Syndrome In Elderly Patients Research Articles

TREATMENT OPTIMIZATION IN MANAGEMENT OF COMBINED PATHOLOGY - ARTERIAL HYPERTENSION AND POST-COVID SYNDROME IN ELDERLY PATIENTS.

The aim: Purpose of the study. Our research is aimed at the increase in the treatment effectiveness for combined pathology, namely, arterial hypertension (AH) and post-COVID syndrome in elderly patients at the stage of providing medical care by family medicine general practitioners with the use of statins, anti¬platelet agents, as well as endothelial-protective drug - L-arginine and anxiolytic effect - mebicar against the background of basic antihypertensive therapy. Materials and methods: The study included treatment and observation of 50 elderly patients with hypertension and post-COVID syndrome. The average age was 68.7«1.89 years. Results: The use of mebicar with moderate tranquilizing (anxiolytic) effect and endothelium-protector - L-arginine in the comprehensive treatment of elderly patients with combined pathology - AH and post-COVID syndrome contributed to the elimination of the main clinical symptoms (headache, poor sleep) in a shorter time; provided significant decrease in the level of systolic blood pressure, reactive anxiety, the decrease in total blood cholesterol, and improvement in blood rheology. Conclusions: Treatment optimization for combined pathology - arterial hypertension and post-COVID syndrome in elderly patients with the use of L-arginine and mebicar in comprehensive treatment, improves the quality of patients' life, reduces the treatment duration.

Comparative study of different combinations of mirabegron and antimuscarinics in treatment for overactive bladder syndrome in elderly patients.

To compare the therapeutic efficacy, adverse events (AEs), and patient preference in elderly patients with overactive bladder (OAB) receiving different combinations of mirabegron and solifenacin. Elderly OAB patients received mirabegron 25 mg (M25) daily for 1 month (1M) followed by randomization to receive M25 (Group 1), mirabegron 50 mg (M50, Group 2), solifenacin 5 mg (S5, group 3); or M25 plus S5 (Group 4) for further 2 months. Efficacy and AEs were evaluated. At the end of 3M, patients' preferred option for future treatment was investigated. A total of 168 patients were enrolled, and 100 completed 3-month treatment. At 1M, all parameters improved significantly except postvoid residual (PVR), 23 (13.7%) patients had no symptom, 16 (9.5%) had no improvement, and 10 (6.0%) withdrew from the trial. Compared parameters at 3M with 1M revealed that quality of life, Patient's Perception of Bladder Condition scores, and voided volume improved significantly in group 1; the OAB Symptom Score (OABSS) increased in group 2; mean PVR and Global Response Assessment (GRA) deteriorated in group 3; and the OABSS and GRA improved in group 4. At 3M, the AEs prevalence increased significantly in group 3. Only 38.1% in group 4 preferred long-term usage of combination therapy. M25 daily is effective and safe in treating elderly OAB patients. Dose escalation to 50 mg or shifting to S5 does not increase the therapeutic efficacy. Combining M25 with S5 provides better treatment efficacy but is associated with lower patient compliance than M25 alone.

Gender discrepancies in predictors for newly onset cardiovascular events and metabolic syndrome in elderly patients from rural China.

