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Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract

With the arrival of an aging society, the number of orthopedic geriatric patient who require surgical treatment is also rapidly increasing. Elderly patients have decreased hematopoietic function, and perioperative blood management is difficult and challenging. This article aims to elaborate on the perioperative blood management strategies for orthopedic geriatric patients, including the diagnosis and treatment of preoperative anemia, specific measures to reduce perioperative blood loss, and blood transfusion strategies.

Abstract Background Different treatment options are discussed for geriatric odontoid fracture. The aim of this study was to compare the treatment options for geriatric odontoid fractures. Methods Included were patients with the following criteria: age ≥ 65 years, identification of seniors at risk (ISAR score ≥ 2), and odontoid fracture type A/B according to Eysel and Roosen. Three groups were compared: conservative treatment, surgical therapy with ventral screw osteosynthesis or dorsal instrumentation. At a follow-up examination, the range of motion and the trabecular bone fracture healing rate were evaluated. Furthermore, demographic patient data, neurological status, length of stay at the hospital and at the intensive care unit (ICU) as well as the duration of surgery and occurring complications were analyzed. Results A total of 72 patients were included and 43 patients could be re-examined (range: 2.7 ± 2.1 months). Patients with dorsal instrumentation had a better rotation. Other directions of motion were not significantly different. The trabecular bone fracture healing rate was 78.6%. The patients with dorsal instrumentation were hospitalized significantly longer; however, their duration at the ICU was shortest. There was no significant difference in complications. Conclusion Geriatric patients with odontoid fracture require individual treatment planning. Dorsal instrumentation may offer some advantages.

Antiarrhythmic drugs are used more and more often, which is related to the aging of the population and the growing number of arrhythmias, especially atrial fibrillation (AF). One of the drugs used in AF is propafenone, considered a relatively safe drug in people without heart disease. Nevertheless, it can cause severe damage to the liver if one ignores the subtle symptoms that indicate an incipient problem. We present the case of an 82-year-old woman diagnosed with paroxysmal AF who developed acute liver injury during treatment with propafenone. On the fifth day of her hospitalization, we observed nausea and vomiting after introducing regular treatment with propafenone. Similar symptoms occurred before hospitalization when propafenone was taken ad hoc in the event of an AF attack. They were treated as dyspeptics in a patient who underwent cholecystectomy. Laboratory tests showed high serum alanine transaminase, gamma-glutamyltranspeptidase, C-reactive protein, total bilirubin, and a slight increase in aspartate transaminase. Infection with hepatic viruses, alcohol abuse, other drugs toxicity, and intrahepatic cholangitis due to cholelithiasis were excluded as a cause of liver damage. With the discontinuation of propafenone, the patient's clinical condition and laboratory test results improved. Similar cases published in the literature are discussed in the paper. It also draws attention to the need to report adverse drug reactions to the appropriate authorities and discusses the reasons for under-reporting in Poland.

La anemia es el descenso de la concentración de hemoglobina e incapacidad de eritropoyesis para compensar la pérdida excesiva de eritrocitos. La población más vulnerable al síndrome anémico (SA) son personas mayores de 60 años, quienes representan alrededor del 12% del total de la población latinoamericana. El objetivo de esta investigación fue analizar la prevalencia del SA en adultos entre 60 a 75 años en 4 parroquias de la ciudad de Ambato en base a valores de hemoglobina (HGC), eritrocitos (RBC) y hematocritos (HCT), durante un periodo de 8 días (12-20 Jul 2022). Se utilizó un diseño descriptivo, transversal, de campo. Con razón de probabilidades (Odd Ratio) en base al Índice de Masa Corporal (IMC) de los pacientes, y la prevalencia de SA con respecto al número total de pacientes. La muestra de estudio fue de 52 de 100 pacientes geriátricos, y se determinó que, en 2 de los 4 sitios, hubo un paciente con nivel elevado de hematíes (6,06 106/Ul), y otro paciente con niveles superiores de HGB (19 g/dL) y HCT (59%), sin embargo, no se evidenció ningún caso de anemia debido a la ingesta adecuada en los alimentos consumidos por parte de la población establecida. La probabilidad de presentar SA en los cuatro sitios de estudio es de nula a muy baja, con una prevalencia de 0,045% incluyendo todos los pacientes.

Background: We describe a case of severe cardiac insufficiency in an older adult undergoing open complex inguinal hernia repair. We present paravertebral injection technique at lower vertebral level without additional needle entry. The feasibility of this technique was verified by observing its intraoperative and postoperative analgesic effects. Case presentation: A 91-year-old male patient was admitted to the hospital with a very large mass in the right lower abdomen. Diagnostic ultrasonography revealed right inguinal irreducible hernia. The patient had severe cardiac insufficiency with a high risk of general and spinal anaesthesia. After adequate preoperative evaluation and cardiac therapy, the anesthesiologist determined to perform paravertebral block at T11 level using 20 mL of ropivacaine (0.5%) as a single anaesthetic technique to complete the operation. The surgery went uneventfully without using any auxiliary analgesics or sedative drugs. The first reported pain was 19 h after surgery. On the 11-point numeric rating scale, the highest and lowest pain scores within the first 24 h were 3 and 0, respectively. On postoperative day three, the patient was discharged and recovered without complications in 7 days and underwent one-month follow-up. Conclusions: Single paravertebral block at T11 level with 20 mL of ropivacaine (0.5%) may be an effective intraoperative anaesthetic technique in older adults with severe cardiac decompensation undergoing complex open inguinal hernia repair. The advantage of this technique was that the ipsilateral somatic and sympathetic nerves above and below the injection site could be blocked without additional needle insertion.

Tom Knauf,1 Benjamin Buecking,2 Lukas Geiger,1 Juliana Hack,1 Ruth Schwenzfeur,3 Matthias Knobe,4 Daphne Eschbach,1 Steffen Ruchholtz,1 Rene Aigner1 On behalf of the Registry for Geriatric Trauma DGU1Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany; 2Department for Trauma Surgery, Klinikum Hochsauerland, Arnsberg, Germany; 3Working Committee on Geriatric Trauma Registry of the German Trauma Society (DGU), München, Germany; 4Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, SwitzerlandCorrespondence: Tom Knauf, Tel +49-6421-58-63174, Fax +49-6421-58-66721, Email knauft@med.uni-marburg.dePurpose: The German Society for Geriatrics recommends the “ISAR” questionnaire as a screening tool for patients ≥ 70 for geriatric screening in emergency rooms. Although the ISAR-score is collected routinely in the “AltersTraumaRegister DGU®” (ATR-DGU), to date less is known about the predictive value of the “ISAR”-score in geriatric trauma patients.Patients and Methods: Currently, 84 clinics participate in the ATR-DGU. This evaluation is limited to the subgroup of proximal femur fractures from 2016– 2018. Patients ≥ 70 years, who underwent surgery for a hip fracture are included in the ATR-DGU. In this evaluation, the influence of the “ISAR”-score on mortality, length of stay, mobility and the destination of discharge was examined.Results: Overall 10,098 patients were included in the present study. The median age was 85 years (interquartile range (IQ) 80– 89 years). According to the ISAR-score 80.6% (n=8142) of the patients were classified as geriatric patients (cut off “ISAR”-score ≥ 2 points). These group of patients had a length of stay of 16 days (IQ10.1– 22.1) compared to the non-geriatric patient cohort showing a length of stay of 15 days (IQ10.1– 20.1). Patients showing an ISAR-score ≥ 2 had an increased risk of being discharged to a nursing home (OR 8.25), not being able to walk (OR 12.52) and higher risk of mortality (OR 3.45).Conclusion: The “ISAR”-score shows predictive power for the length of stay, mobility, hospital mortality and discharge after hospital in the collective of geriatric trauma patients. It therefore seems suitable as a screening tool for geriatric trauma patients in the emergency department and should be considered in this context.Keywords: ISAR-score, hip fracture, geriatric patient, identification of seniors at risk

