Group Of Elderly Patients Research Articles

Immunoparesis Recovery in Transplant-Ineligible Newly Diagnosis Multiple Myeloma Patients: An Independent Prognosis Factor That Could Complement Prognostic Value of Minimal Residual Disease

Introduction: Immunoparesis (IP) or the suppression of polyclonal uninvolved immunoglobulins (Ig) is one of the immune system alterations present in patients with multiple myeloma (MM) at diagnosis. Several studies have shown that the lack of IP recovery after treatment is associated with worse prognosis. However, these are observational retrospective studies and patients were not homogeneously treated. On the other hand, the depth of response, specially reaching minimal residual disease (MRD) negative, is one of the most important prognostic factors in patients with MM. We decided to study, in a prospective way, the prognostic value of IP recovery in a group of elderly patients not suitable for transplantation and treated in a similar way and compare it with the depth of response to treatment, especially with MRD status. Methods: We analyze patients included and treated in the PETHEMA/GEM2010MAS65 study (registered at www.clinicaltrial.gov as #NCT01237249) who reached CR or VGPR. All patients included in this trial were older than 65 years old and transplant-ineligible and were planned to receive 9 cycles of bortezomib plus melphalan and prednisone (VMP) and 9 cycles of lenalidomide plus dexamethasone (LD). Polyclonal Ig were analyzed by nephelometry or turbidimetry at diagnosis, at the end of the treatment (after 18 cycles) and during subsequent follow up. Minimal residual disease (MRD) was analyzed at the end of the treatment by multidimensional flow cytometry (MFC) with a sensitivity level of 10-5. Results: Of the 233 patients included in the study, 161 reached CR or VGPR, but the protocol design did not included determination of uninvolved Igs at diagnosis and for this reason they were only available in 120 patients. Only 9 cases (7,5%) had normal Ig at diagnosis while 111 patients (92,5%) had IP. There were no differences in progression free survival (PFS) and overall survival (OS) between patients with or without IP. We had Ig determination of 117 cases at the end of the treatment and during follow up. Those patients who had IP at diagnosis and recover it after treatment had better PFS (p<0,001; HR 0,33) and better OS (p=0,001; HR 0,35) than those who do not recover it (Figure 1A). We found no differences between those patients who had recovery of IP at cycle 18 than those who recover IP during follow up. When we focused the analysis in CR patients and VGPR patients separately, in both groups recovery of IP was associated with a better PFS and OS. In fact, when we compared both groups, we found that those patients with VGPR and complete recovery of IP had better PFS (p=0,001; HR 0,12) and OS (p=0,015; HR 0,22) than those with CR and no recovery of IP. These data suggest that IP recovery could be a prognostic factor equal or more important than conventional response. MRD information by MFC was available in 112 cases. As previously reported, in this trial those patients with MRD negative (-ve) had longer PFS and OS than MRD positive (+ve). When we analyzed IP recovery in MRD -ve patients we found that patients with MRD -ve and IP recovery (33 cases) had better PFS (p=0,004; HR 0,30) and better OS (p=0,010; HR 0,21) than patients with MRD -ve without IP recovery (11 cases), although it should be recognized that the number of patients within this latter subgroup was rather small (Figure 1B). We performed a multivariate analysis including other prognostic factors, and we found that both MRD and IP recovery have independent prognostic value for PFS, but only MRD and no IP recovery, is an independent prognosis factor for OS. Conclusions: Recovery of IP after non-continuous treatment in elderly patients with CR or VGPR confers better prognosis (PFS and OS). Prognostic value of IP recovery could be equal or more important than conventional response to treatment. Prognostic value of MRD could be complemented when combined with IP recovery, but these data must be confirmed in other series. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Feasibility and Radiological Outcome of Minimally Invasive Locked Plating of Proximal Humeral Fractures in Geriatric Patients.

