Elderly Patient Population Research Articles

Performance Assessment of an Electrostatic Filter-Diverter Stent Cerebrovascular Protection Device: Evaluation of a Range of Potential Electrostatic Fields Focusing on Small Particles

Silent Brain Infarction (SBI) is increasingly recognized in patients with cardiac conditions, particularly Atrial Fibrillation (AF) in elderly patients and those undergoing Transcatheter Aortic Valve Implantation (TAVI). While these infarcts often go unnoticed due to a lack of acute symptoms, they are associated with a threefold increase in stroke risk and are considered a precursor to ischemic stroke. Moreover, accumulating evidence suggests that SBI may contribute to the development of dementia, depression, and cognitive decline, particularly in the elderly population. The burden of SBI is substantial, with studies showing that up to 11 million Americans may experience a silent stroke annually. In AF patients, silent brain infarcts are common and can lead to progressive brain damage, even in those receiving anticoagulation therapy. The use of cerebral embolic protection devices (CEPDs) during TAVI has been explored to mitigate the risk of stroke; however, their efficacy remains under debate. Despite advancements in TAVI technology, cerebrovascular events, including silent brain lesions, continue to pose significant challenges, underscoring the need for improved preventive strategies and therapeutic approaches. We propose a device consisting of a strut structure placed at the base of the treated artery to model the potential risk of cerebral embolisms caused by atrial fibrillation, thromboembolism, or dislodged debris of varying potential TAVI patients. The study has been carried out in two stages. Both are based on computational fluid dynamics (CFD) coupled with the Lagrangian particle tracking method. The first stage of the work evaluates a variety of strut thicknesses and inter-strut spacings, contrasting with the device-free baseline geometry. The analysis is carried out by imposing flow rate waveforms characteristic of healthy and AF patients. Boundary conditions are calibrated to reproduce physiological flow rates and pressures in a patient’s aortic arch. In the second stage, the optimal geometric design from the first stage was employed, with the addition of lateral struts to prevent the filtration of particles and electronegatively charged strut surfaces, studying the effect of electrical forces on the clots if they are considered charged. Flowrate boundary conditions were used to emulate both healthy and AF conditions. Results from numerical simulations coming from the first stage indicate that the device blocks particles of sizes larger than the inter-strut spacing. It was found that lateral strut space had the highest impact on efficacy. Based on the results of the second stage, deploying the electronegatively charged device in all three aortic arch arteries, the number of particles entering these arteries was reduced on average by 62.6% and 51.2%, for the healthy and diseased models respectively, matching or surpassing current oral anticoagulant efficacy. In conclusion, the device demonstrated a two-fold mechanism for filtering emboli: (1) while the smallest particles are deflected by electrostatic repulsion, avoiding micro embolisms, which could lead to cognitive impairment, the largest ones are mechanically filtered since they cannot fit in between the struts, effectively blocking the full range of particle sizes analyzed in this study. The device presented in this manuscript offers an anticoagulant-free method to prevent stroke and SBIs, imperative given the growing population of AF and elderly patients.

Häufigkeit von sexuell übertragbaren Infektio-nen in deutschen Facharztpraxen

The aim of this study is to analyze the incidence of sexually transmitted infections (STI) in dermatological, urological, and gynecological practices in Germany. Data from the nationwide IQVIA Disease Analyzer database was used for this study. This cross-sectional study included 6,535 patients in 2014 and 6,491 patients in 2023 with an insured diagnosis of a sexually transmitted disease in 69 dermatology, 148 gynecology and 55 urology practices. The number of patients treated for sexually transmitted diseases in these practices changed only minimally between 2014 and 2023. On average, each dermatology practice treated 31 patients with STIs in 2023, each gynecology practice treated 21 patients and each urology practice treated 23 patients. Anogenital warts were the most commonly diagnosed STI in all specialties, with prevalence varying by specialty. Interestingly, the number of patients per practice with anogenital warts increased slightly in dermatology and urology practices between 2014 and 2023, while it decreased in gynecology practices. The average age of patients treated for STDs increased between 2014 and 2023 In summary, this study highlights that despite vaccination efforts and awareness campaigns in various medical specialties, STI patient numbers remain almost the same and thus STI continues to be a persistent and increasing challenge in the ageing patient population. The findings call for further initiatives in the public health sector and an adjustment of everyday practice to the special needs of these patient groups.