Amaç Bu çalışmada böbrek taşı tedavisi için kliniğimizde retrograt intrarenal cerrahi(RİRC) uygulanılan geriatrik yaş grubu erkek hastaların etkinlik ve güvenlik sonuçlarının, daha genç yaş hasta grubu ile karşılaştırılarak sunulması amaçlanmıştır. Gereç ve Yöntem Kliniğimizde böbrek taşı nedeniyle RİRC uygulanmış olan, 40 yaş üzeri erkek hastaların verileri retrospektif olarak değerlendirildi. Hastalar yaşlarına göre iki gruba ayrıldı: 40-64 yaş (Grup 1) ve 65 yaş ve üzeri (Grup 2). Komorbidite değerlendirilmesi için anestezi risk skoru (ASA) ve modifiye Charlson komorbidite indeksi (MCKİ) kullanıldı. Hastanenin kayıt sisteminden ve hastaların dosyalarından genel bilgiler, komplikasyon bilgileri, renal anormallik varlığı, taşın bulunduğu böbrek ve lokalizasyonu, taşın dansitesi, taşın boyutu, taş sayısı verileri ve postoperatif taş temizlenme verileri elde edildi. Bulgular Çalışmaya 233 tanesi Grup 1 (40-64 yaş) ve 61 tanesi Grup 2 (65 yaş ve üstü) olmak üzere toplam 294 hasta alınmıştır. ASA ve MCKİ skorları bakımından Grup 2’de yer alan hastaların skorları Grup 1’e göre istatistiksel olarak anlamlı olarak daha yüksek olarak bulunmuştur (sırasıyla p=.000, p=.000). Gruplar arasında taş dansitesi, taş boyutu, taş hacmi, operasyon süresi, hastanede yatış süreleri ve postoperatif taşsızlık oranları bakımından fark bulunmamıştır. Grup 1’de toplam 25 (%10.7) hastada ve Grup 2’de toplam 10 (%16.4) hastada komplikasyon geliştiği tespit edilmiştir ve gruplar arasında genel komplikasyon oranları açısından istatistiki fark bulunmamıştır (p=.265). Sonuç Dünya nüfusunun giderek yaşlanması ile beraber bu hasta grubunun hastalıklarının da en uygun tedavi metodlarıyla tedavi edilmesinin önemi artmıştır. Çalışmamızda RİRC yöntemi ile böbrek taşı tedavisi yaşlı hasta grubunda da güvenli ve etkili olarak çıkmıştır.

Purpose: The aim of this study was to compare the reliability of scoring methods in determining critical geriatric patients in the emergency department. Materials and Methods: This prospective study included patients aged over 65 who presented to the emergency department between 15 October 2014 and 15 November 2014. APACHE II (Acute Physiology and Chronic Health Evaluation II), REMS (Rapid Emergency Medicine Score), HOTEL (Hypotension, Oxygen saturation, low Temperature, ECG changes, and Loss of independence), VIEWS (Vital PAC Early Warning Score) and VIEWS-L (Vital PAC Early Warning Score with Lactate Level) were evaluated. Results: Of the 244 patients included in the study, the mean age of survivors was 75.69 ± 6.96 years, and the mean age of the mortal cases was 80.47 ± 6.63 years, 139 (57%) women. It was found that 30 (12.3%) of the patients included in the study died. The risk scores of the patients hospitalized in the intensive care unit were higher than those who were discharged or hospitalized. All risk scores in the mortality group were found to be significantly higher than the other patient groups. Conclusion: The study showed that risk scoring systems can be used safely in the evaluation of geriatric patients in the emergency department, to predict mortality and to select critically ill patients.

ObjectiveThyroid cancer (TC) is a common malignancy with a poor prognosis with aging. However, no accurate predictive survival model exists for patients with geriatric TC.We aimed to establish prediction models of prognosis in elderly TC.MethodsWe retrospectively reviewed the clinicopathology characteristics of patients with geriatric TC in the Surveillance, Epidemiology, and End Results database (SEER) from 2004 to 2018. The risk predictors used to build the nomograms were derived from the Cox proportional risk regression. These nomograms were used to predict 1-, 3-, and 5-year overall survival and cancer-specific survival in elderly patients with TC. The accuracy and discriminability of the new model were evaluated by the consistency index (C-index) and calibration curve. The clinical applicability value of the model was assessed using the decision curve analysis.ResultsWe used the SEER database to include 16475 patients with geriatric TC diagnosed from 2004 to 2018. The patients from 2004 to 2015 were randomly sorted out on a scale of 7:3. They were classified into a training group (n = 8623) and a validation group (n = 3669). Patients with TC diagnosed in 2016–2018 were classified into external validation groups (n = 4183). The overall survival nomogram consisted of 10 variables (age, gender, marital status, histologic type, grade, TNM stage, surgery status, and tumor size). A cancer-specific survival nomogram consisted of eight factors (age, tumor size, grade, histologic type, surgery, and TNM stage). The C-index values for the training, validation, and external validation groups were 0.775 (95% confidence interval [CI] 0.785–0.765), 0.776 (95% CI 0.792–0.760), and 0.895(95% CI 0.873–0.917), respectively. The overall survival was consistent with a nomogram based on the calibration curve. Besides, the decision curve analysis showed excellent clinical application value of the nomogram. Additionally, we found that surgery could improve the prognosis of patients with geriatric at high-risk (P < 0.001) but not those at low-risk (P = 0.069).ConclusionThis was the first study to construct predictive survival nomograms for patients with geriatric TC. The well-established nomograms and the actual results could guide follow-up management strategies.

Resumen: Objetivo: Describir la evolución de la actividad asistencial y de la coordinación de un equipo especializado hospitalario (equipo de Atención Geriátrica Domiciliaria-AGD) en el apoyo a atención primaria (AP) para la atención de pacientes geriátricos. Emplazamiento: Antigua área de Salud-5 de la Comunidad de Madrid. Participantes, intervenciones y mediciones principales: Evaluación de los pacientes atendidos en su domicilio a petición de AP por AGD, en 1997-1999 y 20 años después, en 2017-2019. Se registraron variables sociodemográficas, clínicas, funcionales y mentales. También datos asistenciales como el tiempo hasta la primera visita, la estancia media, la procedencia y destino de los pacientes, el motivo de consulta y el motivo principal de discapacidad. Resultados: Se atendieron 524 pacientes (58% del total) solicitados desde AP en 1997-1999 y 1196 (72,2% del total) en 2017-2019. Actualmente se muestra un paciente de mayor edad, más incapacitado física y mentalmente, con mayor prevalencia de síndromes geriátricos y mayor fragilidad social. Ha aumentado la demencia como motivo principal de incapacidad, observándose un incremento de la Valoración Geriátrica Integral (VGI) y del control clínico como motivos principales de derivación. Conclusiones: En nuestro medio, transcurridos 20 años, AGD continúa siendo un importante apoyo para AP en el complejo abordaje de los pacientes ancianos frágiles recluidos en su domicilio, que son cada vez más vulnerables desde el punto de vista clínico, funcional, cognitivo y social. Contribuye en el manejo de los síndromes geriátricos, la deprescripción, los ingresos directos hospitalarios cuando se necesitan sin pasar por urgencias y la disminución en la institucionalización, facilitando el mantenimiento del paciente en su domicilio. Abstract: Objective: To describe the evolution of the care and coordination activity of a specialized hospital team (Geriatric Home Care-AGD team) in support of Primary Care (PC) for the care of geriatric patients. Location: Health-5 area of the Community of Madrid. Participants, interventions and main measurements: Evaluation of patients attended at home at the request of PC by AGD, in 1997-1999 and twenty years later, in 2017-2019. Sociodemographic, clinical, functional and mental variables were recorded. Also care data such as time to first visit, average length of stay, origin and destination of patients, reason for consultation and main reason for disability. Results: 524 patients (58% of the total) requested from AP in 1997-1999 and 1196 (72.2% of the total) in 2017-2019 were attended. Currently we show an older patient, more physically and mentally disabled, with a higher prevalence of geriatric syndromes and greater social fragility. Dementia has increased as the main reason for incapacity, with an increase in Comprehensive Geriatric Assessment and clinical control as the main reasons for referral. Conclusions: in our setting, after 20 years, AGD continues to be an important support for PC in the complex approach to frail elderly patients confined to their homes, who are increasingly vulnerable from a clinical, functional, cognitive and social point of view. It contributes to the management of geriatric syndromes, deprescription, direct hospital admissions when needed without having to go to the emergency department, and a decrease in institutionalization, facilitating the maintenance of the patient at home.

