Support In Elderly Patients Research Articles

The Impact of The Labial Flange and Artificial Teeth on Lip Support in Elderly Patients with Maxillary Complete Dentures

Both maxillary complete denture’s labial flange and anterior artificial teeth play important roles in re-establish major support for the upper lip of elderly patients. However, whether the labial flange can be removed and still perceived as aesthetic remain unclear. Objective: To determine the perception of young adults toward the effect of a labial flange and anterior teeth on lip support of an elderly with maxillary complete dentures. Methods: A total of 64 young adults were recruited to evaluate the lip support for facial aesthetics of 30 full-face photographs in 3 different states: with an original complete denture (CD), with a flangeless duplicated denture and without the complete denture. They were rated using a Visual Numerical Scale (VNS) of 10, with 1 being the least attractive and 10 being the most attractive and repeated twice in random order. Soft-tissue profile analysis was performed to determine which facial anatomical landmarks were most important for lip support and aesthetics. Results: The overall VNS rating with CD (6.33 ± 0.58) was significantly higher (p < 0.001) than images with flangeless (5.58 ± 1.01) or without CD (5.23 ± 1.30). The landmarks that showed the most significant changes were in the subnasale area and NLA with original CD (p=0.060, p=0.072) and in frontal lip thickness with flangeless (p=0.082). There are strong correlations between subnasale and NLA and the mean total aesthetic VNS rating of images with CD, but not statistically significant (r=0.708; p=0.118, r=-0.835; p=0.078). Conclusion: The labial flange of a maxillary complete denture plays an important role in lip support and results in the aesthetic perception of the dentures wearer. The anterior teeth alone provide fullness to the lips, but not enough for labial support.

Short-term mechanical circulatory support in elderly patients.

Age over 70years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short-term MCS. Retrospective analysis of ≥70-year-old patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70years). We analyze factors associated with survival in elderly group. Out of 164 short-term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70-year-old patients (73.3% VA-ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high-risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p=0.403) and at follow-up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log-rank p=0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p=0.037), higher lactate (p=0.003) and creatinine (p=0.035) at implant, longer cardiac arrest (p=0.003), and worse post-implantation left ventricular ejection fraction (p=0.003). Patients with indication of MCS for high-risk PCI had higher survival compared to other indications (p=0.013). Short-term MCS with VA-ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high-risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.

The Actual Aspects of Medical Social Monitoring of patients of elderly age

The article presents the results of research carried out jointly by the Krasnoyarsk state medical institute and the regional gerontological center. The data concerning health condition of gerontological patients was collected in 2019. The most sensitive problems of medical and social support of elderly patients were established. The results demonstrated that the elderly patients apply self-medication in terms of independent (without medical appointment) use of medications on daily basis that is potentially dangerous for their health. The particular place is occupied by non-steroid anti-inflammatory medications to stop painful syndrome of various etiologies. The low patient compliance is associated with inadequate communicative activity of physicians. The lacking of insomnia therapy in elderly patients with was established too. The identified problems require timely identification and necessitate special approaches to medical and social support of elderly patients, including intensive education of medical literacy and knowledge concerning methods of prevention, treatment and healthy lifestyle.

Social work for the elderly. Case work method in support of elderly patients with oncological diseases

Professional support for elderly people requires preparation to provide assistance in the face of a health loss, including oncological diseases, the risk of which increases especially at this stage of human development. A social worker asked to help a person who is struggling with an oncological disease needs to have a broad psychological, sociological and pedagogical knowledge. Working by applying the individual case method, a social worker focuses their support actions on a direct impact on the person and their social environment. Generally speaking, the purpose of the case work method is to strengthen the individual, raising their energy and internal abilities through a consciously directed process of individual work with the person, and (if the situation requires it) to extend the support by organising additional help from the specialised institutions , appropriate for solving a given problem. The theoretical background for the effective implementation of the case work method at the stage of diagnosis, then preparation of an assistance plan and implementation of planned intervention activities in the area of assistance to the elderly patients with an oncological disease, may be the concept of A. Maslow. It turns out that the usefulness of this theoretical concept has been repeatedly verified in practice, in processes of identifying the needs of seniors and planning interventions by social workers when dealing with the extremely difficult experience of an oncological disease in late adulthood. The advantage of the theoretical background discussed is that it indicates specific areas of biopsychosocial functioning, which requires concentration and diagnostic sensitivity of social workers in contact with a senior person that goes beyond the standard assessment of the client needs. The aim of this article is to bring closer the theoretical basis for diagnostic and intervention actions that can be undertaken by a social worker providing support to the seniors submitted to oncological treatment.

