Differences In Older Patients Research Articles

Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival?

ObjectiveAcute myeloid leukaemia (AML) prognosis is enhanced with intensive remission induction chemotherapy (ICT) in eligible patients. However, ICT eligibility perceptions may differ among healthcare professionals. This nationwide, population-based study aimed...

Sex differences in cardiovascular and all-cause mortality in nonalcoholic fatty liver disease in the US population

Background and aimsNonalcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver condition. In the United States (US), the prevalence of NAFLD in men is higher than that in women. This study aimed to evaluate sex differences in long-term all-cause and cardiovascular (CV) outcomes in patients with NAFLD. Methods and resultsWe collected data from participants aged ≥18 years from the National Health and Nutrition Examination Surveys, 2000–2014, which included seven continuous 2-year surveys. A US Fatty Liver Index score of ≥30 was used to define NAFLD. We used a weighted Cox proportional hazards model to compare sex differences in overall and CV mortality. The all-cause and CV mortality rates were obtained from the National Center for Health Statistics. From the selected 2627 participants with NAFLD, 65.4% were males. Men had a significantly higher all-cause mortality than women (12.4% vs. 7.7%; p = 0.005), and the risk of CV death was higher in women with NAFLD aged ≤60 years (adjusted hazard ratio 0.214, 95% confidence interval 0.053–0.869, p = 0.031). Men with a body mass index >30 kg/m2 and diabetes showed a higher risk of all-cause mortality. Sex differences in CV events were not apparent in the patients aged >60 years. ConclusionMale sex was associated with all-cause mortality in all the age groups. However, CV death is influenced by age, with a higher risk in young and middle-aged women and no apparent difference in older patients.

Sex differences in etiology and short-term outcome in young ischemic stroke patients receiving mechanical thrombectomy

BackgroundAlthough there are well known sex differences in older patients with ischemic stroke receiving acute reperfusion treatments, there is paucity of data in younger patients.MethodsWe investigated sex-related differences in clinical presentation, stroke etiology and short-term outcomes in consecutive young patients with acute ischemic stroke (AIS) below the age of 50 years receiving mechanical thrombectomy (MT) between January 2011 and May 2021 in a tertiary stroke center.ResultsWe identified a total of 202 young ischemic stroke patients with MT, with 51% being female. Young female AIS patients were significantly younger (39 ± 8 vs. 43 ± 7 years, p < 0.001), and presented with a trend for more severe stroke on admission (median NIHSS 12 vs. 9, p = 0.065), compared to males, respectively. Young female AIS patients had higher rates of embolic strokes of determined or undetermined sources in the anterior circulation, while young male AIS patients suffered more often strokes of arterio-arterial embolism. Complete reperfusion (TICI score 3) was achieved significantly less often in young female AIS patients (69% vs. 83%, p = 0.006), and in-hospital mortality was 2-times higher (5% vs. 2%, p = 0.271) compared to males.ConclusionsYoung female AIS patients receiving MT have higher rates of severe embolic strokes and less often complete reperfusion due to different occlusion sites and stroke etiology compared to males.

