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Objective: Airway management in the elderly may be challenging. Supraglottic airway devices (SADs) may be used to provide airway security. The aim of study was to compare the efficacy and safety of different SADs, LMA classic (c-LMA), proseal LMA (p-LMA) and i-gel in anaesthetised and non-paralysed elderly patients. Method: The study was approved by a local ethics committee. Eighty patients, aged older than 65 years, who were scheduled to undergo elective urological or orthopaedic surgery participated in the study. Each patient was randomly allocated into 1 of 3 groups: Group C: c-LMA (n=26), Group P: p-LMA (n=27) or Group I: i-gel (n=27). The primary outcome was oropharyngeal sealing pressure (OSP). Secondary outcomes included the adequacy of positive pressure ventilation, ease of insertion, success rates, time to insertion, haemodynamic response and complications such as sore throat and dysphagia. Results: There were no significant differences among the groups with respect to OSP (p=0.852), whereas there was a statistically significant difference between Group I and Group C in terms of leak volume and leak fraction (p=0.042 and p=0.020, respectively). Adverse events were similar among the groups (p>0.05). Conclusion: In this study, although the leak volume and leak fraction were lower in i-gel inserted patients, it was shown that i-gel, c-LMA and p-LMA provided adequate airway in elderly patients who were not applied muscle relaxants and will be operated under general anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: We propose a functional treatment strategy for fragility fractures of the pelvis (FFP) in geriatric patients; patients with such fractures normally undergo 10 days of conservative therapy with full-weight bearing within pain limits. Conservative therapy for FFP is continued for patients who can stand with assistance, and surgical stabilization is recommended for patients with difficulty in auxiliary standing at 10 day postadmission. This study aimed to compare the outcomes of functional treatment between geriatric patients with FFP type I/II and those with FFP type III/IV, as described by Rommens et al. Methods: We conducted a retrospective study of 84 geriatric patients who underwent functional treatment for FFP. Based on the results of the first examination, the patients were allocated to the following FFP types: type I/II (n = 53) and type III/IV (n = 31). Change in functional mobility scale described by Graham et al. from before injury to the final follow-up were compared between the groups. Results: There was no significant difference in the functional mobility scale (0.25 ± 0.70 vs. 0.23 ± 0.56, p = 0.889) between FFP type I/II and FFP type III/IV. Conclusion: The outcomes of the functional treatment for FFP for the geriatric patients did not differ significantly between the radiographic classifications. Functional treatment could, therefore, be a treatment option for almost all radiographic types of FFP, especially for geriatric patients. Further investigations are warranted. [ABSTRACT FROM AUTHOR]

Copyright of Zdravotnicke listy is the property of Alexander Dubcek University in Trencin, Faculty of Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Type 2 diabetes is a frequent chronic disease. Given its strong positive association with older age, it is a significant public health issue in elderly populations. Furthermore, the aging of the population, driven by increasing life expectancy in high and middle-income countries leads to an increasing prevalence of diabetes.Although the same diagnostic criteria apply to the elderly and to younger people, there are unique aspects to the care for elderly type 2 diabetes patients. Both treatment goals and preferred medications, as well as non-pharmacological approaches should be adjusted in the elderly. For example, increasing the amount of physical activity may encounter difficulties, while introducing an appropriate diet may be more challenging. The patients' therapeutic adherence requires special attention due to cognitive and physical limitations. The most important treatment goal is to avoid hypoglycemia. Frailty, social and economic issues, comorbidities and the consequent polypharmacy frequently causing drug-drug interactions, as well as the increased danger of drug toxicity due to renal failure are only some of the problems that make the health care for old diabetes patients extremely difficult. Adequate care requires cooperation from a multidisciplinary team of health care professionals.Acute diabetes complications have a higher mortality in the elderly, thus close attention must be paid to avoid them. Family members should be involved in the care of elderly diabetes patients, and it is recommended to educate them on clinical signs of complications. Regular care for the patients including feedback on quality of life and early signs of health issues are essential.

