scholarly journals Is Laparoscopic Adrenalectomy for Pheochromocytoma a Safe and Effective Surgery in Geriatric Patients?

2021 ◽  
Author(s):  
Kadir Gunseren ◽  
Mehmet Çağatay Çiçek ◽  
Deniz Bolat ◽  
Sezgin Yeni ◽  
Hakan Vuruskan ◽  
...  
Keyword(s):  
Patient Population ◽  
Laparoscopic Adrenalectomy ◽  
Geriatric Patients ◽  
The Elderly ◽  
Postoperative Outcomes ◽  
World Health ◽  
Perioperative Outcomes ◽  
Histopathological Diagnosis ◽  
Single Side ◽  
Haemodynamic Changes

Objectives: In this study, we aimed to evaluate the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, it is the first study evaluating the haemodynamic outcomes of pure LA in this patient population. Methods: Between 2000-2020, data of 350 patients who underwent single-side transperitoneal LA were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were enrolled and classified into two groups according to their ages at the date of surgery. Older than 65 years were accepted as elderly according to the World Health Organisation recommendations. Results: Overall 54 patients underwent single side LA for PHEO. Fifteen patients were enrolled in the elderly group and 39 in the young group. There were no significant differences regarding the operation site (0.564) and tumour size (0.878). There were no statistically significant differences in terms of perioperative outcomes, such as mean anaesthesia and operation times, blood loss and haemodynamic changes. Regarding postoperative outcomes; there were no statistically significant differences in mean hospitalization and intensive care unit times. In 1 patient in each grade-1 (prolonged ileus, managed with medical treatment) and grade 2 complication (transfusion during surgery) observed in the elderly and young groups, respectively (p=0.498). Conclusion: Laparoscopic adrenalectomy in elderly patients with PHEO is as safe and effective as in younger patients. One of the most important conditions for achieving good perioperative and postoperative outcomes in the elderly patient population with this challenging surgery is the multidisciplinary approach.

scholarly journals Drug utilization study in geriatric patients visiting medicine OPD in tertiary care hospital

2021 ◽  
Vol 10 (4) ◽  
pp. 386
Author(s):  
Ujwala P. Gawali ◽  
Salman H. Rizvi ◽  
Prashant S. Mishra
Keyword(s):  
Drug Utilization ◽  
Geriatric Patients ◽  
Tertiary Care ◽  
The Elderly ◽  
Essential Medicines ◽  
World Health ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Drug Utilization Study ◽  
Cross Sectional

Background: Drug utilization study is of utmost importance in the elderly. The consumption of drug amongst elderly segment of society is maximum and many of them use at least three prescribed drugs, concurrently. One of the plausible explanation of usage of large number of medicines is prevalence of multi-morbidities as well as suffer from chronic and degenerative pathology amongst them along with the alteration of pharmacokinetics and pharmacodynamics of many drugs are altered with advanced age. Thus, the aim of this study was to assess current prescribing practices among physicians for geriatric patients in tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Medicine in a tertiary healthcare hospital. As per inclusion criteria, patients visiting Medicine outpatient department (OPD) from 01 October 2018 to 31 December 2018 were enrolled in the study.Results: The average number of drugs per encounter was 4.1. 100% of the drugs were prescribed by their generic name and those prescribed from World Health Organization (WHO) list of essential medicines were 70.2%. Analysis of polypharmacy showed maximum 11 and minimum 1 drug was prescribed. Overall analysis of the drugs showed, the most common route of administration was orally. Drugs acting on cardiovascular system (CVS), gastrointestinal system (GI) system, analgesics and anti-inflammatory drugs and vitamins and mineral supplements constitute the major bulk of drug prescribed.Conclusions: In our study, though polypharmacy was found but it was necessary unavoidable, but was within the WHO standards of 1.6 to 4.8. Drugs acting on CVS and GI system were the most common drugs prescribed. Prescriptions with injections and steroids were less in the study population. All the drugs were prescribed by their generic name and most were present in the essential list of medicines.

