Non-geriatric Group Research Articles

2216 Geriatric overactive bladder and botulinum toxin a: feasibility and tolerability in the outpatient setting under local anaesthetic

Abstract Introduction Urinary incontinence significantly impacts the lives of older adults increasing their susceptibility to falls, social isolation and long term care Intravesical Botulinum Toxin A (Botox) offers a well-established treatment for overactive bladders in women. In select centres, it can be administered under local anaesthetic, allowing access for frailer patients at higher risk from general anaesthetic and in whom anti-muscarinic therapies are best avoided. This project performed an analysis of geriatric patients who underwent intravesical Botox under local anaesthetic in an outpatient setting and assessed the tolerability and feasibility. Method 50 women (mean age 66, range 34–88) with overactive bladders underwent Botox administration in 2023. The procedure utilised local anaesthesia (Instillagel) while patients held a supine position with abducted hips on an outpatient couch. A LiNA OperaScope and injeTAK® needle facilitated administration. A sub-analysis focused on patients aged 75+. Pain levels were compared to past cervical smear experiences for reference. Results All 50 patients successfully completed the procedure. 15 were aged 75+ (mean 80.8, range 76–88), with 8 classified as ‘frail’ based on the Prisma 7 score (mean 2.3, range 0–5). The geriatric cohort reported lower average pain levels (1.8/10, range 1–3) compared to the non-geriatric group (2.2/10, range 1–5). Both groups pain perception was also lower than for past smears (2.9/10, range 1–4 vs. 3.4/10, range 1–7). Total ‘operative’ time was <3 minutes for all patients. Two non-geriatric participants experienced post-procedure UTIs, successfully treated with oral antibiotics (Clavien-Dindo II). Conclusion Intravesical Botox under local anaesthesia demonstrated promise as a safe and well-tolerated treatment for geriatric patients with overactive bladder, where lower levels of pain were reported compared to their younger counterparts. Tolerability was also better than previous smear tests and notably offers a relatable and novel comparison point to facilitate clearer counselling for patients and their families regarding this procedure.

Feasibility and Safety of Superomedial Pedicle for Breast Reduction in Geriatric Patients

Introduction Historically, inferior breast reduction is more commonly performed overall and this applies to the elder population. No study to this date has compared whether there is any difference in complications and overall safety between when using superomedial pedicle and inferior pedicle in geriatric patients and furthermore whether the safety profile of superomedial pedicle differs when compared to general population.MethodsPatient files of women who had undergone breast reduction by a single surgeon over a 9 year period (2015–2023) was reviewed retrospectively. Patients over 65 years old at the time of surgery were selected as the main study group. Results were compared to a control group aged 65 years and younger consisting of 136 patients, who also had a breast reduction by the same surgeon.ResultsFifty-four women met the inclusion criteria for the study group and they were further broken down into two subgroups; inferior and superomedial pedicle groups with 25 and 29 patients into each group, respectively. The mean age at the time of the operation was 67.8 years. Geriatric group had more significant comorbidities (37% vs. 9%, p<0.05). Looking solely on patients undergone superomedial pedicle breast reduction, OR times were similar between two age groups and hospital stay was slightly longer in the geriatric population albeit statistically insignificant. The average weight of specimens resected from each breast was 592.4 gr in geriatric population and slightly higher in the younger population with an average weight of 624 grams (p=0.27). Two women in the geriatric group and six women in the non-geriatric group developed major complications where superomedial pedicle was utilized, no meaningful difference was seen when major complications were compared (p=0.24). On the other hand, minor complications were significantly higher in the geriatric population compared to the younger cohort regarding superomedial pedicle reductions (p=0.02). ‘Satisfaction with breasts’ scores of BreastQ from the superomedial breast reduction subgroup was slightly higher than inferior pedicle breast reduction subgroup in geriatric population and it was statistically significant (0.032).ConclusionSafety margins and satisfaction scores of superomedial pedicled breast reduction in geriatric patients seem similar to their younger counterparts. Furthermore, with similar complication rates and with its slightly higher ‘Satisfaction with breasts’ scores when compared to inferior pedicle, superomedial pedicled breast reduction technique can be utilized without reservation in geriatric candidates for breast reduction.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparison of chronic kidney disease progression and associated complications between geriatric and non-geriatric groups.

