Disease In Older People Research Articles

Cardiovascular prevention in old age-Cardiovascular prevention of ageing?

Cardiovascular prevention is also particularly successful in old people in terms of preventing major cardiovascular events. The concept of prevention of geriatric diseases can, however, be expanded taking the insights of geroscience into consideration, so that slowing the ageing process per se can be set as anew goal: ageing is the pertinent basis of nearly all chronic diseases in adulthood, aline of argument for which the cardiovascular system can serve as aprototype. Consequently, treating ageing can help prevent the typical chronic diseases in old people, i.e. multimorbidity and frailty. According to the current guidelines of the European Society of Cardiology (ESC, Eur Heart J 42:3227-3337, 2021) and the German Society for Cardiology (DGK, https://leitlinien.dgk.org/files/03_pocket_leitlinien_praevention_aktualisiert.pdf ) cardiovascular prevention incorporates age-stratified and individually adapted measures and treatment targets in the domains lifestyle (physical activity, body weight, nutrition), psychosocial factors, cardiovascular risk factors (smoking, blood lipids, blood pressure, diabetes), antithrombotic treatment and disease-specific interventions. From abiogerontological perspective, in the midterm these measures could be supplemented by measures and medicinal treatment strategies to slow the biological ageing process, e.g. with senolytics and metformin. Initial clinical studies using senolytics have already been reported.

Live longer and better without aortic valve stenosis

Live longer and better without aortic valve stenosis

Fertility Histories and Heart Disease in Later Life in China.

PurposeBased on life course theories, health among older people is driven by a continuous and cumulative process that develops over the life course. To better understand the aging process, it is important to assess associations between parity and heart disease in older people of China.MethodThe associations between heart disease prevalence and number of births, number of boys or girls ever born were evaluated among 5,990 samples (mean age 64.1 years) using the Probit regression model based on the data from China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013 and 2018. The model was adjusted only for rural or urban residents, and multivariate regression models were run separately by gender.ResultsOur results showed that more than three children or more than two boys ever born were associated with a higher risk of heart disease. However, the number of girls ever born had no significant effect on heart disease in the elderly. We further analyzed the group difference between urban and rural residents using the regression model. More than three children or more than two boys ever born were associated with a high risk of heart disease in rural areas. Compared to urban residents, rural residents were more likely to be suffering from heart disease due to high parity. When considering the digender difference the paper found that more than three children ever born were associated with a high risk of heart disease in the female group. Late age at the time of giving birth for the first time was associated with a poorer risk level of heart disease in the rural residents, because the phenomenon of early childbearing was serious in the rural residents. But after considering the impact on the physical health of using chronic diseases, the first birth and the last birth both increased the risk of heart disease.ConclusionsSome policy implications were being put forward. Firstly, parents who were ready to give birth should be aware of the possible health loss of high parity. Postpartum nutrition supplements and chronic disease prevention were suggested to prevent heart disease in later life. Secondly, the elderly in rural areas should pay more attention to heart diseases. Participating in more daily exercise and physical examinations was a good choice to reduce the risk of heart disease. Thirdly, women who give birth prematurely have a higher risk of CVD. Based on our results, age at entry to parenthood was closely related to the risk of heart disease in later life.

FC077: Cystatin C Testing Improves Risk Stratification Associated with Chronic Kidney Disease Without Adopting Age-Adapted Diagnostic Thresholds: A UK Biobank Study

