Elderly Onset Research Articles

Inflammatory Bowel Disease in the Baby to Baby Boomer: Pediatric and Elderly Onset of IBD

Early- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the "baby" or "baby boomer" with IBD. Around 25% of cases of initial diagnosis of IBD is made before the age of 18years old, and another 15-20% made after the age of 60. Crohn's disease (CD) typically presents as ileocolonic and stricturing or penetrating phenotype among early-onset, whereas among late-onset, it is mainly colonic and inflammatory. Pediatric ulcerative colitis (UC) is mostly pan-colonic versus primarily left-sided among the elderly. Treatment goal for both age groups is primarily symptom control, with growth and development also considered among pediatric patients. Due to alterations in pharmacokinetics, careful monitoring and reduced dose should be considered. A multidisciplinary care team is necessary to ensure better clinical outcomes. Onset of disease at either spectrum of age requires careful management and treatment, with both unique disease- and age-appropriate factors carefully considered.

Polymyalgia rheumatica: an autoinflammatory disorder?

Polymyalgia rheumatica (PMR) is an elderly onset syndrome characterised by aching and stiffness in the shoulders and the pelvic girdle associated to increased levels of acute phase reactants and rapid...

The comparison of risk factor between the young adult and elderly onset of ischemic stroke

Background: Young adults are likely to distinguish risk factor from elderly concerning ischemic stroke. Aims and Objective: Measure the comparison of risk factor between the young adult and elderly onset of ischemic stroke. Material and Methods: This was a cross sectional study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta Indonesia. The stroke was diagnosed with standard way by well-trained neurologist and confirmed with CT Scan. The risk factors were defined systematically. We used OpenEpi sample size calculation and Statistical Package for Social Sciences version 20 with significance level 0,05. Results: The data of 200 subjects consisted of 100 patients aged under 50 years and 100 patients aged above 50 years. Patients in the elderly group more frequently had atrial fibrillation (92,3% vs 7,6%, p= 0.001). On the other hand, the elderly group more often dyslipidemia (52,1% vs 47,9%) and ischemic heart disease (75% vs 25%). Diabetes and hypertension are more common in young onset compare the old one (57,1% vs 42,9% and 57,6% vs 42,4%). There was not a significantly different risk’s factor include dyslipidemia, ischemic heart disease, diabetes and hypertension both of the group. Conclusion: Atrial fibrillation is the leading risk factor for ischemic stroke, particularly in elderly patients. These findings suggest specializing stroke care to secondary prevention in patient with risk factors.

Post-operative complications in elderly onset inflammatory bowel disease: a population-based study.

IBD diagnosed after the age of 60 is increasing. Data on post-operative complications in elderly onset IBD are scarce. To describe the incidence of and factors associated with post-operative complications in elderly onset IBD, diagnosed after the age of 60. Using EPIMAD Cohort (1988-2006), among 841 incident IBD patients, 139 (17%) underwent intestinal surgery, including 100 Crohn's disease (CD) and 39 ulcerative colitis (UC). After a median post-operative follow-up of 6years (2-10), 50 (36%) patients experienced at least 1 complication with a total of 69. During the first 30 post-operative days, the mortality rate was 4%. Thirty-two early complications (<30days) were observed in 23 patients (17%), with 15 infectious, without significant difference between CD and UC. More than half early post-operative complications (n=19, 59%) were severe (>grade 2) without significant difference between CD and UC (P=0.28). Thirty-seven long-term adverse effects of surgical therapy (≥30days) were observed in 33 patients (24%). Multivariate analysis found (1) acute severe colitis (OR=7.84 [2.15-28.52]) and emergency surgery (OR=4.46 [1.75-11.36]) were associated with early post-operative complications, and (2) Female gender (HR=2.10 [1.01-4.37]) and delay before surgery >3months (HR=2.09 [1.01-4.31]) with long-term adverse effects of surgical therapy. One-third of elderly IBD patients experienced at least 1 post-operative complication. Half of the early complications were severe, and infectious. Emergency surgery was the key driver for post-operative complication.

Comprehensive analysis on 559 cases of adrenal incidentalomas in the elderly Chinese.

