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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 patients 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.

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Background: Triage refers to classifying and prioritizing patients based on the severity of their injuries or illnesses in the health care setting. The increasing number of elderly patients seeking care in emergency departments (EDs) highlights the need for special attention to the unique needs of this patient population. Aim: We aimed to compare the qSOFA, Emergency Severity Index (ESI), National Early Warning Score (NEWS), and Manchester Triage System (MTS) scores to assist ED physicians in assessing the severity of elderly patients' clinical conditions and triaging them appropriately. Methods: This cross-sectional study included 1066 patients aged 65 and over who presented to our ED as outpatients or by ambulance between September 1, 2022, and August 30, 2023. Scoring systems at the time of admission to the ED were recorded separately for outpatients and arriving by ambulance. Results: According to the qSOFA, patients with a score of 0 were 0.976 times less likely to arrive by ambulance compared to those scoring 1 and above (OR = 0.976, p =.934). According to the NEWS, patients in the moderate-risk category were 0.447 times less likely to arrive by ambulance (OR = 0.447, p =.054). According to the ESI score, patients requiring high resource use with normal vital signs were 146.758 times more likely to arrive by ambulance (OR = 146.758, p =.001). Conclusion: Significant differences in patients' methods of presentation to the ED were observed based on the MTS, qSOFA, NEWS, and ESI scores. [ABSTRACT FROM AUTHOR]

Background: The aim of the current study is to evaluate the effects of inflammation markers on infection and mortality in patients over 65 years of age monitored in the intensive care unit (ICU). In this study, we attempted to determine the significance of the pan-immune–inflammation value (PIV); the neutrophil–lymphocyte ratio (NLR); the platelet–lymphocyte ratio (PLR); the monocyte–lymphocyte ratio (MLR); the systemic immune–inflammatory index (SII); the systemic immune response index (SIRI); multi-inflammatory indices (MIIs) 1, 2, and 3; and the CRP/albumin ratio (a new biomarker) as prognostic and mortality markers in patients over 65 years of age being monitored in the ICU. Methods: This multicenter, retrospective, cohort study was conducted on patients aged 65 and over who were admitted to two tertiary-level ICUs. Patients with cirrhosis, bone marrow transplantation, hematologic malignancy, steroid intake, current chemotherapy treatment, and neutropenia upon admission to the ICU were excluded from this study. Results: A total of 333 patients were included in this study. The group's 28-day mortality was found to be 31.8%. When each inflammatory marker associated with 28-day mortality was examined, the CRP/albumin ratio was found to be a better indicator than both the NLR and the SIRI, and the results were statistically significant (AUC: 0.665, 95% CI: 0.604–0.726, and p < 0.001). The NLR showed moderate discriminative ability in distinguishing mortality risk (AUC: 0.593, 95% CI: 0.526–0.660, and p = 0.006). Although the SIRI was lower than the NLR, it produced a statistically significant result (AUC: 0.580, 95% CI: 0.514–0.646, and p = 0.019). The CRP/albumin ratio was the most effective inflammatory marker in predicting mortality risk in older patients admitted to the ICU. Conclusions: It is important to monitor inflammatory markers (especially CRP/albumin ratio, NLR, SIRI, and MII 1-2-3) in older patients admitted to the ICU in order to accurately predict 28-day mortality. In the current study, the effects of PIV, MLR, PLR, and SII on the prediction of 28-day mortality in older ICU patients could not be demonstrated. We believe that more clinical studies are needed to determine the effects of PIV, MLR, PLR, and SII on short- and long-term prognoses and survival in older ICU patients. [ABSTRACT FROM AUTHOR]