There is no consensus on the physiologic decline in estimated glomerular filtration rate (GFR) due to geriatric conditions related with the aging or chronic kidney disease (CKD) itself. In this study, we aimed to compare the CKD progression and associated complications in a large sample of geriatric and non-geriatric patients. The data of in 506 patients at age between 30 to 90 years and diagnosed with CKD at stage 2 and above (15 mL/min/1.73 m2 ≤ eGFR < 90 mL/min/1.73 m2) were collected retrospectively and compared among geriatric (>65 years old) and non-geriatric individuals. The rate of hypertension was higher in geriatrics compared to non-geriatrics (96.6% vs 91.9%, P = .04). Among laboratory findings, only PTH level was significantly lower and HCO3 concentration was higher in geriatrics compared to non-geriatrics (P = .02, P < .001, respectively). There was no significant difference in last measured eGFR (P = .99) while that measured 4 years ago was lower in geriatrics compared to that of non-geriatrics (P < .001). eGFR change was smaller in geriatrics compared to non-geriatrics (P < .001), and rate of progressive renal disease among non-geriatric group (39%) was found to be significantly higher than in the geriatrics (17.2%) (P < .001). The prevalence of hyperkalemia was lower in geriatrics at stage 3a (P = .02); prevalence of hyperparathyroidism was lower in those at stage 3b (P = .02) and lastly the acidosis was observed significantly lower in geriatric patients at stage 3a, 3b, and 4 compared to the non-geriatrics at corresponding stages (P < .001, P = .03, and P = .04, respectively). The eGFR change was significantly smaller in geriatrics at stage 3b and 4 (P < .001 and P = .04, respectively) while the rate of progressed renal disease was lower in geriatrics at stage 3a and 3b (21.1% vs 9.9%, P = .03 and 41.2% vs 11.1%, P < .001, respectively). eGFR change in 4-year period and the rates of progressive renal disease are higher in the non-geriatrics and also the prevalence of secondary complications of CKD, such as hyperparathyroidism, acidosis, and hyperkalemia, are higher in non-geriatrics. This may reflect that decline of GFR in geriatric individuals is at least partially related to physiological aging rather than kidney disease. Therefore, devising age related CKD definitions might be appropriate.

Sleep disorders among elderly in Saudi Arabia: A cross-sectional study.

Aging has been shown to have an impact on sleep patterns, necessitating a deep dive into understanding the complex relationship between aging and sleep disorders. This study aimed to assess the prevalence of sleep disorders among elderly people and identify the associations between different factors and sleep disorders in this age group. This study was conducted at nursing homes in Jeddah. The target populations were those aged 65 years and older (geriatric group) and those aged younger than 65 years (nongeriatric group). Validated questionnaires, including the Athens Insomnia Scale, Berlin Questionnaire, Epworth Sleepiness Scale, International restless legs syndrome (RLS) Study Group, and Pittsburgh Sleep Quality Index, were used to assess different sleep disorders. A total of 313 participants were recruited in the geriatric (n = 153) and nongeriatric (n = 160) groups. Compared with the nongeriatric group, the geriatric group had greater risks of obstructive sleep apnea (OSA) (70.6%) and RLS (40.5%) (P < 0.001). Both groups had a notable prevalence of poor sleep quality (86.6%). Although insomnia was found to be common, there was no significant difference in the prevalence of insomnia between the two groups. In addition, insomnia (odds ratio [OR] = 3.04, confidence interval [CI]: 1.06-8.86, P = 0.037), OSA (OR = 3.17, CI: 1.06-9.41, P = 0.038), and high body mass index (OR = 1.76, CI: 1.63-2.9, P = 0.003) were significantly associated with poor sleep quality. This study revealed that sleep disorders, particularly OSA and RLS, are common in the elderly population in Saudi Arabia.

