scholarly journals The impact of non-steroidal anti-inflammatory drugs use in elderly cardiovascular patients: an observational study from tertiary care in South India

2019 ◽  
Vol 7 (5) ◽  
pp. 1787
Author(s):  
Sadhna Sharma ◽  
Biju Govind ◽  
Kondal Rao
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Tertiary Care ◽  
The Elderly ◽  
Left Ventricular ◽  
Risk Of Death ◽  
Increased Risk ◽  
High Prevalence ◽  
One Year ◽  
The Impact

Background: Long-term use of NSAIDs, by patients having cardiovascular conditions, has shown to increase the risk of cardiovascular events and increased risk of death. Hence, the study was conducted to determine the complications related to NSAID use by the elderly patients with cardiovascular disease (CVD).Methods: The study was a single-center prospective observational study conducted November 2017 to October 2018. Elderly patients (>60 years) suffering from various CVDs and reported NSAID intake daily for at least one month were included. A questionnaire included demographic, treatment related history and complete details of NSAIDs intake including nature, dose, indication, source etc. The same questionnaire was again filled at the end of one-year follow-up.Results: A total of 100 participants were included in the study. The mean age was 72±8.6 years. Majority of the patients (93%) had hypertension, and 69% of the patient had previous MI.  Five NSAIDs (diclofenac, ibuprofen, mefenamic acid, naproxen, and ketorolac) were used routinely. At least one over the counter NSAID used was reported by 86%, 57% were prescribed at least one NSAIDs by their orthopaedics and physicians. At the end of 1-year follow-up, authors found that 71% had MI (2% increase), 4% developed reinfarction, 20% had severe left ventricular failure (4% increase), 7% had atrial fibrillation (1% increase), and 2% patients died and 63% patients reported raise in systolic blood pressure by 5mmHg.Conclusions: High prevalence of concomitant NSAID use among elderly CVD patients, which might be contributing towards increase in CVS morbidity and mortality.

Polypill therapy and frailty in elderly: Time to stop treating everything

2021 ◽  
Vol 12 (4) ◽  
pp. 39-42
Author(s):  
Sunil Kumar ◽  
Parth Godhiwala ◽  
Amrutha Garikapati ◽  
Shraddha Jain
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Related Condition ◽  
Medicine Department ◽  
Risk Of Death ◽  
Age Related ◽  
One Year ◽  
The Impact

Background: Frailty is a reversible age-related condition of increased vulnerability and risk of death or unplanned hospitalization. Frailty and polypill therapy are common in elderly, although little is known about the impact, they may have on each other. Aims and Objective: The study was a prospective observational study, designed with an aim to observe the six-month and one-year outcomes of elderly patients on polypill therapy. Material and Methods: Three hundred forty-two patients aged more than 60 years on polypill treatment were enrolled in this study, which were on regular follow up in our rural hospital at geriatric units of medicine department. Results: At the end of one year, 38.1% were in severe frailty (FIRE >0.7) category, out of which death happened at the end of one year were 41.6%. 47.6% required repeated hospitalisations that were on polypill therapy. Conclusions: A reduction of polypill therapy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypill in the development, reversion or delay of frailty.

scholarly journals Outcomes of surgery in patients aged ≥90 years in the general surgical setting

2018 ◽  
Vol 100 (3) ◽  
pp. 172-177 ◽  
Author(s):  
A Sudlow ◽  
H Tuffaha ◽  
AT Stearns ◽  
IA Shaikh
Keyword(s):  
Surgical Procedures ◽  
Emergency Surgery ◽  
Tertiary Care ◽  
Gastrointestinal Surgery ◽  
Care Facility ◽  
Mortality Rates ◽  
Emergency Procedures ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90–106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

scholarly journals The impact of age on approach-related complications with navigated lateral lumbar interbody fusion

2020 ◽  
Vol 49 (3) ◽  
pp. E8
Author(s):  
Yamaan S. Saadeh ◽  
Clay M. Elswick ◽  
Eleanor Smith ◽  
Timothy J. Yee ◽  
Michael J. Strong ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Interbody Fusion ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Lumbar Interbody Fusion ◽  
Related Complication ◽  
Lateral Lumbar Interbody Fusion ◽  
Increased Risk ◽  
The Impact