The study aimed to estimate the possible predictors of cardiovascular events (CVEs) in elderly patients with metabolic syndrome (MetS) from rural China. Moreover, we also attempted to find the potential risk factors for newly diagnosed MetS. The Northeast China Rural Cardiovascular Health Study (NCRCHS) is a community-based prospective cohort study carried out in rural areas of northeast China. Approximately 1,059 elderly patients with MetS but no cardiovascular diseases and 1,565 elderly patients without MetS at baseline were enrolled in this study. They underwent a physical examination, completed a questionnaire in 2012-2013, and were followed up during 2015-2017. Cox proportional hazard analysis was conducted to assess the possible predictors of newly developed CVEs, and multivariate analysis was used to estimate the risk factors of newly diagnosed MetS. The common predictors of newly developed CVEs in both men and women were family history of stroke (HR [hazard ratios] female: 1.696; HR male: 2.504) and soybean consumption (HR female: 0.253; HR male: 0.130). Moreover, minority race (HR: 0.109), systolic blood pressure (SBP) (HR: 1.021), current drinking habits (HR: 2.551), family history of hypertension (HR: 2.297), LDL-C (HR: 1.669), 5,000-20,000 CNY/year annual income (HR: 0.290), and strenuous physical activity (HR: 0.397) were predictors of CVEs only in male elderly patients. For newly diagnosed MetS, body mass index (OR female: 1.212; OR male: 1.207) and fasting blood glucose (OR female: 1.305; OR male: 1.217) were common risk factors in both genders, whereas age (OR:0.958) was a protective factor in men and > 9-h/day sleep duration (OR:0.212) was a protective factor in women. In addition, SBP (OR:1.014) ≥4 times/day, bean consumption (OR:1.955), and uric acid (OR:1.005) increased the risk of MetS in men but not in women. Our study identified many effective predictors of CVEs in rural elderly patients with MetS and confirmed the presence of a gender-based discrepancy. Moreover, we also identified additional risk factors, along with the traditional ones, for newly diagnosed MetS in rural elderly patients.

Correlation between Neutrophil-to-lymphocyte ratio and Euthyroid Sick Syndrome in elderly patients with proximal femur fractures.

Proximal femur fractures are among the most common type of trauma in elderly patients, and Euthyroid sick syndrome has already been related to fractures and trauma. The evidence of a consistent inflammatory state occurring during hip fracture, made us consider as a potential marker also the neutrophil-to-lymphocyte ratio (NLR), which is already in use to measure the prognosis and guide the therapeutic management in various conditions. A retrospective observational analysis on patients affected by proximal femur fractures was conducted. Patients were divided between affected and non-affected by Euthyroid Sick Syndrome (ESS). Standard follow up was conducted at 1, 3, 6 and 12 months. 79 patients were enrolled in this study. There were 19 males and 60 females, the mean age was 83.8 ± 6.5 y.o., and 44 patients were affected by ESS. Affected patients showed higher NLR values (10.2 ± 9.4 vs. 6.9 ± 3.9; p= 0.001) and higher decrease in fT3 values in the 1st post-operative day (1.8 ± 0.4 vs. 2.2 ± 0.3; p= 0.001), higher values of PTH (97.9 ± 46.2 vs. 70.1 ± 36.2; p=0.004) and lower levels of Vitamin D (18.8 ± 7.8 vs. 23.5 ± 12.9; p= 0.04). As regards complications, we found them in 27% of patients in group A, while only in 8% in Group B, with a statistically significant difference (p= 0.03). ESS and NLR are promising prognostic markers in PFF in the elderly patients. If used together, they could help in the pre- and post-operative management of the patients.

Frequency of occurrence of colorectal bradyarrhythmia syndrome in elderly patients

One of the key problems of modern medicine is the bradienteria syndrome, which is manifested by a slowdown in the circadian rhythm of the enteral evacuation function at a frequency of defecation less than 7 times a week. From the standpoint of chronobiology and chronomedicine, the regularity of the circadian rhythm of defecation is the same circadian rhythm of the body as the regularity of the sleep-wake cycle. However, the chronophysiological mechanism of the regularity of the intestinal rhythm and the frequency of its occurrence among people of different ages remains poorly understood. The chronophysiological mechanism of violation of the regularity of the circadian rhythm of defecation shown in our work indicates the need to observe not only the frequency, but also the morning acrophase of this rhythm for the prevention of many complications arising from bradienteria in patients with chronic constipation.

Effects of Personalized Nursing plus Dietary Nursing Management on LP-PLA2, Hcy Levels, and Quality of Life in Elderly Patients with Acute Coronary Syndrome.

