scholarly journals Increasing Burden of Nursing Care on the Treatment of COVID-19 Patients in the Aging Society: Analyses During the First to the Third Wave of Pandemic in Kyoto City, Japan

2021 ◽  
Vol 8 ◽  
Author(s):  
Kohei Fujita ◽  
Eriko Kashihara ◽  
Osamu Kanai ◽  
Hiroaki Hata ◽  
Akihiro Yasoda ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Nursing Care ◽  
Medical Center ◽  
The Elderly ◽  
Underlying Disease ◽  
Third Wave ◽  
Hospital Organization ◽  
Healthcare Resources ◽  
Aging Society

Background: The coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on patient's mental and physical health, regional healthcare resources, and global economic activity. An aging society such as Japan has many retirement homes and long-term stay hospitals for the elderly and their inhabitants. During the COVID-19 pandemic, disease clusters are often identified in retirement homes and long-term stay hospitals. Although we hypothesize that additional burdens of nursing care for elderly patients will reinforce the anxiety and exhaustion of medical staff and healthcare resources in the aging society, the actual situation is not well understood. In this study, we aimed to evaluate the current situation and countermeasures of the COVID-19 pandemic in the aging society.Methods: We reviewed COVID-19 patients who required hospitalization at the National Hospital Organization Kyoto Medical Center, a 600-bed capacity hospital located in Kyoto, Japan, between 1 April 2020 and 31 March 2021. We assessed the characteristics of the COVID-19 patients, disease severity, duration of hospitalization, outcome at discharge, degree of activities of daily living (ADLs), and complications unique to elderly patients.Results: We enrolled 118 patients who required hospitalization during the study period. Approximately 40% of the patients were aged ≥ 80 years. Dementia (27.1%) was the most prevalent underlying disease, followed by diabetes mellitus (23.7%) and chronic kidney disease (23.7%). Approximately 60% of hospitalized COVID-19 patients had impaired ADL at admission. The COVID-19 patients aged 80 years or older required significantly more longer-term hospitalization than the COVID-19 patients aged under 80 years (15.5 ± 8.2 vs. 13.1 ± 7.7, P = 0.032). In elderly patients aged 80 years or older, approximately 50% of patients had geriatric mental disorders, and approximately 70% had bedridden status and feeding difficulty. Poor ADL at admission was significantly associated with COVID-19 mortality (Odds ratio, 5.6; 95% confidence interval, 1.04–45.2; p-value = 0.044).Conclusions: The proportion of elderly patients aged 80 years or older was relatively high during the hospitalization for COVID-19. Poor ADL at admission in these elderly patients was significantly associated with poor prognosis of COVID-19. We should keep in mind that healthcare workers are forced to have an additional burden of nursing care in the aging society during the COVID-19 pandemic. Therefore, interventions to reduce the burden are urgently required.

scholarly journals Increasing burden of nursing care on the treatment of COVID-19 patients in the ageing society: analyses during the first to the third wave of pandemic in Kyoto City, Japan

2021 ◽  
Author(s):  
Kohei Fujita ◽  
Eriko Kashihara ◽  
Osamu Kanai ◽  
Hiroaki Hata ◽  
Akihiro Yasoda ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Nursing Care ◽  
Medical Center ◽  
The Elderly ◽  
Underlying Disease ◽  
Third Wave ◽  
Hospital Organization ◽  
Ageing Society ◽  
Healthcare Resources

