Delirium and Its Pharmacological Causes in Older People, Part Three

2021 ◽  
Vol 36 (12) ◽  
pp. 619-631
Author(s):  
George A. DeMaagd ◽  
Daneen R. DeMaagd ◽  
Ashok Philip
Keyword(s):  
Older People ◽  
Patient Outcomes ◽  
Age Groups ◽  
Evaluation Process ◽  
Diagnostic Process ◽  
Drug Induced ◽  
Younger Patients ◽  
Poor Patient

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. Part one of this three part series reviewed the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people. Parts two and three continued to review the pharmacological classes of medications that cause or contribute to delirium in older people.

Delirium and its Pharmacological Causes in Older People, Part Two

2021 ◽  
Vol 36 (11) ◽  
pp. 534-547
Author(s):  
George A. DeMaagd ◽  
Daneen R. DeMaagd ◽  
Ashok Philip
Keyword(s):  
Older People ◽  
Patient Outcomes ◽  
Age Groups ◽  
Evaluation Process ◽  
Diagnostic Process ◽  
Drug Induced ◽  
Younger Patients ◽  
Poor Patient ◽  
Drug Classes

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. Part one of this three part series reviewed the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes. Part two of this series continues to review drugs and drug classes that can cause or contribute to delirium in older people.

Delirium and Its Pharmacological Causes in Older People, Part 1

2021 ◽  
Vol 36 (10) ◽  
pp. 477-488
Author(s):  
George A. DeMaagd ◽  
Daneen R. DeMaagd ◽  
Ashok Philip ◽  
Carli Ferrara Coalter
Keyword(s):  
Older People ◽  
Patient Outcomes ◽  
Age Groups ◽  
Evaluation Process ◽  
Diagnostic Process ◽  
Drug Induced ◽  
Younger Patients ◽  
Poor Patient

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. This article will review the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

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.

scholarly journals Reference values and factors associated with hand grip strength among older adults living in southeastern Poland

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Agnieszka Wiśniowska-Szurlej ◽  
Agnieszka Ćwirlej-Sozańska ◽  
Justyna Kilian ◽  
Natalia Wołoszyn ◽  
Bernard Sozański ◽  
...  
Keyword(s):  
Older Adults ◽  
Older People ◽  
Reference Values ◽  
Handgrip Strength ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Normative Values ◽  
Dominant Hand ◽  
Cross Sectional ◽  
Factors Associated

AbstractHandgrip strength (HGS) is used as a biomarker for the state of health of older people, but the number of research publications containing the normative values of HGS in older adult populations is limited. The aim of the study was to define reference values and factors associated with HGS in older adults living in southeastern Poland. A cross-sectional study including 405 participants aged 65 and older was conducted. Handgrip strength for the dominant hand was assessed by the average of three trials using a JAMAR dynamometer. The sample was categorized into the following age groups: 65–69 years, 70–74 years, 75–79 years, 80–84 years, 85 and over. The average HGS was 19.98 kg (16.91 kg for women and 26.19 kg for men). There was a decrease in handgrip strength across the age range in both sexes. The average handgrip strength of the older people was 17.97 kg (14.47 kg for women and 25.66 kg for men) for those aged 80–85 and 16.68 kg (13.51 kg for women and 21.77 kg for men) in the group over 85 years old. In both sexes, marital status was an independent factor associated with reduced handgrip strength. In conclusion, this study described, for the first time, handgrip strength values for the southeastern Polish population aged ≥ 65 years according to age and gender.

Evaluating a Model of Service Integration for Older People with Complex Health Needs

2005 ◽  
Vol 4 (1-2) ◽  
pp. 34-41 ◽  
Author(s):  
Steve Bird ◽  
William Kurowski ◽  
Gillian Dickman
Keyword(s):  
Health Care ◽  
Older People ◽  
Service Integration ◽  
Evaluation Process ◽  
Target Population ◽  
Multiple Chronic Conditions ◽  
Health Care Needs ◽  
Care Needs ◽  
Community Based ◽  
Quantitative And Qualitative Methods

Background Older people with multiple chronic conditions and complex health care needs require a comprehensive, accessible and well-coordinated system of services. To address this growing problem, a consortium of acute and community-based health care organisations implemented a ‘Patients First’ model of service integration for the target population. The project evaluation utilised a combination of quantitative and qualitative methods in an action research framework. Findings The evaluation process not only demonstrated the benefits of the project to patients and the health care system, but also contributed to the identification of pivotal components in the model, aspects requiring attention and consequently their refinement. It was also a vehicle for the development of a sense of ownership amongst staff and has evolved into an integral part of the model.

scholarly journals Can welfare-rights advice targeted at older people reduce social exclusion?

