scholarly journals Septoplasty in elderly patients

2020 ◽  
Vol 4 (4) ◽  
pp. 243-246
Author(s):  
S.A. Karpishchenko ◽  
◽  
G.V. Lavrenova ◽  
O.E. Vereshchagina ◽  
P.I. Gas’kova ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Donor Site ◽  
Management Strategies ◽  
Scoring Systems ◽  
Postoperative Management ◽  
Septal Cartilage ◽  
Elderly Persons ◽  
Nasal Breathing ◽  
Deviated Septum ◽  
Age Related

This review article attempts to systematize and summarize the data on the major age-related pathophysiological, biomechanical, and histological processes that contribute to the progression of nasal breathing impairment or the appearance of these symptoms in elderly patients. The specifics of risk assessment of deviated septum surgery using various questionnaires and scoring systems is discussed. The article demonstrates that deviated septum surgery can be performed in these patients and addresses the specificity of donor site selection for a septal graft in elderly patients considering the histological features of various septal cartilage regions. Prior assessment of individual risks is of particular importance since it determines surgical success and favorable postoperative course in these patients. Studies addressing the perspective use of tissue-engineering transplants are unraveled. Management strategies that consider aging biomechanisms potentially affecting treatment efficacy are described. Finally, the article highlights preoperative management, treatment choice, drug dosage regimens, and postoperative management after septoplasty. KEYWORDS: deviated septum, septoplasty, elderly persons, age-related disorders, neuromuscular tone, nasal breathing impairment. FOR CITATION: Karpishchenko S.A., Lavrenova G.V., Vereshchagina O.E., Gas’kova P.I. Septoplasty in elderly patients. Russian Medical Inquiry. 2020;4(4):243–246. DOI: 10.32364/2587-6821-2020-4-4-243-246.

Rheumatologists’ Views and Experiences in Managing Rheumatoid Arthritis in Elderly Patients: A Qualitative Study

2018 ◽  
Vol 45 (5) ◽  
pp. 590-594 ◽  
Author(s):  
Jill Nawrot ◽  
Annelies Boonen ◽  
Ralph Peeters ◽  
Mirian Starmans ◽  
Marloes van Onna
Keyword(s):  
Qualitative Study ◽  
Elderly Patients ◽  
Disease Activity ◽  
Management Strategies ◽  
The Elderly ◽  
Treat To Target ◽  
Management Approach ◽  
Semistructured Interview ◽  
Das28 Score ◽  
Age Related

Objective.In this qualitative study we analyzed the (1) influence of age, comorbidity, and frailty on management goals in elderly patients with RA; (2) experiences of rheumatologists regarding the use of the Disease Activity Score at 28 joints (DAS28) to monitor disease activity; and (3) differences in management strategies in elderly patients with RA compared to their younger counterparts.Methods.Rheumatologists were purposively sampled for a semistructured interview. Two readers independently read and coded the interview transcripts. Important concepts were taxonomically categorized and combined in overarching themes by using NVivo 11 software.Results.Seventeen rheumatologists (mean age 44.8 yrs, SD 7.7 yrs; 29% male) from 9 medical centers were interviewed. Preserving an acceptable level of functioning was the most important management goal in patients ≥ 80 years and in patients with high levels of comorbidity and frailty. The DAS28 score less frequently steered the management strategy, because rheumatologists commented that comorbidity and an age-related erythrocyte sedimentation rate elevation might distort the DAS28 score. Instead, management of elderly patients highly depended on comorbidity, frailty, and their subsequent effects such as cognitive and physical decline, dependency, and polypharmacy. Presence of 1 or more of these factors frequently resulted in a less future-oriented management approach with less emphasis on the maximal prevention of joint erosions.Conclusion.The treat-to-target model is not automatically adopted in the elderly patient population. Future evidence-based RA management recommendations for elderly patients with RA are needed and should account for factors such as comorbidity and frailty.

scholarly journals Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Diana Nordquist ◽  
Thomas M. Halaszynski
Keyword(s):  
Drug Therapy ◽  
Adverse Effects ◽  
Elderly Patients ◽  
Regional Anesthesia ◽  
Pain Control ◽  
The Elderly ◽  
Surgical Patient ◽  
Cochrane Central Register ◽  
Promising Alternative ◽  
Age Related

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

The Benefits of a Muscle-Sparing Below Knee Amputation in the Elderly Population

2021 ◽  
pp. 153857442110451
Author(s):  
Jared M. Theriot ◽  
Prabhat Bhattarai ◽  
David J. Finlay
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Blood Supply ◽  
Weight Bearing ◽  
Complete Healing ◽  
Selective Removal ◽  
Knee Amputation ◽  
Age Related ◽  
Estimated Blood Loss ◽  
Muscle Sparing

