scholarly journals Nutrition status and functional prognosis among elderly patients with distal radius fracture: a retrospective cohort study

2020 ◽  
Author(s):  
takako nagai ◽  
Koji Tanimoto ◽  
Yoshiaki Tomizuka ◽  
Hiroshi Uei ◽  
Masahiro Nagaoka
Keyword(s):  
Regression Analysis ◽  
Confidence Interval ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Distal Radius ◽  
The Elderly ◽  
Nutrition Status ◽  
Mineral Density ◽  
Poor Prognostic Factor ◽  
Nutritional Risk Index

Abstract Background Distal radius fractures (DRF) are common in the elderly and are typical of hand fractures during falls. Malnutrition has also been identified as a poor prognostic factor in elderly patients with fractures. However, the relationship between nutritional status and subsequent falls and functional prognosis in the elderly DRF is not clear. The aim of the present study was to investigate the association between nutritional status and functional prognosis in patients with elderly DRF. Methods Study participants included 229 outpatients who required surgical treatment with DRF. The patients’ clinical information, including age, sex, body mass index, bone mineral density, Geriatric Nutritional Risk Index (GNRI), total number of drugs being treated with on admission, use of drugs for osteoporosis, comorbidity severity, Barthel Index(BI), presence of subsequent falls, fracture type, postoperative follow-up period, and Mayo wrist score was reviewed. The subjects were further divided into two groups according to their GNRI: the malnutrition group and the normal group. Propensity score matching was used to confirm the factor affecting BI and subsequent fall. Results Thirty-one patients (13.5%) were malnutrition before surgery for DRF. According to the multiple liner regression analysis, GNRI positively affected BI efficiency (β=0.392, 95% confidence interval, 0.001 to 0.351, p=0.039). Furthermore, on logistic regression analysis, subsequent fall was correlated with the serum albumin (odds ratio=0.033, 95% confidence interval,0.002 to 0.477, p=0.012). Conclusion Malnutrition impaired the improvement of the activity of daily living (ADL) and increased the incidence of subsequent fall. Improvement of nutritional status before DRF surgery may further improve ADL and prevent falls.

scholarly journals Nutrition status and functional prognosis among elderly patients with distal radius fracture: a retrospective cohort study

2020 ◽  
Author(s):  
Takako Nagai ◽  
Koji Tanimoto ◽  
Yoshiaki Tomizuka ◽  
Hiroshi Uei ◽  
Masahiro Nagaoka
Keyword(s):  
Regression Analysis ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Distal Radius ◽  
Risk Index ◽  
The Elderly ◽  
Nutrition Status ◽  
Mineral Density ◽  
Poor Prognostic Factor ◽  
Nutritional Risk Index

Abstract Background: Distal radius fractures (DRF) are common in the elderly and are typically caused falls. Malnutrition has also been identified as a poor prognostic factor in elderly patients with fractures. However, the relationship between nutritional status and subsequent falls and functional prognosis for DRF in the elderly is not clear. The aim of the present study was to investigate the association between nutritional status and functional prognosis in elderly patients with DRF. Methods: Study participants included 229 outpatients who required surgical treatment for DRF. The patients’ clinical information, including age, sex, body mass index, bone mineral density, Geriatric Nutritional Risk Index (GNRI), total number of drugs being treated with on admission, use of drugs for osteoporosis, comorbidity severity, the Barthel Index (BI), presence of subsequent falls, fracture type, postoperative follow-up period, and Mayo wrist score was reviewed. Subjects were further divided into two groups according to their GNRI: the malnutrition group and the normal group. Propensity score matching was used to confirm factors affecting the BI and subsequent falls. Results: Thirty-one patients (13.5%) presented with malnutrition before surgery for DRF. According to multiple liner regression analysis, the GNRI positively affected the efficiency of the BI (β = 0.392, 95% confidence interval [CI], 0.001 to 0.351, p = 0.039). Furthermore, on logistic regression analysis, subsequent falls were associated with serum albumin levels (odds ratio = 0.033, 95% CI, 0.002 to 0.477, p = 0.012). Conclusion: Malnutrition impaired improvement of activities of daily living (ADL) and increased the incidence of subsequent falls. Improvement of nutritional status before DRF surgery may further improve ADL and prevent falls.