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient-provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.

Quantitative micro-CT-derived biomarkers elucidate age-related lung fibrosis in elder mice

BackgroundIdiopathic Pulmonary Fibrosis (IPF), prevalently affecting individuals over 60 years of age, has been mainly studied in young mouse models. The limited efficacy of current treatments underscores the need for animal models that better mimic an aged patient population. We addressed this by inducing pulmonary fibrosis in aged mice, using longitudinal micro-CT imaging as primary readout, with special attention to animal welfare.MethodsA double bleomycin dose was administered to 18–24 months-old male C57Bl/6j mice to induce pulmonary fibrosis. Bleomycin dosage was reduced to as low as 75% compared to that commonly administered to young (8–12 weeks-old) mice, resulting in long-term lung fibrosis without mortality, complying with animal welfare guidelines. After fibrosis induction, animals received Nintedanib once-daily for two weeks and longitudinally monitored by micro-CT, which provided structural and functional biomarkers, followed by post-mortem histological analysis as terminal endpoint.ResultsCompared to young mice, aged animals displayed increased volume, reduced tissue density and function, and marked inflammation. This increased vulnerability imposed a bleomycin dosage reduction to the lowest tested level (2.5 µg/mouse), inducing a milder, yet persistent, fibrosis, while preserving animal welfare. Nintedanib treatment reduced fibrotic lesions and improved pulmonary function.ConclusionsOur data identify a downsized bleomycin treatment that allows to achieve the best trade-off between fibrosis induction and animal welfare, a requirement for antifibrotic drug testing in aged lungs. Nintedanib displayed significant efficacy in this lower-severity disease model, suggesting potential patient stratification strategies. Lung pathology was quantitatively assessed by micro-CT, pointing to the value of longitudinal endpoints in clinical trials.

One- and five-year mortality according to first use of ticagrelor or clopidogrel at the acute stage of myocardial infarction in elderly patients: the FAST-MI 2015 registry

Abstract Background Guidelines recommend ticagrelor over clopidogrel in patients with AMI, irrespective of their age. The PLATO trial, which showed lower mortality with ticagrelor, included only few very elderly patients. Purpose To analyze one- and 5-year outcomes according to use of ticagrelor vs clopidogrel as first P2Y12-inhibitor at the acute stage of AMI, in real-life conditions in patients aged ≥80 years. Methods FAST-MI 2015 included consecutive patients with AMI in 204 centers throughout France. This analysis focused on patients ≥ 80 years of age, in whom the first P2Y12-inhibitor used was either clopidogrel or ticagrelor. Both Cox time-dependent logistic regression and propensity score (PS) matching were used. Results Among 5,291 patients, 995 (19%) were aged ≥ 80 years, of whom 721 (72%) met the inclusion criteria. Mean age was 86 ± 4 years for patients receiving clopidogrel and 84±3 for those receiving ticagrelor, 54% and 52% respectively were women, and 37% vs 54% had STEMI. Using Cox time-dependent regression, the HR (95%CI) for use of ticagrelor vs clopidogrel first was 1.11 (0.75-1.67), P=0.59 for one-year death and 0.61 (0.43-0.86), P=0.004 for death from one to 5 years. After PS matching, the two cohorts (N=231 each) were well balanced; one-year mortality was similar for the 2 medications, while 5-year survival was higher for those receiving ticagrelor first (Figure). Conclusion In this real-world population of elderly patients (mean age 85 years) with AMI, the use of ticagrelor as the first P2Y12-inhibitor was associated with similar survival at one year and improved survival at 5 years, compared with clopidogrel. The diverging one- and 5-year results suggest the possibility of unmeasured confounders. Further research is needed in older patients.Kaplan-Meir curves: survival at 5-years

Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination in vulnerable groups: monitoring cardiovascular safety of COVID-19 vaccination.

