Young Elderly Patients Research Articles

Genetic Liability to Fractures in the Elderly

The genetic impact on the causation of osteoporotic fractures is unclear. A large twin study is ideally suited to determine the genetic liability to categories of fracture at various ages. A cohort of all 33 432 Swedish twins born from 1896 to 1944 was used to evaluate the genetic liability to fracture occurrence in the elderly. The Swedish Inpatient Registry and computer-assisted telephone interviews enabled us to identify 6021 twins with any fracture, 3599 with an osteoporotic fracture, and 1055 with a hip fracture after the age of 50 years. Genetic variation in liability to fracture differed considerably by type of fracture and age. Less than 20% of the overall age-adjusted fracture variance was explained by genetic variation. The age-adjusted heritability of any osteoporotic fracture was slightly greater (0.27; 95% confidence interval [CI], 0.09-0.28), and for hip fracture alone, it was 0.48 (95% CI, 0.28-0.57). Heritability was not attenuated after further adjustment for several known osteoporotic covariates but was considerably greater for first hip fractures before the age of 69 years (0.68; 95% CI, 0.41-0.78) and between 69 and 79 years (0.47; 95% CI, 0.04-0.62) than for hip fractures after 79 years of age (0.03; 95% CI, 0.00-0.26). The importance of genetic factors in propensity to fractures depends on fracture site and age. The search for susceptibility genes and environmental factors that may modulate expression of these genes in younger elderly patients with hip fracture, the most devastating osteoporotic fracture, should be encouraged. Prevention of fractures in the oldest elderly should focus on lifestyle interventions.

Functional recovery after hip fracture in old-old elderly patients

Hip fracture is epidemic and prevalence increased with advanced age. Impact of comorbid and cognitive status, gender, type of fracture, operative delay and pre-fracture ambulatory levels on functional outcome was shown in previous studies. We studied functional outcome after rehabilitation for hip fracture in old-old elderly (85 years and older) and compared it to young elderly (65–74 years) community-dwelling patients. Before the fracture, old-old elderly patients were more functional dependent, has had more comorbid diseases, and more of them live alone than young elderly. The waiting time to surgery and mean length of stay in orthopedic ward were longer than in young elderly. On admission to rehabilitation treatment, old-old patients presented with more depressed mood, were more cognitive impaired, and more suffer from pain. Old-old patients presented with laboratory data of malnutrition (decreased serum levels of albumin, cholesterol, hemoglobin, hematocrit, lymphocyte count) and inflammation (increased of transferrin and C-reactive protein). Improvement in Functional Independence Measurement (FIM) scale was found in both groups but significantly better in young elderly than in old-old elderly. The change in FIM during the rehabilitation period (ΔFIM) were in FIM total and in those parts of FIM concerning locomotion. The mean duration of rehabilitation stay was significantly longer in old-old elderly patients. On discharge old-old elderly patients more suffer from pain and difference between the groups according to the laboratory and to the cognitive data increased. Age per se is indicator of frailty and determinate functional recovery after hip fracture.

Predictive effect of the injury severity score on the development of multiple organ failure among young adults and elderly patients

Study objectives: Multiple organ failure is a major cause of mortality in the injured patient, representing a significant financial burden to the health care system. Recent studies have demonstrated the importance of early prediction and early resuscitation for multiple organ failure to improve outcome. The objective of this study is to determine the correlation between Injury Severity Score (ISS) and multiple organ failure among severely injured young (aged 18 to 54 years) and elderly (aged 55 years) patients. Methods: This was a cross-sectional observational study from a hospital-based trauma registry. Data from 1997 were collected. All adult cases (>18 years) with acute trauma as defined by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes were included. Descriptive statistics were used to present group characteristics. For significance testing, χ 2 and Fisher's exact test were used for categorical variables. Severe injuries were defined by an ISS greater than 15. Presence of multiple organ failure was based on the definitions proposed by Knaus and Fry. Results: Six hundred forty-two adult trauma patients were included, with 469 classified as young and 173 as elderly. Among the 469 young adults, 193 had ISS greater than 15 (41.2%), and 35 of these developed multiple organ failure (35 of 193, or 18.1%). Among the 173 elderly patients, 88 had an ISS greater than 15 (50.9%), and 51 met the definition for multiple organ failure (51 of 173, or 29.5%). Severely injured (ISS >15) young and elderly groups were more likely to develop multiple organ failure compared with those with an ISS less than 15 ( P P P Conclusion: This study demonstrated a direct relationship between ISS greater than 15 and the development of multiple organ failure. We also observed a fivefold increase in the development of multiple organ failure among severely injured elderly patients. Future studies should focus on early resuscitative interventions based on prompt emergency department severity estimates calculated from anatomic and physiologic scoring systems. Limitations of this study are primarily related to the retrospective data collection process and the subsequent accuracy of the medical records.