Objective To explore the effect of individual nursing combined with dietary management on blood glucose levels and quality of life in elderly patients with acute coronary syndrome with diabetes. Method This study included 68 elderly patients who underwent acute coronary syndrome at Department of Emergency in our hospital from January 2018 to January 2020. And they were assigned to a control group (n = 34) treated with individual nursing and a research group (n = 34) treated with individual nursing and dietary management according to the random number table. A comparison of the changes in blood glucose levels, anxiety and depression, quality of life, and nursing satisfaction was made between groups before and after nursing. Result Before nursing, the differences in blood glucose levels, SAS scores, and SDS scores between groups were not considered statistically significant (P > 0.05). After nursing, the blood glucose levels, SAS, and SDS levels of patients in both groups significantly decreased, and the research group presented a higher decrease when compared with the control group (P < 0.05). The short form health survey (SF-36) showed that the research group had higher scores in physical function (PF), general health (GH), vitality (VT), mental health (MH), social function (SF), role-physical (RP), bodily pain (BP), and role-emotional (RE) compared with the control group (P < 0.05). The satisfaction survey presented that the research group had a significantly higher total score than the control group [(91.40 ± 5.23) vs. (86.61 ± 7.14), P < 0.05]. Conclusion The combination of individual nursing and dietary management not only effectively reduces glycosylated hemoglobin levels and anxiety and depression but also wins better nursing satisfaction in the treatment of acute coronary syndrome in elderly patients. Moreover, their quality of life has been significantly improved after discharge.

Associated factors with metabolic syndrome in elderly patients harboring adrenal incidentaloma: A comparative study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Antiplatelet Therapy in Non-ST-Segment Elevation Acute Coronary Syndromes in Elderly Patients. POPular AGE Hypothesis

Background: The POPular AGE study demonstrated that in patients over 70 years of age clopidogrel would be the P2Y12 receptor inhibitor (P2Y12i) of choice due to its association with lower bleeding incidence and no difference in ischemic events. Objective: We analyzed the safety and efficacy of different treatment regimens with P2Y12i, in patients ≥70 years with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) to test the “POPular AGE” hypothesis in the real world. Methods: This subanalysis of the prospective BUENOS AIRES I registry analyzed data corresponding to 1100 patients from 21 medical centers in Buenos Aires, Argentina, followed-up for 15 months. We considered the subgroup of patients ≥70 years, stratified according to the P2Y12i indicated at discharge. Results: This subgroup had a high burden of comorbidities, with 85.1% hypertension, 30.3% diabetes mellitus, and 43.2% chronic kidney disease. Patients treated with ticagrelor/prasugrel (n=54) presented with higher prevalence of active smoking, less atrial fibrillation and lower CRUSADE score, with no differences in the GRACE score, compared whit those treated with clopidogrel (n=286). At the 15-month follow-up, no significant differences were observed in the BARC ≥2 bleeding rate, with more events in the clopidogrel group, although without statistical significance, (25.4% vs. 18.2%; p=0.327) and a benefit in the incidence of major adverse cardiovascular events (MACE) in the ticagrelor/prasugrel treatment group (18.6% vs 36.3%, p= 0.023). Conclusions: In adequately selected patients with NSTE-ACS ≥70 years, treatment with Ticagrelor/prasugrel could be a safe and effective strategy.

The Frequency of the Main Geriatric Syndromes in Elderly Patients of the Social Institution of Kyrgyz Republic

The Frequency of the Main Geriatric Syndromes in Elderly Patients of the Social Institution of Kyrgyz Republic

Outcomes of Very Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome: Observational Study

Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome in elderly patients has not been published so far. To compare the baseline characteristics and outcomes of STEMI and NSTEMI patients. Retrospective, observational study of patients hospitalized for ACS between January 2018 and December 2019 in the cardiology department of the university hospital of Sfax. The main outcome measure was the incidence of major adverse cardiovascular events (MACE) including cardiovascular death, reinfarction, and stroke. Of 158 ACS patients aged ≥ 75 years (median age 79.72 years, interquartile range 75-97), 33% were classified as ST-elevation myocardial infarction (STEMI), and 67% had non-ST-elevation myocardial infarction (NSTEMI). As compared with those with NSTEMI, STEMI patients had more favorable baseline risk factors with a lower Charlson comorbidity index (3.48 ± 0.18 versus (vs.) 3,84 ± 0.96, P = 0.031), less kidney failure (19.2% vs. 44%, P = 0.005), less prior coronary events (15.7% vs. 44%, P = 0.006) but more severe coronary disease (double vessel disease and triple vessel disease were respectively (45.7% vs. 22%, P = 0.005) and (37% vs. 15.9%, P = 0.007). At a median follow-up of 12 months, MACE were more frequents in STEMI group (26% vs. 13.5%, P = 0.05). Despite more favorable baseline characteristics, elderly STEMI patients have a higher risk of major cardiovascular events compared with NSTEMI patients.

Predictive Value of Serum Lipoprotein-Associated Phospholipase A2 for Type 2 Diabetes Mellitus Complicated with Metabolic Syndrome in Elderly Patients

The aim was to investigate the predictive value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) for type 2 diabetes mellitus (T2DM) complicated with metabolic syndrome (MS) in elderly patients. A total of 296 patients with T2DM admitted from January 2019 to January 2021 were enrolled and assigned to MS group (n = 181) and non-MS group (n = 115). Their clinical data and laboratory test results were compared. Logistic regression analysis was employed to identify independent risk factors for MS in T2DM patients. Spearman's analysis was utilized to explore the correlations between serum Lp-PLA2 level and detection indicators. The predictive value of Lp-PLA2 for MS was analyzed by plotting receiver operating characteristic (ROC) curve, and Cox regression model was applied to explore the correlation of serum Lp-PLA2 level with MS. The results of data subjected to multivariate analysis were used to construct prediction models. The incidence rate of MS was 61.15% in T2DM patients. MS group had a significantly higher serum level of Lp-PLA2 than non-MS group (p < 0.05). Serum Lp-PLA2 was significantly positively correlated to FBG, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), FINS, and HOMA-IR, but significantly negatively associated with LDL-C (p < 0.05). The area under the ROC curve of Lp-PLA2 for predicting MS in T2DM patients was 0.724 (95% CI: 0.625 - 0.826, p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of Lp-PLA2 with an optimal cutoff value of 82.96 ng/mL were 73.7%, 85.4%, 77.56%, and 93.24%, respectively. TC, TG, HDL-C, HbA1c, and Lp-PLA2 were independent risk factors for MS (p < 0.05). The area under the ROC curve of the risk prediction model established based on these indicators was 0.823, and the cutoff value, Youden index, sensitivity, and specificity were 0.219, 0.656, 78.87%, and 87.66%, respectively, indicating higher predictive value. Increased serum Lp-PLA2 level is an independent risk factor for MS in T2DM patients. Lp-PLA2 (82.87 ng/mL) has high predictive value for MS.

Association between atrial fibrillation, frailty, and geriatric syndromes in the late elderly in a south Belgian outpatient and inpatient setting

Study objectiveThis study aims to analyze the relationship between AF, frailty, and geriatric syndromes in elderly patients in an outpatient and inpatient setting in a South Belgian hospital. Participants, design and settingThis is a single center case-control retrospective study including 207 patients enrolled from an outpatient and inpatient setting of the Department of Geriatrics, Jolimont Hospital Group. Frailty was assessed using a complete geriatric assessment and Rockwoods Clinical Frailty Scale. ResultsAF was strongly associated with age, cardiovascular history, congestive heart failure, as well as with multiple geriatric syndromes such as vascular dementia, malnutrition, functional decline in Activities of Daily Living, mobility impairment and chronic ulcerous disease. Furthermore, there was a tight relationship between AF and Rockwoods' frailty phenotypes. This association was maintained throughout multivariable modelling including age (OR 1.06, IC 1.03–1.14, p = 0.042), sex (OR 2.30, IC 1.11–4.84, p = 0.026), congestive heart failure (OR 3.70, IC 1.77–7.91, p < 0.001) and a CFS more than 4 (OR 2.68, IC 1.18–6.43, p = 0.021). ConclusionA deeper understanding of associations between atrial fibrillation and geriatric syndromes and frailty could give new patient management perspectives beyond pharmaceutical or interventional treatment.