COVID-19 vaccines are well tolerated and effective but may have adverse effects on the cardiovascular system. Vaccine-associated myocardial injury was analysed by measuring high-sensitive troponin T (hsTnT); mid-regional pro-adrenomedullin (MR-proADM) levels were evaluated to assess endothelial dysfunction. This was a prospective study with a vulnerable population of healthcare workers (HCWs) and elderly patients (>70 years) who were vaccinated with either one dose of ChAdOx1 nCov-19 adenoviral vector vaccine (AZ) followed by one dose of the BNT162b2 messenger RNA vaccine (BNT), or with two doses of BNT (12th of January - 30th of November 2021). HsTnT and MR-proADM were measured in blood samples at three visits (V1: 1st immediately before vaccination; V2, 3: 3-4 weeks after 1st and 2nd vaccination). HsTnT of HCWs was compared to a healthy reference population. N = 162 volunteers were included (V1 = 161; V2, V3 = 162 each). N = 74 (45.7%) received AZ/BNT and n = 88 (54.3%) received BNT/BNT [elderly: n = 20 (12.3%), HCWs: n = 68 (42.0%)]. Median hsTnT levels were 4 ng/L, 5 ng/L and 4 ng/L (V1-V3) for AZ/BNT and at 5 ng/L, 6 ng/L and 6 ng/L (V1-V3) for BNT/BNT. Compared to the reference population (n = 300), hsTnT was significantly higher at all visits for both vaccination groups (p < 0.01), without differences between the AZ/BNT and BNT/BNT cohort. Median MR-proADM values were 0.43 nmol/L, 0.45 nmol/L, 0.44 nmol/L (V1-V3) in the AZ/BNT cohort and 0.49 nmol/L, 0.44 nmol/L, 0.47 nmol/L for BNT/BNT, respectively. Change of median hsTnT and MR-proADM between visits did not show significant increases. One HCW experienced a permanent and three a transient hsTnT increase ≥14 ng/L. No overall subtle, persistent cardiovascular involvement was observed after the 2nd COVID-19 vaccination. Elevated cardiovascular biomarkers in clinically asymptomatic individuals need further investigations.

Overall survival and disease-free survival prediction in Chinese women with breast cancer aged 70 years or older by using nomograms.

By analyzing the existing data of this study, a prediction tool for the overall breast cancer survival and disease-free survival (DFS) of elderly women was established. Clinicopathologic data were collected from elderly women with BC who were admitted to the Tianjin Medical University Cancer Institute and Hospital from August 2014 to December 2017. Independent prognostic factors for BC in elderly patients were confirmed using the Cox proportional hazards model. Nomograms were developed with these factors for predicting the 3- and 5-year overall survival (OS) as well as DFS. The nomograms' discrimination ability and calibration were assessed through the area under the curve (AUC), concordance index (C-index), decision curve analysis (DCA), and calibration plots. We enroled 889 elderly patients with BC, and the results showed that the 3-year OS rate was 93.4% (95%CI = 91.8%-95.1%), the 3-year DFS rate was 87.8% (95%CI = 85.7%-90.0%), the 5-year OS rate was 85.6% (95%CI = 83.3%-87.9%), and the 5-year DFS rate was 80.1%(95%CI = 77.5%-82.8%). The corrected C-indices of the OS and DFS nomograms were 0.799 and 0.667, respectively (95%CI = 0.767-0.830 and 0.632-0.702, respectively). Relatively high AUC values were shown by the nomograms for estimating OS and DFS. The DCA revealed that the constructed nomograms had net benefits for clinical application. The calibration curves demonstrated an excellent correspondence between the data predicted by the nomograms and the actual survival data. Survival curves indicated that risk stratification could differentiate OS and DFS. This study developed novel and practical nomograms for individual prediction of DFS and OS in elderly BC patients. These nomograms can predict 3- and 5-year OS as well as DFS in the elderly BC patient population, thereby enabling personalized risk assessment and risk-based therapy.

La radiothérapie des CBNPC de stade III : nouvelles techniques, nouvelles combinaisons

Defining the optimal treatment approach for patients with stage III non-small cell lung cancer, where the loco-regional disease extension renders a surgical approach obsolete, represents an important clinical challenge. In addition, many of these patients present with several comorbidities, compromising their tolerance to treatment. This article describes how innovative radiotherapy approaches try to enhance loco-regional tumour control as a first step towards improved survival, often by exploring novel avenues to dose-escalation, while at the same time focus on limiting early and long-term radiation-induced toxicity by applying the most advanced radiotherapy techniques. Moreover, the path towards new combinations with systemic agents, particularly immunotherapy building on the actual standard of combined chemo-radiotherapy with durvalumab in consolidation, is reported. This article wants to give a balanced view on the importance to investigate how we can obtain better local and metastatic disease control by intensifying our combined treatment strategies, while bearing in mind that many of our patients in daily clinical practice may not be able tolerate this. This urges us to also explore less disruptive treatment approaches for our more frail and aged patient population and define in a multidisciplinary manner the most optimal treatment strategy for each individual patient in our daily clinical practice.1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Rehabilitation to Improve Outcomes after Cervical Spine Surgery: Narrative Review.

