Group Of Geriatric Patients Research Articles

Phenotype and prognostic factors in geriatric and non-geriatric patients with transthyretin cardiomyopathy.

Transthyretin cardiac amyloidosis (ATTR-CM) may be an underestimated cause of heart failure among geriatric patients and represent a unique phenotype and prognostic profile. This retrospective, observational, cohort study characterizes cardiac and extracardiac disorders at diagnosis and assesses prognosis among ATTR-CM patients based on age (geriatric vs. non-geriatric) and amyloidosis subtype (wild type, ATTRwt and hereditary, ATTRv). In total, 943 patients with ATTR-CM were included, of which 306 had ATTRv and 637 had ATTRwt. Among these, 331 (35.1%) were non-geriatric (<75years), and 612 (64.9%) were geriatric (≥75years). The population exhibited conduction abnormalities, atrial fibrillation and ischaemic heart disease that progressively deteriorated with age. Among ATTRwt patients, peripheral neuropathy, neurovegetative symptoms, and hearing loss were present across all age groups, but reports of carpal tunnel symptoms or surgery decreased with age. Conversely, among ATTRv patients, reports of extracardiac symptoms increased with age and Val122ILe mutation was highly prevalent among geriatric patients. The 3-year survival was higher among non-geriatric ATTR-CM patients (76%) than geriatric patients (55%) and predictors of 3-year mortality differed. Notably, predictors identified among geriatric patients were alkaline phosphatase (ALP) (HR=1.004, 95% CI: [0.001-1.100)], troponin T hs (HR=1.005, 95% CI: [1.001-1.120)] and tricuspid insufficiency (HR=1.194, 95% CI: [1.02-1.230)]. Whereas, among non-geriatric patients, NT-proBNP (HR=1.002, 95% CI: [1.02-1.04], global longitudinal strain (HR=0.95, 95% CI: [0.922-0.989], and glomerular filtration rate (HR=0.984, 95% CI: [0.968-1.00) were identified. We propose a 3-stage prognostic staging system combining troponin T hs (≥44ng/L) and ALP levels (≥119 UI/L). In the geriatric population, this model discriminated survival more precisely than the National Amyloidosis Centre staging, particularly for classifying between stage 1 (82%), stage 2 (50%) and stage 3 (32%) for ATTRv and ATTRwt. These diagnostic and prognostic indicators, along with ATTR subtype, highlight the distinct characteristics of this important, geriatric ATTR-CM patient group. Recognizing these mortality markers can be valuable for geriatricians to improve the prognostic quality management of geriatric patients with ATTR-CM.

Nutritional disorders and survival rate of elderly and geriatric patients with CKD 3B-5 stage

BACKGROUND. The prevalence of CKD in the population of the elderly and geriatric patients is varies from 23.4% to 35.8%. Nutritional status was recognized as an important factor of CKD prognosis. One of the factors affecting their survival is nutritional status. There have not been many studies on the effect of eating disorders on the survival of elderly and senile patients with CKD.THE AIM: to assess the impact of nutritional status on the survival of elderly patients with CKD stages 3b-5.PATIENTS AND METHODS. We’ve studied 190 people with CKD stages 3b-5 (eGFR&lt;45 ml/min/m2) with an average age of 76 [67;86]. Exclusion criteria’s: dialysis, acute cardiovascular disorders, oncology, and psychiatric disorders. Nutritional status was assessed by Subjective Global Assessment scale, the 5-year risk of the death was evaluated absolute by the Bansal scale. The duration of study - 36 month.RESULTS. In the group of elderly and geriatric patients with CKD stages 3b-5, normal nutritional status was determined in 40.1% of patients, mild to moderate malnutrition in 54.7%, and protein-energy wasting (PEW) in 5.2%; up to 2.8% of patients were underweight. The best 3-year survival rate was observed in patients with normal nutritional status, mild nutritional status disorders and obesity, the worst survival rate - in patients with PEW and underweight (p&lt;0,001). In the group of patients with CKD stage 4 the average Bansal score scale was 8 points, which corresponds to 69% of the absolute risk of death within 5 years; in patients with CKD stage 5, the average score was also 8 [7, 8]. CONCLUSION. In the group of elderly and geriatric patients with CKD stage 3b-5 and PEW survival rate was significantly lower than in patients without nutritional disorders and mild nutritional disorders; we didn’t find correlation between the estimated absolute risk of death according to the Bansal scale and actual survival in 3-year observation period.