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Trazodone is the main anxiolytic used in veterinary medicine because it significantly reduces physiological stress in cats and dogs. In this case, the animals are prone to illness due to the body's decreased immunity. Four drugs from four different classes can be used to relieve acute situational fear and anxiety in dogs and cats: trazodone, gabapentin, alprazolam and oral dexmedetomidine. Of all of these, trazodone is the first choice for both veterinarians and humans, and the commonly chosen commercial product is Trittico. It is worth noting that trazodone can be administered both per os and intravenously. The oral route of administration has been chosen because side effects are rarer.,and the acceptable absolute bioavailability was 84.6%. Dosages were used according to behavioral or medical conditions. In anxiety the dose in dogs is: 1-16 mg/kg q24h for single daily medication or 1-19 mg/kg q24h in combination with other drugs, and in single administration the dose is between 2-14 mg/kg q24h. In behavioral stress in dogs the dose is 3.7 mg/kg alone/combined with NSAIDs, tramadol or other drugs. For sedation, the dose is 3.5 mg/kg q 12-24h.In cats no dose studies are reported. Only in case of accidental stress the dose of 7-15 mg/kg q 24h for 1-1,5h is mentioned.In behavioral stress in dogs the dose is 3.7 mg/kg alone/combined with NSAIDs, tramadol or other drugs. For sedation the dose is 3.5 mg/kg every 12-24h. In cats no studies on the dose administered are reported. In dogs in preoperative administration the dose is between 5-7 mg/kg combined with an opioid (Tramadol, Bupaq/Alvegesic). Postoperatively give 1-3 mg/kg in combination with tramadol for 3 days. Trazodone has a much higher risk of adverse reactions in geriatric patients including: callus, vomiting, colitis, sedation, sedation, increased appetite, paradoxical excitement and panting, hypersalivation and behavioral disinhibition in dogs, and hypersalivation, paradoxical excitement, ataxia, vomiting, diarrhea, callus in cats. [ABSTRACT FROM AUTHOR]

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

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Objective: A significant portion of admissions to emergency departments are made up of elderly patients. We aim to determine the causes of acute abdomen in geriatric patients requiring emergency surgery, evaluate postoperative intensive care needs and mortality rates, and raise awareness about this patient group. Methods: Patient files of individuals aged 65 and older who were consulted in our hospital's emergency department and subsequently admitted to the general surgery service between 2021 and 2023 were retrospectively reviewed. Data including age, gender, underlying diseases, additional illnesses, duration of stay in the intensive care unit, cause of mortality, and length of hospital stay were extracted from the patient's records. The collected data were analyzed statistically for comparisons. Results: Data of 27 patients were accessed these patients, 40.7% (n=11) were female, and 59.3% (n=16) were male. The average age of the patients was determined to be 74.81 years (ranging from 65 to 88). Thirteen patients, comprising 5 males and 8 females, were monitored in the intensive care unit. 6 patients experienced mortality, and all of them were those admitted to the intensive care unit. When comparing mortality rates based on gender, it was 18.8% in male patients and 27.3% in female patients. All 27 patients had at least one comorbidity. Patients who experienced mortality had at least two comorbidities. Twelve patients did not undergo surgery. Conclisions: In the emergency assessment of geriatric patients, a prompt diagnosis should be made, considering comorbidities after diagnosis, and follow-up and treatments should be adjusted multidisciplinary for patients requiring intensive care or those to be monitored in regular rooms. [ABSTRACT FROM AUTHOR]

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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.

