Disease In Geriatric Patients Research Articles

Sphenoid sinus disease in geriatric patients: an analytical approach

The article presents an analytical approach based on intelligent statistical processing of different medical data to the diagnosis and treatment of sphenoid sinus diseases in elderly patients. With the increasing average lifespan and the widespread use of CT and MRI, the detectability of sphenoid sinus diseases is expected to increase, including among the elderly population. A retrospective analysis was conducted on patients who received treatment for sphenoid sinus diseases at the Otorhinolaryngology Clinic of the I.P. Pavlov St. Petersburg State Medical University. The study analyzed more than 50 patients with sphenoid sinus pathology, with 9.8% classified as elderly individuals aged 60 years or older. The most common symptom in elderly patients was headache, and surgical treatment was required in 80% of cases half due to the ineffectiveness of conservative therapy and another 40% due to the presence of formations in the sinus (mycetomas). The postoperative period continued without complications and the mean hospital stay was 7 days. Successful treatment of sphenoiditis in the elderly requires a comprehensive diagnosis and an individualized treatment plan. Endoscopic endonasal surgery of the sphenoid sinus can be safely performed in elderly patients with low anesthetic risks and a specialized surgical team. However, our research has limitations, including a small sample size of elderly patients with sphenoid sinus pathology. Future studies could explore factors such as comorbidities, hormonal changes, age-related influences, or lifestyle differences. Such an integrated approach will allow us to delve deeper into the intricacies of sphenoid sinus pathology in elderly patients.

Effectiveness of midline lumbar fusion with cortical bone trajectory screw fixation for degenerative lumbar spine disease in geriatric patients over 80 years old: a single-center, one-decade experience

Objective: We aimed to retrospectively analyze clinical and surgical outcomes following posterior lumbar interbody fusion with concomitant pedicle screw fixation, midline lumbar fusion, and decompressive laminectomy in patients aged 80 years or older with degenerative lumbar spine disease.Methods: The study group comprised 94 patients aged 80 years or older who received degenerative lumbar spinal surgery at our spine center from January 2011 to December 2020. Among them, 28 patients underwent decompressive laminectomy, 19 underwent posterior lumbar interbody fusion with pedicle screw fixation, and the remaining 47 underwent midline lumbar fusion.Results: No significant intergroup differences were found regarding age, sex ratio, follow-up duration, and surgical level. The visual analog scale for lower back pain on postoperative day 7 was significantly different among the groups (P<0.05). The Oswestry disability index was significantly different among the groups after 1 week of follow-up (P<0.05). The estimated blood loss and operation time also showed significant differences among the groups (P<0.05). There was a statistically significant difference among the groups in postoperative morbidity (P<0.05).Conclusion: Although the clinical outcomes were not significantly different among the three groups, perioperative morbidity was more favorable in the decompression and midline lumbar fusion groups. Therefore, we suggest that midline lumbar fusion is not inferior to posterior lumbar interbody fusion with pedicle screw fixation, if there is a need for fusion in elderly patients over 80 years of age.

A-21 | Lower TNF-α Levels Associate With the Absence of Coronary Artery Disease in Geriatric Patients

A-21 | Lower TNF-α Levels Associate With the Absence of Coronary Artery Disease in Geriatric Patients

Low handgrip strength is associated with diabetic foot disease in geriatric patients with type 2 diabetes.

This study aims to reveal the prevalence of low handgrip strength in older patients with type 2 diabetes who have diabetic foot disease and to assess the association of handgrip strength with diabetic foot disease in older patients with type 2 diabetes. Eighty-nine geriatric patients with diabetic foot ulcers and 69 patients without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were included in the study. The exclusion criteria were the usage of steroids, stroke-induced quadriplegia, myopathy, disability, hemodialysis treatment, type 1 diabetes, patients under 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. A handgrip strength test was performed with a handheld digital dynamometer. For females <16 kg (kilograms), for males <27 kg was accepted as low handgrip strength. Forty-nine patients (55.1%) with diabetic foot ulcers and 25 (36.2%) patients without diabetic foot ulcers had low handgrip strength. There was a significant difference between two groups (p = 0.019). The patients with diabetic foot ulcers who had lower handgrip strength had higher rates of peripheral artery disease than patients with diabetic foot ulcers who had normal handgrip strength (p = 0.02 and p = 0.009, respectively). The patients with diabetic foot ulcers who had lower handgrip strength, had significantly higher rates of Wagner scores 4 and 5 and lower rates of Wagner scores 1 and 3 (p = 0.039). Older patients with type 2 diabetes and diabetic foot disease had a higher rate of low handgrip strength. Low handgrip strength was significantly associated with the occurrence of diabetic foot ulcers and directly correlated with Wagner score in geriatric patients with type 2 diabetes.

