Quality Of Life In Elderly Patients Research Articles

The Impact of Cataract Surgery on Cognitive Impairment and Depressive Mental Status in Elderly Patients

To evaluate the influence of cataract surgery on cognitive function and depressive mental status of elderly patients. Prospective, interventional case series. The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI) are the measures designed to assess vision-related quality of life (QOL), cognitive impairment, and depressive mental status, respectively. These tests were performed before and two months after surgery in 102 patients undergoing phacoemulsification and intraocular lens implantation for bilateral cataract. The change in best-corrected visual acuity by surgery significantly correlated with the change in NEI VFQ-25 score (Pearson correlation, r = -0.310; P = .031). The change in NEI VFQ-25 score by surgery significantly correlated with the change in MMSE score (r = 0.306; P = .035) and the change in BDI score (r = -0.414; P < .001). The change in MMSE score showed significant correlation with the change in BDI score (r = -0.434; P < .001). Vision-related QOL, cognitive impairment, and depressive mental status are all strongly related with each other. Cataract surgery significantly improved vision-related QOL in elderly patients, and cognitive impairment and depressive mental status also improved in parallel with improvement in vision-related QOL.

Adjuvant treatments do not alter the quality of life in elderly patients with colorectal cancer

The current study was performed to longitudinally assess the impact of adjuvant treatments on the quality of life (QoL) of elderly colorectal cancer survivors. The Burgundy Digestive Cancer Registry was used to select all patients aged > or =75 years who were diagnosed with colorectal cancer between 2003 and 2005. A total of 209 patients were asked to complete questionnaires during the first year after diagnosis: at the time of inclusion in the study (Q0), at 3 months after the initial diagnosis (Q3), at 6 months after the initial diagnosis (Q6), and at 12 months after the initial diagnosis (Q12) using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. A total of 125 patients (60%) responded. Mixed model analyses of variance for repeated measurement were used to compare QoL scores according to therapeutic schemes. Interactions between time of follow-up and treatment were tested. Patient sex, age, location of the tumor, and TNM stage of disease did not appear to differ significantly between respondents and nonrespondents. Global Health and Emotional Functioning improved for colon cancer survivors between Q0 and Q12, and were noted to improve between Q3 and Q12 for rectal cancer patients. According to French recommendations, patients who received chemotherapy for stage III colon cancer (P = .176) or radiotherapy for rectal cancer (P = .959) reported no significant changes in Global Health compared with those patients not receiving adjuvant therapies. Patients treated with chemotherapy reported better Physical Functioning than patients who did not received chemotherapy (P = .0113). To the authors' knowledge, the current study is the first to examine trends over time with regard to the influence of adjuvant treatments for colon and rectal cancers on QoL in a general aged population. Providing evidence that adjuvant chemotherapy for colon cancer has no negative impact on the QoL of elderly patients is of great significance in encouraging clinicians to treat this population.

Effect of adjuvant treatments on quality of life in elderly patients with colorectal cancer: A population-based study

4051 Background: Quality of life (QoL) could be determinant to refute the misconception that the elderly are more prone to side effects and that advanced age limits the potential benefit of receiving adjuvant chemotherapy or radiotherapy. The aim of this study was to longitudinally assess the impact of adjuvant treatments on the QoL of colon and rectal cancer elderly survivors. Methods: The population-based Burgundy Digestive Cancer registry was used to select all patients older than 74 years with colorectal cancer from 2003 to 2005. Two hundred nine patients were asked to complete four QoL questionnaires over the first year after diagnosis (Q0: inclusion, Q3: at 3 months, Q6: 6 months and Q12: 12 months) using EORTC QLQ-C30. Then 125 (60%) responded. Mixed model analyses of variance for repeated measurement were used to compare QoL scores according to therapeutic schemes and interactions between time of follow-up and treatment were tested. A p value lesser than 0.05 was significant. Results: Sex, age at diagnosis, location of cancer and stage at diagnosis did not significantly differed between responders and none responders. Global health and emotional functioning increased for colon cancers between Q0 and Q12 and between Q3 and Q12 for rectal cancers. According to French adjuvant treatments recommendations, patients who received chemotherapy for stage III colon cancer (p=.176) or radiotherapy for rectal cancer (p=.959) unexpectedly reported no significant different global health than those not receiving adjuvant therapies. Patients treated with chemotherapy declared higher physical functioning than patients not treated (p=.0113) whatever follow-up. Physical functioning increased for patients who received radiotherapy between Q3 and Q6 (p=.021). Conclusions: This report is the first dealing with trends over time on the influence on QoL of adjuvant chemotherapy and radiotherapy for colon and rectal cancers in a general population of patients aged 75 and over. Providing evidence that colonic adjuvant chemotherapy have no negative impact on the QoL of elderly patients is of great importance to reinforce clinicians to treat this population. No significant financial relationships to disclose.

