Geriatric aspects of modern plastic surgery

Author(s):  
Б.Г. Алиханов ◽  
А.К. Иорданишвили ◽  
С.Г. Павлова ◽  
И.Д. Юшкова

Старение организма человека - закономерный физиологический процесс. В прошлом веке основными причинами обращения людей к пластическим хирургам служили врожденные и приобретенные деформации, а также возрастные изменения кожи лица. В наши дни внешний вид человека стал основным фактором его успешности в обществе. В работе определена мотивация людей пожилого и старческого возраста к выполнению пластических операций, а также проанализирована работа клиник по выполнению пластических операций людям старших возрастных групп. Установлено, что 96,4 % мужчин и 86,9 % женщин старших возрастных групп имеют достаточно полные представления о пластической хирургии. 27,7 % мужчин и 17,2 % женщин пожилого и старческого возраста хотели бы сделать себе пластическую операцию, однако женщины в 10,9 раза чаще обращаются к пластическим хирургам. Анализ работы клиник пластической хирургии показал устойчивую тенденцию увеличения обращаемости людей пожилого и старческого возраста, независимо от пола, к пластическим хирургам для выполнения операций, направленных, главным образом, на улучшение эстетики лица, шеи и коррекцию фигуры путем устранения гравитационного птоза и удаления избыточных подкожных жировых отложений на туловище. Основной причиной отказа от выполнения желаемой пациентом и рекомендуемой пластическим хирургом операции является недостаток денежных средств. Aging of the human body is a natural physiological process. In the last century, the main reasons for people turning to plastic surgeons were congenital and acquired deformities, as well as age-related changes in the skin of the face. Nowadays, a person’s appearance has become the main factor in his success in society. The work determines the motivation of elderly and senile people to perform plastic surgeries, and also analyzes the work of clinics in performing plastic surgeries for people of older age groups. It was found that 96,4 % of men and 86,9 % of women in older age groups have a fairly complete understanding of plastic surgery. Among the elderly and old people, 27,7 % of men and 17,2 % of women have a desire to perform plastic surgery for themselves, however, women are 10,9 times more likely to go to plastic surgeons. Analysis of the plastic surgery clinics showed a steady trend of increasing the number of elderly and senile people, regardless of gender, to plastic surgeons to perform operations aimed mainly at improving the aesthetics of the face, neck and body shaping by eliminating gravitational ptosis and removing excess subcutaneous fat. deposits on the trunk. The main reason for refusal to perform the operation desired by the patient and recommended by the plastic surgeon is the lack of funds.

Author(s):  
М.И. Музыкин ◽  
Е.В. Коковихина ◽  
Е.А. Герасимова ◽  
В.Ф. Мищук ◽  
А.К. Иорданишвили ◽  
...  

Представлены данные клинического обследования 3 329 человек (1 760 мужчин и 1 569 женщин), проживающих в различных регионах РФ (Санкт-Петербург и Ленинградская обл., Москва и Московская обл., Краснодарский край). Цель работы заключалась в изучении частоты утраты зубов и клинических проявлений атрофии альвеолярных отростков (частей) челюстей у пациентов старших возрастных групп для оценки возможности стоматологической реабилитации с использованием ортопедических конструкций на дентальных имплантатах. Изучение распространенности и степени атрофии показало, что в старшей возрастной группе у пациентов в большей мере преобладала 4-я и 5-я степень атрофии, частота встречаемости составила около 20-30 %. Встречаемость 6-й степени атрофии также была выше, чем в других возрастных группах, - она была обнаружена у 17,22 % мужчин и 17,81 % женщин на верхней челюсти и у 22,18 и 15,79 % - на нижней челюсти соответственно. Несмотря на то, что количество пожилых пациентов с полной или частичной утратой зубов не имеет тенденции к снижению, на современном этапе развития стоматологии и дентальной имплантологии восстановление целостности жевательного аппарата с применением искусственных опор возможно фактически во всех клинических случаях. Наличие коморбидной или мультиморбидной патологии не является абсолютным противопоказанием, а является лишь временны΄м фактором, откладывающим стоматологическую реабилитацию до стабилизации общесоматического статуса пациента. The data of clinical examination of 3 329 people (1 760 men and 1 569 women) living in various regions of the Russian Federation (St. Petersburg and Leningrad region, Moscow and Moscow region, Krasnodar Territory) are presented. The aim of the investigation was to study the frequency of tooth loss and clinical manifestations of atrophy of the alveolar processes (parts) of the jaws in patients of older age groups to assess the possibility of dental rehabilitation using orthopedic structures on dental implants. The study of the prevalence and degree of atrophy showed that in the older age group, patients of senile age were more dominated by 4 and 5 degrees of atrophy, the frequency of their occurrence was about 20-30 %. The incidence of grade 6 atrophy was also higher than in other age groups, it was found in 17,22 % of men and 17,81 % of women in the upper jaw and 22,18 % and 15,79 % in the lower jaw, respectively. Despite the fact that the number of patients in older age groups with complete or partial loss of teeth does not tend to decrease, at the present stage of development of dentistry and dental implantology, the possibility of restoring the integrity of the masticatory apparatus with the use of artificial supports is possible in virtually all clinical cases. The presence of comorbid or multimorbid pathology is not an absolute contraindication, but is only a temporary factor that postpones dental rehabilitation until the general somatic status of the patient is stabilized.