Proximal humerus fractures are common injuries in the elderly. Locked plating showed high complication and reoperation rates at first. However, with second-generation implants and augmentation, minimally invasive locked plating might be a viable alternative to arthroplasty or conservative treatment. A retrospective chart review was performed for all patients with proximal humerus fractures treated between 2014 and 2020 with locked plating. All patients over 60 years of age who underwent surgery for a proximal humerus fracture with plate osteosynthesis (NCB, Philos, or Philos with cement) during the specified period were included. Pathological fractures, intramedullary nailing, or arthroplasty were excluded. Primary outcome measurements included secondary displacement and surgical complications. Secondary outcomes comprised function and mortality within one year. A total of 249 patients (mean age 75.6 +/- 8.9 years; 194 women and 55 men) were included in the study. No significant difference in the AO fracture classification could be found. Ninety-two patients were surgically treated with first-generation locked plating (NCB, Zimmer Biomet, Wayne Township, IN, USA), 113 patients with second-generation locked plating (Philos, Depuy Synthes, Wayne Township, IN, USA), and 44 patients with cement-augmented second-generation locked plating (Philos, Traumacem V+, Depuy Synthes). A 6-week radiological follow-up was completed for 189 patients. In all groups, X-rays were performed one day after surgery, and these showed no differences concerning the head shaft angle between the groups. The mean secondary varus dislocation (decrease of the head shaft angle) after six weeks for first-generation locked plating was 6.6 ± 12° (n = 72), for second-generation locked plating 4.4 ± 6.5 (n = 83), and for second-generation with augmentation 1.9 ± 3.7 (n = 35) with a significant difference between the groups (p = 0.012). Logistic regression showed a significant dependency for secondary dislocation for the type of treatment (p = 0.038), age (p = 0.01), and preoperative varus fracture displacement (p = 0.033). Significantly fewer surgical complications have been observed in the augmented second-generation locked plating group (NCB: 26.3%; Philos 21.5%; Philos-augmented 8.6%; p = 0.015). Range of motion was documented in 122 out of 209 patients after 3 months. In the Philos-augmented group, 50% of the patients achieved at least 90° anteversion and abduction, which was only about a third of the patients in the other 2 groups (NCB 34.8%, n = 46; Philos 35.8%, n = 56; augmented-Philos 50.0%, n = 20; p = 0.429). Minimally invasive locked plating is still a valuable treatment option for geriatric patients. With augmentation and modern implants, the complication rate is low and comparable to those of reverse shoulder arthroplasty reported in the literature, even in the challenging group of elderly patients.

Long-Term Outcome of Sustained Endocrine Monotherapy for Elderly Breast Cancer Patients.

Among elderly breast cancer patients, endocrine therapy may be chosen as definitive treatment by patients or physicians. This study investigated the efficacy of endocrine monotherapy (ET) in terms of avoidance of invasive local treatment. Elderly patients (≥70 years) with a diagnosis of estrogen receptor-positive breast cancer who underwent ET between 2008 and 2015 were identified through the Netherlands Cancer Registry. The primary outcome was the cumulative risk of undergoing invasive local treatment (radiotherapy or surgery) for the primary tumor. The secondary outcomes were development of uncontrolled local disease and overall survival (OS). Of the 105 patients (median age, 86 years) enrolled in this study, 91 (78 %) received ET as definitive treatment, whereas 14 received ET as a "bridge to surgery." For the 91 patients who used ET as intended definitive treatment, the 5-year cumulative risk of undergoing invasive local treatment and experiencing uncontrolled disease were respectively 28 % and 16 %. The 5-year cumulative OS was 42 %. Whereas 11 patients had metastatic or locally progressive breast cancer at the time of death, cardiovascular disease, infectious diseases, and old age or dementia were reported as contributing to the death of 39 patients. For a select group of elderly breast cancer patients who received sustained ET, the risk of undergoing invasive local treatment was surpassed by a twofold higher risk of dying. As an alternative to invasive local treatment, ET can be discussed as a safe and effective option for patients unwilling or unfit to undergo surgery.

Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for?

The C2 odontoid fractures represent one of the most common cervical spine injuries. Stabilization and immobility are required for a correct treatment. However, in some cases surgical treatment is recommended. There are still no guidelines for Type II odontoid fractures management. The present study aims at determining how non-union could impact on mortality, functional and clinical outcomes in octogenarian patients conservatively treated. The present investigation is a retrospective case series. All patients with diagnosis of Type II odontoid fractures, over 80 years and conservatively treated in our institution between January 2016 to April 2020 were potentially eligible for the study. The primary outcome was the bony fusion of the fracture after 3 months of conservative treatment. The secondary outcomes were clinical, functional outcomes and mortality. Sixty-four patients were eligible for the study according to inclusion and exclusion criteria. Computer Tomography (CT) evaluation performed 3 months after trauma showed complete fracture healing in 31 patients (48.4%, Fused), while 33 patients (51.6%) were evaluated as non-fused. Among these, 6 months after the CT evaluation, 14 patients were classified as stable, while 19 were classified as unstable. There were no statistically significant changes in clinical and functional outcomes reported in our patient series between patients with complete radiological healing and patients who reported stable fibrous non-union. In a selected group of elderly patients with a high risk for surgery, the conservative treatment of odontoid Type II fractures can be considered a viable management strategy. The achievement of a stable non-union allows for clinical and functional results comparable to complete fracture healing.

