Influential Factors of Successful Hepatitis C Treatment in Elderly Patients

Background: Chronic Hepatitis C virus (HCV) is an infection associated with an increased risk of cirrhosis, hepatocellular carcinoma (HCC), and morbidity and mortality. Treating HCV poses challenges in the elderly population due to the lack of evidence and complexity of patients. Objective: This study aims to evaluate factors that influence HCV treatment success in elderly patients, especially those over age of 70, such as pill burden and comorbidities, in addition to drug interactions and adverse effects. Methods: This was a retrospective chart review of patients treated at our urban academic institution from 2014-2016. Results: Sixty-two patients over the age of 70 were included in this study. The sustained virologic response rate 12 weeks after the completion of treatment (SVR12) was 79%. In a multi-variate analysis, cirrhosis, age closer to 70, and longer duration of treatment were statistically significantly more likely to lead to treatment failure. Though not statistically significant, other factors that may negatively influence achievement of SVR12 were cognitive impairment, cardiovascular disease, multi-tablet HCV regimen, time to initiation of HCV treatment > 90 days, and prior treatment experience. Pill burden of other prescribed medications did not impact SVR12. Adverse events and drug interactions were common in the population. Conclusions: Overall SVR12 rate in the elderly population was lower than that reported in the literature. Factors associated with lower treatment success, especially cirrhosis, should be considered when treating an elderly population. Further data is needed on the impact of other factors on SVR12 attainment in an elderly patient population. Article Type: Original Research

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

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20311 ◽

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.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191677 ◽

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.

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

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000613 ◽

2016 ◽

Vol 31 (5) ◽

pp. 492-497 ◽

Cited By ~ 2

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.

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Post-infection cognitive impairments in a cohort of elderly patients with COVID-19

Molecular Neurodegeneration ◽

10.1186/s13024-021-00469-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yu-Hui Liu ◽

Ye-Ran Wang ◽

Qing-Hua Wang ◽

Yang Chen ◽

Xian Chen ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Elderly Patients ◽

Cognitive Decline ◽

Post Infection ◽

Elderly Population ◽

The Elderly ◽

Cognitive Status ◽

Increased Risk

Abstract Background Understanding the long-term effects of coronavirus disease 2019 (COVID-19) on cognitive function is essential for monitoring the cognitive decline in the elderly population. This study aims to assess the current cognitive status and the longitudinal cognitive decline in elderly patients recovered from COVID-19. Methods This cross-sectional study recruited 1539 COVID-19 inpatients aged over 60 years who were discharged from three COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. In total, 466 uninfected spouses of COVID-19 patients were selected as controls. The current cognitive status was assessed using a Chinese version of the Telephone Interview of Cognitive Status-40 (TICS-40) and the longitudinal cognitive decline was assessed using an Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Cognitive assessments were performed 6 months after patient discharge. Results Compared with controls, COVID-19 patients had lower TICS-40 scores and higher IQCODE scores [TICS-40 median (IQR): 29 (25 to 32) vs. 30 (26 to 33), p < 0.001; IQCODE median (IQR): 3.19 (3.00 to 3.63) vs. 3.06 (3.00 to 3.38), p < 0.001]. Severe COVID-19 patients had lower TICS-40 scores and higher IQCODE scores than non-severe COVID-19 patients [TICS-40 median (IQR): 24 (18 to 28) vs. 30 (26 to 33), p < 0.001; IQCODE median (IQR): 3.63 (3.13 to 4.31) vs. 3.13 (3.00 to 3.56), p < 0.001] and controls [TICS-40 median (IQR): 24 (18 to 28) vs. 30 (26 to 33), p < 0.001; IQCODE median (IQR) 3.63 (3.13 to 4.31) vs. 3.06 (3.00 to 3.38), p < 0.001]. Severe COVID-19 patients had a higher proportion of cases with current cognitive impairment and longitudinal cognitive decline than non-severe COVID-19 patients [dementia: 25 (10.50 %) vs. 9 (0.69 %), p < 0.001; Mild cognitive impairment (MCI): 60 (25.21 %) vs. 63 (4.84 %), p < 0.001] and controls [dementia: 25 (10.50 %) vs. 0 (0 %), p < 0.001; MCI: 60 (25.21 %) vs. 20 (4.29 %), p < 0.001)]. COVID-19 severity, delirium and COPD were risk factors of current cognitive impairment. Low education level, severe COVID-19, delirium, hypertension and COPD were risk factors of longitudinal cognitive decline. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased risk of long-term cognitive decline in elderly population. COVID-19 patients, especially severe patients, should be intensively monitored for post-infection cognitive decline.

