High Percentage Of Elderly Patients Research Articles

Differences in clinical characteristics and outcomes between patients with grade 3a and grades 1–2 follicular lymphoma: a real-world multicenter study

BackgroundThe difference between clinical characteristics and outcomes between follicular lymphoma grade 1–2 (FL1-2) and FL3a defined pathologically remains unclear, resulting in uncertainty how to treat FL3a. However, it may be crucial for clinicians to discriminate grade 3a and grade 1–2 for predicting prognosis and thus making treatment decisions.MethodsWe compared 1403 patients with FL1-2 and 765 patients with FL3a diagnosed between January 2000 and December 2020 from fifteen centers nationwide in China to describe differences in clinical characteristics and outcomes.ResultsCompared with FL1-2 patients, FL3a subgroup had a higher percentage of elderly patients (P = 0.003), and relatively more FL3a patients presented with increased levels of LDH (P < 0.0001) and higher Ki-67 indexs greater than 30% (P < 0.001). More FL3a patients were treated with CHOP ± R (P < 0.0001), and fewer were treated with the watchful-waiting approach (P < 0.0001). The results showed a higher incidence of relapse among FL3a patients, in which more patients underwent histological transformation (HT) when compared to FL1-2 (P = 0.003). 1470 (76.2%) patients of the entire cohort received R-CHOP therapy; survival analysis revealed that FL3a patients had a worse progression-free survival (PFS) rate than FL1-2 patients. Survival of FL3a patients with respect to FLIPI showed an inferior PFS in the intermediate and high-risk groups than FL1-2 patients. FL3a patients had a much worse prognosis than FL1-2 with or without progression of disease within 24 months (POD24). FL3a patients had higher likelihood of lymphoma-related death (LRD, P < 0.05), whereas the rates for non-LRD were comparable.ConclusionIn conclusion, this study demonstrates a marked difference in clinical features and outcomes in FL3a patients compared with FL1-2 patients. The results highlight the need for applying therapeutic approaches distinct from FL1-2 when treating FL3a patients.

MO554THE EFFECT OF HEMOGLOBIN CHANGES AND THE SEVERITY OF CHRONIC KIDNEY DISEASE IN PHYSICAL FUNCTION IN ELDERLY PATIENTS WITH HEART FAILURE

Abstract Background and Aims Anemia is frequently observed in patients with heart failure (HF) and causes increased hospitalization and mortality rates. Anemia is also associated with and is a major risk factor of impaired physical function and frailty. On the other hand, a high percentage of elderly patients with HF have chronic kidney disease (CKD), which is an aggravating factor for anemia, and the combination of anemia and CKD has been reported to increase physical dysfunction and mortality. However, the relationship between hemoglobin (Hb) changes and physical function during hospitalization in elderly patients with HF is unclear, and the impact of CKD severity on these relationships is also unclear. This study aimed to examine the relationship between Hb changes and physical function during hospitalization in elderly patients with HF. We further examined the relationship when stratified by CKD severity. Method Seven hundred and thirty-seven elderly patients with HF, who underwent changes in Hb and physical function test (leg strength, gait speed, and 6-min walking distance [6MWD]), were included in this study. Using a multiple linear regression model, associations between Hb changes and physical function were assessed. In addition, using a generalized linear mixed model, we divided the HF patients into three groups with eGFR ≥60, 30–60, and &amp;lt;30, and examined whether the severity of CKD was related to the Hb change and physical function. Results The median age of the subjects in this study was 77 years (interquartile range 72–82). Changes in Hb during hospitalization were independent determinants of physical function (leg strength, β: 0.158, P &amp;lt; 0.001; gait speed, β: 0.023, P &amp;lt; 0.001; 6MWD, β: 13.039, P &amp;lt; 0.001), even after accounting for factors related to severity of HF. Moreover, the group with more severe CKD showed significantly lower physical function, although Hb improved (P &amp;lt; 0.001) with respect to leg strength and 6MWD compared with the group with lower CKD stage. Conclusion Hb change during hospitalization was an independent determinant of physical function in patients with HF. Patients with a more severe CKD showed lower leg strength values and 6MWD even if Hb improved.