Assessment of the Therapeutic Effect of Physiotherapy on Minimizing Imbalances of Geriatric Patients

2020 ◽  
Vol 62 (2) ◽  
pp. 86-91
Author(s):  
Justyna Pawlak ◽  
Małgorzata Dudkiewicz ◽  
Łukasz Kikowski
Keyword(s):  
Quality Of Life ◽  
Therapeutic Effect ◽  
Body Mass ◽  
Geriatric Patients ◽  
The Elderly ◽  
Risk Of Falling ◽  
Increased Risk ◽  
Climbing Stairs ◽  
Tinetti Test

Introduction: The progressing aging process and comorbidities worsen the efficiency of the balance system in the elderly, which leads to a weakening of stability and, as a consequence, to falls and injuries. The first ones lead to: worsening of functioning, reduced mobility, an increased risk of disease and mortality, therefore systematic physical activity and shaping the balance using physiotherapy, which can prevent dangerous falls is very important. Aim: Assessment of the therapeutic effect of physiotherapy on minimizing imbalances in geriatric patients. M aterial and Methods: The study group consisted of 46 people, including 32 women (69.6%) and 14 men (30.4%); average age of respondents – 72.5 years. They were patients of the Department of Rehabilitation of Poddębice Health Center, Ltd. The researchers used a self-made questionnaire, body mass to height index (BMI) and the Tinetti Test. Results: Patients with an elevated BMI (89.1%), as well as those taking more than 4 medication (78.3%), have had more falls over the past year (respectively 91.4% and 81.4%). After the use of comprehensive therapy, none of the patients achieved a worse result than before the physiotherapy while 91.3% of the respondents had an increase in the number of points scored in the Tinetti Test. The percentage of patients at high risk of falling reduced from 67.4% to 37%. There was also a decrease in the fear of walking (in 58.7%), falling (in 57.7%) and climbing stairs (in 47.9%). According to 78.3% of respondents, physiotherapy positively affected their independence and quality of life. Conclusions: The use of comprehensive physiotherapy reduces the fear of walking, climbing stairs and falling, which can be a good predictor of prevention. Both polypragmasia and an elevated body mass index (BMI) increase the risk of falling. Comprehensive physiotherapy of geriatric patients helps to improve balance and gait stereotype. Physiotherapy for the elderly helps improve the quality of life, independence, minimize imbalances, and thus reduce the risk of falls. Balance exercises play an important role in preventing falls.

A new medical Internet system in healthcare: innovation of Telegeriatrics and healthcare demands of older patients of different age groups (Preprint)

2020 ◽  
Author(s):  
Yu Gong ◽  
Jianyuan Zhou
Keyword(s):  
Cardiovascular Diseases ◽  
General Practitioners ◽  
Older Patients ◽  
Metabolic Diseases ◽  
Treatment Plan ◽  
Age Groups ◽  
The Elderly ◽  
Diagnosis And Treatment ◽  
World Health ◽  
New Model

BACKGROUND Healthcare for older patients is a worldwide challenge for public health system. A new medical Internet system in healthcare which is a new model of telegeriatrics system has been established. The key innovation is the new telegeriatrics system was conducted jointly by general practitioners in the Community Health Service Center and specialists in university teaching hospital. Unlike the typical telemedicine that has been practiced in other countries, the new model provides a solution for the key issues in telemedicine where a doctor is unable to conduct a direct physical examination and the associated potential diagnostic error. OBJECTIVE This study is to introduce the operation mechanism of the new Telegeriatrics system and analyze healthcare demands of older patients in different age groups applying the new Telegeriatrics system. METHODS 472 older patients (aged≥60) were enrolled and divided into the young older group (aged 60 to 74), the old older group (aged 75 to 89) and the very old group (aged≥90) according to the age stratification of World Health Organization. Proportion of the top 10 diseases of older patients of different age groups was analyzed. RESULTS The process of older patients’ diagnosis and treatment made by specialist and general practitioners formed a closed loop. It ensures the timeliness and effectiveness of diagnosis and treatment of older patients. The treatment effect can be observed by general practitioners and specialist can adjust the treatment plan in time. In this study, it was found that older patients in different age groups have different healthcare demands. Coronary heart disease and type 2 diabetes mellitus were found to be the main diseases of the older patients and the young older patients as well as the old older patients applying Telegeriatrics. CONCLUSIONS The new telegeriatrics system can provide convenient and efficient healthcare services for older patients and overcome the disadvantage of currently used models of telegeriatrics. Older patients in different age groups have different medical care demands. Cardiovascular diseases and metabolic diseases have become the main diseases of the elderly applying the new Telegeriatrics system. Healthcare policy makers should invest more medical resources to the prevention of cardiovascular diseases and metabolic diseases in the elderly.