Objective: In this study, we aimed to investigate the relationship between older patients with various illnesses' anxiety and Coronavirus disease-2019 (COVID-19) fear of death. Materials and Methods: An elderly population made up the study participants who applied to the Gaziantep University Faculty of Medicine, Department of Geriatrics Outpatient in order between 01.02.2022 and 01.05.2022, had at least one disease, and were under treatment. The sociodemographic data form and the COVID-19 fear scale, the death anxiety scale, and the fear of death scale were administered to all patients. SPSS for Windows 22 (Statistical Package for Social Sciences for Windows 22) was used in the calculations. Results: Two hundred and fifty patients who met the inclusion requirements received examination with a variety of tools. Two hundred and thirty four patients who completely filled out the forms were used in the analysis. The mean age of the patients was 70.51±6.11 years, 114 (48.7%) were male, and 120 were female (51.3%). COVID-19 fear scale and fear of death scale were statistically significantly higher in women (p=0.037, p=0.010, respectively). Cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, genito-urinary, and multisystem-related diseases were diagnosed in the participants. The groups' differences on the death anxiety scale were statistically significant (F: 2.805, p=0.012) as a consequence of the comparison of the groups. Conclusion: This was the first study to group the diseases in the elderly according to the systems and compared with the fear of COVID-19, anxiety of death, and fear of death. To generalize the results, prospective controlled research with bigger samples is required. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Depigmented skin lesions are commonly encountered in day-to-day practice and can cause significant social stigma. They are challenging to diagnose clinically and histopathologically. Idiopathic Guttate Hypomelanosis (IGH), a pigmentary condition commonly affecting older individuals, can lead to cosmetic deformity and have a significant psychological impact. Dermoscopic evaluation offers a quick and easy way to resolve diagnostic confusion and prevent unnecessary biopsies. Aim: To study the clinical and dermoscopic features of IGH. Materials and Methods: This cross-sectional observational study was conducted in the Department of Dermatology, Venereology, and Leprosy at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh (MP), India from July 2021 to June 2022. A total of 180 patients with IGH lesions underwent a detailed clinical history, dermatological and systemic examinations, followed by dermoscopic examination. The collected data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the results were tabulated in terms of distribution, frequency, and mean±Standard Deviation (±SD). Results: Among the 180 patients, the most affected age group was 51-60 years. A total of 108 (60%) were females and 72 (40%) were males. The most common site of involvement was the distal part of the lower extremity in 152 (84.4%) cases, followed by the distal part of the upper extremity in 115 (63.8%) cases. A total of 46 (25.5%) patients had a history of excessive sun exposure. Additionally, 21 (11.6%) patients had other associated features of photoaging, such as xerosis, solar lentigo, seborrhoeic keratosis, freckles, and actinic keratosis. The most common dermoscopic pattern observed was amoeboid in 103 (57.2%) patients, followed by feathery in 41 (22.7%), petaloid in 23 (12.7%), nebuloid in 13 (7.2%), and a combination of patterns in six percent of patients. Conclusion: The IGH was more common in females and older age groups, with the distal parts of the lower extremity being the most frequently involved site. Excessive sun exposure was a common risk factor for IGH, and several patients may have associated signs of photoaging. The most common dermoscopic pattern observed was amoeboid. Therefore, clinical dermoscopic examination can be helpful in identifying IGH and differentiating it from other depigmented lesions. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome causing severe nutritional and respiratory complications. Objective: We aimed to describe the characteristics and therapeutic needs of older patients with OD admitted to a general hospital. Design, Participants and Measurements: Prospective cohort study with patients (≥70 years) with OD consecutively admitted to a general hospital. OD was clinically assessed with the Volume-Viscosity Swallowing Test and nutritional status with the Mini Nutritional Assessment-short form. Oral health (OH) and periodontal diseases were evaluated by dentists. Functionality, frailty, sarcopenia, comorbidities, dehydration, quality of life (QoL) and mortality were also assessed. Results: We included 235 patients (87.3±5.5 years) with OD hospitalized for acute diseases (9.6±7.6 days). On admission, they had low functionality (Barthel: 51.3±25.1), frailty (Fried: 3.9±0.9; Edmonton: 10.3±2.7, 87.2–91.1% frail) and high comorbidities (Charlson: 3.7±2.0). Moreover, 85.1% presented signs of impaired safety and 84.7% efficacy of swallow. Up to 48% required fluid adaptation with a xanthan gum-based thickener (89.4% at 250 mPa·s; 10.6% at 800 mPa·s) and 93.2% a texture-modified diet (TMD) (74.4%, fork-mashable; 25.6%, pureed). A total of 98.7% had nutritional risk, 32.3% sarcopenia and 75.3% dehydration. OH was moderate (Oral Hygiene Index-simplified: 2.0±1.3) and 67.4% had periodontitis. QoL self-perception was 62.2% and 5.5% of patients died during hospitalization. Conclusion: Hospitalized older OD patients have impaired safety of swallow, frailty, malnutrition, dehydration, low functional capacity and poor OH and high risk of respiratory infections. They need a multimodal intervention including fluid thickening, TMD, thickened oral nutritional supplementation and OH care to improve health status and reduce OD-associated complications. [ABSTRACT FROM AUTHOR]

Buccal foams containing omeprazole (OME) have been developed as potential drug delivery systems for individuals encountering swallowing difficulties, particularly pediatric and geriatric patients. The buccal foams were formulated from lyophilized aqueous gels of maltodextrin, used as a sweetener, combined with various polymers (alginate, chitosan, gelatin, tragacanth) to fine tune their structural, mechanical, and physicochemical properties. Consistent with the requirements for efficient drug delivery across buccal epithelium, the foam comprised of hydroxypropyl methylcellulose and alginate (HPMC-Alg-OME), exhibited moderate hardness and high mucoadhesion resulting to prolonged residence and increased transport of the active across porcine epithelium. The HPMC-Alg-OME foam induced a 30-fold increase in the drug's apparent permeability across porcine buccal tissue, compared to the drug suspension. The developed buccal foams exhibited excellent stability, as evidenced by the unchanged omeprazole content even after six months of storage under ambient conditions (20 °C and 45% RH). Results indicate that buccal foams of omeprazole may address the stability and ease of administration issues related to oral administration of the drug, particularly for children and elderly patients who have difficulty swallowing solid dosage forms. [Display omitted] • Development of an easy-to-administer buccal foam of omeprazole for patients with swallowing difficulties. • The foam significantly increased omeprazole's permeability across buccal tissue compared to the drug suspension. • Buccal foams of omeprazole address stability and administration challenges for children and elderly patients. [ABSTRACT FROM AUTHOR]