Socio-Demographic Characteristics and Association of Risk Factors with Type of Acute Coronary Syndrome in Elderly Patients

Socio-Demographic Characteristics and Association of Risk Factors with Type of Acute Coronary Syndrome in Elderly Patients

Geriatric assessment in elderly patients receiving oral anticoagulants: results of the nursing study

Abstract Background It is well known that thrombosis and bleeding risk increases with age, in the same time prevalence of geriatric syndromes increases too. It can influence negatively on efficacy and safety of anticoagulant therapy. However, impact of geriatric syndromes is often underestimated in clinical practice. Purpose To evaluate prevalence of geriatric syndromes in elderly patients receiving oral anticoagulants (OAC). Methods This study enrolled 510 patients (19% male) aged 75–100 (mean 82±4) years hospitalized to our clinic consecutively from June to November in 2019. Nurses examined all patients according to specially designed nursing assessment algorithm that included Mini-Cog test, Morse Fall and Norton scales, Barthel Activities of daily living Index, Short Physical Performance Battery (SPPB) tests, Mini Nutritional Assessment (MNA) scale, Geriatric Depression Scale (GDS-15), and some other questionnaires. Before hospitalization, 61 patients (12%) received OAC due to atrial fibrillation (AF) (83,6%), venous thromboembolism (VTE) (9,8%) and AF+VTE (6,6%). In all patients, AF frequency was 21% (n=107), but OAC were prescribed in 51% (n=55) only. Patients receiving OAC (group 1; n=61) did not differ from those without OAC (group 2; n=449) by age, sex, frequency of hypertension, previous myocardial infarction and revascularization, stable angina, and some other chronic diseases. Results Patients in group 1 had lower score on Norton scale (17,2±2,3 vs 18,1±1,8; p=0,001), Barthel Index (87,9±19,1 vs 94,4±10,7; p&amp;lt;0,001), SPPB (4,5±3,1 vs 6,0±3,3; p=0,001), walk speed (0,50±0,44 vs 0,60±0,30 m/s; p=0,014) and higher score on Morse Fall scale (47,8±20,7 vs 39,8±20,6; p=0,005) compared to patients in group 2. They had higher frequency of frailty (SPPB tests ≤7 score) (82% vs 66%; p=0,011), functional dependence (Barthel Index ≤60 score) (71% vs 44%; p&amp;lt;0,001) and pressure ulcers high risk (Norton scale ≤13 score) (6,6% vs 1,6%; p=0,012). They also had higher frequency of fall in the past year (57% vs 41%; p=0,017), high fall risk (Morse Fall scale ≥51 score) (38% vs 28%; p=0,073) and subcutaneous hematomas (25% vs 12%; p=0,009). Univariate regression analysis with age and sex adjustment showed that patients receiving OAC had higher risk of functional dependence (OR 3,05; 95% CI 1,69–5,49; p&amp;lt;0,001), frailty (OR 2,31; 95% CI 1,16–4,62; p=0,018) and pressure ulcers high risk (OR 4,24; 95% CI 1,19–15,16; p=0,026). OAC therapy was also associated with falls in the past year (OR 1,94; 95% CI 1,13–3,35; p=0,016) Conclusion Patients receiving OAC had a higher incidence of some geriatric syndromes, such as frailty, functional dependence, falls, pressure ulcers high risk, and lower functional status compared to patients without OAC. Nursing assessment of geriatric patients provides physician with additional data that allows to identify factors potentially affecting the efficacy and safety of OAC therapy. Funding Acknowledgement Type of funding sources: None.

