metabolomics and lipidomics were processed, respectively, with a GC-MS platform and with high-resolution LC-MS. Results Differences in diseased and healthy metabolomic and lipidomic profiles were not detected, while the concentration of some acylcarnitines and amino acids resulted to be significantly different in the two groups. In particular, two long-chain acylcarnitines (LCACs), C14 and C18:1, were more abundant in the plasma of AF patients, while glycine, which has scavenger properties, had a lower concentration. High levels of circulating LCACs have been associated with cardiovascular diseases and they are known to alter the heart electrophysiology, thus representing a possible marker of the development of arrhythmias. We can hypothesize that the different concentrations we found possibly reflect a higher oxidative and metabolic stress induced by the arrhythmia. Conclusions The alterations of the LCACs we found in AF patients could represent the basis to guide specific therapeutic interventions aimed at reducing the incidence of the hemodynamic and embolic complications of the arrhythmia. In particular, recent guidelines for the management of AF patients introduced the acronym ABC, which means ‘Avoid stroke’—A, ‘Better symptoms management’—B, and ‘Cardiovascular risk and comorbidity management’—C. In this sense, the present research represents an attempt to join and enrich the traditional clinical approach with data derived from laboratory activity, to improve the outcome of the oldest segment of cardiac patients, often presenting rhythm alterations.

Introduction and general comments

ESC CardioMed ◽  
2018 ◽  
pp. 1625-1634 ◽  
Author(s):  
Bernard Iung ◽  
Pieter Kappetein
Keyword(s):  
Multimodality Imaging ◽  
Oral Anticoagulants ◽  
Quality Care ◽  
The Elderly ◽  
Risk Scores ◽  
Clinical Approach ◽  
Industrialized Countries ◽  
Mechanical Valves ◽  
History Of ◽  
Patient’S History

Valvular heart disease (VHD) is frequent is industrialized countries and its prevalence increases with age due to the predominance of degenerative aetiology. Clinical approach is paramount for evaluation of the patient’s history, symptoms and for the detection of VHD by auscultation. Echocardiography plays a major role in diagnosis and assessment of severity and prognosis. Other investigations are mainly non-invasive and include stress testing, multimodality imaging and biomarkers. Risk stratification is essential to weigh the risk of intervention against the expected natural history of VHD. It should include risk scores, keeping in mind their limitations, in particular in the elderly. Heart valve centres are required to deliver high-quality care and provide adequate training. Non-vitamin K antagonist oral anticoagulants may be used in patients with atrial fibrillation and aortic stenosis, aortic regurgitation, mitral regurgitation, or aortic bioprostheses beyond 3 months after implantation, but are contraindicated in mitral stenosis and mechanical valves.

scholarly journals Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review

2021 ◽  
Author(s):  
Martina Rekatsina ◽  
Antonella Paladini ◽  
Dariusz Myrcik ◽  
Omar Viswanath ◽  
Ivan Urits ◽  
...  
Keyword(s):  
Nervous System ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Pain Assessment ◽  
Full Text ◽  
Pain Perception ◽  
The Elderly ◽  
Clinical Approach ◽  
Advanced Dementia ◽  
Opioid Prescription

Background: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in central nervous system along with changes in the peripheral nervous system due to aging have a significant impact in pain perception. Often clinicians decide to prescribe opioids in order to relief pain, also without a clear indication. Aim: This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods: A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles which were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. Results: This review discuss the complex physiological and pharmacological changes in elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in elderly. Information regarding opioid prescription in nursing homes as well as recorded indications for opioids use, type and dosing of opioid and compliance of treatment in advanced dementia are also provided. Conclusions: Opioid prescription in elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients, need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.

Cell surface changes during aging of human bladder epithelium examined by lectin probes and SEM

1990 ◽  
Vol 48 (3) ◽  
pp. 966-967
Author(s):  
J. Jacob ◽  
M.F.M. Ismail
Keyword(s):  
The Elderly ◽  
Ultrastructural Changes ◽  
Pokeweed Mitogen ◽  
Asymmetric Structure ◽  
Luminal Surface ◽  
Bladder Epithelium ◽  
Aldehyde Groups ◽  
Cell Surface Changes ◽  
Phosphate Buffered Saline ◽  
Surface Changes

Ultrastructural changes have been shown to occur in the urinary bladder epithelium (urothelium) during the life span of humans. With increasing age, the luminal surface becomes more flexible and develops simple microvilli-like processes. Furthermore, the specialised asymmetric structure of the luminal plasma membrane is relatively more prominent in the young than in the elderly. The nature of the changes at the luminal surface is now explored by lectin-mediated adsorption visualised by scanning electron microscopy (SEM).Samples of young adult (21-31 y old) and elderly (58-82 y old) urothelia were fixed in buffered 2% glutaraldehyde for 10 m and washed with phosphate buffered saline (PBS) containing Ca++ and Mg++ at room temperature. They were incubated overnight at 4°C in 0.1 M ammonium chloride in PBS to block any remaining aldehyde groups. The samples were then allowed to stand in PBS at 37°C for 2 h before incubation at 37°C for 30 m with lectins. The lectins used were concanavalin A (Con A), wheat germ agglutinin (WGA), phytohaemagglutinin (PHA) and pokeweed mitogen (PWM) at a concentration of 500 mg/ml in PBS at pH 7.A.

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