Disease In Elderly Patients Research Articles

P1089 Efficacy and safety of mirikizumab as induction and maintenance treatment in adults 60 years or older with moderately to severely active ulcerative colitis

Abstract Background Mirikizumab (MIRI), an anti-IL-23p19 antibody, has demonstrated efficacy and safety in adults with moderately to severely active ulcerative colitis (UC) in two Phase 3 trials (LUCENT-1/-2; NCT03518086, NCT03524092). [1] As novel therapies for UC are not well studied in adults ≥60 years (older adults), we aimed to evaluate the efficacy and safety of MIRI compared to placebo (PBO) during induction and maintenance treatment among this especially vulnerable subgroup of patients with UC. [2. 3] Methods In LUCENT-1, patients with UC were randomized to receive 3 intravenous (IV) doses of 300mg MIRI or PBO every four weeks (Q4W) at W0, W4, and W8. In LUCENT-2, responders to MIRI induction at W12 were re-randomized to subcutaneous (SC) 200mg MIRI or PBO Q4W for another 40 weeks (until W52 of continuous treatment). Endpoints evaluated in this post-hoc analysis included clinical response, clinical remission, symptomatic remission, endoscopic remission, corticosteroid (CS)-free remission (W52 only), histologic-endoscopic mucosal improvement (HEMI), histologic-endoscopic mucosal remission (HEMR), and bowel urgency (clinically meaningful improvement and remission). Efficacy in the subgroup of older adults was assessed at W12 and W52 using Fisher’s Exact tests. Safety data were summarized among patients aged 60 and older who received at least one dose of study treatment. Results At LUCENT-1 baseline, 13.3% of patients (n=154/1162) were ≥60 years, with a median age of 65 [Quartile (Q)1: 62.0, Q3: 69]. Apart from higher prevalence of comorbidities, longer disease duration, older age at diagnosis, and lower frequency of concomitant treatment with thiopurines, the baseline demographics and characteristics were similar to the overall patient population, including disease activity (per modified Mayo Score and Mayo Endoscopic Subscore), disease extent, and prior advanced therapy failure. At W12 and W52, a significantly greater proportion of older adults treated with MIRI vs. PBO achieved clinical response and symptomatic remission (Table 1). While the studies were not powered to detect differences between MIRI and PBO in this subgroup, there were numerically higher response rates for MIRI vs. PBO for all other outcomes. The safety profile for MIRI in older patients was consistent with the overall study population. There were no deaths and no discontinuations due to adverse events among MIRI-treated older adults (Table 2). Conclusion Mirikizumab induced and maintained clinical response and was well tolerated in patients 60 years of age and older with moderately to severely active UC. References 1)D’Haens G, Dubinsky M, Kobayashi T, et al. Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis [published correction appears in N Engl J Med. 2023 Aug 24;389(8):772. doi: 10.1056/NEJMx230004]. N Engl J Med. 2023;388(26):2444-2455. doi:10.1056/NEJMoa2207940 2)Ananthakrishnan AN, Nguyen GC, Bernstein CN. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review. Gastroenterology. 2021;160(1):445-451. doi:10.1053/j.gastro.2020.08.060 3)Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly. J Crohns Colitis. 2017;11(3):263-273. doi:10.1093/ecco-jcc/jjw188

MULTIDISCIPLINARY APPROACH TO TREATMENT OF PATIENT WITH BIOPROSTHETIC AORTIC VALVE DYSFUNCTION AND RENAL CELL CARCINOMA WITH TUMOR THROMBUS

