Variables In Elderly Patients Research Articles

Correlation Between Blood Urea Nitrogen and Short- and Long-Term Glycemic Variability in Elderly Patients with Type 2 Diabetes Mellitus Who Were hospitalized:A Retrospective Study.

Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by insulin resistance and progressively impaired insulin secretion resulting in dynamic fluctuations in glucose levels.High blood urea nitrogen (BUN) levels have been linked to decreased insulin sensitivity, suppressed insulin synthesis and increased risk of incident diabetes mellitus in humans as well as insulin use in patients with T2DM.This study characterize the association between BUN levels and short-term and long-term glycemic variability(GV) in the elderly patients with T2DM who were hospitalized. A total of 927 elderly patients with T2DM were included in the study. The short-term GV was quantified using parameters such as standard deviation (SD), coefficient of variation (CV), time in range (TIR), and mean amplitude of glycemic excursions (MAGE), based on multi-point fingertip blood glucose monitoring. The long-term GV was quantified using parameters such as SD, CV, variation independent of the mean (VIM), and average successive variability (ARV), based on fasting blood glucose(FPG). The relationship between BUN levels and short-term and long-term GV in elderly T2DM who were hospitalized was explored using methods such as Spearman correlation coefficient, linear regression analysis, logistic regression analysis, and interaction tests. In elderly patients with T2DM were hospitalized, there is a significant correlation between BUN levels and both short-term and long-term GV. BUN is negatively correlated with the GV parameter TIR (r=-0.12, P=0.000), and positively correlated with SD (r=0.12, P=0.000), CV (r=0.07, P=0.026), MAGE (r=0.11, P=0.001), FPG-SD (r=0.08, P=0.013), and FPG-CV (r=0.08, P=0.014).Furthermore, the association remains consistent across different age, gender, BMI, and haemoglobin A1c (HbA1c) subgroups (P interaction > 0.05). In elderly patients with T2DM were hospitalized, BUN levels were positively associated with GV.Therefore, monitoring BUN levels were beneficial in assessing the degree of GV.

Cardiovascular risk in elderly Egyptians with myelodysplastic syndromes

BackgroundMyelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell-derived disorders manifested by cytopenias peripherally. MDS initiates an inflammatory process which lead to atherosclerosis. Patients with MDS have 1.5-fold higher risks of cardiovascular risks.ObjectiveEvaluation of cardiovascular risk and unraveling the possible correlation of carotid intima media thickness (CIMT) with clinical, hematologic, and laboratory variables in elderly patients with MDS.MethodsWe conducted a case–control research on 168 participants to elicit the serum level of homocysteine, serum high-sensitive C-reactive protein (Hs-CRP), and CIMT in relation to cardiovascular risk, 84 of whom had MDS diagnoses. From March 2021 to the end of May 2023, we chose them among the inpatients and outpatients of the Menoufia University Hospitals’ Clinical Hematology Division. We contrasted the chosen MDS patients with 84 healthy individuals as controls.ResultsRight and left CIMT were significantly higher in MDS patients than controls as well as for lipid profile, blood pressure, blood sugar, and Hs-CRP. Homocysteine was higher in MDS patients but of no statistical significance.ConclusionAs CIMT and C-reactive protein level were significantly higher in studied patients, we may consider MDS group of patients to have higher risk for cardiovascular disease than normal people.

Association and interaction between clinician-rated measures of depression and anxiety with heart rate variability in elderly patients with psychiatric disorders

BackgroundOlder adults are vulnerable to comorbid depression and anxiety symptoms; however, these conditions are widely underrecognized and often untreated. Understanding their combined manifestation using objective measurements, such as clinician-rated scales and heart rate variability (HRV), can help refine the diagnosis and select a treatment strategy for geriatric patients. MethodsThis study included patients over 65 years who were mainly diagnosed with either category of depressive or anxiety disorders from the psychiatric outpatient clinic in a university hospital. A total of 114 patients met eligibility with a completed collection of electrocardiograms, the Hamilton Depression Rating Scale (HDRS; clinician-rated depression), and the Hamilton Anxiety Scale (HAS; clinician-rated anxiety) to assess the severity of symptoms. Both main and interaction effects between HDRS and HAS on HRV parameters were examined. ResultsSignificant interaction effects between clinician-rated depression and anxiety (HDRS × HAS) on HRV reduction in frequency parameters (i.e., nuLF, nuHF, LF/HF ratio) were found, which consistently indicated autonomic nervous system dysregulation. Findings imply that HRV could reflect synergistic effects of comorbid depressive and anxiety symptoms, perhaps due to the amplification of individual symptoms in geriatric patients. ConclusionsThe results imply that using objective measurements can improve diagnostic accuracy, particularly in geriatric patients with comorbid status, and the normalization of the autonomic nervous system might be a candidate target for prevention and treatment.