ObjectiveThis study was conducted to describe the incidence, classifications and characteristics of adrenal incidentalomas (AIs) in the elderly Chinese.MethodsPrimary clinical records in Shanghai Changzheng Hospital (n = 559) were collected for incident cases of AI between January 1, 2002 and December 1, 2016. We examined demographics, endocrine functions, treatment, etiology, and prognoses.ResultsWe identified 559 new diagnoses of elderly onset AIs, of which 41.25% were male and were diagnosed at a mean age of 74.39 ± 9.03 years. About 61% showed no typical symptoms. Upon systematic review, 41.34% showed dysglycemia, high blood pressure, kaliopenia, and so on. 24.15% (n = 135) received complete or partial endocrine function assessments. A total of 281 cases underwent surgical treatment, and 278 cases went through regular follow‐ups without any operation. Preoperative evaluation was basically consistent with postoperative pathology (P > .05). During the follow‐up, the presence of new subclinical hypercortisolism was 8.99%, and the tumor grew up 3.92% per year (1.96 ± 0.09 mm). 51 cases (9.12%) eventually received further invasive examinations or surgical treatments.ConclusionThe detection of AI in the elderly Chinese is increasing annually. The imaging method and endocrine function tests have great roles in distinguishing between benignancy and malignancy. The diagnosis and treatment of the elderly Chinese with AI should receive multidisciplinary assessment. Biochemical and morphological follow‐up of aged patients with AI should be conducted every 5 years at least.

Phenotype and natural history of elderly onset inflammatory bowel disease: a multicentre, case-control study.

Onset during old age has been reported in upto 10% of total cases of inflammatory bowel disease (IBD). To evaluate phenotypic characteristics and the use of therapeutic resources in patients with elderly onset IBD. Case-control study including all those patients diagnosed with IBD over the age of 60 years since 2000 who were followed-up for >12 months, identified from the IBD databases. Elderly onset cases were compared with IBD patients aged 18 to 40 years at diagnosis, matched by year of diagnosis, gender and type of IBD (adult-onset). One thousand three hundred and seventy-four elderly onset and 1374 adult-onset cases were included (62% ulcerative colitis (UC), 38% Crohn's disease (CD)). Among UC patients, elderly onset cases had a lower proportion of extensive disease (33% vs 39%; P < 0.0001). In CD, elderly onset cases showed an increased rate of stenosing pattern (24% vs 13%; P < 0.0001) and exclusive colonic location (28% vs 16%; P < 0.0001), whereas penetrating pattern (12% vs 19%; P < 0.0001) was significantly less frequent. Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (P < 0.0001), immunosuppressants (P < 0.0001) and anti-TNFs agents (P < 0.0001) in elderly onset cases. Regarding surgery, we found a significantly higher surgery rate among elderly onset UC cases (8.3% vs 5.1%; P < 0.009). Finally, elderly onset cases were characterised by a higher rate of hospitalisations (66% vs 49%; P < 0.0001) and neoplasms (14% vs 0.5%; P < 0.0001). Elderly onset IBD shows specific characteristics and they are managed differently, with a lower use of immunosuppressants and a higher rate of surgery in UC.

Clinical characteristics and long-term prognosis of elderly onset ulcerative colitis.

The aim of this study was to investigate the clinical characteristics and prognosis of patients with elderly onset ulcerative colitis (EOUC), a new growing subgroup of UC. This study retrospectively analyzed 3060 South Korean UC patients diagnosed between 1977 and 2014. The clinical characteristics and prognosis of EOUC, defined as UC in those aged ≥60years at diagnosis, were compared with those of non-EOUC (NEOUC). Among the 3060 patients, 226 were diagnosed with EOUC (7.4%, median age at diagnosis 65.9years [interquartile range, 62.9-68.7years], 58.4% male). The frequency of EOUC increased from 3.9% in the interval 1977-1999 to 9.7% in the interval 2008-2014 (P<0.001). There were more ex-smokers in the EOUC than in the NEOUC group (44.2% vs 19.9%, P<0.001). In the EOUC group, extensive colitis at diagnosis, and the maximum extent thereof, was less than in the NEOUC group (13.7% vs 22.6%, P=0.002, and 34.5% vs 42.5%, P=0.011, respectively). The 10-year cumulative colectomy rate was significantly higher in the EOUC than in the NEOUC group (12.6% vs 7.7%, P=0.015). UC-related and all-cause mortality were higher in the EOUC than in the NEOUC group (3.5% vs 0.6%, P<0.001, and 12.4% vs 1.8%, P<0.001, respectively). Elderly onset ulcerative colitis patients are likely to exhibit distinct features both at diagnosis and during follow-up. It is necessary to pay more attention to, and to conduct further studies on, this particular group of patients.