Identification of determinants of healthy ageing in Italy: results from the national survey IDAGIT

2020 ◽  
pp. 1-21
Author(s):  
Erika Guastafierro ◽  
Ilaria Rocco ◽  
Rui Quintas ◽  
Barbara Corso ◽  
Nadia Minicuci ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Public Health Problem ◽  
The Elderly ◽  
Factor Loading ◽  
Healthy Ageing ◽  
World Health ◽  
Italian Population ◽  
Social Environments ◽  
Ageing Model ◽  
Health Organization

Abstract Healthy ageing is a public health problem globally. In Europe, the dependency ratio of the elderly is expected to increase by 21.6 per cent to 51.2 per cent in 2070. The World Health Organization (WHO) study on healthy ageing started in 2002 as a concept whereby all people of all ages should be able to live in a healthy, safe and socially inclusive way. The aim of this study is to present preliminary results of the project Identification of Determinants of Healthy Ageing in Italy (IDAGIT) that aimed to collect data on the active and healthy ageing of the Italian population aged over 18 using the conceptual framework of the WHO's ageing model. To link the determinants of the IDAGIT studies to those of the WHO model, we performed a confirmatory factor analysis which reported these variables as significant (in order of factor loading): smoking, cognition score, comorbidity, outdoor built environment, participation, working expertise and income. Considering comorbidity, 83.8 per cent of the sample declared not having any chronic diseases or to have only one, and regarding neurological diseases, only nine people had received a diagnosis of stroke. Regarding gender, the personal determinants and physical and social environments did not result in statistically significant differences, whereas we found statistical differences between the aged groups in all variables analysed. These results provide a first bio-psycho-social perspective on ageing in the Italian population.

scholarly journals Decreasing Emergency Room Utilization in High Risk Geriatric Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 135-135
Author(s):  
Shamsi Fani ◽  
Lizette Munoz ◽  
Susana Lavayen ◽  
Blair McKenzie ◽  
Audrey Chun ◽  
...  
Keyword(s):  
New York ◽  
High Risk ◽  
Emergency Room ◽  
Geriatric Patients ◽  
Social Issues ◽  
The Elderly ◽  
Mount Sinai Hospital ◽  
Status Change ◽  
Community Paramedicine ◽  
Ed Visits

Abstract Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.

Propofol Versus Midazolam/Fentanyl Sedation for Colonoscopy in the Elderly Patient Population

2017 ◽  
Vol 32 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Pamela Lovett ◽  
Victoria Gómez ◽  
David O. Hodge ◽  
Beth Ladlie
Keyword(s):  
Elderly Patient ◽  
Patient Population ◽  
The Elderly

scholarly journals Implicações do uso do Aparelho de Amplificação Sonora Individual na qualidade de vida de idosos

CoDAS ◽  
2017 ◽  
Vol 29 (5) ◽  
Author(s):  
Camila Zorzetto Carniel ◽  
Juliana Cristina Ferreira de Sousa ◽  
Carla Dias da Silva ◽  
Carla Aparecida de Urzedo Fortunato-Queiroz ◽  
Miguel Ângelo Hyppolito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
World Health Organization ◽  
The Elderly ◽  
World Health ◽  
World Health Organization Quality ◽  
Hearing Handicap ◽  
Organization Quality ◽  
Health Organization ◽  
Post Hoc

RESUMO Objetivo Avaliar, por meio de questionários padronizados, a qualidade de vida de idosos com deficiência auditiva diagnosticada que utilizam ou não a prótese auditiva (AASI) e de idosos sem queixa auditiva. Método Trata-se de um estudo transversal, com amostra não probabilística, distribuída em três grupos divididos da seguinte forma: 30 idosos com perda auditiva diagnosticada e com indicação para uso do aparelho de amplificação sonora individual (AASI), mas que ainda não faziam uso da prótese; 30 idosos com deficiência auditiva que usavam o AASI; e 30 idosos sem queixa auditiva. Os participantes completaram um questionário que investigava dados sociodemográficos e familiares, o Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) e o World Health Organization Quality of Life - versão breve (WHOQOL-Breve). Além das análises descritivas dos dados, foram realizados testes para comparação dos três grupos, aplicando-se a análise de variância (ANOVA) e o teste post hoc de Bonferroni. Resultados Os três grupos se diferenciaram significativamente em todos os domínios de qualidade de vida. O grupo de idosos com perda auditiva diagnosticada e com indicação para uso do AASI apresentou menores escores que o grupo de idosos com deficiência auditiva que usavam o AASI e que o grupo de referência. O grupo com AASI apresentou os melhores resultados de qualidade de vida. Conclusão A perda auditiva afeta a qualidade de vida do idoso. O uso efetivo da prótese auditiva é benéfico a esta população, melhorando suas condições de vida e saúde.