Abstract BACKGROUND AND AIMS Age-adapted thresholds of estimated glomerular filtration rate (eGFR) have been proposed for the diagnosis of chronic kidney disease (CKD) [1] to acknowledge decline in kidney function with increasing age [2]. Proponents of age-adapted thresholds suggest that subjects over the age of 65 with eGFR 45–59 mL/min/1.73 m2 and without albuminuria appear to be at low risk of adverse outcomes [1]; however, the risks associated with CKD extend beyond kidney failure [3]. We evaluated whether cystatin C testing (eGFRcys) could improve risk stratification in CKD without adopting age-adapted thresholds. METHOD Data were from participants in the UK Biobank cohort with eGFR based on serum creatinine (eGFRcr) ≥45 mL/min/1.73 m2 and without albuminuria. Participants with a history of cardiovascular disease or kidney failure at baseline were excluded. CKD status was initially categorized by eGFRcr, then concordance of eGFRcys < 60 mL/min/1.73 m2 was determined. Multivariable-adjusted Cox proportional hazards models evaluated associations of CKD status with death, myocardial infarction (MI), stroke and kidney failure. Analyses were stratified by age: older (65–73 years) and younger (<65 years) participants. RESULTS Among 76 629 older and 351 773 younger participants, followed over median 11.5 (IQR 10.8–12.2) years, there were 24 251 deaths, 6983 MI, 4081 strokes and 209 kidney failure events. Of 2016 older participants with eGFRcr 45–59 mL/min/1.73 m2 37% had eGFRcys > 60 mL/min/1.73 m2. Furthermore, eGFRcr alone did not detect 6278 (8%) of older participants with eGFRcys < 60 mL/min/1.73 m2. In cross-sectional analyses, the median baseline eGFR was lower at higher age for all equations: this was most pronounced for eGFRcys (Figure 1). CKD by eGFRcys only or with both markers experienced higher absolute incidence of MI, stroke and mortality compared to those without CKD by either marker (Figure 2). Compared to those without CKD, older participants with concordant eGFRcr and eGFRcys < 60mL/min/1.73 m2 had elevated adjusted risks of death (HR 1.8, 1.6–2.0), MI (HR 1.9, 1.5–2.4), stroke (HR 1.7, 1.2–2.3) and kidney failure (HR 4.2, 1.2–14.1). Findings were similar in younger participants with concordant eGFRcr and eGFRcys < 60 mL/min/1.73 m2 for death (HR 2.2, 1.9–2.6) and stroke (HR 2.1, 1.4–3.2), though not MI (HR 1.2, 0.8–1.8). When CKD was not confirmed by eGFRcys, eGFRcr 45–59 mL/min/1.73 m2 was not associated with increased hazards of death (HR 1.1, 0.9–1.4), MI (HR 1.1, 0.7–1.7) or stroke (HR 1.1, 0.7–1.9) in older participants, nor in younger participants for the same outcomes: death (HR 1.1, 0.8–1.3), MI (HR 1.2, 0.8–1.9) and stroke (HR 0.8, 0.4–1.6). CONCLUSION Among persons with CKD, cardiovascular disease and mortality are important risks that should be considered when determining CKD status. CKD categorization by eGFRcr alone includes a large proportion of individuals who have similar risks to persons without CKD. eGFRcys detects a substantial number of high-risk individuals not identified to have CKD by eGFRcr. In the absence of cystatin C testing, lower, age-adapted thresholds for diagnosis of CKD may inadequately detect the broader risks associated with kidney disease in older people.

FC077: Cystatin C Testing Improves Risk Stratification Associated with Chronic Kidney Disease Without Adopting Age-Adapted Diagnostic Thresholds: A UK Biobank Study