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The impact of polypharmacy and drug interactions among the elderly population in Western Sicily, Italy

Aging Clinical and Experimental Research ◽

10.1007/s40520-017-0755-2 ◽

2017 ◽

Vol 30 (1) ◽

pp. 81-87 ◽

Cited By ~ 8

Author(s):

Giulia Scondotto ◽

Fanny Pojero ◽

Sebastiano Pollina Addario ◽

Mauro Ferrante ◽

Maurizio Pastorello ◽

...

Keyword(s):

Drug Interactions ◽

Elderly Population ◽

The Elderly ◽

Western Sicily ◽

The Impact

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Association of Frailty With the Risk of Mortality and Resource Utilization in Elderly Patients in Intensive Care Units: A Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.637446 ◽

2021 ◽

Vol 8 ◽

Author(s):

Feiping Xia ◽

Jing Zhang ◽

Shanshan Meng ◽

Haibo Qiu ◽

Fengmei Guo

Keyword(s):

Intensive Care ◽

Elderly Patients ◽

Resource Utilization ◽

Meta Analysis ◽

The Elderly ◽

Cochrane Central Register ◽

Old Patients ◽

Risk Of Mortality ◽

Increased Risk ◽

The Impact

Background: The associations of frailty with the risk of mortality and resource utilization in the elderly patients admitted to intensive care unit (ICU) remain unclear. To address these issues, we performed a meta-analysis to determine whether frailty is associated with adverse outcomes and increased resource utilization in elderly patients admitted to the ICU.Methods: We searched PubMed, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials through August 2021 to identify the relevant studies that investigated frailty in elderly (≥ 65 years old) patients admitted to an ICU and compared outcomes and resource utilization between frail and non-frail patients. The primary outcome was mortality. We also investigated the prevalence of frailty and the impact of frailty on the health resource utilization, such as hospital length of stay (LOS) and resource utilization of ICU.Results: A total of 13 observational studies enrolling 64,279 participants (28,951 frail and 35,328 non-frail) were finally included. Frailty was associated with an increased risk of short-term mortality (10 studies, relative risk [RR]: 1.70; 95% CI: 1.45–1.98), in-hospital mortality (five studies, RR: 1.73; 95% CI: 1.55–1.93), and long-term mortality (six studies, RR: 1.86; 95% CI: 1.44–2.42). Subgroup analysis showed that retrospective studies identified a stronger correlation between frailty and hospital LOS (three studies, MD 1.14 d; 95% CI: 0.92–1.36).Conclusions: Frailty is common in the elderly patients admitted to ICU, and is associated with increased mortality and prolonged hospital LOS.Trial registration: This study was registered in the PROSPERO database (CRD42020207242).

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Health risk assessment and countermeasure analysis of the elderly population exposed to PM2.5 microenvironment

Work ◽

10.3233/wor-205361 ◽

2021 ◽

pp. 1-11

Author(s):

Yan Xu ◽

Wantian Cui

Keyword(s):

Mental Health ◽

Health Risk ◽

Elderly Population ◽

Mental Health Problems ◽

Negative Impact ◽

The Elderly ◽

Exposure Concentration ◽

Physical Diseases ◽

The Impact

BACKGROUND: China’s atmospheric PM2.5 pollution is serious, and PM2.5 exerts a negative impact on the human respiratory system, cardiovascular, and mental health, and even more serious health risk for the elderly with weak immunity. OBJECTIVE: This work aims to analyse the impacts of PM2.5 microenvironment exposure on the health of the elderly and provide corresponding countermeasures. METHODS: The survey subjects are 118 retired elderly people in the community. PM2.5 exposure concentrations are monitored in summer (June 10 ∼ July 10, 2019) and winter (November 25 ∼ December 25, 2019). RESULTS: The exposure concentration in winter is higher than that in summer, with statistical difference (P < 0.05). Under the impact of PM2.5 microenvironment exposure, smoking in the elderly can increase the concentration of PM2.5, and long-term exposure to PM2.5 in the elderly can cause mental health problems. CONCLUSION: Long-term exposure of the elderly to the PM2.5 microenvironment leads to physical diseases and even psychological problems, which requires attention.

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How to Treat Hepatocellular Carcinoma in Elderly Patients

Pharmaceuticals ◽

10.3390/ph14030233 ◽

2021 ◽

Vol 14 (3) ◽

pp. 233

Author(s):

Piera Federico ◽

Emilio Francesco Giunta ◽

Annalisa Pappalardo ◽

Andrea Tufo ◽

Gianpaolo Marte ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Elderly Patients ◽

Elderly Population ◽

Primary Tumour ◽

The Elderly ◽

Chronic Liver Diseases ◽

Old Patients ◽

Choice Of Treatment ◽

Definition Of ◽

Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

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744. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine and Influenza Vaccine Against Pneumococcal Pneumonia Among Elderly Patients Aged 65 Years and Older in the Republic of Korea: A Case–Control Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.751 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S267-S267

Author(s):

Jong Hun Kim ◽

Byung Chul Chun ◽

Joon Young Song ◽

Hyo Youl Kim ◽

In-Gyu Bae ◽

...