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on patients’ mental and physical health, regional healthcare resources, and global economic activity. An ageing society such as Japan has many retirement homes and long-term stay hospitals for the elderly and their inhabitants. During the COVID-19 pandemic, disease clusters are often identified in retirement homes and long-term stay hospitals. Although we hypothesize that additional burdens of nursing care for elderly patients will reinforce the anxiety and exhaustion of medical staff and healthcare resources in the ageing society, the actual situation is not well understood. In this study, we aimed to evaluate the current situation and countermeasures of the COVID-19 pandemic in the ageing society. Methods We reviewed COVID-19 patients who required hospitalization at the National Hospital Organization Kyoto Medical Center, a 600-bed capacity hospital located in Kyoto, Japan, between 1 April 2020 and 31 March 2021. We assessed the characteristics of the COVID-19 patients, disease severity, duration of hospitalization, outcome at discharge, degree of activities of daily living (ADLs), and complications unique to elderly patients. Results We enrolled 118 patients who required hospitalization during the study period. Approximately 40% of the patients were aged ≥ 80 years. Dementia (27.1%) was the most prevalent underlying disease, followed by diabetes mellitus (23.7%) and chronic kidney disease (23.7%). Approximately 60% of hospitalized COVID-19 patients had impaired ADL at admission. The COVID-19 patients aged 80 years or older required significantly more longer-term hospitalization than the COVID-19 patients aged under 80 years (15.5 ± 8.2 vs. 13.1 ± 7.7, P = 0.032). In elderly patients aged 80 years or older, approximately 50% of patients had geriatric mental disorders, and approximately 70% had bedridden status and feeding difficulty. Conclusions The proportion of elderly patients aged 80 years or older was relatively high during the hospitalization for COVID-19. We should keep in mind that healthcare workers are forced to have an additional burden of nursing care in the ageing society during the COVID-19 pandemic. Therefore, interventions to reduce the burden are urgently required.

scholarly journals P1171DIALYSIS PRESCRIPTION FOR THE SPREAD OF PERITONEAL DIALYSIS IN THE ELDERLY PATIENTS CLARIFIED BY THE EXAMINATION OF RELATIONSHIP BETWEEN KT/V AND NURSING CARE LEVEL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Makoto Hiramatsu ◽  
Keisuke Maruyama ◽  
Akifumi Ohnishi ◽  
Noriya Momoki ◽  
Keisuke Nonaka ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Nursing Care ◽  
Oldest Old ◽  
Urine Volume ◽  
The Elderly ◽  
Age Group ◽  
Care Level ◽  
Aging Society ◽  
Young Old ◽  
Independent Elderly

Abstract Background and Aims Recently, more elderly patients who are independent or able to live at home with support of family are opting for peritoneal dialysis (PD). And assisted PD becomes the useful cure in the super-aging society. Japanese nursing-care insurance system which began in 2000 is useful for the spread of PD in the elderly. A purpose of this study is to check the current situation of the PD therapy in the elderly needing care. And it is to plan the spread of assisted PD in the elderly patients. Method Of the 789 elderly patients controlled by dialysis at our hospital between 2000 and 2018, 265 patients (33.6%) selected PD. 106 patients (30.1%) of young-old group (65-74 years, n=352), 108 patients (32.6%) of old group (75-84 years, n=331), and 51 patients (48.1%) of oldest old (≧85 years, n=106) started PD. We studied total Kt/V, total Ccr, volume of urine, volume of dialysate, the bag exchange number and dialysate retention time in 90 PD patients. We estimated total Kt/V and relations of the nursing care level in elderly PD patients. The data of patients divided into 4 groups: young group (≦64 years, n=30), young-old group (65-74 years, n=19), old group (75-84 years, n=27) and oldest-old group (≧85 years, n=14). Total Kt/V and relations of the nursing care level between 1 and 5 based on assessment of care requirements in PD patients with or without assisted PD were studied. Results The nursing-care insurance acquisition rate of each age group was 3.3%, 18.8%, 51.9%, 78.6% and assisted PD rate was 0%, 21.1%, 55.6%, 92.9%, respectively. Total urine volume was 759±506 L/day in the independent elderly patients and was 603±433 in the elderly patients with assisted PD. Dialysate volume was 5.5±2.0L/day in the independent elderly patients and was 4.0±2.1 in the elderly patients with assisted PD (p<0.05). The daily bag exchange number of times was 3.6±1.0 in the independent elderly patients and was 2.9±1.1 in the elderly patients with assisted PD (p<0.05). The volume of dialysate was 5.5 ±2.0 L/day in the independent elderly patients and was 4.0±2.1 L/day in the elderly patients with assisted PD (p<0.05). Though total Kt/V did not have the difference in each age group, total Kt/V was 1.74±0.36 in the non-need of nursing care elderly patients and was 1.37±0.30 (p <0.05) in the need of nursing care elderly patients. Total Kt/V was 1.72±0.30 in the independent elderly PD patients and was 1.53±0.44 in the elderly patients with assisted PD. Total Kt/V and the nursing care level were significantly inversely correlated (p = 0.011). Total Kt/V and the life independence degree of patients with dementia were significantly inversely correlated (p = 0.001) Conclusion Elderly PD patients can achieve improved levels of well-being with low volume peritoneal dialysates. The application of dialysis prescriptions using APD and and/or icodextorin decrease the burden of changing PD bags for elderly patients, nurses and families who support them (assisted PD). PD for elderly patients will create a paradigm shift of dialysis therapy in the super aging society.