Coinfection of Toxoplasma Gondii and Intestinal Parasites among Elderly Immunocompromised Patients

Introduction: Patients with cancer and hemodialysis are prone to opportunistic infections. The present research aims to examine the frequency of Toxoplasmosis and intestinal parasites in these patients. Methods: In the present cross-sectional study, seventy stool and blood samples from immunocompromised patients (46 hemodialysis and 24 cancer patients) from Guilan Province were collected in 2017-2018. Different tests including direct smear examination and formalin-ether was conducted for the intestinal protozoan parasites. To detect coccidian parasites (e.g. Cryptosporidium spp.) Ziehl Neelsen staining was applied. The anti T.gondii antibodies were detected via ELISA method. Results: Totally 6.52% and 4.16% cases of hemodialysis and cancer patients were positive for intestinal parasite infection respectively. Blastocystis hominis was only intestinal parasite that were detected in these patients. IgG anti-Toxoplasma antibody detected in 35 (76.8%) hemodialysis and 15 (62.5%) cancer patients. IgM antibody were found in 1 elderly hemodialysis patient. Mix infection (Toxoplasmosis and Blastocystis) was observed in 6.52% and 4.16% in hemodialysis and cancer patients respectively. Conclusion: It is recommended to evaluate these patients for intestinal parasitic infections during hemodialysis or chemotherapy sessions. Data showed the high percentage of elderly patients were susceptible to reactivation of chronic Toxoplasmosis. Therefore, in order to refer them for early therapy or other interventions, it is important that elderly hemodialysis and cancer patients with toxoplasma infection be diagnosed and identified.

Low-dose rituximab as induction therapy for ANCA-associated vasculitis.

Administration of four once-weekly doses of 375mg/m2 rituximab (RTX) is commonly used as remission induction therapy for ANCA-associated vasculitis (AAV). Low-dose RTX has been recently shown to produce closely similar results to conventional treatments in other autoimmune diseases. However, the therapeutic potential of this approach in AAV remains largely unknown. Here, we analyzed the efficacy and tolerability of high- and low-dose regimens of RTX in patients with AAV. We retrospectively examined AAV patients who met the classification algorithm of Watts et al. from 2006 to 2016. Patients were divided into high- (HD) and low-dose (LD) RTX groups. HD-RTX was the original regimen while LD-RTX consisted of two once-weekly doses of 375mg/m2. Cumulative complete remission (CR) rates for 1year were compared, and serial changes in peripheral B cell counts and serious adverse events were monitored. Apart from a higher percentage of elderly patients in the LD group (p < 0.01), the 17 patients with HD-RTX and 11 patients with LD-RTX showed no significant differences in clinical characteristics, including Birmingham Vasculitis Activity Score (BVAS), Vasculitis Damage Index (VDI), and the initial dose of glucocorticoid. On 1-year observation, cumulative CR rates did not significantly differ (p = 0.20). Further, peripheral B cell counts and incidence of serious adverse events also did not differ. Cumulative CR rate did not significantly differ between LD and HD groups. Further study is warranted to confirm these results.

Assisted Administration of Subcutaneous Rituximab to the Patient's Home. Significant Reduction of Indirect Costs Incurred By Care Recipients and Unpaid Caregivers Together with a Total Adherence to the Treatment Schedule and Same Safety