2008 ◽  
Vol 28 (6) ◽  
pp. 875-899 ◽  
Author(s):  
SUZANNE MOFFATT ◽  
GRAHAM SCAMBLER
Keyword(s):  
Older People ◽  
Social Exclusion ◽  
Social Relations ◽  
Care Service ◽  
Health Care Service ◽  
Age Groups ◽  
Median Income ◽  
Welfare Rights ◽  
Welfare Benefits ◽  
The Impact

ABSTRACTIt is known that, in general, people of pensionable age have gained in income compared to other age groups in the British population over the last two decades, but that a substantial minority still experience relative poverty. This paper reports a small qualitative study into the effectiveness of a welfare-rights advice and acquisition service for men and women aged 60 or more years that was provided through a local primary health-care service. Additional financial and non-financial resources were obtained by accessing previously unclaimed state-welfare benefits. It was found that these significantly improved the participants' quality of life. Fourteen of the 25 participants received some type of financial award as a result of the service offered, with the median income gain being £57 (€84 or US $101) per week. The impact of additional resources was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to cope with emergencies; and reduced stress related to financial worries. Knowledge of and access to welfare-rights services also appeared to have a positive effect. It is argued that a level of material resources above a basic level is necessary for social relations and for accessing services and civic activities, and can reduce social exclusion among older people.

Cochlear implantation in elderly patients: stability of outcome over time

2016 ◽  
Vol 130 (8) ◽  
pp. 706-711 ◽  
Author(s):  
O Hilly ◽  
E Hwang ◽  
L Smith ◽  
D Shipp ◽  
J M Nedzelski ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cochlear Implantation ◽  
Short Form ◽  
Age Groups ◽  
The Elderly ◽  
Long Term Results ◽  
Profound Hearing Loss ◽  
Younger Patients ◽  
Over Time

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.

Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19556-e19556
Author(s):  
Kitsada Wudhikarn ◽  
Radhika Bansal ◽  
Arushi Khurana ◽  
Matthew Hathcock ◽  
Michael Ruff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Older Patients ◽  
Clinical Course ◽  
International Prognostic Index ◽  
Age Groups ◽  
Central Nervous System Involvement ◽  
Microvascular Disease ◽  
B Cell Lymphoma ◽  
Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

Adjuvant Analgesia Reduces Risk of Poor Patient Outcomes in Pediatric Posterior Spinal Fusion

2018 ◽  
Author(s):  
Rebecca Rosenberg ◽  
Stacey Trzcinski ◽  
Mindy Cohen ◽  
Thomas Errico ◽  
Mark Erickson ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Patient Outcomes ◽  
Posterior Spinal Fusion ◽  
Poor Patient

EMPLOYMENT OF OLDER PEOPLE IN THE MODERN LABOR MARKET

2021 ◽  
pp. 409-418
Author(s):  
В.Ю. Бабышев ◽  
Г. А. Барышева
Keyword(s):  
Labor Market ◽  
Older People ◽  
Older Workers ◽  
Age Groups ◽  
Labor Legislation ◽  
Demographic Aging ◽  
Age Cohort ◽  
Working Age ◽  
Medical Advances ◽  
The Impact

В статье рассматривается занятость лиц пожилого возраста в условиях сорвеменных технологических, медицинских и демографических изменений. Актуальность темы исследования обусловлена демографическим старением населения, современными достижениями медицины и изменением характера трудовых операций в результате научно-технического прогресса. В данной статье проверены следующие конкурирующие гипотезы: производительность работников старших возрастных групп находится ниже уровня рентабельности из-за неуклонного ухудшения здоровья или, наоборот, ценность работников старших возрастных групп на современном рынке труда возрастает из-за повышения роли опыта, навыков и квалификации. Дополнительно проанализирован вопрос влияния систем пенсионного обеспечения на мотивацию лиц пожилого возраста к продолжению трудовой деятельности. Для проверки данных гипотез на основе статистики Организации экономического сотрудничества и развития проведен анализ общего уровня занятости, участия в рабочей силе и безработицы, а также временной и неполной занятости по нескольким возрастным группам в диапазоне 15-65 лет и старше. Для оценки динамики проанализирована ситуация на 2000 и 2019 гг. В целом сделан вывод, что количественные и качественные параметры занятости у работников старших возрастных групп уступают среднему рабочему возрасту, однако во временной динамике использование человеческого капитала лиц пожилого возраста растет. В области геронтологии рекомендовано уделять повышенное внимание улучшению здоровья возрастной когорты 65 лет и старше и изменению трудового законодательства в плане стимулирования продолжения трудовой деятельности после официального наступления пенсионного возраста. The article examines the employment of older people in the context of disrupted technological, medical and demographic changes. The relevance of the research topic is due to the demographic aging of the population, modern medical advances and changes in the nature of labor operations as a result of scientific and technological progress. In this article, the following competing hypotheses are tested: the productivity of older workers is below the level of profitability due to a steady decline in health, or vice versa, the value of older workers in the modern labor market is increasing due to the increasing role of experience, skills and qualifications. Additionally, the question of the impact of pension systems on the motivation of older people to continue working is analyzed. To test these hypotheses, based on OECD statistics, we analyzed the overall level of employment, labor force participation and unemployment, as well as temporary and underemployment for several age groups in the range of 15-65+ years. To assess the dynamics, the situation for 2000 and 2019 was analyzed. In general, the author concludes that the quantitative and qualitative parameters of employment of older people are inferior to the average working age, but over time, the use of the human capital of older people is growing. In the field of gerontology, it is recommended to pay increased attention to improving the health of the 65+ age cohort and changing labor legislation in order to stimulate the continuation of work.

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