Geriatric Group Research Articles

Effects of a Movement-Based Mind-Body Intervention in Managing Osteoarthritis Symptoms in Older Adults

In a secondary analysis, this study examined differences in age (younger vs. older geriatric groups), gender, and living arrangement (living alone vs. living with others) in elderly patients with osteoarthritis (OA) who utilized chair yoga (CY) as an type of movement-based mind-body intervention (MMBI) for symptom management. A two-arm, assessor-blinded, randomized control trial was used to examine effects of CY (twice-weekly 45-minute sessions for 8 weeks) on pain interference, physical function, and psychosocial outcomes by gender, age, and living arrangement in older adults with OA who could not participate in traditional exercise. A total of 112 older adults completed CY or a health education program (HEP) and participated in five data collection points. Older women in the CY group showed greater reduction in pain interference during the CY intervention than those in HEP, F(4, 86) = 3.255, p = .016, η2 = .131. The younger group (ages 61 to 74) had decreased depression scores during the intervention, F(4, 87) = 2.598, p = .042, η2 = .107. Regardless of the intervention (CY or HEP), depression scores in older adults who were living alone decreased substantially during the intervention. Group-based and supervised CY interventions are recommended for older adults with OA to reduce pain interference, reduce depressive symptoms, and develop social networks. Online-based synchronous CY sessions may address physical activity needs and improve mental well-being in this population in light of physical distancing practices due to COVID-19.

Nonspecific Chronic Low Back Pain in Elderly Patients

Introduction: Low back pain is one of the most common causes of disabilities in old people often due to lumber degeneration (osteoarthritis) and spinal canal stenosis. In our study, we determine the prevalence and associated changes of low back pain that increase with age.
 Methodology: This observational cohort study was carried out from March 2019 to March 2021 at the El-Moussenin Center in Port Said. The study included 300 patients aged ≥65 years with a chronic nonspecific low back pain for at least six months, a Visual Analogue Scale (VAS) score of 3 and more, and an absence of spinal pathology such as infection, tumor, fracture, spondylolisthesis, or spinal degeneration of grade 2 and above. Patients were divided into two groups: (i) a study group including patients with a mean age of 75 years with nonspecific chronic LBP (n = 150) and (ii) an age- and sex-matched control group (n = 150) with no chronic low back pain using propensity score-matched analysis. All patients underwent whole spinal X-ray, lumbar MRI, CBC, and DXA.
 Result: We analyzed laboratory finding, radiological finding for global spinal parameter, and lumber degeneration body composition analysis using whole body dual energy X-ray absorptiometry. We found increase in red blood cell distribution width (it is an index of aging), it was higher in geriatric with CLBP (32) and in control (6.9) with a p-value < 0.001. Skeletal muscle mass index was 6.23 ± 0.92 in the studied group and 6.43 ± 1.02 in the control group with a p-value = 0.045. Increase in fat mass was noted in both the studied (32.17 ± 7.07) and the control (29.28 ± 7.48) groups with a p-value < 0.001. Moreover, those patients had lower lumbar lordosis, higher sagittal vertical axis regarding decrease in muscle mass in trunk and extremities.
 Conclusion: Red blood cell distribution width which is a sign of aging was high in geriatric group with CLBP. Moreover, geriatric CLBP is often associated with osteoporosis which affects the pain threshold and triggers CLBP due to age-related loss of skeletal muscle mass and spinal sagittal malalignment.