▪Dec 2018, 7 consecutive patients, ( CLL n = 1; FL n = 3; DLBCL n= 1 AEA n=1,ITP n=1), were enrolled in the study. Median age of the patients was 68 years (range, 28-87). The pharmacoeconomic analysis included assessment of direct costs ( hospital inpatient, physician inpatient, physician outpatient, emergency department nursing home care, specialists' and other health professionals' care, diagnostic tests, prescription drugs and drug sundries, and medical supplies),indirect costs incurred by care recipients and unpaid caregivers, including time, productivity and travel cost.Results Rituximab subcutaneous formulation was administered at a fixed dose of 1400 mg with a frequency related to the type and the phase of the treated disease. Before starting MabThera subcutaneous injections, all patients received beforehand, a full dose of Rituximab by intravenous infusion. Premedication with an anti-pyretic an antihistaminic and prednisone , was given orally in the evening before and the morning of the subcutaneous administration the infusion was carried out by the staff of the home care unit together with a doctor. All the procedure was controlled by the hospital specialist through a smart-phone. Median age of the patients was 58 years (range, 32-83). Median number of courses delivered to each patient was 6 (range, 4- 12) .Adherence to treatment was 100%.No Infusion related adverse reactions have been observed.ConclusionIn our experience, despite the high percentage of elderly patients of whom 36% living in rural area, it was possible to give treatment to all patients with high adherence and satisfaction. There has been a reduction in direct medical costs due to less use of hospitalization, a reduction of indirect costs by 70% due to the lower number of working days lost and a drastic reduction of travel costs, with the same safety of administration. DisclosuresNo relevant conflicts of interest to declare.

Abstract: The Impact of Age on Late Complications after Nasal Bone Fractures from Blunt Trauma: A 10-Year Retrospective Review

BACKGROUND: Nasal bone fractures are the most frequent fractures in facial trauma due to its central location and protruding framework. The impact of age on development of late complications after nasal bone fractures has not been well-studied. A greater understanding of the impact of age-related differences on outcomes after nasal bone fractures is essential in order to improve clinical assessment and management. METHODS: A 10-year retrospective chart review of adults with nasal bone fractures presenting to a Level 2 trauma center was performed to evaluate the late complications related to nasal bone fractures. This study variables considered include age, gender, mechanisms of injuries, nasal deformities, sinusitis, olfactory disturbances, airway obstruction, septal perforation, synechiae, types of fractures, and any post-injury operative interventions. Our data was organized into 2 cohorts: adult (aged 18–64 years) and elderly (>64 years). The impact of age on late complications was statistically assessed with statistical significance of p-value less than or equal to 0.05. RESULTS: There were 833 adult patients who sustained nasal fractures from 2007 to 2017. There was 123 patients in the elderly cohort and 710 adult patients aged 18–64 years. The most common mechanism of injury resulting in nasal bone fractures in the elderly was mechanical falls (52%), and the most common mechanism in the adult cohort was motor vehicle accidents (33.8%). There was no statistically significant difference in nasal bone fracture patterns between both groups (p>0.05). Adult patients were more likely to undergo a post-injury operative intervention (p<0.05). There was a higher percentage of elderly patients who had late complications compared to the adult cohort. The most common late complication was olfactory disturbances in both groups. Nasal deformities and airway obstruction, however, were more often reported in the adult cohort, and sinusitis as well as olfactory disturbances are more frequently reported in the elderly (p<0.05). CONCLUSION: Mechanical falls accounted for the majority of nasal bone fractures in the elderly, whereas a motor vehicle accident was the common mechanism of injury in the adult cohort. There was no difference in nasal bone fracture patterns between the elderly and the adult cohorts. Age, however, did affect the decision to undergo operative interventions, especially in the adult cohort. Elderly patients experienced more complications than their adult counterpart. Posttraumatic olfactory disturbance was the most frequent complication reported in both groups, secondary to distortion of the sinus tract. Sinusitis and olfactory disturbances are more likely to be experienced in the elderly.

Nutritional status assessment of the elderly patients with congestive heart failure by mini nutritional assessment test

Background: Malnutrition is a common problem among elderly patients, especially those with heart failure, and is known to increase mortality rates. Objectives: The current study evaluated nutritional status to identify changes in the elderly patients with congestive heart failure (CHF) during hospital stay. Patients and Methods: This cross-sectional study recruited 225 CHF hospitalized elderly patients, comprised of 154 males (68.4%) and 71 females (31.6%) at ameanage of 71.1±7.35 years. The mini nutritional assessment (MNA) was performed to estimate functional, cognitive and nutritional status. The MNA, an18-item tool to evaluate subjective and objective findings, including anthropometric measurements for nutritional risk, is found to be sensitive, specific and accurate in identifying elderly people at nutritional risk. Results: According to the MNA questionnaire, 9.8% of the elderly were malnourished, 80.9% at risk of malnutrition and 9.3% well nourished.Weight loss, bedsore, and level of knowledge and income had a significant relationship with nutritional status based on the MNA (P value < 0.05). Conclusions: Considering the high percentage of elderly patients with malnutrition or at risk of malnutrition, the need for nutritional intervention is obvious. The MNA seems to be a reliable tool to identify individuals at risk of malnutrition. To decrease hospital stay duration and cost, application of the MNA is suggested.