Background It is well accepted that good muscle coverage of the bones at the end of a below knee amputation (BKA) stump is preferable, for both weight bearing and protection against prosthesis failure. Elderly patients often have atrophy of the leg musculature secondary to age-related physiological changes and decreased use. These patients often have poor coverage and bulk in their stumps after the standard BKA. We propose a selective muscle-sparing approach to these patients, utilizing selective removal of muscle bundles with regard to their blood supply and fascial planes. The surgical method technique along with outcomes of patients undergoing the procedure is presented here. Methods A retrospective chart review was performed to identify patients who had undergone a muscle-sparing BKA from March 2008 to October 2017 by a single surgeon. Estimated blood loss, operative time, and perioperative and postoperative complications were assessed. Results Forty-six patients greater than 60 years of age underwent muscle-sparing BKA procedures. Complete healing was seen in 30 (65%) patients, while 7 (15%) were lost to follow-up and 9 (20%) required conversion to an above knee amputation (AKA). Intraoperative outcomes in our series were notable for an average estimated blood loss (EBL) of 84.3 ml, lower than the traditional BKA (average EBL 150-500 ml), with comparable operative times averaging 131 minutes and as short as 85 minutes (skin incision to dressing). No patients in the cohort required postoperative blood transfusions (day 0–4), significantly less than the reported 3–7 ml/kg body weight blood requirements in similar patient populations. Conclusions The muscle-sparing BKA technique should be considered in elderly patients, where the normally bulky posterior calf muscle mass is lacking. The selective removal of muscle bundles with regard to their blood supply leaves maximum coverage of the bone with decreased potential hematoma formation and blood loss.

Abstract P329: White Matter Score Does Not Predict Post-tPA Hemorrhage in Elderly Patients Evaluated Acutely via Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Bilal Tariq ◽  
Shekhar Khanpara ◽  
Eliana Bonfante Mejia ◽  
Liang Zhu ◽  
Christy T Ankrom ◽  
...  
Keyword(s):  
White Matter ◽  
Elderly Patients ◽  
The Elderly ◽  
Periventricular White Matter ◽  
Severe Stroke ◽  
Age Related ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage ◽  
Relationship Of ◽  
Patient Presentation

Background: While tPA may be safe in the elderly, increasing age appears to augment risk of post-tPA symptomatic intracranial hemorrhage (sICH). Age-related white matter changes (ARWMC) are associated with increased sICH. Patients evaluated for acute ischemic stroke (AIS) via telestroke (TS) may not have access to MRI to allow incorporation of microbleeds in tPA decisions. We assessed if increased CT-based ARWMC was associated with increased sICH in elderly patients. Methods: Patients 80 years and older who received tPA for AIS at spoke hospitals were selected from our TS network registry from 9/2015 to 12/2018. TS spoke CT scans from patient presentation were reviewed by three of the authors for periventricular white matter (PWMC) and deep white matter (DWMC) changes. Total ARWMC score, based on the Fazekas score, was collected. Total ARWMC score was either mild (0-2), moderate (3-4), or severe (5-6). PWMC and DWMC were either mild (0-1) or moderate-severe (2-3). Logistic regression adjusted for age, sex, race, ethnicity, NIHSS and premorbid mRS was used to analyze relationship of ARWMC scores with sICH and patient-outcomes. Results: Of 241 patients, median age overall was 86 years (IQR 83-90), and 66% were female. The overall median ARWMC score was 3 (IQR 2-5). Regression analysis showed that more severe ARWMC scores did not lead to higher frequency of post-tPA ICH (moderate OR 0.57, CI 0.19-1.71; severe OR 1.32, CI 0.48-3.65) including sICH (moderate OR 0.78, CI 0.21-2.94; severe OR 2.09, CI 0.62-7.02). Similarly, severe PWMC and DWMC were not associated with increased risk of post-tPA ICH (PWMC OR 1.31, CI 0.51-3.38; DWMC OR 1.25, CI 0.52-3.01), including sICH (PWMC OR 1.61, CI 0.51-5.08; DWMC OR 1.81, CI 0.65-5.01). In our cohort, older patients had no difference in hemorrhage (ICH OR 0.93 CI 0.85-1.00: sICH OR 0.95 CI 0.86-1.04), and patients with less severe stroke were more likely to have hemorrhage (ICH OR 1.06 CI 1.02-1.10; sICH OR 1.08 CI 1.03-1.13). IRR among the CT scan readers was moderate (k=0.504). Conclusions: ARWMC scores were not associated with post-tPA ICH in the elderly. Our analysis lends support for the use of tPA despite severity of white matter disease. ARWMC should not be used to assist in tPA decision-making in elderly patients via telestroke.