HighlightsThis review presents a clinical case of a patient with a rare combination of two life-threatening pathologies whose treatment required high-tech surgery. The effectiveness of a multidisciplinary approach to treatment has been demonstrated. AnnotationAortic stenosis (AS) is the most common heart disease in elderly patients requiring treatment. Malignant neoplasms of the kidneys account for about 3% of all cancers in the Russian Federation, and the formation of tumor thrombi in the renal and inferior vena cava occurs in 4–10% of patients with this pathology. Given the prevalence of aortic stenosis and renal cell carcinoma (RCC), the number of patients with a combination of these two conditions keeps increasing and they are recommended to undergo surgical treatment at multidisciplinary clinical centers. Transcatheter aortic valve implantation (TAVI) and radical nephrectomy with intracorporeal thrombectomy using the DaVinci Si robotic surgical system may be a preferred approach for the treatment of critical AS and RCC for this category of patients.At the multidisciplinary clinical center a patient with dysfunctional bioprosthetic aortic valve implanted in 2010 and NYHA class 3 heart failure with history of endovascular treatment of coronary artery disease, peripheral arterial disease and carotid endarterectomy and concomitant renal cell carcinoma with tumor thrombosis of the renal vein received surgical treatment in 2 stages: TAVI – the first stage, and robot-assisted right-sided nephrectomy and thrombectomy from the renal vein – the second stage. The patient was discharged from the Center on the 7th day after TAVI and on the 6th day after surgery for renal cancer. Six months after the procedure, there was a decrease in the functional class of heart failure, satisfactory function of the transcatheter aortic valve bioprosthesis, decrease in the size of the left ventricle, decrease in the brain natriuretic peptide, and the absence of cancer progression.

Prevalence and Trends of Oral Diseases in Elderly Patients at Tripoli University Hospital: A 20-Year Retrospective Analysis

It is now well recognized that there has been a revolution in the age pyramid of many societies, and within a very short time, there will be more people over 60. This is because of a considerable increase in the expectation of life. The current study evaluated retrospectively the frequency and prevalence of elderly patients' lesions recorded from the Pathology Department and Oral Maxillofacial Department database of Tripoli University Hospital, Tripoli, Libya from 2002 to 2022 year. The total number of reports was 2366 biopsies. The cross-sectional study included patients aged 60 and over. An oral and maxillofacial pathologist revised all histopathologic diagnoses. The study used SPSS version 25 software for data management, and analysis, employed basic descriptive statistics and bivariate analysis to examine the relationship between oral lesions prevalence and demographic factors like age and gender, with a p-value of <0.05. The percentage of oral and maxillofacial lesions in older patients during the period 2002 to 2022 was approximately 7.4%. Regarding gender distribution, 50.9% of the patients were male and 49.1% were female. The average age for females was 68.33 ± 6.449 years, and for males, it was 68.28 ± 7.399 years. Inflammatory lesions were the most common (40.7%) of the cases. Followed by autoimmune diseases (13.9%) while odontogenic cysts, salivary gland disease, and malignant tumors showed the same percentage (9.3%). According to the study's findings on the frequency of oral lesions in geriatrics. Knowledge of clinical signs and histopathology of oral cavity disease is necessary for prevention, early diagnosis, and correct treatment plan.

Untangling the complex mechanisms associated with Alzheimer's disease in elderly patients using high-throughput RNA sequencing data and next-generation knowledge discovery methods: Focus on potential gene signatures and drugs for dementia.

Alzheimer's disease (AD) is a complex neurodegenerative disorder that primarily affects elderly individuals. This study aimed to elucidate the intricate mechanisms underlying AD in elderly patients compared with healthy aged individuals using high-throughput RNA sequencing (RNA-seq) data and next-generation knowledge discovery methods (NGKD), with a focus on identifying potential therapeutic agents. High-throughput RNA-seq data were obtained from the Gene Expression Omnibus (GEO) database (accession number: GSE104704). These data were derived from healthy and diseased human brains (eight young healthy brains [young], 10 aged healthy brains [Old], and 12 aged diseased brains [AD]). We used NGKD tools such as GEO RNA-seq Experiments Interactive Navigator (GREIN) to obtain differentially expressed genes (DEGs) by comparing the AD versus Old RNA-seq data and further filtered and normalized to obtain differentially regulated Kyoto Encyclopedia of Genes and Genomes (KEGG), Reactome and Panther pathways using ExpressAnalyst tool. Besides, WebGestalt was used to identify differentially regulated Gene Ontologies (GO) and the pre-ranked Gene Set Enrichment Analysis (GSEA) was performed using GSEA software. The X2K web tool was used to infer upstream regulator networks and X2K Appyter tool for obtaining transcription factors (TFs) and kinase network information. LFW1000 and L1000CDS2 tools were used to identify specific drugs that reverse AD-associated gene signatures in elderly patients. Our study revealed significant downregulation of pathways related to neuroactive receptor-ligand interaction, synaptic vesicle cycle, and neuronal system in elderly individuals with AD. GO analysis showed negative enrichment of functions related to cognition, potassium ion transport, receptor-ligand activity, SNARE binding, and primary lysosomes. The transcription factors SUZ12 and REST, along with increased MAPK signaling, were identified as key regulators of downregulated genes. Several drugs and natural products, including dihydroergocristine, mepacrine, gedunin, amlodipine, and disulfiram have been identified as potential therapeutic agents for reversing AD-associated gene signatures. This comprehensive analysis of AD in elderly individuals using RNA-seq data and NGKD tools revealed multiple differentially regulated pathways, gene signatures, and potential drugs for dementia treatment. These findings highlight the complex molecular mechanisms underlying AD and provide insights into potential therapeutic strategies. Further research is needed to validate these findings and to develop personalized treatment approaches for AD in elderly patients.