2018 ◽  
Vol 39 (8) ◽  
pp. 1752-1781 ◽  
Author(s):  
EVA K. ANDERSSON ◽  
MARIANNE ABRAMSSON ◽  
BO MALMBERG

ABSTRACTEarlier research on residential mobility has demonstrated a tendency for the young old of the 55+ population to prefer peripheral locations, whereas older age groups choose central locations. Here, we present survey results indicating that such late-adulthood differences in preferences are supported by age-related shifts corresponding to differences in housing preferences expressed by individuals in peripheral as well as central locations in Sweden. A sample of 2,400 individuals aged 55 years and over was asked to select the seven most important characteristics of a dwelling from a list of 21 alternatives (Survey of Housing Intentions among the ELDerly in Sweden (SHIELD), 2013). The preferences expressed were used as dependent variables in logistic regressions to determine to what extent the housing preferences of older people are linked to age, gender, socio-economic status and type of geographical area. The results demonstrated a close link between neighbourhood characteristics and housing preferences. Owning the dwelling, having a garden and access to nature were stressed as important by individuals living in non-metropolitan middle-class areas and in suburban elite areas. The youngest cohort expressed similar preferences. Older age groups instead stressed the importance of an elevator, single-storey housing and a good design for independent living; preferences that have similarities to those expressed by individuals living in large cities and smaller urban centres where such housing is more readily available.


2006 ◽  
Vol 19 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Myriam Juda ◽  
Mirjam Münch ◽  
Anna Wirz-Justice ◽  
Martha Merrow ◽  
Till Roenneberg

Abstract: Among many other changes, older age is characterized by advanced sleep-wake cycles, changes in the amplitude of various circadian rhythms, as well as reduced entrainment to zeitgebers. These features reveal themselves through early morning awakenings, sleep difficulties at night, and a re-emergence of daytime napping. This review summarizes the observations concerning the biological clock and sleep in the elderly and discusses the documented and theoretical considerations behind these age-related behavioral changes, especially with respect to circadian biology.


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.