S70 Impact of Frailty on Readmissions and Inpatient Outcomes of Older Adults (≥65 Years) With Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is a major cause of adult hospitalizations in the United States. More than 10 billion US dollars are spent each year on treatment of patients admitted for AP. While data on hospitalizations for AP is widely analyzed, there are limited studies regarding the role that frailty has on this group of patients. The goal of our study is to determine what impact patient frailty has on readmission and on inpatient outcomes. Methods: The National Readmission Database (NRD) 2017-18 was queried. AP patients age >= 65 were selected based on appropriate ICD-10 diagnostic codes. Hospital frailty risk score (HFRS) was calculated for all the AP patients such that patients with HFRS score < 5 were considered to be not frail (NF) and patients with HFRS score >= 5 were considered frail based on the prevalence of comorbidities in each individual. Differences in mean length of stay (LOS) and in-hospital mortality were analyzed using multivariate logistic regression. Cox proportional-hazards regression analysis was used to determine the difference in 30-day readmission between the two groups. Results: A total of 91,031 patients aged 65 years and older with AP were identified in our search. Of these, 31,012 (mean age 76.5) were considered frail (average HFRS score 8.2) and the remaining 60,020 (mean age 74.1) were deemed to be not frail (average HFRS score 2.1). The rate of in-patient mortality was significantly higher in the frail group compared to the not frail group (3.53% vs 0.27%) with an adjusted odds ratio of 10.95 (p < 0.001). Frail AP patients had a significantly longer LOS when compared to NF (6.8 vs 3.6 days; adjusted mean difference 2.6 days, p < 0.001). The difference in 30-day readmission rates between the frail and NF group was also highly statistically significant; (12.0% vs 8.9%, respectively; adjusted hazard ratio 1.2%, 95% CI 1.15-1.26%; p < 0.001). Conclusion: AP patients consume a great deal of healthcare resources and the burden is increasing due to the aging population. Our study finds that the elderly frail group of AP patients is more fragile and has a higher 30-day readmission rate. It would be prudent to risk stratify patients admitted with AP and devise a more customized treatment approach for the more vulnerable frail group, in hopes of reducing inpatient mortality and lessening the burden on our healthcare system that results from longer stays and readmissions. (Figure)Figure 1.: Kaplan-Meier curves of readmission after acute pancreatitis comparing the frail and not frail (NF) groups

The effectiveness of nab-paclitaxel plus gemcitabine and gemcitabine monotherapy in first-line metastatic pancreatic cancer treatment: A real-world evidence.

Pancreatic cancer is one of the most lethal malignancies with a rise in mortality rates. FOLFIRINOX and nab-paclitaxel plus gemcitabine demonstrated a survival benefit compared to gemcitabine alone. Both protocols are now considered the standard of first-line treatment with no significant difference between them, primarily based on observational studies. Although new therapeutic options have emerged recently, the prognosis remains poor. We conducted a retrospective single-center study on 139 patients treated for metastatic pancreatic adenocarcinoma (mPDAC) with gemcitabine monotherapy (Gem) or nab-paclitaxel + gemcitabine (Nab-P/Gem) in the first line. The aim of our study was to evaluate the effectiveness in terms of overall survival (OS) and progression-free survival (PFS) as well as the influence of patient and disease characteristics on outcomes. Nab-P/Gem resulted in OS of 13.87 months compared to 8.5 months in patients receiving Gem. The same trend was achieved in PFS, 5.37 versus 2.80 months, respectively, but without reaching statistical significance. Furthermore, the 6-month survival in the Nab-P/Gem group was also higher, 78.1% versus 47.8%. In terms of survival, the group of elderly patients, patients of poorer performance, with higher metastatic burden and liver involvement, benefited the most from combination therapy. In our analysis ECOG performance status (p.s.), previous primary tumor surgery, and liver involvement were found to be independent prognostic factors. The addition of nab-paclitaxel to gemcitabine resulted in a significant improvement in the OS of patients with mPDAC. Subgroup analysis demonstrated that patients with some unfavorable prognostic factors benefited the most.

Clinical risk factors of carbohydrate antigen-125, cytokeratin fragment 19, and neuron-specific enolase in liver metastases from elderly lung cancer patients.

