scholarly journals Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 86
Author(s):  
Christiano Argano ◽  
Giuseppe Natoli ◽  
Salvatore Mularo ◽  
Alessandro Nobili ◽  
Marika Lo Monaco ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Real Life ◽  
Chronic Obstructive ◽  
Laboratory Findings ◽  
Obstructive Pulmonary Disease ◽  
Patients With Diabetes ◽  
The Impact ◽  
Diabetes Patients

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSI) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes.

scholarly journals Impact of Vitamin D Therapy on the Progress COVID-19: Six Weeks Follow-Up Study of Vitamin D Deficient Elderly Diabetes Patients

2021 ◽  
pp. 201010582110414
Author(s):  
Amin R. Soliman ◽  
Tarek Samy Abdelaziz ◽  
Ahmed Fathy
Keyword(s):  
Vitamin D ◽  
Large Scale ◽  
Clinical Laboratory ◽  
Vitamin D Supplementation ◽  
Chronic Obstructive ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
Diabetes Patients

Background Coronavirus disease-19 (COVID-19) is an ongoing pandemic causing considerable fatalities worldwide. Vitamin D modulates the immune response through effects on various cells, such as: macrophages, B and T lymphocytes, neutrophils, and dendritic cells. Aim To explore whether supplementation of vitamin D, in the form of a single intramuscular cholecalciferol injection, to patients with diabetes, COVID-19, and low vitamin D levels could improve the prognosis of those patients. Methods This was a placebo-controlled randomized prospective study. The study has two arms as follows: the intervention arm (40 vitamin D deficient diabetes elderly patients that acquired SARS-CoV-2), compared to the control arm (16 elderly diabetes patients, with deficient vitamin D with SARS-CoV-2). Patients in the intervention arm were given vitamin D as a single intramuscular injection (200,000 IU); patients in the control arm were given placebo. The primary outcome was mortality within 6 weeks of the diagnosis of COVID-19. Clinical, laboratory, treatment, and outcome data were recorded after 6 weeks of follow-up. Results No significant difference in 6 weeks mortality was observed between patients who received vitamin D and patients who received placebo (17.5% vs 18.8%, p = 0.838). Age, presence of hypertension, and chronic obstructive pulmonary disease were independent predictors of mortality at 6 weeks. Conclusion Vitamin D supplementation did not reduce the severity or mortality of COVID-19 at 6 weeks. Further large scale studies are required to explore the effect of vitamin D therapy on survival in patients with diabetes mellitus who acquire COVID-19.

scholarly journals Impact of tobacco-related chronic obstructive pulmonary disease on developmental trajectories of comorbidities in the Taiwan population

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Te-Wei Ho ◽  
Yi-Ju Tsai ◽  
Chun-Ta Huang ◽  
Angela Shin-Yu Lien ◽  
Feipei Lai
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Developmental Trajectories ◽  
Chronic Obstructive ◽  
Control Groups ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
And Control ◽  
The Impact

AbstractComorbidities adversely affect the quality of life and survival of patients with chronic obstructive pulmonary disease (COPD), and timely identification and management of comorbidities are important in caring for COPD patients. This study aimed to investigate the impact of COPD on long-term developmental trajectories of its comorbidities. From 2010 to 2013, all spirometry-confirmed COPD patients with a 5-year follow-up period were identified as the cases. The prevalence of comorbidities and their trajectories in COPD cases were obtained and compared with those in non-COPD controls matched for age, sex, smoking status and Charlson comorbidity index (CCI). Over the study period, a total of 682 patients, 341 each in COPD and control groups were included, with a mean age of 69.1 years and 89% male. The baseline mean CCI was 1.9 for both groups of patients and significantly increased to 3.4 and 2.7 in COPD and control groups after 5 years, respectively (both P < 0.001). Through the 5-year follow-up, a significant increase in the prevalence of all comorbidities of interest was observed in the COPD cohort and the incidence was remarkably higher for hypertension [incidence rate ratio (IRR) 1.495; 95% confidence interval (CI) 1.017–2.198], malignancy (IRR 2.397; 95% CI 1.408–4.081), diabetes mellitus (IRR 2.927; 95% CI 1.612–5.318), heart failure (IRR 2.531; 95% CI 1.502–4.265) and peptic ulcer disease (IRR 2.073; 95% CI 1.176–3.654) as compared to the non-COPD matched controls. In conclusion, our findings suggest that the presence of COPD may be considered a pathogenic factor involved in the development of certain comorbidities.