Geometry impact on fundamental properties of theophylline-containing SLS printed pharmaceutical tablets

Selective Laser Sintering (SLS) has the potential to offer a more accurate alternative to current-practice manipulation of oral dosage forms for pediatric, geriatric, and dysphagia-suffering patient groups. In order to create the best possible dosage forms for these patient groups, an in-depth look into how a dosage forms geometry impacts the overall properties is essential. In this study, the impact of geometry on SLS manufactured oral dosage forms on the tablet’s microstructure, actual-to-theoretical volume, mass deviation, disintegration, and dissolution was investigated. Three different shapes; cylinder, hollow cylinder, and conical frustum with similar surface area (SA), as well as three cylinders with different diameters, were investigated. The results indicate that the geometry has an impact on the mass uniformity, resultant volume, disintegration, and dissolution properties of the tablets. The mass uniformity analysis of the tablets provided the most variation between tablets of different sizes, with more uniformity for tablets with similar SA-to-volume ratio (SA/V). When examining the actual-to-theoretical volume of the tablets, a greater variance between the actual and theoretical volumes for shapes with higher overall SA was observed. The values found are approximately 1.05 for the three differently sized cylinders, 1.23 for the conical frustum, and 1.44 for the hollow cylinder, following this trend. Disintegration data supported a link between SA/V and average disintegration time, observed with the tablet of the highest SA/V disintegrating in 12 s and the tablet with the lowest SA/V disintegrating in 58 s. Dissolution results also indicated a strong dependence on SA/V. Hence, when novel ways to produce oral dosage form tablets become available by additive manufacturing, such as SLS, both geometry and SA/V must be taken into consideration in the tablet design process to ensure appropriate release kinetics and dosing standards.

Performance of trauma scoring systems in predicting mortality in geriatric trauma patients: comparison of the ISS, TRISS, and GTOS based on a systemic review and meta-analysis.

This meta-analysis aimed to evaluate the performance of the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and the Geriatric Trauma Outcome Score (GTOS) in predicting mortality in geriatric trauma patients. The MEDLINE, Web of Science, and EMBASE databases were searched for studies published from January 2008 to October 2023. Studies assessing the performance of the ISS, TRISS, or GTOS in predicting mortality in geriatric trauma patients (over 60years old) and reporting data for the analysis of the pooled area under the receiver operating characteristic curve (AUROC) and the hierarchical summary receiver operating characteristic curve (HSROC) were included. Studies that were not conducted in a group of geriatric patients, did not consider mortality as the outcome variable, or had incomplete data were excluded. The Critical Appraisal Skills Programme (CASP) Clinical Prediction Rule Checklist was utilized to assess the risk of bias in included studies. STATA 16.0. was used for the AUROC analysis and HSROC analysis. Nineteen studies involving 118,761 geriatric trauma patients were included. The pooled AUROC of the TRISS (AUC = 0.82, 95% CI: 0.77-0.87) was higher than ISS (AUC = 0.74, 95% CI: 0.71-0.79) and GTOS (AUC = 0.80, 95%CI: 0.77-0.83). The diagnostic odds ratio (DOR) calculated from HSROC curves also suggested that the TRISS (DOR = 21.5) had a better performance in predicting mortality in geriatric trauma patients than the ISS (DOR = 6.27) and GTOS (DOR = 4.76). This meta-analysis suggested that the TRISS showed better accuracy and performance in predicting mortality in geriatric trauma patients than the ISS and GTOS.