Actual state of injection techniques and effect of medical treatment instructions in elderly patients with diabetes using insulin

Support for elderly patients using insulin to continue self-injection safely is required for clinical settings. The aim of this study was 1) to clarify the actual state of self-injection procedures for elderly people injecting insulin and 2) to verify whether or not the injection procedures can be improved by nurses' medical treatment instructions. The subjects were outpatients at an educational facility certified by the Japan Diabetes Society. Basic clinical characteristics, the Mini-Cog cognitive function test, basic ADL and instrumental ADL, and 24 items of the self-injection procedure were evaluated by nurses. After receiving a 30-minute face-to-face session of individual instructions from trained nurses two or more times, the injection procedure was re-evaluated. Of the 63 study subjects, 10 were injecting insulin with the support of others (supported injection group). The median age in the self-injection group was 72 years old, while that in the supported injection group was 82 years old. The supported injection group was older, the female ratio higher, and the Mini-Cog and ADL indices lower than in the self-injection group (p <0.05). The median history of the use of insulin was over 10 years in both groups. In the self-injection group, the degree of proficiency with the injection technique was significantly improved after receiving the instructions (p <0.05). The biggest improvement was in response to the question, "Do you know that you need to shift the site of injections?", which doubled (p <0.05). The correct answer rate for "Do you know the name of your insulin formulation?" was less than half, and it remained unchanged even after receiving instructions. In the supported injection group, 90% had a Mini-Cog of ≤2 points, but 6 subjects (60%) were able to perform an injection by themselves with others supporting the adjustments made to the amount of insulin. The self-injection technique improved significantly, even in elderly people, following the delivery of medical treatment instructions by nurses, and the item with the highest improvement effect was subjects' understanding of the need to shift the injection site. Our study showed that even in elderly people with cognitive dysfunction who are performing injections with the support of others, some of the injection procedures were retained by relying on procedural memory acquired in the past.

Correlation analysis of empathy satisfaction and empathy, mental resilience, and social support in elderly patients with functional dyspepsia

Correlation analysis of empathy satisfaction and empathy, mental resilience, and social support in elderly patients with functional dyspepsia

Risk Factors for Mortality and Respiratory Support in Elderly Patients Hospitalized with COVID-19 in Korea.

BackgroundThe mortality risk of coronavirus disease 2019 (COVID-19) is higher in patients with older age, and many elderly patients are reported to require advanced respiratory support.MethodsWe reviewed medical records of 98 patients aged ≥ 65 years who were hospitalized with COVID-19 during a regional outbreak in Daegu/Gyeongsangbuk-do province of Korea. The outcome measures were in-hospital mortality and the treatment with mechanical ventilation (MV) or high-flow nasal cannula (HFNC).ResultsThe median age of the patients was 72 years; 55.1% were female. Most (74.5%) had at least one underlying condition. Overall case fatality rate (CFR) was 20.4%, and median time to death after admission was 8 days. The CFR was 6.1% among patients aged 65–69 years, 22.7% among those aged 70–79 years, and 38.1% among those aged ≥ 80 years. The CFR among patients who required MV was 43.8%, and the proportion of patients received MV/HFNC was 28.6%. Nosocomial acquisition, diabetes, chronic lung diseases, and chronic neurologic diseases were significant risk factors for both death and MV/HFNC. Hypotension, hypoxia, and altered mental status on admission were also associated with poor outcome. CRP > 8.0 mg/dL was strongly associated with MV/HFNC (odds ratio, 26.31; 95% confidence interval, 7.78–88.92; P < 0.001), and showed better diagnostic characteristics compared to commonly used clinical scores.ConclusionPatients aged ≥ 80 years had a high risk of requiring MV/HFNC, and mortality among those severe patients was very high. Severe initial presentation and laboratory abnormalities, especially high CRP, were identified as risk factors for mortality and severe hospital course.