Influencing factors of elderly hospitalized psychiatric patients complicated with physical disease: a cross-sectional study of 332 patients in Guangzhou China

ObjectiveTo investigate the influencing factors of the number of physical diseases in elderly hospitalized psychiatric patients.MethodsA total of 332 hospitalized elderly patients with mental illness were enrolled in this study. The number of combined physical diseases was divided into three groups, which were 0, 1 ~ 2, and ≥ 3. Data collected included sociodemographic characteristics, depressive symptoms, anxiety symptoms, delirium status, social support, medication adherence, social functioning, ability to perform daily living, and swallowing function.ResultsThe sample included 64.2% of female patients, mainly concentrated in 60 ~ 69 years old (48.2%). The length of hospital stay of patients was mainly 15 ~ 30 days (55.7%), and the course of disease was mainly 2 ~ 10 years (38.3%). After adjusting for confounding factors such as gender, poor lifestyle habits, course of disease, length of hospital stay, psychiatric symptoms, depressive symptoms, anxiety symptoms, delirium, social functioning, social support, and drug therapy compliance, we found that the number of physical disorders in elderly patients with mental illness was related to age, ability of daily living, and swallowing function. The increase of age, the decrease of the ability of daily living, and poor swallowing function contribute to a higher number of comorbid medical disorders in elderly patients with mental illness (P < 0.05).ConclusionAccording to the results, age, ability of daily living and swallowing function were the main influencing factors in the number of complicated physical diseases in elderly patients with mental illness. Future research should focus on improving the daily living ability and swallowing function of elderly patients with mental illness, in order to reduce the prevalence of other physical diseases in elderly patients with mental illness.

Predicting Severe COVID-19 Outcomes in the Elderly: The Role of Systemic Immune Inflammation, Liver Function Tests, and Neutrophil-to-Lymphocyte Ratio.

Background: Patients aged 80 years and above are at increased risk for severe COVID-19 outcomes. This study aimed to evaluate the prognostic utility of the derived neutrophil-to-lymphocyte ratio (dNLR), aspartate-aminotransferase-to-lymphocyte ratio index (ALRI), aspartate-aminotransferase-to-platelet ratio index (APRI), and systemic immune inflammation index (SII) in predicting severe disease, intensive care unit (ICU) admission, and mortality among COVID-19 patients aged 80 years and older. Methods: In this retrospective cohort study, 138 elderly patients (≥80 years) and 215 younger controls (<65 years) with confirmed COVID-19 were included. Laboratory data at admission were collected, and the dNLR, ALRI, APRI, and SII scores were calculated. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of these indices. Results: The SII had the highest area under the ROC curve (AUC) for predicting severe disease in elderly patients (AUC = 0.857, 95% CI: 0.795-0.919, p < 0.001), with an optimal cutoff value of 920 × 10⁹/L (sensitivity 86%, specificity 78%). Elevated SII was significantly associated with increased risk of ICU admission (hazard ratio (HR): 2.9, 95% CI: 1.8-4.6, p < 0.001) and mortality (HR: 3.2, 95% CI: 1.9-5.2, p < 0.001). Similarly, dNLR showed good predictive value (AUC = 0.792, 95% CI: 0.722-0.862, p < 0.001). Conclusions: SII and dNLR are valuable prognostic biomarkers for predicting severe outcomes in COVID-19 patients aged 80 years and above. Early identification using these indices can assist clinicians in risk stratification and management decisions to improve patient outcomes.

Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort

IntroductionBiological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. MethodsMulticenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included.Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients’ colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). ResultsA total of 1090 patients were included. After induction, at approximately 12–14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response.At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab – 9 patients (37.5%) – compared to the other biological treatments analyzed.With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments.As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. ConclusionsBiological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy.In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.

TNF-α/IL-1β/IL-1α/IL-12 inflammatory cytokine axes coupled with TLR1/TLR3/TLR5/MYD88 immune signaling pathway over-activation contribute to simultaneous carotid and coronary artery and occlusion in elderly patients

BackgroundIt remains difficult to evaluate the risk factors for concomitant carotid artery as well as coronary artery diseases in elderly patients. The aim of this research was to determine the TNF-α/IL-1β/IL-1α/IL-12 axes-TLR1/TLR3/TLR5/MYD88 immune signaling pathway interactions in coexistent carotid artery occlusion and coronary artery occlusion in elderly patients. MethodsElderly patients, who underwent carotid ultrasonography and coronary computed tomography angiography, were consecutively included in this research. The analyzed groups consisted of those with coexistent carotid artery occlusion and coronary artery occlusion as well as healthy individuals were enrolled as control group. The circulating levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-1α (IL-1α), interleukin-12 (IL-12), toll-like receptor 1 (TLR1), toll-like receptor 3 (TLR3), toll-like receptor 5 (TLR5) and myeloid differentiation factor 88 (MYD88) were measured. ResultsThe biomarkers (TNF-α, IL-1β, IL-1α, IL-12, TLR1, TLR3, TLR5 and MYD88) were significantly increased in carotid artery occlusion + left circumflex coronary artery occlusion group when compared with control group and carotid artery occlusion + right coronary artery occlusion group, respectively (P < 0.001), and were further elevated in carotid artery occlusion + left anterior descending coronary artery occlusion group when compared to carotid artery occlusion + right coronary artery occlusion group and carotid artery occlusion + left circumflex coronary artery occlusion group, respectively (P < 0.001). ConclusionThis research demonstrated that the TNF-α/IL-1β/IL-1α/IL-12 axes and TLR1/TLR3/TLR5/MYD88 immune signaling pathway implicated in the pathogenesis of carotid artery occlusion with coronary artery occlusion in elderly patients.

Clinical characteristics and bloodstream infection pathogens by gram-negative bacteria in different aged adults: A retrospective study.

This study aims to determine the characteristics and distribution of pathogenic bacteria in bloodstream infections (BSIs) by gram-negative bacteria in adults. One hundred seventy-one adult patients with BSIs who were treated at the Affiliated Hospital of Chengde Medical College between January 2018 and January 2020 were included in this study. The patients were assigned to the young- and middle-aged group and elderly group based on age. General patient data were analyzed. More elderly patients had BSIs and gram-negative bacteria than young- and middle-aged patients. The incidence of underlying diseases in elderly patients was significantly higher than the young- and middle-aged patients (P < .01). The composition of Brucella spp. was significantly different between the elderly group and young- and middle-aged group (P < .05). There were significantly more gallbladder infections in the elderly group than the young- and middle-aged group, and significantly fewer elderly patients had no definite infection sites than the young- and middle-aged group (P < .05). The incidence of complications and in-hospital mortality in the elderly group was higher than the young- and middle-aged group (P < .05). BSIs caused by gram-negative bacteria mainly involved elderly patients. BSIs were characterized by complications and a poor prognosis, as well as pathogenic bacteria and primary infection sites.