Introduction: The population is aging, and older adults comprise most patients in the intensive care units. Colistin (COL) has been re-introduced to treat increasingly common resistant Gram-negative bacterial infections. Our study aims to investigate the factors affecting COL nephrotoxicity in a general population and geriatric age group. Materials and Methods: This retrospective study included 170 patients, a total of 116 (68.2%) of whom were in the geriatric group (age ≥65). Acute renal failure was evaluated using the RIFLE score. Factors associated with COL nephrotoxicity were described firstly in a general population and then in the geriatric group patients. Results: Advanced age [Odds ratio (OR): 1.043; 95% confidence interval (CI): 1.018-1.068; p=0.001] and initial serum creatinine level (OR: 23.122; 95% CI: 3.123-171.217; p=0.002) were found to be the independent risk factors associated with nephrotoxicity. In the evaluation of the geriatric population based on nephrotoxicity, the initial serum urea and creatinine levels, and overall mortality rates were found to be statistically significantly higher in the group with nephrotoxicity (p

Pendahuluan: Kegagalan perawatan endodontik umumnya terjadi akibat obturasi yang tidak adekuat dan kebocoran pada restorasi akhir. Kegagalan tersebut dapat diatasi dengan perawatan saluran akar ulang. Perawatan tersebut pada pasien geriatri memerlukan berbagai pertimbangan penatalaksanaan sesuai dengan kondisi fisiologis dan sistemik pasien. Tujuan laporan kasus ini untuk menjelaskan perawatan saluran akar ulang non-bedah gigi insisif lateral kanan atas pada pasien geriatri. Laporan kasus: Perempuan berusia 69 tahun datang ke Instalasi Rawat Jalan Spesialistik Konservasi Gigi Rumah Sakit Gigi dan Mulut Universitas Padjadjaran (RSGM Unpad) untuk memperbaiki tambalan gigi atas depan kanan yang pecah dan untuk merawat gigi tersebut karena terasa tidak nyaman saat digunakan untuk mengunyah. Gigi pernah dilakukan perawatan saluran akar dan penambalan sewarna gigi sekitar empat tahun yang lalu. Pemeriksaan intraoral menunjukan perkusi positif pada gigi insisif lateral kanan rahang atas. Pemeriksaan radiografis periapikal memperlihatkan bahan pengisi saluran akar tidak adekuat, pelebaran membran periodontal di sepertiga apikal, serta terputusnya lamina dura di sepertiga apikal. Rencana perawatan adalah perawatan saluran akar ulang non bedah. Perawatan berlangsung dalam enam kali pertemuan singkat, dengan tahapan pengambilan gutta-percha menggunakan file hedstrom, preparasi saluran akar dengan instrumen rotary, obturasi saluran akar dengan gutta-percha serta sealer resin plus dan restorasi akhir veneer direk berbahan komposit. Simpulan: Perawatan saluran akar ulang non-bedah pada gigi insisif lateral kanan atas berhasil dilakukan dengan ditandai hilangnya keluhan pasien, perbaikan pada gambaran radiografis serta gigi dapat berfungsi secara normal. Keberhasilan perawatan dipengaruhi oleh rencana perawatan yang tepat dengan mempertimbangkan faktor etiologi kegagalan perawatan endodontik serta perubahan fisiologis dan kondisi patologis yang terdapat pada pasien. Kata kunci: Perawatan saluran akar ulang, insisif lateral, pasien geriatri. ABSTRACT Introduction: Endodontic treatment failure generally results from inadequate obturation and leakage at the final restoration. This failure can be relieved by re-root canal treatment. Such treatment in geriatric patients requires various management considerations according to the patient’s physiological and systemic conditions. This case report was aimed to describe the non-surgical root canal re-treatment of maxillary right lateral incisor in a geriatric patient. Case report: A 69-years-old woman came to the Conservative Dentistry Specialist Outpatient Unit of the Universitas Padjadjaran Dental Hospital (RSGM Unpad) to repair a broken maxillary right front tooth fill and to treat the tooth due to the uncomfortable feeling each time the mastication was performed. The tooth was treated with root canals and tooth-coloured fillings about four years ago. Intraoral examination revealed positive percussion of the maxillary right lateral incisor. The periapical radiograph showed inadequate root canal filling, dilation of the periodontal membrane in the third apical, and severed lamina dura in the third apical. The treatment plan was non-surgical root canal re-treatment. The treatment took place in six short sessions, with the steps of gutta-percha collection using a Hedstrom file, the root canal preparation with a rotary instrument, and the root canal’s obturation with gutta-percha plus resin sealer and final restoration of a composite direct veneer. Conclusion: Non-surgical root canal treatment of the upper right lateral incisor was successfully performed as indicated by the absence of the patient’s complaints, improvement in the radiographic image, and the teeth’ normal function. The treatment's success is influenced by a proper treatment plan considering the aetiological factors of endodontic treatment failure, the physiological changes, and pathological conditions present in the patient. Keywords: Root canal re-treatment, lateral incisor, geriatric patient.

INTRODUCTION[|]The prevalence of sleep problems increases with age. Both anxiety and depression symptoms can cause certain changes in sleep architecture. The aim of this study is to investigate the relationship of anxiety and depression levels with sleep quality and insomnia severity in geriatric patients with depression and concomitant anxiety symptoms.[¤]METHODS[|]Fifty-three patients aged 60 and over were included in the study. Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), Insomnia Severity Index (ISI), Mini-Mental State Examination (MMSE) and Pittsburgh Sleep Quality Index (PSQI) were applied to the patients. [¤]RESULTS[|]There was a positive and statistically significant relationships between the total GDS score and the mean PSQI Subjective sleep quality and Sleep latency scores, as well as between BAI and PSQI Subjective sleep quality, Sleep latency, Sleep disturbance, Daytime dysfunction and global PSQI score (p=0.018; p=0.006; p=0.043; p=0.009; p=0.012; p=0.045; p=0.049, respectively). There was positive and statistically significant relationships between total GDS, total ISI and ISI subscale scores, and there was positive and statistically significant relationships between BAI scores, total ISI, and ISI subscale scores (p=0.002; p=0.002; p=0.001; p=0.006, respectively). [¤]DISCUSSION AND CONCLUSION[|]This study showed that sleep disorders were closely associated with anxiety and depression levels in the geriatric patients with depression. The deterioration in sleep quality and the increase in insomnia severity associated with the aging process may increase the incidence of new depressive disorders, while current anxiety and depression symptoms may cause sleep disorders.[¤]

INTRODUCTION[|]In parallel with the increase in the elderly population in our country as in the world, the rate of the patients applied to the emergency services has shown an increase. The present study aims to investigate the application reasons of the patients aged 65 and over who were followed up in our emergency internal medicine unit, to examine their current diseases, to treat their newly-emerging acute problems, and to evaluate their follow-up processes.[¤]METHODS[|]All patients aged 65 and over, who applied to the Emergency Internal Medicine Unit a tour hospital between October 2017 and December 2017, were retrospectively evaluated in this study. Gender, current disease, application reason and diagnosis (including ICD 10 codes) of the patients were recorded through their files. Applications were examined retrospectively through the hospital information system, and all data were entered into the program called SPSS 20.00 in the computer environment.[¤]RESULTS[|]The mean age of 310 geriatric patients aged 65 and over who were examined in this study was 76.6.The youngest age was 65 and the oldest age was 103. Furthermore, it was found that 149 (47.9%) of the patients were men, 161 (51.8%) of them were women, 129 (41.5%) of them were between the ages of 65 and 74, 133 (42.8%) of them were between the ages of 75 and 84, 48 (15.4%) of them were in the age of >85. The most common diseases were cardiovascular system diseases, gastrointestinal system diseases and urinary system diseases. [¤]DISCUSSION AND CONCLUSION[|]In our day, the rate of the elderly population applied to emergency services has increased. It has been found that the most common diseases are cardiovascular system diseases, gastrointestinal system diseases and urinary system diseases. In the first examination of the patients at hospitals, determination of the methods on diseases in accordance with their physical examination findings, anamnesis and medical treatment will be beneficial in terms of their life quality and survival.[¤]