Dietary Support in Elderly Patients with Inflammatory Bowel Disease.

Ageing of the human population has become a big challenge for health care systems worldwide. On the other hand, the number of elderly patients with inflammatory bowel disease (IBD) is also increasing. Considering the unique clinical characteristics of this subpopulation, including many comorbidities and polypharmacy, the current therapeutic guidelines for the management of IBD should be individualized and applied with caution. This is why the role of non-pharmacological treatments is of special significance. Since both IBD and older age are independent risk factors of nutritional deficiencies, appropriate dietary support should be an important part of the therapeutic approach. In this review paper we discuss the interrelations between IBD, older age, and malnutrition. We also present the current knowledge on the utility of different diets in the management of IBD. Considering the limited data on how to support IBD therapy by nutritional intervention, we focus on the Mediterranean and Dietary Approaches to Stop Hypertension diets, which seem to be the most beneficial in this patient group. We also discuss some new findings on their hypothetical anti-inflammatory influence on the course of IBD.

Partial parenteral nutrition support in elderly patients with chronic hemorrhage after minimally invasive percutaneous nephrolithotomy

Partial parenteral nutrition support in elderly patients with chronic hemorrhage after minimally invasive percutaneous nephrolithotomy

Application of enhanced recovery after surgery nursing based on nutritional support in elderly patients with hip fracture

Objective To explore the effects of enhanced recovery after surgery based on nutritional support in perioperative nursing of elderly patients with hip fracture and joint replacement. Methods From January 2015 to June 2017, we selected 278 elderly hip fracture patients with nutritional risk (NRS 2002≥3) by convenience sampling. All of the patients were divided into observation group (n=132) and control group (n=146) with the method of envelope. Observation group accepted nutritional support and brought it into enhanced recovery nursing process. Control group applied routine perioperative nursing without standardized nutritional support. We compared the albumin and loss of hemoglobin at the second day after surgery, the score of activity of daily living (ADL) , time of getting out from bed for the first time, hospital stay as well as complications of patients between two groups. Results The albumin at the second day after surgery and score of ADL of patients in observation group were (29.16±1.33) g/dl and (63.90±5.47) respectively higher than those in control group; the loss of hemoglobin after surgery, time of getting out from bed for the first time, hospital stay in observation group were (1.34±0.30) g/dl, (1.56±0.20) d, (7.08±2.23) d respectively lower than those in control group; the differences were all statistical (t=-3.089, -14.881, -13.640, -15.279, -8.480; P<0.05) . The incidence of complications of observation group was 9.09% lower than that of control group (19.18%) with statistical difference (χ2=3.877, P<0.05) . Conclusions Enhanced recovery nursing based on nutritional support can shorten the hospital stay in elderly patients with hip fracture, promote postoperative rehabilitation after hip joint replacement and improve clinical outcomes of patients. Key words: Aged; Hip fractures; Nutritional support; Arthroplasty, replacement, hip; Enhanced recovery after surgery; Nutritional risk

Effect of the nutritional support in elderly patients with malnutrition

Rationale: To evaluated nutritional status to old patients with malnutrition before and after nutritional support, so as to provide more scientific and reasonable personalized dietary guidance for elderly patients.

Correlation study between resilience and self-efficacy and social support in elderly patients with chronic heart failure

Objective To investigate the relationship between levels of resilience and self-efficacy, social support in elderly patients with chronic heart failure. Methods A questionnaire survey was conducted among 102 elderly patients with chronic heart failure recruited by convenience sampling method in Cardiology Department of Caofei-dian District Hospital in Tangshan City from October 2015 to March 2016. Self-Efficacy for Symptom Management Scale (SESMs) , Perceived Social Support Scale (PSSS) , The Connor-Davidson Resilience Scale (CD-RISC) were applied in the survey to evaluate patients' resilience, self-efficacy and social support respectively. SPSS 17.0 software was used for statistical analysis. Pearson analysis was used to analyze the correlation between resilience, self-efficacy and social support. Multiple linear regression analysis was used to analyze the influencing factors of resilience. Results The scores of resilience was (57.73±6.07) , and resilience was positively related with self-efficacy and social support (r=0.685, 0.575; P<0.05) . The result of multiple linear regression analysis showed that self-efficacy and social support contributed 35.1% of the variance of patients' resilience. Conclusions The resilience level of elderly patients with chronic heart failure is relatively poor, and resilience is closely related to self-efficacy and social support. Key words: Aged; Heart failure; Resilience, psychological; Social support; Self-efficacy