Timing of withdrawal of life-sustaining therapy in traumatic brain injury: exploring indicators of poor prognosis in adult and geriatric populations

ABSTRACT Objective The lack of objective prognostication tools for severe traumatic brain injury (TBI) causes variability in the application of withdrawal of life-saving treatment (WLST). We aimed to determine whether WLST in persons with severe TBI is associated with known indicators of poor prognosis. Methods This retrospective descriptive study focused on adult (18–64 years) and geriatric (≥65 years) patients with severe TBI who were admitted between August 1, 2018 and July 31, 2021 at a Level I trauma center and subsequently underwent WLST. The data collected from the Trauma Registry and electronic health records included information regarding demographic characteristics, injury severity, clinical variables, and length of hospital stay and were used to examine the indicators of poor prognosis and WLST. Results Among the 164 participants with TBI who met the inclusion criteria, 61.0% were geriatric, and 122 (74.4%) patients had 0 or only 1 of the poor prognostic indicators prior to WLST. The non-geriatric group had more indicators of poor prognosis than the geriatric group. Participants with fewer indicators of poor prognosis had a longer length-of-stay. Conclusion In severe TBI cases, standardized prognostication tools can help guide informed WLST decisions, particularly in geriatric patients, improving care consistency.

PREVALENCE OF THYROID DYSFUNCTION IN PREVIOUSLY DIAGNOSED DIABETES MELLITUS IN GERIATRIC AND NON-GERIATRIC PATIENTS

Objectives: The aim of the study was to assess the prevalence of thyroid dysfunction in previously diagnosed diabetes mellitus in geriatric and non-geriatric patients. Methods: The present study was done at a medical college tertiary care center that caters to the needs of a vast amount of population in and around the region of Indore. Results: In the present study, we noted that the thyroid stimulating hormone levels were higher in the older population as compared to the non-geriatric group which was significant p=0.002. In the present study, we noted that the overall mean levels of thyroid stimulating hormone were 3.89 mg/dL standard deviation (SD) + 4.57, in the non-geriatric group, the mean levels of thyroid stimulating hormone were 4.63 mg/dL SD + 5.15 mg/dL and in the geriatric group, the mean levels of thyroid stimulating hormone were 13.15 mg/dL SD + 3.81 mg/dL. In the present study, we noted that the thyroid stimulating hormone levels were higher in the older population as compared to the non-geriatric group which was significant p=0.002. Conclusion: The disease diabetes mellitus has a higher prevalence in males as compared to the females with the male-to-female ratio being (1.57:1), and this trend was same in both the study groups non-geriatric (1.8:1), and geriatric (1.68:1).

Clinical features of chronic fungal rhinosinusitis in Korean geriatric and non-geriatric patients.

Worldwide, the incidence of chronic fungal rhinosinusitis (CFRS) has increased. Although ageing leads to weakening of the immune system, which increases susceptibility to CFRS, the CFRS characteristics in geriatric patients are unclear. Therefore, we comparatively analysed the clinical characteristics of CFRS in geriatric and non-geriatric patients. This retrospective analysis compared the demographics, rhinologic symptoms, multiple allergen simultaneous tests, olfactory function tests, paranasal sinus computed tomography findings, and outcomes of 131 patients with CFRS who underwent functional endoscopic sinus surgery and 131 enrolled patients were divided in geriatric (> 65years) and non-geriatric (≤ 65years) groups. Among the geriatric and non-geriatric participants (n = 65, 49.6% and n = 66, 50.4%, respectively), hypertension and diabetes mellitus were more common in the geriatric group. Demographics, including symptoms, showed no significant intergroup differences. Normosmia and hyposmia were significantly less prevalent, whereas phantosmia and parosmia were more prevalent in the geriatric group than in the non-geriatric group (p = 0.03 and p = 0.01, respectively). Sphenoidal sinus involvement was significantly higher in geriatric patients than in non-geriatric patients (p = 0.02). Based on greater sphenoidal sinus involvement, a deeper anatomical area is more vulnerable to fungal infection in the geriatric group than in the non-geriatric group. Increasing clinicians' awareness of CFRS in geriatric patients with olfactory dysfunction, including phantosmia and parosmia, is important for early intervention.