Geriatric syndromes in elderly patients with myocardial infarction

Abstract Introduction The average age of patients with acute coronary syndrome ACS has been progressively increasing in recent decades. Recommendations for the management of patients with ACS emphasize the importance of a patient-oriented approach, including aged 75 and over. Purpose To assess the geriatric status in elderly patients with myocardial infarction MI. Methods 92 patients with MI were studied, mean age 81.6±4.2. Questionnaire “age is no disqualification”, The Short Physical Performance Battery, Mini Nutritional Assessment- MNA, Barthel Activities of daily living Index, Instrumental Activities of Daily Living, gait velocity, “Get up and go”, dynamometry, Mini Mental State Examination- MMSE, clock drawing test, geriatric depression scale- GDS. Statistical data processing was performed using the Statistica for Windows ver 10.0. Results The frailty syndrome FS was in 38.0% patients, preasthenia in 17.4%, 44.6% without FS. Impairment of memory, understanding, orientation was in 85.7% fragile, 87.5% of pre-fragile, 36.6% in strong, p&amp;lt;0.001. In FS group, visual and hearing impairments were 85.7% versus 50.0% with preasthenia, 24.4% without FS (p&amp;lt;0.001). Episodes of urinary incontinence were 7.3% in strong, pre-fragile – 62.5%, fragile – 57.1%, p&amp;lt;0.001. Difficulty gait- 43.8% in preasthenia, 19.5% without FS, in FS group 68.6%, p&amp;lt;0.001. 34.1% of strong, 75% of pre-fragile and 82.9% of fragile used a walking stick. The majority of strong – 85.4% and preasthenia – 81.3% took daily walks. Constant pain is experienced by 9.8% strong, 6.3% pre-fragile, 31.4% fragile. According to MNA data, the lowest scores were in fragile – 23.2±2.5, without FS – 26.5±1.7 (p=0.000), 25.4±1,6 in pre-fragile (p=0.002). The risk of malnutrition was in 7.3% without FS, 18.8% in preasthenia, 54.3% with FS. The baseline PA in without FS group and preasthenia was the same, the Barthel Index – 100 [100; 100], with FS – 95 [85; 100]. A pronounced dependence on outside help experienced 5.7%, 25.7% moderate, 40% mild. The time to complete the “Get up and go” averaged 11.8±4.2 for strong, 16.3±5.4 for preasthenia, 20.3±6.3 for fragile. The average pinch strength in the group without FS was 18.8±8.1 kg of the right hand and 16.3±7.3 kg of the left hand, it is higher than in preasthenia 11.1±5.6 kg and 8.3±3.9kg, p=0.000), FS 10.0±4.7kg and 8.5±4.6kg, p=0.000. 36.6% without FS, 12.5% with preasthenia, 8.6% with FS had no cognitive deficiency and scored 28–30 points on the MMSE. Strong received 8.5 [8; 9] in clock drawing test, preasthenia – 7.6 [7; 9], fragile – 6.7 [6; 8.5]. GDS revealed probable depression in 34.1% without FS, in 75% preasthenia, 88.2% with FS. Conclusion In patients with MI and FS, geriatric syndromes were significantly more often detected, reflecting disorders of physical and mental health and performance status, which can serve as additional criteria for predicting the risks of unfavorable outcomes in MI in elderly and long-livers. Funding Acknowledgement Type of funding sources: None.

Impairment of stability and gait in elderly patients of a social inpatient institution of the Kyrgyz Republic

Objectives to study the frequency of impairments of the ability to move in elderly patients care recipients of a social inpatient institution of the Kyrgyz Republic. Material and methods. We examined 88 inmates of a social inpatient institution, among them there were 47 (53,4%) men and 41 (46,6%) women aged 65 to 74 years. The average age was 71,96,4 years. Results. Disorders of general motor activity were observed in 62 (70,55,31%) patients. The violations of stability and walking parameters were more pronounced, they were found in 70 (79,55,04%) and 71 (80,76,31%) patients respectively. When assessing the parameters of stability, the disturbances were observed in all positions; mostly they manifested themselves during the tests for standing with closed eyes (46,64,27; р0,05) and when leaning back (44,33,83; р0,05). Conclusion. A comprehensive geriatric assessment to identify the main geriatric syndromes in elderly patients of residential social institution should become an integral part of the organization of medical care aimed at solving these problems and the subsequent mandatory correction of these disorders.

