Age Groups In Europe Research Articles

Vaccines for the Elderly and Vaccination Programs in Europe and the United States.

The share of the elderly population is growing worldwide as life expectancy increases. Immunosenescence and comorbidities increase infectious diseases' morbidity and mortality in older adults. Here, we aimed to summarize the latest findings on vaccines for the elderly against herpes zoster, influenza, respiratory syncytial virus (RSV), COVID-19, and pneumococcal disease and to examine vaccine recommendation differences for this age group in Europe and the United States. PubMed was searched using the keywords "elders" and "vaccine" alongside the disease/pathogen in question and paraphrased or synonymous terms. Vaccine recommendations were also sought in the European and US Centers for Disease Control and Prevention databases. Improved vaccines, tailored for the elderly, mainly by using novel adjuvants or by increasing antigen concentration, are now available. Significant differences exist between immunization policies, especially between European countries, in terms of the recipient's age, number of doses, vaccination schedule, and implementation (mandatory or recommended). Understanding the factors that influence the immune response to vaccination in the elderly may help to design vaccines that offer long-term protection for this vulnerable age group. A consensus-based strategy in Europe could help to fill the gaps in immunization policy in the elderly, particularly regarding vaccination against RSV and pneumococcus.

EUROLD: preliminary results of the ecological study on suicide and its associated socioeconomic variables in people over 85 in Europe.

The present study aims to compare the suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries. In addition, the study aims to perform a preliminary analysis of which socioeconomic factors could explain higher suicide rates in this age group in Europe. An analysis of the Eurostat database has been made. In this pilot phase, certain socioeconomic variables representative of people over 85 years of age were chosen based on criteria of suitability, according to the bibliography available for other regions and availability of the information provided. The conditional suicide rate in this age group with respect to the overall suicide rate in each country has been calculated. Furthermore, Spearman correlations between the suicide rates in this age group and the chosen socioeconomic factors were performed. Conditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, suicide in this age group was associated with different economic ratios, the old-age dependency ratio, and the self-perceived health ratio. After performing a multivariate regression, the model that best explained the differences between the European countries included the variables "old-age dependency ratio" and "economic impossibility to buy new clothes ratio." Different socioeconomic factors, specifically poverty and economic inequality, added to the old-age dependency ratio, could explain huge differences between the suicide rates in people over 85 years of age in the different European countries.

Зростання рівня безробіття серед молоді як один з наслідків пандемії COVID-19

For studying the excess of youth unemployment in comparison with other age groups in Europe and selected world regions, the authors hypothesized the high efficiency of government employment policy, taking into account the possible consequences of displacing other age groups. The aim of the study is to formulate proposals for reducing youth unemployment in Europe and selected world regions in accordance with the identified specific causes of this phenomenon. The main objectives of the study are: - consideration of macroeconomic indicators of Europe and selected world regions in 2015 to 2020 and the peculiarities of their interconnection; - identification of the most specific causes of youth unemployment excess in comparison with other age groups in Europe and selected world regions; - formation of proposals for reducing youth unemployment and justification of their feasibility. To achieve the purpose, special and general scientific methods were used, including: graphic method, comparison, formalization, systematization, generalization, induction, deduction, analysis and synthesis. Based on a study of employment in selected world regions in 2015 to 2020, it was found that there is a significant excess of youth unemployment compared to the general unemployment rate. However, unemployment may be less of a problem for young people than for adults, as it tends to be shorter. Moreover, young people may simply change jobs more often, so the higher unemployment rate observed is mainly functional and therefore not particularly harmful. Reducing youth unemployment is a difficult task, but complete inaction in this area or attempts to solve unemployment problems in other age groups at the expense of youth employment can lead to more severe economic consequences. In general, the hypothesis of the high efficiency of government employment policy, taking into account the possible consequences of displacing other age groups, is proven. Among the main motives prompting scientists to further study the problems of youth unemployment are the economic and social difficulties that the economically active population faces when they lose their jobs. In the future, concrete steps can be developed by states in the framework of employment policy, which can include individual counseling procedures, as well as systemic interventions based on the analysis of social circles in which young people are involved (for example, families and couples, not just individuals). The impact of the COVID-19 pandemic on the macroeconomic indicators of Europe and selected world regions is examined. In particular, the dynamics of real GDP and employment rates during 2012-2020 are reflected. It was found that young workers in Europe were more prone to job losses during the crisis than the elderly population. However, the downward trend in youth employment affects not only Europe but also other regions of the world, including developing countries, where youth unemployment can be three times higher than the general rate. A number of reasons for low youth employment are identified, including a barrier to entry the labor market due to the lack of experience, insecurity of jobs, high frequency of voluntary dismissals and a tendency of youth unemployment towards over-cyclicality.