Evaluation of the Prognostic Value of Heart Rate Variability in Elderly Patients with Multivessel Coronary Artery Disease against the Background of Invasive and Non-Invasive Treatment

The purpose of this study was to evaluate the prognostic value of HRV in elderly patients with multivessel coronary artery disease (MVCAD) on the background of invasive and non-invasive treatment. Methods and Results: This study included 254 patients over age 65 with lesions of the left trunk of the left coronary artery in combination with lesions of 2 or more coronary arteries. To assess HRV, all patients underwent 24-hour Holter ECG monitoring at baseline and one year later. Depending on the treatment strategy, patients were divided into 3 groups. Group 1 consisted of 99 patients who, in addition to the standard treatment, underwent PSI (from 1 to 4 stents); Group 2 included 86 patients who, in addition to the standard treatment, underwent CABG (from 2 to 4 shunts); Group 3 included 69 patients who received only optimal drug therapy (ODT). The results have shown that a decrease in HRV is an independent predictor of complications associated with an increase in coronary insufficiency in CAD patients. Such indicators of HRV as SDNN, SDNNi, TP, VLF, and LF have a significant positive predictive value in patients undergoing ODF and/or undergoing PCI. For patients undergoing CABG, at least in the first year after surgery, HRV cannot be considered as an independent prognostic marker. For elderly patients with MVCAD, 24-hour Holter ECG monitoring with subsequent analysis of HRV is recommended to assess the recovery process and pharmacotherapy.

Effects of Teneligliptin on HbA1c levels, Continuous Glucose Monitoring-Derived Time in Range and Glycemic Variability in Elderly Patients with T2DM (TEDDY Study).

BackgroundTo evaluate the effects of teneligliptin on glycosylated hemoglobin (HbA1c) levels, continuous glucose monitoring (CGM)-derived time in range, and glycemic variability in elderly type 2 diabetes mellitus patients.MethodsThis randomized, double-blinded, placebo-controlled study was conducted in eight centers in Korea (clinical trial registration number: NCT03508323). Sixty-five participants aged ≥65 years, who were treatment-naïve or had been treated with stable doses of metformin, were randomized at a 1:1 ratio to receive 20 mg of teneligliptin (n=35) or placebo (n=30) for 12 weeks. The main endpoints were the changes in HbA1c levels from baseline to week 12, CGM metrics-derived time in range, and glycemic variability.ResultsAfter 12 weeks, a significant reduction (by 0.84%) in HbA1c levels was observed in the teneligliptin group compared to that in the placebo group (by 0.08%), with a between-group least squares mean difference of –0.76% (95% confidence interval [CI], –1.08 to –0.44). The coefficient of variation, standard deviation, and mean amplitude of glycemic excursion significantly decreased in participants treated with teneligliptin as compared to those in the placebo group. Teneligliptin treatment significantly decreased the time spent above 180 or 250 mg/dL, respectively, without increasing the time spent below 70 mg/dL. The mean percentage of time for which glucose levels remained in the 70 to 180 mg/dL time in range (TIR70–180) at week 12 was 82.0%±16.0% in the teneligliptin group, and placebo-adjusted change in TIR70–180 from baseline was 13.3% (95% CI, 6.0 to 20.6).ConclusionTeneligliptin effectively reduced HbA1c levels, time spent above the target range, and glycemic variability, without increasing hypoglycemia in our study population.

