Geriatric Group Research Articles

Evaluation of Physical Therapy Interventions for Improving Musculoskeletal Pain and Quality of Life in Older Adults.

Background: The ageing process may lead to functional limitations, musculoskeletal pain, and worsened quality of life. The aim of this paper is to evaluate two physical therapy interventions for reducing musculoskeletal pain and improving quality of life in older adults. Methods: A cohort study was carried out with older people (60–75 years old). The Geriatric Physical Therapy group (n = 70) received massage therapy, therapeutic exercise, and therapeutic education program for 5 weeks; the Standardized Therapeutic Exercise group (n = 140) received a standardized therapeutic exercise and therapeutic education program for 3 weeks. Health-related quality of life (SF-36v2) and musculoskeletal pain intensity (VAS) were collected at baseline (A0), post-intervention (A1), and 12 weeks after baseline (A2). Results: There was pain intensity reduction in both groups (p < 0.05) and health-related quality of life improvement, except for Emotional Role (p = 0.34); Physical Function (p = 0.07), Bodily Pain (p = 0.02), and General Health (p = 0.09). At A2 there was a difference (p < 0.05) for neck pain in favor of the Geriatric Physical Therapy Group. Conclusions: Within the limitations of the study, it was possible to conclude that both physical therapy interventions showed a positive effect for reducing non-specific neck pain and low back pain in older adults, which may contribute to health-related quality of life improvement.

Evaluation of Mortality Risk with CURB-65 and PSI in Patients with and Without Geriatric COVID-19 Pneumonia.

Aim: The evaluation and management of pneumonia resulting from the infections of coronavirus disease 2019 (COVID-19) urgently require assessing disease severity to decide on the hospital admission and determine the therapeutic needs and options. This study compared the effectiveness of the CURB-65 scoring system and pneumonia severity index (PSI) to evaluate the mortality risk in the geriatric group having COVID-19 pneumonia and with other non-COVID-19 pneumonia. Methods: 527 patients in ages 65 years or older, whose computerized tomography scans showed ground glass densities, were selected among 21,134 patients who applied for laboratory confirmation of COVID-19. All demographic, clinical, and laboratory data were retrospectively scanned, and selected patients having COVID-19 pneumonia or non-COVID-19 pneumonia were followed up. Results: The overall mortality rate among all patients was 25.6%, the ratio of the patients having COVID-19 pneumonia was 14.3%, and the ratio of patients having non-COVID-19 pneumonia was 29.2%. ROC analysis showed that PSI&gt;group III among COVID-19 patients had an effective discriminative effectiveness in predicting mortality with 77.8% sensitivity, 73.2% specificity, PPV 32.6%, NPV 95.2% (AUC:0.800, 95% CI: 0.720–0.866; P&lt;0.0001). In predicting mortality in COVID-19 pneumonia patients with a CURB-65 score &gt;2, sensitivity was 66.7%, PPV 60% specificity, and NPV 94.3% (AUC: 0.857, 95% CI: 0.783–0.913; P&lt;0.0001). Conclusions: For pneumonia patients with a PSI score greater than three and CURB-65 score greater than two, COVID-19 and non-COVID-19 infections are powerful scores in predicting mortality. Each scoring system has its advantages in stratifying geriatric patients on admission and hospitalization.

A Comparative Analysis of Hospital Triage Systems in the Geriatric Adult Trauma Patients: A Quality Improvement Pilot Study.

The objective of our study is to compare the predicted hospital admission disposition based on the level of risk as determined by the modified Trauma-Specific Frailty Index (mTSFI) score with those determined by arbitrary decisions made based on the Emergency Severity Index (ESI) severity level. We surveyed 100 trauma patients ages 50 and older, admitted to a level 1 trauma center between April 2019 and July 2019. We retrospectively reviewed the hospital admission disposition of each patient under the ESI, which was then compared to the mTSFI-predicted hospital admission disposition. The mTSFI scores were calculated by surveying each patient. Statistical analysis was performed to identify any statistical significance of concordance and discordance when comparing the mTSFI and ESI. The average age was 57.6 ± 4.2 years old in the non-geriatric group vs 76.3 ± 7.3 years old in the geriatric group. There was a male predominance in both groups (61% vs 69.5%). The mTSFI identified a higher percentage of triage discordance in the non-geriatric group (73%) compared to the geriatric cohort (53%) (95% difference CI, [39.6-40], P = .05). Non-geriatric patients have higher recorded rate of frailty than previously recognized and screening should begin at age 50, not 65. The mTSFI may be an effective tool to appropriately triage adult trauma patients at increased risk due to frailty and may reduce in-hospital complications.