Köpeklerin Yaşlanmaya Bağlı Bilişsel Bozukluğu

Canine cognitive disorder (CDS) is a neurodegenerative, progressive, and irreversible disorder of senior dogs, generally over eight years old. CDS is characterized by a decrease in cognitive functions. Clinically significant changes in dog’s behavior and daily routines including disorientation, decrease in social interactions, changes in sleep-wake cycles, loss of household habits, poor communication, increased anxiety, and changes in activity levels with the potential to create significant problems and discomfort in the lifestyle of the owners, deteriorating pet-owner attachment and generally be frustrating for the owner. The definite diagnosis depends on brain biopsies, and there is no confirmed clinical diagnosis method developed, meeting the whole criteria of CDS. The owner assessment using several scales available is the primary tool to rely on, which has a high potential to be subjective. Although it still has many dark sides, CDS is a disease with convenient diagnostic and therapeutic strategies available. Veterinarians need to consider this disease in geriatric patients and cooperate by increasing owner awareness, stopping or at least slowing down the disease in elderly dogs, and making the geriatric period more comfortable for both the dog and the owner. This review aims to introduce current information in the diagnosis and treatment of CDS.

Treatment Paradigms for Older Adults with Pancreatic Cancer: a Nuanced Approach.

Pancreatic cancer is increasing in incidence in the USA. This disease disproportionately affects older adults, and as the percentage of adults > 65years old increases with the aging of the baby boomers, the prevalence is expected to rise over the coming decade. These patients are often more susceptible to disease-related symptoms and have less ability to withstand both cancer and treatment-related side effects. Therefore, it is imperative that treating physicians thoughtfully consider their recommended treatment approach towards this vulnerable patient population. This review focuses on the current state of research of older adults with pancreatic adenocarcinoma, highlighting deficiencies in the representation of this patient population in clinical trials. It is vital that the treating physicians take a nuanced approach towards therapy of localized and metastatic disease in geriatric patients. A one size fits all treatment algorithm is no longer appropriate in any cancer patient, let alone the elders who are particularly vulnerable to developing treatment-related toxicities. To help guide therapy decisions, it is important to perform a comprehensive geriatric assessment which may uncover unexpected frailty and lead to a change in the recommended treatment approach. In this way, we can support older adults during therapy for this aggressive malignancy and provide optimal care.

COVID-19 Nedeniyle İnterne Edilen Geriatrik Hastalarda Malnütrisyon Riski ile Prognoz Arasındaki İlişki

Objective: We evaluated the effect of nutritional status on the prognosis of the disease in geriatric patients hospitalized due to COVID-19 disease.Materials and Methods: 110 patients over 65 years old were included. Malnutrition risk was assessed by Nutritional Risk Screening 2002 (NRS 2002). The patients were divided into two groups according to the NRS 2002 score (≥3 as group-1, &amp;lt;3 as group-2). Prognosis markers of the patients were recorded. Statistical significance level was set at p&amp;lt;0.05.Results: The study was conducted 110 patients (Man/Woman:51/59). In group-1, duration of hospitalization, tomography involvement, intubation rate and referral to intensive care, respiratory rate, leukocyte count, C reactive protein (CRP), ferritin, d-dimer levels were higher than group-2 (p&amp;lt;0.05). In group 1; 35 cases were discharged, 18 cases were transferred to 1st level intensive care, and 2 cases were transferred to 3rd level intensive care. In the group 2, 53 cases were discharged, and 2 cases were transferred to 1st level intensive care unit. There was a significant positive correlation between NRS 2002 score and age, respiratory rate, leukocyte, CRP, d dimer and days of hospitalization score (p&amp;lt;0.05).Conclusion: Malnourished patients have higher poor prognostic markers, longer hospital stay and more intensive care needs.