Augmentation techniques for the treatment of osteoporosis-associated fractures of the extremities

The current demographic development is leading to an increasing number of cases of osteoporosis-related fractures. Affected individuals are typically part of avulnerable, predominantly geriatric patient group with limited physical resources. Additionally, the pathophysiological characteristics of osteoporotic bones with reduced bone quality and quantity, pose asignificant challenge to the osteosynthesis techniques used. Achieving rapid postoperative mobilization and stable weight-bearing osteosynthesis to prevent postoperative medical complications are the main goals of the surgical management. In recent years augmentation techniques have gained in importance in the treatment of osteoporosis-related fractures by significantly enhancing the stability of osteosyntheses and reducing mechanical complication rates. The main options available are polymethyl methacrylate (PMMA) augmentation and various bioresorbable bone substitute materials with different properties. Implant augmentations can be applied at various locations in the extremity bones and standardized procedures are now available, such as for the proximal humerus and femur. When used correctly, low complication rates and promising clinical outcomes are observed. This article aims to provide an overview of available techniques and applications based on the current literature. Guidelines and substantial scientific evidence are still limited.

One-year survival after liver transplantation in a group of geriatric patients

One-year survival after liver transplantation in a group of geriatric patients

The effect of cataract surgery on quality of life and sleep in geriatric patient group

Aim: Investigation of the effects of cataract surgery on quality of life and sleep in geriatric patient group Methods: Ninety four patients who were diagnosed with cataract and operated were included. Preoperative and postoperative best corrected visual acuity (BCVA) was measured with the Snellen chart. Cataract types were divided into 3 categories as nuclear, cortical and posterior subcapsular. The VFQ-25 (vision-related quality of life) questionnaire and the Pittsburgh Sleep Quality Questionnaire were administered to the patients before and after the surgery. Results: One hundred thirty-eight eyes of 94 patients were operated. 45.7% of the patients had nuclear, 16% had cortical, 38.3% had posterior subcapsular cataracts. VFQ 25 questionnaire scores increased from 70.70±3.46 (42-89) to 85.65±7.09 (70-97) postoperatively (p&lt;0.001). While the preoperative Pittsburgh sleep quality index (PSQI) score of the patients was 8.70±2.99 (2-17), it was 6.26±3.19 (1-17) postoperatively (p&lt;0.001). There was a positive correlation between the increase in postoperative visual acuity (?) and the VFQ 25 questionnaire score increase (?) (r=0.891, p=0.000). ?VFQ 25 and ? PSQI values were higher in patients who underwent bilateral cataract surgery, but this difference was not statistically significant (p=0.199, p=0.808). ?VFQ 25 after posterior subcapsular cataract surgery was greater than nuclear and cortical type. ? PSQI values were similar in nuclear, posterior subcapsular and cortical cataracts. Conclusion: Geriatric patients with posterior subcapsular cataracts had a higher postoperative vision-dependent quality of life than patients with other cataract types. Cataract surgery has positive effects on sleep quality of geriatric patients, regardless of cataract type and laterality (bilateral/unilateral).