Clinical profile of 80-year-old and older thyroid eye disease patients

Thyroid eye disease (TED), an autoimmune orbital disorder, follows a time-of-onset bimodal peak: 40-44 and 60-64years for women, 45-49 and 65-69years for men. TED, however, can also commence in old age. The study's purpose was to evaluate TED in octo- and nonagenarians. Medical records of 19 ≥ 80years geriatric patients at time of diagnosis were compared to 122 TED patients, aged 20-79. A second analysis was performed after subdividing the control group into two age groups, ≤ 40 ("young group," 16 patients) and 41-79years ("middle-aged group," 106 patients). The geriatric group's mean age was 84years (80-94), 11 males and 8 females. Mean follow-up time was 16months. Compared to the controls, the geriatric patients smoked less (p = 0.012), were more often hypothyroid (p = 0.019), and had concurrent myasthenia gravis (p = 0.02) at time of diagnosis. Diplopia was the most common presenting symptom among the elderly (p = 0.005) and proptosis among the controls, specifically the young group (p = 0.027). Bilateral signs were more common among seniors (p = 0.049). Optic neuropathy was diagnosed in 10% of the geriatric group (2/19) and 11% of middle-aged group (12/106), all being resolved after steroids or orbital decompression. Active disease (clinical activity score (CAS) score = > 3) was more common among the middle-aged group (p = 0.024) while the geriatric patients tended towards higher TED severity grades. Orbital decompression and eyelid repositioning surgeries were more common among the middle-aged group. Strabismus surgeries were more common among seniors. TED among octo- and nonagenarians has unique patterns, with different demographic features, more exposed to diplopia, hypothyroidism, association with myasthenia gravis, and bilateral involvement. Special attention should be given when medically managing this subgroup.

The Use and Knowledge of Validated Geriatric Assessment Instruments Among US Community Oncologists.

The use of a standardized geriatric assessment (GA) to inform treatment decisions in older adults with cancer improves quality of life, reduces treatment-related toxicity, and is guideline-recommended. This study aimed to assess community oncologists' knowledge and utilization of GAs. Between September 2019 and February 2020, practicing US-based oncologists were invited to attend live meetings and complete web-based surveys designed to collect information on treatment decision making and various practice-based challenges in oncology care. Among the 349 oncologists surveyed, 74% practiced in a community setting. Sixty percent did not use a formal GA to inform treatment decisions for any of their older patients; the most common reasons for not using a GA were "Too cumbersome to incorporate into routine practice" (44%) and "Adds no value beyond the comprehensive history and physical exam" (36%). Validated GA instruments used in routine clinical practice included: Mini-Mental State Exam (54%), Comprehensive Geriatric Assessment (23%), Cancer and Aging Research Group toxicity tool (12%), and Chemotherapy Risk Assessment Scale for High-Age Patients tool (9%). Nineteen percent of oncologists were not aware of any validated GA instruments. Eastern Cooperative Oncology Group performance status and comorbidities were the most frequently used assessment factors to inform treatment decisions (88% and 73%, respectively). Many oncologists have not incorporated GA tools because of perceptions that GAs are difficult to implement or do not add any value. Increasing education of the benefits of GA-directed therapy could help to increase GA utilization among community oncologists.

Editorial introductions.

Editorial introductions.