Effect of Treatment Regimen on Long-Term Mortality of Geriatric Patients Diagnosed With Stable Coronary Artery Disease.

BackgroundIncreased life expectancy across the world has resulted in an increase in the proportion of the elderly population who are lost to heart diseases. Advanced age and comorbidities are believed to change the response to treatments. In this study, we aimed to investigate the effects of surgical and medical treatments on the mortality of stable coronary diseases.MethodsA total of 150 geriatric patients who underwent coronary angiography (CAG) were followed up in our cardiology clinic. Patients who decided to undergo coronary artery bypass graft (CABG) surgery after CAG and were willing to undergo the operation were assigned to group 1, whereas those who were unwilling to undergo the operation were not eligible for percutaneous coronary intervention and were followed up medically, and were assigned to group 2. Keeping the primary goal as mortality rates, both the groups were compared using medical records for three years after the treatment.ResultsAfter three years, the overall mortality rate included six patients (16%) in the CABG group versus 63 patients (55%) in the medical therapy group (p < 0.001). The CABG therapy was found to be significantly and independently associated with first- and third-year mortality (risk ratio: 0.064, 95% confidence interval: 0.009-0.467, p = 0.007; risk ratio: 0.305, 95% confidence interval: 0.151-0.615, p < 0.001, respectively). Kaplan-Meier analysis for first- and third-year all-cause mortality rates led to significant results and curves between the groups.ConclusionOur study revealed that compared to CABG surgery in the treatment of coronary artery disease in geriatric patients, medical treatment is associated with poor outcomes in terms of mortality in long-term follow-up.

Specificity of estimation and prognostic value of glomerular filtration rate in older age groups with cardiovascular pathology.

The demographic situation in recent decades has been characterized by a progressive increase in the proportion of older age groups in both developed countries and the Russian Federation. The main contribution to morbidity and mortality of people over 60 years of age is made by diseases of the circulatory system. Early development and progression of cardiovascular diseases contributes to kidney dysfunction, often developing against the background of morphological changes occurring with age in the kidneys, called "senile kidney". Reduction of glomerular filtration rate in elderly patients is not mandatory and in most cases occurs as a result of an existing pathological process. The combined effect of changes in GFR and cardiovascular disease on the prognosis of older patients remains poorly understood, which determines the relevance of the study of chronic kidney disease in geriatric patients.

Safety and Tolerability of Pharmacotherapies for Parkinson's Disease in Geriatric Patients.

Parkinson's disease is a chronic neurodegenerative movement disorder affecting people mainly beyond their 50s. Geriatric patients with Parkinson's disease experience a specific profile of comorbidities. Multimorbidity and resulting polypharmacotherapy are frequent at this age. Comorbid diseases, widely spread, involve arterial hypertension, ischemic heart disease, heart failure, atrial fibrillation, polyneuropathy, diabetes mellitus, cerebrovascular disease, sarcopenia, and frailty. Following years of drug development, levodopa is still the most effective drug for the treatment of motor symptoms. However, a wide range of other drugs are available with specific effects, contraindications, and complications. The treatment of geriatric patients with Parkinson's disease is challenging and requires the cooperation of multidisciplinary teams. A careful assessment of a patient's Parkinson's disease symptoms, comorbidities, medication, vital signs, and resources is crucial for an effective and safe therapy. Laboratory tests can assist in the identification of contraindications for specific treatments. Identifying potentially inadequate drugs from prescription lists can lead to a better targeted treatment for geriatric patients with Parkinson's disease. Future research should help develop a more evidence-based therapy of geriatric patients with Parkinson's disease. For this purpose, randomized controlled trials of geriatric patients are urgently needed. An international register concerning issues of safer drug application and monitoring could help to implement a better treatment.