Audit of a Services to Improve Access project to improve access for skin cancer surgery.

Like many general practices in low decile communities with a high percentage of elderly patients, the Paeroa Medical Centre was relying heavily on secondary care to provide skin cancer surgical services, which led to delays in treatment and under-utilisation of the skills available in primary care. A new system utilising Services to Improve Access (SIA) funding was developed to provide partially funded skin cancer surgery within primary care. A 6-month period of this work by one general practitioner (GP) was audited. This has demonstrated that the majority of minor dermatological surgery can be successfully managed in primary care, with more timely and convenient treatment and substantial cost savings to the health system.

Life after hypomethylating agents in myelodysplastic syndrome: new strategies.

Hypomethylating agents, azacitidine and decitabine, are successfully used for the treatment of myelodysplastic syndromes (MDS). In spite of improvement in survival, MDS is still incurable without hematopoietic stem cell transplant, and in case of absence/loss of response to hypomethylating agents, outcome is poor. The purpose of this article is to provide an overview of the new approach to MDS, elucidate the advancements in understanding factors predictive of response to hypomethylating agents, the progress of research to better stratify individual patients, and optimize therapeutic choices, the availability and efficacy of new drugs. The prognostic importance of recurrent somatic mutations has been elucidated (i.e., ASXL1, TP53 and SF3B1 mutations) and the power to predict response to hypomethylating therapy ascribed to specific mutations (TET2 mutations). The most challenging agents among the numerous evaluated are those with a strong biological background, targeting specific molecular alterations (IDH2 mutation) or altered signaling pathways. Hematopoietic stem cell transplant remains the only curative option, and wider choice of donor (sibling, unrelated, cord blood, haploidentical) and different approaches to conditioning renders it feasible for a higher percentage of elderly patients with MDS. Few new molecules have reached phase III, the majority being in phase I/II studies. Most importantly, prognostic tools have profoundly improved whereas attitude of hematologists is changing rapidly. http://links.lww.com/COH/A9.

The Kidney Transplant Recipient Evaluation Process in the Elderly: A Single Centerʼs Experience.

OBJECTIVES: - To determine the outcomes of the recipient evaluation process in elderly patients, focusing on the number of patients approved versus turned down for kidney transplantation (KT) - To identify clinical characteristics associated with an increased risk for turn down. METHODS: We performed a retrospective review of patients 60 years old or older referred to our center for KT over a 3-year period. Variables collected included: Patient demographics including known co-morbid conditions based on history, Outcome of the evaluation process, Reasons cited for turn down, Diagnostic tests performed after clinic evaluation. A multivariate analysis was performed to determine the effect of predictors on the probability of being turned down. RESULTS: 526 patients were included in the study. 75 (14.2%) patients were deemed unacceptable candidates based on chart review and were not evaluated in clinic. 365 patients were evaluated in clinic (Figure 1). 198/365 (54.2%) were approved for KT. 109/365 (29.8%) were turned down. After adjustment for age, gender, duration of dialysis and other risk factors, the following clinical characteristics were associated with a higher risk of turn down: History of CAD, peripheral vascular disease (PVD) or both (OR=3.022, 95% CI 1.889-2.836, p=0.000004), History of COPD (OR 7.315, 95% CI 2.555-20.942, p=0.0002), and History of CA (OR 2.231, 95% CI 1.043-4.775, p=0.0002). Of the 109 patients turned down after clinic evaluation, CAD, PVD, or both were cited as reasons for turn down in 48 (44%) patients. Results of Cardiac Catheterization (17/26) or Computed Tomography (CT) Angiography (25/27) were the basis for this decision in majority of patients.Figure: No Caption available.CONCLUSION: A high percentage of elderly patients are deemed unacceptable candidates for KT in our center even after screening via chart review prior to a clinic evaluation. A history of CAD, PVD, COPD or CA place a candidate at an increased risk for turn down. Ultimately, CAD and PVD are the primary reasons cited for turn down. Utilizing Cardiac Catheterization and CT Angiography as first-line tests in these patients may lead to improved cost-effectiveness of the evaluation process.