The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in optimal recovery after cervical spine surgeries. Nevertheless, there is no agreement in the existing research regarding the most suitable postsurgical rehabilitation program. Consequently, this review assesses the ideal rehabilitation approach for adult patients following cervical spine operations. This review covers activities of daily living and encompasses diverse treatment methods, including physiotherapy, specialized tools, and guidance for everyday activities. The review is organized under three headings: (1) historical perspectives, (2) patient-reported functional outcomes, and (3) general and disease-specific rehabilitation. Rehabilitation programs are determined on the basis of patient-reported outcomes, performance tests, and disease prognosis. CSM requires strengthening of the neck and shoulder muscles that have been surgically invaded. In contrast, the CCI requires mobility according to the severity of the spinal cord injury and functional prognosis. The goal of rehabilitation for CCTs, as for CCIs, is to achieve ambulation, but the prognosis and impact of cancer treatment must be considered. Rehabilitation of the cervical spine after surgery is essential for improving physical function and the ability to perform daily activities and enhancing overall quality of life. The rehabilitation process should encompass general as well as disease-specific exercises. While current rehabilitation protocols heavily focus on strengthening muscles, they often neglect the crucial aspect of spinal balance. Therefore, giving equal attention to muscle reinforcement and the enhancement of spinal balance following surgery on the cervical spine is vital.

Decision Support in Cardiac Surgery: Early Exploration of Requirements with Cardiac Anesthetists and Surgeons.

Successful implementation of clinical decision support tools is rare, the key barrier being the lack of user involvement during development. Following the idea, development, exploration, assessment, long-term follow-up (IDEAL) framework, this study aims to provide early insights into the current challenges, clinical processes, and priorities when developing new decision support tools in cardiac surgery. Using a qualitative approach, semi-structured interviews were conducted with cardiac anesthetists and surgeons from three Scottish cardiac centers. Thematic analysis identified adverse postoperative outcomes, ageing cardiac patient population and changing surgical procedures to be the main challenges in cardiac surgery. Existing risk prediction tools were largely not used due to a perceived lack of utility and validation. This study underscores the need to shift focus towards predicting postoperative complications, instead of mortality. It emphasizes the importance of early collaboration with clinical experts and stakeholders in developing decision support systems that are fit for purpose. By identifying the priorities of cardiac clinicians, the study lays the groundwork for developing clinically meaningful prediction models.

Impact of Procedure Risk vs Frailty on Outcomes of Elderly Patients Undergoing Emergency General Surgery: Results of a National Analysis.

The direct association between procedure risk and outcomes in elderly patients who undergo emergency general surgery (EGS) has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly patients who undergo EGS is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly patients who undergo EGS compared with frailty. Elderly patients (age >65 years) undergoing EGS operative procedures were identified in the NSQIP database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5-Item Frailty Index (mFI-5; mFI 0 nonfrail, mFI 1 to 2 frail, and mFI ≥3 severely frail) and based on procedure risk. Multivariable regression models and receiving operative curve analysis were used to determine risk factors associated with outcomes. A total of 59,633 elderly patients who underwent EGS were classified into nonfrail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group. Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared with frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly patients who underwent EGS compared with frailty. Assessing frailty in the population of elderly patients who undergo EGS without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy: A single-center retrospective study.

The population of elderly patients with gastric cancer is increasing, which is a major public health issue in China. Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer. To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy. A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020. The overall rate of malnutrition was 31.8%. The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group (P < 0.001). Nutritional characteristics in the malnourished group, including body mass index, prognostic nutritional index (PNI), albumin, prealbumin, and hemoglobin, were all significantly lower than those in the well-nourished group. The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the well-nourished group (22.1% vs 33.5%, P = 0.001). Age ≥ 70 years (HR = 1.216, 95%CI: 1.048-1.411), PNI < 44.5 (HR = 1.792, 95%CI: 1.058-3.032), operation time ≥ 160 minutes (HR = 1.431, 95%CI: 1.237-1.656), and postoperative complications grade III or higher (HR = 2.191, 95%CI: 1.604-2.991) were all recognized as independent risk factors associated with delayed discharge. Malnutrition is relatively common in elderly patients undergoing gastrectomy. Low PNI is an independent risk factor associated with delay discharge. More strategies are needed to improve the clinical outcome of these patients.

