scholarly journals TREATMENT OF ARTERIAL TRAUMA IN PATIENTS OF VARIOUS AGES

Author(s):  
Vitaliy Petrov ◽  
◽  
Roman Trutiak ◽  
Boris Dyachushun ◽  
Roksolana Yaremkevych ◽  
...  

Aim. To identify the differences in arterial trauma (AT) treatment in patients of different ages. Materials and methods. The hospital medical records of 222 patients with AT who were treated in the Lviv Regional Clinical Hospital between 1992 and 2019 were studied. The following patterns were analyzed: age, etiology and mechanism of injury, type of AT, topography, symptoms, type of diagnosis, method of treatment. Patients were divided into seven age groups according to V. Quinn (1994): infants, early childhood, childhood, adolescents, young adults, adults and the elderly. Patients received one of three types of treatment – conservative, surgical or endovascular. Surgical treatment was further divided into simple operations (ligation or suture repair) and complex operations (end-to-end anastomosis or replacement). Results. Conservative treatment was used in 7.66±1.78%, surgical in 90.99±1.92% and endovascular in 1.35±0.77% of clients. The percentage of conservative treatment was higher among the infants (88.9±10.48%) and lower among the young adults (0.9%), as compared to the average. Among the operated patients, simple operations were performed in 48.45±3.59%, and complex operations in 51.55±3.59%. The distribution of different types of simple and complex operations between different age groups was similar. Regression analysis confirmed the influence of age factor, along with the type of AT, on the choice of treatment of patients. In addition, atherosclerotic changes were found in 20% of the adults and 50% of the elderly patients in the AT area. Conclusions. The age category of the patient makes an impact of the treatment method for patients with AT. Differences were related to the children of their first years of life, who were often managed conservatively. In the adults and the elderly, arterial damage may coincide with atherosclerotic changes in the blood vessels

2018 ◽  
Vol 12 (1) ◽  
pp. 67-74
Author(s):  
Guillermo Sánchez ◽  
Diana Buitrago

Background: The clinical characteristics and physio-pathogenic mechanisms of asthma in patients older than 60 years appear to differ from the behavior described for other age groups. Therefore, the effectiveness of medications for elderly patients with asthma should not be extrapolated from studies conducted on teenagers or young adults. Objective: The study aimed to establish the clinical effect of montelukast 10 mg in elderly patients with mild and moderate asthma compared to its effect on young adults. Method: A prospective cohort study was conducted during 12 weeks of follow-up, which consecutively included the total population of adult patients attended by a group of 21 general practitioners, between July and December 2016. Young adults (18-59 years) and older adults were included (60 years or older) with mild or moderate asthma, which, according to the criteria of his treating physician, had been prescribed montelukast 10 mg/day. The variables of interest were: use of inhaled corticosteroids during the last month, use of inhaled beta-2 adrenergic agonists as a rescue in the last month, having attended the emergency service during the last month due to an asthma attack, presence of wheezing in the physical examination, the number of attacks in the last month and the number of days without symptoms in the last month. Results: A total of 126 patients entered the cohort and 104 completed the follow-up, of which 29% were older adults. On admission, 65.4% of patients (68/104) had used rescue inhaled beta2 in the last month and had been using schemes with corticosteroids. After 12 weeks of follow-up, 58.1% (43/74) of the young adults required treatment schedules with corticosteroids, while in the elderly, only 36.7% of the patients (11/30) required this treatment scheme (p-value: 0.047). Regarding the use of rescue inhaled beta-2 at 12 weeks, 55% of young adults reported using them, compared to 33.3% of older adults (p-value: 0.041). Conclusion: In this cohort of patients, treated with montelukast 10 mg/day for 12 weeks, there was a reduction of broncho-obstructive symptoms and exacerbations of the disease. In older adults compared to young adults, a greater reduction in the use of beta2 agonists rescue medications and in the concomitant use of inhaled corticosteroid schemes was documented.


2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.


2021 ◽  
Vol 14 (3) ◽  
pp. 233
Author(s):  
Piera Federico ◽  
Emilio Francesco Giunta ◽  
Annalisa Pappalardo ◽  
Andrea Tufo ◽  
Gianpaolo Marte ◽  
...  

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.


2016 ◽  
Vol 130 (8) ◽  
pp. 706-711 ◽  
Author(s):  
O Hilly ◽  
E Hwang ◽  
L Smith ◽  
D Shipp ◽  
J M Nedzelski ◽  
...  