Clinical and magnetic resonance imaging features of elderly onset dentatorubral-pallidoluysian atrophy.

Dentatorubral-pallidoluysian atrophy (DRPLA) is an autosomal dominant spinocerebellar ataxia caused by CAG triplet expansion in atrophin 1 and is frequently associated with cerebral white matter lesions. To elucidate the clinical features of elderly onset DRPLA and the key radiological findings for differentiating DRPLA from physiological white matter lesions in healthy elderly subjects, we reviewed the clinical and magnetic resonance imaging (MRI) features of ten patients with elderly onset genetically confirmed DRPLA (>60years) and compared their MRI findings with those of age- and sex-matched ten healthy subjects with asymptomatic cerebral white matter lesions. The initial symptom was cerebellar ataxia in all DRPLA patients, and five of them did not have any symptoms other than ataxia at the time of MRI examination. Atrophy of the brainstem, superior cerebellar peduncle, and cerebellum was detected in all DRPLA patients and none of the healthy subjects. Abnormal signals in the brainstem (inferior olive, pons, and midbrain), thalamus, and cerebellar white matter were frequently observed in elderly onset DRPLA patients but not in healthy subjects. In conclusion, elderly onset DRPLA presents as cerebellar ataxia alone in the early stage of disease. Atrophy of the brainstem, superior cerebellar peduncle, and cerebellum and abnormal signals in the brainstem, cerebellum, and thalamus are key findings for differentiating elderly onset DRPLA from asymptomatic cerebral white matter lesions in healthy subjects.

Phenotypic Characterization of Elderly Onset Inflammatory Bowel Disease: IBD at 60 and Beyond

Phenotypic Characterization of Elderly Onset Inflammatory Bowel Disease: IBD at 60 and Beyond

Influence of age at diagnosis on the clinical characteristics of Crohn's disease in Korea: Results from the CONNECT study.

The present study evaluated the clinical characteristics of Korean patients with Crohn's disease (CD) according to their age at diagnosis in a nationwide multicenter cohort study. A total of 1224 patients diagnosed with CD between 1982 and 2008 in 32 hospitals were included, and age at diagnosis was categorized as ≤16 (G1), 17-40 (G2), 41-59 (G3) and ≥60 (G4) years old. The baseline characteristics, medication, and intestinal resection were compared according to the age at diagnosis. The number of patients in each age group was 155 (G1; 12.7%), 919 (G2; 75.1%), 120 (G3; 9.8%), and 30 (G4; 2.5%). The frequencies of ileocolonic disease in the late adult onset and elderly onset groups were lower than those in the other groups (P<0.001). The cumulative probabilities of thiopurine and anti-tumor necrosis factor use in late adult onset and elderly onset groups were significantly reduced compared with those of the other groups (P<0.01). However, the risk of the first intestinal resection was not different among the age groups. The ileal location (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.11-2.27), complicated behavior (HR: 3.35; 95% CI: 2.63-4.27), and early thiopurine use (HR: 0.27; 95% CI: 0.17-0.43) were associated with the first intestinal resection, whereas the age at diagnosis was not a risk factor. Elderly onset CD may be related to favorable outcomes in Korea. Thus, the heterogeneity of this disease should be considered when developing a tailored strategy for the treatment of CD.

Expression of CCR3, SOX5 and LC3 in patients with elderly onset rheumatoid arthritis and the clinical significance.