1959 ◽  
Vol 57 (4) ◽  
pp. 367-385 ◽  
Author(s):  
Cecily M. Tinker

1. A review of the few studies so far made on the high mortality from tuberculosis among elderly men, and a consideration of the available statistics, indicate that urbanization is one of the principal factors responsible.2. In the present inquiry, which was confined to London, 445 newly diagnosed cases of tuberculosis in men over 40, together with the same number of paired controls, were studied by means of a questionnaire and of personal interview.3. It was found that the tuberculous patients differed significantly from the controls in the following characteristics; Scots, Irish, Welsh, or foreign nationality; single, widower or divorced; resident in common lodging houses or hostels; inadequate or special diet; history of gastrectomy; a winter cough; shortness of breath; insufficient sleep; and heavy drinking and smoking. On the other hand, overtime or night work, diabetes, rheumatoid arthritis, asthma, and mental illness were distributed fairly evenly in the two groups.4. Unfortunately no group of elderly women exists in this country living under the same sort of conditions as the elderly men studied here, so that it was impossible to determine how far the various factors considered were responsible for the high rate of late adult male tuberculosis. A study, however, of a population of established civil servants living under ordinary conditions revealed little difference between the observed rates of tuberculosis and those expected on the basis of national notification figures for men and women in the older age groups.5. It appears that a low standard of personal hygiene, associated especially with heavy smoking and drinking and residence in loading houses, predispose to the development of tuberculosis in the elderly male. Part of the evil effect of living in common lodging houses in particular may be due to the increased risk of exposure to tuberculous infection that it entails.6. It is tentatively concluded that the casual workers of an urbanized community are one of the principal reservoirs of tuberculous infection in large towns, and since there is no numerically comparable female population, this group, and its immediate male contacts, account in large measure for the difference between the male and female tuberculosis rates in the older age groups.This work was initiated during the tenure of a Prophit Scholarship of the Royal College of Physicians, and completed with the aid of a grant from the Medical Research Council.I am indebted to members of the Prophit Committee of the Royal College of Physicians for their support and encouragement, and most particularly to Dr G. S. Wilson, Director of the Public Health Laboratory Service, under whose guidance the work was carried out. Figures relating to the incidence of tuberculosis in the Civil Service are published by kind permission of Dr W. E. Chiesman, Treasury Medical Adviser, and Dr M. C. W. Long, Dr J. W. Parks, and Dr H. Stannus Stannus, whose departmental records were used to compute the figures.I am greatly indebted to the consultants and staff of the seventeen chest clinics who co-operated in the investigation, for their interest and help in tracing patients, and to the medical superintendents of numerous sanatoria and chest hospitals, and to the surgeons who permitted me to interview patients under their care as controls.I should like also to acknowledge the assistance received from the medical officers of health of the metropolitan boroughs who kept me informed of notifications from lodging houses in their areas, and supplied information about the accommodation.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261061
Author(s):  
Diego Casas-Deza ◽  
Vanesa Bernal-Monterde ◽  
Angel Nicolás Aranda-Alonso ◽  
Enrique Montil-Miguel ◽  
Ana Belen Julián-Gomara ◽  
...  

Background Risk for severe COVID-19 increases with age. Different vaccination strategies are currently being considered, including those aimed at slowing down transmission and those aimed at providing direct protection to those most at risk. Methods The objectives of the current study were i) to assess age-related incidence and survival between PCR-diagnosed COVID-19 cases (n = 61,993) in the Autonomous Community of Aragon from March to November 2020, and ii) to characterize age differences regarding the course of the disease in hospitalized patients in a tertiary university hospital. Results We found a similar incidence of COVID-19 in individuals between 10 and 79 years. Incidence increased in those over 80 years possibly because of the elevated transmission within the nursing homes. We observed a profound disparity among age groups; case fatality rates (CFRs) were near 0 in cases younger than 39 years throughout different waves. In contrast, there was an age-dependent and progressive increase in the CFRs, especially during the first pandemic wave. SARS-CoV-2 infection caused a more severe and rapid progression in older patients. The elderly required faster hospitalization, presented more serious symptoms on admission, and had a worse clinical course. Hospitalized older individuals, even without comorbidities, had an increased mortality risk directly associated with their age. Lastly, the existence of comorbidities dramatically increased the CFRs in the elderly, especially in males. Conclusion The elevated incidence of COVID-19 and the vulnerability of the elderly call for their prioritization in vaccination and targeted prevention measures specifically focused on this aged population.


2016 ◽  
Vol 175 (1) ◽  
pp. 49-54 ◽  
Author(s):  
David Strich ◽  
Gilad Karavani ◽  
Shalom Edri ◽  
David Gillis

ObjectiveWe previously reported increasing free T3 (FT3) to free T4 (FT4) ratios as thyroid-stimulating hormone (TSH) increases within the normal range in children. It is not known if this phenomenon is age-related among humans, as previously reported in rats. This study examines the relationships between TSH and FT3/FT4 ratios in different ages.DesignRetrospective examination of thyroid tests from patients without thyroid disease from community clinics.MethodsFree T3, free T4, and TSH levels from 527 564 sera collected from patients aged 1 year or greater were studied. Exclusion criteria were the following: missing data, TSH greater than 7.5mIU/L, and medications that may interfere with thyroid hormone activity. A total of 27 940 samples remaining after exclusion were stratified by age. Samples with available anthropometric data were additionally stratified for body mass index (BMI). Correlations of TSH to FT4, FT3, and FT3/FT4 ratios by age group were examined.ResultsUp to age 40, for each increasing TSH quartile, FT3 and the FT3/FT4 ratio increased and FT4 decreased significantly (for both FT3, FT4 and FT3/FT4 ratio,P<0.05 for every TSH quartile when compared with the 1st quartile, except FT3 in the 30–40 age group). In older age groups, increasing TSH was not associated with increased FT3/FT4 ratio.ConclusionAs TSH levels increase, FT3/FT4 ratios increase until age 40, but this differential increase does not occur in older age groups. This may reflect a decrease in thyroxine (T4) to triiodothyronine (T3) conversion with age, which may be part of the aging process.