Introduction: appendicitis remains the most assisted intra-abdominal surgical emergency; its diagnosis in the elderly is more difficult due to atypical presentations and comorbidities. Objective: to characterize epidemiologically, clinically and anatomopathologically geriatric patients operated on for acute appendicitis. Methods: an observational, descriptive investigation of a series of cases was carried out. Eighty-nine patients older than 60 years old operated for acute appendicitis and discharged alive were included in the study. A documentary review of medical records and biopsy reports was carried out and epidemiological, clinical and anatomopathological variables were defined. Results: patients between 60 and 69 years of age (66.2%) and male sex (58.4%) predominated. There was a higher number of patients operated in less than 24 hours (39, 43.8%) with a diagnosis of acute catarrhal appendicitis. Postoperative complications were dominated by surgical wound sepsis (7.86%) and pneumonia (5, 61%). The most frequent anatomopathologic diagnosis was acute catarrhal appendicitis (43, 48.3%). Conclusions: a greater number of patients were diagnosed and operated before 24 hours. The delay in diagnosis and treatment coincided with anatomopathological findings of complicated appendicitis. Several clinical and surgical complications were less frequent in other age groups. [ABSTRACT FROM AUTHOR]

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.

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Aim: Malnutrition, as one of the significant risk factors for falling, causes adverse consequences for the patient. The progression of malnutrition and the risk of falling increases significantly with age and contributes to the repeated hospitalisation of the geriatric patient. Identification, analysis and synthesis of studies related to malnutrition as a risk factor for falls in hospitalised geriatric patients. Method: We carried out the literature review on licensed electronic databases PubMed, Scopus and Web of Science in the period 2005-2022. Of total number of 2,743 studies studied, we included five in the final analysis. Results: The analysed studies confirmed the association between malnutrition and the risk of falls in the geriatric patient population. Patients aged ≥80 years, BMI <20 and the presence of hypoproteinaemia or hypoalbuminaemia led to reduced mobility and self-sufficiency, increased risk of falls, increased incidence of falls and recurrent falls with consequent injury during hospitalisation. Conclusion: Malnutrition in hospitalised geriatric patients is associated with impaired mobility, increased risk of falls, reduced quality of life and increased mortality. Nurses are competent in identifying the patient at risk and to carry out objective screening for the risk of malnutrition and falls during hospitalisation. [ABSTRACT FROM AUTHOR]

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: Morbidity/mortality and oncologic outcomes can be worsened in geriatric rectal cancer patients due to comorbidities and frailty. The aim of this study was to compare surgical and oncological results of geriatric rectal cancer patients using inflammation-based prognostic scores. Methods: The prospectively maintained database of 991 rectal cancer patients treated at our center between 2007 and 2020 were analyzed. All conventional clinicopathologic features, and oncologic outcomes are compared between patients ≥ 65 years old (geriatric patients: Group I) and < 65 years old (non-geriatric patients: Group II). The modified Glasgow Prognostic Score (mGPS) and the C-reactive protein-albumin ratio (CAR), were determined. The prognostic value of mGPS and CAR as well as the well-known clinico-pathologic factors to predict surgical morbidity, mortality, local and/or distant recurrence, and overall survival was assessed. Results: There were 567 (57.2%) patients who were ≥ 65 years old (Group I; 349 males, median age 74 [range 65–9]) years) and 424 (42.8%) who were < 65 years old (Group II; 252 males, median age 58 [range 20–64] years). The high-grade [Clavien–Dindo III–IV] complications rates of Group I and Group II patients sere 20% (n = 113), and 9% (n = 37), respectively. High-grade complications were related to mGPS (p < 0.001) and CAR (p < 0.001) values. The high-grade complication rate was found to be higher in Group I than in Group II, and this was statistically significant (p < 0.001). High preoperative mGPS and CAR values were significantly associated with postoperative mortality (p < 0.001). In Cox multivariate analysis, mGPS (p = 0.003) and CAR (p = 0.001) were significantly in correlation with lowered overall survival. The mGPS and CAR were found to be independent prognostic factors for overall survival. Conclusions: The mGPS and CAR can predict severe postoperative complications and early mortality. mGPS, and CAR have a powerful prognostic value and the potential clinical usefulness to predict decreased overall survival in both geriatric and non-geriatric rectal cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to project to evaluate the reasons for admission, diagnosis, demographic data, risk scores, and death rates of geriatric patients to the emergency department (ED) in Northern Syria. Methods: Geriatric patients aged 65 and over who were admitted to the ED of hospitals and hospitalized between January 1, 2022, and March 31, 2022, were included in the study. The reasons for the patient's admission to the ED were evaluated as the ten most common diagnoses for their problems. Results: A total of 354 patients were included in the study. In the study, the most common cerebrovascular accident (15.8%), heart failure (13.6%), and myocardial infarction (7.6%) were observed. The three most common reasons for admission to the ED were found to be shortness of breath (18.6%), clouding of consciousness (10.5%), and chest pain (8.5%). Conclusion: The study is the first geriatric population study conducted in Northern Syria after the war. When these results are evaluated, it is thought that giving more importance to cerebrovascular disease and cardiac problems of elderly patients in the ED, and making rapid diagnosis and treatment interventions can significantly reduce morbidity and mortality in this region. [ABSTRACT FROM AUTHOR]