AbstractBackground:Cochlear implantation is the standard of care for treating severe to profound hearing loss in all age groups. There is limited data on long-term results in elderly implantees and the effect of ageing on outcomes. This study compared the stability of cochlear implantation outcome in elderly and younger patients.Methods:A retrospective chart review of cochlear implant patients with a minimum follow up of five years was conducted.Results:The study included 87 patients with a mean follow up of 6.8 years. Of these, 22 patients were older than 70 years at the time of implantation. Hearing in Noise Test scores at one year after implantation were worse in the elderly: 85.3 (aged under 61 years), 80.5 (61–70 years) and 73.6 (aged over 70 years;p= 0.039). The respective scores at the last follow up were 84.8, 85.1 and 76.5 (p= 0.054). Most patients had a stable outcome during follow up. Of the elderly patients, 13.6 per cent improved and none had a reduction in score of more than 20 per cent. Similar to younger patients, elderly patients had improved Short Form 36 Health Survey scores during follow up.Conclusion:Cochlear implantation improves both audiometric outcome and quality of life in elderly patients. These benefits are stable over time.


2005 ◽  
Vol 39 (11) ◽  
pp. 1852-1860 ◽  
Author(s):  
William R Garnett

OBJECTIVE To review and evaluate the medical literature concerning antiepileptic drug (AED) therapy in elderly patients. DATA SOURCES A MEDLINE search (1982–December 2004) was conducted. Bibliographies of the articles identified were also reviewed, and an Internet search engine was used to identify additional pertinent references. STUDY SELECTION AND DATA EXTRACTION Clinical studies and reviews were evaluated, and relevant information was included. DATA SYNTHESIS The elderly have the highest incidence of seizures among all age groups. Complex partial seizures are the most common, followed by primary generalized tonic–clonic seizures. An accurate diagnosis may prove difficult because of a low suspicion of epilepsy in the elderly and other diseases that may mimic seizures. Most AEDs are approved for treatment of elderly patients who have partial and tonic–clonic seizures. However, a number of age-related variables should be addressed when selecting an appropriate AED. Age-dependent differences in pharmacokinetics and pharmacodynamics of AEDs must be taken into account. Drug–drug interactions must be considered since elderly people often take multiple medications. The ultimate factor that often determines AED selection is tolerability. CONCLUSIONS Numerous factors must be considered in treating elderly patients for seizures, but maximizing the ability of patients to tolerate drug therapy is often the basis for AED selection. Special consideration should be made along several lines, including elderly patients’ cognitive functioning and their tendency to respond to lower AED concentrations.


2017 ◽  
Vol 37 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Anna Giuliani ◽  
Akash Nayak Karopadi ◽  
Mario Prieto-Velasco ◽  
Sabrina Milan Manani ◽  
Carlo Crepaldi ◽  
...  

End-stage renal disease (ESRD) is common in the elderly population, and renal replacement therapy (RRT) is often required. However, in this particular subgroup of patients, the choice between hemodialysis (HD) and peritoneal dialysis (PD) is often not an easy decision to make. Published literature has adequately demonstrated that PD prevalence is significantly less than HD across all patient age groups despite several advantages. We also know that elderly patients are less likely to complete a PD assessment, due to both medical and social barriers. Additionally, elderly patients are often reluctant to go ahead with PD despite being eligible PD candidates, mainly due to the fear of performing self-therapy. Recently, many new assisted PD (asPD) programs have cropped up in several countries. The main aim of these programs is to overcome barriers to PD and to promote PD utilization among elderly and non-self-sufficient patients. Although asPD has proven to be associated with good clinical results, there still remain concerns about its greater use. In this review, we will first describe an ideal asPD model and then enumerate examples of strategies and outcomes associated with successful asPD programs worldwide.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rioboo ◽  
E Abuassi Alnakeeb ◽  
S Raposeiras Roubin ◽  
I Munoz Pousa ◽  
M Cespon Fernandez ◽  
...  