Perioperative Outcomes of Percutaneous Nephrolithotomy in Septuagenarians and Beyond

2021 ◽  
Vol 104 (9) ◽  
pp. 1497-1502
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Renal Calculus ◽  
Perioperative Outcomes ◽  
Kidney Calculi ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Background: Life expectancy has continuously risen worldwide. Because the elderly may tolerate complications poorly, the risks and benefits of percutaneous nephrolithotomy (PCNL) in those patients should be discussed thoroughly. Objective: To analyze utility and operative outcomes of PCNL with respect to age. Materials and Methods: A retrospective study of PCNL was performed at Ramathibodi Hospital between 2011 and 2020. The patients were divided into two age groups, 1) below 70 years old and 2) 70 years old and above. Comparison of demographics, operative data, and postoperative outcomes were analyzed. Results: Of the 253 patients, the overall stone-free rate (SFR) was 59.7%. The SFR in younger groups and older groups were 59.4% (126/212) and 61.0% (25/41), respectively, which was not significantly different (p=0.999). There was a similar in-stone burden between the two groups (p=0.573). Patients in the older group had worse renal function, higher American Society of Anesthesiologists score, and more comorbidities, including hypertension and ischemic heart disease. However, estimated blood loss, length of hospital stay, operative time, percent change in eGFR, and complications were comparable between the groups. Conclusion: PCNL is a safe and effective treatment of kidney calculi in septuagenarians and older patients, even with the risk of higher comorbidities and poorer renal function than in younger patients. Keywords: Percutaneous nephrolithotomy; Renal calculus; Stone-free status; Septuagenarians

Elder Abuse

2021 ◽  
Keyword(s):  
Criminal Justice ◽  
Older People ◽  
Elder Abuse ◽  
Evolutionary Process ◽  
The Elderly ◽  
World Health ◽  
Private Space ◽  
Positive Treatment ◽  
Justice Model ◽  
Health Organization

Criminological concerns with the victimization of the elderly has developed parallel to, and independently of, the elder abuse debate. Criminologists have traditionally been concerned with the commission of acts against the older person in public as opposed to private space. A further hindrance to criminological enquiry is the practice of defining elder abuse in terms of victim needs, rather than of basic human rights. There has been no neat evolutionary process from positive treatment of the elderly, attributed to some golden age in the past to their increasing present victimization rates globally. Elder victimization is a long way from the simplistic notions of “granny battering.” There is general agreement among scholars that older people regularly suffer victimization in private space—in the household and in care institutions. They regularly experience multiple forms of abuse. One can attribute some of these experiences to major social changes as declining family support for older people diminishes and the proportion of young to old decreases. The World Health Organization (WHO) states that as the global population ages, the number of people aged sixty years and older is estimated to reach 1.2 billion worldwide by 2025. More pointedly, the longevity is also inextricably linked to the maltreatment of the global old. In particular, we have seen offenders apprehended in transgressions against the young, women, and ethnic minorities but have yet to see an active criminal justice response concerned with the experience of elder victimization. The discipline’s reluctance to recognize elder victimization is associated with it commonly being labeled as victimization by intimates, and to be understood through the lenses of psychology and psychiatry rather than through a criminal justice model. Care and individual needs of the elderly have been the traditional focus, rather than social justice, reason, and rights. Justice and rights involve choice and free will. Older people are not simply passive recipients of other people’s actions—they resist their victimization and often fight back. This article is a critical exposition of the sources available on elders abused as part of a larger account of the experience of older people worldwide. In particular, the reader is reminded that this article is limited due to publishing word constraints. Therefore, it provides a balanced, limited overview of the major literature and research available in the Western context. More pointedly, the literature cited here is intended to reflect on recent scholarship considered to have the potential of adding to the debate in criminology and elder victimization. Given that the study of elder abuse is still in its infancy in the discipline of criminology, this article is therefore necessarily interdisciplinary.

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