The relationship between nutritional status and heart rate variability in elderly patients

The relationship between nutritional status and heart rate variability in elderly patients

The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: a prospective observational study

BackgroundThis study aimed to explore predictive factors of time below target glucose range (TBR) ≥ 1% among patients’ characteristics and glycemic variability (GV) indices using continuous glucose monitoring data in elderly patients with type 2 diabetes.MethodsWe conducted a prospective observational study on 179 (71 female) Japanese outpatients with type 2 diabetes aged ≥ 65 years. The characteristics of the participants with TBR ≥ 1% were evaluated by multivariate logistic regression analysis. Receiver-operating characteristic (ROC) curve analyses of GV indices, comprising coefficient of variation (CV), standard deviation, and mean amplitude of glycemic excursions, were performed to identify the optimal index for the identification of patients with TBR ≥ 1%.ResultsIn the multivariate logistic regression analysis, none of the clinical characteristics, including HbA1c and C-peptide index, were independent markers for TBR ≥ 1%, while all three GV indices showed significant associations with TBR ≥ 1%. Among the three GV indices, CV showed the best performance based on the area under the curve in the ROC curve analyses.ConclusionsAmong elderly patients with type 2 diabetes, CV reflected TBR ≥ 1% most appropriately among the GV indices examined.Trial registration UMIN-CTR: UMIN000029993. Registered 16 November 2017

A presença de sarcopenia ou dinapenia influencia a relação entre a força de preensão palmar com o estado de saúde e a força muscular inspiratória em pacientes idosos com DPOC

The objective of this study was to investigate the presence of sarcopenia or dinapenia, and the association between handgrip strength (PPF) with health status and inspiratory muscle strength in elderly patients with chronic obstructive pulmonary disease (COPD). The study's findings suggest that, in the presence of sarcopenia, FPP was related to health status and inspiratory muscle strength. In addition, in this same group, FPP influenced the outcome variables in elderly patients with COPD. Elderly; Pulmonary Disease Chronic Obstructive; Sarcopenia.

Effect of acupuncture on blood pressure variability in elderly patients with cerebral infarction complicated with essential hypertension

To observe the therapeutic effect of acupuncture on blood pressure variability (BPV) in elderly patients with cerebral infarction complicated with essential hypertension. Seventy-six elderly patients with cerebral infraction complicated with essential hypertension were randomized into an observation group and a control group, 38 cases in each group. Xingnao Kaiqiao acupuncture and nifedipin were given in the control group. On the basis treatment in the control group, the Huoxue Sanfeng and Tiaohe Ganpi acupuncture was applied at Renying (ST 9), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36) and Taichong (LR 3) in the observation group for 30 min. The treatment was given once a day, 5 times a week for 8 weeks. The 24-hour ambulatory blood pressure was monitored in the two groups. The changes of blood pressure and blood pressure variability were observed before and after 8 weeks of treatment, and the occurrence of adverse reactions during the treatment were recorded. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), daytime SBP, DBP, nighttime SBP and DBP were reduced in the two groups after 8 weeks of treatment (P<0.05), and the results in the observation group were lower than those in the control group (P<0.05). After 8 weeks of treatment, the daytime, nighttime, 24 h systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) in the observation group were lower than those before treatment (P<0.05), there was no significant difference between before and after treatment in the control group (P>0.05). Huoxue Sanfeng and Tiaohe Ganpi acupuncture method can effectively control the blood pressure and blood pressure variability in the elderly patients with cerebral infraction complicated with essential hypertension.

A Prospective Study Identifying a Change in Energy and Protein Intake of Older Adults during Inpatient Rehabilitation.

Understanding older patients’ dietary intake patterns may improve the timing of strategies to address hospital malnutrition. The aims of this study were to explore longitudinally the change in daily energy (kJ/day) and protein (g/day) intake, and associated factors. Data were derived using a 5-point scale to visually estimate plate waste, and known nutrient composition data. Analyses determined the change in intake between admission and day 14, and admission, day 14 and day 28, respectively. Data were available for 39 participants between admission and day 14 (median (interquartile range) age 82 (78–87) years; 54% male) and 12 participants between admission, day 14 and day 28 (median (IQR) age 79 (69–84) years; 58% male). From admission to day 14 there was a significant increase in the mean (SD) daily intake of energy (6177 (1879) kJ/day vs. 7213 (1903), p < 0.001) and protein (63.7 (23) g/day vs. 76.4 (23.0) g/day, p = 0.003) but no change from admission to day 14 to day 28. There was a significant inverse relationship between amount consumed at admission and change in intake. Variability in elderly patients’ intake over time has implications for the timing of nutritional care and data collection in research studies.

Prevalence and Predictors of Abuse in Elderly Patients with Depression at a Tertiary Care Centre in Saurashtra, India.