Abstract Introduction The clinical utility and validity of the PRECISE-DAPT bleeding risk score for elderly patients with acute coronary syndrome (ACS) is unknown. We investigated the previous aspect in a contemporary population treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) at discharge. Methods Retrospectively, from 2010 to 2016, we studied 3,814 consecutive patients with the diagnosis of ACS. All patients were treated with in-hospital PCI and DAPT at discharge. Elderly was defined if patients aged ≥75 years. Patients were categorized into three risk strata according to their PRECISE-DAPT score (very low-low: <17 points, moderate: 18–24 points, and high risk: ≥25 points). We included the first bleeding event occurred during the first year after discharge. Bleeding events were defined according to the BARC classification system, and divided into two subgroups: BARC 2–5 and BARC 3–5. The ability to separate high bleeding risk patients from lower bleeding risk patients was checked by the cumulative incidence function curves and compared using the Fine-Gray test, thus adjusting for death (non-bleeding related) as a competing risk. Discrimination (C statistic) and calibration (Hosmer-Lemeshow test) were used to test the predictive capacity of the score in pts aged ≥75 years and <75 years. Results 25.2% (n=961/3814) were ≥75 years old, 38.4% of them were women. DAPT duration was 11.5 (interquartile range [IQR] 2.5–13.7) vs. 12.0 (RIQ 8.2–14.1) months in the elderly vs. younger; (p<0.001). 92.5% (n=889) of the elderly were at high risk of bleeding (PRECISE-DAPT≥25 points), compared to 21.3% (n=607) of the youngest. The incidence of BARC 2–5 and BARC 3–5 was 7.4% and 2.7% in the elderly compared to 5.1% and 1.4% among the younger patients (p<0.001). The figure shows the ability of the PRECISE-DAPT score at capturing the risk of BARC 2–5 bleeding (panel A and B), in both age groups. Using the cut-off point ≥25, the effect in the prediction of BARC 2–5 bleeding and BARC 3–5 did not differ significantly between the elderly and those <75 years: sHR = 1.9 (95% CI: 1.2–6.00) in the elderly vs. 1.8 (95% CI: 1.3–2.5) in the other group (p=0.99) and sHR = 3.3 (95% CI: 1.9–6.0) vs. 3.6 (95% CI: 1.9–6.7) (p=0.83), respectively. There were no significant differences between the elderly and those under 75 years in terms of statistical C values either for BARC 2–5 bleeding (0.60 vs. 0.58) or BARC 3–5 bleeding (0.64 vs. 0.67). The score performed well in term of calibration in both groups (all p-values >0.3). Conclusion Although the use of PRECISE-DAPT resulted in classifying the majority of elderly patients at high risk of bleeding and despite exhibiting modest discriminative power, it performed well at classifying patients according to their risk of 1-year out-of-hospital bleeding in both age groups. PRECISE-DAPT appears to identify the truly low risk patients among the elderly, as compared to the younger group.


2020 ◽  
Vol 16 (1) ◽  
pp. 82-93
Author(s):  
O. D. Ostroumova ◽  
M. S. Cherniaeva ◽  
D. A. Sychev

Arterial hypertension (AH) is one of the most common diseases in the elderly. It has been proven that lowering blood pressure (BP) is effective in preventing stroke and cardiovascular complications in patients even at the age of ≥80 years. On the other hand, there is evidence that a significant decrease in BP can be harmful to older people and may lead to a higher risk of overall mortality. Therefore, existing guidelines for the treatment of AH determine specific approaches for managing patients of older age groups, where the target BP levels are determined not only by age and concomitant diseases, but also by the presence of frailty. Moreover, there is a need to monitor the dynamics of frailty indicators (social, functional, cognitive and mental status of the patient), since their deterioration may require changes in the tactics of antihypertensive therapy (dose reduction, drug withdrawal or replacement) and changes in target BP levels. In this regard, in recent years, the possibility/necessity of a planned and controlled process of dose reduction, drug withdrawal or replacement, if this drug can be harmful and/or does not bring benefits (deprescribing), has attracted attention. This article is a review of current literature, which presents the design and main characteristics of randomized clinical trials (RCTs) and systematic reviews on the deprescribing of antihypertensive drugs in elderly patients with AH and frailty. An analysis of these studies showed the benefits of deprescribing of antihypertensive drugs for elderly patients with frailty, which avoids potential harm to their health, improves the quality of life and reduces the economic cost of treatment. Therefore, deprescribing of antihypertensive drugs can be used as an additional tool to achieve the necessary target BP values in patients of an older age group. However, for the development of deprescribing of antihypertensive drugs schemes and its introduction into clinical practice, the results of large specially planned RCTs are needed to study this issue.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 96-96 ◽  
Author(s):  
Ulrike Proetel ◽  
Nadine Pletsch ◽  
Michael Lauseker ◽  
Lida Kalmanti ◽  
Annette Schreiber ◽  
...  