Abstract Background Several approaches to medication optimisation by identifying drug-related problems in older people have been described. Although some interventions have shown reductions in drug-related problems (DRPs), evidence supporting the effectiveness of medication reviews on clinical and economic outcomes is lacking. Application of the STOPP/START (version 2) explicit screening tool for inappropriate prescribing has decreased inappropriate prescribing and significantly reduced adverse drug reactions (ADRs) and associated healthcare costs in older patients with multi-morbidity and polypharmacy. Therefore, application of STOPP/START criteria during a medication review is likely to be beneficial. Incorporation of explicit screening tools into clinical decision support systems (CDSS) has gained traction as a means to improve both quality and efficiency in the rather time-consuming medication review process. Although CDSS can generate more potential inappropriate medication recommendations, some of these have been shown to be less clinically relevant, resulting in alert fatigue. Moreover, explicit tools such as STOPP/START do not cover all relevant DRPs on an individual patient level. The OPERAM study aims to assess the impact of a structured drug review on the quality of pharmacotherapy in older people with multi-morbidity and polypharmacy. The aim of this paper is to describe the structured, multi-component intervention of the OPERAM trial and compare it with the approach in the comparator arm. Method This paper describes a multi-component intervention, integrating interventions that have demonstrated effectiveness in defining DRPs. The intervention involves a structured history-taking of medication (SHiM), a medication review according to the systemic tool to reduce inappropriate prescribing (STRIP) method, assisted by a clinical decision support system (STRIP Assistant, STRIPA) with integrated STOPP/START criteria (version 2), followed by shared decision-making with both patient and attending physician. The developed method integrates patient input, patient data, involvement from other healthcare professionals and CDSS-assistance into one structured intervention. Discussion The clinical and economical effectiveness of this experimental intervention will be evaluated in a cohort of hospitalised, older patients with multi-morbidity and polypharmacy in the multicentre, randomized controlled OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multi-morbid elderly), which will be completed in the last quarter of 2019. Trial registration Universal Trial Number: U1111-1181-9400 Clinicaltrials.gov: NCT02986425 , Registered 08 December 2016. FOPH (Swiss national portal): SNCTP000002183 . Netherlands Trial Register: NTR6012 (07-10-2016).

Background: Older persons are at risk of compromised oral conditions, including dental infections, periodontal problems, tooth loss, benign mucosal lesions, xerostomia, oral candidiasis, and oral cancer. Poor oral hygiene has contributed to increase the risk of aspiration pneumonia, as well as malnutrition, in geriatric patients. We described cases of poor oral health status associated with increased risk of malnutrition and pneumonia in geriatric. Case Report: The patients were an 80-year-old female and a 61-year-old male who were referred from the Internal Medicine Department to the Oral Medicine Clinic at the Dr. Hasan Sadikin Hospital, Bandung, for the evaluation and management of oral health problems. Their medical histories revealed that they had low nutritional intake prior to being hospitalized. Clinically, both patients had pale conjunctiva and appeared underweight. Anthropometry measurements of the female patient showed her body weight was 36 kg, height was 150 cm, and upper-arm circumference measurement was 20 cm, whereas the male patient was measured at 43 kg, 174 cm, and 20 cm, respectively. The nutritional status based on percentage upper-arm circumference measurement method or called % Lingkar Lengan Atas of both patients were 66.8%. Intraoral findings showed coated tongues, multiple gangrene radix at all regions, plaque, and calculus seen on most tooth surfaces, and a lack of saliva. A thorax radiography examination found the patients had pneumonia. A diagnosis of community-acquired pneumonia, severe malnutrition, xerostomia, and periodontitis was made for each patient. The management of the patients included administering systemic antibiotics, promoting their nutritional status gradually with adequate intake, and improving their oral health status with an antiseptic mouthwash and the rehabilitation of malfunctioning teeth. Conclusion: Oral health status has a close relationship with the risk of malnutrition and pneumonia in geriatric patients. Therefore, comprehensive management is needed to improve the quality of life of geriatric patients.

Background: Fear of falling (FOF) is common in Parkinson’s disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. Methods: In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. Results: According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Conclusion: Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

Standing up from a seated position is a prerequisite for any kind of physical mobility but many older persons have problems with the sit-to-stand (STS) transfer. There are several exosuits available for industrial work, which might be adapted to the needs of older persons to support STS transfers. However, objective measures to quantify and evaluate such systems are needed. The aim of this study was to quantify the possible support of an exosuit during the STS transfer of geriatric patients. Twenty-one geriatric patients with a median age of 82 years (1.–3.Q. 79–84 years) stood up at a normal pace (1) from a chair without using armrests, (2) with using armrests and (3) from a bed with pushing off, each condition with and without wearing an exosuit. Peak angular velocity of the thighs was measured by body-worn sensors. It was higher when standing up with exosuit support from a bed (92.6 (1.–3.Q. 84.3–116.2)°/s versus 79.7 (1.–3.Q. 74.6–98.2)°/s; p = 0.014) and from a chair with armrests (92.9 (1.–3.Q. 78.3–113.0)°/s versus 77.8 (1.–3.Q. 59.3–100.7)°/s; p = 0.089) compared to no support. There was no effect of the exosuit when standing up from a chair without using armrests. In general, it was possible to quantify the support of the exosuit using sensor-measured peak angular velocity. These results suggest that depending on the STS condition, an exosuit can support older persons during the STS transfer.

According to the forecast data in 2050, every fifth inhabitant of Poland will be in the elderly population. According to the WHO definition, a person who has over 60 years of age qualifies for geriatric care. A geriatric patient is a specific subject of nursing care due to the multitude and diversity of the course of many health problems. Extending the average life expectancy of the inhabitants of Poland is a fact that should be accepted and take holistic and individual actions towards the patient so that they meet his numerous bio-psycho-social needs. They are a determinant of the quality of health services provided. Senior care should be provided by professionals who will make an in-depth analysis and give the patient multidirectional help. It is also necessary help the family both in a situation where the patient lives alone at home, as well as when he is admitted to the hospital. The aim of the work is to show the problems of a geriatric patient staying in the hospital and the essence of nursing activities in caring for him. Because they have a big impact on the health and quality of life of seniors.

Abstract Background Due to the increase in elderly patients who undergo major abdominal surgery there is a subsequent increase in postoperative complications, prolonged hospital stays, health-care costs and mortality rates. Delirium is a frequent and severe complication in the ‘frail’ elderly patient. Different preoperative approaches have been suggested to decrease incidence of delirium by improving patients’ baseline health. Studies implementing these approaches are often heterogeneous, have a small sample and do not provide high-quality or successful strategies. The aim of this study is to prevent postoperative delirium and other complications by implementing a unique multicomponent and multidisciplinary prehabilitation program. Methods This is a single-center controlled before-and-after study. Patients aged ≥70 years in need of surgery for colorectal cancer or an abdominal aortic aneurysm are considered eligible. Baseline characteristics (such as factors of frailty, physical condition and nutritional state) are collected prospectively. During 5 weeks prior to surgery, patients will follow a prehabilitation program to optimize overall health, which includes home-based exercises, dietary advice and intravenous iron infusion in case of anaemia. In case of frailty, a geriatrician will perform a comprehensive geriatric assessment and provide additional preoperative interventions when deemed necessary. The primary outcome is incidence of delirium. Secondary outcomes are length of hospital stay, complication rate, institutionalization, 30-day, 6- and 12-month mortality, mental health and quality of life. Results will be compared to a retrospective control group, meeting the same inclusion and exclusion criteria, operated on between January 2013 and October 2015. Inclusion of the prehabilitation cohort started in November 2015; data collection is ongoing. Discussion This is the first study to investigate the effect of prehabilitation on postoperative delirium. The aim is to provide evidence, based on a large sample size, for a standardized multicomponent strategy to improve patients’ preoperative physical and nutritional status in order to prevent postoperative delirium and other complications. A multimodal intervention was implemented, combining physical, nutritional, mental and hematinic optimization. This research involves a large cohort, including patients most at risk for postoperative adverse outcomes. Trial registration The protocol is retrospectively registered at the Netherlands National Trial Register (NTR) number: NTR5932. Date of registration: 05-04-2016.