Abstract BACKGROUND AND AIMS Age-adapted thresholds of estimated glomerular filtration rate (eGFR) have been proposed for the diagnosis of chronic kidney disease (CKD) [1] to acknowledge decline in kidney function with increasing age [2]. Proponents of age-adapted thresholds suggest that subjects over the age of 65 with eGFR 45–59 mL/min/1.73 m2 and without albuminuria appear to be at low risk of adverse outcomes [1]; however, the risks associated with CKD extend beyond kidney failure [3]. We evaluated whether cystatin C testing (eGFRcys) could improve risk stratification in CKD without adopting age-adapted thresholds. METHOD Data were from participants in the UK Biobank cohort with eGFR based on serum creatinine (eGFRcr) ≥45 mL/min/1.73 m2 and without albuminuria. Participants with a history of cardiovascular disease or kidney failure at baseline were excluded. CKD status was initially categorized by eGFRcr, then concordance of eGFRcys < 60 mL/min/1.73 m2 was determined. Multivariable-adjusted Cox proportional hazards models evaluated associations of CKD status with death, myocardial infarction (MI), stroke and kidney failure. Analyses were stratified by age: older (65–73 years) and younger (<65 years) participants. RESULTS Among 76 629 older and 351 773 younger participants, followed over median 11.5 (IQR 10.8–12.2) years, there were 24 251 deaths, 6983 MI, 4081 strokes and 209 kidney failure events. Of 2016 older participants with eGFRcr 45–59 mL/min/1.73 m2 37% had eGFRcys > 60 mL/min/1.73 m2. Furthermore, eGFRcr alone did not detect 6278 (8%) of older participants with eGFRcys < 60 mL/min/1.73 m2. In cross-sectional analyses, the median baseline eGFR was lower at higher age for all equations: this was most pronounced for eGFRcys (Figure 1). CKD by eGFRcys only or with both markers experienced higher absolute incidence of MI, stroke and mortality compared to those without CKD by either marker (Figure 2). Compared to those without CKD, older participants with concordant eGFRcr and eGFRcys < 60mL/min/1.73 m2 had elevated adjusted risks of death (HR 1.8, 1.6–2.0), MI (HR 1.9, 1.5–2.4), stroke (HR 1.7, 1.2–2.3) and kidney failure (HR 4.2, 1.2–14.1). Findings were similar in younger participants with concordant eGFRcr and eGFRcys < 60 mL/min/1.73 m2 for death (HR 2.2, 1.9–2.6) and stroke (HR 2.1, 1.4–3.2), though not MI (HR 1.2, 0.8–1.8). When CKD was not confirmed by eGFRcys, eGFRcr 45–59 mL/min/1.73 m2 was not associated with increased hazards of death (HR 1.1, 0.9–1.4), MI (HR 1.1, 0.7–1.7) or stroke (HR 1.1, 0.7–1.9) in older participants, nor in younger participants for the same outcomes: death (HR 1.1, 0.8–1.3), MI (HR 1.2, 0.8–1.9) and stroke (HR 0.8, 0.4–1.6). CONCLUSION Among persons with CKD, cardiovascular disease and mortality are important risks that should be considered when determining CKD status. CKD categorization by eGFRcr alone includes a large proportion of individuals who have similar risks to persons without CKD. eGFRcys detects a substantial number of high-risk individuals not identified to have CKD by eGFRcr. In the absence of cystatin C testing, lower, age-adapted thresholds for diagnosis of CKD may inadequately detect the broader risks associated with kidney disease in older people.

Prior oral proton-pump inhibitor use is associated with reduced severity of aspirin-related upper gastrointestinal bleeding in older people.

Low-dose aspirin is commonly used for primary or secondary prophylaxis against cardiovascular disease in older people. However, the potential risk of upper gastrointestinal (UGI) ulceration and bleeding associated with low-dose aspirin use is often not appreciated by prescribers and older consumers. Among 133 serial patients with UGI bleeding, aspirin-users aged ≥70 years had a ninefold increased likelihood of overt UGI bleeding compared with non-users, reducing by 90% in regular proton-pump inhibitor users (adjusted odds ratio 0.10). We recommend risk-versus-benefit discussions when recommending aspirin to older people.

Non-communicable diseases in older people living with HIV in four African countries: a cohort study.