Geriatric benign paroxysmal positional vertigo: a single-center study

ObjectiveTo compare the clinical features, risk factors, distribution of Benign Paroxysmal Positional Vertigo (BPPV) subtypes, and effectiveness of canalith repositioning between geriatric and non-geriatric patients with BPPV. MethodsA total of 400 patients with BPPV were enrolled. Canalith repositioning was performed according to the semicircular canals involved. Patients were divided by age into a geriatric group (≥60 years) and a non-geriatric group (20–59 years). Clinical characteristics, potential age-related risk factors, distribution of subtypes, and effectiveness of canalith repositioning were compared between the groups. ResultsFemale sex was significantly more common in all age groups, with a peak female-to-male ratio of 5.1:1 in the group aged 50–59 years. There was a higher proportion of men in the geriatric group. A history of disease associated with atherosclerosis was significantly more common in the geriatric group (p < 0.05). Migraine was significantly more common in the non-geriatric group (p = 0.018), as was posterior canal BPPV. The horizontal canal BPPV (especially horizontal canal BPPV-cupulolithiasis), and multicanal BPPV subtypes were more common in the geriatric group, whereas anterior canal BPPV was more common in the non-geriatric group. Two canalith repositioning sessions were effective in 58.0% of the geriatric cases and in 72.6% of the non-geriatric cases (p = 0.002). There was a tendency for the effectiveness of canalith repositioning to decrease with increasing age. ConclusionBPPV was more common in women. However, the proportion of men with BPPV increased with age. Elderly patients often had a history of diseases associated with atherosclerosis (i.e., hypertension, diabetes, and hyperlipidemia). The horizontal canal BPPV (particularly horizontal canal BPPV-cupulolithiasis) and multicanal BPPV subtypes were more common and the anterior canal BPPV subtype was less common in elderly patients. The effectiveness of canalith repositioning may decrease with age. Therefore, older patients should receive more comprehensive medical treatment. Level of evidence4.

Clinical, Biochemical, and Outcome Profile of Hyponatremia in Geriatric and Non-Geriatric Individuals Admitted to a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Hyponatremia is one of the most common electrolyte disturbances encountered in medical wards, occurring in up to 22% of hospitalised patients. Timely recognition and correction of hyponatremia in hospitalised patients may help decrease in-hospital mortality and symptom severity, reduce the need for intensive hospital care, decrease the duration of hospitalisation and associated costs, and improve the treatment of underlying co-morbid conditions and patient’s quality of life. Aim: To compare the clinical presentation, aetiology, biochemical profile, management strategies, and outcomes of hyponatremia in geriatric and non-geriatric individuals admitted to a tertiary care centre. Materials and Methods: This prospective cohort study was conducted in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute, Pondicherry, India, from March 2021 to September 2022. A total of 166 subjects (83 geriatric and 83 non-geriatric patients) receiving inpatient services with hyponatremia were enrolled in the study by consecutive sampling. Patients over 18 years of age admitted to the Department of General Medicine with serum sodium levels below 135 mEq/L were included. Comparison of both the groups were done based on clinical presentation, laboratory values, co-morbidities, prescription drugs taken, aetiology, treatment given, and outcomes. For quantitative variables, mean, standard deviation, and independent t-tests were used, while percentages were used for qualitative variables. Results: The majority of subjects in the non-geriatric group belonged to the age group of 50-59 years, with a mean age of 50.7 years. In the geriatric group, most subjects were in the age group of 65-74 years, with a mean age of 74.5 years. The most common cause of hyponatremia in both groups was Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), with 32 (38.6%) cases in the non-geriatric group and 27 (32.5%) cases in the geriatric group. This was followed by volume overload in the non-geriatric group, with 14 (16.9%) cases, and drug-induced hyponatremia in the geriatric group, with 22 (26.5%) cases. The most common drug causing hyponatremia was furosemide in both groups. In non-geriatric patients, the most common symptom was giddiness, with 28 (34.1%) cases, while in geriatric patients, it was nausea/vomiting, with 25 (30.1%) cases. Tolvaptan was the most common treatment used in both groups, with 12 (92.3%) of patients with mild hyponatremia receiving it in the non-geriatric group (p=0.042), and 46 (55.4%) patients in the geriatric group, with most of them having moderate hyponatremia (26, 86.7%, p&lt;0.001). Conclusion: The results of the non-geriatric and geriatric groups were similar in terms of clinical presentation, biochemical parameters, management strategies, and outcome of hyponatremia. However, the aetiology of hyponatremia appeared to be different. The most common cause of hyponatremia was SIADH in both groups, followed by volume overload in the non-geriatric group and drug-induced hyponatremia in the geriatric group.