Objective: Lung cancer is a common malignant tumor characterized by challenging detection and lack of specificity in clinical manifestations. To investigate the correlation of tumor markers in the serum with liver metastasis and prognosis of lung cancer. Methods: A total of 3,046 elderly lung cancer patients were retrospectively studied between September 1999 and July 2020. Divided into liver metastasis group and non-liver metastasis group. We compared a series of serum biomarkers between the two groups of elderly patients to predict the prognosis in patients with lung cancer by fluorescence in situ hybridization (FISH), advanced flow cytometry (FCM) and multi tumor marker protein chip, including tumor markers in the serum included alkaline phosphatase (ALP), serum calcium, hemoglobin (HB), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin fragment 19 (Cyfra21-1), carbohydrate antigen-125 (CA-125), carbohydrate antigen-153 (CA-153), carbohydrate antigen-199 (CA-199), and free prostate specific antigen (free PSA). We used binary logistic regression analysis to determine risk factors, and used receiver operating curve (ROC) analysis to evaluate the diagnostic value of liver metastases in elderly patients with lung cancer. Results: The proportion of lung cancer in the liver metastasis group was higher than that observed in the non-liver metastases group. The expression levels of CA-125, Cyfra21-1, and NSE in the liver metastasis group of lung cancer were significantly higher than those reported in the non-liver metastases group (p < 0.05). ROC curve analysis shows that the area under the curve of CA-125, Cyfra21-1, and NSE are 0.614, 0.616 and 0.608, respectively. The sensitivity and specificity of CA-125 were 45.70% and 76.20%, the sensitivity and specificity of Cyfra21-1 were 60.10% and 57.10%, and the sensitivity and specificity of NSE were 44.10% and 75.00%, respectively. Conclusion: High levels of CA-125, Cyfra21-1, and NSE in the serum may be associated with liver metastasis in elderly patients with lung cancer. CA-125 and NSE are factors influencing the prognosis of elderly patients with liver metastasis of lung cancer.

Hypotensive effects of drug combinations in elderly and old patients with controlled arterial hypertension

Aim. To assess the frequency of arterial hypotension, orthostatic hypotension, low blood pressure (BP) and their clinical manifestations in the group of elderly and senile patients with a controlled course of arterial hypertension (AH), taking combinations of drugs based on an angiotensin-converting enzyme inhibitor (ACE inhibitor).Materials and methods. The study included 171 male and female residents of Krasnodar Territory with drug-controlled AH (blood pressure - BP less than 140/90 mm Hg in the background of previous antihypertensive therapy containing an ACE inhibitor perindopril), and with diseases of atherosclerotic genesis. All patients were questioned, tested for balance control, assessed for the risk of falls according to the Morse scale, hypotension in orthostasis was determined, measured office BP, carried out daily monitoring of BP with the determination of the time indices of hypotension and low BP.Results. Most often patients took a combination of ACE inhibitors with calcium channel blockers (CCB) (28.1% of cases), beta-blockers (BB) (27.1%) or diuretics (29.1%). Assessing the risk of falls on the Morse scale, there was a significantly lower level in patients who took the combination of perindopril with CCB compared with those who received perindopril with BB (15 versus 25 points respectively, p=0.039). Patients receiving perindopril and CCB lost balance in the “legs together” position in 19.3% and in the “tandem” or “semi-tandem” position of the feet in 29.8% of cases, that could be compared to the group taking perindopril and a diuretic (22% and 33.9%, respectively) and significantly lower than in the groups with perindopril and BB therapy (34.5% and 50.9%, respectively, p1=0.037, p2=0.043). The time index of low systolic and diastolic BP during therapy with perindopril and CCB was significantly lower than the corresponding indicator in the groups of patients treated with perindopril and BB (22% and 17% versus 27% and 21%, respectively, p1=0,009, p2=0,024), and the time index of low systolic BP for the combination of perindopril and diuretic is lower than for the combination of perindopril and BB (23% versus 27%, respectively, p=0.023).Conclusion. The data obtained on the frequency of arterial hypotension, orthostatic hypotension and low BP in the group of elderly and senile patients indicate the advisability of further studying the risks of drug hypotension in order to better personalize the treatment of AH.