Structured approach for infected prosthesis

Endoprosthesis infections represent amajor challenge for doctors and patients. Due to the increase in endoprosthesis implantation because of the increasing life expectancy, an increase in endoprosthesis infections is to be expected. In addition to infection prophylaxis, methods of infection control become highly relevant, especially in the group of geriatric and multimorbid patients. The aim is to reduce the high 1‑year mortality from prosthesis infections through astructured algorithm. Prosthesis infections can basically be divided into early and late infections. According to the criteria of the International Consensus Meeting, alate infection is defined as the occurrence more than 30days after implantation. With respect to the planned approach, the (p)TNM classification offers an orientation. In the early postoperative interval the clinical appearance is crucial as in this phase neither laboratory parameters nor an analysis of synovial fluid show ahigh sensitivity. It is fundamental that, apart from patients with sepsis, environment diagnostics should be initiated. If alate infection is suspected, in addition to radiological diagnostics (X-ray, skeletal scintigraphy and if necessary, computed tomography, CT), laboratory (C-reactive protein, CRP, leukocytes, blood sedimentation, and if necessary, interleukin‑6, procalcitonin) and microbiological diagnostics (arthrocentesis with synovial analysis and microbiology) are indicated; however, in addition to the arthrocentesis result, the clinical appearance is crucial in cases where an exclusion cannot be confirmed by laboratory parameters. If an infection is confirmed, the treatment depends on the spectrum of pathogens, the soft tissue situation and the comorbidities, including amultistage procedure with temporary explantation and, if necessary, implantation of an antibiotic-containing spacer is necessary. Aprosthesis preservation using the debridement, antibiotics and implant retention (DAIR) regimen is only appropriate in an acute infection situation. Basically, radical surgical debridement should be carried out to reduce the pathogen load and treatment of apossible biofilm formation for both early and late infections. The subsequent antibiotic treatment (short or long interval) should be coordinated with the infectious disease specialists. Astructured approach for prosthesis infections oriented to an evidence-based algorithm provides asufficient possibility of healing. An interdisciplinary approach involving cooperation between orthopedic and infectious disease specialists has proven to be beneficial. Surgical treatment with the aim of reducing the bacterial load by removing the biofilm with subsequent antibiotic treatment is of intrinsic importance.

Preexisting anticoagulation is an independent predictor of mortality in geriatric trauma patients - a retrospective cohort study.

Preexisting anticoagulation is common among geriatric trauma patients. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of preexisting anticoagulation with mortality in a group of geriatric trauma patients. A retrospective review of geriatric trauma patients was conducted for those admitted to a Level 1 trauma center from January 2018 to December 2020. Vital signs, demographics, injury characteristics, laboratory data, and mortality were all collected. Multivariable logistic regression analysis was performed for the association of preexisting anticoagulation and a primary endpoint of all-cause mortality. These groups were controlled for preexisting comorbidities, injury severity scores, and systolic blood pressure in the emergency department. Four thousand four hundred thirty-two geriatric patients were admitted during the study period. This cohort was made up of 36.9% men and 63.1% women. Three thousand eight hundred fifty-nine (87.2%) were white; the average age was 81±8.5 years, and the median injury severity score (ISS) was 5. The mean systolic blood pressure was 150±32mmHg, mean heart rate was 81±16bpm, mean lactate was 2.3±1.3, mean hematocrit was 37.3±8.8, and mean international normalized ratio (INR) was 1.7±10.3. One thousand five hundred ninety-two (35.9%) patients were on anticoagulation (AC) upon presentation. One hundred and sixty-five (3.7%) mortalities were recorded. Multivariable logistic regression analysis results show that preexisting anticoagulation [ odds ratio (OR) 1.92, 95% CI 1.36-2.72] was independently predictive of death. The analysis was adjusted for systolic BP in the emergency department less than90mmHg (OR 5.55, 95% CI 2.83-10.9), having more than 1 comorbidity (OR 2.30, 95% CI 1.57-3.38) and ISS (OR 1.13, 95% CI 1.10-1.15). Our study indicates that preexisting anticoagulation is associated with mortality among geriatric trauma patients.

The investigation of malnutrition and life quality’s relation with mortality in the patients who are 65 years old and above and are hospitilazed at the palliative care service