Peculiarities of Diagnostics of Lower Extremities Peripheral Artery Disease in Geriatric Patients

Peculiarities of Diagnostics of Lower Extremities Peripheral Artery Disease in Geriatric Patients

Iron hypothesis and coronary artery disease in geriatric patients

Context and aims: Iron is a pro-oxidant factor in the pathogenesis of CAD. The association of body iron status was investigated relative to the occurrence and severity of CAD.Design and methods: The subjects consisted of 110 males and 115 females who were classified as either a CAD case or a control according to the results of coronary angiography.Results: A new parameter, the “serum free iron index,” was defined as the ratio of serum iron to UIBC. The level of ferritin showed significant increase [97.2 (67.0–171.2) µg/L vs. 85.6 (52.5–129.4), p = .034], whereas serum total iron, free iron index, transferrin, UIBC and iron saturation were unchanged in CAD patients relative to control group. Among the indices of body iron only serum ferritin had significant association with the likelihood (OR of 1.004 (1.000–1.007), p = .04) and severity of CAD [χ2(3)= 7.99, p = .01], but the correlation was lessened in the presence of classical risk factors. Serum ferritin had also the highest and significant efficiency to predict CAD (AUC = 0.61, p = .020).Conclusions: Serum ferritin as a marker of intracellular iron has significant association with CAD; nevertheless, the correlation is not independent. Since iron deficiency is prevalent in elderly patients, iron hypothesis needs to expand to the both sides of iron deficiency and toxicity.

Aspirin prescribing patterns for primary prevention of cardiovascular disease in geriatric patients with diabetes: Survey of prescribers based on experience

Evidence and guidelines provide conflicting recommendations regarding the use of aspirin for primary prevention of cardiovascular disease, particularly in geriatric patients with diabetes. The objective of this study is to identify aspirin-prescribing patterns and determine if it is consistent with the 2013 American Diabetes Association and American Geriatrics Association guidelines. A survey was distributed to attending physicians, fellow physicians, and mid-level practitioners in internal medicine, geriatric, cardiology, and endocrinology clinics in Detroit, MI, USA. Most providers (88%) indicated that they would give aspirin for primary prevention of cardiovascular disease. Of those who chose to give aspirin, all chose to prescribe a dose of 81 mg. Most providers elected to prescribe aspirin based on patient age (86%) and comorbidities (98%). Aspirin is routinely prescribed for geriatric patients with diabetes for the primary prevention of cardiovascular disease. The guidelines provide conflicting recommendations; therefore, provider education is needed to guide decision-making in the elderly.

P428: Huntington disease in geriatric patients – ethics and specific care education and support both for patient and families

P428: Huntington disease in geriatric patients – ethics and specific care education and support both for patient and families

Perioperative Risikostratifizierung geriatrischer Patienten bei nichtkardialen Eingriffen

Older patients more often suffer perioperative complications than younger people. Especially geriatric patients who require emergency treatment represent a high-risk group. Therefore, perioperative risk assessment supports the treatment team in identifying patients at risk and in defining the treatment plan accordingly. A thorough medical history and clinical examination are pivotal elements of any risk stratification. The organ-specific risk assessment is primarily used to plan the surgical and anesthesiological procedures. For a comprehensive risk assessment in geriatric patients, the organ-specific risk stratification is insufficient. Assessment instruments that reflect the idiosyncrasies of multidimensional disease in geriatric patients can complement risk stratification. These should include the assessment of multimorbidity, frailty, nutrition, activities of daily living, and cognition. In addition to risk prediction, geriatric assessment has the major advantage of providing both a diagnostic and a planning perspective. This allows the implementation of supporting measures for optimal perioperative care, which is the goal of any risk stratification. Risk scores provide a global assessment, but they have their limitations in predicting individual patient risk.

Quantitative analysis of periodontal pathogens present in the saliva of geriatric subjects

PurposeAt present, information regarding periodontal disease in geriatric patients is scarce. The purpose of this study was to quantify the periodontal pathogens present in the saliva of Korean geriatric patients and assess the relationship between the bacterial levels and the periodontal condition.MethodsSix putative periodontal pathogens were quantified by using a real-time polymerase chain reaction assay in geriatric patient groups (>60 years) with mild chronic periodontitis (MCP), moderate chronic periodontitis (MoCP), and severe chronic periodontitis (SCP). The copy numbers of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Prevotella intermedia were measured.ResultsIt was found that the bacterial copy numbers increased as the severity of the disease increased from MCP to SCP, except for P. intermedia. For P. intermedia, it was found that samples in the MCP group yielded the largest amount. It was also found that the quantities of P. gingivalis, T. forsythia, and T. denticola, the so-called "red complex" bacteria, were lower than those of F. nucleatum, A. actinomycetemcomitans, and P. intermedia in all of the samples.ConclusionsCollectively, the results of this study suggest that the levels of P. gingivalis, T. forsythia, F. nucleatum, and T. denticola present in saliva are associated with the severity of periodontal disease in geriatric patients.