COVID -19 in Geriatric Population

The causative factors of Coronavirus disease mainly the viruses. Through news we aware that pneumonia cases seen recently in Wuhan city, China. Due to unknown causes. Coronaviruses that cause illness such as a common cold. The Coronavirus infection identified with respiratory symptoms and pneumonia, the severe form of coronavirus infection mainly associated with death and low immune system patients. It is very important for us to more focus on geriatric people because in our countries, geriatric group people facing health problems at this present situation. According to articles Clinical Pathology, Pathogenesis, Immunopathology, and Mitigation Strategies, in that said geriatric people and low immune system patient with symptoms related history are more prone to COVID infection. But according to recent information by WHO all people are at risk of coronavirus but mostly geriatric people facing more risk of developing a severe respiratory infection. Geriatric people easily get coronavirus syndrome due to physical changes that occur as increasing age. There were 95% of these deaths seen in geriatric people above 60 years older. Above 50% of all fatal conditions occurred in geriatric people between 60- 80 years ago. There having disease control and prevention center, which indicate that rates of hospitalizations, intensive care unit admissions and mortality reported among COVID-19 cases in the United States are substantially higher among patients older than 45 years compared with younger patients, with case-fatality rates exceeding 1.4% among patients aged 55 to 64 years and exceeding 2.7% among those aged 65 to 74 years.

Evaluation of diabetes self-management education in geriatrics with type 2 diabetes in Turkey.

This study was conducted to evaluate the diabetes education efficiency of individuals over 65 years old in Turkey, which has the highest prevalence of diabetes in Europe. We retrospectively evaluated 320 patients who attended Turkey diabetes self-management group education program (TDSMEP) between 2016 and 2020 in a secondary hospital. Participants who have been followed up for a maximum of 9 months are grouped as over 65 years old and under. Of the 320 patients, 114 formed the geriatric group and 206 the non-geriatric group. After the training, the number of patients who had HbA1c≤7% increased significantly in both the geriatric (28.1-45.6%) and non-geriatric (19.9-42.2%) (P=0.001) groups. After the training, similar HbA1c goals were achieved in the geriatric and non-geriatric groups. The most significant HbA1c decrease was observed at the 3rd month of follow-up and remained stable until the 9th month. In logistic regression analysis, the factors affecting HbA1c failure (HbA1c>7%) after training in the geriatric group were long diabetes duration (OR=1.07, 95% CI: 1.02-1.13, P=0.01), high basal HbA1c levels (OR=1.31, 95% CI: 1.03-1.67, P=0.03), and low education level (OR=3.88, 95% CI: 1.54-9.76, P=0.001). This is the first study to evaluate the effectiveness of TDSMEP for geriatric individuals whose HbA1c≤7% increased from 28% to 45.6% during follow-up after the training. TDSMEP is recommended for all adult age groups, regardless of age range.

Treatment of Chronic Hepatitis C Virus Using Direct Acting Antivirals in Geriatric Egyptian Patients.

There is high proportion of geriatric patients who acquired chronic hepatitis C virus infection. There is a shortage in evidence- based data as regards direct-acting antivirals in this group of patients. The aim was to assess safety, efficacy, and tolerability of direct acting antiviral drugs in Egyptian geriatric patients. This prospective study was performed on 177 patients with chronic hepatitis C and administrated different regimens of direct acting antivirals. Patients were divided into two groups: Group I: patients below 65 years old (N = 143), and Group II: patients > 65 years old (N = 34). Pretreatment history taking, baseline characteristics, and investigations were done for both groups. Follow up was made to detect treatment efficacy and adverse effects. Geriatric group were found to have more comorbidities (diabetes mellitus, hypertension, and cardiomyopathy); also liver cirrhosis. Minor adverse effects occurred in both groups without significant difference included fatigue, insomnia, headache, and dizziness. Vomiting, diarrhea, and skin rash occurred in group II more than group I. Leucopenia, thrombocytopenia, jaundice, and significant anemia occurred without significant difference between both groups. Eighteen patients (25%) of 72 patients who took ribavirin had to reduce ribavirin dose or to stop it. The overall treatment response in the entire study was 97.7% without significant difference between both groups. Direct acting antivirals are recommended regardless the age. These drugs are effective and tolerable in elderly patients. Attention to other comorbidities, drug-drug interactions, and follow up are recommended.

Critical care ultrasound in geriatric trauma resuscitation leads to decreased fluid administration and ventilator days.