Aims: Our study aims to determine the impact of malnutrition on the quality of life of elderly patients receiving palliative care and identify the factors influencing quality of life. Methods: The study included patients aged 65 and older who were admitted to the Kırıkkale University Medical Faculty Hospital Palliative Care Service between November 2019 and February 2020. Patients with a history of active malignancy, hospitalization within the past 3 months, severe dementia precluding obtaining written consent, and patients under 65 years of age were excluded. Scores obtained from the Mini Nutritional Assessment-Short Form (MNA-SF) were recorded, with scores of 12 or higher considered as normal nutrition. Those with scores below 12 were reevaluated for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, and those meeting any of the phenotypic and etiological criteria were considered malnourished. Malnutrition severity was reclassified according to the GLIM criteria. The 13-item OPQOLbrief questionnaire was used to evaluate their quality of life. The questionnaire was published in Turkish by Çalışkan et al. Each question was rated on a scale of 1-5, with “Strongly Disagree” scored as 1, “Disagree” as 2, “Undecided” as 3, “Agree” as 4, and “Strongly Agree” as 5. Results: The mean total MNA score was found to be statistically lower in patients classified as mild and severe malnutrition according to the GLIM classification compared to those without malnutrition (p&lt;0.001). The rate of MNA scores between 12 and 14 in patients without malnutrition was higher than that of patients with mild and severe malnutrition, while the rate of scores between 8 and 11 was higher in patients with severe malnutrition. The rate of scores between 0 and 7 was higher in patients with mild and severe malnutrition (p&lt;0.001). The mean total MNA (p&lt;0.001) and QOL (p=0.021) scores were statistically lower in patients with malnutrition compared to those without malnutrition. The rate of MNA scores between 12 and 14 and between 8 and 11 was higher in patients without malnutrition, while the percentage of MNA scores between 0 and 7 was higher in patients with malnutrition. Conclusion: In the geriatric patient group, we believe that the GLIM criteria used in our study are more comprehensive and sensitive in detecting malnutrition in terms of phenotypic and etiological aspects through patient questioning.

Oncological outcomes in geriatric patients with early stage gynecological cancer who underwent surgery and radiotherapy

ABSTRACT&#x0D; Background: &#x0D; Evaluation of oncological results obtained with surgery and adjuvant radiotherapy in geriatric patient group with early stage gynecological cancer.&#x0D; Methods: &#x0D; 31 patients aged 65 years and older who were operated for early stage gynecological cancer and had adjuvant radiotherapy were included in the study. All patients were evaluated in terms of general characteristics, local and systemic treatments, and oncological outcomes.&#x0D; Results:&#x0D; Percentages of patients diagnosed with endometrium ca and cervix ca are 80.6% and 19.4%, respectively. The median age of the patients was 69 (range, 65-86). All patients underwent total abdominal hysterectomy and bilateral salpingo oophorectomy, followed by adjuvant pelvic radiotherapy. Intracavitary vaginal brachytherapy was applied to 90.3% of the patients. At a median follow-up of 69 months, 3.2% of patients had local recurrence and 3.2% had distant metastases. The five-year DFS and OS rates were 93% and 80%, respectively&#x0D; Conclusions:&#x0D; Treatment planning in geriatric patient group should be shaped according to prognostic factors, age group and comorbidity. Remarkable oncological results can be obtained with multimodality treatments in the selected patient group.

Comparison of blood gas analysis&amp;nbsp;parameters, biochemical tests&amp;nbsp;and hematological parameters in&amp;nbsp;geriatric patients admitted to the&amp;nbsp;emergency department

&lt;b&gt;Aim:&lt;/b&gt; The primary aim is to compare blood gas parameters (sodium, potassium, glucose, hemoglobin, hematocrit) with biochemical test and hospital hemogram results and thus to investigate the compatibility of blood gas estimation with other laboratory tests in geriatrics. The secondary aim is to compare the effects of these parameters on patient mortality.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; Patients over the age of 65 who applied to the emergency department were included in our retrospective study. Statistical Package for Social Sciences (SPSS Inc., version 20.0; Chicago, IL) was used for statistical analyzes applying to the emergency department. Statistical significance was accepted as p&amp;lt;0.05.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 102 patients were included in our study and 51.97% were male. 9.8% of our patients died. The diagnostic test performance analyzes of BG (blood gas) hemoglobin, hemoglobin, BG hematocrit, hematocrit, BG glucose, glucose, BG sodium, sodium, BG potassium, potassium in predicting mortality revealed with the AUC(area under curve) value being calculated as unsuccessful for BG hemoglobin, hemoglobin, BG hematocrit and hematocrit (AUC value: 0.47, 0.45, 0.46, 0.50). AUC (area under curve) value being calculated as weak for BG glucose, glucose and BG sodium (AUC value: 0.64, 0.61, 0.63 respectively). AUC value being calculated as medium for sodium (AUC value: 0.71).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; There is no superiority of blood gas parameters over hematological and biochemical parameters in predicting mortality in the geriatric patient group. However, blood gas parameters can be used in patient management as they correlate with other laboratory tests.