Assisted Administration Of Subcutaneous 5-Azacytidine to The Patient's Home. Significant Reduction Of Indirect Costs Incurred By Care Recipients and Unpaid Caregivers Together With a Total Adhesion To The Treatment Schedule and Same Safety

Background and aimAdministration of azacitidine is planned in-patient daily, there is no experience of its administration to the patient's home. The aim of this work was to evaluate the feasibility of a program of home administration of azacitidine able to reducing the cost-of-illness, to increase adherence to treatment while maintaining the same safety of the therapy given in hospital. Material and methodsBetween Jan 2008 and Dec 2012, 22 consecutive patients, (MDSs, n = 15; CMML, n = 4; AML, n = 3), were enrolled in the study.The pharmacoeconomic analysis included assessment of direct costs ( hospital inpatient, physician inpatient, physician outpatient, emergency department nursing home care, specialists' and other health professionals' care, diagnostic tests, prescription drugs and drug sundries, and medical supplies),indirect costs incurred by care recipients and unpaid caregivers, including time, productivity and travel cost. ResultsAzacitidine 75 mg/m2/day was administered as a subcutaneous injection for 7 consecutive days every 4 weeks, Median age of the patients was 71 years (range, 65–83). Median number of courses delivered to each patient was 9 (range, 3–31) Hematologic responses (CR/PR/mCR) were induced in 6 patients (27.0%) Median number of treatment courses to achieve any response was 2 (range, 1–6) Adverse events were evaluated for the first 6 courses for all patients, for a total of 124 courses. Major adverse events were cytopenia and cytopenia-related infection. Grade 3 or higher neutropenia was 64.4%) but incidence of febrile episode requiring intravenous antibiotics was 8,4% slightly lower than reported from the pivotal clinical study. Grade 3 or higher non-hematologic toxicities were infrequent. Injection site reaction 0.4 and site pain 0% Median follow-up duration of surviving patients was 46.9 months (range, 11.8–55.5). Of the 14 patients who were RBC transfusion dependent at baseline, 48.0% of these patients became RBC transfusion independent during the treatment period. Adherence to treatment was 100%.In our experience, despite the high percentage of elderly patients of whom 36% living in rural area, it was possible to give treatment to all patients with 100% adherence. There has been a reduction in direct medical costs due to less use of hospitalization, a reduction of indirect costs by 63% due to the lower number of working days lost and a drastic reduction of travel costs, with the same efficacy and safety of administration. Disclosures:Off Label Use: drug administration at patient home instead of hospital.

Prescripción inapropiada de fármacos en personas mayores atendidas en un centro de Atención Primaria según los criterios STOPP-START

ObjectiveTo determine the prevalence and characteristics of inappropriate prescribing of drugs (IP) in patients >65 years-old evaluated by a primary care team (PCT), using the STOPP-START criteria. Material and methodCross-sectional sample of patients older than 65 years-old with active clinical history in 2010, and who were attended in 13 urban clinics (systematic random sampling, expected IP prevalence of 40%, precision: 5% confidence level: 95%). Requirement was reviewed clinical histories in 2010, using the STOPP-START criteria. ResultsA total of 363 patients were selected (56.7% women), mean age 75.2 years (SD: 7.02). The most frequent diseases were cardiovascular (76.9%) and osteoarticular (57.6%) diseases, and the average number of prescription drugs was 4.9 (SD: 3.32). IP was detected in 170 patients (46.8%; 95% CI: 41.7-52.0%), 42% in men (95% CI: 34.3-49.8%) and 46.6% in women (95% CI: 39.8-53.4%), with no differences between sexes (P=.386), with a higher prevalence if polypharmacy or comorbidity were present (P<.001). The STOPP criteria were met in 131 patients (36.1%; 95% CI: 31.1-41.0%), and START criteria in 73 (20.1%; 95% CI: 16-24.2%), with no difference between sexes (P=.623 for STOPP, and P=.678 for START). The most frequent STOPP criteria were observed in the musculoskeletal system (50 patients, 38.2%; 95% CI: 29.8-46.5%) and START endocrinology indicators (38 patients, 52.1%; 95% CI: 40.0-63.9%). ConclusionsThe STOPP-START tool detected and systematised IP in a high percentage of elderly patients treated by a PCT, and can promote improvement in prescribing strategies.