Abstract Introduction The outcome of elderly patients with chronic myeloid leukemia (CML) treated with imatinib has been studied in several trials. However, there are no reports on the effects of different imatinib dosages in older vs. younger CML patients. Methods To evaluate the efficacy of imatinib in the elderly, we analyzed data from the German CML-Study IV, a randomized 5-arm trial designed to optimize imatinib therapy alone or in combination. There was no upper age limit for inclusion. Patients with BCR-ABL positive CML in chronic phase randomized to imatinib 400 mg/d (IM400) or imatinib 800 mg/d (IM800) were compared, stratified according to median age at diagnosis in western populations ≥ 65 years vs. < 65 years, regarding effectively administered imatinib dose, time to hematologic, cytogenetic and molecular remissions, adverse events (AEs), rates of progression to accelerated phase (AP) and blast crisis (BC), survival, and causes of death. The full 800 mg dose was given after a 6 weeks run-in period with imatinib 400 mg/d to avoid excessive cytopenias. The dose could then be reduced according to tolerability for maximum patients' compliance. Results From July 2002 through March 2012, 1,551 patients were randomized, 828 of these to IM400 or IM800. Median age of these patients was 52 years (IM400: 53 years; IM800: 51 years). 784 patients were evaluable for follow-up (IM400: 382; IM800: 402). 193 patients were ≥ 65 years, 591 < 65 years. 110 patients (29%) on IM400 and 83 (21%) on IM800 were ≥ 65 years. Median observation time on IM400 was 63.0 months in the elderly and 67.6 months in the younger group, on IM800 50.9 months in the elderly and 50.1 months in the younger group. The median dose per day was lower for elderly patients on IM800 (421 mg/d for patients ≥ 65 years vs. 556 mg/d for patients < 65 years), with the highest median dose in the first year (466mg/d for patients ≥ 65 years vs. 630mg/d for patients < 65 years). The median dose for patients on IM400 was 400 mg/d for both age groups. There was no difference between age groups in achieving a complete hematologic remission or a complete cytogenetic remission, neither if IM400 and IM800 were combined, nor in an analysis according to treatment groups. Elderly patients on IM400 achieved major molecular remission (MMR) and deep molecular remission (MR4) significantly later than younger patients (18.1 vs. 15.9 months, p=0.013; 54.4 vs. 33.3 months, p=0.012, respectively) whereas no difference was detected for patients on IM800 (11.9 vs. 10.5 months; 24.2 vs. 26.1 months, respectively). Imatinib was well tolerated in elderly patients with only few WHO grade 3-4 AEs being more frequent in the elderly than in younger patients (dermatologic AEs on IM400: 5.4 vs. 0.4%; infections on IM800: 8.3 vs. 2.5%). There were no significant differences between age groups in probabilities of progression to AP or BC neither if IM400 and IM800 were combined, nor in an analysis according to treatment groups. Five-year age-adjusted relative survival for elderly patients was comparable to that of younger patients. Conclusion We could demonstrate that elderly patients achieved molecular remissions significantly later when treated with standard dose imatinib but not when treated with higher imatinib dosages. As the safety profile of IM800 in senior patients was favorable too we conclude, that the optimal dose for elderly patients could be higher than 400 mg/d. Disclosures: Müller: Ariad: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Hochhaus:Pfizer: Consultancy; ARIAD: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding, Travel Other. Hehlmann:BMS: Consultancy, Research Funding; Novartis: Research Funding. Saussele:BMS: Honoraria, Research Funding, Travel, Travel Other; Pfizer: Honoraria; Novartis: Honoraria, Research Funding, Travel Other.


2020 ◽  
pp. 19-19
Author(s):  
G.P. Voinarovska ◽  
E.O. Asanov

Background. Among the combinations of comorbid conditions, a special role belongs to the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD). Because COPD is often associated with CHD, most authors believe that there is a direct link between COPD, progression of bronchial obstruction, and pathological conditions of the cardiovascular system, including mortality from myocardial infarction. In elderly patients, according to some researchers, the link between COPD and CHD is most pronounced. Objective. To establish the frequency of COPD in patients with CHD in older age groups. Materials and methods. The studies are based on the results of a comprehensive survey of 635 patients with CHD aged 60-89 years, who were observed for a long time of the State Institution “Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine”. Results and discussion. The share of patients with CHD in whom COPD was detected in the group of elderly people is 19.4 %. This is much more than the average population. The frequency of COPD in patients with CHD decreases significantly with further aging. The prevalence of COPD among elderly patients is much lower than among elderly patients. This can most likely be explained by the fact that a significant proportion of patients with CHD with COPD do not live to old age. The analysis revealed that in elderly patients there is bronchial obstruction of more severe stages. This is due to the fact that CHD patients with COPD who live to old age have worsening bronchial patency due to the longer duration of the disease. It has been established that the majority of patients with CHD with COPD, both elderly and senile, are male. This can be explained by the negative effects of smoking. Conclusions. The incidence of COPD in patients with CHD in the elderly is much higher than in the population. At the same time, the incidence of COPD among patients with CHD in the elderly is much lower than among the elderly. In patients of advanced age bronchial obstruction is more expressed.


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