A retrospective cohort study of the effect of intravenous tranexamic acid infusion on geriatric hip fractures patients undergoing proximal femoral nail antirotation

Background: Tranexamic acid (TXA) has been used in the management of bleeding. We are conducting a retrospective cohort study to analyse the effect of intravenous TXA infusion on the surgical outcomes of geriatric hip fracture cases which undergoes proximal femoral nail antirotation. Methods: In this study, 364 patients who had undergone proximal femoral nail antirotation between January 2018 and December 2019 in United Christian Hospital have been recruited. Two-hundred thirteen patients were recruited in controlled group and 151 patients were recruited in TXA group. One gram of TXA acid was injected intravenously on induction of anaesthesia and before surgical incision. Outcomes including length of stay, operation time, intraoperative blood loss, haemoglobin and haematocrit drop and post-operative blood transfusion have been measured. Results: There was a reduction in operative time, intraoperative blood loss, post-operative haemoglobin and haematocrit drop and post-operative blood transfusion in TXA group, with a reduction in the intraoperative blood loss (Controlled group: 97.8 ± 67.7 ml, TXA group: 76.0 ± 71.4, Difference −22.3%, p-value: 0.0036) and post-operative haematocrit drop (Controlled group: 0.04 ± 0.03, TXA group: 0.03 ± 0.03, Difference −25%, p-value: 0.05) being statistically significant. The length of stay is not statistically significant between the two groups. TXA is an antifibrinolytic agent which acts by binding to plasminogen which inhibits plasma formation. It has a potential reduction in blood loss in major operations. Conclusion: Intravenous TXA infusion helps to reduce blood loss in a patient undergoing proximal femoral nail antirotation. It is safe to use in the geriatric group of patients. We would recommend the usage of TXA infusion to improve the surgical outcome.

Effects of age and comorbidities on prognosis and mortality in geriatric patient groups in ıntensive Care.

Treatment of geriatric intensive care patients is tiring and difficult for intensive care physicians due to comorbidities, accompanying acute illnesses and vulnerabilities. The aim of our study was to determine other factors affecting mortality and morbidity with age in geriatric intensive care patients. A total of 937 geriatric intensive care patients were divided into three groups as young-old (65-74 years), middle-old (75-84 years), and oldest-old (85 years and more). Demographic characteristics such as age, gender, and comorbid diseases (oncological malignancy, chronic renal failure, sepsis, chronic anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pulmonary embolism) were recorded. The number of patients who needed a mechanical ventilator, developed decubit ulcers, underwent percutaneous tracheostomy, and renal replacement therapy were recorded. In addition, the number of central venous catheter insertions for patients, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), hospitalization days, and mortality rates were recorded and compared. In the comparison between the groups in terms of gender, in the 65-74 years' age group, male gender was higher, while in the age group of 85 years and more, the female gender was found to be statistically higher. Among comorbid diseases, the rate of oncological malignancy was found to be statistically significantly lower in patients aged 85 years and more. Comparing the APACHE II scores of the patients as per the groups, scores were found to be statistically significantly higher in the oldest-old group. APACHE II Score, central venous catheter application, chronic obstructive pulmonary disease, chronic renal failure, sepsis, oncological malignancy, and renal replacement therapy were shown to be statistically significant as factors affecting death. The factors affecting the survival or hospitalization time of the patients of decubit ulcer, mechanical ventilator, percutaneous tracheostomy, chronic obstructive pulmonary disease, Sepsis, APACHE II Score, and age were shown to be statistically significant. Our study showed that not only age has an effect on mortality and morbidity in geriatric intensive care patients but also comorbidities and intensive care treatments of the patients are also effective in this process.