Prevalence of Epstein–Barr virus antibodies in different age groups in Europe and Asia: a systematic review and meta-analysis

Introduction. Attempts to assess the prevalence of antibodies (seroprevalence) to the Epstein-Barr virus have been made several times. Still, a complete understanding of this issue has not been reached due to the small samples of the surveyed. The goal is to evaluate seroprevalence in different age groups in Europe and Asia using a systematic review and meta-analysis. Material and methods. The search for publications was carried out on PubMed, Cochrane Reviews/CochraneLibrary, eLibrary, Cyberleninka, Researchgate from May 6 to 30, 2020. A total of 2,364 articles were found, 12 of which were included in the study. Seroprevalence to Epstein-Barr virus was determined in 67,561 individuals aged 0 to 80 years. The research results were distributed by age groups, continents (Europe and Asia), and their implementation (2000-2012 and 2013-2019) and subjected to meta-analysis. Results. Minimal seroprevalence was detected among children under 1 and 1-2 years of age (53.3 and 50.9%). With increasing age, it grew, and people over 18 years of age were more than 90%. In 2013-2019, the index value (68.9%) was significantly higher than in 2000-2012 (89.6%). In Asian countries in 2000-2019, seroprevalence (86.7%) was considerably higher than in Europe (76.3%). The highest growth rate was observed in 7-14 years. In 2000-2012, the maximum growth rate of seroprevalence occurred in 15-17 years and 2013-2019 - 3-6 years. For all age groups, the growth rate was higher in Europe than in Asia and 2013-2019 compared to 2000-2012. Conclusion. The meta-analysis revealed differences in seroprevalence depending on age and territory of residence and the growth of indices in the trend.

COVID-19-Related Fatalities and Intensive-Care-Unit Admissions by Age Groups in Europe: A Meta-Analysis.

Objectives: Precise international estimates of the age breakdown of COVID-19–related deaths and intensive-care-unit (ICU) admissions are lacking. We evaluated the distribution of COVID-19–related fatalities and ICU admissions by age groups in Europe.Materials and methods: On April 6, 2020, we systematically reviewed official COVID-19–related data from 32 European countries. We included countries that provided data regarding more than 10 COVID-19–related deaths stratified by age according to pre-specified age groups (i.e., <40, 40–69, ≥70 years). We used random-effects meta-analysis to summarize the data.Results: Thirteen European countries were included in the review, for a total of 31,864 COVID-19–related deaths (range: 27–14,381 per country). In the main meta-analysis (including data from Germany, Hungary, Italy, The Netherlands, Portugal, Spain, Switzerland; 21,522 COVID-19–related fatalities), the summary proportions of individuals <40, 40–69, and ≥70 years old among all COVID-19–related deaths were 0.1% (0.0–0.2; I2 28.6%), 13.0% (10.8–15.4; I2 91.5%), and 86.6% (84.2–88.9; I2 91.5%), respectively. ICU data were available for four countries (France, Greece, Spain, Sweden). The summary proportions of individuals around <40–50, around 40–69, and around ≥60–70 years old among all COVID-19–related ICU admissions were 5.4% (3.4–7.8; I2 89.0%), 52.6% (41.8–63.3; I2 98.1%), and 41.8% (32.0–51.9; I2 99%), respectively.Conclusions: People under 40 years old represent a small fraction of most severe COVID-19 cases in Europe. These results may help health authorities respond to public concerns and guide future physical distancing and mitigation strategies. Specific measures to protect older people should be considered.