1991 ◽  
Vol 6 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Steven A. Meador

AbstractPurpose:To investigate the relationship between age and Advanced Life Support (ALS) utilization.Population:All patients from 1 January 1987 to 31 December 1988 transported by ALS ambulances within Lebanon County, a rural/urban county of 112,000.Methods:All runs resulting in patient treatment by ALS personnel were tallied at five-year age intervals and sub-grouped by trauma- and non-trauma-related calls. Utilization rates for each age group were obtained by dividing the calls by the population of each group. Correlation with age was tested by Spearman's rank correlation. Treatment rates for age groups were calculated for the six most frequent medical etiologies. To illustrate the effect of age distributions, age rates were applied to projected state and national population distributions.Results:There was a significant correlation with age for all transports (p < .01; r=.93) and for those not related to trauma (p<.01; r=.98). Correlation was not detected for trauma-related responses (p>.10; r=.19). Non-trauma-related case incidence varied among age groups, ranging from 1.1/1,000 for age five through nine years to 89/1,000 for age 80–84 years. Congestive heart failure, cardiac ischemia, syncope, myocardial infarction, and cardiac arrest evidenced increased incidence with age. Seizure did not. Older populations had a higher projected utilization of ALS services than did the younger age groups.Conclusion:Non-trauma ALS utilization is highly dependent on the age of the patient. Due to projected aging of the population and increased utilization of ALS by the elderly, projected utilization will increase at a rate faster than will the population. Age:rate data can be combined with population projections to estimate future need.


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.


2003 ◽  
Vol 88 (1) ◽  
pp. 185-191 ◽  
Author(s):  
Reinhold Vieth ◽  
Yasmin Ladak ◽  
Paul G. Walfish

Vitamin D requirements are thought to vary with age, but there is little comparative evidence for this. One goal in establishing a vitamin D requirement is to avoid secondary hyperparathyroidism. We studied 1741 euthyroid, thyroid clinic outpatients without evidence of calcium abnormalities, ranging in age from 19 to 97 yr, whose serum and urine had been analyzed for calcium, vitamin D, and parathyroid status. We found no effect of age on the 25-hydroxyvitamin D [25(OH)D] concentration associated with specific vitamin D intakes, and there was no relationship between 25(OH)D and 1,25hydroxyvitamin D [1,25(OH)2D]. In every age group, serum 1,25(OH)2D declined with increasing creatinine (P &lt; 0.001). What changed with age included creatinine, which correlated with 25(OH)D (r = 0.146, P &lt; 0.001) only in the youngest age group (19–50 yr) but not in the older age groups (P &gt; 0.1). Creatinine did not correlate with PTH in the youngest age group, but the relationship became significant as age increased (e.g. for the elderly, r = 0.365, P &lt; 0.001). Linear regression of log PTH vs. log 25(OH)D agreed with the natural shape of the relationship observed with scatterplot smoothing, and this showed no plateau in PTH as 25(OH)D increased. We compared PTH concentrations among age groups, based on 20 nmol/liter increments in 25(OH)D. Mean PTH in adults older than 70 yr was consistently higher than in adults younger than 50 yr (P &lt; 0.05 by ANOVA and Dunnett’s t test). PTH levels of the elderly who had 25(OH)D concentrations greater than 100 nmol/liter matched PTH of younger adults having 25(OH)D concentrations near 70 nmol/liter. This study shows that all age groups exhibit a high prevalence of 25(OH)D insufficiency and secondary hyperparathyroidism. Older adults are just as efficient in maintaining 25(OH)D, but they need more vitamin D to produce the higher 25(OH)D concentrations required to overcome the hyperparathyroidism associated with their diminishing renal function.


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