scholarly journals Nutrition status and functional prognosis among elderly patients with distal radius fracture: a retrospective cohort study

2020 ◽  
Author(s):  
Takako Nagai ◽  
Koji Tanimoto ◽  
Yoshiaki Tomizuka ◽  
Hiroshi Uei ◽  
Masahiro Nagaoka
Keyword(s):  
Regression Analysis ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Distal Radius ◽  
Risk Index ◽  
The Elderly ◽  
Nutrition Status ◽  
Mineral Density ◽  
Poor Prognostic Factor ◽  
Nutritional Risk Index

Abstract Background : Distal radius fractures (DRF) are common in the elderly and are typical of hand fractures during falls. Malnutrition has also been identified as a poor prognostic factor in elderly patients with fractures. However, the relationship between nutritional status and subsequent falls and functional prognosis for DRF in the elderly is not clear. The aim of the present study was to investigate the association between nutritional status and functional prognosis in elderly patients with DRF. Methods : Study participants included 229 outpatients who required surgical treatment for DRF. The patients’ clinical information, including age, sex, body mass index, bone mineral density, Geriatric Nutritional Risk Index (GNRI), total number of drugs being treated with on admission, use of drugs for osteoporosis, comorbidity severity, the Barthel Index (BI), presence of subsequent falls, fracture type, postoperative follow-up period, and Mayo wrist score was reviewed. Subjects were further divided into two groups according to their GNRI: the malnutrition group and the normal group. Propensity score matching was used to confirm factors affecting the BI and subsequent falls. Results: Thirty-one patients (13.5%) presented with malnutrition before surgery for DRF. According to multiple liner regression analysis, the GNRI positively affected the efficiency of the BI (β = 0.392, 95% confidence interval [CI], 0.001 to 0.351, p = 0.039). Furthermore, on logistic regression analysis, subsequent falls were associated with serum albumin levels (odds ratio = 0.033, 95% CI, 0.002 to 0.477, p = 0.012). Conclusion : Malnutrition impaired improvement of activities of daily living (ADL) and increased the incidence of subsequent falls. Improvement of nutritional status before DRF surgery may further improve ADL and prevent falls.

scholarly journals Association among Geriatric Nutrition Risk Index and functional prognosis in elderly patients with osteoporotic vertebral compression fractures: a retrospective cohort study

2020 ◽  
Author(s):  
Takako Nagai ◽  
Hiroshi Uei ◽  
Kazuyoshi Nakanishi
Keyword(s):  
Regression Analysis ◽  
Nutritional Status ◽  
Risk Index ◽  
Linear Regression Analysis ◽  
Compression Fracture ◽  
The Elderly ◽  
Vertebral Compression Fractures ◽  
Mineral Density ◽  
Nutritional Risk Index ◽  
The Relationship

Abstract Background Osteoporotic vertebral compression fracture (OVCF) is one of the most common fractures in the elderly and the number is increasing. In addition, nutritional status is associated with functional prognosis in the elderly. However, there are limited reports on the relationship between nutritional status and functional prognosis in OVCF. Furthermore, there are no reports that have examined the relationship between OVCF nutritional status and functional prognosis using geriatric nutritional risk index (GNRI) for nutritional assessment. The aim of this study was to investigate the association between nutritional status, activities of daily living (ADL), and fall after fracture in patients with OVCF. Methods The clinical information of 187 conservatively treated OVCF patients was retrospectively examined. This information included: age, sex, body mass index, total number of drugs used for treatment at admission, bone mineral density, use of drugs for osteoporosis, fracture type, comorbidity severity, nutritional status, Barthel Index (BI), and fall after OVCF. Subjects were divided into two groups according to their GNRI. Propensity score matching was used to confirm factors affecting BI and falls after OVCF. Results Sixty-eight patients (36.4%) presented with malnutrition at fracture. According to multiple linear regression analysis, GNRI positively affected BI gain (β = 0.283, 95% confidence interval [CI], -122.2 to -0.706, p = 0.001). Furthermore, on logistic regression analysis, fall after OVCF was associated with GNRI (odds ratio = 0.896, 95% CI, 0.832 to 0.964, p = 0.003). Conclusions Malnutrition in elderly OVCF patients decreases the acquisition of ADL and increases fall risk. Improvement of nutritional status during OVCF treatment may lead to improvement of ADL and prevention of falls.