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 Liver and Pancreatic Resection in the Elderly

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 259-261 ◽  
Author(s):  
O. J. Garden
Keyword(s):  
Survival Rate ◽  
Liver Resection ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Complication Rate ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Term Survival ◽  
Pancreatic Resections

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

scholarly journals Neurologic and Neuroscientific Evidence in Aged COVID-19 Patients

2021 ◽  
Vol 13 ◽  
Author(s):  
Shraddha Mainali ◽  
Marin E. Darsie
Keyword(s):  
Elderly Patients ◽  
Systemic Disease ◽  
Respiratory Illness ◽  
The Elderly ◽  
Cerebrovascular Diseases ◽  
Medical Comorbidities ◽  
Viral Illness ◽  
Atypical Presentations ◽  
Severe Systemic Disease

The COVID-19 pandemic continues to prevail as a catastrophic wave infecting over 111 million people globally, claiming 2. 4 million lives to date. Aged individuals are particularly vulnerable to this disease due to their fraility, immune dysfunction, and higher rates of medical comorbidities, among other causes. Apart from the primary respiratory illness, this virus is known to cause multi-organ dysfunction including renal, cardiac, and neurologic injuries, particularly in the critically-ill cohorts. Elderly patients 65 years of age or older are known to have more severe systemic disease and higher rates of neurologic complications. Morbidity and mortality is very high in the elderly population with 6–930 times higher likelihood of death compared to younger cohorts, with the highest risk in elderly patients ≥85 years and especially those with medical comorbidities such as hypertension, diabetes, heart disease, and underlying respiratory illness. Commonly reported neurologic dysfunctions of COVID-19 include headache, fatigue, dizziness, and confusion. Elderly patients may manifest atypical presentations like fall or postural instability. Other important neurologic dysfunctions in the elderly include cerebrovascular diseases, cognitive impairment, and neuropsychiatric illnesses. Elderly patients with preexisting neurologic diseases are susceptibility to severe COVID-19 infection and higher rates of mortality. Treatment of neurologic dysfunction of COVID-19 is based on existing practice standards of specific neurologic condition in conjunction with systemic treatment of the viral illness. The physical, emotional, psychologic, and financial implications of COVID-19 pandemic have been severe. Long-term data are still needed to understand the lasting effects of this devastating pandemic.

scholarly journals Comparison of Outcomes Between McKeown and Sweet Esophagectomy in the Elderly Patients for Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482090470
Author(s):  
Dongni Chen ◽  
Yihuai Hu ◽  
Youfang Chen ◽  
Jia Hu ◽  
Zhesheng Wen
Keyword(s):  
Squamous Cell Carcinoma ◽  
Propensity Score ◽  
Esophageal Squamous Cell Carcinoma ◽  
Elderly Patients ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
The Elderly ◽  
Perioperative Outcomes ◽  
Term Survival