Outcome Prospective of Late Duodenal Perforation Repairs in Elderly

Introduction: Perforated duodenal ulcer is the communal emergency seen in surgical department, and postoperative complications of this emergency surgeries are very high which requires the related factors identification with this incidence. Aim: This study was designed to evaluate duodenal ulcer in older patients by revealing the patient's health status, early and late repair, choice of surgical procedure, and differences between older and younger duodenal ulcer patients. Study Design: A Retrospective study. Place and duration: In the Surgical Unit 2 of, Sheikh Zayed Medical College/ Hospital Rahim Yar Khan for two-year duration from January 2020 to December 2021. Methods: This study included 140 patients were alienated into 2 age groups as geriatric patients’ group (A) and adult age group (B). Patient age, gender, co-morbidities, drug use, presence of Helicobacter pylori infection, medical conditions that may have been affected by perforation, such as characteristic pain (severe upper abdominal pain or vague abdominal pain), extent of symptoms at presentation, smoking, outcomes of late repair versus early repair was recorded. Results: 140 patients were registered in the analysis. Group I (n = 70) consisted of geriatric patients (age&gt; 65) and Group-II (n = 70) adults’ patients (age &lt;65). Both groups have male dominance in this study. In both groups, the most common comorbidities were diabetes (25.7% and 8.6%, respectively) and arterial hypertension (42.8% and 41.4%, respectively), hypertension (p = 0.002) and coronary artery disease (p = 0.035) was much high in group I, while morbidity and mortality were higher in the group of elderly patients. Conclusion: Duodenal perforation is a serious disease that requires urgent surgical intervention, especially in the geriatric age. Keywords: Duodenal ulcer perforation, acute abdomen, geriatric surgery.

Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit.

BackgroundKorea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.MethodsWe retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis. ResultsComparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.ConclusionsThe proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

Validity and safety of laparoscopic gastrectomy with D1+ lymphadenectomy for very elderly advanced gastric cancer patients; retrospective cohort study.

It remains unclear whether laparoscopic gastrectomy with optimal lymphadenectomy is appropriate for very elderly patients with advanced gastric cancer. This study aimed to assess the validity of laparoscopic gastrectomy with D1+ lymphadenectomy performed for advanced gastric cancer in patients aged 80years or more. Included in this retrospective study were 122 patients who underwent curative laparoscopic gastrectomy for advanced gastric cancer between 2013 and 2018. All patients over 80years old underwent laparoscopic gastrectomy with D1+ lymphadenectomy. We divided patients by age between those who were very elderly (age≥80years; very elderly group [n=57]) and those who were non-very elderly (age<80years; control group [n=65]), and we compared patient and clinicopathological characteristics, intraoperative outcomes, and short- and long-term outcomes between the two groups. We also performed multivariate analyses to identify predictors of postoperative prognosis. Eastern Cooperative Oncology Group Performance Status of grade 2 or higher and mean Charlson comorbidity index score and body mass index were significantly different between the very elderly group and the control group. Adjuvant chemotherapy was used in relatively few very elderly group patients. Operation time, blood loss volume, and postoperative morbidity and mortality did not differ between the two groups. The overall survival and disease-specific survival rate of very elderly group patients with the Charlson comorbidity index score of <3 was not significantly different from that of the control group patients. The treatment of advanced gastric cancer by laparoscopic gastrectomy with D1+ lymphadenectomy to be both safe and effective in the very elderly group patients with the Charlson comorbidity index score of <3.

EFFECTS OF POSTURAL DRAINAGE AND DEEP BREATHING EXERCISES ON DYSPNEA, OXYGEN SATURATION AND LEVEL OF EXERTION IN ELDERLY POST COVID-19 PATIENTS

Background and Aim: Elderly patients have reduced lung capacity and decrease respiratory functions due to aging process Different positioning techniques contribute in airway clearance of patients and increase in oxygen saturation level. Therefore, this study aims to find out best intervention to improve dyspnea, level of exertion and quality of life of post COVID elderly group of patients. Methodology: Study Design &amp; Sampling technique: Randomized clinical trial and non-probability convenient sampling technique with sealed envelope Randomization. Study Setting &amp; Participants: National Hospital and Medical Centre-DHA Lahore and 48 patients. The sample size of 48 patients was taken in this study to find the effect of postural drainage and deep breathing exercises. Patients were divided into two groups. Steam was given to both groups as a common treatment. Group A was treated with postural drainage and steam while Group B was treated with deep breathing exercises and steam. Modified Borg‘s Dyspnea, pulse oximetry and RPE scale is used for scoring. Intervention or data collection tools: Postural drainage and deep breathing exercises in 2 groups. Pulse oximetry. The Modified Borg Dyspnea Scale and Perceived exertion scale were tools. Outcome measures: oxygen level, severity of dyspnea and level of exertion. Results: Mean±S.D of patients in Postural drainage was 58.96±6.24 and in deep breathing 59.33±6.38 .pulse oximetery pre value 3.50±0.51, 3.25±0.61 in postural drainage and deep breathing respectively while post values were 1.50±0.59 and 2.25±0.68. For MBD scale pre value was 7.33±0.92, 6.92±1.14in postural drainage and deep breathing respectively while post values were 1.75±1.03and 4.84±0.82 and PES pre value was 6.87±0.81, 4.42±1.10 in postural drainage and deep breathing respectively while post values were 2.42±1.10 and 2.54±1.32 Conclusion: Postural drainage was more effective than deep breathing exercises on dyspnea, oxygen saturation and level of exertion in elderly of post covid-19 patient