Introduction and purpose of the work. Pain is one of the most common causes of medical rescue teams’ callings. Most of the cases are solved at patients’ homes. Some problems presented by geriatric patients are too difficult to be evaluated at home and need to be admitted to hospitals’ emergency departments(ED) for further diagnosis. Geriatric patients are often burdened with multiorgan dysfunctions which can cause pain. This problem in senior population is often overlooked or underestimated Material and method. Survey was conducted among 100 patients after 65 years of age who were admitted to ED because of pain. Location, the intensity of pain before and after application of analgesia, vital signs( heart rate, blood pressure, the number of breaths, temperature), previously administered pain killers and sociodemographic factors were evaluated and noted Results. Women predominated in the study group as well as the patients with posttraumatic pain (mostly fall from the same height). Forty five percent of patients took a painkiller at home. Preliminary average rating of pain numeric scale (NRS) was 7.49 points. Respondents who received painkillers before coming to the ED, felt more severe pain than those who did not take medications (NRS 7.93 vs. 7.41). Thirty minutes after application of analgesic pain intensity averaged 3.74 points. Conclusions. Pain is a common cause among elderly patients who report to ED, despite previously adopted analgesics. It remains underestimated in prehospital care and needs special attention in emergency departments.

Aim. To develop a progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias.Material and methods. The study was carried out in 2 stages. The study sample consisted of 262 elderly and senile people (mean age, 69,5±1,1 years). There 145 elderly (mean age, 68,4±1,2 years) and 117 senile patients (mean age 74,4±1,3 years). We analyzed medications used for six months in geriatric patients with arrhytmias and senile asthenia (SA) and without it. The combined strategy of management of geriatric patients with arrhytmias and SA was tested.Results. SA is most common in geriatric patients who are taking drugs such as class I a, b, c antiarrhythmics, class V antiarrhythmics (cardiac glycosides), diuretics (torasemide, furosemide), and statins. This indicates the need to avoid polypharmacy and to adjust the treatment of geriatric patients with cardiac arrhythmias in accordance with Beers criteria. Presented study revealed that in patients with SA, the total antioxidant activity is reduced, which indicates the need to restore antioxidant defence to such patients. A combined strategy has been developed for the management of geriatric patients with cardiac arrhytmias and SA.Conclusion. The combined strategy of managing older patients with arrhytmias and SA helped to improve the geriatric status, prevent SA, and increase antioxidant defence. A significant improvement in the quality of life was noted, in particular, in relation to the mental and psychological well-being.

Latar Belakang Sebanyak 38.6% kasus kematian pasien COVID-19 di Indonesia terjadi di populasi lansia. Data mengenai profil klinis pasien rawat inap lansia dengan COVID-19 masih tidak ada. Padahal kelompok pasien ini adalah pasien risiko tinggi selama pandemi ini yang memerlukan perhatian lebih. Metode Studi deskriptif ini menggunakan data lengkap pasien lansia dengan COVID-19 yang dirawat inap di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN Cipto Mangunkusumo) dari April hingga akhir Agustus 2020. Data termasuk karakteristik klinis, gejala, komorbiditas, multimorbiditas dan luaran mortalitas pasien. Hasil Di populasi pasien lansia (n=44), mayoritas berusia di antara 60-69 tahun (68%), berjenis kelamin laki-laki (66%), dan tidak memiliki riwayat kontak erat dengan pasien COVID-19 sebelumnya (86%). Gejala tersering ialah demam, batuk, dan sesak yang merupakan gejala khas COVID-19, sedangkan penyakit kronis tersering adalah diabetes melitus, hipertensi, dan keganasan. Multimorbiditas ditemukan hanya di 14% pasien lansia, dan para pasien tersebut bertahan hidup pasca infeksi virus SARS-CoV-2. Angka kematian pasien lansia rawat inap dengan COVID-19 di studi ini adalah 23%, dan 90% dari kasus kematian berjenis kelamin laki-laki. Kesimpulan Pasien laki-laki mendominasi kasus terkonfirmasi dan kasus kematian lansia dengan COVID-19. Gejala khas COVID-19 hanya ditemukan di sekitar setengah pasien penelitian. Pasien yang meninggal dunia memiliki persentase gejala khas lebih tinggi. Gejala tidak khas pun mungkin ditemukan di pasien lansia. Immunosenescence dan fungsi imunoregulasi jenis kelamin tertentu dihipotesiskan memiliki peran penting dalam menyebabkan kematian lansia di studi ini. Kata Kunci: Profil Klinis, Lansia, Pasien Geriatri, COVID-19, Indonesia ABSTRACT Background Older people contributed to 38.6% of death cases related to COVID-19 in Indonesia. Data regarding clinical profile of hospitalised elderly with COVID-19 in Indonesia were still lacking. Older people are at-risk population in the pandemic, whom we should pay attention to. Methods This single centre descriptive study utilised complete data of elderly inpatients with COVID-19 in Indonesia’s national general hospital from April to late August 2020. The data consisted of clinical characteristics, symptoms, comorbidities, multimorbidity, and mortality outcome. Results Among elderly patients (n=44), a majority of patients were aged 60-69 years (68%), were male (66%), and had no history of close contact with COVID-19 patient (86%). The most common symptoms were fever, cough and shortness of breath (classic symptoms of COVID-19), whereas the most common chronic diseases were diabetes mellitus, hypertension, and malignancy. Multimorbidity was only found in 14% of patients, all of whom remained alive following SARS-CoV-2 infection. The death rate among elderly inpatients with COVID-19 in this study was 23%, and male older adults contributed to 90% of death cases. Conclusion Male patients dominated both confirmed cases and death cases among elderly with COVID-19. Classic symptoms of COVID-19 were only found in about half of the study patients. Non-survivors had higher percentage of the classic symptoms of COVID-19 than survivors. Atypical COVID-19 presentations are possible in older adults. We postulated that immunosenescence and sex-specific immunoregulatory function play an important role in causing death in this study cohort. Keywords: Clinical Profile, Elderly, Geriatric Patient, COVID-19, Indonesia

INTRODUCTION: The geriatric population is increasing in South Africa and globally. According to Statistics South Africa (STATSSA), people aged 60 years or older constitute approximately 8.4%-9.3% of the population in the Free State province, South Africa, the majority of which are rural dwellers. Elderly patients constitute a high percentage of patients presenting at the emergency department (ED) and it has been suggested that understanding the pattern of geriatric morbidities presenting at the ED can help prepare the healthcare workers and the healthcare system to confront the challenges of delivering acute geriatric care. In this present study, we compiled the profile of geriatric patients that presented at the ED of Botshabelo district hospital (BDH), Free State province, South Africa, with the aim of formulating evidence-based strategies to improving quality of service and patient outcome. METHODS: this was a descriptive, retrospective cross-sectional clinical audit of all geriatric cases (⥠65 years), that presented at the ED of BDH from January 1st 2017, to March 31st 2017. RESULTS: geriatric cases accounted for 25% of the total adult ED presentation at BDH. The majority (66.6%, n=197) of the patients were female and the mean age at presentation was 75 years. The majority (63.5%) of cases were self-referred and trauma (fracture) was the most frequently diagnosed morbidity. More than half (53.7%) of the cases were classified as priority 2 (P2) and the average waiting time was 86 ± 93 minutes. Less than half of the patients (48.3%; n=143) were admitted for further management, while 36.1% (n=107) of them were discharged from the ED. The remaining 46 cases (15.5%) were referred to a tertiary hospital for further management. CONCLUSION: it is crucial that healthcare facilities in South Africa recognise the special needs of elderly patients due to the growing aging population. Compiling the profile of geriatric cases presenting at ED can help identify crucial area of need and help prepare the healthcare workers and the healthcare system to confront challenges of delivering acute geriatric care. Findings presented herein will assist in formulating evidence-based strategies to improve geriatric patient outcome at the ED in BDH.

The role of hydroxychroloquine (HCQ) sulfate as therapeutic option in coronavirus disease 2019 (COVID-19) patients aroused great interest and hope, so much so as to authorize several studies in the world. Despite the beneficial effects demonstrated in vitro and in some case-series, doubts remain about its clinical use, so that at present more than 20 different therapeutic study protocols have been proposed. Very recently, a protocol has been authorized by the Italian Medicines Agency (AIFA), in order to evaluate the efficacy of out-of-hospital treatment with HCQ in the reducing viral loads and need for hospitalization in symptomatic COVID-19 infected patients who are confined at home. The article describes lights and shadows of HCQ therapy in the elderly and geriatric patients affected by COVID-19, and suggests that the geriatrician should use HCQ only after careful patient selection and be aware of its pharmacokinetic properties and adverse effects, before better-designed studies determine their benefit, if any, in treating COVID-19.

Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Materials and Methods: This study is a retrospective analysis from the Registry for Geriatric Trauma (ATR-DGU). The data were collected prospectively from patients with proximal femur fractures treated between January 2016 and December 2018. Among other factors, anticoagulation was surveyed. The primary outcome parameter was time-to-surgery. Further parameters were: type of anesthesia, surgical complications, soft tissue complications, length of stay and mortality. Results: In total, 11% (n = 1595) of patients took DOACs at the time of fracture, whereas 9.2% (n = 1325) were on VKA therapy. During the study period, there was a shift from VKA to DOACs. The time-to-surgery of patients on DOACs and of patients on VKA was longer compared to patients who did not take any anticoagulation. No significant differences with regard to complications, type of anesthesia and mortality were found between patients on DOACs compared to VKA treatment. Conclusion: An increased time-to-surgery in patients taking DOACs and taking VKA compared to non-anticoagulated patients was found. This underlines the need for standardized multi-disciplinary orthopedic, hematologic and ortho-geriatric algorithms for the management of hip fracture patients under DOAC treatment. In addition, no significant differences regarding complications and mortality were found between DOAC and VKA users. This demonstrates that even in the absence of widely available antidotes, the safe management of geriatric patients under DOACs with proximal femur fractures is possible.

This leads the geriatric patients to receive multiple drugs regimen (polypharmacy) which include using anticholinergic drugs. Risk of anticholinergics drug use is associated with cognitive impairments that have been demonstrated in experimental and cohort studies. The objective of this study is to determine the profile of anticholinergic drug use and its impact on cognitive reduction in elderly patients at Outpatient Unit Department of Kota Surakarta General Hospital. This study used cohort design. Data were collected through patient medication records and direct interviews to measure the cognitive status of patients using a six-item cognitive impairment test questionnaire (6-CIT). This study divided the respondents into two group; 178 patients (50,6%) took anticholinergic agents, and 174 patients (49,4%) did not use the anticholinergic drugs. Data analysis used Chi-square comparative test and linear regression test with SPSS (Statistical Package for Social Science). The results showed 136 patients or 58,12% use level one anticholinergic drug. The most widely used anticholinergic are diazepam (13,9%) and furosemide (12,5%). The anticholinergic drugs were extensively used by patients who suffer circulatory system diseases as much as 171 (32,1%), followed by endocrine disease, nutrition and metabolic diseases were 83 (15,6%). The number between women and men who take anticholinergics is not significantly different, 91 (51.41%) for women. Whereas by age, the number of most anticholinergic prescribed for patients who are 60 to 74 years is 124 patients (69,66%). There was a significant correlation between anticholinergic drug use in decreasing cognitive function of the geriatric at Outpatient Unit Department of Kota Surakarta General Hospital (p

Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.

According to the forecast data in 2050, every fifth inhabitant of Poland will be in the elderly population. According to the WHO definition, a person who has over 60 years of age qualifies for geriatric care. A geriatric patient is a specific subject of nursing care due to the multitude and diversity of the course of many health problems. Extending the average life expectancy of the inhabitants of Poland is a fact that should be accepted and take holistic and individual actions towards the patient so that they meet his numerous bio-psycho-social needs. They are a determinant of the quality of health services provided. Senior care should be provided by professionals who will make an in-depth analysis and give the patient multidirectional help. It is also necessary help the family both in a situation where the patient lives alone at home, as well as when he is admitted to the hospital. The aim of the work is to show the problems of a geriatric patient staying in the hospital and the essence of nursing activities in caring for him. Because they have a big impact on the health and quality of life of seniors.

Introduction and purpose of the work. Pain is one of the most common causes of medical rescue teams’ callings. Most of the cases are solved at patients’ homes. Some problems presented by geriatric patients are too difficult to be evaluated at home and need to be admitted to hospitals’ emergency departments(ED) for further diagnosis. Geriatric patients are often burdened with multiorgan dysfunctions which can cause pain. This problem in senior population is often overlooked or underestimated Material and method. Survey was conducted among 100 patients after 65 years of age who were admitted to ED because of pain. Location, the intensity of pain before and after application of analgesia, vital signs( heart rate, blood pressure, the number of breaths, temperature), previously administered pain killers and sociodemographic factors were evaluated and noted Results. Women predominated in the study group as well as the patients with posttraumatic pain (mostly fall from the same height). Forty five percent of patients took a painkiller at home. Preliminary average rating of pain numeric scale (NRS) was 7.49 points. Respondents who received painkillers before coming to the ED, felt more severe pain than those who did not take medications (NRS 7.93 vs. 7.41). Thirty minutes after application of analgesic pain intensity averaged 3.74 points. Conclusions. Pain is a common cause among elderly patients who report to ED, despite previously adopted analgesics. It remains underestimated in prehospital care and needs special attention in emergency departments.

Backgroundand Objectives: Hip fractures are among the most typical geriatric fractures. Subtrochanteric fractures are considered difficult to treat, and, to date, there is no consensus on the optimal surgical treatment. Materialisand Methods: We analyzed data from the Registry for Geriatric Trauma, which includes patients ≥ 70 years old with hip fractures or periprosthetic fractures requiring surgery (21,734 patients in 2017–2019). For this study, we analyzed only the subgroup of patients with a subtrochanteric fracture. We analyzed the difference between closed and open surgical methods on a range of outcomes, including mortality, mobility, length of acute hospital stay, and the need for surgical revisions. Results: A total of 506 patients with subtrochanteric fractures were analyzed in this study. The median age was 85 years (interquartile range of 81–89). About 21.1% (n = 107) were operated on with a closed technique, 73.3% (n = 371) with open reduction without using a cerclage, and 5.53% (n = 28) with open reduction with the additional use of one or more cerclage wires. A total of 3.56% (n = 18) of the patients had complications requiring operative revision, most commonly soft tissue interventions (open vs. closed reduction—3.26% vs. 4.67%) (p = 0.687). Patients treated with open reduction were significantly more mobile 7 days after surgery (p = 0.008), while no significant effects on mortality (p = 0.312), length of hospital stay (p = 0.968), or surgical complications (p = 0.687) were found. Conclusion: Proper reduction is the gold standard practice for successful union in subtrochanteric fractures. This study shows that open reduction is not associated with a higher complication rate but does lead to increased mobility 7 days after operation. Therefore, in case of doubt, a good reduction should be aimed for, even using open techniques.

Background: Many diseases are more common in older people than in younger people, and it may be more difficult to make a diagnosis because older patients often have nonspecific symptoms. The purpose of this study was to analyze the geriatric patients treated in an otolaryngology emergency room at a Taiwanese teaching hospital over a 5-year period. Methods: A retrospective review was performed on patients older than 18 years of age who presented in otolaryngology emergency rooms from January 2010 to December 2014. A total of 4101 patients were enrolled in this study. Patients aged older than 65 years of age were defined as the elderly group. The retrieved data incvluded age, gender, clinical presentations, and treatment modalities for further analysis. Results: A total of 502 patients (12.2%) were included in the elderly group. There were 287 males and 215 females ranging from 65 to 100 years of age with mean age of 75.7 ± 7.6. The most common need was pharyngolaryngology (n = 274; 54.6%) followed by otology (n = 128; 25.5%), rhinology (n = 77; 15.3%), and head and neck surgery (n = 23; 4.6%). Acute upper respiratory tract infection was the most frequent diagnosis. Foreign bodies were mostly found in the throat followed by the ears. Most patients with epistaxis sustained anterior nasal septum bleeding. More than 65% of the patients (335/502; 66.7%) were true emergencies. Conclusions: The non-emergent disease, acute upper respiratory tract infection was the most frequent diagnosis. Although geriatric patients had a variety of medical conditions, most can be managed with a conservative treatment strategy.

Stainless steel crowns (SSC) are extensively used in child patients. They are mainly used following the pulp therapy in deciduous teeth. They are also used in multi-surface restoration, as an abutment in space maintainers, correction of anterior tooth cross bite, restoration of hypoplasic teeth, etc. In permanent teeth, they are mainly used as interim restorations following root canal treatment in first molars prior to the eruption of permanent second molars. The main advantage of SSC is its limited chair side time, durability and ease of placement. Patients with conditions such as pregnancy and old age who cannot tolerate multiple and long appointments can greatly benefit from the use of SSC. Though SSC can be used by other dental specialties very effectively, its use seems to be limited to pediatric dentistry. Presented here are few adult cases in which SSC is given with good success.