Mental wellbeing among the oldest old, living in nursing home or at home

Abstract Background People 80 plus are the fastest growing age-group in Europe. While research is focusing on health deficiencies and losses and need for medical care and follow up, life conditions and mental health of older people are fields with insufficient knowledge. The promotion, maintenance, and improvement of well-being in this group is a great public health concern. This study aimed to explore differences in perspectives of what contributes to mental wellbeing (MWB) within three groups of persons 80 plus: 1) living at home, 2) living at home and attending day center some weekdays, 3) living in nursing home. Methods A qualitative approach was followed, with six focus groups - two in each of the three categories. 35 persons were recruited from senior community centers, adult day care centers, and nursing homes. Data was assessed using qualitative content analysis. Results The preliminary results from our study show significant variations between the three groups of participants in their perspectives on what contributes to MWB for them. In group 1 and partly group 2, engagement in fruitful or inspiring activities and insightful experiences with friends strongly associated with MWB. While the relevance of these factors also was mentioned by participants in group 3, they at the same time pointed at the limitations of living in a nursing home. Staying healthy and maintaining independence positively contributed to MWB in all three groups, however highly relatively, based on the person’s actual health situation. Having close relationships with family and friends were considered important in all three groups. Conclusions Perspectives on what contributes to MWB among persons 80 plus varies a lot as they control for what is possible based on own health and functionality, but also on what is accessible depending on institutional limitations. While such conditions are partly accepted, there is a potential for better MWB, simply based on more and/or better initiatives. Key messages Perspectives on what contributes to mental wellbeing among the oldest old varies a lot based on health and functionality, and on what is possible and accessible within institutions for elderly. There is a potential for better mental wellbeing based on more and/or better initiatives.

Learning from Each Other

This article is based on the European project on confirmation work. It provides a brief description of the theological and ecclesiological background of this project as well as of the empirical studies carried out in this project in nine European countries and summarizes some of the main results. The example of Germany is used for presenting more detailed insights into the practice of confirmation work there as well as the religious attitudes of the confirmands. Given the high participation rates (more than 90% of Protestant youth in the respective age group in Europe versus 59% in the United States), the emphasis on reaching as many young people as possible is seen as a core characteristic of confirmation work in Germany and Europe. In a second step, the author considers confirmation in Europe and in the United States comparatively by identifying and discussing commonalities and differences on the basis of the empirical results from the research on confirmation work in the European and in the American project. One main difference is identified in the emphasis on mentorship (United States) and young volunteers (Europe). The final part of the article has its focus on the question of what confirmation work in the United States and in Europe could possibly learn from each other.

Geographic Differences in Phenotype and Treatment of Children with Sickle Cell Anemia from the Multinational DOVE Study