Fabry Disease in Elderly Patients with Unexplained Renal Failure and Left Ventricular Hypertrophy? Two Case Reports

Fabry Disease in Elderly Patients with Unexplained Renal Failure and Left Ventricular Hypertrophy? Two Case Reports

Fecal occult blood is associated with an increased risk of cerebral small vessel disease in elderly patients

Background and purposeStudies have shown that fecal occult blood is associated with an increased risk of ischemic stroke, but the relationship between fecal occult blood and cerebral small vessel disease (CSVD) remains largely unknown. This study aimed to identify predictors for CSVD, with fecal occult blood and its proxies as potential influencing factors in elderly patients. MethodPatients aged 65 years or older with various chronic diseases were enrolled. The presence of CSVD was evaluated by brain MRI results. Fecal occult blood was measured by fecal immunochemical test. Logistic regression analysis was used for the association between the presence of fecal occult blood and the risk of CSVD. ResultsLogistic regression analysis indicated that a prevalence of positive fecal occult blood was related to CSVD (Model 1, adjusted OR=1.63, 95% CI: 1.15–2.29, P=0.006). We subsequently grouped all subjects as positive fecal occult blood (259, 16.48%) and negative fecal occult blood (1313, 83.52%), and logistic regression analysis indicated that a prevalence of CSVD was related to positive fecal occult blood (Model 2, adjusted OR=1.50, 95% CI: 1.08–2.08, P=0.015). In addition, the ratios of lacunes (67.18% vs. 53.85%, P<0.001) and enlarged perivascular spaces (43.63% vs. 34.42%, P=0.005) were higher in patients with positive fecal occult blood than in controls. ConclusionsThe presence of fecal occult blood is probably related to the risk of CSVD in elderly patients and could be used as a screening tool for CSVD in elderly populations.

A narrative review of the challenges and impact of breast cancer treatment in older adults beyond cancer diagnosis.

Breast cancer is the most prevalent cancer among women worldwide, with 45% of them over 65 years old. Older breast cancer patients tend to be underrepresented and understudied in major clinical trials. This narrative review provides a comprehensive overview of the current evidence regarding treatment decision-making, treatment toxicities, and proposed survivorship management recommendations for geriatric cancer patients. A literature search was conducted on PubMed and Google Scholar. The search strategy included a combination of keywords related to clinical management and treatment toxicities of older cancer breast cancer patients. English articles published between May 1990 to May 2024 were included. Older breast cancer patients represent a heterogeneous group with specific needs and treatment considerations. Treatment decisions for geriatric cancer patients should be based on a comprehensive geriatric assessment (CGA), which considers the patient's functional status, comorbidities, and preferences, rather than relying solely on chronological age. Breast cancer surgery is generally well tolerated in older patients, with a low rate of systemic complications and 30-day post-surgery mortality. In selected elderly patients, axillary surgery may be omitted to minimize side effects. The choice of endocrine therapy should take into account the side effect profile, patient's comorbidities, concomitant medications, and preferences. While aromatase inhibitors provide better efficacy, musculoskeletal side effects and osteoporosis may be a concern for older patients. CDK4/6 inhibitors have a similar efficacy in elderly patients as younger patients, but the incidence of neutropenia and dose modifications or interruptions are more frequent. Reported radiotherapy side effects are similar across age groups, although the occurrence of radiation-induced pulmonary toxicities was found to be associated with old age. Chemotherapy is reserved for triple-negative and HER2-positive disease in elderly patients due to known side effects. such as neutropenia, cardiotoxicity, and cognitive impairment. Data on the efficacy and safety of immunotherapy use in older patients are limited. Physicians should make additional efforts to evaluate age-specific treatment efficacy and treatment-induced toxicities. Further efforts to enhance the representation of older patients in breast cancer trials are warranted.

Immunosuppressive therapy of systemic connective tissue diseases in elderly patients

Immunosuppressive therapy of systemic connective tissue diseases in elderly patients

Clinical and experimental evaluation of the efficacy of a new remineralizing gel in the comprehensive treatment of caries and non-carious lesions in elderly patients