Comparative Characteristics of Elderly and Middle-Aged Patients with Myocardial Infarction at the Third Stage of Cardiac Rehabilitation

The need for adaptation of existing cardiac rehabilitation programs for elderly myocardial infarction patients is dictated both by the progressive aging of the Russian population and by the higher prevalence of cardiovascular diseases among them, including coronary heart disease in the form of a previous myocardial infarction. The necessary condition for successful realization of the set task is to take into account the identified features of myocardial infarction patients of older age group, who are admitted for cardiac rehabilitation. Aim. To give a comparative characteristic of patients with myocardial infarction of older and middle age groups admitting to the third stage of cardiac rehabilitation in the Ivanovo State Medical Academy clinic (ISMA). Material and methods. 85 patients with myocardial infarction were examined, they were admitted from primary vascular centers for a three-week course of cardiac rehabilitation at the ISMA clinic. According to the WHO age periodization, 2 groups were identified: 40 middle-aged patients (Group 1); 45 elderly patients (Group 2). An individual cardiac rehabilitation program was developed for each patient, which included daily controlled physical training, dosed walking, staircase walking at individually calculated pace, correction of the revealed cardiovascular risk factors, information support, adequate drug therapy, correction of psychological disorders if needed. Clinical features of the disease course, tolerance to physical activity were analyzed in both groups. Results. The characteristic features of MI patients of the older age group in comparison with the middle-aged patients admitted to the third stage of cardiac rehabilitation in the ISMA clinic are: dominance of non-working pensioners; high polymorbidity; higher frequency of development of repeated MI without ST-segment elevation on ECG; predominance of complicated formation of left ventricular aneurysms and heart rhythm disturbances forms of MI; low frequency coronary revascularization in the acute period of the course of the disease; prevalence of persons with signs of diastolic heart failure with preserved or slightly reduced left ventricular ejection fraction; lower exercise tolerance. After completion of cardiac rehabilitation course in patients of older age group the increase in 6MWT distance covered was 18%, while in middle-aged group it was only 8.3%. The implementation of the three–week rehabilitation program led to an increase in the number of patients with 1 FC of coronary heart disease due to a decrease in the number of patients with 3 and 4 FC of coronary heart disease in the middle-aged group and 4 FC of coronary heart disease in the elderly. Conclusion. The identified features specify the necessity to include methods of concomitant pathology correction, individual approach to the choice of physical activity programs based on a thorough clinical assessment, including risk stratification of post-rehabilitation complications and rehospitalizations in the cardiac rehabilitation program. A three-week program of the third stage of cardiac rehabilitation of MI patients increases exercise tolerance to a greater extent in elderly patients compared with middle-aged patients.

Technical and oncological safety of laparoscopic gastrectomy for gastric cancer in elderly patients ≥ 80 years old

BackgroundAs the incidence of gastric cancer increases in elderly patients worldwide, laparoscopic gastrectomy (LG) for elderly patients with gastric cancer is also increasing. However, whether LG is an optimal surgical modality for elderly patients with gastric cancer remains unclear. This study aimed to evaluate the technical and oncological safety of LG for elderly patients ≥ 80 years old with gastric cancer.MethodsPatients who received curative gastrectomy for gastric cancer from 2003 to 2015 were enrolled in the study. They were divided into the LG in elderly patients aged over 80 years (LG-E) group, open gastrectomy (OG) in elderly patients (OG-E) group, and LG in non-elderly patients < 80 years (LG-NE) group. Patients’ demographics and short- and long-term outcomes, such as postoperative complications and 5-year survival rate, were compared between the three groups, retrospectively.ResultsThe LG-E, OG-E, and LG-NE groups comprised 45, 43, and 329 patients, respectively. In the comparison between the LG-E and OG-E groups, the incidence of distal gastrectomy (DG) and the proportions of patients with pathological tumor stage T1, pathological N0, and final stage I were significantly higher in the LG-E versus OG-E group (89 vs. 56%, 76% vs. 16%, 82% vs. 37%, and 84% vs. 35%, p < 0.01, respectively). Blood loss and the incidence of overall postoperative complications in the LG-E group were significantly lower than those in the OG-E group (40 vs. 240 g, p < 0.01, and 29% vs. 53%, p < 0.05, respectively). Although the 5-year overall survival (OS) rate was not significantly different between the two groups, the 5-year disease-specific survival (DSS) rate was significantly higher in the LG-E group versus OG-E group (93% vs. 78%, p < 0.05). Overall comorbidities were significantly higher in the LG-E group versus LG-NE group, but there were no significant differences in short-term outcomes between the two groups. Further, although the 5-year OS rate was significantly lower in the LG-E group versus LG-NE group (67% vs. 87%, p < 0.01), there was no significant difference between the two groups in 5-year DSS rate.ConclusionLG is technically and oncologically safe for the treatment of gastric cancer in both elderly patients aged ≥ 80 years and the non-elderly and can be an optimal surgical modality for elderly patients with gastric cancer.