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.

Introduction: Dermatitis herpetiformis (DH) is an autoimmune vesiculobullous disease associated with celiac enteropathy. The clinical manifestation of DH is the occurrence of a papulovesicular rash on the skin. Oral mucosal involvement in DH is very rare. This study aimed to describe the impact of COVID-19 on the acute exacerbation of oral dermatitis herpetiformis. Case Report: A 74-year-old woman was referred to the Oral Medicine Department with a chief complaint of the blisters on the skin for a week and ulcers in the oral cavity appeared two days ago. Extraoral examination revealed crusts on the neck and extremities. The lips appeared dry and desquamative. Intraoral examination revealed erosive lesions covered with a white-yellowish plaques on the right and left sides of the buccal mucosa, an ulcer with a diameter of 0.5 cm, and purpura hemorrhagic on left buccal mucosa and right lateral border of the tongue. Histopathological examination of the skin lesion revealed a subepithelial blister with eosinophils and neutrophil cells. The definitive diagnosis of dermatitis herpetiformis was made. She was given 5 mg intravenous dexamethasone, cetirizine 10 mg, and clindamycin 300 mg by the dermatologist. We gave hyaluronic acid 0.025% mouthwash for oral ulcers and petroleum jelly for the lips. The oral lesions had significant improvement after 4 weeks of treatment. Two months later, the patient experienced acute exacerbation after being infected with COVID-19 (anti-SARS-CoV-2 IgG S-RBD > 40,000 AU/mL). The oral lesions healed after a month of treatment. Conclusion: COVID-19 can trigger the acute exacerbation of dermatitis herpetiformis. SARS-CoV-2 causes an immune dysregulation and hypersensitivity reaction. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The mortality rates of patients over 65 years suffering from hip fractures were compared with/without infection related to SARS-CoV-2 virus during the 3 years of the pandemic. PATIENTS AND METHODS: Patients with femoral proximal region fracture (Type A-B) over 65 years were searched between January 2019 and February 2021 retrospectively. 487 patients met the inclusion criteria and were classified as Group I for surgery before and Group 2 for surgery during the pandemic. Demographic characteristics of the groups, hospitalization time before surgery, hospitalization total time, post-operative time until death and mortality rates were analyzed. RESULTS: The survival rate of hip fracture patients over 65 was higher for the surgeries performed during the pandemic compared to Group I (p=0.032). Patients with 2, 3 or 4 comorbidities in Group I had higher mortality rates (p<0.05). According to fracture type, the mortality rates were higher in Group I (patients with femoral neck fractures) (p=0.005), in contrast mortality rate for trochanteric fractures (p>0.05) remained the same. Mortality rates of Group I and II did not differ according to either time from admission to operation, or time to surgery for fracture types. The mortality rates at 1, 4, 12, and 24 months were determined to be 8.83%, 20.14%, 36.75%, and 45.22%, respectively in Group I, and 8.86%, 23.15%, 32.51%, and 33.49% in Group II with no difference. CONCLUSIONS: The approaches taken in extraordinary circumstances such as a pandemic can change the course or outcomes of a disease. These changes may emerge as different mortality rates between periods of time. Further studies to lower mortality rates depending on hip fracture are warranted especially for patients over 65. [ABSTRACT FROM AUTHOR]