Introduction: Malnutrition is an abnormal condition of the human body. It is caused by insufficient absorption, intake or increased nutrient losses, necessary to maintain proper health. Purpose: Performance of size the threat to society which is malnutrition. Identify the problems that malnourished people have. Identify the role that a nurse play in the care of a person suffering from malnutrition. Materials and methods: An analysis of 16 scientific articles and the contemporary literature covering nursing care of patient with malnutrition. Using the key words: malnutrition, geriatric patient, nursing care plan. Results: Nursing care of geriatric patient with malnutrition results from specific symptoms occurring in malnutrition. The most important task in nursing care of patient with malnutrition is correct, honest and objective, constant assessment of nutritional status. Taking all possible measures to prevent the deepening of the malnutrition. Cooperation with the therapeutic team and the patient. Conclusion: malnutrition and the risk of malnutrition increases proportionally along with the steady growth of the elderly. Malnutrition is affected by medical and not medical factors. Malnutrition is often diagnosed late, and evaluation is made of screening and complex tests that assess nutritional status.A group of older people characterized by a variety of health problems means that there is no single treatment for malnutrition in all patients. Treatment is multidirectional, individual, holistic for each patient. It aims to prevent the further consequences of eating disorder. An extremely important role for a nurse in an elderly person with malnutrition is to educate the patient and his family, as well as to address current mental and physical problems.

Marta Muszalik,1 Tomasz Kornatowski,2 Halina Zielińska-Więczkowska ,3 Kornelia Kędziora-Kornatowska ,1 Ate Dijkstra41Clinic of Geriatrics, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland; 2Department of Preventive Medicine and Environmental Health, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland; 3Department of Pedagogy and Nursing Didactics, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland; 4Research group iHuman, NHL University for Applied Sciences, Leeuwarden, the NetherlandsPurpose: The main aim of our research was to evaluate general health, functioning, and performance parameters, as well as care problems of Geriatric Clinic inpatients in relation to deficits in fulfilling needs. The assessment of health-related quality of life was also performed.Patients and methods: The research subjects were patients attending the Clinic of Geriatrics: 149 women and 78 men; 227 persons in total. The research was carried out using a diagnostic poll method, with the application of the Activities of Daily Living questionnaire of assessment of daily efficiency on the basis of the Katz index, the Instrumental Activities of Daily Living questionnaire, the Care Dependency Scale used to measure the level of care dependency and human needs, and the Nottingham Health Profile scale.Results: The results showed that the majority of respondents achieved high and medium levels of functional capability. The main problems associated with the fulfillment of needs were difficulties with the adoption of appropriate body posture, movement restrictions, and problems related to participating in unassisted leisure activities outside the home. The general deficit in fulfilling the needs of the patients was low. The most significant problems were related to sleep disorders, restrictions in freedom of movement, loss of vital energy, and ailments resulting in the observable presence of pain.Conclusion: Good daily functioning of elderly patients significantly depended on their intellectual and mental efficiency. Elderly patients require a comprehensive, holistic approach to a variety of problems that occur with aging.Keywords: daily activity, elderly people, human needs

Introduction: Population of geriatric patients would increase in line with that of elderly population. Health problems related to this group of people would have impact on general and oral health maintenance aiming for good quality of life. Objectives: This study aimed to determine the profile of oral health, saliva, and oral mucosa on geriatric patients at Geriatric Policlinic in Cipto Mangunkusumo Hospital. Materials and Methods: This research was a descriptive crosssectional study, which data was taken using questionnaire containing basic demographical information and oral clinical examination using standard form used by Faculty of Dentistry Universitas Indonesia. Results: The study included 75 geriatric patients, ranging from 60 to 86 of age. The mean of DMF-T score of 69 geriatric patients was 4.68 ±2.893, OHI-S 2.790 ±1.102, PBI 0.779±0.585. The mean of unstimulated salivary pH score was 6.618 ± 0.54 and stimulated buffer capacity of saliva was 7.46±2.827. Mean of salivary flow rate is 0.24mL/min and 39 people had hiposalivation. 93 normal variations and 117 pathological oral lesion was found. Conclusion: This study showed that poor oral health status and pathological oral lesion found in this study elderly population could be caused from poor salivary flow, pH saliva, and buffer capacity of saliva. Systematic oral examination of the elderly is of considerable importance and ought be carried out regularly by a dentist in collaboration with the physician; making holistic management of the elderly properly performed.DOI: 10.14693/jdi.v17i2.46

Background: Ultrathin transnasal EGD is a very safe technique in common people. This study was conducted to explore the safety and tolerance of ultrathin transnasal esophagogastroduodenoscopy (EGD) in geriatric patients. Methods: A total of 327 patients referred for diagnostic transnasal EGD were allocated to three groups on the basis of age: group A (between 70 and 85 years), group B (older than 85 years), and control (younger than 70 years). Pre-EGD anxiety was measured using the 100-mm visual analog scale (VAS). After EGD, patients were required to complete a questionnaire on pain, nausea, choking, overall discomfort, and quality of the examination either using VAS or answering some questions. The duration of EGD was timed. Blood pressure (BP), oxygen saturation (SpO2), and heart rate (HR) were monitored before, during, and after EGD. Results: There was no statistically significant association with age, gender, baseline VAS, SpO2, BP, HR, and duration of the procedure among all groups. Transnasal EGD was successfully completed in all patients. No severe complication(s) occurred in all groups. Compared to baseline data, systolic BP (SBP), diastolic BP (DBP), and HR gradually rose before endoscopy was initiated, but they decreased 5 minutes after endoscopic insertion. However, the change in SpO2 showed a contrary trend during the whole procedure. There was no statistical significance with the differential value compared to the baseline of DBP, HR, and SpO2 during the different stages between groups A, B, and control. Compared to baseline data, only SBP during following endoscopic insertion and endoscopy in group B increased with statistical significance. On the basis of the patients’ evaluation, no difference was found in intubation pain, overall discomfort, choking, nausea/vomiting, or overtolerance among the three groups. Conclusion: Ultrathin transnasal EGD has good technical performances, has high security and reliability, and is generally well accepted and preferred by geriatric patients.

Today we are faced with an aging society that may develop malnutrition because of dysphagia related to dementia, stroke, and malignancy seen often in the elderly. The preferred form of nutritional supplementation for this group is enteral nutrition, and the most appropriate long-term method is by use of a gastrostomy. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 as an alternative to the traditional operative procedure and rapidly became the preferred procedure. In geriatric patients, the principal indications are neurological dysphagia and malnutrition, related to an underlying disease or anorexia-cachexia in very elderly. PEG is contraindicated in the presence of respiratory distress, previous gastric resection, total esophageal obstruction, coagulation disorders and sepsis in the elderly. Common complications include wound infection, leakage, hemorrhage, and fistula in the general population, but aspiration pneumonia is the major case of death in this group. Risks and complications of PEG must be discussed with patients and their families; and the decision for percutaneous endoscopic gastrostomy insertion should only be made after careful consideration and discussion between managing physicians, allied health professionals, and the patient and/or family. Four ethical principles may help make feeding decisions: beneficence, non-maleficence, autonomy and justice. Attentive long-term care after tube replacement is mandatory. Acceptance of percutaneous endoscopic gastrostomy placement by patients and their families tends to increase once favorable outcomes are offered.

El Síndrome de Stevens-Johnson (SSJ) es una enfermedad dermatológica rara con afectación mucocutánea y sistémica, siendo la forma más grave de eritema exudativo multiforme y presentándose como una variante de la necrólisis epidérmica tóxica relacionado con etiología múltiple. Presentamos el caso de una paciente geriátrica de 84 años de edad, presentado SSJ relacionado con la toma de levofloxacino. La complejidad de cuidados que requirió en una unidad de hospitalización, así como la escasez de referentes bibliográficos en nuestro medio nos conllevaron a elaborar este plan de cuidados enfermeros.Stevens-Johnson Syndrome (SJS) is a rare dermatological disease with mucocutaneous and systemic involvement, with the mose severe forme of SJS, presenting as a variant of toxic epidermal necrolysis related to a multiple etiology. We report a case of geriatric patient 84 years of age present the syndrome associated with taking levofloxacin. The complexity of care require in an inpatient unit, and the paucity of references in our environment led us to develop this plan of nursing.