Outcomes of simultaneous resection for elderly patients with colorectal liver metastasis: A propensity score matching analysis.

Evidence on simultaneous resection for elderly patients (age ≥ 70 years) with colorectal liver metastasis (CRLM) is lacking. Four hundred and eighty-two CRLM patients treated by simultaneous resection were categorised into young group (age < 70 years) and elderly group (age ≥ 70 years). Propensity score matching (PSM1) was performed to adjust for differences in baseline characteristics and compare short-term outcomes. An additional propensity score matching (PSM2) including short-term outcomes was performed to analyse survival. Subgroup analysis was performed in patients stratified by the Clinical Risk Score (CRS). After PSM1, 87 young group patients were matched to 50 elderly group patients. Patients in the elderly group had a significantly higher rate of overall post-operative complications (68.0% vs. 46.0%, p=0.013). After PSM2, 89 young group patients were matched to 47 elderly group patients. Progression-free survival (PFS) was comparable between the two groups (median 11.0months vs. 9.8 months, p=0.346). Age ≥ 70 independently predicted worse overall survival (OS) (Hazard ratio, HR=2.57, 95% confidence interval, CI 1.37-4.82) in multivariate analysis. In the subgroup multivariate analysis of patients with CRS score 3-5, age ≥ 70 was independently associated with worse PFS (HR=1.62, 95% CI 1.01-2.62) and OS (HR=2.34, 95% CI 1.26-4.35). Simultaneous resection for elderly CRLM patients is acceptable. Further studies are required to determine the optimal treatment for elderly CRLM patients with high CRS scores.

Amikacin pharmacokinetics in elderly patients with severe infections

ObjectiveThe aim of this study was to characterize the population pharmacokinetics of amikacin in elderly patients by means of nonlinear mixed effects modelling and to propose initial dosing schemes to optimize therapy based on PK/PD targets. MethodA total of 137 elderly patients from 65 to 94 years receiving intravenous amikacin and routine therapeutic drug monitoring at Hospital Universitario Severo Ochoa were included. Concentration–time data and clinical information were retrospectively collected; initial doses of amikacin ranged from 5.7 to 22.5 mg/kg/day and each patient provided between 1 and 10 samples. ResultsAmikacin pharmacokinetics were best described by a two-compartment open model; creatinine clearance (CrCL) was related to drug clearance (2.75 L/h/80 mL/min) and it was augmented 28% when non-steroidal anti-inflammatory drugs were concomitantly administered. Body mass index (BMI) influenced the central volume of distribution (17.4 L/25 kg/m2). Relative absolute prediction error was reduced from 33.2% (base model) to 17.9% (final model) when predictive performance was evaluated with a different group of elderly patients. A nomogram for initial amikacin dosage was developed and evaluated based on stochastic simulations considering final model to achieve PK/PD targets (Cmax/MIC>10 and AUC/MIC>75) and to avoid toxic threshold (Cmin<2.5 mg/L). ConclusionInitial dosing approach for amikacin was designed for elderly patients based on nonlinear mixed effects modeling to maximize the probability to attain efficacy and safety targets considering individual BMI and CrCL.

Differentiated thyroid carcinoma in the elderly: influence of age on disease-free and overall survival.

We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients. A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years). The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not. Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.

Prognostic Factors and Treatment Strategies for Elderly Patients with Malignant Meningioma: A SEER Population-Based Study.