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

Aim: Primary hyperparathyroidism is the most important cause of clinically hypercalcemia. Parathyroid adenomas are the most common endocrinology disorder in primary hyperparathyroidism. In this study, we aimed to evaluate the reliability of this surgery in patients older than 65 years by examining the data of patients who underwent parathyroidectomy for parathyroid adenoma. Material and Method: Patients were divided into two groups as those aged 65 years and over and adults. Age, gender, comorbidities, ASA score, preoperative and postoperative laboratory findings, imaging methods and operative times were reviewed. A p value of <0.05 was used for significance. Results: Ninety patients with parathyroid adenoma were included in the study. Female gender was dominant in both groups. The mean age was 52.15 } 8.87 in Group 1 and 71.39 } 5.76 in Group 2. When the associated co-morbidity was evaluated, no statistical difference was found between the two groups for diabetes mellitus and hypertension diseases. When the patients with nephrolithisis were evaluated, there were 21/64 (32%) kidney stones in group 1 and 6/26 (23%) kidney stones in group 2 and there was no statistical difference in both groups. Although the ASA score was higher in the geriatric group, there was no difference between the duration of surgery and length of hospital stay. There were no postoperative complications and morbidity. Conclusion: Adenoma surgery is an effective treatment method for primary hyperparathyroidism. Additional diseases and geriatric age period patients do not lead to an increase in surgical efficacy and complication rates. The surgeon procedure time was not prolonged despite the significant difference in ASA score in geriatric patients. Minimally invasive parathyroidectomy is a safe surgical procedure in geriatric patients. Our study as far as we know is the first in our literature about minimal invasive parathyroidectomy on geriatric patients. [ABSTRACT FROM AUTHOR]

Objective: 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). 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. [ABSTRACT FROM AUTHOR]

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Geriatric dentistry is the delivery of dental care to older adults involving diagnosis, prevention, management and treatment of problems associated with age related diseases. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. There is evidence that oral diseases impact cardiovascular, endocrine and pulmonary health particularly in the elderly, which will certainly provide additional stimuli for the elderly to seek dental care. Improving the quality of life at old age will demand tooth retention and consequently the need for restorative care. Retaining teeth disease free and maintaining them amidst multitude of risk factors associated with old age, is a multifaceted challenge. . The future implications of Geriatric dental care are of considerable importance. Commitment by dentists to meet the oral health needs of this geriatric population is key to the improvement and change in the current status of this population. This review article discusses various dental diseases seen in geriatric patients and their management. [ABSTRACT FROM AUTHOR]

Objective: 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. 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 FROM AUTHOR]

Copyright of Journal of Surgery & Medicine (JOSAM) is the property of Journal of Surgery & Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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). [ABSTRACT FROM AUTHOR]

Almost one third of colorectal cancer (CRC) cases are diagnosed in an emergency setting, mostly among geriatric patients. Clinical scenarios are often complex and decision making delicate. Besides the obvious need to consider the patient's and/or family and care givers' desires, the surgeon should be able to make the best educated guess on future outcomes in three areas: oncological prognosis, morbidity and mortality risk, and long-term functional loss. Using simple and brief tools for frailty screening reasonable treatment goals with curative or palliative intent can be planned. The most frequent clinical scenarios of CRC in emergency are bowel obstruction and perforation. We propose treatment algorithms based on assessment of the patient's overall reserve and discuss the indications, techniques and impact of a stoma in the geriatric patient. Bridge to surgery strategies may be best adapted to help the frail geriatric patient overcome the acute disease and maybe return to previous state of function. Post-operative morbidity and mortality rates are high in emergency surgery for CRC, but if the geriatric patient survives the post-operative period, oncological prognosis seems to be similar to younger patients. Because the occurrence of complications is the strongest predictor of functional decline and death, post-operative care plays a major role to optimize outcomes. Future studies should further investigate emergency surgery of CRC in the older adults focusing in particular on functional outcomes in order to help physicians counsel patients and families for a tailored treatment. [ABSTRACT FROM AUTHOR]

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.

Background/objective: In 2020 the COVID-19 pandemic posed a major challenge to the healthcare system. The hypothesis is that the COVID-19 pandemic in 2020 had an impact on the care of older adults with proximal femoral fractures due to resource scarcity, regardless of whether or not the patient was infected., Material and Methods: This study analyzed the data of 87 hospitals which entered 15,289 patients in the Geriatric Trauma Register ("AltersTraumaRegister DGU®", ATR-DGU) in Germany in 2019 and 2020. In this study we analyzed the influence of the COVID-19 pandemic on the inpatient treatment of hip fractures as well as the mid-term follow-up during the first 120 days. For the main analysis, we compared patients documented during the COVID-19 pandemic in 2020 (April-December) with a control group in 2019 (April-December). Additionally, we performed a subgroup analysis of the periods with high COVID-19 incidence rates., Results: Between 2019 and 2020 a total of 11,669 patients (2020: n = 6002 patients vs. 2019: n = 5667 patients) were included in this study. Only minor differences were found between the patients treated during the pandemic; however, when the COVID-19 incidence in Germany was greater than 50/100,000 residents, significantly fewer patients (p < 0.001) were discharged to a geriatric rehabilitation ward (27.2% vs. 36.3%) and an increased mortality rate during inpatient treatment was determined (8.4% vs. 4.6%) (p < 0.001)., Discussion: The healthcare system was able to respond to the pandemic and patients' clinical courses were not impaired as long as the incidences were low. Nevertheless, the healthcare system reached its limits in times of higher incidence, which was also directly reflected in the patient outcome, mortality and place of discharge., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Aim: To determine the association between family functionality and mild cognitive impairment in the family with the elderly., Methodology: Analytical cross-sectional design in families with geriatric patients. A family with a geriatric patient was considered when at least one of its members was over 60years of age. The comparison groups were the family with a geriatric patient without cognitive impairment and the family with a geriatric patient with mild cognitive impairment determined with the MoCA instrument. Family functionality was evaluated with the family APGAR instrument, which identifies three categories: family functionality, moderate family dysfunction, and severe family dysfunction. Statistical analysis included Chi square and Mann-Whitney test., Results: In the family with a geriatric patient, in the group without cognitive impairment the prevalence of family functionality is 89.7% and in the group with mild cognitive impairment the prevalence of family functionality is 59.3% (MW=4.87, P<.000)., Conclusion: There is an association between family functionality and mild cognitive impairment., (Copyright © 2023 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