The lifespan of people living with HIV is increasing, and non-communicable diseases (NCDs) are becoming an important driver of morbidity in this population. We examined the prevalence of NCDs in older people with HIV and factors associated with development of NCDs. The African Cohort Study is a prospective cohort enrolling adults with and without HIV at 12 sites in Kenya, Tanzania, Uganda, and Nigeria. Using data collected from Jan 21, 2013 to June 30, 2021, we assessed the prevalence and odds of NCDs, including renal insufficiency (estimated glomerular filtration rate [GFR] <60 mL/min/1·73 m²), elevated blood pressure (any systolic blood pressure >139 mm Hg or diastolic BP >89 mm Hg), obesity (body mass index >30), diabetes (fasting glucose ≥126 mg/dL or receiving medication for diabetes) or hyperglycaemia (fasting glucose ≥99 mg/dL or non-fasting ≥199 mg/dL). Diabetes and hyperglycaemia were collectively evaluated as dysglycaemia. We used multivariable logistic regression with generalised estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with NCDs. Diabetes and hyperglycaemia models were adjusted for potential confounders including study site and sex. Renal insufficiency models had similar adjustments with the addition of elevated blood pressure and hyperglycaemia. Of 3434 participants, 2003 (59·3%) were female and 1431 (40·7%) were male, and 2949 (85·9%) were living with HIV. Of people living with HIV, 2188 (74·2%) were younger than 50 years and 761 (25·8%) were aged 50 years or older. Among people living with HIV aged 50 or older, 27·5% (n=209 had elevated blood pressure, 13·4% (102) had dysglycaemia, 4·3% (33) had renal insufficiency, and 11·7% (89) had obesity at last visit. Compared with people without HIV under 50, people living with HIV aged 50 or older had increased adjusted odds of having diabetes (5·29, 95% CI 2·61-10·70), hyperglycaemia (1·86, 1·38-2·50), and renal insufficiency (6·37, 2·38-17·1). We found no differences between individuals aged 50 years or older with and without HIV for diabetes, hyperglycaemia, and renal insufficiency. There was a high burden of NCDs in this cohort. HIV status was not associated with NCD prevalence, although the study was probably underpowered to detect such an association. Screening and treatment for common NCDs, such as raised blood pressure and dysglycaemia, should be considered as part of HIV integrated care. Such an approach might help to prevent other NCDs, such as renal insufficiency, and improve the span of healthy life. PEPFAR via cooperative agreements between HJF and the US Department of Defense.

Latent CMV makes older adults less naïve.

There is a widespread general consensus that protective immunity against infectious disease in older people is less effective than in younger adults, due to “immunosenescence”.1 There has been considerable controversy as to whether latent infection with human herpesviruses (HHV), particularly HHV5 (cytomegalovirus, CMV), seminally contributes to this state of immunosenescence. While it is clear that CMV-infected-vs-non-infected individuals display markedly different distributions of diverse immune cell phenotypes in the blood, the clinical implications of these findings remain unclear.

Linear IGA-dependent bullous dermatosis in a 2-year-old child

Linear IgA-dependent bullous dermatosis is a rare subepidermal bladderworm disease that occurs in both adults and children. The pathogenesis of the disease, regardless of age, is the same, where the basis is the autoimmune response to antigens of the basal membrane zones of the skin, the clinical picture in childhood differs from the manifestations at an older age, having a clear picture and localization of manifestations. The causes of the onset of the disease in older people are most often associated with taking medications, manifested as a side effect of the therapy being taken, cancer, and in children, both an acquired character and a genetic predisposition are responsible for the manifestation of linear IgA-dependent bullous dermatosis. The diagnosis can be confirmed by histological and immunofluorescence analysis.

Family Support in Controlling Hypertension among the Elderly in Lhokseumawe City: A Descriptive Phenomenological Study

Family is the main support system in caring for its members, including the elderly with hypertension. Treatment of the disease in old people is through help from a spouse, child, or close relatives because they often live with their families. Therefore, this study aims to determine the form of family support in controlling hypertension among the elderly, including physiological, psychological, socio-cultural, and spiritual supports. The qualitative method was used with a descriptive phenomenological approach. The respondents consist of eight family members who cared for the elderly with uncomplicated hypertension during the past year. The themes found include responding to hypertension with traditional ingredients, the existence of quality time with the elderly, being free to select the activities they like, and prioritizing themselves to worship a lot. Based on the results, efforts are needed from community nurses to provide health promotion education on the importance of family support in controlling hypertension amond people.