This study investigated the expression of C-C chemokine receptor type 3 (CCR3), transcription factor SOX5 (SOX5) and microtubule-associated protein 1 light chain 3 (LC3) in patients with elderly onset rheumatoid arthritis (EORA) and the clinical significance. Ninety patients with elderly onset rheumatoid arthritis were selected in our hospital from January to December in 2016 to serve as patient group. At the same time, 50 healthy people were selected as control group. Levels of CCR3, SOX5 and LC3 in serum of two groups were detected by enzyme-linked immunosorbent assay (ELISA). Expression levels of CCR3, SOX5 and LC3 mRNA in peripheral blood mononuclear cells (PBMCs) were detected by reverse transcription-PCR (RT-PCR). Expression level of CCR3 mRNA in patient group was 0.752±0.054, which was significantly higher than that in control group (0.287±0.032, t=8.932, P<0.05). Levels of CCR3, SOX5 and LC3 in serum of patients in patient group were significantly higher than those in control group (P<0.05). Positive correlations were found between serum levels of CCR3 and SOX5 (r=0.613, P<0.05), serum levels of CCR3 and LC3 (r=0.637, P<0.05), and serum levels of SOX5 and LC3 (r=0.645, P<0.05). CCR3, SOX5 and LC3 are highly expressed in PBMC and serum, which may be closely related to the occurrence and development of EORA. These indexes may be used as indicators of clinical diagnosis and prognosis of patients with EORA.

Characteristics of Turkish patients with elderly onset psoriatic arthritis: A retrospective cohort study.

Psoriatic arthritis (PsA) is a chronic inflamatory disease characterized with axial and peripheral joints involvement. It rarely affects patients older than 65 years old.The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset psoriatic arthritis (EOPsA) and young-onset (YOPsA) patients.A total of 180 patients diagnosed with PsA according to CASPAR criteria and followed-up in single center were included in this study. The patients with initial symptoms started after age 65 were accepted as EOPsA. Demographic, clinic, and laboratory data and the medications which the patients received were recorded and retrospectively evaluated.Nineteen (10.5%) of 180 patients were diagnosed as EOPsA, and 161 (89.5%) patients were evaluated as YOPsA. The mean patient age was 42.1years for the YOPsA group and 68.3 years for the elderly onset group. Mean duration of disease was 5.6 years for the early onset group and 1.3 years for the elderly onset group (P = .001). Fourteen (73.3%) of 19 EOPsA patients were female and 5 of them were male. Higher rates of fatique, pain scores, comorbid diseases, and acute phase reactants elevation were detected in EOPsA patients comparing to YOPsA (P = .000, P = .000, P = .001, and P = .001, respectively). YOPsA patients have more dactilitis, nail involvement, elevated PASI scores, and smoking habitus when compared with EOPsA patients (P = .019, P = .03, P = .005, P = .004, respectively). In terms of the treatment options chosen, there was no significant difference in the use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CS), methotrexate (MTX), and sulfasalazine (SSL), but there was a more frequent use of anti-tumor necrosis factor-alpha in the YOPsA group.YOPsA and EOPsA patients may presented with different clinical and laboratory features. EOPsA patients are characterized with higher rates of fatigue, pain scores, comorbid diseases, and acute phase reactants and less dactilitis, nail involvement, and anti-TNF-alpha usage.

Is primary Sjögren's syndrome a risk factor for malignancies different from lymphomas? What does the literature highlight about it?