Application of a perioperative nursing strategy in the surgical treatment of elderly patients: a narrative review†

Abstract With the steady increase of older people in society, a progressively greater number of patients belonging to the geriatric group need surgical treatment. Since elderly patients with reduced physiological reserve and organ failure often have chronic diseases, geriatric syndrome, and other clinical problems, the perioperative nursing of elderly patients is more complicated. Therefore, we need to comprehensively consider clinical issues, such as patients’ preoperative status, surgical risks, and postoperative quality of life and life expectancy, and conduct comprehensive evaluations and holistic, individualized, and continuous nursing and therapy through the participation of interdisciplinary teams to achieve better curative effects. Here, the perioperative nursing of elderly patients is reviewed, including preoperative evaluation and nursing, intraoperative management, and postoperative nursing.

Comprehensive comparison between geriatric and nongeriatric patients with trauma.

The incidence of geriatric trauma is increasing due to the growing elderly population. Healthcare providers require a global perspective to differentiate critical factors that might alter patients’ prognosis.We retrospectively reviewed all adult patients admitted to a trauma center during a 4-year period. We identified 655 adult trauma patients aged from 18 to 64 (nongeriatric group) and 273 trauma patients ≥65 years (geriatric group). Clinical data were collected and compared between the 2 groups.The geriatric group had a higher incidence of trauma and higher Injury Severity Scores than did the nongeriatric group. Fewer geriatric patients underwent surgical treatment (all patients: geriatric vs nongeriatric: 65.9% vs 70.7%; patients with severe trauma: geriatric vs nongeriatric: 27.6% vs 44.5%). Regarding prognosis, the geriatric group exhibited higher mortality rate and less need for long-term care (geriatric vs nongeriatric: mortality: 5.5% vs 1.8%; long-term care: 2.2% vs 5.0%).We observed that geriatric patients had higher trauma incidence and higher trauma mortality rate. Aging is a definite predictor of poor outcomes for trauma patients. Limited physiological reserves and preference for less aggressive treatment might be the main reasons for poor outcomes in elderly individuals.

The incidence of thyroid dysfunction in diabetic patients – A study done at a tertiary care center in South India

It has been noted that in the Indian population the incidence of thyroid disorder is common and its incidence rises with advancing age. Screening for thyroid disorder is indicated for the certain high risk patients such as elderly and those already having other endocrinal disorders There are various studies that have shown a finding that a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, of which hypothyroidism is the commonest disorder Owing to this we at the medical college at south India decided to evaluate the occurrence of thyroid dysfunction in patients who have been diagnosed with diabetes mellitus and also to compare the level of thyroid dysfunction in the younger and the older population.Department of surgery, medicine and Pharmacology at Al Azhar Medical College Thodupuzha, Kerala, India for a duration of 3 years on 300 patients. The present study was an observational study during the period of study, the test subjects patients having diabetes mellitus and healthy individuals (Controls)coming for regular health check-up with no co morbidities detected were included in this study as controls.In the non -geriatric age group the mean age was 49.6 years SD + 8.15 years and in the geriatric age group the mean age was 68.78 years SD + 4.83 years. The commonest age group in the study was between the age of 61-70 years with of the study population. The age group in the present study ranged between the age of 30 years and 79 years. The incidence of diabetes mellitus increased with age, but the control of sugars is better with age thyroid dysfunction was as follows 20% had hyperthyroidism (36%) hypothyroidism. There is a linear increase with the prevalence of thyroid disorders with age with a r= 0.77 and p &amp;#60; 0.05.The incidence of thyroid dysfunction also increased with age As compared to the non -geriatric group which was the incidence higher in older age group p &amp;#60; 0.05.This study reveals about at least one in three who have DM are suffering from thyroid dysfunction, that increases with increasing age and uncontrolled sugars in this part of the world, which might warrant routine screening.