MO167: SAFETY OF SGLT2 INHIBITORS (SGLT2I) IN PEOPLE OVER 75 YEARS

Abstract BACKGROUND AND AIMS The use of iSGLT2 in people over 75 years was initially associated with a higher rate of adverse effects (AEs). Subsequent clinical trials have consistently demonstrated no increase of serious adverse effects in this group of patients, but the incidence of minor adverse events remains to be analysed in this group of patients The objective of this study is to evaluate in real life the incidence of adverse effects attributable to this family of drugs in patients aged 75 years (75+) or more at the beginning of treatment with iSGLT2 taking as reference population patients aged less than 75 years (&amp;lt;75). The incidence of cardiovascular events and death was also analysed. METHOD Observational study, one-centre. We selected all the patients undergoing iSGLT2 treatment at our centre since 2015 till 2021, grouping them according to their age at the start (75 + versus &amp;lt;75 years). RESULTS A total of 153 patients started treatment with iSGLT2 in our centre, 33 (21.6%) were 75 or older. Follow-up time was 19.0 months, interquartile range [8.9–30.3]. Mean age 67.3 years (SD 10.5), m: f ratio was 3:1 and type of SGLT2i was dapagliflozin 49%, canagliflozin 29% and empagliflozin 22%. A total of 28 patients (18.3%) had some side effect of the drug, without significant differences between + 75 and &amp;lt;75. The most frequent AEs in both groups were genitourinary (GU) infections (10.3%) and falls (9.2%), Eight patients discontinued treatment (five due to any AEs) with similar distribution in both groups. GU tract infections were more frequent in the first year of treatment treatment (100% during first year in 75+ and 46.7% in &amp;lt;75 years). We did not found any difference in older patients in the rate of CV events or death (Log rank 0.6) CONCLUSION Side effects of iSGLT2 were uncommon in our population, and age above 75 years was not associated with a higher incidence of AEs. GU tract infections, which were the most prevalent AE, were more frequent in the first year of treatment indicating the need of a more careful monitoring in this period of time.

Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level.

BackgroundDeprescribing requires patients' involvement and taking patients' attitudes toward deprescribing into account. To understand the observed variation in these attitudes, the influence of contextual-level factors, such as country or healthcare setting, should be taken into account.MethodsWe conducted a systematic review of studies using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire among older adults. We searched articles in Medline and Embase up to 30 June 2021. PRISMA guideline was used for the search process and reporting. We summarized the outcomes from the rPATD and compared attitudes at study population level between high or low-middle-income countries, global regions, and healthcare settings using ANOVA testing. Correlations of the rPATD outcomes with the mean age of the study populations were tested. Associations with the rPATD outcomes at individual patient level extracted from the included studies were summarized.ResultsSixteen articles were included. Percentages of patients willing to stop medication were significantly lower in low-middle-income countries (<70% in Nepal and Malaysia) compared to high-income countries (>85% in USA, Australia, European countries). No significant differences were observed when results were compared by global region or by healthcare setting but a high willingness (>95%) was seen in the two studies conducted in an inpatient population. A higher mean age at study level was associated with a higher willingness to stop medication. At individual level, associations between patient characteristics, including demographics and education, and attitudes toward deprescribing showed inconsistent results.ConclusionFindings about attitudes toward deprescribing are influenced by contextual factors. Future research should pay more attention to the influence of the healthcare system and setting as well as the culture on patients' attitudes.

Implementation of Double Immune Checkpoint Blockade Increases Response Rate to Induction Chemotherapy in Head and Neck Cancer.

Simple SummaryThe study compares the effects on complete remission rate (CR) of a single dose of durvalumab/tremelimumab immediately after a single-cycle platinum and docetaxel as part of induction therapy for a controlled trial in head and neck cancer with chemotherapy alone from a historical collective. The CR rate was 60.3% after induction chemoimmunotherapy (ICIT; induction chemotherapy plus double immune checkpoint blockade) compared with 40.3% after induction chemotherapy (IC) alone. Patients with HPV-positive oropharyngeal cancer may benefit the most from additive double checkpoint inhibition, which is presumably due to the higher amount of infiltrating immune cells. Patients older than 60 years without HPV-positive oropharyngeal cancer are unlikely to benefit. To determine whether a single dose of double immune checkpoint blockade (induction chemoimmunotherapy (ICIT)) adds benefit to induction single-cycle platinum doublet (induction chemotherapy (IC)) in locally advanced head and neck squamous cell carcinoma (HNSCC), patients treated with cisplatin 30 mg/m2 d1-3 and docetaxel 75 mg/m2 d1 combined with durvalumab 1500 mg fixed dose d5 and tremelimumab 75 mg fixed dose d5 (ICIT) within the CheckRad-CD8 trial were compared with a retrospective cohort receiving the same chemotherapy (IC) without immunotherapy. The endpoint of this analysis was the complete response rate (CR). A total of 53 patients were treated with ICIT and 104 patients with IC only. CR rates were 60.3% for ICIT and 40.3% for IC (p = 0.018). In the total population (n = 157), the most important predictor to achieve a CR was treatment type (OR: 2.21 for ICIT vs. IC; p = 0.038, multivariate analysis). The most diverse effects in CR rates between ICIT and IC were observed in younger (age ≤ 60) patients with HPV-positive OPSCCs (82% vs. 33%, p = 0.176), while there was no difference in older patients without HPV-positive OPSCCs (53% vs. 48%). The analysis provides initial evidence that ICIT could result in higher CR rates than IC. Young patients with HPV-positive OPSCCs may have the greatest benefit from additional immune checkpoint inhibitors.