BackgroundPrimary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune disease with an elevated risk of developing lymphoproliferative malignancies (LM). Whether pSS is a risk factor or not for non-lymphoma malignancies (NLM) has been scarcely evaluated in the literature. Age is per se a risk factor for malignancies: patients over 70 years old have 4 times higher risk for cancers than adults. Even if the mean age of pSS onset usually is in the 4th and 5th decade, its onset in patients aged over 65 years (Elderly Onset pSS – EOpSS) is not uncommon.Material and methodsTo evaluate pSS as a risk factor for NLM we performed a systematic electronic search on PubMed in the period 2006–2016 to identify all the publications on this topic. The studies were eligible for inclusion if they reported specific Standardized Incidence Ratio (SIR) with 95% CI. Studies that did not report sufficient published and/or original data were excluded.ResultsOnly 7 articles of 494 that we found in PubMed fulfilled the inclusion criterion. In the vast majority of these, SIR values were not statistically significant for NLM. The occurrence of NLM after LM was statistically significant in some studies and a NLM represented the most frequent cause of death. The possibility that NLM may represent a paraneoplastic syndrome seems much more frequent than LM, the risk of which increases with time after the diagnosis. Data regarding the neoplastic weight of EOpSS are mainly pointed out by case reports.ConclusionsPrimary Sjögren’s syndrome is not associated with an increased risk for NLM. However the possibility that NLM may appear after recovery from lymphoma should be carefully considered because it could be cause of the patient’s death. Similarly the possibility that NLM may represent a paraneoplastic syndrome must be highlighted. The relationship between EOpSS and SIRs for NLM should be deepened with studies on ad hoc cohorts.

Comparative study of elderly-onset versus young-onset rheumatoid arthritis: clinical features and treatment

Objective To compare the clinical features and treatment between elderly onset rheumatoid arthritis(EORA)and young onset rheumatoid arthritis(YORA). Methods The EORA patients(n=60)and the YORA patients(n=90)were compared regarding sex ratio, activity of pathogenetic condition, disease severity, extra-articular manifestations, complications, laboratory indexes, and therapeutic schedules. Results The female/male ratio was 36/24(1.50∶1.0)in group EORA, and 69/21(3.3∶1.0)in group YORA, with higher female/male ratio in in group YORA.The frequency of morning stiffness, proximal interphalangeal joint involvement and metacarpophalangeal joint involvement were lower in group EORA(53.3%, 46.676% and 61.67%)than in group YORA(72.2%, 77.8%, 81.11%)(χ2=5.521, 15.385, 6.960, P=0.018, 0.000, 0.008 respectively). Large joints involvement at onset of rheumatoid arthritis was higher in group EORA(38.33%)than in group YORA(18.89%)(χ2=6.960, P=0.008). The joint swollen and tender counts were comparatively less(16.51±7.34)and(15.92±8.44)in group EORA than in group YORA(22.46±7.58)and(23.8±8.93)(t=5.080、5.740, all P=0.000)respectively.The accumulated disease activity score(DAS28)was higher in group EORA(5.86±1.57)than in YORA(4.92±1.64)(t=3.360, P=0.001). HAQ score was lower in group EORA(0.83±0.85)than in group YORA(1.16±0.91)(t=2.43, P=0.02). Comorbid conditions such as osteoarthritis, osteoporosis, cardiovascular disease and chronic renal insufficiency were more frequent in group EORA(51.7%, 31.7%, 18.3% and 15.00%)than in group YORA(27.8%, 15.6%, 5.6% and 4.4%)(χ2=11.722, 5.445, 6.168, 5.067, P=0.001, 0.020, 0.013, 0.024). The positive rate of RF were more higher in YORA(70.00%)than in group EORA(48.33%)(χ2=7.126 P=0.008). The synthetic or biologic traditional DMARDs(disease modifying anti-rheumatic drugs)were widely used in group YORA(78.9% and 31.1%)than in group EORA(40.0% and 10.0%)(χ2=14.940, 9.153, P=0.000, 0.002). The more frequently used program with glucocorticoids hormonal therapy was received in group EORA(38.3%)than in group YORA(20.00%)(χ2=6.092 P=0.014). Conclusions EORA patients differs from YORA patients in many of ways, including a more balanced gender distribution, atypical presentation at onset of disease, more frequent involvement of large joints, seronegativity in a higher percentage, and less frequent positivity of anti CCP-antibody, which makes diagnosis more difficult in the earlier period.Therapy of EORA with DMARDs should be instituted based on disease activity, if there is no contraindication. Key words: Elderly onset rheumatoid arthritis; Disease activity

Metabolic characteristics and renal dysfunction in 65 patients with tophi prior to gout.