The aim of this study was to compare the perioperative outcomes and long-term survival rates of the McKeown and Sweet procedures in patients with esophageal cancer younger than 70 years or older than 70 years. A total of 1432 consecutive patients with esophageal squamous cell carcinoma (ESCC) who received surgery at Sun Yat-sen University Cancer Center from January 2009 to October 2012 were analyzed. Propensity score matching was used to balance the clinical characteristics of the patients who underwent different surgical approaches, and 275 and 71 paired cases were matched among those younger and older than 70 years, respectively. The prognosis and postoperative outcomes were compared between the McKeown and the Sweet esophagectomy. For patients younger than 70 years, those who underwent the McKeown procedure had better overall survival (OS) than those in the Sweet group (log rank = 4.467; P = .035). However, no significant difference in disease-free survival and OS was observed between two approaches for the elderly patients (log rank = 1.562; P = .211 and log rank = 0.668; P = .414, respectively). Cox regression analysis revealed that McKeown approach was a positive prognostic factor compared to the Sweet approach for patients younger than 70 years in univariable analysis (HR = 0.790; 95% CI, 0.625-0.997; P = .047), whereas the surgical approach was not significantly related to the prognosis in the elderly patients. For patients older than 70 years, the occurrence of anastomotic fistula increased in those who underwent the McKeown procedure (23.9% vs 11.3%, P = .038, for the McKeown and Sweet esophagectomy, respectively). The McKeown approach increases the OS in younger patients with ESCC. However, for patients older than 70 years, the Sweet approach was proven to be an effective therapy, given the better perioperative outcomes and similar long-term survival compared with patients in the McKeown group.

Spontaneous spinal cerebrospinal fluid leaks as the cause of subdural hematomas in elderly patients on anticoagulation

2010 ◽  
Vol 112 (2) ◽  
pp. 295-299 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Brian K. Pikul ◽  
Charles Louy
Keyword(s):  
Elderly Patients ◽  
Intracranial Hypotension ◽  
Medical Center ◽  
Spontaneous Intracranial Hypotension ◽  
The Elderly ◽  
Cortical Atrophy ◽  
Csf Leak ◽  
Subdural Hematomas ◽  
Maximal Diameter ◽  
Subdural Bleeding

Subdural hematoma is a relatively common complication of long-term anticoagulation, particularly in the elderly. The combination of anticoagulation and cerebral cortical atrophy is believed to be sufficient to explain the subdural bleeding. The authors report a series of elderly patients who were on a regimen of anticoagulation and developed chronic subdural hematomas (SDHs) due to a spontaneous spinal CSF leak. They reviewed the medical records and imaging studies of a consecutive group of patients with spontaneous intracranial hypotension who were evaluated at Cedars-Sinai Medical Center. Among 141 patients with spontaneous spinal CSF leaks and spontaneous intracranial hypotension, 3 (2%) were taking anticoagulants at the time of onset of symptoms. The mean age of the 3 patients (1 woman and 2 men) was 74 years (range 68–86 years). All 3 patients had chronic SDHs measuring between 12 and 23 mm in maximal diameter. The SDHs resolved after treatment of the underlying spontaneous spinal CSF leak, and there was no need for hematoma evacuation. Epidural blood patches were used in 2 patients, and percutaneous placement of a fibrin sealant was used in 1 patient. The presence of an underlying spontaneous spinal CSF leak should be considered in patients with chronic SDHs, even among the elderly taking anticoagulants.

Associate Members: A Life Worth Living

1986 ◽  
Vol 49 (11) ◽  
pp. 362-364 ◽  
Author(s):  
Jean Parker
Keyword(s):  
Elderly Patients ◽  
Long Term Care ◽  
The Elderly ◽  
Worth Living ◽  
Term Care ◽  
Life Worth Living ◽  
Meaningful Existence ◽  
Time And Energy

Long-term care patients need a meaningful existence. It is our responsibility to ensure that time and energy are channelled into purposeful solutions for the disease of ‘time with nothing to do’. The author has taken up this challenge. Working as an activities organizer with the elderly for 11 years, she was determined never to take the role of a baby-sitter. The recreation unit has grown from its first eight guests to a purpose-built unit with approximately 1,500 attendances per month. A busy happy atmosphere now prevails where once there was a sea of dead faces. The choice to retain a sense of dignity and purpose should be available to all elderly patients who require long-term care.

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