Physical therapy enhances functions and quality of life in older patients with breast cancer-related lymphedema: A prospective experimental study.

Lymphedema of the arm is one of the most common complications following breast cancer surgery. The primary aim of this study was to evaluate the effects of complex decongestive physical therapy (CDPt) on upper extremity functions, activities of daily living (ADL), and quality of life (QoL), and secondly the effects of the degree of lymphedema on post-treatment differences in older patients with breast cancer-related lymphedema (BCRL). Sixty-eight patients who had BCRL were included between 2015 and 2017. Arm function was evaluated with the Constant-Murley scale, while ADL was measured with the Lawton Instrumental Activities of Daily Living Scale, and QoL was measured with the Lymphedema Functioning, Disability and Health Questionnaire as pre- and post-treatment tests. The patients underwent a CDPt program for 6 weeks. There were statistically significant improvements for all outcome measurements in older patients with Grade 1 and 2 lymphedemas after the treatment (P < 0.001). The Grade 1 patients had a greater difference at mobility, participation in the life and social activities, and their total scores of quality of life had a significance level of P < 0.001. Older patients with Grade 1 BCRL had better mobility, participation in the life, and social activities. CDPt provides enhancement of arm functions, ADL, and QoL in older patients with breast cancer-related lymphedema.

Dysphagia prevalence and associated survival differences in older patients with lung cancer: A SEER-Medicare population-based study

IntroductionThe impact of dysphagia in persons with lung cancer is unknown. The objective of this study is to measure the prevalence and survival differences associated with dysphagia in older adults with lung cancer. Materials and MethodsLinked SEER cancer registries - Medicare data, 1991–2009 was utilized to identify 201,674 persons with lung cancer. Most were male (53%), had regional or distant disease (74%), and were aged <80 years (82%). The pre-existing prevalence of dysphagia was identified using claims codes before the lung cancer diagnosis. Survival was analyzed using Kaplan Meier curves and Cox proportional hazard models. Results8517 (4%) had dysphagia prior to their lung cancer diagnoses. Younger age, worse disease stage, more comorbidities, and hospital rurality were associated with higher likelihood of dysphagia. Patients with dysphagia had worse survival (median survival 8 months [95%CI 7,9]) than those without dysphagia (median survival 12 months [95%CI 11,13]). After adjusting for sociodemographic, clinical, and disease characteristics, dysphagia was still associated with worse survival (Hazard ratio of death 1.34, [95%CI 1.28–1.35], p ≤ .0001). Discussion and ConclusionsThis is the first Medicare claims-based study of older adults with lung cancer and dysphagia. Pre-existing dysphagia occurred in approximately 1 in 25 patients with lung cancer and was associated with worse survival. Determining the best methods to evaluate and treat dysphagia in patients with lung cancer is an important avenue for future studies.

THE FEASIBILITY OF USING COMMUNITY PHARMACISTS TO COUNSEL OLDER ADULTS ON FALL PREVENTION

Despite recognition as a serious public health problem, older adults falls increased 30% between 2007-2016. Numerous evidence-based fall prevention programs exist, but may have inadequate reach. Pharmacists are highly trained and accessible clinicians who have potential to counsel on fall prevention. This study describes the reach of a fall prevention outreach conducted by a large national pharmacy chain in partnership with local area agencies on aging (AAAs). On August 7, 2018, the pharmacy chain held an outreach during which older patients were incentivized to speak with pharmacists about their fall risk and prevention strategies. In Ohio, AAAs provided pharmacists additional support and availability of AAA fall prevention programs. A random sample of pharmacists was sent a follow-up survey to assess the program’s reach, except in Ohio where all pharmacists received the survey. Response rates were 41% (N=111) and 59% (N=160) in Ohio and non-Ohio states, respectively. We estimate that pharmacists discussed fall prevention with an additional 57,642 on 8/7/2018. The difference in older patients counseled on fall prevention on 8/7/2018 vs. a typical day was significantly greater (p=0.03) for Ohio pharmacists (µ=9.28) compared to non-Ohio pharmacists (µ=5.94). The majority of pharmacists in Ohio and non-Ohio states were moderately or extremely confident in their ability to discuss fall prevention with older patients (69.82% vs. 72.72%) and play an important role in fall prevention (59.75% vs. 54.54%). This study demonstrates the feasibility of utilizing community pharmacists, in partnership with AAAs, to reach large numbers of older adults to counsel on fall prevention.

SEX STEROIDS AND MACULAR TELANGIECTASIA TYPE 2.

To investigate the relationship between macular telangiectasia Type 2 and systemic levels of sex steroids or their antagonization. In a prospective single-center study, 90 patients with macular telangiectasia Type 2 were investigated. Female patients were evaluated for previous surgical (e.g., ovariectomy) and/or pharmacological (e.g., aromatase inhibitors, tamoxifen) therapy resulting in reduced action of sex steroids. In males, free serum testosterone levels were assessed in patients and controls. Fourteen of 49 (29%) female patients had a history of pharmacological suppression of sex steroids and/or ovariectomy. These patients were younger at disease onset when compared with those without such medical history (mean ± SD: 47.1 ± 7.8, range: 38-59, versus 60.1 ± 7.6, range: 45-76; P < 0.0001). Male patients showed significantly lower free serum testosterone levels compared with controls at younger age (P < 0.0001 and 0.04 in the first and second age quartiles, respectively), as opposed to nonsignificant differences in older patients. In men ≤ 60 years of age, a biochemical hypogonadism (free serum testosterone < 0.05 ng/mL) was present in 53% (8/15) and 4% (2/49) of patients and controls, respectively (P < 0.0001). The results indicate that steroidal sex hormones might be involved in the presumably multifactorial pathophysiology of macular telangiectasia Type 2.

Presentation and Outcome Differences in Older Patients with Preexisting Coronary Artery Disease Admitted with Myocardial Infarction

Background: Managing older patients who present with an MI is challenging. Older patients usually have more comorbidities putting them at higher risk of death however receive more conservative therapies.

High-Grade Diffuse Large B-Cell Lymphoma in Elderly Patients: Russian Multicenter Trial Results in R-EPOCH/R-HMA Protocol

Background: The number of elderly patients with diffuse large B-cell lymphoma (DLBCL) in our aging society continues to rise. Median of age for patients with diffuse large B-cell lymphoma (DLBCL) is 60. Approximately 50% of older patients with DLBCL are defined as high-grade by IPI and these forms are characterized by aggressive course and poor response to standard chemotherapy (CT). Intensive protocols cannot be performed due to their toxicity for older patients with comorbidity. Addition of R-HMA to R-DA-EPOCH favourably changes the outcome in patients with untreated high-grade diffuse large B-cell lymphoma and didn't have higher toxicity [ASH 2015 # 2708].Aim: To evaluate the efficacy and toxicity of R-EPOCH/R-HMA protocol in older patients with untreated high-grade diffuse large B-cell lymphoma.Patients and Methods: 19 untreated older DLBCL patients from 4 centers were enrolled in a prospective study between August 2013 - July 2016; stage II-IV; ECOG 0-3; median age 66 years (60-78); age ≥70y/60<70y 21%/79%; M/F 52%/48%; IPI: 52% high-intermediate and 48% high risk; 26% with bone marrow involvement. Severe comorbidity was diagnosed in 8 (42%) patients (coronary heart disease, hypertonic disease, chronic obstructive pulmonary disease and arrhythmia). All patients underwent 4-6 courses (2-3 cycles) of chemotherapy: R-EPOCH (standard dose and scheme), R-HMA (R 375 mg/m2 d1, MTX 500 mg/m2 24 hours d 2, AraC 1000 mg/m2 q 12 hrs d 3-4). In 3 cases of DLBCL with bone marrow involvement BEAM conditioning and autologous stem cell transplantation were applied.Results: The median follow-up is 18 months (3-37). There was no mortality associated with toxicity. The main non-hematological toxicities of R-HMA were infections (mucositis, pneumonia, sepsis, enteropathy) grades 1-2 and 3-4 in 90% and 10%, respectively. Hematological toxicity grade 4 for less than 4 days we observed only after courses R-HMA. Complete remission (CR) was achieved in 18 (100%) patients and 1 patient in the treatment now. There are four failures in patients older than 60 years: three relapses (after 6 and two after 14 month CR) and one death after 7 month CR by reasons not related with DLBCL.With a median follow 18 months overall and event-free survival of 19 older patients constituted 93,8% and 75,9%, respectively (Fig.1). There is no difference in older patients according to stage, IPI, LDH level, ECOG status for OS and EFS. So the combination of R-EPOCH/R-HMA may be considered as optimal intensive approach in older patients.Conclusions: TheR-EPOCH/R-HMA protocol demonstrated acceptable toxicity and high efficacy in older patients with high-grade DLBCL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Comparison of Drug Use Between Clinical Practice and Regulatory Approval: Results in Older Japanese Patients With Rheumatoid Arthritis, Diabetes, High Blood Pressure, or Depression.

In this study, differences in older patients between drug use as reported in clinical practice and in clinical trials for regulatory approval were examined. Electronic medical record (EMR) data such as patient background (age, sex), concomitant drugs, data on laboratory tests, and prescribed doses of drugs from outpatients with rheumatoid arthritis, diabetes, high blood pressure, or depression at Chiba University Hospital were obtained for the period from January 2003 to December 2012. These data were compared with data from relevant clinical trials for regulatory approval in order to examine differences in drug use. There were 5134 eligible patients. The prescribed doses of drugs were lower than the standard approved doses for depression and rheumatoid arthritis but were generally within the approved dose range for type 2 diabetes mellitus and hypertension. When comparing the characteristics of older patients taking tacrolimus, 5.6% to 17.0% of those would not be able to participate in clinical trials because of liver or renal abnormality, and the incidence rates of some adverse drug events (ADEs) differed significantly between clinical practice and clinical trials. Appropriate doses of drugs for older patients may differ from approved doses in certain diseases. Complex situations such as a lot of polypharmacy, comorbidity, and functional impairment in older patients in clinical practice make it difficult to evaluate safety based on data from clinical trials. In the future, utilization of a database created from the EMR of older patients should be considered for assessment of drug safety in older patients in clinical practice.

Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials

Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the association of age with treatment differences in symptomatic patients and provide age-specific estimates of the risk of stroke and death within narrow (5 year) age groups. In this meta-analysis, we analysed individual patient-level data from four randomised controlled trials within the Carotid Stenosis Trialists' Collaboration (CSTC) involving patients with symptomatic carotid stenosis. We included only trials that randomly assigned patients to CAS or CEA and only patients with symptomatic stenosis. We assessed rates of stroke or death in 5-year age groups in the periprocedural period (between randomisation and 120 days) and ipsilateral stroke during long-term follow-up for patients assigned to CAS or CEA. We also assessed differences between CAS and CEA. All analyses were done on an intention-to-treat basis. Collectively, 4754 patients were randomly assigned to either CEA or CAS treatment in the four studies. 433 events occurred over a median follow-up of 2·7 years. For patients assigned to CAS, the periprocedural hazard ratio (HR) for stroke and death in patients aged 65-69 years compared with patients younger than 60 years was 2·16 (95% CI 1·13-4·13), with HRs of roughly 4·0 for patients aged 70 years or older. We noted no evidence of an increased periprocedural risk by age group in the CEA group (p=0·34). These changes underpinned a CAS-versus CEA periprocedural HR of 1·61 (95% CI 0·90-2·88) for patients aged 65-69 years and an HR of 2·09 (1·32-3·32) for patients aged 70-74 years. Age was not associated with the postprocedural stroke risk either within treatment group (p≥0·09 for CAS and 0·83 for CEA), or between treatment groups (p=0·84). In these RCTs, CEA was clearly superior to CAS in patients aged 70-74 years and older. The difference in older patients was almost wholly attributable to increasing periprocedural stroke risk in patients treated with CAS. Age had little effect on CEA periprocedural risk or on postprocedural risk after either procedure. None.