OBJECTIVEAge is known to be a risk factor for increased complications due to surgery. However, elderly patients can gain significant quality-of-life benefits from surgery. Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure that is commonly used to treat degenerative spine disease. Recently, 3D navigation has been applied to LLIF. The purpose of this study was to determine whether there is an increased complication risk in the elderly with navigated LLIF.METHODSPatients who underwent 3D-navigated LLIF for degenerative disease from 2014 to 2019 were included in the analysis. Patients were divided into elderly and nonelderly groups, with those 65 years and older categorized as elderly. Ninety-day medical and surgical complications were recorded. Patient and surgical characteristics were compared between groups, and multivariate regression analysis was used to determine independent risk factors for complication.RESULTSOf the 115 patients included, 56 were elderly and 59 were nonelderly. There were 15 complications (25.4%) in the nonelderly group and 10 (17.9%) in the elderly group, which was not significantly different (p = 0.44). On multivariable analysis, age was not a risk factor for complication (p = 0.52). However, multiple-level LLIF was associated with an increased risk of approach-related complication (OR 3.58, p = 0.02).CONCLUSIONSElderly patients do not appear to experience higher rates of approach-related complications compared with nonelderly patients undergoing 3D navigated LLIF. Rather, multilevel surgery is a predictor for approach-related complication.

scholarly journals Recurring infection with ecologically distinct human papillomavirus (HPV) types explains high prevalence and diversity

2017 ◽  
Author(s):  
Sylvia Ranjeva ◽  
Edward B. Baskerville ◽  
Vanja Dukic ◽  
Luisa Villa ◽  
Eduardo Lazcano-Ponce ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Hpv Prevalence ◽  
Increased Risk ◽  
High Prevalence ◽  
Hpv Types ◽  
One Year ◽  
The One ◽  
The Impact

AbstractThe high prevalence of human papillomavirus (HPV), the most common sexually transmitted infection, arises from the coexistence of over 200 genetically distinct types. Accurately predicting the impact of vaccines that target multiple types requires understanding the factors that determine HPV diversity. The diversity of many pathogens is driven by type-specific or “homologous” immunity, which promotes the spread of variants to which hosts have little immunity. To test for homologous immunity and to identify mechanisms determining HPV transmission, we fitted nonlinear mechanistic models to longitudinal data on genital infections in unvaccinated men. Our results provide no evidence for homologous immunity, instead showing that infection with one HPV type strongly increases the risk of infection with that type for years afterwards. For HPV16, the type responsible for most HPV-related cancers, an initial infection increases the one-year probability of reinfection by 20-fold, and the probability of reinfection remains 14-fold higher two years later. This increased risk occurs in both sexually active and celibate men, suggesting that it arises from auto-inoculation, episodic reactivation of latent virus, or both. Overall our results show that high HPV prevalence and diversity can be explained by a combination of a lack of homologous immunity, frequent reinfections, weak competition between types, and variation in type fitness between host subpopulations. Due to the high risk of reinfection, vaccinating boys that have not yet been exposed may be crucial to reduce prevalence, but our results suggest that there may also be large benefits from vaccinating previously infected individuals.

scholarly journals P1342OUTCOME OF ELDERLY PATIENTS AFTER PREDIALYSIS VASCULAR ACCESS CREATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dr Sanjay Bhat ◽  
Alok Srivastava ◽  
Nisar Ahmad ◽  
Priyanka Rai ◽  
R P Singh ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vascular Access ◽  
Tertiary Care ◽  
Primary Patency ◽  
Dialysis Initiation ◽  
High Rate ◽  
Care Hospital ◽  
Risk Of Death ◽  
One Year ◽  
Dialysis Outcomes

Abstract Background and Aims Guidelines to create vascular access for elderly patients is guided by a number of factors i.e. competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes, influencing the outcomes in this population . Does early creation of AVF in elderly patients with advanced CKD influence dialysis outcomes needs evaluation. Method We conducted a retrospective study among elderly (> 65 years ) who chose to create a permanent vascular access before dialysis initiation were identified between Jan 2014-Jan 2017 in Tertiary care hospital, Lucknow and assessed in 43 elderly patients (aged ≥65 years) with CKD undergoing predialysis AVF . Results They were observed for the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. 45.6 % were diabetic, 78.9% were hypertensive, and 14.2 % had peripheral vascular disease. In all, 67% of patients with predialysis AVF initiated dialysis within 1 years of access placement, but the overall risk of dialysis initiation was modified by patient age. Only one half of patients initiated dialysis with a functioning AVF, 47.9% of AVFs were created <90 days before dialysis initiation. The primary patency rates were 42.7% at one year and 37.8 % at 2 years. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF. In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 1 year. As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter. Conclusion Insertion of an AVF closer to dialysis initiation may serve as a “catheter-sparing” approach and allow delay of permanent access placement in selected elderly patients with CKD.