Automatic Medication Dispenser for Medication Support in Elderly Patients Living at Home

Automatic Medication Dispenser for Medication Support in Elderly Patients Living at Home

High-dose thiotepa-based chemotherapy with autologous stem cell support in elderly patients with primary central nervous system lymphoma: a European retrospective study

In this retrospective multicentre study, we investigated the outcomes of elderly primary central nervous system lymphoma (PCNSL) patients (⩾65 years) who underwent high-dose chemotherapy followed by autologous stem cell transplantation (HDT-ASCT) at 11 centres between 2003 and 2016. End points included remission, progression-free survival (PFS), overall survival (OS) and treatment-related mortality. We identified 52 patients (median age 68.5 years, median Karnofsky Performance Status before HDT-ASCT 80%) who all underwent thiotepa-based HDT-ASCT. Fifteen patients (28.8%) received HDT-ASCT as first-line treatment and 37 (71.2%) received it as second or subsequent line. Remission status before HDT-ASCT was: CR 34.6%, PR 51.9%, stable disease 3.8% and progressive disease 9.6%. Following completion of HDT-ASCT, 36 patients (69.2%) achieved CR (21.2% first-line setting and 48.1% second or subsequent line setting) and 9 (17.3%) PR (5.8% first-line setting and 11.5% second or subsequent line setting). With a median follow-up of 22 months after HDT-ASCT, median PFS and OS were reached after 51.1 and 122.3 months, respectively. The 2-year PFS and OS rates were 62.0% and 70.8%, respectively. We observed two HDT-ASCT-associated deaths (3.8%). In selected elderly PCNSL patients, HDT-ASCT, using thiotepa-based conditioning regimes, is feasible and effective. Further prospective and comparative studies are warranted to further evaluate the role of HDT-ASCT in elderly PCNSL patients.

Research Trends into Support for Families Coping with Dementia in Japan

In Japan, there is a growing need for family support of elderly patients with dementia because the number of sufferers is expected to increase over coming years. We conducted a review of 92 studies into the support provided to the families of patients with dementia in Japan. They were reviewed by care setting, study focus, and study design. Most studies were in home settings, followed by hospital settings, with the fewest in long-term care facilities. A wide range and quality of studies were performed in home settings, including quantitative descriptive and interventional studies; however, qualitative descriptive studies and case studies predominated. We identified a need to perform additional studies to verify support programs at home. Concerning family support in hospitals, studies were mainly performed in relation to early diagnosis of dementia and early discharge from hospital, and we observed a clear need to investigate the development of new support programs. Finally, although the need for family support is estimated to be high in long-term care facilities, we found only a few studies investigating this issue. In particular, more studies are needed on the topic of end-of-life care. To offer support that meets the needs of families in various care settings, there is an urgent need to accumulate evidence about patients and their families in each setting.

Hope and social support in elderly patients with cancer and their partners: an actor-partner interdependence model.

Assess relationships between oldest-old (minimum 86 years) patients' perceived social support to their own and their spousal caregivers' hope through application of the actor-partner interdependence model (APIM). 58 dyads of patients and their spousal caregivers completed standardized self-report measures of depression, distress, hope and social support. Patients presented high distress levels. Among patients and spouses, perceived social support was positively correlated to their own level of hope (β = 0.44, p < 0.0001; β = 0.56, p < 0.0001, respectively) and negatively correlated to the other's level of hope (β = -0.25, p < 0.024; β = -0.44, p < 0.0001, respectively). The actor-partner interdependence model was found to be adequate for describing relationships between social support and hope among dyads of oldest-old patients and their spousal caregivers. Patients and caregiver seem to utilize social support to enhance hope.