Assessing the nutritional status and impact of a series of nutritional interventions on elderly inpatients using bioelectrical impedance analysis: A service evaluation.

The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat-free mass index (FFMI). A prospective, comparative, single-centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. BIA is quick, non-invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning.

A multidisciplinary program to wean infants and toddlers from long-term tube feeding: Lessons learned from a retrospective study.

Children maintain growth and development by ingesting adequate calories and nutrients, typically achieved via oral intake of food and liquids. When unable to eat and drink orally, they need temporary or permanent enteral nutritional support via nasogastric, nasoduodenal, gastrostomy, or jejunostomy tubes. The objectives of this retrospective study are to describe lessons learned from operating a weaning program at ALYN Hospital for over a decade, the characteristics of the patient population (gender, age, medical condition, and type of tube feeding and hospitalization), and which of these characteristics correlate with successful weaning. Data were obtained from the hospital's secure database of 82 infants and toddlers, 37 boys (45.4%) and 45 girls (54.9%) aged 3 months to 10.8 years who took part in a tube feeding intervention from 2011 to 2020. Descriptive and correlational analyses were performed to characterize the participants and their responses to the program. Fifty-one children (62.2%) were less than 2 years, 26 children (31.7%) were 2-4.11 years, and only 5 children were aged 5 years (6.1%) and older. Fifty-six children were successfully weaned from tube feeding, 9 children were eventually successful, but the process took longer than anticipated, 11 children were partially weaned and 6 were not successfully weaned. These results are discussed within the context of a successful weaning program related to participant characteristics (medical condition, age, gender, and weight), and subsequent recommendations are offered related to the intervention setting, duration, and intensity; redefining success in weaning and the need for long-term follow-up.

No benefit from TMZ treatment in glioblastoma with truly unmethylated MGMT promoter: Reanalysis of the CE.6 and the pooled Nordic/NOA-08 trials in elderly glioblastoma patients.

The treatment of elderly/ frail patients with glioblastoma is a balance between avoiding undue toxicity, while not withholding effective treatment. It remains debated, whether these patients should receive combined chemo-radiotherapy with temozolomide (RT/TMZ→TMZ) regardless of the O6-methylguanine DNA methyltransferase gene promoter (MGMTp) methylation status. MGMT is a well-known resistance factor blunting the treatment effect of TMZ, by repairing the most genotoxic lesion. Epigenetic silencing of the MGMTp sensitizes glioblastoma to TMZ. For risk-adapted treatment, it is of utmost importance to accurately identify patients, who will not benefit from TMZ treatment. Here, we present a reanalysis of the clinical trials CE.6 and the pooled NOA-08 and Nordic trials in elderly glioblastoma patients that compared RT to RT/TMZ→TMZ, or RT to TMZ, respectively. For 687 patients with available MGMTp methylation data, we applied a cutoff discerning truly unmethylated glioblastoma, established in a pooled analysis of 4 clinical trials for glioblastoma, with RT/TMZ→TMZ treatment, using the same quantitative methylation-specific MGMTp PCR assay. When applying this restricted cutoff to the elderly patient population, we confirmed that glioblastoma with truly unmethylated MGMTp derived no benefit from TMZ treatment. In the Nordic/NOA-08 trials, RT was better than TMZ, suggesting little or no benefit from TMZ. For evidence-based treatment of glioblastoma patients validated MGMTp methylation assays should be used that accurately identify truly unmethylated patients. Respective stratified management of patients will reduce toxicity without compromising outcomes and allow testing of more promising treatment options.

The use of biological and targeted synthetic basic anti-inflammatory drugs in elderly patients with rheumatoid arthritis: for or against

Due to the global aging of the population and increasing life expectancy, the population of elderly patients with rheumatoid arthritis is growing, both due to patients with onset after 60 years of age (EORA), and elderly patients in whom the disease started at a young age. Treatment of such patients is associated with a number of difficulties, which is associated with the characteristics of the aging of the immune system and the body as a whole, and the burden of comorbid conditions. Elderly patients, unlike young ones, have a higher risk of developing adverse events when prescribed both basic and biological drugs. These features lead to a more “gentle” treatment strategy for elderly patients, limited use of adequate doses of basic drugs and a low number of prescriptions of biological drugs among doctors. This article provides current data on the safety and effectiveness of the use of biological and targeted synthetic disease-modifying anti-inflammatory drugs in elderly patients with rheumatoid arthritis.