Imaging examination procedures, navigation and minimally invasive procedures in acetabular surgery

Acetabular fractures still pose aspecial challenge even today. Considering the increasing case numbers, especially in the geriatric patient group, modern imaging examination procedures represent an essential pillar of the diagnostics. Especially in this vulnerable patient group, minimally invasive methods are necessary, which can be guaranteed by intraoperative navigation; however, the choice of surgical access and implants is also made based on the existing morphological characteristics of fractures, which highlights the importance of an imaging modality that is as detailed as possible. Last but not least, new developments concerning the surgical treatment of these injuries are also based on this. This article summarizes the current state of the techniques and the available literature.

Effect of the using a pupillometer on recovery and early cognitive functions in anesthesia management for endoscopic retrograde cholangiopancreaticography in geriatric patients

Background/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure used for the diagnosis and treatment of pancreaticobiliary pathologies. Because it is an invasive procedure that is difficult to tolerate by the patient and takes a long time, it is preferable to use it under deep patient sedation and even under general anesthesia in some cases. This study aimed to evaluate the effects of using a pupillometer versus the Ramsey sedation scale (RSS) during anesthesia management for ERCP on recovery and return of cognitive functions in the geriatric patient population. Methods: A mini-mental test was applied to evaluate the pre-operative cognitive functions of the cases before the intervention. The included patients were divided into groups using the sealed-envelope method. Management of the depth of anesthesia was evaluated by Ramsey sedation scale; in group R and was evaluated by pupillometer in group P. The infusion dose of dexmedetomidine was changed to 0.1 µg/kg/h according to the results of the evaluation. Results: Sixty cases were included in the study. No difference between the groups in terms of age (P=0.246), gender (P=0.797), American Society of Anesthesiologists (ASA) score (P=0.197), comorbidity (P=0.748), anesthesia duration (P=0.397), midazolam doses (P=0.561), propofol doses (P=0.677), and intra-operative hemodynamic values (P=0.668) were found. Intra-operative dexmedetomidine dose was statistically significantly lower (P=0.004), and recovery was faster in group P (P&lt;0.001). While no differences between the groups in the pre-operative mini-mental test scores (P=0.140) were found, the post-operative scores were statistically significantly lower in group R (P=0.025). Conclusion: In this study, it was observed that the pupillometer led to a reduction in the use of dexmedetomidine and cognitive functions were better during the post-operative recovery period. As a result, depth of anesthesia can be monitored with a pupillometer. Although the use of pupillometer in endoscopic interventions in the geriatric patient group does not make a hemodynamic difference when compared with the RSS, the pupillometer leads to accelerated recovery from anesthesia, improvement in the return of cognitive functions, and reduction in drug consumption.

The problem is the prescription of drug therapy to reduce the risk of fractures and its solution

The older people with osteoporosis, especially those with low-energy fractures, are the most vulnerable group of geriatric patients. They are shown the appointment of anti-osteoporotic therapy, which should be effective and safe. Unfortunately, the real prescription of medical treatment of osteoporosis in the world barely reaches 20%. This is due not only to low adherence to therapy by elderly patients, but also to financial and economic difficulties in obtaining drugs. For most patients, drug therapy for osteoporosis is quite expensive, especially given its long-term, often lifelong, course of action. However, new opportunities have now emerged to provide certain anti-osteoporotic drugs not only to patients in the preferential category, but also without disabilities. This will not only increase the number of patients receiving treatment for osteoporosis, but also reduce the risk of fractures, both primary and recurrent, the risk of falls, injuries and premature death among the elderly population. The article presents modern possibilities of providing medicines to patients with osteoporosis and its complications in the form of pathological fractures using clinical and statistical groups (CSG) as new methods of payment for inpatient and hospital-replacing care in the Russian Federation.