Radiochemotherapy in Special Populations with Limited-Disease Small-Cell Lung Cancer and Locally Advanced Non-Small-Cell Lung Cancer

SUMMARY The evidence to date confirms that concurrent radiochemotherapy (RT–ChT) is the treatment of choice in small-cell lung cancer and locally advanced non-small-cell lung cancer. But these patients require a good performance status and an interdisciplinary group of clinicians, which is hard to find at some facilities around the world. Socioeconomic differences worldwide, inadequate tolerance to RT–ChT, tobacco comorbidities, the high percentage of elderly patients and their low level of recruitment in clinical trials could explain, in part, the reason why lung cancer still remains the leading cause of cancer-related death around the world. This review focuses on RT–ChT in a special population of eldery, comorbid patients and populations with limited resources from developing countries with locally advanced non-small-cell lung cancer and limited-disease small-cell lung cancer.

Perfil e grau de dependência de idosos e sobrecarga de seus cuidadores

OBJETIVO: Analisar o perfil e o grau de dependência de idosos usuários de um Centro de Internação Domiciliar, bem como o perfil e a sobrecarga em seus cuidadores. MÉTODOS: Estudo exploratório e descritivo composto por amostra de 31 idosos e 31 cuidadores. A coleta de dados foi realizada por meio de entrevista no domicílio, com aplicação de questionário semiestruturado, contendo variáveis sóciodemográficas. Para avaliação do grau de dependência dos idosos, foram utilizados o Índice de Katz e Escala de Lawton e a sobrecarga dos cuidadores foi mensurada com base na Escala Zarit Burden Interview. RESULTADOS: Foi revelado percentual elevado de idosos com dependência total para atividades básicas e instrumentais da vida diária, sendo a variável estatisticamente significativa em relação à sobrecarga dos cuidadores e a percepção sobre seu estado de saúde. CONCLUSÃO: A análise das variáveis estudadas pode contribuir para o delineamento de propostas de intervenção baseada nas reais necessidades do grupo estudado.

Prevalence of pain in elderly hospitalized patients

Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient's recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.

Alta prevalencia de consumo de neurolépticos en las personas ancianas con demencia

Background and objectives The management of psychological and behavioural symptoms associated with dementia frequently requires the use of neuroleptic drugs. The objective of this study was to determine the prevalence, characteristics and possible differential factors of people aged ≥ 65 years with dementia who take or not neuroleptic drugs. The subgroup with Alzheimer disease was analysed. Patients and methods Five-hundred and fifteen patients aged ≥ 65 years with dementia were prospectively evaluated. Data were collected on sociodemographic variables, type of dementia, Barthel Index (BI), Lawton Index (LI), Mini Mental State Exam (MMSE), Charlson Index, treatment with neuroleptic, antidepressants, benzodiazepines and non-benzodiazepine hypnotic-sedatives drugs, specific dementia treatments, vascular risk factors and comorbidities. The stage and severity of dementia were evaluated by the Global Deterioration Scale (GDS), creating two groups: Mild-moderate (GDS 3, 4 and 5) and severe (GDS 6 and 7) disease. Results There were 364 women (70%) and 151 men, with a mean age of 81±6 years, of whom 10.1% were institutionalized. Two hundred and seventy patients (52.5%) had mild-moderate disease and 245 had severe disease (47.5%). Neuroleptic drugs were being taken by 233 (45.2%) patients. In the multivariate analysis, neuroleptic drug use was associated with male gender, institutionalization, worse LI scores, more severe dementia and not having heart failure. The subgroup with Alzheimer disease was associated with worse IB and not having arterial hypertension. Conclusion A high percentage of elderly patients with dementia are treated with neuroleptic drugs. There are significant differences in the prescription of neuroleptic drugs according to patient sociodemographic characteristics, severity of dementia and comorbidities.