Patterns of biopsy-proven renal diseases in geriatric patients: A single medical center experience.

The elderly population is expanding rapidly, and that has become a major healthcare burden in terms of chronic kidney disease. The distribution patterns of kidney diseases in these elderly patients remain largely unclear. Here, we compared biopsy-based renal disease patterns between elderly and nonelderly patients. We performed a single-center, retrospective study (1992-2008) on biopsy-proven renal diseases to compare results between geriatric patients (age ≥ 65 years; n = 254) and nongeriatric patients (18 ≤ age < 65 years; n = 2592). Renal pathology was interpreted by pathologists based on light microscopy, immunofluorescence, and electron microscopy. The ages of the geriatric and nongeriatric groups were 71.8 ± 4.5 (65.1-87.3) and 39.7 ± 17.6 (18-64.9) years, respectively, and 74% and 41% of them, respectively, were men. In the geriatric group, the most frequent diagnosis was membranous nephropathy (46.1%), followed by minimal change disease/focal segmental glomerulosclerosis (16.9%), diabetic nephropathy (8.3%), hypertensive nephrosclerosis (7.5%), and IgA nephropathy (5.9%). The geriatric group had more membranous nephropathy and less lupus nephritis and IgA nephropathy than the nongeriatric group. Furthermore, the 5-year survival rate of the geriatric group was significantly low. Our results demonstrated the different distributions of renal biopsy patterns in geriatric patients diagnosed with acute or chronic progressive kidney injury and proteinuria through renal biopsy.

Loss of body weight and skeletal muscle negatively affect postoperative outcomes after major abdominal surgery in geriatric patients with cancer

ObjectivesMalnutrition characterized by the involuntary loss of body weight and skeletal muscle can be the result of both aging and malignancy. As a result, geriatric patients could face an increased nutritional risk. This study aimed to investigate the nutritional and functional status of geriatric patients and their association with postoperative complications. MethodsPatients who underwent abdominal surgery for digestive cancer in our center between January 2020 and August 2021 were included in the study. Computed tomography scans were collected to evaluate muscle mass and density. Changes in body weight, muscle strength, physical performances, nutritional risk, and status were evaluated upon admission. Postoperative outcomes collected included postoperative length of stay, complications, and 30-d readmission. ResultsA total of 1513 patients were included for the analysis. Of these, 72.8% were at risk for malnutrition (70.3% in the non-geriatric group and 75.4% in the geriatric group; P = 0.031), and 28.9% had malnutrition according to the Subjective Global Assessment (26.0% in the non-geriatric group and 31.8% in the geriatric group; P = 0.016). Compared with younger patients, geriatric patients have decreased muscle mass (skeletal muscle index, 44.8 versus 47.4; P < 0.001) and skeletal muscle density. Significant weight loss and loss of skeletal muscle occurred concurrently in 18.8% of the patients and were more frequent in the geriatric group (22.3% versus 14.7%; P < 0.001). In multivariate analysis, an age of 65 y or older (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.07–1.86; P = 0.014), a serum albumin level ≤4.11 g/dL (OR, 1.35; 95% CI, 1.03–1.77; P = 0.03), skeletal muscle loss (OR, 1.69; 95% CI, 1.28–2.24; P < 0.001), declined functional status (OR, 1.5; 95% CI, 1.14-1.98; P = 0.004), systematic inflammation (OR, 1.71; 95% CI, 1.09–2.8; P = 0.026), and significant weight loss (OR, 1.4; 95% CI, 1.06–2.85; P = 0.017) were independent predictors of overall postoperative complications. Although there was a trend of interactions between advanced age, skeletal muscle loss, and significant weight loss, multivariate analysis showed none of the interactions were significantly predictive of overall postoperative complications. ConclusionsGeriatric patients are at greater risk for malnutrition. Their declined nutritional and functional status together with advanced age could increase the risk for postoperative complications. Nutrition evaluation should be part of the preoperative workup, and timely interventions should be initiated if needed, especially in geriatric patients.

Exploring the rates of malnutrition risk and related factors among inpatients

Aim: The purpose of the study was to reveal the rates of malnutrition risk among inpatients, to determine those who were not malnourished but became iatrogenically-malnourished, and to identify whether malnutrition was prevented or alleviated among how many patients following enteral/parenteral nutrition.&#x0D; Materials and Method: We carried out the study with 349 patients hospitalized in internal and surgical medicine wards between March 01-31, 2017 (1 month) at the Medical Faculty Hospital of Kırıkkale University. The data of this descriptive research was gathered using the NRS-2002 test administered at initial admission and in the first and second weeks (for malnutrition screening) and a demographic information form inquiring about patients’ demographic characteristics, chronic illnesses, medication, and malignancy status.&#x0D; Findings: The findings revealed the mean age of the patients was 60.1±15.5 years and that 54.4% were males. While 75.1% were hospitalized in internal medicine wards, 24.9% received inpatient treatment in surgical medicine wards. About one-fourth of the patients (24.4%) had malnutrition at first admission: 28.6% in internal medicine wards and 11.5% in surgical medicine wards (p = 0.001). Besides, %34.9 of the geriatric group and %16.7 of the non-geriatric group had malnutrition risk, and the difference between the groups was significant (p&lt;0.001). Moreover, there was a significant difference between the male and female patients by malnutrition risk (32.1% vs. 15.1%; p&lt;0.001). The patients in internal medicine and pulmonology wards had significantly increased rates of malnutrition risk in the first week (p = 0.001 and p&lt;0.001, respectively). Yet, the second-week evaluations among the patients in these wards and the first-week and second-week evaluations among those in other wards yielded no significant increase in their malnutrition risk.&#x0D; Conclusion: Overall, the NRS-2002 test revealed considerably high rates of malnutrition risk among the participating inpatients. The risk was found to be significantly higher in the males, geriatric patients, patients with malignancy, and patients in internal medicine wards when compared to the females, non-geriatric patients, patients without malignancy, and patients in pulmonology wards, respectively. Besides, the rates of malnutrition risk significantly increased among the patients in internal medicine and pulmonology wards at the end of the first week. Considering the excess rates of malnutrition risk in the present findings, prioritizing malnutrition risk assessment among all patients admitted may be a simple but effective solution to prevent malnutrition from hindering relevant therapies.

The Surgical Timing and Complications of Rib Fixation for Rib Fractures in Geriatric Patients.

Rib fractures (RF) are a common injury that cause significant morbidity and mortality, especially in geriatric patients. RF fixation could shorten hospital stay and improve survival. The aim of this retrospective study was to evaluate the clinical impact and proper surgical timing of RF fixation in geriatric patients. We reviewed all the medical data of patients older than 16 years old with RF from the trauma registry database between January 2017 and December 2019 in Chang Gung Memorial Hospital. A total of 1078 patients with RF were enrolled, and 87 patients received RF fixation. The geriatric patients had a higher chest abbreviated injury scale than the non-geriatric group (p = 0.037). Univariate analysis showed that the RF fixation complication rates were significantly related to the injury severity scores (Odds ratio 1.10, 95% CI 1.03–1.20, p = 0.009) but not associated with age (OR 0.99, 95% CI 0.25–3.33, p = 0.988) or the surgical timing (OR 2.94, 95% CI 0.77–12.68, p = 0.122). Multivariate analysis proved that only bilateral RF was an independent risk factor of complications (OR 6.60, 95% CI 1.38–35.54, p = 0.02). RF fixation can be postponed for geriatric patients after they are stabilized and other lethal traumatic injuries are managed as a priority.