The unrecognized potential of pet cats for studying aging and age-related diseases

Old cats develop chronic diseases similar to diseases in older people. One-fourth of American households own cats, and almost half are more than 7 years old. Cats share the same environment and are exposed to many of the same chemical stresses. In addition, genomic diversity and population stratification are similar to that occurring in people. With these comparative features, the aging cat represents a geroscience model to investigate the pathogenesis and therapeutic interventions for aging. However, cats are generally not recognized as a translational model for aging research mainly because of the lack of knowledge and appreciation within the scientific community. In addition, cat owners are not aware of any research programs designed to enhance healthy aging in their pets because none exist. Much work is needed to inform and educate the scientific community as well as cat owners about the power of aging cats as a transformative model to investigate aging and age-related diseases that will benefit both human and feline health.

Cerebral small vessel disease is detectable on 3.0 TESLA magnetic resonance imaging: Established 3.0 TESLA magnetic resonance imaging first time in Mongolia

Cerebral small vessel disease (CSVD) is a common neurological disease in older people. For patients diagnosed with small vessel disease by CT brain, for the first time in Mongolia, MRI brain (3.0 TESLA) was performed. The purpose of the study was to collect data from 58 patients aged 50–85 years old.

THE ASSOCIATION BETWEEN FLOSSING TEETH AND ORAL HEALTH IN ADULTS

Background: In older people, the impact of oral habits is largely unknown. The goal of this study was to see if there was a link between flossing at home and the prevalence of periodontal disease in older people.&#x0D; Methodology: The incidence of tooth loss over a five-year period was also examined. Pearson chi-square tests and covariate-adjusted Cochran-Mantel-Haenszel tests were used to evaluate dichotomous and categorical variables. Clinical factors were compared using multiple linear regression depending on flossing practice. Molars exhibited the greatest benefit (&gt;40%) for flossing practice (P = 0.0005) among all teeth. In conclusion, flossers had much less oral illness than non flossers when it came to older people. Over a 5-year period, flossers had decreased periodontal disease, dental caries, and tooth loss. These findings add to the growing body of evidence that flossing is an important oral hygiene habit for older persons who want to avoid the progression of oral disease.&#x0D; Keywords: OHI, interdental cleaning, elderly, prevention, periodontal disease, caries.

Knowledge, Awareness and Practices (KAP) about COVID-19 in Jazan

Corona viruses are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). A typical presentation of MERS-COV disease is fever, cough and shortness of breath. Pneumonia is a common finding, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported. Severe illness can cause respiratory failure that requires mechanical ventilation and support in an intensive care unit. The virus appears to cause more severe disease in older people, people with weakened immune systems, and those with chronic diseases such as renal disease, cancer, chronic lung disease, and diabetes. No vaccine or specific treatment is currently available to prevent. The only way to prevent from COVID-19 is to have proper knowledge and awareness. So, accessing knowledge and awareness among people is very important. In this paper a study have been carried out to access the knowledge, awareness and practices about COVID-19 among the people of Jazan. The data collected in this survey can be used as a baseline data to monitor public perception and their behavior in case of a future outbreak of any infectious disease in Jazan. This study will be useful to get the current level of knowledge and awareness among people of Jazan. © 2021 NSP.

Pharmacological Management of Hyperlipidemia in Older individuals.

To provide an up-to-date review of current hyperlipidemia guidelines and discuss pharmacotherapeutic management of hyperlipidemia in older individuals. A PubMed search of articles published through October 2020 was performed using a combination of the following words: older adults, hyperlipidemia, statin, ezetimibe, fibrate, fish oil, niacin, bile acid sequestrant, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. Relevant original research, review articles, and guidelines were assessed for the management of hyperlipidemia in the older individuals. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. Hyperlipidemia is a common chronic disease state in the elderly population, though there is limited evidence for clinical outcomes in older people when compared withwith the general adult population. Statins have the most evidence for primary and secondary prevention of cardiovascular disease in older people, though ezetimibe and PCSK9 inhibitors have a role as add-on or monotherapy in patients who do not tolerate statins. Optimal management of hyperlipidemia in older people is important in order to avoid further complications and improve outcomes. Pharmacists can help improve management in the elderly by incorporating up-to-date evidence from guidelines and providing medication education specifically for this population.