Insulin therapy in elderly patients with diabetes mellitus

Insulin therapy is an effective measure of improving glucose control even in elderly patients with type 2 diabetes. However, it is controversial whether insulin therapy does disturb the quality of life (QOL) as well as cognitive function in the elderly. In our previous study of 455 diabetic patients, the well-being as assessed by the morale scale was similar in three treatment groups. In contrast, the symptom-burden, social burden, and worry about diabetes as assessed by the Elderly Diabetes Burden Scales was more increased in insulin-treated group as compared to the diet-treated group after adjustment for age, gender, HbAlc, frequency of hypoglycemia, microangiopathy, macroangiopathy, and social support. In another study of 213 patients, MMSE scores were similar among treatment groups, while attention and learning were most impaired in insulin-treated groups after adjustment for age, gender, HbAlc, and duration of diabetes. Although the mechanism for the association between insulin treatment and cognitive impairment is unknown, hyperglycemia, hypoglycemia, and cerebral complications in insulin-treated patients may be possible explanations. Whatever mechanism may be involved, hypoglycemia should be considered especially if unexpectedly low HbAlc (< 6.5%) is observed or atypical neuropsychological symptoms appear. It is unknown how insulin withdrawal is successful in elderly diabetic patients. Using rapid or ultrarapid insulin injections three times daily, good glucose control achieved the goal of plasma glucose level of < 140 mg/dl before meals and at bedtime. Then, insulin therapy was converted to oral treatment of glimepiride (2 to 6 mg/day) and/or voglibose (0.6 mg/day) in 30 patients with poorly controlled Type 2 diabetes. About 83% of the patients were successful in the insulin withdrawal according to the criteria of HbAlc levels after two months < 8.0%. After removal of glucose toxicity, insulin withdrawal should be attempted to improve QOL in elderly patients with diabetes mellitus.

Quality of Life in elderly patients with cancer

The incidence of most types of cancers is age-dependent and the progressive ageing is rapidly increasing the number of elderly people who need treatment for cancer. Elderly patients present peculiar characteristics that make the choice of the correct treatment more difficult and these patients are often undertreated. Moreover, elderly patients are largely underrepresented in cancer treatment trials, and this makes the experimental evidence on this topic even weaker. Health-related Quality of Life (QOL) has been considered as one of the hard end-points for clinical cancer research, and treatment of elderly cancer patients represents a typical situation where its assessment can be particularly useful, because the expected toxicity of treatment could be relevant in the discussion of the treatment choice. However, QOL assessment in the elderly is complicated by several unresolved methodological problems (higher frequency of illiteracy, worse compliance with the questionnaires, concomitant diseases, use of instruments not validated in the aged population). Conduct of clinical trials dedicated to elderly patients is now encouraged but there are few published studies. Advanced non-small-cell lung cancer is one of the fields with the largest amount of research on QOL in elderly patients. The ELVIS study demonstrated the efficacy of single-agent chemotherapy, both in terms of QOL and of survival. The MILES study, in which combination chemotherapy was not superior than single agents, showed that baseline QOL is a strong prognostic indicator in these patients. QOL of patients with breast cancer has been another important field in clinical research over the last decades, and interest on this topic in elderly patients is growing, from loco-regional to palliative treatment.In conclusion, some steps have been done in clinical cancer research dedicated to elderly patients, and the role of QOL assessment in this setting is important. However, many methodological problems must be resolved, in order to obtain reliable and useful results. A QOL assessment could also be useful for elderly patients in clinical practice, where it could improve patient-clinician communication: a wider application of properly selected instruments should be recommended.

Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital

Although percutaneous endoscopic gastrotomy (PEG) has been widely acknowledged as a safer method for enteral feeding, its long-term impact on prognosis and quality of life (QOL) in elderly patients is not sufficiently understood. Regarding the indications of PEG, there still exist issues to be studied due to lack of convincing evidence for reduction of expected complications such as aspiration pneumonia or for improvement of prognosis in patients with severe dementia. In this study we investigated the survival rate after PEG placement and family satisfaction retrospectively in 78 elderly inpatients who underwent PEG, by sending questionnaires to the patients or their caregivers. The results of 68 cases (88%) recovered showed that the 1-year survival rate was 64.0%, and the 2-year survival rate was 55.5%. Fifty-three percent of families of patients showed overall satisfaction regarding the induction of PEG. The survival rate was relatively higher than that from previously reported studies. The differences we observed may be attributed to variations in patients' backgrounds (clinical, socio-economic, cultural) in therapeutic interventions. We recognized the importance of clarifying factors which would affect the prognosis and QOL in elderly patients who undergo PEG. The indication for PEG can be made based on comprehensive assessment of the relevant factors in individual cases, taking patient's or caregiver's wishes into consideration.

Effect of an inhaled beta 2-adrenergic agent on pulmonary function and quality of life in elderly patients with chronic obstructive pulmonary disease

We tested the effects of inhaled beta 2-adrenergic drug on the physiologic function of the respiratory system and quality of life (QOL) in elderly patients with chronic obstructive pulmonary disease (COPD). We measured the pulmonary function, static respiratory pressures, and ventilation during exercise, before and after inhalation of the beta 2-adrenergic drug, fenoterol bromide (FB) in 12 male COPD patients (mean age 82.1 +/- 0.6 years old), QOL was measured with a St George's Respiratory Questionnaire (SGRQ) in the patients. Forced expiratory volume in one second was increased by the inhalation of FB in the patients, whereas the ratio of residual volume to total lung capacity was decreased by the inhalation. Maximum inspiratory pressure was significantly increased after the inhalation of FB. Dyspnea sensation during exercise assessed by the Borg scale was reduced by the inhalation of FB. The scores on SGRQ were improved by one-month treatment with FB. These results indicate that treatment with FB is effective for both physiological function of the respiratory system and several aspects of QOL in elderly patients with COPD.

Effect of inhaled anticholinergic drug on pulmonary function and quality of life in elderly patients with chronic obstructive pulmonary disease

Effects of inhaled anticholinergic drug on the physiological function of the respiratory system and quality of life (QOL) in elderly patients with chronic obstructive pulmonary disease (COPD) have not been fully elucidated. We examined the pulmonary function, static respiratory pressures, and ventilation during exercise, before and after inhalation of oxitropium bromide (OTB) in 12 male patients with COPD (mean age 82.1 +/- 0.6 years). QOL was measured with a St George's Respiratory Questionnaire (SGRQ) in the patients. Forced expiratory volume in one second was increased by the inhalation of OTB in the patients, whereas the ratio of residual volume to total lung capacity was decreased by the inhalation. Maximum inspiratory pressure was significantly increased after the administration of OTB. Dyspnea sensation during exercise measured on the Borg scale was reduced by the inhalation of OTB. The scores of SGRQ were improved by one-month treatment with OTB. These results suggest that the treatment with OTB are effective for both physiological function and several aspects of QOL in elderly patients with COPD.