scholarly journals Effects of 3-year GH replacement therapy on bone mineral density in younger and elderly adults with adult-onset GH deficiency

2012 ◽  
Vol 166 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Mariam Elbornsson ◽  
Galina Götherström ◽  
Celina Franco ◽  
Bengt-Åke Bengtsson ◽  
Gudmundur Johannsson ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Elderly Patients ◽  
Bone Mineral ◽  
The Elderly ◽  
Marginal Effect ◽  
Adult Onset ◽  
Mineral Density ◽  
Gh Replacement ◽  
Femur Neck

ObjectiveLittle is known of the effects of long-term GH replacement on bone mineral content (BMC) and bone mineral density (BMD) in elderly GH-deficient (GHD) adults.Design/patients/methodsIn this prospective, single-center, open-label study, the effects of 3-year GH replacement were determined in 45 GHD patients >65 years and in 45 younger control GHD patients with a mean age of 39.5 (s.e.m.1.1) years. All patients had adult-onset disease and both groups were comparable in terms of number of anterior pituitary hormonal deficiencies, gender, body mass index, and waist:hip ratio.ResultsThe mean maintenance dose of GH was 0.24 (0.02) mg/day in the elderly patients and 0.33 (0.02) mg/day in the younger GHD patients (P<0.01). The 3 years of GH replacement induced a marginal effect on total body BMC and BMD, whereas femur neck and lumbar (L2–L4) spine BMC and BMD increased in both the elderly and the younger patients. The treatment response in femur neck BMC was less marked in the elderly patients (P<0.05 vs younger group). However, this difference disappeared after correction for the lower dose of GH in the elderly patients using an analysis of covariance. There were no between-group differences in responsiveness in BMC or BMD at other skeletal locations.ConclusionsThis study shows that GH replacement increases lumbar (L2–L4) spine and femur neck BMD and BMC in younger as well as elderly GHD patients. This supports the notion that long-term GH replacement is also useful in elderly GHD patients.

scholarly journals A novel nutritional index “simplified CONUT” and the disease risk index independently stratify prognosis of elderly patients with acute myeloid leukemia

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hajime Senjo ◽  
Masahiro Onozawa ◽  
Daisuke Hidaka ◽  
Shota Yokoyama ◽  
Satoshi Yamamoto ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Nutritional Status ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
The Elderly ◽  
Genetic Alterations ◽  
Newly Diagnosed ◽  
Hematopoietic Stem ◽  
Acute Myeloid

Abstract Elderly patients aged 65 or older with acute myeloid leukemia (AML) have poor prognosis. The risk stratification based on genetic alteration has been proposed in national comprehensive cancer network (NCCN) guideline but its efficacy was not well verified especially in real world elderly patients. The nutritional status assessment using controlling nutritional status (CONUT) score is a prognostic biomarker in elderly patients with solid tumors but was not examined in elderly AML patients. We performed prospective analysis of genetic alterations of 174 patients aged 65 or older with newly diagnosed AML treated without hematopoietic stem cell transplantation (HSCT) and developed simplified CONUT (sCONUT) score by eliminating total lymphocyte count from the items to adapt AML patients. In this cohort, both the NCCN 2017 risk group and sCONUT score successfully stratified the overall survival (OS) of the elderly patients. A multivariable analysis demonstrated that adverse group in NCCN 2017 and high sCONUT score were independently associated with poor 2-year OS. Both risk stratification based on NCCN 2017 and sCONUT score predict prognosis in the elderly patients with newly diagnosed AML.