Age and carotid intervention outcomes

In The Lancet, the Carotid Stenting Trialists' Collaboration (CSTC) present a meta-analysis of the effect of increasing age on perioperative death or stroke related and late ipsilateral stroke in 4754 symptomatic patients randomised to carotid endarterectomy (CEA) or carotid artery stenting (CAS) in three European randomised controlled trials (RCTs; EVA-3S, SPACE, and ICSS) and one North American RCT (CREST). 1 Howard G Roubin GS Jansen O et al. on behalf of the Carotid Stenting Trialists' CollaborationAssociation between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet. 2016; (published online Feb 12.)http://dx.doi.org/10.1016/S0140-6736(15)01309-4 Google Scholar Key findings were that once the perioperative period (between randomisation and 120 days) passed, there was no difference in late ipsilateral stroke between CEA and CAS, irrespective of age, and that increasing age had no effect on procedural risks after CEA, but there was a stepwise increase in perioperative stroke or death after CAS, contributing to the CAS versus CEA treatment difference, which became apparent at 65–69 years of age (hazard ratio 1·81, 95% CI 0·97–3·38) and most pronounced over the age of 70 (2·28, 1·39–3·75). Because there was no difference in stroke rates after the perioperative period, the magnitude of the procedural risk will ultimately determine whether CEA or CAS is safer in individual patients. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trialsIn these RCTs, CEA was clearly superior to CAS in patients aged 70–74 years and older. The difference in older patients was almost wholly attributable to increasing periprocedural stroke risk in patients treated with CAS. Age had little effect on CEA periprocedural risk or on postprocedural risk after either procedure. Full-Text PDF

Safety of duloxetine for the treatment of older patients with osteoarthritis knee pain or chronic low back pain

Many people experience chronic pain as they age. Duloxetine is a non-narcotic medication for treatment of chronic pain associated with osteoarthritis of the knee and chronic low back pain as demonstrated in 5 placebo-controlled clinical trials. These studies included 839 duloxetine-treated patients, 237 (28.2%) of whom were aged ≥ 65 years. This post hoc analysis analyzed the safety and tolerability of duloxetine comparing older (≥ 65 years) and younger (18-64 years) patients during12-13 weeks of treatment. Safety was assessed by the frequency rate of ≥5% in treatment-emergent adverse events (TEAEs) for duloxetine that were also significantly higher than placebo; occurrence of serious adverse events (SAE); and significant changes in vital signs or clinical laboratory measures. The duloxetine/placebo differences in each age group were analyzed by a logistic regression model with covariates of treatment, age group, and treatment-by-age group interaction. Statistically significant interaction was defined as p<.10. In each age group, patients taking duloxetine experienced at least 1 TEAE with similar frequency (older, 57.0% vs. younger, 63.3%; p=.91, and there was no significantly greater duloxetine/placebo difference in older patients compared with younger patients for TEAEs that occurred ≥5% with duloxetine and that were significantly higher than placebo. In patients taking duloxetine, the frequency of a TEAE "Fall” was numerically higher in older patients (3, 1.3%) compared with younger patients (3, 0.5%) but without any statistically significant findings. No deaths were reported, and there were no statistically significant increases in SAEs for duloxetine patients compared with placebo in older patients. In summary, no significant treatment-by-age group interactions were observed for any of the safety analyses, which suggest that duloxetine does not present an increased risk for older patients. This work was supported by Eli Lilly and Company.