scholarly journals Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study

2020 ◽  
Vol 17 (24) ◽  
pp. 9399
Author(s):  
Karina Friis ◽  
Anna Aaby ◽  
Mathias Lasgaard ◽  
Marie Hauge Pedersen ◽  
Richard H. Osborne ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Mental Illness ◽  
Health Literacy ◽  
General Population ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Background: The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. Methods: Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. Results: Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11–1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01–2.14)), diabetes (HR 1.91 (95% CI 1.13–3.22)) and mental illness (HR 2.18 (95% CI 1.25–3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. Conclusions: Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.

scholarly journals Sex-Differences in the Pattern of Comorbidities, Functional Independence, and Mortality in Elderly Inpatients: Evidence from the RePoSI Register

2019 ◽  
Vol 8 (1) ◽  
pp. 81 ◽  
Author(s):  
Salvatore Corrao ◽  
Christiano Argano ◽  
Giuseppe Natoli ◽  
Alessandro Nobili ◽  
Gino Corazza ◽  
...  
Keyword(s):  
Sex Differences ◽  
Elderly Patients ◽  
Rating Scale ◽  
Functional Independence ◽  
Chronic Obstructive ◽  
Data Sets ◽  
Sex Dimorphism ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death

Background: The RePoSi study has provided data on comorbidities, polypharmacy, and sex dimorphism in hospitalised elderly patients. Methods: We retrospectively analysed data collected from the 2010, 2012, 2014, and 2016 data sets of the RePoSi register. The aim of this study was to explore the sex-differences and to validate the multivariate model in the entire dataset with an expanded follow-up at 1 year. Results: Among 4714 patients, 51% were women and 49% were men. The disease distribution showed that diabetes, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, and malignancy were more frequent in men but that hypertension, anaemia, osteoarthritis, depression, and diverticulitis disease were more common in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment, mood disorders, and disability in daily life measured by the Barthel Index (BI) were worse in women. In the multivariate analysis, BI, CIRS, and malignancy significantly increased the risk of death in men at the 1-year follow-up, while age was independently associated with mortality in women. Conclusions: Our study highlighted the relevance and the validity of our previous predictive model in the identification of sex dimorphism in hospitalised elderly patients underscoring the need of sex-personalised health-care.

scholarly journals Analysis of the impact of vaccination of pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with diabetes

2019 ◽  
Vol 91 (11) ◽  
pp. 49-54
Author(s):  
G L Ignatova ◽  
E V Blinova ◽  
V N Antonov ◽  
I V Grebneva
Keyword(s):  
Lipid Profile ◽  
Carbohydrate Metabolism ◽  
Pneumococcal Vaccine ◽  
Clinical Symptoms ◽  
Pneumococcal Infection ◽  
Chronic Obstructive ◽  
Shortness Of Breath ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Aim. The article presents data on the evaluation of the clinical efficacy of using a conjugated pneumococcal vaccine in patients with COPD in combination with 2-type diabetes during a 3-year follow - up period. Materials and methods. The study included 309 patients with an isolated course of COPD and in combination with diabetes. The main parameters for evaluating the effectiveness were: the dynamics of clinical symptoms - shortness of breath on the mMRC scale, CAT test, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia, the state of carbohydrate metabolism (HbA1c) and the lipid profile. For vaccine prevention 13-valent conjugated pneumococcal vaccine Prevenar-13 was used. Results and conclusions. The use of PСV13 helps to reduce the severity of respiratory symptoms, reduce the number and duration of exacerbations of COPD, reduce the number of pneumonia. Both in isolated course of COPD and in combination with diabetes. Vaccination PCV13 in patients with comorbid course contributes to the compensation of carbohydrate metabolism and improve the lipid profile.

scholarly journals COPD detected with screening: impact on patient management and prognosis

2014 ◽  
Vol 44 (6) ◽  
pp. 1571-1578 ◽  
Author(s):  
Loes C.M. Bertens ◽  
Johannes B. Reitsma ◽  
Yvonne van Mourik ◽  
Jan-Willem J. Lammers ◽  
Karel G.M. Moons ◽  
...  
Keyword(s):  
Frail Elderly ◽  
Patient Management ◽  
Drug Prescription ◽  
Screening Strategy ◽  
Community Dwelling ◽  
Elderly Subjects ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Impact