Background: Sickle cell anemia (SCA) is characterized by significant phenotypic variability. DOVE1 was a Phase 3, double-blind, randomized, parallel-group, placebo-controlled, multinational study that investigated the efficacy and safety of prasugrel, a P2Y12 adenosine diphosphate receptor antagonist, for reduction of vaso-occlusive crises (VOCs), a composite of painful crisis or acute chest syndrome, in 2- to <18-year-olds with SCA (age cohorts: 2 to <6 years, 6 to <12 years, and 12 to <18 years) (NCT01794000).Methods: DOVE was conducted at 51 sites in 13 countries across 4 continents. A total of 341 subjects were randomized (prasugrel, n=171; placebo, n=170) and SCA genotypes (homozygous hemoglobin S; hemoglobin Sβ0 thalassemia) were included. Eligibility required ≥2 VOCs in the prior year. Baseline clinical and laboratory characteristics and study endpoints were compared by region. Since no overall treatment effect was found, data provided reflect the combined 341 subjects (Americas, N=57; sub-Saharan Africa [SSA], N=148; North Africa/Middle East, N=110; Europe, N=26).Results: Per regional enrollment, the largest proportion of subjects were 6 to <12 years in SSA (48.6% [n=72]), 12 to <18 years in the Americas (45.6% [n=26]) and North Africa/Middle East (58.2% [n=64]), but more evenly divided among the 3 age groups in Europe (30.8-34.6% [n=8-9]). Self-reported racial groupings differed by region (p<0.001): 100% white in North Africa/Middle East; 100% black in SSA; 19.2% white, 76.9% black, and 3.8% multiple in Europe; and 1.8% white, 96.4% black, and 1.8% multiple in the Americas. Mean body mass index was <17 in SSA and Europe (15.3 and 16.6 kg/m2) but >18 in North Africa/Middle East and the Americas (18.3 and 18.1 kg/m2) (p<0.001). Mean blood pressures were lowest in SSA (systolic: 99.0 vs. 105.4-108.0 mmHg, p=0.004; diastolic: 58.3 vs. 60.4-62.9 mmHg, p=0.003).The proportion of subjects with history of acute chest syndrome prior to enrollment was lower in SSA (6.1%) than other regions (18.2-66.7%, p<0.001). Mean number of VOCs in the year prior to enrollment was higher in the Americas than other regions (5.8 vs. 3.2-3.4, p=0.041).Hydroxyurea (HU) use at baseline varied by region: 91.2% in the Americas, 72.7% in North Africa/Middle East, 42.3% in Europe, and 6.8% in SSA (p<0.001). For subjects not on HU at baseline (Table 1), mean hemoglobin at baseline was lowest in SSA (7.6 g/dL); reticulocyte count was lowest in the Americas (214.8 billion/L) and highest in Europe (327.8 billion/L) (p=0.004).For all geographic regions, the most frequent serious adverse events (SAEs) were classified as blood and lymphatic system disorders, with the highest percentage reported as painful crisis. The second most frequent SAEs in SSA, North Africa/Middle East, and Europe were various infections and infestations. The second most frequent in the Americas was respiratory, thoracic, and mediastinal disorders; all were reported as acute chest syndrome.The overall rate of VOCs (events per patient-year) was 3.2 in Europe, 3.0 in the Americas, 2.6 in SSA, and 2.0 in North Africa/Middle East. The percentage of patients hospitalized for VOCs was greatest in Europe (76.9%) compared to other regions (28.4-57.9%); however, mean hospital stay per VOC was similar across regions (5.3-6.2 days). The percentage of VOCs causing hospitalization was highest in Europe (67.7%), followed by North Africa/Middle East (48.7%), the Americas (46.5%), and SSA (26.4%). In SSA, the majority of VOCs were managed as outpatient hospital visits (67.9%), whereas other regions more frequently used inpatient hospital visits (33.2-55.2%). Regardless of region, almost all VOCs were treated with analgesics (overall: 99.5%) and approximately half were treated with intravenous (IV) fluids (overall: 54.4%). In contrast, the proportion of VOC-related transfusions was greater in North Africa/Middle East and Europe (18.6% and 18.8%) than in the Americas and SSA (10.0% and 6.4%).Conclusions: In the DOVE study, management of VOCs with analgesics and IV fluids was similar across regions. However, there were regional differences in VOC-related hospitalizations and transfusions that may reflect differences in culture, utilization of resources, disease severity, or a combination of factors.

Is Age the New Class? Economic Crisis and Demographics in European Politics

As the crisis turns into long-term economic downturn, younger age-groups in Europe seem to be hit with higher levels of unemployment while the welfare state is steadily shrinking. The young have suddenly become a social group united by collective material interests, but does this translate into a sense of a collective political interest? The paper examines to what extent the dominant class-based social science of the post-war years can help us understand the politics of age-groups. The analysis highlights four changes since post-war years: the workplace has changed, impacting socialization; modern media has changed, impacting mobilization; the political landscape is fairly institutionalized, tempering the possibilities for new political concerns to find voice; and those who would define and articulate the political priorities of the young are leaving the Old Continent.

Das Mammakarzinom - Therapiestandards und neue Therapiemöglichkeiten 2012, ein onkologisches Review

Breast cancer is the leading cancer in women with an annual incidence rate of 110/100.000 women in all age groups in Europe. The incidence rate increases in older women. Treatment includes surgery, radiotherapy, chemotherapy with or without antibody therapy and hormonal treatment. During the last 40 years the survival rate has significantly improved. From the 1970ies to 2010 the five year survival rate has risen from 85% to 98% early breast cancer. Similarly, in metastatic breast cancer 5-year survival has increased from below 10% in 1970 to 26% in 2010. This was possible because of better treatment options and better screening causing earlier diagnosis of breast cancer. This article reviews the standard treatment of breast cancer according to ESMO/ASCO guidelines and discusses new treatment options and new therapeutic strategies for breast cancer.