Tophi typically occur many years after uncontrolled gout. Therefore, their development before gout remains unusual. Such patients might exhibit some characteristic differences compared with typical tophaceous gout patients. In this study, 65 tophaceous gout patients with tophi as the first sign of gout (tophi-first group) were enrolled. Their clinical characteristics were compared with those of 1421 patients whose tophi occurred after gout (tophi-after group). Compared with the tophi-after group, the tophi-first group had a significantly higher percentage of female patients and patients with elderly onset of disease and a lower percentage of patients with a positive family history; these patients had lower body mass indices, serum urate levels, and estimated glomerular filtration rates (eGFRs). Female sex and negative family history were identified as the principal determinants of tophi development before gout. The decreasing eGFR among the tophi-first group was not due to the group per se but was a result of older age, longer tophi duration, and hyperuricemia. The most common site of initial tophi occurrence in both groups was the toe. In the tophi-first group, the occurrence rates for initial tophi sites were significantly higher at the finger but were lower at the ankle. The tophi-first group exhibited distinct characteristics of age, gender, family history, BMI, serum urate levels, and initial tophi site. This group had fewer comorbidities but similar renal dysfunction compared with the tophi-after group. Thus, patients presenting with tophi should be treated promptly, even if they have no history of gout symptoms.

Longitudinal Decline of Striatal Subregional [18F]FP-CIT Uptake in Parkinson's Disease.

Dopamine transporter imaging is suggested to be a useful imaging biomarker for Parkinson's disease (PD) progression and monitoring drug effects. We investigated the longitudinal decline characteristics of striatal [18F]FP-CIT uptake in PD. We retrospectively reviewed 35 PD patients and 9 non-PD patients. All patients underwent [18F]FP-CIT PET at the initial diagnosis and follow-up. PET images were spatially normalized and analyzed with eight striatal and one occipital VOI templates. We measured the specific to non-specific binding ratio (SNBR) of the striatal subregions and calculated the absolute annual reduction (AAR) and relative annual reduction (%RAR) of the SNBRs. Total striatal SNBRs in PD patients were significantly lower than those in non-PD patients, with the most significant difference in the posterior putamen. Both AAR (0.26±0.14 vs. 0.09±0.19, p<0.05) and %RAR (6.9±3.5 vs. 1.2±2.7, p<0.001) of total striatal SNBRs were significantly greater in PD than non-PD patients. There were no significant differences in the AAR and %RAR of total striatal SNBRs between elderly and young onset PD. The AARs of the posterior putamen were higher in early PD than in advanced PD. Conversely, the %RARs were not significantly different between early and more advanced PD. The disease duration was significantly negatively correlated with the AAR but not with the %RAR of the posterior putamen. The longitudinal decline of striatal [18F]FP-CIT uptake in PD was nonlinear and significantly faster than that in non-PD, with a different rate of decline among the striatal subregions.

Analysis of clinical characteristics in elderly onset rheumatoid arthritis patients combined with interstitial lung disease

Objective To analyze the clinical characteristics in elderly onset rheumatoid arthritis(RA) patients combined with interstitial lung disease(ILD). Methods Four hundred and four cases of elderly onset RA patients were summarized.They were divided into two groups according to whether combined with ILD.Its clinical manifestations, laboratory examinations and combined diseases were analyzed. Results (1)Male elderly patients with onset of RA were more likely to occur ILD than female(χ2=6.251, P=0.012). There was no significant difference in duration analysis of two groups(t=1.750, P=0.081). (2)The elderly onset patients in RA with knee pain were more likely to happen ILD(χ2=7.048, P=0.008), the difference was significant.And there was no significantly statistical difference in the shoulder joint pain(χ2=0.028, P=0.866), elbow pain(χ2=0.022, P=0.882), hand joint pain(χ2=2.041, P=0.153), hip pain(χ2=0.129, P=0.720), joint deformities(χ2=0.013, P=0.908), morning stiffness(χ2=0.000, P=0.984) and joints rheumatoid nodules(χ2=0.349, P=0.555) of two groups.(3)The elderly onset RA patients with a high level of serum RF were more likely to happen ILD(t=3.325, P=0.001), the difference was significant.And there was no significantly statistical difference in serum ANA antibodies(χ2=0.004, P=0.948), anti SSA(χ2=0.718, P=0.397), SSB antibody(χ2=0.638, P=0.424), AKA antibody(χ2=0.949, P=0.330), CCP antibody(χ2=0.500, P=0.479) and the level of ESR(t=0.582, P=0.561), CRP(t=0.381, P=0.703) and PLT(t=-1.246, P=0.213). (4)The elderly onset RA patients with ILD were more likely to appear osteoporosis(χ2=7.467, P=0.006), the difference was significant.And there was no significantly statistical difference in the occurrence of high blood pressure(χ2=0.403, P=0.526) and diabetes(χ2=0.180, P=0.671) in the two groups. Conclusion Male patients, the elderly onset RA patients with knee pain and associated with high level of serum RF more often occur with ILD.And the elderly onset RA patients with ILD are more likely to appear osteoporosis. Key words: Rheumatoid arthritis; Interstitial lung disease; Elderly onset