Context:Elder abuse has devastating consequences such as poor quality of life, psychological distress and loss of property and security. Abuse of elderly patients with depression has not been adequately researched in India.Aims:To explore the prevalence and predictors of abuse and its relation to various sociodemographic variables in elderly patients with depression.Settings and Design:A cross-sectional, observational study carried out at a tertiary care centre in Jamnagar.Methods and Materials:In all, 100 elderly patients with depression, attending Out Patient Department of Psychiatry at Shree M. P. Shah Government Medical College and Guru Gobind Singh Hospital, Jamnagar, were selected using simple random sampling by lottery method. Actual Abuse Tool and Elder Abuse Suspicion Index were used to detect abuse. Geriatric Depression Scale was used to assess depression, and Mini Mental State Examination was used to rule out dementia.Statistical Analysis:Descriptive statistics, Chi-square test, and binary logistic regression were used.Results:The prevalence of abuse was 24%. Among those who had experienced abuse, 50% had experienced psychological abuse, 17% had experienced neglect, 8% had experienced exploitation and 4% had experienced physical abuse. About 54% of patients with severe depression had experienced abuse. Daughters-in-law (54%) and sons (42%) were the most common perpetrators. Illiteracy and severe depression were found to be the predictors of abuse.

Effects of depression on heart rate variability in elderly patients with stable coronary artery disease

Depression is an independent risk factor in coronary artery disease (CAD). Our objective was to evaluate the impact of depression on heart rate variability (HRV) in patients with stable CAD. This study included patients with a stable CAD who admitted to our hospital in the geriatric medical center from August 2016 to December 2016. All patients agreed to participate in the study and sign informed consent. The study group included 90 CAD patients with a diagnosis of depression and 99 CAD patients without depression. All study population underwent a 24-hour Holter recording for HRV. The depression was assessed by 5-Item Geriatric Depression. There was a linear correlation between age and HRV. There were no significant differences in heart rate variability between male and female patients, married and unmarried/widowed, smoking and nonsmoking, drinking and nondrinking groups. Multiple linear regression analysis showed that there were correlations between depression and HRV. β-blockers were associated with SDNN, SDANN, SDNN index, and RMSSD in HRV. Depression is an important risk factor for heart rate variability in elderly patients with CAD. Clinicians should pay attention for evaluation of depressive patients with CAD.

Abstract WP334: In-hospital Systolic Blood Pressure Variability in Elderly Patients With Primary Intracerebral Hemorrhage

Introduction: Systolic blood pressure (SBP) regulation is the cornerstone of intracerebral hemorrhage (ICH) management, and SBP variability (SBPV) is associated with poor outcomes. We aimed to determine SBPV patterns and associated factors in a prospective cohort of ICH patients. Methods: Primary ICH patients are consented, assessed in-hospital and followed up at 30 and 90 days. All SBP values and BP management details for the hospital stay were collected from electronic medical records. Day and night intervals were defined as 0601 - 2159hrs and 2200 - 0600hrs, respectively. Mean and standard deviation (SD) were calculated for all intervals in each patient. Overall, between and within patient SBPV for day and night was characterized by generalized estimating equation (GEE)-based methods. We identified patients with a high SBPV (HSBPV) and built logistic regression models to determine associated factors. Results: Thus far, 158 patients have been enrolled, with detailed SBP data was available for 126. Total in-hospital follow-up period is 1,446 days [Median (IQR): 8 (4.25 - 15)]. We analyzed 34,740 SBP readings, yielding 3,010 day/night intervals. The in-hospital mean (SD) SBP was 138.2 (15.6) mmHg. GEE-based estimates for mean night SBP were significantly lower compared to day (137.2 v 139.1 mmHg, p &lt; 0.01). Mean SBP SD was 9.1 mmHg between patients while 13.4 mmHg within patients’ individual readings. HSBPV was defined as SD &gt; 13 mmHg. Age and high admission SBP were independently associated with HSBPV after controlling for sex, race, admission NIHSS, ICH score, hemorrhage volume and Nicardipine infusion use (Figure). Enrollments are continuing and updated data with outcomes will be presented. Conclusion: Characterization of patients with HSBPV can help in triage and management decisions based on risk-stratification. Elderly patients may be at a higher risk of SBPV, warranting exploration of possible SBPV contribution to poor outcomes in the elderly.

Heart rate variability in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention and risk of complicated in-hospital period

Heart rate variability in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention and risk of complicated in-hospital period

Study of Insulin Requirement Modeling in Hospitalized Elderly Patients with Type 2 Diabetes at a Late Stage of Stepwise Escalation Therapy.