Age-related histologic and biochemical changes in auricular and septal cartilage

2017 ◽  
Vol 127 (11) ◽  
pp. E399-E407 ◽  
Author(s):  
Kiersten L. Riedler ◽  
Alireza Shokrani ◽  
Alexander Markarian ◽  
Laurel M. Fisher ◽  
Jon-Paul Pepper
Keyword(s):  
Septal Cartilage ◽  
Biochemical Changes ◽  
Age Related

Optimizing Antiepileptic Drug Therapy in the Elderly

2005 ◽  
Vol 39 (11) ◽  
pp. 1852-1860 ◽  
Author(s):  
William R Garnett
Keyword(s):  
Drug Therapy ◽  
Elderly Patients ◽  
Antiepileptic Drug ◽  
Age Groups ◽  
The Elderly ◽  
Complex Partial Seizures ◽  
Medline Search ◽  
Age Related ◽  
Epilepsy In The Elderly ◽  
Clonic Seizures

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.

scholarly journals Age-related characteristics of gastric carcinoma in young and elderly patients

Cancer ◽  
1996 ◽  
Vol 77 (9) ◽  
pp. 1774-1780 ◽  
Author(s):  
Yoshihiko Maehara ◽  
Yasunori Emi ◽  
Shinichi Tomisaki ◽  
Tatsuo Oshiro ◽  
Yoshihiro Kakeji ◽  
...  
Keyword(s):  
Gastric Carcinoma ◽  
Elderly Patients ◽  
Age Related

scholarly journals Long-term cyclic aerobic training preserves the brain's health in elderly persons (brief review)

2016 ◽  
Vol 24 (4) ◽  
pp. 152-163
Author(s):  
A S Radchenko ◽  
B B Davydov ◽  
A N Kalinichenko
Keyword(s):  
Aerobic Training ◽  
Brain Perfusion ◽  
Favorable Effect ◽  
Elderly Persons ◽  
Periodical Literature ◽  
Brain Health ◽  
Memory State ◽  
Age Related ◽  
The Brain

It was identified on the base of special periodical literature analyze that cyclic muscular work systematically performed during large part of the person's life (former athlete) provides mainly the favorable effect on the brain. Ventricular-arterial coupling improvement ameliorates brain perfusion, and creates function advantages to brain health in old age. At that, the gray and white matter fading hampered, especially in structures that associated with visual control and human body spatial orientation, motor control and memory state, and age-related attenuation of cognitive functions in comparison with sedentary persons of the same age.

FEATURES OF PERICARDIAL DISEASES IN ELDERLY PERSONS (LITERATURE REVIEW)

2021 ◽  
pp. 245-250
Author(s):  
Н.Ю. Шимохина ◽  
М.М. Петрова
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Elderly Patients ◽  
Elderly People ◽  
Malignant Neoplasms ◽  
Elderly Persons ◽  
Limited Data ◽  
Pericardial Diseases ◽  
Inflammatory Drugs ◽  
European Society Of Cardiology

В рекомендациях Европейского общества кардиологов (ESC), выпущенных в 2015 г., представлены ограниченные данные о ведении пожилых пациентов с перикардитом. У лиц пожилого возраста высока вероятность наличия таких факторов риска перикардита, как злокачественные новообразования или почечная недостаточность. Трудности диагностики заболеваний перикарда могут возникнуть в группе пожилых пациентов с сопутствующей ИБС и развитием острого инфаркта миокарда. В терапии перикардита у пожилых пациентов в первую очередь используют нестероидные противовоспалительные препараты, предпочтительно аспирин. Лицам пожилого возраста не рекомендован прием индометацина. Сложности медикаментозного лечения могут быть связаны с полипрагмазией и когнитивными нарушениями у пожилых пациентов с коморбидными заболеваниями. Прогноз в группе пациентов старше 60 лет, перенесших перикардит, менее благоприятен в сравнении с более молодыми лицами. The recommendations of the European Society of Cardiology (ESC), released in 2015, provide limited data on the management of elderly patients with pericarditis. Elderly people are more likely to have pericarditis risk factors such as malignant neoplasms or renal failure. Difficulties in diagnosing pericardial diseases may occur in a group of elderly patients with concomitant coronary heart disease and the development of acute myocardial infarction. In the treatment of pericarditis in elderly patients, non-steroidal anti-inflammatory drugs, preferably aspirin, are primarily used. Elderly people are not recommended taking indomethacin. Difficulties of drug treatment may be associated with polypharmacy and cognitive impairment in elderly patients with comorbid diseases. The prognosis in the group of patients older than 60 who have undergone pericarditis is less favorable in comparison with younger persons.

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