Outcomes of Vestibular Schwannoma Surgery among the Elderly: Analysis of the National Inpatient Sample

2016 ◽  
Vol 156 (1) ◽  
pp. 166-172 ◽  
Author(s):  
Michael J. Sylvester ◽  
Darshan N. Shastri ◽  
Viral M. Patel ◽  
Milap D. Raikundalia ◽  
Jean Anderson Eloy ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Vestibular Schwannoma ◽  
Academic Medical Center ◽  
Postoperative Bleeding ◽  
The Elderly ◽  
Hospital Charges ◽  
National Inpatient Sample ◽  
Elderly Cohort

Objective To compare comorbidities and in-hospital complications between elderly and nonelderly patients undergoing vestibular schwannoma (VS) surgery. To examine average length of stay (LOS) and hospital charges among elderly patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Retrospective analysis of the National Inpatient Sample for patients undergoing VS surgery from 2002 to 2010: 4137 patients met inclusion criteria, with 519 (12.5%) in the elderly cohort (≥65 years). Outcomes of elderly and nonelderly (<65 years) patient cohorts were compared. Results Compared with the nonelderly cohort, the elderly cohort had more comorbidities, including diabetes mellitus, hypertension, and pulmonary disease (all P < .001). Elderly patients had longer LOS (6.5 vs 5.4 days; P = .001) but did not incur significantly greater hospital charges. Rates of cerebrospinal fluid leak, meningitis, and facial nerve injury did not vary significantly between groups. The elderly cohort experienced higher rates of in-hospital complications, including acute cardiac events, iatrogenic cerebrovascular infarction/hemorrhage, postoperative bleeding (hemorrhage/hematoma), and in-hospital mortality (all P < .05). In binary logistic regression, correcting for patient demographics and presence of comorbidities, elderly status was associated with 1.848 (95% confidence interval, 1.167-2.927; P = .009) greater odds of medical complications and 13.188 (95% confidence interval, 1.829-95.113; P = .011) greater odds of in-hospital mortality. Conclusion Elderly patients undergoing VS surgery have more comorbidities, in-hospital complications, and longer LOS than nonelderly patients. The elderly cohort had a greater rate of in-hospital mortality, though rare. Interestingly, elderly patients did not have a higher rate of many known complications associated with VS surgery and did not incur more hospital charges.

scholarly journals Baseline Characteristics and Effects of Growth Hormone Therapy over Two Years in Younger and Elderly Adults with Adult Onset GH Deficiency

2006 ◽  
Vol 91 (11) ◽  
pp. 4408-4414 ◽  
Author(s):  
Celina Franco ◽  
Gudmundur Johannsson ◽  
Bengt-Åke Bengtsson ◽  
Johan Svensson
Keyword(s):  
Elderly Patients ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
The Elderly ◽  
Adult Onset ◽  
Mineral Density ◽  
Open Label ◽  
Gh Replacement ◽  
Waist Hip Ratio ◽  
Baseline Characteristics

Abstract Context: The effects of GH replacement in elderly GH-deficient (GHD) adults are not well known. Objective/Design/Patients: In this prospective, single-center, open-label study, baseline characteristics and the effects of 2-yr GH replacement were determined in 24 GHD adults above 65 yr of age and in 24 younger GHD patients (mean age, 37 yr; range, 27–46 yr). All patients had adult onset disease, and both groups were comparable in terms of the number of pituitary hormonal deficiencies, gender, body mass index, and waist/hip ratio. Duration of hypopituitarism was, however, longer in the elderly patients. Results: The mean maintenance dose of GH was 0.31 (sem, 0.03) mg/d in the elderly GHD patients and 0.44 (0.04) mg/d in the younger patients. The less marked response in IGF-I sd score, total body fat, and extracellular water in the elderly patients lost significance when the dose of GH was accounted for in the statistical analyses. Despite the lower dose in the elderly GHD group, these patients had a more marked reduction in waist/hip ratio and serum low-density lipoprotein-cholesterol level, and these differences remained also after correction for duration of hypopituitarism. There was no difference at baseline or in responsiveness in lean mass, bone mineral density, and glucose homeostasis. Conclusions: This study identifies elderly GHD adults as a GH-sensitive group in whom a low dose of GH can improve body composition and serum lipid profile without any significant impairment of glucose metabolism. GH replacement should therefore be considered in elderly GHD adults.