Aspirasyon Pnömonisi ile Yoğun Bakım Ünitesine Yatan Geriatrik Hastalarda Erken Mortalite Belirteçleri

Aim In the geriatric group, aspiration pneumonia is one of the most common causes of Intensive Care Unit admission. Multiple comorbidities related with systemic diseases, as well as dementia, fraility and difficulty in swallowing or protecting the airway may all contribute the development of the AP in the geriatric age. Furthermore, many other variables may influence the outcome of this patient group. In this study, it is aimed to determine the parameters that may have an effect on the intensive care mortality. Materials and Methods 221 patients aged ≥ 80 years who were admitted to the third level ICU with the diagnosis of aspiration pneumonia were retrospectively analyzed. They were divided into two groups according to the 28-day outcome (survived-nonsurvived). The admission levels of arterial blood Ph and pCO2 and lactate , blood urea, creatinine, potassium (K) and sodium (Na) levels, APACHE II, Glaskow Coma Scale (GCS), modified shock index (MSI) and the aspiration pneumonia's source ( community-acquired aspiration pneumonia (CA-AP) or healthcare-associated aspiration pneumonia (HCA-AP) )were recorded.The effects of these variables on 28-day mortality were analyzed. Results The presence of HCA-AP, GCS and APACHEII scores were found to be significantly correlated between the two groups. ROC analysis were done for those variables and cutoff points werecalculated. Logistic regression analysis indicated that APACHEII (&amp;gt;22.5,AUC:0.812,P=0.00) and GCS (&amp;lt;9, AUC:0.730, P=0.00) as the most prominentin dependent predictors of mortality (p&amp;lt;0,05, odds ratio 7.68, 3.23 respectively) with the presence of HCA-AP. Conclusion Although many variables are significant in predicting the first 28 days of mortality in ICU admission of geriatric patients with aspiration pneumonia, the presence of HCA-AP, high hospitalization APACHE II score and low GCS score were significant independent variables.

Association between the plasma-to-red blood cell ratio and survival in geriatric and non-geriatric trauma patients undergoing massive transfusion: a retrospective cohort study

BackgroundThe benefits of a high plasma-to-red blood cell (RBC) ratio on the survival of injured patients who receive massive transfusions remain unclear, especially in older patients. We aimed to investigate the interaction of age with the plasma-to-RBC ratio and clinical outcomes of trauma patients.MethodsIn this retrospective study conducted from 2013 to 2016, trauma patients who received massive transfusions were included. Using a generalized additive model (GAM),we assessed how the plasma-to-RBC ratio and age affected the in-hospital mortality rates. The association of the plasma-to-RBC ratio [low (< 0.5), medium (0.5–1.0), and high (≥ 1.0)] with in-hospital mortality and the incidence of adverse events were assessed for the overall cohort and for patients stratified into non-geriatric (16–64 years) and geriatric (≥ 65 years) groups using logistic regression analyses.ResultsIn total, 13,894 patients were included. The GAM plot of the plasma-to-RBC ratio for in-hospital mortality demonstrated a downward convex unimodal curve for the entire cohort. The low-transfusion ratio group was associated with increased odds of in-hospital mortality in the non-geriatric cohort [odds ratio 1.38, 95% confidence interval (CI) 1.22–1.56]; no association was observed in the geriatric group (odds ratio 0.84, 95% CI 0.62–1.12). An increase in the transfusion ratio was associated with a higher incidence of adverse events in the non-geriatric and geriatric groups.ConclusionThe association of the non-geriatric age category and plasma-to-RBC ratio for in-hospital mortality was clearly demonstrated. However, the relationship between the plasma-to-RBC ratio with mortality among geriatric patients remains inconclusive.

Correlation of Neutrophil to Lymphocyte Ratio with Interleukin-10 in Diagnosis and Monitoring of Coronavirus Disease-19 Patients

BACKGROUND: The enforcement of diagnosis and monitoring of therapy success in SARS-Cov-2 infection, which causes COVID-19 disease, necessitates laboratory tests that may assess and identify patients prior to developing critical circumstances requiring additional treatment. The Neutrophil to Lymphocyte Ratio (NLR) and Interleukin-10 (IL-10) testing are two laboratory procedures used. AIM: This study aims to determine the correlation between NLR and Interleukin-10 (IL-10) in diagnosing and monitoring COVID-19 patients. METHODS: An observational analytic cross-sectional design enrolled about 73 COVID-19 patients who met the inclusion criteria and were willing to participate in the study. The levels of NLR and IL-10 were assessed by Sysmex XS-800i Automated Hematology Analyzer and sandwich ELISA methods. Data were analyzed using SPSS version 17 for Windows. RESULTS: A median of NLR values was 4.02 (1.24-47.89), following IL-10 concentration was 1.870 (0.110–33.368) pg/mL. There was a significant difference in NLR values between critical and non-critical categories (p = 0.000), geriatric and non-geriatric groups (p = 0.006), as well as in groups with comorbid and without comorbidities (p = 0.006). Meanwhile, a significant difference in IL-10 levels was only found between critical and non-critical categories (p = 0.000). There was a moderately significant positive correlation between NLR and IL-10 in COVID-19 patients (r = 0.411; p = 0.000). CONCLUSION: There is a significant positive correlation between NLR values and IL-10 levels in COVID-19 patients.