This study explored the relationships between exogenous insulin requirements and endogenous variables in elderly patients with type 2 diabetes (T2D). Patients with T2D 65 years of age or older were enrolled for a short hospitalization period in order to start or change their basal-bolus therapy. The following data were collected: age, sex, diabetes duration, body mass index, glycosylated hemoglobin, estimated glomerular filtration rate (eGFR), and triglyceride (TG) levels. Data from 71 elderly T2D patients (31 men/40 women; 75.7 ± 6 years of age) were analyzed by data mining techniques. The total daily dose of insulin (TDI) ranged from 0.24 U/kg to 2.5 U/kg (ratio >1:10). Three clusters of patients were identified: Cluster 1 (n = 22) consisted of older patients (age, 82.05 ± 3.6 years) (P < 0.0001) with a TDI of 0.59 ± 0.21 U/kg/day and lower TG level (1.1 ± 0.4 mmol/L) (P < 0.0001). Cluster 2 (n = 22) consisted of patients with a TDI of 0.71 ± 0.24 U/kg/day with a higher eGFR (75.3 ± 18.8 mL/min) (P < 0.001) and a shorter duration of diabetes (13.6 ± 6.4 years) (P < 0.001). Cluster 3 (n = 27) consisted of patients with a larger proportion of macroangiopathic complications (P < 0.05), having a TDI of 1.31 ± 0.54 U/kg/day, higher TG level (2.2 ± 0.7 mmol/L) (P < 0.001), and lower eGFR (46.3 ± 16 mL/min). The average basal-bolus ratio was 43%/57% with a maximum bolus requirement due to carbohydrate intake at breakfast. Insulin requirements in elderly T2D patients vary widely. Age, TG level, and eGFR appeared to be the most predictive factors of TDI. Because of the small sample size, further studies would be required to extrapolate these results.

Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation

Study ObjectiveTo investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation. DesignA randomized, double-blinded, and placebo-controlled study. SettingUniversity-affiliated teaching hospital. ParticipantsEighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia. InterventionsRight stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline. MeasurementsSystolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0); immediately before intubation (T1); immediately after intubation (T2); and 1, 3, and 5 minutes postintubation (T3, T4, and T5). Main ResultsNo significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group. ConclusionSGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.

RESEARCH ON CARDIAC ARRHYTHMIA AND HEART RATE VARIABILITY BASED ON 24- HOUR HOLTER ECG IN ELDERLY PATIENTS WITH DILATED CARDIOMYOPATHY

Objectives: Study several parameters of cardiac arrhythmia and heart rate variability in elderly patients with dilated cardiomyopathy (DCM), investigate the relationship and correlation between these parameters with NYHA functional heart failure class, EF, LVDd in elderly patients with DCM. Subjects and methods: 30 patients with DCM undergone treatment in Cardiovascular Department. Their ages were ≥ 60. These patients were diagnosed heart failure according to Framingham criteria and DCM according to WHO/ISFC criteria. 24-hour Holter ECG was the method used to analyse cardiac arrhythmia as well as heart rate variability (HRV). These parameters were compared with those considered normal of 81 people. Results: Sinus bradycardia accounted for 6.7%, sinus tachycardia 96.7%, sinus pause 13.3%, premature ventricular contraction 76.7%, supraventricular tachycardia 6.7%, ventricular tachycardia 40%. Lown’s classification: Lown’s class I undertook 46.7%, Lown’s class II 53.3%, Lown’s class III 23.3%, Lown’s class IVA 63.3%, Lown’s class IVB 36.7%, V 6.7%, p &lt; 0.01. HRV indices: SDNN: 57.93 ± 16.99 ms, SDANN: 47.33 ± 16.69 ms, SDNNidx: 31.83 ± 11.00 ms, rMSSD: 19.87 ± 4.39 ms, pNN50: 3.67 ± 2.88%, the parameters acquired from case group were lower than those of control group with statistical difference (p &lt; 0.0001). HRV decreased in proportion to NYHA functional heart failure class and LVEF. There was proportional correlation between LVEF with SDNN (r=0.77, p &lt; 0.01), SDANN (r=0.76, p&lt;0.01), SDNNidx (r=0.66, p&lt;0.01), rMSSD (r=0.58, p&lt;0.01), and pNN50 (r=0.69, p&lt;0.01). Conclusion: 24-hour Holter ECG was valuable in detecting cardiac arrhythmia and HRV in elderly patients with DCM. This method also contributed to the following up, treatment and prognosis of this disease. Keywords: Arrhythmia, heart rate variability, dilated cardiomyopathy, elderly