Risk factors for potential drug interactions in general practice

Objective: To identify patient- and practice-related factors associated with potential drug interactions. Methods: A register analysis study in general practices in the county of Funen, Denmark. Prescription data were retrieved from a population-based prescription database (Odense University Pharmacoepidemiologic Database, OPED) covering prescriptions to all inhabitants in the county of Funen, Denmark. All individuals exposed to concurrent use of two or more drugs (polypharmacy) were identified. Combinations of drugs with potential interactions were registered and classified as major, moderate, or minor, depending on the severity of outcome and the quality of documentation. A two-level random coefficient logistic regression model was used to investigate factors related to potential drug interactions. Results: One-third of the population was exposed to polypharmacy, and 6% were exposed to potential drug interactions during 1 year. Patient factors associated with increased risk of potential drug interactions were high age, a high number of concurrently used drugs, and a high number of prescribers. Practice factors associated with potential drug interactions were a high percentage of elderly patients and a low percentage of female patients listed.Conclusion: Prescription data may be useful in quality-improvement programmes to identify groups of patients and practices at increased risk of drug interactions.

Narrow and wide prescribers among general practitioners

The aims of this study were to analyse (1) if it is possible to classify general practitioners (GPs) or groups of practitioners (practice units) as overall narrow or wide prescribers and (2) to what extent the size of practice drug formularies is associated with general prescribing behaviour, practice activity and demography. Data were retrieved from the Odense University Pharmacoepidemiologic Database (OPED) and the prescribing patterns of 177 practice units were analysed in a 4-year period including 2000 and 2003. We characterised the drug repertoire for new treatments using a Formulary Diversity Scale based on two formulary measures, the DU 90% and the Formulary Selectivity Index. Multiple regressions were used to analyse the association between formulary size and practice characteristics. The final Formulary Diversity Scale comprised 15 therapeutic drug groups and 151 different analogues. The average score based on the DU 90% segment was 46 drugs (range: 28-65) corresponding to 30% of drugs available. Using the Formulary Selectivity Index the average diversity score was 0.70. Practices with a high number of patients and a high percentage of elderly patients were more likely to use a wide range of drugs. The Formulary Diversity Scale revealed wide variation between practice units, indicating the existence of both overall narrow and wide prescribers among GPs. The number of patients attending the practice and the percentage of elderly patients were directly associated with the use of more analogues.

Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury

Primary objective: To compare functional physical and cognitive outcome of patients in three age groups with mild, moderate and severe traumatic brain injury (TBI) at discharge from acute care.Research design: Retrospective database review.Methods and procedures: Scores on the Extended Glasgow Outcome Scale (GOSE) and on the FIM™ instrument,discharge destination and length-of-stay (LOS) were gathered and compared for 2327 patients with TBI admitted to a level 1 trauma hospital from 1997–2003 divided into three age groups; 971 patients between 18–39 years, 672 between 40–59 years and 684 aged 60–99 years.Main outcomes and results: Relative to younger adults with similar TBI severity, elderly patients showed worse outcome on the GOSE and FIM™ instrument (physical and cognitive ratings) and longer LOS. No difference was observed between the young and middle-aged groups except for cognitive FIM™ ratings and LOS for severe TBI. A higher percentage of elderly patients went to in-patient rehabilitation, to long-term care facilities or died compared to young and middle-aged patients. A higher number of young and middle-aged patients were discharged home.Conclusions: Further development of services in early rehabilitation as well as post-rehabilitation geared to the specific needs of the elderly patient with TBI is required as the population ages.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia