Elderly Patients For Treatment Research Articles

Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation.

There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p = 0.048, CI 1.003-8.286).

E50 - Safety and toxicity in elderly patients in treatment for metastatic colon cancer

E50 - Safety and toxicity in elderly patients in treatment for metastatic colon cancer

Thyroid hormonal profile in elderly patients treated with two different levothyroxine formulations: A single institute survey

PurposeRecent evidences suggest that, despite the large use of levothyroxine (L-T4), up to 40% of patients are over-treated developing sub-clinical hyperthyroidism. We compared TSH, fT4 and fT3 serum levels of elderly patients in treatment with liquid and tablet L-T4 formulations over a period of time of five years. SubjectsPatients were recruited by searching the database of those treated and followed at the Thyroid Unit of the University of Brescia. ResultsTwo hundred and ninety-nine patients (251 females, 48 males) were treated with L-T4 in tablet form (groupT) and 118 subjects (107 female, 11 male) with liquid LT4 (groupL). The two groups were super-imposable by age, median L-T4 dosage, TSH, fT4 and fT3 values. A slightly but not significantly higher BMI value was observed among patients of group L over those of group T (26.9±2.9 vs. 26.4±2.1 kg/cm2, respectively). During five years of LT-4 treatment, sub-clinical or over-hypothyroidism was found in 13 (4.3%) and 3 (2.5%) patients of group T and group L (P=0.335), whereas, subclinical or clinical hyperthyroidism was significantly more frequent among patients of group T than those of group L [69 (23%) vs. 5 (4.2%) patients, (P=0.0001)]. Logistic regression analysis showed that only the Tablets were associated with the risk of developing subclinical or hyperthyroidism [OR 2·354 (1·136–4·827), P=0.021]. ConclusionsWe show a greater stability in the thyroid profile of hypothyroid elderly patients in treatment with liquid thyroxine as opposed to those being treated by tablet formulation over five years of follow-up.

Hipovitaminose D em idosos institucionalizados tratados com anticonvulsivantes, uma associação frequente

BACKGROUND: Elderly people have a high prevalence of hypovitaminosis D, especially when they are exposed to anticonvulsants. OBJECTIVE: The present study evaluated the influence of chronic use of anticonvulsants on serum levels of vitamin D in institutionalized elders aged above 65 years. METHODS: Eighteen elderly subjects treated with anticonvulsants were studied for at least 12 months and compared to 16 untreated elders. RESULTS: Vitamin D deficiency was observed in both groups, but the group treated with anticonvulsants showed a more remarkable deficiency. Although there was no statistically significant difference in serum parathyroid hormone levels, elderly patients in treatment had a higher value (53.44 ± 28.92 pg/ml) compared to untreated elders (38.5 ± 10.8 pg/ml: p = 0.42). Statistically significant difference was observed between serum 25-hydroxyvitamin D in treated female patients (9.22 ± 3.80 ng/ml) compared to untreated female patients (18.78 ± 7.62 ng/ml: p = 0.03). DISCUSSION: The observed deficiency in both groups suggests that elderly subjects have lower serum 25-hydroxyvitamin D. Compared to untreated elderly women, elderly women treated with anticonvulsants showed a significantly lower serum level of vitamin D.