Objetivos: Describir en un Hospital de Media y Larga Estancia (HMLE) los resultados iniciales tras la implantación de un programa de valoración e intervención sobre la disfagia y conocer que variables mostraban diferencias significativas entre los enfermos con y sin disfagia así detectados. Métodos: Estudio descriptivo retrospectivo de la valoración realizada a los pacientes con sospecha de disfagia y de la intervención posterior en los que esta se confirmó. Se usó para dicha valoración un método clínico estandarizado que utiliza diferentes viscosidades y volúmenes. Tras su confirmación se llevaron a cabo cuidados dietéticos, posturales y formativos. Se recogieron variables demográficas, clínicas y de laboratorio. Resultados: Se incluyó a 146 pacientes, describiéndose sus correspondientes valoraciones y las intervenciones en los 110 que presentaron disfagia. Esto representó una prevalencia de disfagia del 14,8% de los pacientes ingresados. En el análisis univariante entre los pacientes con y sin disfagia, los primeros presentan al ingreso mayor presencia de sonda de alimentación (p 0,011) y menor proporción de deterioro cognitivo leve (p 0,048); y al alta menor recuperación funcional (p < 0,01) y mayor presencia de sonda de alimentación (p 0,028), de desnutrición (p < 0,01) y de mortalidad (p 0,02). Conclusiones: Para mejorar la calidad asistencial en HMLE es recomendable la implantación de un programa de atención a la disfagia, dada su frecuente presencia e importantes repercusiones clínicas. La disfagia detectada se relacionó con la presencia de sonda de alimentación y tuvo claras implicaciones evolutivas a nivel funcional, nutricional y de pronóstico vital.Objectives: To describe the initial results of the implementation of a dysphagia assessment and intervention programme and to know which variables showed significant differences between patients with and without dysphagia detected by this way at an intermediate and long stay hospital. Methods: Descriptive and retrospective study on the assessment performed to patients suspected of having dysphagia and of the subsequent intervention done on those in whom it was confirmed. A standardized clinical method using different viscosities and volumes was used. After confirming the condition, different dietary, postural, and educational cares were undertaken. Demographical, clinical, and analytical variables were registered. Results: 146 patients were included, 110 of them presenting dysphagia of whom the corresponding assessments and interventions were described. This represented a dysphagia prevalence of 14.8% among all admitted patients. The univariate analysis between patients with and without dysphagia showed that the former presented at the time of admission a higher prevalence of a feeding tube (p = 0.011) and a lower proportion of mild cognitive impairment (p = 0.048); and at the time of hospital discharge, lower functional recovery (p < 0.01) and higher presence of a feeding tube (p = 0.028), hyponutrition(p < 0,01), and mortality (p = 0.02). Conclusions: Given its frequent presentation and important clinical repercussion, and in order to improve health care quality at ILSH, the implementation of a dysphagia care programme is advisable. The dysphagia detected was correlated with the presence of a feeding tube and had clear implications on the clinical course at a functional and nutritional level and vital prognosis.

Objective: to reduce the risk from surgical treatment in geriatric cancer patients with severe concomitant cardiovascular (CV) diseases through the differentiated intra- and postoperative use of pacing technologies for correction of life-threatening cardiac rhythm and conduction disturbances.Subjects and methods. Two hundred and eight patients (mean age 72.0±5.8 years) receiving pulse-reducing cardiotropic therapy to compensate for CV disorders, who had undergone extensive radical surgical interventions for abdominal and small pelvic malignancies of mainly Stage III (mean duration 4.2±1.6 hours) under multimodal general anesthesia, were examined. A pacing technique was chosen depending on the pattern of arrhythmia and antrioventricular (AV) block.Results. During CV therapy, bradycardia at a heart rate of 44 to 57 beats per min was identified in 71 (34.1%) patients. Perioperative pacing correction of bradycardia was required in 58 (27.9%) patients, of them 46 had no AV conduction disturbances, which permitted the use of transesophageal atrial pacing (TEAC). Endocardial pacing was performed in 12 patients with impaired AV conduction and bradysystole in the presence of persistent atrial fibrillation during and early after surgery. In the postoperative period, it was necessary to continue long-term (more than 20 hours) TEAC in the asynchronous mode in 7 patients. Extensive surgical interventions of the planned volume were made in all the patients being examined. None patient had any CV events, including pacing complications.Conclusion. Temporary pacing techniques are effective in correcting critical circulatory disorders during surgical treatment in elderly patients with persistent drug-induced bradycardia when they are treated with cardiotropic drugs.

Spinal subdural haematoma is rare and may be associated with blood dyscrasia, anticoagulant therapy, lumbar puncture, rupture of arteriovenous malformation, tumour bleeding and spinal trauma. We present a 65-year-old female with history of hypertension and atrial fibrillation. She was on anticoagulant. She presented to the emergency department with an acute lumbar back pain, severe paraparesis and urinary retention. Examination on admission, revealed lower limb paralysis (grade 1/5), cauda equina syndrom and difficulty in self-voiding. A lumbar spine magnetic resonance imaging (MRI) scan was arranged urgently. No coagulation abnormality was detected. MRI demonstrated an epidural haematoma at T12-L1 with spinal cord compression. Decompression was recommended but the patient refused surgery. A complete resolution of the haematoma and neurological recovery ensued without surgical intervention. Neurological recovery was observed within 24 h after Spinal subdural haematoma onset. MRI one month later showed total absorption of haematoma. One year later, the patient always has urinary retention, and she is under intermittent catheterization. Surgical decompression is still the main treatment option of Spinal subdural haematoma, however, a conservative therapeutic approach with careful observation may be considered as a treatment of choice in some cases where surgery is refused (high risk or other reasons) and neurologic recovery is early and sustained.

When geriatric patients with maxillofacial defects are handled, the clinician must be confident of addressing and managing the psychology of these patients. It is also required that the clinician must understand and be sensitive to the medical and financial states of geriatric patients. The loss of an eye has a far-reaching impact on an individual’s psychology and an immediate replacement is necessary to promote the physical and psychological healing of the patient and to improve his/her social acceptance. Special approaches and treatment goals are considered while treating geriatric patients with ocular defects and special consideration is given to the appointment length, the number of appointments and their medical and financial statuses. This article presents the prosthetic rehabilitation of a geriatric patient with an ocular defect, with a customized stock ocular prosthesis, by using a minimal intervention geriatric approach.

A number of techniques have been advocated for the treatment of recurrent temporomandibular joint dislocation. Autologous blood injection around the articular capsule and/or into the articular cavity, which is one of the treatment modality, was recently reintroduced. We report a case of 82-year-old female with bilateral recurrent temporomandibular joint dislocation, treated by technique of autologous blood injection. The outcome was successful and required no further treatment in eight months follow up, thus the procedure had proven to be safe, simple, minimally invasive and cost effective.

The aim of our study was to find out the changes of cognitive functions of geriatric patients after orthopedic surgery and when these differen­ ces are marked. We also tried to find out factors, which have influence on the results of common mental activity, to estimate the dynamics of mental activity and to choose the most optimal intervals of estimation. The population of our investigation consisted of 25 consecutive adult patients, undergoing orthopedic operation, applying regional anesthesia. Neurophysiological assessment where all patients underwent neurophysiological tests consisted of the Mini-mental State Examination (MMSE), 6 Item Cognitive Impairment test (6CIT), Trail-making test – a neuropsychological test of visual attention and task switching. Patients were tested the day before the surgery (MMSE1, 6CIT1, TMT1), on the day of the surgery (MMSE2, 6CIT2, TMT2) and on the third day after the surgery (MMSE3, 6CIT3, TMT3). The day before the surgery reveals that results of MMSE1, 6CIT1 tests were better in a group of younger patients. We found that the results of the MMSE test were significantly worse 3 days after the surgery than those before the procedure in the A group, p = 0.016. The biggest digression was fixed in “copying” and “repeating” after the surgery intervention, p = 0.01, p = 0.04. The orientation in time significantly decreased in the group B after the surgery, p = 0.00. MMSE, 6CIT, TMT test results were significantlt worse in older patients rather than younger ones 3 days after the surgery. We set that the elderly have a significantly shorter duration of education. Younger patients and patients with a longer studying period achieved better results of tests. The results mean that age and lasting of education are significant predictors of POCD. Our pilot study confirmed that POCD develops for older patients, undergoing neuroaxial anesthesia for orthopedic surgery. It is very important to continue studies and reveal how to decrease POCD events, keep the quality of life.