It is uncertain whether screening of older persons for chronic obstructive pulmonary disease (COPD) is worthwhile because the effects on patient management and prognosis are unknown.We aimed to assess the short-term consequences of detecting COPD in frail elderly subjects with dyspnoea, considering pulmonary drug use, hospitalisations and all-cause mortality.Community-dwelling frail elderly subjects, aged 65 years and older, with dyspnoea, participating in a screening study on COPD and heart failure were included. Final diagnoses were assigned by an expert panel based on all data from the screening strategy, including spirometry. Follow-up data were collected from the general practitioners.Of the 386 patients, 84 (21.8%) were received a new diagnosis of COPD. Overall, changes in pulmonary drug prescription during 6 months of follow-up were infrequent (n = 53, 13.7%; among new cases of COPD, 15 (17.9%) out of 84). Of all participants, 25.9% were hospitalised in the first year of follow-up, with the highest rate in patients with newly detected COPD (32.1%).Many new cases of COPD could be detected by screening frail elderly subjects with dyspnoea, but the impact on patient management seems limited. Our study underlines the importance of obtaining follow-up data to assess the true impact of a (screen-detected) diagnosis of COPD on patient management and outcome.

Enhanced Recovery After Surgery Protocols. Does Frailty Play a Role?

2020 ◽  
pp. 000313482095635
Author(s):  
Adam Studniarek ◽  
Daniel J. Borsuk ◽  
Slawomir J. Marecik ◽  
John J. Park ◽  
Kunal Kochar
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Frailty Index ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Ed Visits ◽  
The Impact ◽  
Colorectal Procedures

Introduction The 5-modified frailty index (mFI) is a valid predictor of 30-day mortality after surgery. With the wide implementation of enhanced recovery after surgery (ERAS) protocols in colorectal patients, the predictive power of frailty and its contribution to morbidity and length of stay (LOS) can be underestimated. Methods We reviewed all colectomy patients undergoing ERAS protocol at a single, tertiary care institution from January 2016-January 2019. The 5-mFI score was calculated based on the presence of 5 comorbidities: Congestive heart failure (CHF), diabetes mellitus, chronic obstructive pulmonary disease, functional status, and hypertension (HTN). Multivariate analysis was used to assess the impact of 5-mFI score on morbidity, emergency department (ED) visits, readmissions, and LOS. Results 360 patients were evaluated including 163 elderly patients. Frailer patients had a higher rate of ED visits ( P = .024), readmissions ( P = .029), and LOS ( P < .001). Patients with CHF had a higher chance of prolonged LOS, whereas patients with HTN had a higher chance of ED. Elderly patients with an mFI score of 3 and 4 were likely to have longer LOS ( P = .01, P = .07, respectively). Elderly patients with an mFI score of 4 were 15 times more likely to visit ED and 22 times more likely to be readmitted than patients with an mFI score of 0. Discussion An increase in 5-mFI for elderly patients undergoing colorectal procedures increases ED visits or readmissions, and it correlates to a higher LOS, especially in elderly patients. This instrument should be used in the assessment of frail, elderly patients undergoing colorectal procedures.

scholarly journals Lobar Lung Resection in Elderly Patients With Non-Small Cell Lung Carcinoma: Impact of Chronic Obstructive Pulmonary Disease on Surgical Outcome

2014 ◽  
Vol 99 (4) ◽  
pp. 319-324 ◽  
Author(s):  
O. Senbaklavaci
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Elderly Patients ◽  
Pulmonary Disease ◽  
Lung Resection ◽  
Small Cell ◽  
Chronic Obstructive ◽  
Small Cell Lung ◽  
Obstructive Pulmonary Disease ◽  
Perioperative Morbidity ◽  
The Impact

Abstract The aim of this study was to evaluate the impact of chronic obstructive pulmonary disease (COPD) on the perioperative morbidity and mortality after lobar lung resection for non-small cell lung cancer (NSCLC) in patients aged 70 years and older. The medical records of 73 patients ≥70 years who underwent lobar lung resection for NSCLC from 2003 to 2013 at our department were reviewed retrospectively. There were 27 patients with a mean age of 73.6 years and mean predicted forced expiratory volume in 1 s (FEV1) of 69.7% in the COPD group whereas remaining 46 patients (mean age = 75.6 years) in the non-COPD group had a mean predicted FEV1 of 79.1%. There were no significant differences in perioperative morbidity (4.8% in the COPD group versus 17.4% in the non-COPD group) between both groups. We had no perioperative mortality in both groups. Lobar lung resection for NSCLC seems to be a safe therapy option for elderly patients with COPD who are fulfilling the common functional criteria of operability so that radical surgery should remain the mainstay of treatment for early-stage NSCLC in this increasing subpopulation.

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