scholarly journals Safety and Eficacy of Low Dose- Bortezomib Plus Melphalan/Prednisone (velcadito protocol) in Elderly Patintes Not Eligible to Transplant in Newly Dignosed Multiple Myeloma. Restrospective Study of 26 Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5710-5710
Author(s):  
Breno Moreno Gusmão ◽  
Danielle Isadora Blumenschein ◽  
Ernesto Perez Persona ◽  
Jose Maria Guinea De Castro ◽  
Iracema Esteves Lopes ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Elderly Patients ◽  
Low Dose ◽  
Conflicts Of Interest ◽  
Pharmacoeconomic Analysis ◽  
Albert Einstein ◽  
The Elderly ◽  
High Rate ◽  
Grade 3 ◽  
The Impact

Abstract Introduction: Protocols based on bortezomib have become the standard therapy in the elderly and not eligible for transplantation. The VISTA study showed OR 71%, CR 30%, regardless of adverse factors such as age, renal failure or cytogenetic changes, but the patient had a high rate neuropathy (44%). The Spanish group and the Italian group modified the dose of bortezomib achieving rates of CR 22% and 20%, reducing neurotoxicity 8% and 5% respectively. We present the experience of 26 newly diagnosed patients treated with low-dose bortezomib associdados the melphalan / prednisone (Velcadito protocol). Objective: The aim of this study is to assess the effectiveness and safety of low-dose bortezomib in elderly patients not eligible to transplant. We evaluated according to the criteria IMWG. Results: We evaluated 26 patients treated at the Hospital Universitario de Alava (Spain) and Hospital Israelita Albert Einstein (Brazil) among 2004 to 2016. The patients received 1 cycle with bortezomib 1.3mg/m2 (days 1,4,8,11) associated with melphalan 9 mg/m2 (1- 4 days) and prednisone 60mg/m2 (1- 4 days) 28 days cycle. From the 2nd cycle the patient received low doses of bortezomib (1 mg / m2, days 1 and 4) no change in other drugs and treatment regimen. The mean age was 78 years. 50% men/ 50% women. 2 patients had poor cytogenetics Pronóstico, 1 intermediate and 23 standard. According to the IMWG: ISS1 = 7 (26%) ISS 2 = 10 (38.5%), ISS3 = 6 (23%). 38,4% (n=10) of patientes had neuropathy but only 11,5%(n=3) grade 3-4. 61,5% (n=16) presented as neutropenia toxicity, 19,2% (n=5) with grade 3 (neutrophils <1000). 15,3% (n=4) had thrombocytopenia with grade greater than 3. Response rate was 100%, and if we consider at least PR was 92% (CR 38.5% VGPR 31%). The global survival had median of 80 months (95% confidence interval 57,8 - 102,1%) and the survival free of progression had median of 37 months (95% confidence interval 15 - 58,9%) with follow-up of 91 months. Conclusion: The use of velcadito protocol is safe, very effective and seems to be a good option for elderly patients with newly diagnose MM. A pharmacoeconomic analysis is recommended to assess the impact of the cost of treatment. Being a prospective clinical trial where an analysis of this impact of all patients treated with subcutaneous bortezomib beyond the characteristics of this study. Disclosures No relevant conflicts of interest to declare.

scholarly journals 315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Pasquale Campana ◽  
Maddalena Conte ◽  
Maria Emiliana Palaia ◽  
Laura Petraglia ◽  
Adele Ferro ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Frailty Index ◽  
The Elderly ◽  
Risk Scores ◽  
Surgical Risk ◽  
The Impact

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age &gt; 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.

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