Managing chronic wet cough in children: another piece of the puzzle

Chronic wet cough is the hallmark of chronic obstructive pulmonary disease in older people and bronchiectasis in adults and older children. In young children, the commonest cause of chronic wet cough is protracted bacterial bronchitis (PBB) but there are large gaps in our understanding of this high prevalence condition.1 These include the optimal treatment strategy to control symptoms, prevent recurrence, and reduce long-term morbidity. Such issues highlight the inequalities experienced by children with respiratory disease compared with affected adults.

COVID-19 herd immunity by immunisation: are children in the herd?

COVID-19 herd immunity by immunisation: are children in the herd?

New horizons in cardiogeriatrics: geriatricians and heart failure care-the custard in the tart, not the icing on the cake.

Heart failure (HF) can be considered a disease of older people. It is a leading cause of hospitalisation and is associated with high rates of morbidity and mortality in the over-65s. In 2012, an editorial in this journal detailed the latest HF research and guidelines, calling for greater integration of geriatricians in HF care. This current article reflects upon what has been achieved in this field in recent years, highlighting some future challenges and promising areas. It is written from the perspective of one such integrated team and explores the new role of cardiogeriatrician, working in a multidisciplinary team to deliver and improve care to increasingly complex, older, frail patients with multiple comorbidities who present with primary cardiology problems, especially decompensated HF. Geriatric liaison has improved the care of frail patients in orthopaedics, cancer services, stroke, acute medicine and numerous community settings. We propose that this vital role should now be extended to cardiology teams in general and to HF in particular.

Real‑world challenge for clinicians treating advanced gastroesophageal adenocarcinoma (Review).

Gastroesophageal adenocarcinoma (GOA) is a disease of older people. Incidence is rising in the developed world and the majority of patients present with advanced disease. Based on clinical trial data, systemic chemotherapy in the advanced setting is associated with improvements in quality of life and survival. However, there is a recognised mismatch between trial populations and the patients encountered in clinical practice in terms of age, comorbidity and fitness. Appropriate patient selection is essential to safely deliver effective treatment. In this narrative review, we discuss the challenges faced by clinicians when assessing real-world patients with advanced GOA for systemic therapy. We also highlight the importance of frailty screening and the current available evidence we can use to guide our management.

Pneumonia in old age

Die Pneumonie ist eine bei alten Menschen häufige und schwere Erkrankung. Sie steht in dieser Patientengruppe an vierter Stelle der zum Tode führenden Erkrankungen. Die Diagnose kann oft aufgrund einer atypischen klinischen Präsentation schwierig sein. Daher sollte bei jeder Verschlechterung eines alten Menschen ursächlich auch an eine Pneumonie gedacht werden. Geriatrische Probleme wie Gebrechlichkeit und physische und psychische Einschränkungen sollten ebenso erfasst werden wie die soziale Situation, da alle diese Faktoren prognoserelevant sind. Prognostisch ungünstiger verlaufen Pneumonien, die im Pflegeheim oder von Pflegebedürftigen erworben wurden. Sie gelten zwar als ambulant erworben, sollten dennoch besonders beachtet werden. Die Behandlung unterscheidet sich nicht grundsätzlich von der Behandlung jüngerer Patient, sollte aber besondere Situationen wie den in einer Patientenverfügung festgelegten Patientenwunsch bei der Therapieplanung berücksichtigen. Gerade ältere Menschen zeigen unter einer COVID(coronavirus disease)-19-Infektion oft atypische klinische Bilder, sodass bei akuten Veränderungen im Alter auch daran zu denken ist.