ObjectiveMalignant meningioma (MM) is a relatively rare disease with poor survival. Few studies had focused on MM in the elderly population. This study aims to explore the prognostic factors and optimal therapeutic strategy in elderly patients with MM.MethodsWe took advantage of the Surveillance, Epidemiology, and End Results (SEER) database to include 275 adult patients with histologically confirmed MM between 2011 and 2018. The Kaplan–Meier curves were plotted by different covariates to reveal the survival probability. Univariate and multivariable Cox proportional hazard regression analyses were applied to identify prognostic factors for cancer-specific survival (CSS).ResultsThe multivariable analysis in the elderly group revealed that when compared with patients receiving gross total resection (GTR), patients receiving biopsy had significantly worse CSS (HR = 3.72; 95% CI: 1.35–10.21; P = 0.011), whereas patients receiving subtotal resection (STR) had nearly the same CSS (HR = 0.83; 95% CI: 0.37–1.86; P = 0.653). Meanwhile, postoperative radiotherapy (PORT) showed no significant association with CSS in the elderly patient group (HR = 0.94; 95% CI: 0.42–2.12; P = 0.888).ConclusionSurgical resection is recommended for elderly patients with MM in the absence of surgical contraindications, but GTR does not present survival benefit in the elderly patients compared with STR. Additional large-scale clinical studies are needed to explore the survival benefit of PORT applied in patients with MM.

Short- and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study.

Robotic liver resection (RLR) has increasingly been accepted as it has overcome some of the limitations of open liver resection (OLR), while the outcomes following RLR in elderly patients with hepatocellular carcinoma (HCC) are still uncertain. This study aimed to evaluate the short and long-term outcomes of RLR vs. OLR in elderly HCC patients. Perioperative data of elderly patients (≥ 65years) with HCC who underwent RLR or OLR between January 2010 and December 2020 were retrospectively analyzed. A 1:2 propensity score-matched (PSM) analysis was performed to minimize the differences between RLR and OLR groups. Univariable and multivariable Cox regression analyses were used to identify independent prognosis factors for overall survival (OS) and recurrence-free survival (RFS) of these patients. Of the 427 elderly HCC patients included in this study, 113 underwent RLR and 314 underwent OLR. After the 1:2 PSM, there were 100 and 178 patients in the RLR and the OLR groups, respectively. The RLR group had a less estimated blood loss (EBL), a shorter postoperative length of stay (LOS), and a lower complications rate (all P < 0.05), compared with the OLR group before and after PSM. Univariable and multivariable analyses showed that advanced age and surgical approaches were not independent risk factors for long-term prognosis. The two groups of elderly patients who were performed RLR or OLR had similar OS (median OS 52.8 vs. 57.6months) and RFS (median RFS 20.4 vs. 24.6months) rates after PSM. RLR was comparable to OLR in feasibility and safety. For elderly patients with HCC, RLR resulted in similar oncologic and survival outcomes as OLR.

Evaluation of Abnormal Movements among Senior Schizophrenics: A Local Study with Reference to Tardive Dyskinesia

Introduction: Tardive dyskinesia (TD) includes involuntary choreiform or athetoid movements of the jaw, lower face, tongue, and extremities, developing in association with the use of an antipsychotic medication, and may develop in about 20 to 40 percent of patients who require long-lasting hospitalization. In the present study, the prevalence of this condition has been measured among an elderly group of schizophrenic patients. Methods: One hundred and one elderly schizophrenic patients, who were hospitalized in the chronic section of a community psychiatric hospital, were selected for the present cross-sectional study. Abnormal Involuntary Movement Scale (AIMS) was employed to screen for patients with schizophrenia who also had TD. Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Schedule for Assessment of Insight, and Clinical Global Impressions – Severity of illness, as well, had been used as ancillary scales for evaluation of severity of general psychopathology of schizophrenia, and comparing the TD patients with the group of patients without TD, for probing the intervening parameters. Results: While abnormal movements were clear in 38.61% (n=39) of elderly schizophrenic patients, only seven of them (6.93 %) could be diagnosed as TD, based on the above-mentioned criteria. All of them were using conventional antipsychotic medications, accompanied with anticholinergic medications. Among TD patients, three cases had only abnormal facial and oral movements, one patient had atypical facial and oral movements as well as anomalous extremity movements, one patient had irregular facial and oral movements in addition to unusual trunk movements, and lastly, two patients had nonstandard extremity movements. In addition, around 71% of patients with TD were aware of their unusual movements. Between-group analysis did not show any significant difference between patients with TD and patients without TD in age, duration of illness, positive symptoms, negative symptoms, insight, and general psychopathology. Conclusion: According to the findings of the present study, the prevalence of Tardive Dyskinesia among elderly schizophrenic patients, who were using typical antipsychotic medications, is very lower than what has been indicated thus far.