Introduction: dental care in the elderly is of high interest and less time is devoted to it. Objective: to design an educational program about oral cancer aimed at the institutionalized geriatric population. Methods: a descriptive, cross-sectional study was carried out in the period from January 2018 to February 2019 in a sample of 76 institutionalized geriatric patients belonging to the “Celia Sánchez Manduley” Stomatological Clinic in the City of Santa Clara. The following variables were studied: risk factors, level of information, level of schooling and evaluation by specialists' criteria; the data were collected in a questionnaire. Results: deficient oral hygiene and the use and condition of prosthesis were identified as main risk factors, as well as an inadequate knowledge about smoking, the negative effects of alcoholism and oral self-examination with regard to oral cancer. Conclusions: patients with an inadequate level of information on oral cancer predominated. An educational program considered relevant, feasible and with quality by the Stomatology Specialists was designed. It was considered that these results were possible due to the strength of the content of the topics offered and the use of innovative participatory techniques; human and material resources were taken into account in each activity implemented in which the promotion and prevention of oral cancer aimed at institutionalized geriatric patients were developed. [ABSTRACT FROM AUTHOR]

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 during 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 was 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. [ABSTRACT FROM AUTHOR]

In this article we describe the methods of rehabilitation and physical deconditioning syndrome of the elders, the influence of physical training to improve the quality of life. Aging is a complex process in which a multitude of pathological, genetic and lifestyle factors are involved, and which is frequently associated with a reduction in functional capacity and the presence of chronic diseases. Physical inactivity and the presence of a sedentary lifestyle represent a significant risk factor affecting the health of the elderly. The geriatric patient is a biologically aged patient who presents an acute risk of losing his independence, following acute and/or chronic pathologies, with the limitation of physical, physiological, mental and/or social functions. The ability to perform the basic activities for ordinary independent living is compromised, diminished, or lost, so the physical deconditioning syndrome occurs. The person in question has increased needs for rehabilitation, psychological and physical care to avoid partial or total loss of independence. [ABSTRACT FROM AUTHOR]

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

A high-flow nasal cannula is commonly used to manage hypoxic respiratory failure. High-flow nasal cannula not only reduces respiratory effort and work of breathing but also provides better patient comfort. It lowers mortality compared to standard oxygen therapy or non-invasive ventilation and is associated with more ventilator-free days. A 60-year-old female presented for the correction of ankle fracture with pneumonia and successfully underwent lower limb orthopaedic surgery under the subarachnoid block with the use of high-flow nasal oxygen therapy. High-flow nasal cannula may be considered as one of the useful options for intraoperative management of pneumonia in patients undergoing lower limb surgery under regional anaesthesia. [ABSTRACT FROM AUTHOR]

Background/Aims: Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses. Material and Methods: Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub‐group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury. Results: Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p =.02) and site of injury (p =.02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury. Conclusions: There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to analyze the reasons for admission of Alzheimer's patients who applied to the emergency services. Materials and methods: The study was conducted prospectively on patients with Alzheimer's disease who applied to the emergency departments of Bursa Uludag University Health Application and Research Center, Health Sciences University Bursa Yüksek İhtisas Training and Research Hospital and Bursa City Hospital between 01.07.2021 and 01.07.2022. Result: A total of 248 patients, 103 male (41.5%) and 145 female (58.5%), were included in the study. It was determined that the three most common diagnoses received by the patients in the emergency department were pneumonia (17.7%), ischemic cerebrovascular disease (10.3%), and urinary system infection (9.3%). It was determined that 42.7% of the patients were hospitalized in clinical and 18.1% in intensive care units. Conclusion: As a result, it was determined that the most common diagnoses of Alzheimer's patients admitted to the emergency department were pneumonia, ischemic cerebrovascular disease and urinary tract infection, respectively and more than half of all admitted patients had indications for hospitalization. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of the study was to follow up the cortisol levels in relation to the postoperative pain intensity, its levels after treatment with opiate and non-opiate analgesics, and to monitor the relationship between the blood glucose and cortisol levels. Another goal was to optimize the postoperative analgesia of geriatric patients with the known combinations of analgesics. METHODS: The cohort comprised 28 geriatric patients undergoing laparoscopic cholecystectomy. The patients were divided according to the intensity of postoperative pain into the groups with opiate and nonopiate analgesia. Furthermore, they were divided according to their physical condition (ASA classifi cation) into two groups, ASA 2 and ASA 3. We evaluated three values of blood glucose levels, on the day before surgery, on the operative and the first postoperative days and those of cortisol on the day of surgery. RESULTS: The patients had the blood glucose levels without significant deviation during the three days of measurements. The cortisol levels increased with the intensity of postoperative pain. High levels of cortisol were observed not only in the patients, who experienced acute pain after non-optimal postoperative analgesia, but also in those treated with strong opiates in the immediate postoperative period. The patients with mild pain intensity, treated with a combination of non-opiate analgesics, had the lowest values. The role of the patient's gender in both blood glucose and cortisol levels was not observed. CONCLUSION: The cortisol levels have not corresponded so much with the assessment of acute postoperative pain as with the stress that was evoked in the patient due to hospitalization and fear of surgery. It is crucial to eliminate as much as possible all the stressors that can affect the cortisol levels and thus the blood glucose levels (Fig. 6, Ref. 25). [ABSTRACT FROM AUTHOR]

Introduction: The incidence of meningiomas increases exponentially after the age of 65. However, this age is characterized by a higher incidence of comorbidities and the benefit of the surgery may not always exceed its risk. Treatment optimization should therefore be objectively assessed using scoring systems as well. Materials and methods: A retrospective analysis evaluated the group of patients treated at the Brno University Hospital between 2013–2018 (N = 108). Patients were older than 65 years of age. Three procedures were considered in the treatment: watch and wait strategy, surgery and stereotactic radiosurgery. The groups of patients were evaluated in terms of the incidence of comorbidities and the outcome of the patients with regard to the choice of treatment modality. Scoring systems were used in the indication for individual types of treatment. Furthermore, short-term and long-term morbidity and mortality were evaluated in individual groups. Results: Significant dependence in the analysis of annual mortality in the SKALE system has been proved. No statistically significant relationship was found between mortality and sex, collateral oedema, and tumour location. In contrast, age, tumour size, and Karnofsky score before treatment were significant predictors of prognosis. Conclusion: Individualized patient analysis and neurosurgeon experience continue to be important factors in treatment selection in elderly patients with a diagnosis of meningioma. However, the scoring systems used to select a treatment modality in elderly patients make it possible to significantly optimize the treatment process and, ultimately, the prognosis of the disease. [ABSTRACT FROM AUTHOR]

The current study was designed to investigate the clinical management of deconditioned patients. In the current study, we investigate the clinical manifestations of deconditioned patients. A subacute functional deficiency was determined when getting up from a supine position and developing tachycardia with an increase in heart rate by 30 or more per minute for 10 minutes. This study included 172 elderly patients aged 65 to 74 years. The average age of the patients was 69.2+2.2 years. There were 102 men and 70 women in the study. These patients were registered at the dispensary with the therapists of outpatient clinics after an infectious disease. Within 6 months after the treatment, a comprehensive geriatric assessment of patients was performed. All patients were divided into four groups depending on the indicators of motor activity, which in the framework of this study was the criterion of the adaptive function of the body and viability. Patients with normal motor activity indicators did not have the decondition and were designated as a control group. Patients with the decondition did not have normal indicators of motor activity. The obtained results were processed statistically. According to the results of our study, it was noted that the assessment of the six months after the treatment showed heterogeneity of patients from a functional point of view with a homogeneous somatic structure. Six months after the treatment, out of 172 people, 45 people (26.2%) had normal motor activity indicators (39-40 points); according to the questionnaire "Assessment of motor activity in the elderly", the average score was 39.6+0.2; 42 people (24.4%) had mild motor activity disorders (34-38 points), the average score was 36.1+0.4; moderate disorders (21-33 points) were registered in 47 people (27.3%), the average score was 27.9+2.1; significant motor activity disorders (0-20 points) occurred in 38 people (22.1%), the average score was 13.2+1.4. The fall syndrome was characteristic of those patients with the decondition who demonstrated moderate and significant motor activity disorders 6 months after the treatment. In particular, in people with significant motor activity disorders, there was a decrease in muscle strength in the lower extremities by 48.3+3.2% and in the upper extremities – by 27.1+3.1% (P<0.05). As a result of the presence of the decondition, an unfavorable cascade of geriatric syndromes is formed in the form of an increase in the level of situational anxiety from 21.9-24.8 to 58.4-75.3 points on the Spielberger-Hanin scale, a deterioration in morale with an increase in the severity of depression from 5.8-6.0 to 11.0-14.9 points, a decrease in the quality of sleep on the ten-point visual analog scale from 8.3-8.4 to 5.2-5.7 points on the Beck scale, an increase in the proportion of patients at risk of developing malnutrition syndrome from 4.8-6.7% to 46.8-68.4%, the development of the fall syndrome, which, in turn,, it is a predictor of the development of dinapenia in the form of a decrease in the strength of the upper extremities by 22.7-27.1%, a decrease in the strength of the lower extremities by 29.6-49.6%, with a faster rate of decrease in the strength of the lower extremities compared to the upper extremities by 1.8 times, which, accordingly, reduces the rehabilitation potential. Clinical manifestations of the decondition in elderly patients were such geriatric syndromes as anxiety, depression, cognitive decline, sleep disorders, hypomobility, dinapenia, risk of developing malnutrition syndrome and falls syndrome. [ABSTRACT FROM AUTHOR]