Keyword(s):

Elderly Patients ◽

Elderly Population ◽

Case Control Study ◽

The Elderly ◽

Case Control ◽

Polysaccharide Vaccine ◽

Vaccine Effectiveness ◽

Pneumococcal Polysaccharide Vaccine ◽

The Republic ◽

Control Study

Abstract Background The national immunization program (NIP) of annual influenza vaccination to the elderly population (≥65 years of age) in the Republic of Korea (ROK) has been implemented since 1987. Recently, the 23-valent pneumococcal polysaccharide vaccine (PPV23) through the NIP has been provided to the elderly population in the ROK since May 2013. The aim of this study was to assess PPV23 and influenza vaccine (IV) effectiveness in preventing pneumococcal pneumonia (PP) among elderly patients ≥65 years of age. Methods A case–control study using a hospital-based cohort was conducted. Cases of PP including bacteremic PP and nonbacteremic PP were collected from 14 hospitals in the pneumococcal diseases surveillance program from March 2013 to October 2015. Controls matched by age and sex in the same hospital were selected. Demographic, clinical information, and vaccination histories were collected. Previous immunization was categorized into “vaccinated” if a patient had received vaccines as follows: PPV23 (4 weeks to 5 years) and IV (2 weeks to 6 months) prior to the diagnosis of PP for case patients and prior to the hospital admission for control patients. Adjusted odds ratio (OR) was calculated, controlling for underlying medical conditions. Vaccine effectiveness was defined as (1 – OR) × 100. Results During the study period, a total of 661 cases (104 bacteremic PP cases and 557 nonbacteremic PP cases) and 661 controls were enrolled for analyses. For overall patients ≥65 years of age, there was no significant vaccine effectiveness against PP. For young elderly patients with 65–74 years, IV alone (1.2%, [95% confidence interval (CI) −95.3% to 50.0%]) and PPV23 alone (21.9%, [95% CI −39.0% to 56.1%]) were not effective. However, significant vaccine effectiveness of PPV23 plus IV against PP was noted (54.4%, [95% CI 6.9–77.7%], P = 0.031). For older elderly patients ≥75 years of age, no significant vaccine effectiveness was observed. Conclusion Our study indicates that PPV23 plus IV may be effective in preventing PP among young elderly patients with 65–74 years, suggesting additive benefits of influenza plus PPV23 vaccination. Further studies are required to confirm the persistent additive protective effectiveness. Disclosures All authors: No reported disclosures.

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A comparative study of the voice-related quality of life among Egyptian elderly with and without voice complaints

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00051-z ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Nesreen Fathi Mahmoud ◽

Huda Zahran ◽

Sherif Abdelmonam

Keyword(s):

Quality Of Life ◽

Elderly Population ◽

Life Quality ◽

Voice Disorders ◽

The Elderly ◽

Different Types ◽

Related Quality ◽

The Impact ◽

The Voice

Abstract Background This study focuses on the self-perception of the voice in the elderly as assessed by the Voice-Related Quality of Life (V-RQOL) questionnaire. This work aimed to compare differences in the voice-related quality of life outcomes between (1) elderly with and without voice disorders, (2) female and male elderly with voice disorders, and (3) different types of voice disorders, and to explore the correlation between the V-RQOL and perceptual analysis done by the clinician. Forty-three dysphonic and 44 non-dysphonic elderly filled out the Voice-Related Quality of Life (V-RQOL) protocol that analyzes the impact of dysphonia on life quality. Vocal perceptual assessment of each subject with dysphonia was made by three voice therapists, followed by a flexible nasofibrolaryngoscope. Results A significant statistical difference was found between the means of total V-RQOL scores and its subdomains for each group (dysphonic and non-dysphonic). No significant differences were found between male and female elderly with dysphonia. The statistical analysis showed a significant correlation with the vocal assessment made by the clinicians and the V-RQOL self-assessment made by the subjects. Conclusions This study provides valuable information regarding the risk factors that contribute to vocal quality in the elderly population. Our results revealed that different types of voice disorders are common among the elderly population with significant negative effects on quality of life. It was observed that the poorest score on the V-RQOL was for functional voice disorders, followed by neoplastic lesions, whereas MAPLs had the best score on the V-RQOL.

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