The role of vitamers and dietary-based metabolites of vitamin D in prevention of vitamin D deficiency

There is little doubt that vitamin D deficiency across all age groups in Europe is a problem. Low vitamin D status arises due to limited, if any, dermal synthesis during the winter months at latitudes above 40°N, putting increased importance on dietary supply of the vitamin. However, dietary intakes by most populations are low due to the limited supply of vitamin D-rich foods in the food chain. Thus strategies that effectively address this public health issue are urgently required. It has been emphasized and re-emphasized that there are only a limited number of public health strategies available to correct low dietary vitamin D intake: 1 improving intake of naturally occurring vitamin D-rich foods, 2 vitamin D fortification (mandatory or voluntarily) of food, and 3 vitamin D supplementation. Recent evidence suggests that the levels of vitamin D added to food would need to be high so as to ensure dietary requirements are met and health outcomes optimized. In addition, knowledge of the most effective forms of vitamin D to use in some of these preventative approaches is important. There is still uncertainty in relation to the relative efficacy of vitamin D2 versus D3, the two main food derived forms and those used in vitamin D supplements. The major metabolite of vitamin D with biological activity is 1,25(OH)2D; however, this is usually used for pharmacological purposes and is not typically used in normal, healthy people. The other major metabolite, 25(OH)D, which has also been used for pharmacological purposes is present in certain foods such as meat and meat products (particularly offal) as well as eggs. This metabolite may have the potential to boost vitamin D status up to five times more effectively that native vitamin D3 in foods. However, the exact bioactivity of this compound needs to be established.

Prevalence of Dilated Cardiomyopathy in Doberman Pinschers in Various Age Groups

Dilated cardiomyopathy (DCM) in Doberman Pinschers is an autosomal dominant inherited disease. The prevalence of DCM in Doberman Pinschers of various age groups in Europe is currently unknown, but this information would be important to develop recommendations for screening programs. To evaluate the prevalence of cardiomyopathy in various age groups of Dobermans. Seven hundred and seventy-five examinations in 412 Doberman Pinschers. Dogs were included in a prospective longitudinal cohort study. Each examination included echocardiography and 24-hour ECG (Holter) examination. A cut-off value of >100 ventricular premature contractions (VPCs) per 24 hours on Holter examination or abnormal echocardiography was considered diagnostic for cardiomyopathy. The cumulative prevalence included all dogs with DCM and healthy dogs >7 years of age. DCM prevalence in various age groups was as follows: age group 1 (1 to <2 years) 3.3%, age group 2 (2 to <4 years) 9.9%, age group 3 (4 to <6 years) 12.5%, age group 4 (6 to <8 years) 43.6%, and age group 5 (>8 years) 44.1%. The cumulative prevalence of Doberman Pinscher cardiomyopathy was 58.2%. There was an equal sex distribution, but male dogs showed earlier echocardiographic changes than did female dogs, which had significantly more VPCs. The prevalence of Doberman cardiomyopathy is very high in Europe. Disease manifestation and progression are different between male and female dogs. Yearly screening for DCM by Holter examination and echocardiography is recommended, starting at 2 years of age.

Clinical data on Fluarix®: an inactivated split seasonal influenza vaccine

Influenza viruses cause annual winter epidemics in temperate regions, with significant morbidity, mortality and economical impact. Fluarix® is a split, trivalent, inactivated vaccine, manufactured from highly purified, egg-grown influenza viruses by GlaxoSmithKline. In 2005, Fluarix underwent accelerated approval for use in adults by the US FDA following a US-based, randomized, placebo-controlled trial that established its safety and immunogenicity in adults. The vaccine has been licensed in Europe since 1992 for all age groups. Multiple registration trials in all age groups in Europe have demonstrated that the vaccine was safe and well tolerated and of immunogenicity standards that met the requirements of the European Committee for Medicinal Products for Human Use. There are no published clinical trials evaluating the effectiveness or efficacy of Fluarix against influenza and its complications. Currently, Fluarix plays an important role in the diversification of the supply chain of influenza vaccine to the community. However, vaccines with improved immunogenicity in at-risk populations, such as the elderly, and with less reliance on growth in eggs, as well as the inherent demanding timelines, are needed to enhance the control of influenza.