Geriatric trauma populations respond differently than younger trauma populations. Critical care ultrasound (CCUS) can guide resuscitation, and it has been shown to decrease intravenous fluid (IVF), lower time until operation, and lower mortality in trauma. Critical care ultrasound-guided resuscitation has not yet been studied in geriatric trauma. We hypothesized that incorporation of CCUS would decrease amount of IVF administered, decrease time to initiation of vasopressors, and decrease end organ dysfunction. A PRE-CCUS geriatric trauma group between January 2015 and October 2016 was resuscitated per standard practice. A POST-CCUS group between January 2017 and December 2018 was resuscitated based on CCUS performed by trained intensivist upon admission to the intensive care unit and 6 hours after initial ultrasound. The PRE-CCUS and POST-CCUS groups underwent propensity score matching, yielding 60 enrollees in each arm. Retrospective review was conducted for demographics, clinical outcomes, and primary endpoints, including amount of IVF in the first 48 hours, duration to initiation of vasopressor use, and end organ dysfunction. Wilcoxon two-sample, χ2 tests, and κ statistics were performed to check associations between groups. There was no statistical difference between PRE-CCUS and POST-CCUS demographics and Injury Severity Scores. Intravenous fluid within 48 hours decreased from median [interquartile range] of 4941 mL [4019 mL] in the PRE-CCUS to 2633 mL [3671 mL] in the POST-CCUS (p = 0.0003). There was no significant difference between the two groups in time to initiation of vasopressors, vasopressor duration, lactate clearance, intensive care unit length of stay, or hospital length of stay. There was a significant decrease in ventilator days, with 26.7% PRE-CCUS with ventilation longer than 2 days, and only 6.7% POST-CCUS requiring ventilation longer than 2 days (p = 0.0033). Critical care ultrasound can be a useful addition to geriatric resuscitation. The POST-CCUS received less IV fluid and had decreased ventilator days. While mortality, lactate clearance, complications, and hospital stay were not statistically different, there was a perception that CCUS was a useful adjunct for assessing volume status and cardiac function. Therapeutic, level II.

Characteristics of esophageal achalasia in geriatric patients over 75 years of age and outcomes after peroral endoscopic myotomy.

As the population ages, the proportion aged ≥75 years is expected to increase. Many studies on peroral endoscopic myotomy (POEM) as treatment for esophageal achalasia have already been reported; however, few studies have been designed on patients aged ≥75 years. The purpose of this study is to describe the characteristics of esophageal achalasia in patients >75 years and to evaluate the outcomes of POEM. This study included 121 patients who underwent POEM for esophageal achalasia, which was divided into the geriatric (n= 18) group aged ≥75 and the young (n= 103) group ≤74 years. The characteristics of esophageal achalasia and the short-term outcomes after POEM in the geriatric group compared with the young group were retrospectively investigated. The median age of the geriatric group was 78 years, and two patients were initially diagnosed with refractory pneumonia, and esophageal achalasia was initially overlooked. The preoperative Eckardt score of the geriatric group was significantly lower than that of the young group (4 vs. 6, P=0.007), particularly in the regurgitation score. The Eckardt score and integrated relaxation pressure of both groups were significantly improved after POEM (P < 0.001). There were no cases of perioperative complications in the geriatric group. POEM for esophageal achalasia is a safe and effective treatment even in geriatric patients >75 years of age. In geriatric patients with recurrent or intractable pneumonia, it is important to rule out esophageal achalasia. Geriatr Gerontol Int 2021; 21: 788-793.

Oncologists’ perceptions of the need for assessing individual domains in the geriatric assessment and worthwhile outcomes in treating older patients with cancer

Background: Although the multidimensional geriatric assessment (GA) is considered the standard of care, it is not uniformly practiced. In older patients with cancer, shared decision-making requires a clear understanding of the goals of therapy. Objectives: We aimed to understand the perceptions of health-care professionals of the need to assess the various domains in the GA and what would constitute worthwhile outcomes in older patients with cancer. Materials and Methods: An online questionnaire survey was conducted by the geriatric oncology group of the Department of Medical Oncology at the Tata Memorial Hospital in Mumbai, India. Participants in the survey included various health professionals with an interest in the care of older patients with cancer. Data were collected in Microsoft Excel and basic descriptive statistics were performed. Results: Between July and August 2020, 234 health-care professionals responded to the survey. The respondents included predominantly medical oncologists (146, 70.9%), practicing in academic centers (148, 65.6%) from India (168, 87%). According to 46% of the respondents, over 30% of the patients in their practices were in the geriatric age group; yet, 144 (73.8%) respondents reported that they referred &lt;10% of their older patients with cancer for a GA. Almost all the respondents agreed that it was important to check for the presence of polypharmacy, inappropriate medications, comorbidities, drug interactions, falls, function, psychological status, cognition, nutrition, social support, and quality of life in the older patients with cancer. Over 95% of the respondents thought that formal training in the GA should be part of the oncology training programs. According to 139 respondents (63%), an improvement in the quality of life or a decrease in toxicity were more important goals of cancer-directed therapy in older patients with cancer, compared to prolongation of overall survival. Conclusion: There is a recognition of the importance of performing a multidimensional GA in older patients with cancer; however, this has not translated into a widespread performance of the GA in actual practice. It would be important to address the barriers to implementing the GA in the clinic, to help optimize the care of older patients with cancer. The goals of cancer-directed therapy should be clearly discussed with the patients in order for true shared decision-making to occur.

Epidemiology and outcomes of geriatric and non-geriatric patients with drug allergy labels in Hong Kong.

Adverse drug reactions are more common in geriatric patients than in younger patients, but there have been insufficient studies concerning the epidemiology or burden of drug allergy labels in geriatric patients. We prospectively investigated the prevalence and outcomes of geriatric patients with drug allergy labels in a cohort of hospitalised patients. Patients admitted to a regional hospital over a 6-month period were recruited for this study. All patients with drug allergy labels were prospectively followed until discharge; clinical data were anonymously extracted for analyses. Patients were categorised into either geriatric (aged ≥65 years) or non-geriatric (aged <65 years) groups. Demographic characteristics, clinical outcomes, and prevalences of drug allergy labels were compared between groups. There were 4361 admissions involving 3641 patients during the 6-month study period. Overall, 492 patients (13.5%) had drug allergy labels, consisting of 151 non-geriatric patients (30.7%) and 341 geriatric patients (69.3%). The prevalence of drug allergy labels did not significantly differ between geriatric and non-geriatric patients (13.5% vs 13.5%, P=0.976). Significantly more patients in the geriatric group had drug allergy labels to cardiovascular system drugs (15.5% vs 4.6%, P=0.001). Geriatric patients had a significantly lower rate of direct discharge from the hospital (73.0% vs 88.1%, P<0.001) and required transfers to convalescent or rehabilitation care for further management. More than 13% of hospitalised geriatric patients had drug allergy labels. The leading causes of drug allergy labels were similar between geriatric and non-geriatric patients. Geriatric patients with drug allergy labels had significantly more labelled allergies to cardiovascular system drugs and adverse clinical outcomes.

Survival Associations between Patient Age and Treatment Modality in Olfactory Neuroblastoma: A Retrospective Population-Based Study.

Olfactory neuroblastoma (ONB) is a rare neuroepithelial-derived malignancy that usually presents in the nasal cavity. The rarity of ONB has led to conflicting reports regarding associations of patient age and ONB survival and outcome. Moreover, long-term outcomes of chemotherapy and other treatment modalities are speculated. Here, we aimed to compare survival outcomes across age groups through time and determine associations between treatment modality and survival. In this retrospective population-based study, we analyzed the SEER 2000–2016 Database for patients with ONB tumors. Using Kaplan–Meier survival analysis, a significant effect of age and cancer-specific survival (CSS) was observed; geriatric ONB patients had the lowest CSS overall. Generalized linear models and survival analyses demonstrated that CSS of the pediatric patient population was similar to the geriatric group through 100 months but plateaued thereafter and was the highest of all age groups. Radiation and surgery were associated with increased CSS, while chemotherapy was associated with decreased CSS. GLM results showed that tumor grade, stage and lymph node involvement had no CSS associations with age or treatment modality. Our results provide insight for future investigations of long-term outcomes associated with ONB patient age and treatment modality, and we conclude that survival statistics of ONB patients should be analyzed in terms of trends through time rather than fixed in time.

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years\u2019 experience from a single center in Turkey

BackgroundThe aim of our study was to describe musculoskeletal system tuberculosis (TB) as a single-center experience.MethodsThis is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max).ResultsOverall, 31 patients (3.2 % of all TB cases) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of treatment was 12.9 ± 5.5 months. Of the 31 patients, six (19.4 %) had concomitant pulmonary TB. One of the patients was in the pediatrics age group, and two of them were in the geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9 %).ConclusionsThe physicians should be suspicious about the diagnosis of musculoskeletal TB disease. If the diagnosis and treatment are delayed, spinal damage and other consequences might be incurable.

Geriatric Patient with Osteoarthritis and Obesity Survived from Critically Ill of COVID-19: A Case Report

Introduction: The Corona Virus Disease (COVID-19) pandemic has become a major problem worldwide. Currently, the group of geriatrics always coincidence with chronic diseases like hypertension, diabetes mellitus, and osteoarthritis discovered with a general level of severity, disability and even death. In addition, obesity is associated with several high risks of disease severity and worse clinical outcome in COVID-19.Case: a geriatric patient with comorbidities of osteoarthritis and obesity class 1 suffered from critically ill COVID-19. Clinical manifestations that were atypical and without a history of epidemiology made it difficult to screen for COVID. Furthermore, it was found that the respiration rate, heartbeat, and blood pressure increased, oxygen saturation was only 86%, crackles all over the right lung, chest x-ray showed bilaterally infiltrates and reverse transcriptase-polymerase chain reaction (RT-PCR) test showed positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on admission. Patients managed with high flow nasal canulla (HFNC) flow 40 lpm and FiO2 78% with temperature 370C, selection of appropriate hydrophilic antibiotic such moxifloxacin iv and antiviral therapy. Obesity-related calorie regulation is given according to The Indonesian Association of Clinical Nutritionists (PDGKI), osteoarthritis medicationis still provided during the treatment resulted in a very good clinical progress. Furthermore, the patient finally recovered and was allowed to go home on the 13th day of treatment with maximum improvement.Conclusion: It is very important for clinicians to know the complex therapy management of patients in the geriatric group. This is because this population generally had atypical clinical symptoms and those that were admitted to the hospital already had severe cases.

Effects of a Movement-Based Mind–Body Intervention in Managing Symptoms in Older Adults with Osteoarthritis: Gender, Age, and Living Arrangement Differences

Background: Movement-based mind–body interventions (MMBIs) have been identified as an alternative and complementary therapy to ameliorate symptoms associated with osteoarthritis (OA). However, there is little evidence regarding effects of MMBI to improve chronic pain, physical function, and psychosocial health associated with gender, age group, or living arrangement. This study examined differences in age (younger vs. older geriatric groups), gender, and living arrangement in elderly patients with OA who utilized chair yoga (CY) as a type of MMBI for symptom management. Materials and Methods: This study used a two-arm assessor-blinded randomized control trial to examine effects of CY (twice-weekly 45-minute sessions for 8 weeks) on pain interference, physical function, and psychosocial outcomes by gender, age, and living arrangement in older adults with OA who could not participate in exercise. Results: A total of 112 older adults completed CY or a health education program (HEP) and provided data at five data collection points. Older women in the CY group showed greater reduction in pain interference during the CY intervention than those in the HEP. The younger geriatric group (ages 61–74 years) had decreased depression scores during the eight-week intervention period. Regardless of the intervention (CY or HEP), depression scores in older adults who were living alone decreased substantially during the intervention. Conclusion: Supervised group-based CY is recommended for older adults with OA. Online CY programs may be a way to address physical activity needs and improve mental well-being in this population in light of physical distancing practices due to coronavirus disease 2019. ClinicalTrials.gov: NCT02113410.

Prevalence of anemia and associated factors among the elderly population in South Khorasan, Birjand, 2019.

Background: Anemia is a multifactorial and common public health problem in geriatric age groups, especially in developing countries. Therefore, this study was designed to study the prevalence of anemia and associated factors among the elderly population in Birjand, Iran, in 2019. Methods: This was a cross-sectional approach to the baseline data of the Birjand longitudinal aging study (BLAS) in which 1396 people aged ≥ 60 years were screened for the presence of anemia based on the World Health Organization (WHO) criteria. For each participant, a standard questionnaire was administered. Furthermore, the height, weight, and body mass index (BMI) were calculated. Blood samples were obtained from each participant for hematological examination. Hemoglobin, hematocrit, and other indices of cell blood count were measured using an automatic cell counter. The prevalence rates were estimated using survey analysis with the weight of Birjand county older population. Univariate and multivariable logistic regression analyses were applied to detect the associated factor with anemia. Results: The mean age of the participants was 69.73±7.66 years. The crude prevalence of anemia was 11.10%, and the age-standardized prevalence based on the standard WHO population 2000-2025 was equal to 16.78% (12.81%–21.66%) (15.95% [10.41%–23.69%] in women and 17.32% (12.65%–23.25%) in men. Mild and normocytic anemia were the predominant types. The mean hemoglobin, hematocrit, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were lower in women than in men and the mean platelet count in women was higher (p<0.001). In the final multivariate logistic regression model, only age groups, BMI, fish consumption, and chronic kidney disease (CKD) were related to anemia. Conclusion: In conclusion, our findings showed the association of anemia with some risk factors and diseases. Anemia in geriatric age groups is often underdiagnosed; hence, identification of subgroups at risk for anemia and its associated risk factors in geriatric groups has a paramount importance in preventing adverse outcomes.

Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations

BackgroundPalliative care in trauma patients is still evolving. The goal was to compare characteristics, outcomes, triggers and timing for palliative care consultations (PCC) in geriatric (≥65 y.o.) and non-geriatric trauma patients. Materials and methodsRetrospective study included 432 patients from two level 1 trauma centers who received PCC between December 2012 and January 2019. Non-geriatric (n = 61) and geriatric (n = 371) groups were compared for: mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Score (GCS), Do-Not-Resuscitate (DNR) orders, futile interventions (FI), duration of mechanical ventilation (DMV), ICU admissions, ICU and hospital lengths of stay (ICULOS; HLOS), timing to PCC, and mortality. Further propensity matching (PM) analysis compared 59 non-geriatric to 59 Geriatric patients matched by ISS, GCS, and DNR. ResultsGeriatric patients were older (85.2 versus 49.7), with falls as predominant MOI. Non-geriatric patients comprised 14.1% of all patients with PCC and were more severely injured than Geriatrics: with statistically higher ISS (24.1 versus 18.5), lower RTS (5.4 versus 7.0), GCS (7.1 versus 11.5), with predominant MOI being traffic accidents, all P < 0.01. Non-Geriatrics had more ICU admissions (96.7% versus 88.1%), longer ICULOS (10.2 versus 4.7 days), DMV (11.1 versus 4.1 days), less DNR (57.4% versus 73.9%), higher in-hospital mortality (12.5% versus 2.6%), but double the time admission-PCC (11.3 versus 4.3 days) compared to Geriatrics, all P < 0.04. In PM comparison, despite same injury severity, Non-geriatrics had triple the time to PCC, five times the HLOS of geriatrics, and more FI (25.4% versus 3.4%), all P < 0.001. ConclusionsPCC remains underutilized in non-geriatric trauma patients. Despite higher injury severity, non-geriatrics received more aggressive treatment, and had three times longer time to PCC, resulting in higher rate of FI than in Geriatrics.

Assessment of morbidity and mortality factors affecting geriatric trauma: A comprehensive cross-sectional study in Central India

India is the second-most populous country in the world has about 76.6 million people at or over the age of 60, constituting above 7.7% of total population. A cross-sectional study of 300 cases of geriatric and non-geriatric population groups was conducted at well-established Trauma, Orthopaedic and Neurosurgical services centre in Central India. Mechanisms of injury sustained by the participants showed that Falls which include both Ground level falls (GLF) and Fall from height (&gt;2 metres) contributed to 55.4% cases in the geriatric population. The next most common cause of trauma in the geriatric population was road traffic accidents amounting to 34.3% of the cases. Data on the injuries sustained by both the study cohorts in terms of the different body regions based on Abbreviated Injury Scale (AIS) and Injury severity score (ISS) showed the head region was most consistently and maximally injured in both the study populations. Comorbidity profiles of geriatric and non-geriatric trauma populations showed significantly high hypertension, cerebrovascular disease, diabetes, diminished hearing and vision among the geriatric group. The maximum number of geriatric patients underwent Orthopaedic and spine surgeries (44.9%), Intercostal drain placements (34.6%), while the non-geriatric population had a higher number of Craniotomies (40%) and Intercostal drain placement (33.5%) surgeries respectively. The geriatric population had a significantly higher crude mortality rate of 39.3% compared to the non-geriatric population ( 26.3% ). With reference to intervention procedures, the geriatric population had a lower percentage of operative intervention and a higher rate of conservative management as compared to the non-geriatric population.

Geriatric sudden deafness

PurposeSudden sensorineural hearing loss, briefly sudden deafness (SD), in the elderly remains less investigated despite rapidly aging population in most countries around the world. This study investigated whether aging process affects the treatment outcome of SD in the elderly. Patients and methodsEighty patients with SD, comprising 40 geriatric patients aged >65 years and 40 non-geriatric patients aged 55–64 years, were enrolled in this study. All patients underwent an inner ear test battery including audiometry, and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP), and caloric tests. ResultsPre-treatment mean hearing level in the geriatric group (94 ± 16 dB) did not significantly differ from non-geriatric group (89 ± 20 dB). After treatment for 3 months, mean hearing gain in the geriatric group (22 ± 18 dB) with an improvement rate of 65%, did not significantly differ from non-geriatric group (21 ± 28 dB) with 58% improvement rate. Both inter-subject and intra-subject analyses revealed that the aging process greatly influenced the cVEMP and oVEMP responses, while less influenced the caloric responses. ConclusionThe treatment outcome of SD in geriatric patients aged >65 years did not significantly differ from that in non-geriatric patients aged 55–64 years, indicating that aging process did not affect treatment outcome of SD. Unlike treatment outcome for the presbycusis is unsatisfactory, treatment outcome for the elderly with SD could be favorable.

ENT and Head and Neck problems in geriatric population –A review

Ageing is a natural biological property of all living beings. There is an estimated 120 crore population around the world currently over the age of 65 years, it is also estimated that half of the world’s population would be in geriatric group by year 2050. Developed nations have about 30% of their population in geriatric age group. In India 10% of population belong to geriatric age, even though it comparatively low with other nations the numbers are huge due to population size. Special senses such as hearing and smell are impaired along with ageing body. Other otorhinolaryngological problems are also common due to degenerative changes in head and neck region. Cosmetic problems are a concern too due to the ever increasing zeal for youthfulness in modern society. We review some of the common problems faced in the elderly. Keywords: Gerontology head and neck otorhinolaryngology ageing.