Barriers to conservative kidney management for Japanese healthcare professionals involved in the treatment of end-stage renal disease.

Conservative kidney management (CKM) is a treatment alternative for patients with end-stage kidney disease (ESKD). Despite the increasing population of elderly dialysis patients in Japan, CKM is not as readily available compared with that in North America and Europe. Therefore, it is important to clarify the barriers to CKM in Japan. We interviewed 11 experts to explore their beliefs and issues regarding CKM. Based on the interviews, we categorized the CKM barriers into eight categories and created a 24-item questionnaire. A questionnaire survey was conducted among 112 medical professionals involved in ESKD management. To investigate the types of barriers, we conducted an exploratory factor analysis using the questionnaire results. Responses were obtained from 53 (47.3%) of 112 subjects (18 doctors, 29 nurses, 6 clinical engineers), with 94.3% considering CKM as a treatment option for ESKD. Factor analysis categorized the questions into the following: (1) Lack of palliative care experience, (2) Ethics and responsibility, (3) Patient's problem, (4) Dialog with patients and families, and (5) Lack of support system. Regarding barriers to CKM, "lack of experience in palliative care" and "lack of support system" scored the highest, and "ethics and responsibility" scored the lowest. Barriers to CKM may be classified into five factors, with "lack of experience in palliative care" and "lack of support system" being the important barriers to overcome. Additionally, most healthcare professionals consider CKM as the fourth option for renal replacement therapy.

Comparative outcomes of treatment modalities in nonagenarians with nonmetastatic pancreatic adenocarcinoma

BackgroundThere has been an increase in the elderly patient population seeking care for pancreatic ductal adenocarcinoma (PDAC). This study aimed to delineate the effectiveness of therapeutic options in nonagenarians (aged 90–99 years) diagnosed with resectable PDAC. MethodsThis study used the National Cancer Database to identify patients with nonmetastatic PDAC (stage I-III) from 2004 to 2021. The study compared median overall survival (mOS) using Kaplan-Meier curves among 5 treatment categories: surgery, surgery along with chemoradiation, chemotherapy alone, radiotherapy alone, and chemoradiation alone. Cox proportional hazards regression was used in multivariate analyses. ResultsOf 459,174 patients, 793 aged ≥ 90 years had nonmetastatic PDAC. Of 793 patients, 245 (30.9 %) underwent chemotherapy alone, 296 (37.3 %) underwent radiotherapy alone, 162 (20.4 %) underwent chemoradiation alone, 58 (7.3 %) underwent curative-intent resection, and 32 (4.0 %) underwent surgery combined with chemoradiation. The mOS estimates in different treatment modalities were 9.5 months (95 % CI, 6.7–14.5) for surgery alone, 19.1 months (95 % CI, 2.4–64.3) for surgery combined with chemoradiation, 8.2 months (95 % CI, 7.2–9.2) for chemotherapy alone, 8.4 months (95 % CI, 7.6–9.6) for radiotherapy alone, and 11.2 months (95 % CI, 8.7–12.9) for chemoradiation alone (P < .001). In multivariate analysis, the odds of survival were better for patients who underwent surgery alone than for those who underwent chemotherapy alone, although the odds of survival did not significantly differ between patients who underwent radiotherapy alone and those who underwent chemoradiation alone. Nonetheless, surgery combined with chemoradiation was associated with decreased mortality risk compared with surgery alone (hazard ratio, 0.46; 95 % CI, 0.25–0.87; P = .02). Operative 30-day mortality rate was 8.8 %, and 90-day mortality rate was 17.8 %. ConclusionSurgery combined with chemoradiation improved the survival of nonagenarians with PDAC compared with other therapies. However, only 1 in 25 patients received all 3 treatment components. Moreover, our study highlights a very high operative mortality rate in nonagenarians.