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.

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Due to the introduction of new medical technologies, there is an increase in the number of people, including those of elderly and senile age, who have extended their lives but need constant care at home from medical and social services. Research on age differences in biological needs with home care found for middle-aged people, when compared with elderly and senile-aged individuals, that the greatest difficulties and the greatest contribution to a reduction of the quality of life were made by insufficient nutrition, limited independence in the performance of household manipulations due to joint damage, pain, and other biological causes, as well as hypothermia syndrome. People of older age groups were characterized by the need to bridge the lack of communication, to enhance the role of the family in the implementation of care, and to increase confidence in caregivers and the availability of medicines and religious services. The original model of biopsychosocial, activating, home care for the geriatric contingent of patients differs from traditional approaches in the use of activating kinesiotherapy and cognitive exercises. Developed on the basis of identified age-based determinants of the quality of life, it contributes to the achievement of a higher level of functionality and independence of the geriatric patient, which is accompanied by an improved quality of life. [ABSTRACT FROM AUTHOR]

Introduction. Geriatric age is a natural stage of human ontogenesis, which is usually characterized by a decrease in overall efficiency, increased degradation of mental and physical functions. Aim. Assessment of attitudes of students of nursing major towards people of geriatric age. Material and methods. The study covered 202 students of nursing major; a diagnostic survey using own survey questionnaire. Results. Students declared that they were treating elder people with respect and kindness, they pointed to a positive image of the elderly person, however associated the phenomenon of ageing with disability and diseases. Unfortunately, almost half of the respondents would not like to work with elderly people in the future. Most of the respondents declare helping elderly people -- these were younger people as well as people living with seniors. Nearly half of the respondents would not allow their loved ones to be taken to a special facility even if they had a severe illness and most often it related to people who have elderly people in their surroundings. Conclusions. The majority of respondents shows positive attitudes towards people of geriatric age and points to their positive image, while the majority of respondents associates old age in a negative way. Nearly half of the respondents would not like to work with elderly people in the future. Nearly half of the respondents would not allow a loved person to be taken to a special facility even if they had a severe illness and a significant proportion of respondents help elderly people. [ABSTRACT FROM AUTHOR]

Objective: Most of the dental treatments are performed by local anesthesia. However, there may be dental procedures where general anesthesia and sedation are required. General anesthesia in geriatric patients carries more than normal risk. The aim of this study is to discuss the anesthetic approaches in elderly patients who may have serious risks for anesthesia. Method: A total of 8535 patients who were treated between April 2014 and April 2018 in the general anesthesia operating room of our hospital were examined. The records of 42 patients aged 65 years and older were evaluated retrospectively. Results: The 61.9% of the patients were female and 38.1% of them were male. The rates of patients undergoing sedation and general anesthesia were 52% and 48%, respectively. Nasal intubation was performed in 16 patients and oral intubation in 4 patients. The average duration of anesthesia was recorded as 75.52 minutes. In 35% of the patients, only local anesthetic infiltration, however in addition to infiltration local anesthetics tramadol was used in 35%, paracatemol in 15% and nonsteroid antiinflammatory drug in 5% of the patients were used for postoperative analgesia. The most common concomitant disorder was hypertension and diabetes. The patients were mostly using antihypertensives, oral antidiabetic, antiarrhythmic and anticoagulant drugs. Conclusion: Patients with geriatric age are especially at risk for anesthesia. If general anesthesia is preferred for dental surgery in elderly patients; in order to reduce the complications that may occur we should be more concerned about the physiology of this age group, accompanying comorbidities and the anesthetic interactions of the drugs they are using. [ABSTRACT FROM AUTHOR]