The Association of Gender and Mortality in Geriatric Trauma Patients.

The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.

P275 HOLDING AREA IN EMERGENCY DEPARTMENT : A STRATEGY TO IMPROVE ADHERENCE TO INTERNATIONAL GUIDELINES IN CASES OF PULMONARY EMBOLISM IN ELDERLY

Abstract Premises Pulmonary embolism is a disease still characterized by high mortality. Despite a great development of the guidelines it is not clear what adherence to them is in real life, especially in the emergency room. Purpose of the Study See if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the area to which the patient is addressed. Methods Monocentric retrospective observational study, on a group of geriatric patients (&amp;lt;75 y) that include all the people accessed to our ED, where they received acute PE dignosis. Enrolment started on 2016 and finished on 2019. We collected data from medical history, physical examination, lab tests, imaging; we calculated characteristic scores from the diagostic/therapeutic algorhitm, both regarding PE risk (Wells, Geneva and Years), and the 30–day mortality risk presentazione (sPESI). We then analized guidelines adherence in three decision–making turning–points: 1 Correct applicarion of decisional scores examined, which classify the patient in low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct therapy administration since the ED as suggested by the guidelines; 3 The eventual observation in the medium–intensity care area with close monitoring for the subpopulation of patients with finding of right ventricular dilation or myocardial enzymes impairement (considered at high risk of short–term shock and mortality). Results we enrolled 249 patients, with a mean age of 83 years and female prevalence (F = 62%). Of these, 69% were referred by Triage to medium–high intensity of care, the remaining 31% was directed to low intensity of care. 42.5% of the total patients were referred to OBI. The two areas of intensity of care showed similar adherence to guidelines (approximately 50%) without there being a statistically significant difference between the two areas (p &amp;gt; 0.05) Adherence to guidelines was higher in the holding area – OBI (75 %) compared to that of those managed in theaters (50%) in a statistically significant way (p &amp;lt; 0.001). Conclusions The study suggests that holding areas located in Emergency Departments can considerably increase adherence to international guidelines.

Effect of bone anabolic therapy on bone remodeling and bone density in geriatric patients with osteoporosis and falling syndrome

Older adults with severe osteoporosis are the most vulnerable group of geriatric patients. They are shown the purpose of anti-osteoporotic therapy, which should be effective and safe. Teriparatide showed a decrease in the risk of fractures, an increase in BMD. In Russia, the use of teriparatide in the geriatric population is extremely scarce. assess clinical course, bone metabolism parameters and efficacy of bone-anabolic therapy in elderly and senile patients with severe osteoporosis and falls. The longitudinal prospective study included 100 patients 60 years and older with severe osteoporosis who had one or more falls within the last year. All patients were prescribed calcium and vitamin D preparations and bone-anabolic therapy (teriparatide 20 mg daily subcutaneously). The duration of follow-up was 24 months and included 3visits: screening, at 12 and 24 months. The effectiveness of bone-anabolic therapy was carried out on the basis of assessing the frequency of new fractures, reduction of pain, changes in BMD according to X-ray densitometry, dynamics of bone metabolism markers. All patients had severe osteoporosis and aggravated comorbidity status, suffered a fall within the last year, and also low-energy fractures in the past. One in three patients had a vertebral fracture, one in five had a proximal femoral fracture. Prior to the start of the study, 61 patients received antiosteoporotic therapy. During the follow-up, 4 patients died, 96patients completed the study. Against the background of teriparatide therapy, a decrease in the number of new cases of low-energy fractures and the number of patients with chronic pain was obtained. An increase in BMD was noted in the lumbar spine after 24 months and in the femoral neck after 12 months. There was no negative dynamics of the BMD. Also after 12 months, an increase in P1NP and C-terminal telopeptide of collagen type 1 was noted, after 24 months - osteocalcin andC-terminal telopeptide. The use of teriparatide can be recommended as an effective intervention to treat severe osteoporosis in geriatric patients with falls.