Influencing factors of glycemic variability in elderly patients with type 2 diabetes

To explore the influencing factors of glycemic variability in elderly patients with type 2 diabetes. A total of 337 elderly patients received continuous glucose monitoring (CGM) from January 2007 to January 2011. The evaluation variables of glycemic variability included standard deviation of blood glucose (SDBG), mean amplitude of glycemic excursion (MAGE), absolute means of daily differences (MODD) and postprandial glucose excursion (PPGE). The normal reference value of glycemic variability was defined according to the diagnostic criteria of Chinese Diabetes Society guideline. The difference of glycemic variability was compared by gender, age and diabetic duration. The values of SDBG, MAGE, MODD and PPGE in females were all higher than those in males (P < 0.05) and no difference existed between various age groups. The level of glycemic variability increased gradually with the extension of diabetic duration (P < 0.01). Logistic regression analysis showed that gender (MAGE: OR = 0.44, P = 0.023; SDBG: OR = 0.39, P = 0.023), diabetic duration (MAGE: OR = 1.58, P = 0.006; SDBG: OR = 2.42, P < 0.001) and HbA1c (MAGE: OR = 2.44, P < 0.001; SDBG: OR = 2.68, P < 0.001) were significant influencing factors of glycemic variability (MAGE/SDBG) in elderly patients with type 2 diabetes (P < 0.05), but not age, body mass index (BMI) or diabetic neuropathy. Gender, diabetic duration and HbA1c are significant influencing factors of glycemic variability while age, BMI or diabetic neuropathy has no association with glycemic variability in elderly patients with type 2 diabetes.

The Impact of Age on Morbidity and Mortality following Esophagectomy for Esophageal Cancer

In patients with esophageal cancer, treatment decisions often involve a balance between a high-risk procedure and the chance for long-term benefit. The decision can be additionally challenging for elderly patients since some studies have reported an increased incidence of morbidity and mortality in this age group, and data are not clear on the overall benefit of multimodality therapy. To investigate the management and outcomes associated with esophagectomy in elderly patients with esophageal cancer, we performed a review of the literature as well as an analysis of our own institutional data, with a focus on the impact of age on surgical outcomes. We examined type of surgery, neoadjuvant and adjuvant therapy, postoperative complications, length of hospitalization, and mortality as variables in elderly patients with esophageal cancer. When assessing the impact of age on the success of esophagectomy, several studies have concluded that advanced age itself is not a predictor of outcomes as much as associated comorbidities are. Our own experience suggests that age is not associated with adverse outcomes when controlling for patient comorbidities. This finding is similar to data reported elsewhere. When considering treatment for patients of advanced age, the risks of treatment should be compared with the survival benefits of the therapy prescribed, taking into account additional factors such as poor performance status, existing comorbidities, and residual tumor following neoadjuvant therapy. Many reports, as well as our own experience, have concluded that when adjusted for comorbidities, patient age does not significantly affect outcomes.

Population pharmacokinetics of digoxin in elderly patients

This study was aimed at determining the population pharmacokinetics of digoxin and identifying factors that explain pharmacokinetic variability in elderly patients. The data of 142 elderly patients and 448 samples were collected after repetitive oral digoxin. Blood samples were drawn at various times after administration. Population pharmacokinetic analysis was performed using nonlinear mixed effects modelling program (NONMEM). A one-compartment model with first-order absorption and elimination was selected as the base model. The influence of demographic characteristics, biochemical and haematological indices as well as other commonly used co-medications were explored. The typical values with interindividual variability for apparent clearance (CL/F) and apparent volume of distribution (V/F) were 8.9Lh(-1) (43.2%) and 420L (65.8%), respectively. The residual variability was 31.6%. CL/F decreased significantly with renal function, total body weight, calcium channel blockers or spironolactone co-therapy and symptom with congestive heart failure. The median parameter estimates from a nonparametric bootstrap procedure were comparable and within 5% of the estimates from NONMEM. These results provide important information for clinicians to optimize digoxin regimens in elderly patients.