Investigation of innate immune function in adult and geriatric horses

In order to better understand the influence of age on innate immune function in horses, blood was collected from twelve adult horses (aged 10–16 years; mean: 13 years) and ten geriatric horses (aged 18–26 years; mean: 21.7 years) for analysis of plasma myeloperoxidase, complete blood counts, and cytokine and receptor expression in response to in vitro stimulation with heat-inactivated Rhodococcus equi, heat-inactivated Escherichia coli, and PMA/ionomycin. Gene expression was measured using RT-PCR for IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-12α, IL-13, IL-17α, TLR2, TLR4, and TNFα. Endocrine function and body weight were measured to assess any potential impacts of ACTH, insulin, or body weight on immune function; none of the horses had pituitary pars intermedia dysfunction. The geriatric horse group had lower concentrations of plasma myeloperoxidase (P = 0.0459) and lower absolute monocyte counts (P = 0.0477); however, the difference in monocyte counts was no longer significant after outliers were removed. Additionally, only two significant differences in cytokine/receptor expression in whole blood were observed. Compared with adult horses, the geriatric horses had increased TNFα expression after in vitro stimulation with heat-inactivated R. equi (P = 0.0224) and had decreased IL-17α expression after PMA/ionomycin stimulation when one outlier was excluded (P = 0.0334). These changes may represent a compensatory mechanism by which geriatric horses could ensure adequate immune responses despite potentially dysfunctional neutrophil activity and/or decreased monocyte counts. Aging may influence equine innate immune function, and additional research is warranted to confirm and further explore these findings.

Treatment patterns and survival outcomes of older patients with advanced pancreatic cancer (APC): A Canadian real-world evidence study.

385 Background: We aimed to compare chemotherapy regimens used and overall survival (OS) among geriatric patients (≥ 75 years) with APC as compared to old (65-74 years) and young (&lt; 65 years) patients with APC. Methods: In this retrospective population-based analysis, we identified patients with APC (defined as inoperable/metastatic disease) from 5 large provinces in Canada who were diagnosed from 2011 to 2016. Kaplan-Meier curves were plotted to derive OS and multivariable Cox regression models were constructed to determine the associations of different age groups on OS. Results: We included 636 patients diagnosed with APC of whom 258 (40.6%), 247 (38.8%) and 131 (20.6%) were young, old and geriatric. Approximately half (45.7%) of all patients were women. Eastern Cooperative Oncology Group performance status (ECOG PS) was known in 508 patients at diagnosis among whom 62.2% were 0-1 and 37.8% were 2+. ECOG PS was more likely to be 2+ in the geriatric group (46.8% vs 41.1% vs 31.3%; P = 0.017). Most patients (95.8%) had metastatic disease while the remaining patients had inoperable locally advanced disease. Within the study cohort, 38.7% received chemotherapy. Treatment rates differed based on age: 41.9% in young patients, 40.9% in old patients and 28.2% in geriatric patients (P = 0.02). Choice of first-line chemotherapy varied and included FOLFIRINOX (F) in 99 (40.2%), gemcitabine and nab-paclitaxel (GN) in 91 (37.0%) and gemcitabine (G) in 56 (22.8%). F, GN and G were administered in 27.0%, 32.4% and 40.5% of geriatric patients, 40.6%, 32.7% and 26.7% of old patients, and 44.4%, 42.6% and 13.0% of young patients, respectively (P = 0.007). After adjusting for baseline factors, both geriatric (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.42-1.17; P = 0.175) and old patients were as likely to receive chemotherapy (OR, 1.04; 95% CI, 0.70-1.56; P = 0.815) as their young counterparts. The median OS was 7.1 (6.3-8.4), 6.7 (5.5-8.9) and 5.3 (4.3-6.8) months in young, old and geriatric patients, respectively. After adjusting for baseline variables, both geriatric (hazard ratio [HR], 1.25; 95% CI, 0.96-1.62; P = 0.101) and old patients (HR, 1.16; 95% CI, 0.94-1.42; P = 0.171) experienced similar OS as young patients. ECOG PS 2+ at presentation was associated with worse OS as was treatment with G. Conclusions: Overall treatment rates for APC are low in the real world. The poor OS in geriatric patients with APC is driven by poor PS and use of less intensive chemotherapy. Age alone should not be considered a contraindication for more intensive chemotherapy since treatment benefit is observed across all age groups. [Table: see text]