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

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

Comprehensive comparison between geriatric and nongeriatric patients with trauma.

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

Clinical features of eczema and dermatitis in the elderly: A cross-sectional study in mainland China

Purpose: The clinical features of eczema and dermatitis in the elderly have not been fully studied. To investigate the proportion and clinical features of geriatric eczema patients in mainland China. Patients and methods: A multicenter cross-sectional study conducted in outpatients with eczema from 39 tertiary hospitals in 15 provinces. Results: 1128 elderly patients (12.88%) had eczema and dermatitis. The mean age of those was 68.2 ± 6.8 years (range, 60–90 years) with a median course of 5.5 ± 8.9 years, which is much longer than that of non-geriatric patients (2.6 ± 4.1 years, p &lt; 0.001). Compared to non-geriatric patients, more patients involved in extremities (76.2% vs 61.5%, p &lt; 0.001) and trunk (37.2% vs 26.4%, p &lt; 0.001), but less in head and neck (18.3% vs 30.4%, p &lt; 0.001; 25.3% vs 20.6%, p &lt; 0.001). 13.4% of eczema and dermatitis in the elderly was widespread, which is much higher than that of 8% in non-geriatric group (13.4% vs 8%, p &lt; 0.001). 22.9% of geriatric eczema patients reported severe itching, which is much higher than that of 14% in counterparts (22.9% vs 14%, p &lt; 0.001). A positive correlation was observed between age and severe itching (Spearman’s rank correlation test, p &lt; 0.001). More geriatric patients had xerosis (39.6% vs 30.4%, p &lt; 0.001) and more lichenification was found (25.6% vs 13.3%, p &lt; 0.001). Conclusion: More than 10% of eczema occurs in the elderly patients. Longer disease duration, more severe itching, more extremities and trunk involvement, and prone to widespread, xerosis, and lichenification make it a special entity which should be studied further.

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

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

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

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

Geriatric sudden deafness

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

Geriatric Type 2 diabetes; the risk factors and associations for medication non-adherence.

Objectives: To determine medication adherence in geriatric type 2 diabetes cases, risk factors for non-adherence and association with functional dependence. Study Design: Descriptive cross sectional. Setting: Department of Medicine, RIHS Islamabad. Period: Sept. 2016 - Feb. 2017. Material &amp; Methods: 100 type 2 diabetes cases (&gt;65 years) included in group-A (geriatric group) and 100 gender matched type 2 diabetes cases (&lt;65 years) in group-B (non-geriatric group). Type 1 diabetes cases, critically ill and with incomplete medication record were excluded. Morisky Diabetes Questionnaire (MMAS-8) applied for medication adherence. Glycemic control, diabetes duration, co-morbids, treatment regime, poly-pharmacy, alternative medicine, functional status (Katz index) and visual morbidity assessed in both groups. Data analyzed by SPSS V-20 and Chi-square test applied with significant p &lt; 0.05. Results: Mean age was 71.43+5.58 years (group-A) vs. 49.28+6.57 years (group-B). Mean diabetes duration was 9.61+8 years (group-A) vs. 7.4+4.9 years (group B). Functional status was independent in 53%(group-A) vs. 86%(group-B), significantly dependent 40%(group-A) vs. 11%(group-B) and dependent 7% (group-A) vs. 3% (group-B). High adherence in 3% (group-A) vs. 10%(group B); medium 24%(group-A) vs. 32%(group-B) and low 73%(group-A) vs. 58% (group B). Non-adherence in 73%(group-A) vs. 58%(group-B). Poly-pharmacy, co-morbids, combination anti-diabetes regimes, visual morbidity, physical dependence and poor glycemic control was frequent in geriatric diabetes cases (p&lt;0.05). Conclusions: Medication adherence has pivotal role to attain target glycemic control. Higher medication non-adherence in geriatric diabetes cases needs to be addressed. Counseling sessions supported by literature in local language and addressing the identified risk factors may improve medication adherence in geriatric diabetes cases, hence improved glycemic control and morbidity.