Yoğun Bakım Ünitesindeki Geriatrik COVID-19 Hastalarının Özellikleri ve Mortalite Prodüktörleri: Retrospektif Klinik Çalışma

Objective: Although coronavirus disease-2019 (COVID- 19) is seen in all age groups, the disease may progress more severely in adults with geriatric patients and comorbidities. We aimed to determine mortality rates and factors that may affect mortality by comparing the demographic, clinical, laboratory and radiological characteristics of different geriatric age groups. Material and Methods: A total of 444 COVID-19 intensive care unit (ICU) patients aged ≥65 years who were diagnosed with COVID-19 (real-time polymerase chain reaction positive) were included in the study. The patients were classified into 3 groups according to their age: younger-aged (65-74 years old), middle-aged (75-84 years old) and advanced-aged (≥85 years old) and the groups were compared. Results: The most common hospital admission symptom of total of 444 (73.2%) patients was dyspnoea. There was a statistical difference between genders in three groups (p<0.001). There was no difference between the mortality rates of the 3 groups (p=0.097). According to multiple logistic regression analysis, age ≥85 years, lactate dehydrogenase (LDH), procalcitonin and myalgia/joint pain were determined to be the risk factors that may affect mortality (p values 0.01, 0.025, 0.033 and 0.01, respectively). Conclusion: In geriatric COVID-19 ICU patients, advanced-age (≥85 years), male gender, laboratory parameters (e.g., interleukin-6, ferritin, procalcitonin, LDH) and, dyspnoea are the risk factors that increased mortality. Mortality rate was similar in geriatric groups.

Community perception of accessibility and barriers to utilizing mental health services.

BACKGROUND:The Government of India and State Government authorities are trying their best to provide adequate mental health services through various mental health policies and programs. To reduce the burden in psychiatric hospitals, Government has decentralized mental health services. Although Government has provided mental health services, the utilization has always been low due to many reasons. In the present study, an attempt was made to assess the accessibility and the barriers to utilizing mental health services with various community stakeholders.MATERIALS AND METHODS:This is a qualitative study wherein data was collected from youth, women, geriatric groups, community key leaders, and Anganwadi workers. The primary data were collected through focused group discussions and interview methods. The collected data were analyzed using thematic coding.RESULTS:A total of twenty-five factors have been identified in the study, which were categorized under eight themes. (a) Lack of awareness and misinformation on mental health, illness, and available services, (b) Perceived causes for mental illness, (c) Reasons for not approaching health professionals, (d) Treatment adherence-related issues, (e) No multidisciplinary team in private hospitals and lack of involvement in government sector (f) Manpower issues, (g) Quality of service issues and building confidence among community people, and (h) Belief system and stigma.CONCLUSIONS:Inadequate mental health services, lack of awareness of mental health, and illness are still persist. The District Mental Health Program and other service providers need to reach communities, especially in remote areas. Periodical evaluation should be carried out to improve the utilization of mental health services.

Prolonged Use of Noninvasive Ventilation in COVID-19 Geriatric Patients with Acute Respiratory Failure, can it be Tolerated?