scholarly journals Orthogeriatrics in Italy: the Gruppo Italiano di Ortogeriatria (GIOG) audit on hip fractures in the elderly

2018 ◽  
Vol 4 (2) ◽  
Author(s):  
Amedeo Zurlo ◽  
Giuseppe Bellelli
Keyword(s):  
Hip Fracture ◽  
Observational Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Study Group ◽  
Web Based ◽  
Italian Study ◽  
Multicenter Observational Study ◽  
Functional Deficit ◽  
High Prevalence

The Gruppo Italiano di Ortogeriatria (GIOG) is an Italian study group promoted by three Italian Scientific Geriatric Societies with the aim of disseminating orthogeriatric methodology in Italy. In 2015 it has supported a multicenter web-based audit to collect data on functioning of Italian orthogeriatrics. The study, still ongoing, has enrolled until now 2577 cases of elderly patients undergoing surgery for hip fracture from 14 Italian orthogeriatric units. The population in question consists of markedly elderly and frail subjects, due to high prevalence of pre-existing functional deficit conditions, but it is also clinically complex; the most frequent fracture is intertrochanteric and the most performed surgery approach is intramedullary nail. This is the largest multicenter observational study conducted so far in Italy on elderly patients with hip fracture.

scholarly journals Cardiac Dysfunction in Critically Ill patients with COVID-19 – A Multicentre Observational Study

2021 ◽  
Author(s):  
Jacob Holmqvist ◽  
Josefine Beck-Friis ◽  
Carl Jensen ◽  
Keti Dalla ◽  
Simon Mårdstam ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Dysfunction ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Clinical Variable ◽  
Risk Of Death ◽  
Lv Dysfunction ◽  
Increased Risk

Abstract Introduction: The importance of cardiac dysfunction in critically ill patients with COVID-19 is not well studied. The aim of the study was to assess the incidence, clinical risk factors, and prognosis of cardiac dysfunction in critical illness caused by COVID-19, and to evaluate if cardiac biomarkers can detect this condition.Methods: This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 hours from admission to the ICU and again after four to seven days. Cardiac biomarkers and clinical data were collected at the time of echocardiography. Cardiac dysfunction was defined as either left ventricular (LV) dysfunction (having an ejection fraction < 50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (having a tricuspid annular plane systolic excursion (TAPSE) < 17mm or a moderate/severe RV dysfunction assessed visually).Results: We included 132 patients of whom 94 (71%) were included prospectively. The vast majority were intubated (n=127). At the time of admission to ICU, 35 (27%) patients had cardiac dysfunction and 7 patients (5%) had cardiac dysfunction detected later in the ICU-period. LV dysfunction was found in 18 patients and RV dysfunction in 17 patients, 7 patients had both RV and LV dysfunction. Noradrenaline > 0.20µg/kg/min was the only clinical variable associated with a higher risk of cardiac dysfunction. RV dysfunction was associated with an increased risk of death in a risk-adjusted model (OR 3.98, p = 0.013). Troponin and N-terminal pro b-type natriuretic peptide (NTproBNP) had moderate values in detecting cardiac dysfunction (AUC 0.729 and AUC 0.744, respectively). A combination of troponin < 1.44 times the upper reference limit and NTproBNP < 857ng/L had 85% probability of excluding cardiac dysfunction.Conclusions: Cardiac dysfunction is common in critically ill patients with COVID-19. Although not easily detected with clinical variables, cardiac biomarkers might be helpful. RV dysfunction is associated with an increased risk of death, these patients might benefit from further investigation or treatments. Trial registration: Registered on 24 Aug 2020 at Clinicaltrials.gov; registration number NCT04524234.

scholarly journals One-year mortality among elderly people after hospitalization due to fall-related fractures: comparison with a control group of matched elderly

2012 ◽  
Vol 28 (4) ◽  
pp. 801-805 ◽  
Author(s):  
Evandro Silva Freire Coutinho ◽  
Katia Vergetti Bloch ◽  
Claudia Medina Coeli
Keyword(s):  
Local Community ◽  
Public Health Problem ◽  
The Elderly ◽  
Control Group ◽  
Important Public Health Problem ◽  
Elderly Individuals ◽  
Risk Of Death ◽  
Increased Risk ◽  
One Year ◽  
The One