Updated safety and efficacy analysis comparing elderly vs nonelderly patients treated with consolidation nivolumab or nivolumab plus ipilimumab after chemoradiation for unresectable stage III NSCLC from the BTCRC LUN 16-081 clinical trial.

e13770 Background: Lung cancer is the leading cause of cancer related deaths. The median age of those diagnosed with lung cancer continues to increase as the overall population ages. Consolidation immunotherapy after chemoradiation has become the standard treatment for patients with unresectable stage III NSCLC. However, little has been reported regarding the safety and efficacy of this strategy in an elderly patient population. Methods: Data was analyzed from a randomized phase II clinical trial in patients with unresectable stage III non-small cell lung cancer (NSCLC) who were randomized to Nivolumab (N) or Nivolumab/Ipilimumab (NI) after concurrent chemoradiation. We performed an ad-hoc analysis comparing the efficacy and toxicity based on age groups &lt;65 and ≥ 65. A total of 54 patients received N (480mg IV every 4 weeks for up to 6 cycles) and 51 patients received N (240mg IV every 2 weeks) + I (1mg/kg IV every 6 weeks for up to 4 cycles). Results: From 9/2017 to 4/2021, 105 patients were enrolled. Fifty-five were age &lt;65 (26 in N and 29 in NI) and 50 were ≥65 (28 in N and 22 in NI). Patients were matched for baseline characteristics (Table). In the N alone group, pneumonitis was noted in 14 patients: 9 (34.6%) &lt;65 and 5 (17.9%) age ≥ 65 (p=0.16). In the NI group, 19 patients experienced pneumonitis: 9 (31%) were&lt;65 and 10 (45.5%) were ≥ 65 (p=0.29). Hospitalization was noted in 9 patients in the N group: 6 (23.1%) &lt; 65 and 3 (10.7%) ≥ 65 (p=0.28). In the NI group, 20 patients were hospitalized: 9 (31%) were &lt;65 and 11(50%) were ≥ 65 (p=0.16). At 24 months, the PS for all patients &lt;65 was 61.3% and 60.5% for patients ≥65(p=0.62). PFS was 46.8% for &lt;65 and 73.8% for ≥65 (p=0.15) in the N group and 75.4% for &lt;65 and 45.4% for ≥65 in the NI group(p=0.02). OS for patients &lt;65 was 84% at 24 months and 73% for ≥65 for both groups (p=0.466). For individual groups, OS was 72.5% in &lt;65 and 81.4% for ≥65 (p=0.27) in the N group and 92.8% for &lt;65 and 68.2% for ≥65 in the NI group (p=0.029). Conclusions: Adverse events in both age groups were comparable but overall higher in NI arm in both younger and elderly patients. OS estimates were similar for both age groups in N while higher in younger patients compared to older adults in NI. [Table: see text]

Efficacy and Safety of Rivaroxaban for Extremely Aged Patients with Venous Thromboembolism: A Retrospective, Cross-Sectional Real-World Study.

Rivaroxaban, a non-vitamin K antagonist oral anticoagulant, has become widely used for the management of venous thromboembolism (VTE) in adult patients. However, few trials have explored the efficacy and safety of rivaroxaban in VTE patients over 80 years of age. This necessitates further real-world studies of rivaroxaban across elderly populations. We performed a retrospective single center study involving extremely aged VTE sufferers treated with rivaroxaban. The sample comprised 121 patients newly initiated on rivaroxaban diagnosed between January 2018 and January 2020. Patients were followed up for no less than 2 years. The effectiveness outcome was the disappearance of thromboembolism. The safety outcome was the incidence of major bleeding events. Comorbidities and complications were recorded throughout the entire study. The efficacy outcome occurred in 114 of 121 patients (94.21%) and the safety outcome occurred in 12 of 121 patients (9.91%). Increased hemorrhages were observed in patients with infection (15.15% vs 7.80%), but no significant difference was observed due to limited sample size (P=0.3053). Patients with an age-adjusted Charlson comorbidity index score higher than 6 points exhibited higher bleeding rates (14.08% vs 4.00%; P=0.0676) and lower thrombus cure rates (88.73% vs 100%; P=0.0203). Patients with infection should be more careful of bleeding events during rivaroxaban therapy. An age-adjusted Charlson comorbidity index score higher than 6, which predicted poor survival, indicated inferior safety and efficacy of rivaroxaban. To investigate the efficacy and safety of Rivaroxaban in an aged venous thromboembolism patient population under real-world conditions.