Cervical Disc Disease in Geriatric Patients: A Comparison Study

Aim: Cervical disc disease (CDD) is a common clinical entity. This is a retrospective comparison study of surgical CDD outcomes in 285 geriatric patients (age > 65) and 2715 non-geriatric patients (age < 65). Methods: The geriatric group consisted of 146 men and 139 wom-en, with mean age of 70.4 years. Results: Geriatric patients, when compared to non-geriatric pa-tients, were more likely to present with chronic, multi-level, severe radiculopathy and myelopathy. Patients > 65 years old required more instrumentation use than patients < 65 years old. Conclusion: Overall outcomes were less favorable among geriatric patients, with significantly lower percentage of excellent/good outcomes, significantly greater percentage of poor outcomes, and more frequent clinically relevant recurrence. In addition, length of hospitalization was significantly greater in the geriatric patient group.

Cervical Disc Disease in Geriatric Patients: A Comparison Study

Aim: Cervical disc disease (CDD) is a common clinical entity. This is a retrospective comparison study of surgical CDD outcomes in 285 geriatric patients (age > 65) and 2715 non-geriatric patients (age < 65). Methods: The geriatric group consisted of 146 men and 139 wom-en, with mean age of 70.4 years. Results: Geriatric patients, when compared to non-geriatric pa-tients, were more likely to present with chronic, multi-level, severe radiculopathy and myelopathy. Patients > 65 years old required more instrumentation use than patients < 65 years old. Conclusion: Overall outcomes were less favorable among geriatric patients, with significantly lower percentage of excellent/good outcomes, significantly greater percentage of poor outcomes, and more frequent clinically relevant recurrence. In addition, length of hospitalization was significantly greater in the geriatric patient group.

Prophylactic anticoagulation for venous thromboembolic disease in geriatric patients.

Venous thromboembolic disease (VTED) occurs commonly in geriatric medical patients, causing significant morbidity and mortality. Although VTED is preventable, prophylactic anticoagulation is underused. Awareness of the clinical risk factors that contribute to VTED in the elderly is essential for identifying candidates for prophylaxis. Iatrogenic risk factors include venous catheterization, transvenous pacemaker placement, hormone replacement therapy, and immobilization or prolonged bed rest. Medical conditions associated with increased risk include a previous episode of VTED, myocardial infarction, heart failure, severe lung disease, cancer, and neurological conditions associated with paresis. Obstacles to the widespread usage of VTED prophylaxis in geriatric medical patients include the clinically silent nature of VTED, underestimation of the risk and clinical effect of VTED in this population, and concerns about the cost and safety of anticoagulant therapy in this population. Clinical practice guidelines devised specifically for geriatric medical patients facilitate rational use of thromboprophylaxis in this population. The safety, efficacy, cost-effectiveness, and convenience of low-molecular-weight heparins for thromboprophylaxis are reflected in their increasing prominence in clinical practice guidelines and clinical use.

Estimation of reference intervals from a senieur protocol compatible aged population for immunogerontological studies

Because many laboratory values change with age, the study of healthy aging as well as diagnosis of disease in geriatric patients requires specific age-corrected reference intervals. We have established such reference intervals for a healthy population aged 65–74 years by selection of a sample group applying the clinical criteria of the SENIEUR protocol and we have compared them with those of a young control group (20–33 years) fulfilling the same criteria. Significant or minor elevations were seen, e.g. for plasma concentrations of fasting glucose, urea, total and LDL-cholesterol, triglycerides, γ-glutamyl-transferase, alkaline phosphatase, erythrocyte sedimentation rate and serum neopterin levels. These reference intervals can be used for selecting a SENIEUR compatible population aged between 65 and 74 years. Additionally, plasma lipid parameters (cholesterol, triglycerides) are proposed to be included in the SENIEUR protocol.