Pain in dementia

Increasing life expectancy of the world’s population is accompanied by increasing number of elderly patients with dementia. According to various studies, the prevalence of pain syndrome in elderly patients with dementia ranges from 35.3% to 63.5%. The review represents data on the epidemiology, clinical manifestations, methods of diagnosis and treatment of pain syndrome in patients with dementia. Medicinal and non-pharmacological methods of pain relief are discussed.

Non-ST-segment elevation acute coronary syndrome in elderly patients and long-livers. Features of treatment. Literature review and case report

Despite the growing population of elderly people and long-livers every year, the treatment of acute coronary syndrome in these groups is not fully developed and is not regulated in clinical guidelines due to the lack of large randomized clinical trials. The article presents a literature review covering the following issues arising during clinical decision-making in the treatment of non-ST-segment elevation acute coronary syndrome in this group of patients: selection of invasive treatment strategy, scope of myocardial revascularization, appointment of dual antiplatelet therapy taking into account the bleeding risk, decreased renal function and senile asthenia. In addition, a case report of successful treatment of a 101-year-old female patient with non-ST-segment elevation myocardial infarction, who underwent percutaneous coronary intervention with stenting of infarct-related artery, was presented.

Self-care Behavior and Frailty Syndrome among Elderly Patients with Heart Failure

BACKGROUND: The development of technology gives an impact on life expectancy in the elderly. In Yogyakarta, the total of the elderly was higher than in other provinces in Indonesia. The elderly experience a decreased functional state that may lead to impaired body organs, such as heart failure. Heart failure has increasingly become a serious health problem. At present, 80% of elderly patients experience heart failure because of a decrease in functional status. The elderly may also experience frailty syndrome, which can provide a poor prognosis in terms of mortality, rehospitalization, and quality of life. It needs complex management; one of these is self-care behavior that can prevent the spread of frailty syndrome. AIM: The study aims to assess the correlation between self-care behavior and frailty syndrome in elderly patients with heart failure. METHODS: The study included 87 elderly patients with heart failure who visited the cardiology outpatient unit in two private hospitals. Self-care was measured using the self-care heart failure index, and frailty syndrome was assessed using the frailty index. A correlation test was conducted using Spearman rho. RESULTS: The result showed inadequate self-care behavior with a mean score of 48.70. The mean score of frailty syndrome was 0.142, categorized in the pre-frail phase. No correlation was found between self-care behavior and frailty syndrome with p=0.20. CONCLUSION: Self-care behavior in elderly patients with heart failure is still inadequate and in the pre-frail phase. Nurses and other health professionals should consider intervention to increase self-care behavior among the elderly and screening to increase their awareness of frailty syndrome.

Higher Frequency of Undetected Acute Coronary Syndrome in Elderly Patients with Chest Pain Who Visited the Emergency Department: A Large-Cohort Retrospective Study.

Background Acute coronary syndrome (ACS) is a critical disease encountered in the emergency department (ED). Despite the development of diagnostic tools, it may be difficult to diagnose ACS because of atypical symptoms and equivocal test results. We investigated the difference in the rates of revisit and undetected ACS between adult and elderly patients who visited the ED with chest pain. Method Data from 11,323 patients who visited the ED with chest pain at university hospitals in Korea were retrospectively analyzed. The cohort was categorized into two age groups: the adult (30–64 years) and elderly (>65 years). Baseline characteristic data (age, sex, vital signs, triage category, etc.) were obtained. We selected patients who revisited the ED within 30 d and investigated whether ACS was diagnosed. Result The revisit rate was higher in the elderly (12%) than in the adult group (8.3%). The rate of undetected ACS among the revisited patients was 2.91% (18/7,186) in adults and 6.08% (16/1,998) in elderly patients. Conclusion Elderly patients with chest pain had an increased rate of ED revisits and undetected ACS than adult patients. We recommend that old patients should be hospitalized to observe the progression of cardiac complaints or receive short-term follow-up.