Situation analysis of medical social support and self-perceived burden in elderly patients with chronic obstructive pulmonary diseases in Chengdu

Objective To analyze the situation of medical social support and self-perceived burden in elderly patients with chronic obstructive pulmonary diseases (COPD) in Chengdu, explore the influence of medical social support for patients with family oxygen cure. Methods A convenient sampling was conducted in 4 hospitals in Chengdu, and selected totally 124 elderly patients with COPD in January 2013 as the research object. Results Those patients' average daily life ability score was (20.19±7.10) points, 42 cases' daily life ability was normal, 44 had deficiency in daily life, 38 had obvious flaws; 16 cases received medical social support condition at a critical level, 66 at a general level, 42 in good condition; the difference of the ability of daily life between actual support and other supports was statistically significant (P 0.05). Patients with long term oxygen therapy had higher self-perceived burden than patients without oxygen therapy at home [(18.65±3.97) points vs. (17.69±6.24) points,t=6.015,P<0.05], but patients with long term oxygen therapy had better medical and social support condition than those without oxygen therapy at home [(282.11±37.47) points vs. (262.26±61.14) points,t=6.624,P<0.05]. Conclusions The level of medical and social support in elderly patients with COPD need improve. Nurses need to provide better guidance for patients with long term oxygen therapy, ensure them obtain adequate information, improve their emotional support and social interaction, enhance their medical social support condition. Key words: Aged; Pulmonary disease, chronic obstructive; Medical social support; Self-perceived burden

Quality of Life Is Related to Social Support in Elderly Osteoporosis Patients in a Chinese Population.

ObjectiveTo explore the association between quality of life and social support in elderly osteoporosis patients in a Chinese population.MethodsA total of 214 elderly patients who underwent bone mineral density screening were divided into two groups: elderly patients with primary osteoporosis (case group, n = 112) and normal elderly patients (control group, n = 102). Quality of life and social support were compared between the two groups.ResultsQuality of life and social support were significantly different between the case and control groups. The physical function, role-physical, bodily pain, general health, vitality, social-functioning, role-emotional and mental health scores in case group were significantly lower than those in the control group (P < 0.01). The objective support, subjective support, utilization of support, and total scores in case group were significantly lower than those in the control group (P < 0.01). Quality of life and social support were positively correlated in the case group (r = 0.672, P < 0.01).ConclusionQuality of life and social support in elderly patients with osteoporosis in China were poorer than in elderly patients without osteoporosis and were positively correlated. Our findings indicate that increased efforts to improve the social support and quality of life in elderly osteoporosis patients are urgently needed in China. Further longitudinal studies should be conducted to provide more clinical evidence to determine causative factors for the observed association between risk factors and outcomes.

Extracorporeal Membrane Oxygenation Support in Postcardiotomy Elderly Patients: The Mayo Clinic Experience

We conducted a retrospective study to assess whether providing extracorporeal membrane oxygenation (ECMO) support to elderly patients (aged 70 years or more) who failed separation from cardiopulmonary bypass after cardiac surgery was a viable option. From 2003 to 2013, 45 patients aged 70 years or more underwent 47 runs of ECMO postoperatively. There were 31 men (68.9%). The mean age was 76.8 years. Five patients were in cardiogenic shock preoperatively. Forty-four patients required venoarterial ECMO support for cardiogenic shock. Mean duration of support was 103.8 ± 74.3 hours. Twenty-one patients (46.6%) died while on ECMO support. Twenty-four patients (53.3%) were weaned off ECMO initially, and 11 patients were discharged from hospital. Inhospital mortality was 75.6%. Postoperative complications included acute kidney injury in 30 patients (44.4%), pneumonia in 12 (26.7%), and sepsis in 11 (24.4%). There were 30 deaths (88.2%) attributable to cardiac causes. Preoperative atrial fibrillation, chronic kidney injury, lactic acidosis on ECMO support, and persistent coagulopathy were associated with higher mortality. Postcardiotomy ECMO support in elderly patients is associated with high postoperative morbidity and mortality. Nevertheless, it often provides the last line of therapy for these critically ill patients and may provide positive outcomes in selected subgroups.

Clinical Characteristics of Respiratory Extracorporeal Life Support in Elderly Patients with Severe Acute Respiratory Distress Syndrome

Background: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. Methods: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (≥ 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. Results: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. Conclusions: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.