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Background: Risk factors of refracture after fragility fractures include osteoporosis, female gender and advanced age among others. We hypothesized that the assessment of functionality, muscle health and nutrition status contribute to the risk prediction for further fractures and death., Methods: We assessed 334 patients admitted to the department of acute geriatrics for sociodemographic data, bone fragility, selected laboratory tests, body composition and data on functionality using the comprehensive geriatric assessment. Patients had follow-ups until the occurrence of further fractures or death. Dual-energy X-ray absorptiometry and pulse echo measurements were performed to assess bone mineral density. Fracture risk was assessed using the FRAX score and muscle strength according to published guidelines on sarcopenia., Results: The mean age was 81 years (70-95), and 82.3% (275/334) were women. An incidence of 10.4% (35/334) new fragility fractures was observed within 24 months, and the mortality rate was 12.2% (41/334). A significantly higher rate of further fractures was associated with lower BMI (body mass index) (HR 0.925, CI 0.872-0.98; p = 0.009), lower parathyroid hormone levels (HR 0.986, CI 0.973-0.998; p = 0.026) and with the diagnosis of osteoporosis (HR 2.546, CI 1.192-5.438; p = 0.016). No significant associations were present in patients with previous fractures, with higher age, higher FRAX scores, sarcopenia, in women, sarcopenic obesity, frail patients, lower grip strength, lower walking speed, lower Barthel index or lower DI (density index) values. The predictive power for further fractures was 10.7% higher adding osteosarcopenia, BMI and parathyroid hormone levels to standard assessment parameters osteoporosis, age and the status of previous fractures. Mortality was significantly higher with advanced age (HR 1.101, CI 1.052-1.151; p < 0.001), in men (HR 6.464, CI 3.141-13.305; p < 0.001), in smokers (p = 0.002), higher FRAX score (HR 1.039, CI 1.009-1.070; p = 0.010), lower renal function (HR 0.987, CI 0.976-0.997; p = 0.010), lower Tinetti test scores (HR 0.943, CI 0.900-0.987; p = 0.012), lower walking speed (HR 0.084, CI 0.018-0.382; p = 0.001), lower hand grip (HR 0.876, CI 0.836-0.919; p < 0.001) and lower Barthel index scores (HR 0.984, CI 0.971-0.997; p = 0.015)., Conclusions: In a cohort of geriatric patients, the addition of BMI, low parathyroid hormone levels and osteosarcopenia increases the predictive power for further fractures by 10.7%. These parameters are a valuable addition to the standard assessment parameters age and history of sustained fractures. Mortality is partly associated with potentially treatable functional parameters., (© 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Purpose: Femur fractures and subsequent surgical procedures are expected to increase with the growth of the older population. Despite the elevated risk of postoperative pulmonary complications in older patients, research focusing on those of very advanced age is limited. We aimed to investigate the incidence and risk factors of pulmonary complications following femur fracture surgery in patients ≥80 years., Patients and Methods: This retrospective cohort study included patients aged ≥80 years admitted to the Orthopedic Surgery Department for femur fracture surgery between 2020 and 2022. We assessed the incidence and risk factors of postoperative pulmonary complications, defined as pneumonia, atelectasis, pulmonary edema, pleural effusion, and venous thromboembolism (VTE). We also examined risk factors for respiratory failure and 90-day mortality, using logistic regression models., Results: The study included 479 patients with a mean age of 86.0 years, and 78.5% were women. Postoperative pulmonary complications occurred in 11.7% of patients, with pleural effusion being the most common (4.4%), followed by pneumonia and atelectasis. The incidence of VTE was 1.5%. Patients who developed pulmonary complications had significantly longer hospital stays (14 days vs 10 days; p<0.001), a greater proportion of patients needing oxygen supplementation (71.4% vs 31.4%; p<0.001), and higher all-cause 90-day mortality (14.3% vs 5.9%; p=0.042). Age, chronic lung disease, and Parkinson's disease were significant risk factors for pulmonary complications. Coronary artery disease, stroke, and prolonged surgery were significantly associated with respiratory failure, whereas internal fixation, coronary artery disease and older age were associated with 90-day mortality. Distal femur fractures were significant risk factors for VTE, while VTE prophylaxis methods were not associated with VTE risk., Conclusion: At least one postoperative pulmonary complication occurred in 11.7% of the participants. Several comorbidities were associated with pulmonary complications, respiratory failure, and 90-day mortality, highlighting the importance of identifying these comorbidities prior to surgery., Competing Interests: The authors have no competing interests., (© 2024 Chai et al.)

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.