Frailty Screening and Pre-habilitation in Older Spine Patients – Reversing the Effects of Sedentary Life-styles to Improve Surgical Outcomes for Older Patients and Reduce Healthcare Costs

AbstractDysphagia in older adults can have a profound adverse influence nutrition and hydration status, quality of life, morbidity, mortality and healthcare costs in adults. Identification and management of dysphagia in older adults are most effective when implemented by a team, including a nurse, physician, speech-language pathologist, dietitian and occupational therapist. However, each professional’s role may vary according to the standards, responsibilities and resources available in local settings.

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Exposure to Anticholinergic and Sedative Drugs and Healthcare Costs in Older Patients with Neurocognitive Disorders

Journal of Alzheimer s Disease ◽

10.3233/jad-201127 ◽

2021 ◽

Vol 80 (4) ◽

pp. 1515-1524

Author(s):

Frederic Gervais ◽

Virginie Dauphinot ◽

Christelle Mouchoux ◽

Pierre Krolak-Salmon

Keyword(s):

Healthcare Costs ◽

Older Patients ◽

Psychological Symptoms ◽

Functional Limitation ◽

Neurocognitive Disorders ◽

Neurocognitive Disorder ◽

Pharmacological Interventions ◽

Sedative Drugs ◽

Substantial Economic Burden ◽

Regional Public Health

Background: Literature supports an increasing number of older patients living with neurocognitive disorders alongside with their annual worldwide costs. Therapeutic management of behavioral and psychological symptoms includes the use of anticholinergic and sedative drugs for which significant exposure is negatively associated with clinical outcomes. Objective: The aim of this study was to assess the healthcare costs differences related to an increase in the exposure to anticholinergic and sedative drugs in older patients with neurocognitive disorder. Methods: A longitudinal study was conducted during 3 years on 1,604 participants of the MEMORA cohort linked with both regional public health insurance and hospital discharge databases between 2012 and 2017. Direct medical and non-medical costs were included. Exposure to anticholinergic and sedative drugs was measured by the drug burden index (DBI). Results: Costs difference associated with a DBI≥0.5 were + 338€ (p < 0.001). After adjustment on comorbidities, NCD stage, cognitive impairment, functional limitation, polypharmacy, and sociodemographic characteristics, a DBI≥0.5 was found to be an independent predictor of an increase of total healthcare costs by 22%(p < 0.001). Conclusion: Anticholinergic and sedative drugs have a substantial economic burden among older patients with neurocognitive disorder. More studies are required to assess the clinical and economic impact of an efficient strategy based on the reduction of the exposure to anticholinergic and sedative drugs and the promotion of non-pharmacological interventions.

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6. The External Costs of Sedentary Life-Styles

The Costs of Poor Health Habits ◽

10.4159/harvard.9780674422261.c6 ◽

1991 ◽

pp. 107-126

Keyword(s):

External Costs ◽

Life Styles ◽

Sedentary Life

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Evaluation of the Braden scale in predicting surgical outcomes in older patients undergoing major head and neck surgery

Laryngoscope Investigative Otolaryngology ◽

10.1002/lio2.491 ◽

2020 ◽

Author(s):

Rajan Grewal ◽

Michael C. Sklar ◽

John R Almeida ◽

Wei Xu ◽

Jie Su ◽

...

Keyword(s):

Head And Neck ◽

Surgical Outcomes ◽

Older Patients ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Braden Scale

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Prevalence and risk factors of preoperative malnutrition risk in older patients and its impact on surgical outcomes: a retrospective observational study

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-021-01933-3 ◽

2021 ◽

Cited By ~ 1

Author(s):

Ying Mao Gn ◽

Hairil Rizal Abdullah ◽

Wayren Loke ◽

Yilin Eileen Sim

Keyword(s):

Risk Factors ◽

Observational Study ◽

Surgical Outcomes ◽

Older Patients ◽

Retrospective Observational Study

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Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-772479/v1 ◽

2021 ◽

Author(s):

Yasumi Maze ◽

Toshiya Tokui ◽

Masahiko Murakami ◽

Bun Nakamura ◽

Ryosai Inoue ◽

...

Keyword(s):

Conservative Treatment ◽

Aortic Dissection ◽

Hospital Mortality ◽

Surgical Outcomes ◽

Older Patients ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Treatment Groups ◽

Significant Difference

Abstract Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

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HERBAL COMMUNITY: Another consideration about Pharmacognosy

Pharmaceutics and Pharmacology Research ◽

10.31579/2693-7247/009 ◽

2020 ◽

Vol 3 (2) ◽

pp. 01-03

Author(s):

Shah Murad

Keyword(s):

Metabolic Disorders ◽

Ldl Cholesterol ◽

Nigella Sativa ◽

International Diabetes Federation ◽

Heart Association ◽

Life Styles ◽

Hypolipidemic Agents ◽

Sedentary Life ◽

Group 2 ◽

Group 1

The metabolic disorders are main and increasing public-health and clinical challenge worldwide because of urbanization, excessive energy intake, increasing obesity, and sedentary life styles. According to International Diabetes Federation (IFD) diabetes is one of the major metabolic disorders and a dangerous risk factor for heart problems. Twenty five percent of the world’s adults have metabolic disorders. Recently in year 2013 the American Heart Association also reported that adults have abnormal serum lipid profile. Allopathic drugs used as hypolipidemic agents have number of unwanted effects. Herbal therapy for Hyperlipidemia is getting attention due to their less frequent side effects. In this study we have compared hypolipidemic effects of Fenofibrate 40 mg with Nigella sativa. Seventy five hyperlipidemic patients from National Hospital Lahore were enrolled for study. Consent was taken from all enrolled participants and were divided in three equal numbers ie; twenty five in each group. Group 1 was on Nigella sativa, group 2 was on Gemfibrozil and third group was on placebo therapy. They were advised to take drugs for two months. After completion of study pretreatment and post treatment values of LDL cholesterol were analyzed statistically. In 25 patients who were on Nigella sativa, their LDL cholesterol decreased from 191.14±3.45 to 159.40±2.98 mg/dl. 31.7 mg/dl LDL reduction was observed when compared with placebo group. In 25 patients who were on Fenofibrate 40 mg, their LDL cholesterol decreased from 197.77±3.91 mg/dl to 159.62±2.20 mg/dl. LDL reduction in this group was 38.2 mg/dl. These changes are highly significant with p-values of <0.001. We concluded from this study that hypolipidemic characteristic of Nigella sativa is comparable and therapeutically as effective as traditionally used hypolipidemic medication Fenofibrate.

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