Fall-related fractures among the elderly represent an important public health problem. Severe fractures have been related to increased risk of death. In order to investigate the mortality profile of elderly individuals with severe fractures, 250 patients aged 60 years and over, hospitalized due to fall-related fractures and 250 elderly without fractures living in the local community were followed-up for one year. They were matched according to sex, age, time of hospitalization and neighborhood. Deaths were identified using probabilistic linkage of the research dataset and the local mortality registry. The one-year cumulative mortality was 25.2% in the case of individuals with severe fractures and 4% for those individuals without. The mortality distribution was not homogeneous across the follow-up period. Two-thirds of deaths among the elderly individuals hospitalized due to fracture occurred within the first 3 months, whereas mortality among those individuals without fractures took place later. Heart disease, pneumonia, GI bleeding, sepsis, and pulmonary embolism, diabetes and stroke were important causes of one-year mortality.

The Impact of Age upon Contingency Planning for Multiple-casualty Incidents Based on a Single Center’s Experience

2016 ◽  
Vol 31 (5) ◽  
pp. 492-497 ◽  
Author(s):  
Itamar Ashkenazi ◽  
Sharon Einav ◽  
Oded Olsha ◽  
Fernando Turegano-Fuentes ◽  
Michael M. Krausz ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Multiple Organ ◽  
Contingency Planning ◽  
Trauma Patients ◽  
Publication Type ◽  
Level Ii ◽  
Increased Risk ◽  
Multiple Casualty Incidents ◽  
The Impact

AbstractIntroductionTrauma patients in the extremes of age may require a specialized approach during a multiple-casualty incident (MCI).ProblemThe aim of this study was to examine the type of injuries encountered in children and elderly patients and the implications of these injuries for treatment and organization.MethodsA review of medical record files of patients admitted in MCIs in one Level II trauma center was conducted. Patients were classified according to age: children (≤12 years), adults (between 12-65 years), and elders (≥65 years).ResultsThe files of 534 were screened: 31 (5.8%) children and 54 (10.1%) elderly patients. One-third of the elderly patients were either moderately or severely injured, compared to only 6.5% of the children and 11.1% of the adults (P<.001). Elderly patients required more blood transfusions (P=.0001), more computed tomography imaging (P=.0001), and underwent more surgery (P=.0004). Elders were hospitalized longer (P=.0003). There was no mortality among injured children, compared to nine (2.0%) of the adults and seven (13.0%) of the elderly patients (P<.0001). All the adult deaths occurred early and directly related to their injuries, whereas most of the deaths among the elderly patients (four out of seven) occurred late and were due to complications and multiple organ failure.ConclusionsInjury at an older age confers an increased risk of complications and death in victims of MCIs.AshkenaziI, EinavS, OlshaO, Turegano-FuentesF, KrauszMM, AlficiR. The impact of age upon contingency planning for multiple-casualty incidents based on a single center’s experience. Prehosp Disaster Med. 2016;31(5):492–497.

scholarly journals Osteoporosis in the elderly

2020 ◽  
Vol 22 (3) ◽  
pp. 34-40
Author(s):  
Ekaterina N. Dudinskaya ◽  
Natalia V. Brailova ◽  
Veronika A. Kuznetsova ◽  
Olga N. Tkacheva
Keyword(s):  
The Elderly ◽  
Risk Of Death ◽  
Treatment And Prevention ◽  
Increased Risk ◽  
High Prevalence ◽  
Risk Of Falls ◽  
Prevention Of Osteoporosis ◽  
Therapeutic Measures ◽  
Principles Of Treatment ◽  
Characteristic Features

Osteoporosis in the elderly and senile can be compared with the epidemic of the 21st century due to the high prevalence and increased incidence among people who have survived the 50-year threshold, which make up the bulk of patients. Osteoporosis is associated with a significant increase in the risk of falls and fractures, leading to adynamia and an increased risk of death. Despite the insufficient knowledge of the pathogenesis of the disease, the available data have already allowed the development of preventive measures and treatment principles. Currently, there are preventive and therapeutic measures aimed at reducing the risk of falls, fractures and repeated fractures, however, earlier detection of the disease in old age is often difficult due to the characteristic features of geriatric patients. The polymorbidity, unexpressed clinical picture, the development of frailty syndrome, sarcopenia, social and mental maladaptation and an increase in the frequency of depression make the population of elderly and senile people vulnerable to an increased risk of osteoporosis, falls and fractures and associated hospitalizations and mortality. This review highlights the features of pathogenesis, clinical features, principles of treatment and prevention of osteoporosis in the older age group.

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