Relevance. Remineralization therapy and fluoridation are well-established methods for preventing hard tissue diseases of the teeth across various age groups. Given the unique composition and structure of teeth in the elderly, there is a need for specialized remineralization and fluoridation agents tailored to this demographic.Materials and methods. A new remineralizing gel, formulated from a mixture of tetra- and dimethylglycerolates of silicon, was developed specifically for the prevention and treatment of hard tissue diseases in elderly patients. The clinical efficacy of this gel was assessed using enamel resistance test (ERT) values and electroodontodiagnostics (EOD) both before and after treatment. Laboratory analyses included the evaluation of phosphorus, calcium, and the Ca/P ratio in saliva using Mindray reagents. An experimental study on tooth sections treated with various remineralizing agents was conducted using a Tescan MIRA LMS scanning electron microscope, equipped with an Oxford Instruments EDS X-max80 attachment, to determine the chemical composition and surface characteristics.Results. The clinical application of the new gel resulted in significant reductions in ERT and EOD values, indicating its effectiveness. An increase in the calcium-phosphorus ratio in saliva further demonstrated the gel’s remineralizing properties. The experimental study revealed the highest fluoride uptake in tooth sections treated with the new gel, confirming its penetration into the hard tissues of the teeth.Conclusion. The new gel, based on a silicon glycerolate mixture, demonstrated superior efficacy in elderly patients compared to other remineralizing agents, which is attributed to the high conductive properties of its base.

The use of a clinical calculator to determine the rate of development of chronic kidney disease in elderly patients with type 2 diabetes mellitus

Aim – to develop an applied prognostic calculator for the rate of progression of CKD in elderly patients with type 2 diabetes, which makes it possible to identify a group of high rate of GFR reduction in conditions of routine outpatient admission. Material and methods. 69 clinical indicators were studied, the interrelationships and significance of differences in parameters in the groups identified according to the original diagnostic parameter, the glomerular filtration rate reduction index with a threshold value of 3.83 ml/min/1.73 m2 per year, above which the rate of progression of CKD was considered high. Results. By using regression analysis, significant factors for the prognostic calculator were identified: the duration of diabetes and insulin therapy, concomitant diagnosis of obesity, pulse in the ankle artery, severe stage of polyneuropathy, risk group IV of hypertension, treatment with sulfonylureas, the number of antihypertensive drugs taken. When evaluating the information capacity and predictive ability of the calculator, the area under the AUC ROC curve was 0.89 (0.80; 0.99) p 0.001, which characterizes the quality of the diagnostic technique as high. Conclusion. The presented calculator gives the doctor the opportunity to identify a group of patients with the risk of rapid progression of CKD directly on an outpatient basis.

Relationship between bone turnover markers and renal disease in elderly patients with type 2 diabetes: a cross-sectional study

ObjectiveThe prevalence of type 2 diabetes mellitus (T2DM) and bone metabolism disorders increase with age. Diabetic kidney disease (DKD) is one of the most serious microvascular complications of T2DM, and bone metabolism disorders are closely linked to the occurrence of DKD. The relationship between bone turnover markers(BTMs) and the kidney disease in elderly patients with T2DM remains unclear. Therefore, this study aims to investigate the association between common BTMs and DKD in a large sample of elderly patients. The goal is to provide a basis for early identification of high-risk individuals for DKD among elderly T2DM patients from a bone metabolism perspective.MethodsIn this cross-sectional study, BTMs were collected from a cohort of 2,051 hospitalized Chinese patients. The relationships between 25-hydroxyvitamin D (25-OH-D), β-CrossLaps (β-CTX), osteocalcin (OSTEOC), intact parathyroid hormone (iPTH), and total type I collagen N-terminal propeptide (TP1NP), and DKD, as well as urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were analyzed using regression analysis and restrictive cubic spline (RCS) curves.ResultsHigher 25-OH-D levels were independently linked to a lower incidence of DKD and decreased UACR. The RCS curves showed a linear association of 25-OH-D and DKD, approaching the L-shape. β-CTX was independently and positively correlated with UACR. There is an independent positive correlation between OSTEOC and UACR and a negative correlation with eGFR. iPTH is independently and positively correlated with DKD incidence and UACR, and negatively correlated with eGFR. Additionally, the RCS curves showed a non-linear association of OSTEOC and iPTH and DKD, approaching the J-shape, and the point of inflection is 10.875 ng/L and 34.15 pg/mL respectively. There is an independent positive correlation between TP1NP and UACR incidence, and a negative correlation with eGFR. Risk estimates significantly increase with higher TP1NP levels in the RCS model.ConclusionBTMs are closely associated with kidney disease in elderly patients with T2DM. These discoveries potentially assist clinicians in establishing more preventive measures and targeted treatment strategies for elderly patients with T2DM.