Theory of Mind differences in older patients with early‐onset and late‐onset paranoid schizophrenia

Theory of Mind (ToM) is considered an essential element of social cognition. In younger schizophrenia patients, ToM impairments have extensively been demonstrated. It is not clear whether similar impairments can be found in older schizophrenia patients and if these impairments differ between older patients with early-onset and late-onset schizophrenia. Theory of Mind abilities were assessed using the Hinting Task in 15 older patients (age 60 years and older) with early-onset paranoid schizophrenia, 15 older patients with late-onset paranoid schizophrenia and 30 healthy controls. ANCOVA was performed to test differences between groups. Analyses were adjusted for level of education. Effect sizes, partial eta squared (ε(2) ), were computed as an indication of the clinical relevance of the findings. Patients with early-onset schizophrenia scored significantly lower on the Hinting Task (mean 16.1; SD 4.3) compared with patients with late-onset schizophrenia (mean 18.6; SD 1.5) and with healthy controls (mean 19.0; SD 1.4). The effect size of this difference was large (ε(2) = 0.2). These results suggest that ToM functioning may be a protective factor modulating the age at onset of psychosis. Further studies into the relationship between social cognition and onset age of psychosis are warranted.

Tai Chi Exercises Benefit Even Oldest Adults

Tai Chi Exercises Benefit Even Oldest Adults

Internal sphincterotomy and haemorrhoidectomy in acute haemorrhoids. Its value in reduction of postoperative pain.

Abstract Two groups of 16 patients each were studied. All were operated on for prolapsed and thrombosed haemorrhoids. One group was subjected to the typical Milligan-Morgan haemorrhoidectomy, while in the other an internal sphincterotomy was carried out in addition to haemorrhoidectomy. This was done in an effort to determine the effect of internal sphincterotomy on the reduction of postoperative pain. We were pleased to note a definite beneficial effect from the addition of sphincterotomy in patients aged under 40 years, although we found no significant difference in older patients.

The role of age and race in receiving breast cancer treatment: A cross-sectional survey of an urban population

6047 Background: Breast cancer treatment differences in older patients and in certain groups. These differences may be due to a variety of factors, in addition to age and race, which include: comorbid illnesses, performance status, socioeconomic status, and education. Methods: The sample consisted of a cross-sectional survey of 257 Latina, African American and White women living in Los Angeles County, age 55 or older from the Los Angeles County Cancer Surveillance Program’s (CSP) rapid ascertainment program (the Tumor Registry) who were between three and nine months of diagnosis and at least one month post treatment. These patients were interviewed, their medical records abstracted, and the doctor’s surveyed. The primary outcomes for this analysis were surgical, radiation, hormone, and chemotherapy treatment options. Logistic regression analysis was used controlling for age, race/ethnicity, socio-demographic characteristics, Katz comorbidity, functional status, and stage of disease. Results: Univariate analysis demonstrated significant trends with age and race across most treatment choices. In multivariate analysis, the effect of age and race was less pronounced. Factors such as insurance status, comorbidity, and education were very significant for treatment selection. Medi-Cal patients were less likely to receive lumpectomy (Odds Ratio, OR=0.19) and none received reconstruction post mastectomy. Educated patients were more likely to have an axillary lymph node dissection, LND, (OR=7.5) and post-lumpectomy radiation (OR=3.94). Those with higher Katz comorbidity were less likely to receive a LND (OR=0.70) or chemotherapy (OR=0.76). Nevertheless, older women were less likely to have LND (OR=0.49) and chemotherapy (OR=0.24) compared to younger women. African-American women were less likely to have adjuvant hormone therapy (OR=0.50) compared to Caucasians and Latinas. Conclusion: Although age and race are factors in certain breast cancer treatment decisions, other factors such as education and insurance status and may serve as important targets in order to improve care. No significant financial relationships to disclose.