Organic psychosis: Much more than dopamine

IntroductionMost of elderly onset psychosis present as a consequence of one or more organic processes. We present the case of an 81-year-old patient with diagnosis of a posterior fossa meningioma. It emerged with abrupt positive symptoms of psychosis with important family and social disruption. The interest of the case lies in the low frequency of psychiatric symptoms associated to this type of tumor, given its location. Thus, these symptoms may be explained, by normal pressure hydrocephalus (NPH) secondary to the tumor.ObjectivesTo highlight the importance of performing a complete organic screening in elderly onset psycotic patients.Material and methodFrom the mentioned case, we performed a literature review of psychopathology associated with NPH.ResultsPsychiatric examination demonstrated parasitization delusions and delusional misinterpretations; tactile and visual zoomorphic hallucinations were also present. They were compatible with Ekbom syndrome; anxiety and behavioral disorganization were prominent. We introduced treatment with risperidone 0.5 mg/12 h with important decrease of positive psychotic symptoms. Currently, the patient is waiting for a ventricular-peritoneal shunt.ConclusionsThe NPH usually presents with memory failures, psychomotor slowing, problems in calculating and writing. It may progress to a neurological impairment so intense that may be indistinguishable from Alzheimer's disease. From a psychopathological point of view, affective or psychotic symptoms and/or behavioral disorganization may also appear. In few cases, HNT onset shows with prominent psychiatric symptoms instead of neurological impairment. These symptoms may improve with pharmacological and surgical treatment. Thus, it is important to get an accurate diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Diabetes and Aging: Unique Considerations and Goals of Care.

Diabetes in older adults is a growing public health burden. The unprecedented aging of the world's population is a major contributor to the diabetes epidemic, and older adults represent one of the fastest growing segments of the diabetes population. Of impending concern is that these numbers are projected to grow dramatically over the next few decades (1,2). Almost one-third of U.S. adults over the age of 65 years have diabetes. Approximately half of those are undiagnosed, and an additional one-third of older adults have prediabetes (3). Persons with diabetes today are living much longer compared with those in the past. We also recognize that management of older adults with diabetes is clearly more complicated given the observation that they commonly have multiple coexisting medical conditions that can impact clinical management. While rates of diabetes-related complications have declined overall in the general population, the incidence rates of macrovascular complications such as acute myocardial infarction and stroke continue to be the highest in older age-groups. These individuals also have the highest rate of diabetes-related end-stage renal disease (4). Heterogeneity in the health status of older adults (ranging from robust and otherwise healthy individuals to those with frailty and multiple comorbid conditions) and the paucity of evidence from clinical trials represent a challenge to making generalized treatment recommendations for older adults. Although many more individuals with type 1 diabetes are living longer (5), type 2 diabetes remains the most common type in older age-groups. Furthermore, older adults with diabetes may either have elderly onset disease (diagnosed at age 65 years or older) or long-standing diabetes with onset in middle age or earlier years (6), adding to the complexity of managing diabetes in older adults. Consequently, the American Diabetes Association (ADA) organized a Consensus Development Conference on Diabetes and Older Adults …

P.03.16: Elderly Onset Celiac Disease: Distinctive Features at Diagnosis and Long-Term Complications

P.03.16: Elderly Onset Celiac Disease: Distinctive Features at Diagnosis and Long-Term Complications