Net ecosystem production in a temperate pine plantation in southeastern Canada

Eddy covariance measurements of carbon dioxide (CO 2) and water vapour fluxes were made from June 2002 to May 2003 over a 65-year-old temperate conifer plantation forest in southern Ontario, Canada. This site is part of a newly initiated long-term tower flux measurement program over a chronosequence of white pine plantation forests, known as the Turkey Point Flux Station. Net ecosystem productivity (NEP) showed a strong dependence on environmental variables such as temperature, light regime, and vapour pressure deficit. In the summer, saturation water deficit exerted a strong control on photosynthetic uptake through decreased bulk surface conductance. There was a linear relationship between monthly carbon uptake and water loss. For each kilogram of water evaporated from the stand, approximately 2.15 g of carbon was sequestered. Annual NEP was 196 g C m −2 from June 2002 to May 2003. Annual gross ecosystem productivity (GEP) was 1442 g C m −2 and annual ecosystem respiration ( R) was 1247 g C m −2. A cross-site comparison of this site with 19 other, planted and natural, temperate conifer forests showed that NEP at the Turkey Point plantation was relatively low compared to other plantation forests of similar age group in Europe and North America. This analysis also showed that GEP and R of plantation forests was significantly higher than that of natural forests. In plantation forests, GEP and NEP linearly decreased with forest age, while R decreased little. Natural stands showed an increase in GEP and R with stand age, except for an old growth stand in western USA. This showed that photosynthesis, rather than respiration, plays a dominant role in net carbon uptake of both plantation and natural forests. In both, plantation and natural, stands there was a weak or no relationship between NEP and annual temperature and precipitation, while annual GEP and R was positively correlated to these environmental variables. The differences in carbon uptake among plantations and between plantation and natural temperate conifer forests were due more to physical and physiological differences among stands (e.g. stand age, tree density, leaf area index, site history, and adopted management practices in case of plantation forests), rather than differences in environmental variables.

Gastrointestinal diseases in the paediatric age groups in Europe: epidemiology and impact on healthcare.

Gastrointestinal diseases in the paediatric age groups in Europe: epidemiology and impact on healthcare.

The Status of the Humanities and Social Sciences in Higher Education

The demand for higher education has diminished in a number of industrialized countries, which is an alarming phenomenon because of a growing demand for a highly educated workforce within industry. The European Round Table of Industrialists1 sees that the present proportion of 10 percent of university graduates of all employees must be increased in enterprises. The proportion of university graduates of the whole age group in Europe is clearly lower than that in its major economic competitor countries, the United States and Japan. In Europe the figure is just over one-fifth, whereas in Japan it is approaching 40 percent and in the United States it has already passed 50 percent, that is, the limit of universal higher education. The rapidly changing political, social, and economic situation has made the individual by far the most important factor of production, and now it appears that investment in human capital is inadequate and in part incorrectly directed. Environmental and energy problems force industry t...

Renal Replacement Therapies in the Elderly: Part 1. Hemodialysis and Chronic Peritoneal Dialysis

Recent demographic data from the United States and Europe demonstrate that the dialysis population is growing progressively older. In the United States the median age at onset of end-stage renal disease (ESRD) had reached 61 years in 1990, and the fraction of ESRD patients older than 65 years will approach 60% by the year 2000. The primary treatment of geriatric ESRD is center hemodialysis (82% of elderly patients). Chronic peritoneal dialysis in this age group is limited in the United States to less than 10%. Only 2.7% of elderly patients have a functioning transplant. Despite their complex medical and psychosocial conditions, survival and rehabilitation are acceptable in the elderly dialysis patient and these patients tend to be more compliant. Five-year dialysis patient survival rates in the United States are 19% and 10%, respectively, for the 65 to 74 and 75 to 84 age groups compared with 32% and 19%, respectively, for the same age groups in Europe. Five-year survival, particularly in the elderly, is even higher in Japan. Several factors favor the delivery of low doses of hemodialysis in the elderly and discontinuing dialysis is more common in the elderly. Continuous ambulatory peritoneal dialysis is a satisfactory alternative treatment modality for geriatric ESRD. Most studies confirm that survival of elderly patients on continuous ambulatory peritoneal dialysis and hemodialysis is similar. The 1991 United States Renal Data System report showing higher mortality among diabetic continuous ambulatory peritoneal dialysis patients than among hemodialysis patients may reflect selection of such patients, who may have more co-morbid conditions. In special cases, continuous cyclic peritoneal dialysis can be an alternative treatment for elderly ESRD patients.