We report six cases of the use of Non-invasive ventilation (NIV) in the COVID-19 geriatric patients with acute respiratory failure. The one case continued with intubation or invasive mechanical ventilation (IMV) and five cases did not do IMV. The novel Coronavirus disease 2019 (COVID-19) infection can occur acute respiratory failure from mild to severe. The Severe Acute respiratory failure due to COVID-19 requires oxygen therapy in the form of NIV or IMV. NIV can reduce complications related to IMV, especially the incidence of nosocomial infections and complications due to invasive procedures. The geriatric group with COVID-19 has higher risk than the young group. The many comorbidities, decreased immune function and organ systems that occur in geriatrics worsening of COVID-19 symptoms and course. NIV is only an introduction or the first step before IMV is done with close monitoring before the patients get worse. The use of NIV that is not in accordance with the indications and IMV delaying can increase the risk of COVID-19 patients mortality.

Short-stay thyroid surgery for older patients, is it safe?

Background/Aim. The incidence of nodular thyroid disease increases significantly with age as well as the incidence and aggressiveness of thyroid cancers. The aim of this study was to determine if thyroid surgery for geriatric patients is safe in a short hospital stay surgery setting. Methods. In this retrospective study we have analyzed medical histories of all operated geriatric patients (65 years and older) in which a total or hemithyroidectomy was performed in the period from January 2012 to December 2018. Patients with thyroid reoperations and with simultaneous neck dissections were excluded from the study. The analyzed geriatric patients were divided into hemithyroidectomy and total thyroidectomy groups and were paired with two control age groups (20-44 years and 45-64 years), in a numerical ratio of 1: 1: 1. Results. 976 patients were operated of the thyroid diseases, 214 total thyroidectomies and 33 hemithyroidectomies. In all three hemithyroidectomy groups the average hospital stay was 24 hours, in the total thyroidectomy geriatric group 150 of 214 patients (70.1%) spent 24 hours in the hospital. In the geriatric population, incidence of neck swelling and increased drainage output were higher compared to the control group, and thus the need for longer hospitalizations. Comparing the years, it was shown that subjects with each subsequent year of intervention have a 22% lower chance of developing complications, and regarding pathohistological finding benign thyroid hyperplasia is less likely to develop complications compared to malignant hyperplasia. Conclusion. According to our study total thyroidectomy can be safely performed within the concept of a short hospital stay in patients under 65, while in the elderly, hospitalization days may be extended due to more frequent surgical and non surgical complications, while hemithyroidectomy is safe for all age groups.

Polypharmacy among Geriatric People: Community Pharmacy based study in Bhaktapur district, Nepal

Background and Objectives: Polypharmacy among geriatric group is a major problem. Risk of an adverse effect increases exponentially with number of drugs used, partly because multiple drug therapy reflects the presence of many disease. The aim of this study was to assess the polypharmacy among geriatric people visiting community pharmacy of Bhaktapur district. Material and Methods: A prospective cross sectional study was conducted among 114 geriatric people (&gt;60Years). The data collected from patients included: Socio-demographic details as age, gender, comorbid diseases, medication history. In this study, polypharmacy was considered as having &gt; 5 medications per prescription. Medication appropriateness for patient was analyzed by applying, screening tool to alert to right treatment (START) and screening tool of older person’s prescription (STOPP) criteria. Results: Out of 114 geriatric patients 57.9% were male and 42.1% were female. Number of drugs prescribed to the patients were 634 with an average of 5.56 drugs per person. Cardiovascular drugs accounted for most (33.4%) followed by gastrointestinal tract drugs (11.5%), anti-diabetic drugs (10.89%). Over the counter drugs (OTC) were more common among geriatric, mainly proton pump inhibitor and non-steroid anti-inflammatory drugs. Depending upon the number of drugs, five and more than five drugs were consumed by single patients (n=73). Poly pharmacy can be seen among 64.03% geriatric patients. Potentially inappropriate medications were prescribed to 54 patients, overprescribing to38.5% and omission to 8.7% depending upon screening tool to alert to right treatment (START) and screening tool of older person’s prescription (STOPP) START. Conclusions: In this study polypharmacy was more common among geriatric group. Geriatric group were receiving around 64.03% polypharmacy, 47.3% inappropriate prescription and 33.3% using over the counter drugs.

노인 아임상 우울군에서 편도체 세부영역 부피의 특징

Objectives The purpose of this study was to identify the volumetric alterations of the amygdala and their association with geriatric subclinical depression. Method Eighteen and 19 subjects aged 65 and above were recruited for the subclinical depression and the control group, respectively. Subclinical depression was defined by a cut-off value of 8 points on the Short Geriatric Depression Scale and no diagnosis of clinical psychiatric disorders. Participants of both groups must have normal cognitive functions assessed using Mini-Mental Status Examination. T1-weighted magnetic resonance images were acquired using 3T magnetic resonance imaging scanner. Volumes of bilateral amygdala and their nuclei, and lateralization indexes were determined using FreeSurfer(version 7.1.1). Statistical methods of Mann-Whitney U test, and Analysis of Covariance were used. Results Volumes of the left and right amygdala were smaller in the geriatric subclinical depression group compared to the control group(p≤0.048). There were significant volume reductions in left lateral nucleus, left anterior amygdaloid area, right lateral nucleus, right basal nucleus, right accessory basal nucleus, right anterior amygdaloid area, right cortical nucleus and right paralaminar nucleus(p≤0.034). Conclusion Various regions of amygdala nuclei which are known to be associated with emotional processing were smaller in size in the group of geriatric subclinical depression. Further studies are warranted to identify the neurophysiological factors that provoke the amygdala volume reduction in geriatric subclinical depression.

Geriatric patients with esophageal motility disorders benefit more from minimally invasive peroral endoscopic myotomy: a multicenter study in Japan.

Geriatric patients with existing studies on the safety and efficacy of peroral endoscopic myotomy (POEM) for achalasia involve small sample sizes and single institutions. However, multi-center, large-scale data analyses are lacking. The study aimed to clarify the characteristics of geriatric patients with esophageal motility disorders (EMDs) and determine the procedure-related outcomes and clinical course following POEM. This cohort study included 2,735 patients with EMDs who were treated at seven Japanese facilities between 2010 and 2019. The patients' characteristics and post-POEM clinical courses were compared between the geriatric (age ≥ 75years; n = 321) and non-geriatric (age < 75years; n = 2,414) groups. Compared with the non-geriatric group, the geriatric group had higher American Society of Anesthesiologists physical status scores; more recurrent cases; lower incidence of chest pain; and higher incidence of type III achalasia, distal esophageal spasm, and Jackhammer esophagus. Furthermore, the incidence of sigmoid esophagus was higher, although esophageal dilation was not severe in this group. POEM was safe and effective for geriatric patients with treatment-naïve and recurrent EMDs. Furthermore, compared with the non-geriatric group, the geriatric group had lower post-POEM Eckardt scores, fewer complaints of refractory chest pain, and a lower incidence rate of post-POEM reflux esophagitis. Geriatric patients are characterized by worse clinical conditions, more spastic disorders, and greater disease progression of EMDs, which are also the indications for minimally invasive POEM. POEM is more beneficial in geriatric patients as it has lowering symptom scores and incidence rates of reflux esophagitis.

Psychological Problem in Geriatric Age Group

The proper definition of geriatrics is not easy to define. It can be said it is the health care / medical care provided to the elderly age group people of the society. Old/elderly is also preferred over the geriatric term but is not that precise, sixty-five years is said to be the age group coming into the geriatric group, but some of the people do not need any medical care until the age of seventy- seventy years. Biological or physiological impairment, as well as socioeconomic circumstances, can affect functional status. Their functional ability determines the elderly's capacity to stay at home. Doctors should reasonably expect to care for an increasing number of elderly people with complex medical and psychosocial issues. As a result of these challenges and issues, difficult ethical dilemmas may arise. As a result, practitioners should be aware of ethical difficulties that arise frequently when caring for older patients. Poor patient-clinician communication can lead to ethical difficulties; as a result, we present practical guidelines for better communication. People were more likely to develop physical disabilities, despair, and cognitive impairment as they got older, especially those in the 80-89 age bracket. Current data for India's old provide a foreshadowing of a new challenges if programme managers and policymakers do not take prompt action in this area. There is a need to raise awareness of the medical and socioeconomic difficulties that India's elderly confronts and initiatives for improving their quality of life.