Renal replacement or conservative treatment in end-stage renal disease in elder patients?

When elder individuals develop chronic kidney failure, doctors, patients, and family members are faced with the decision: Should dialysis (still) be initiated, or should a conservative-palliative therapy strategy be chosen? A prerequisite for shared decision-making is structured education about the various options, ensuring all necessary information and consequences are communicated. This article outlines the advantages and disadvantages of haemodialysis and peritoneal dialysis, as well as conservative-palliative therapy. Additionally, it discusses the option of a trial dialysis and the choice to discontinue ongoing dialysis.

The Role of Cardiovascular Rehabilitation in the Elderly Patient.

Cardiovascular disease is the leading cause of morbidity and mortality in the elderly population. Coronary artery disease, heart failure, and peripheral artery disease constitute the prevailing conditions. Cardiac rehabilitation (CR) represents a cornerstone in the secondary prevention of cardiovascular disease, since it has been associated with significant cardiovascular benefits in the above-mentioned conditions, by significantly reducing cardiovascular outcomes and improving functional independence and quality of life. Besides, CR offers the background for optimizing the control of cardiovascular risk factors and implementing physical exercise, also providing psychological and social support. The prevalence of cardiovascular disease increases with age, associating high morbidity and mortality. In addition, comorbidities, frailty, and other geriatric conditions, entities that also entail poor prognosis, are often present in elderly patients. Indeed, frailty is recommended to be systematically addressed in elderly patients with cardiovascular disease, and there is growing evidence regarding the benefits of CR programs in this setting, also associated with lower adverse events during follow-up. However, elderly patients are less often referred to CR after a cardiovascular event when compared to their younger counterparts. In this review, we summarized the benefits of CR programs in the elderly population with established cardiovascular disease, proposing a comprehensive framework that integrates personalized care strategies. Cardiovascular disease is the leading cause of morbimortality, especially in the elderly. The management of cardiovascular disease in elderly patients poses unique challenges, since they represent a heterogeneous group and evidence is low. CR can provide significant benefits in older patients, encompassing physical training and specific management of geriatric syndromes.

Diabetic Kidney Disease in Elderly Patients

Diabetic Kidney Disease in Elderly Patients

P08 Exploring the role of cellular senescence in cutaneous repair

Abstract Introduction and aims Chronic nonhealing wounds are a life-threatening skin disease in elderly patients and patients with diabetes that costs the National Health Service over £8 billion per year to treat. Unfortunately, current treatments are inadequate, thus there is an urgent need to develop effective therapies. Cellular senescence is emerging as a potential therapeutic target owing to its association with a wide range of age-related pathologies. Cells undergo senescence in response to ageing and stress, losing their ability to proliferate or perform normal tissue functions. Our previous work in mice provided the first mechanistic demonstration that senescent cell accumulation drives poor healing. Moreover, clinical trials currently assessing the efficacy of senescence-targeted drugs (senolytics) are providing repurposing opportunities for cutaneous pathologies. Therefore, the aim of this research is to (i) investigate the role of senescence in human chronic wounds and (ii) determine whether senolytics can be repurposed to promote pathological skin repair. Methods Skin and wounds were collected from healthy, aged and diabetic donors to quantify senescence levels (senescence-associated β-galactosidase), characterize senescent cell types (immunofluorescence) and determine key drivers of skin senescence (RNA sequencing). Additionally, we screened the wound healing potential of a panel of senolytics in healthy skin vs. skin from patients with chronic wounds. Results We found significant accumulation of senescence in pathological skin wounds, localized to stromal cells. Senescence levels also correlated substantially with clinical parameters, such as wound site, diabetic status and infection. RNA sequencing revealed key links between senescence and immunity, suggesting inflammation as a crucial driver of skin senescence. Finally, senolytic treatment significantly accelerated healing in skin from patients with chronic wounds. Conclusions Our data provide the first in-depth characterization of senescence in human chronic skin wounds, crucially identifying novel therapeutic targets of senescence, while simultaneously assessing the potential of drug repurposing for patient benefit.