EBM of hip protectors

In Japan, where the population is rapidly growing older, the prevention of hip fractures is becoming increasingly important. Although bisphosphonates were reported to prevent these fractures, their effectiveness was confirmed in relatively younger elderly patients. The prevention of hip fractures, the majority of which occur in older people, may not be achieved sufficiently only by bisphosphonates, and may require other measures including the use of a hip protector. Elderly people who tend to fall, nursing-home residents, and elderly patients who have already suffered from a hip fracture are considered to be good candidates for wearing hip protectors. The main mechanism of hip fractures is falling sideways over the trochanter. Hip protectors have been developed to attenuate the impact force on the trochanter that results from falling. There have been 6 randomized clinical trials and 4 of them confirmed the efficacy of hip protectors in preventing hip fractures. The other 2 reports did not show a statistically significant efficacy, but a large number of falls occurred without wearing hip protectors. The problem of the limited adherence with their use should be solved.

FRACTAL CHANGES IN HEART RATE DYNAMICS WITH AGING AND HEART FAILURE

In this work we analyze interbeat cardiac time series arising of three groups: healthy young and healthy elderly subjects and patients with congestive heart failure. We use the fractal dimension method proposed by Higuchi. We find that fractal organization is different for each group. In the case of healthy young subjects only one value of the fractal dimension is necessary to fit the interbeat data, whereas in the cases of healthy elderly and patients with congestive heart failure a crossover behavior in the fractal dimension is present but in opposite directions. By means of a "zoom" on the hinges of the crossover point interesting effects of aging are presented. Finally, we discuss our results in the context of heart interbeat dynamics.

Relationship between lobar intracerebral hemorrhage and leukoencephalopathy associated with cerebral amyloid angiopathy: Clinicopathological study of 64 Japanese patients

Cerebral amyloid angiopathy (CAA) has two major clinical manifestations: intrucerebral hemorrhages and is chemic lesions. Among these, the lobar fype of intracerebral hemorrhage (ICH) is a well-known clinical manyestation, while the CAA-related diffuse deep white matter degeneration known as leukoencephalopathy is thought to be rare. The characteristics of CAA-related leukoencephalopathy are still incompletely understood, and the relationship between lobar ICH and leukoencephalopathy in patients with CAA has not been properly clarified. The main purpose of this study is to elucidate the clinical and histopathological features of CAA-related lobar ICH and leukoencephalopathy in order to determine whether the degree of deep white matter degeneration parallels the severity of CAA-associated vasculopathies that lead to vascular wall rupture.We studied 64 Japanese patients with histopathologi-cally proven amyloid beta protein (AP) type CAA presenting with lobar ICH (52 biopsy and 12 autopsy). In this study, a lotal of 106 hematomas were observed C.4A-related cerebrul hemorrhages tend to occur recurrently and multocaly. Multiple simultaneous lobur hemorrhages occasionally developed (9.4%). CAA-related ICH in the sixth decade was not rare (14.1%). Although most patients suffered relapsing and/or multiple severe ICH, no patient in our series presented with diffuse leukoencephalopathy.In conclusion, Aβ type cerebrovascular amyloid deposition causes recurrent, multifocal, and open multiple simultaneous ICH even in relatively younger elderly patients, but rarely produces diffuse leukoencephalopathy. This suggests that CAA-associated vasculopathies that cause vascular wall rupture do not always lead to is chemic deep white matter degeneration, and that there may be another unknown pathogenetic mechanism producing the latter CAA-related white matter lesion.

Rehabilitation after proximal femur fracture surgery in the oldest old

Lieberman D, Lieberman D. Rehabilitation after proximal femur fracture surgery in the oldest old. Arch Phys Med Rehabil 2002;83:1360-3. Objective: To assess the course and results of rehabilitation after proximal femur fracture (PFF) in patients 85 years of age or older, compared with younger elderly patients, with an emphasis on functional status. Design: Prospective cohort study. Setting: A rehabilitation geriatric ward in a tertiary university hospital in southern Israel. Participants: The study group included 127 elderly patients 85 years of age or older who were hospitalized for rehabilitation following surgery for PFF. The comparison group was comprised of 297 patients aged 75 to 84 years who were hospitalized for the same indication in the same time period. Interventions: Not applicable. Main Outcome Measures: Functional studies by FIM™ instrument, mental status by the Folstein Mini-Mental State Examination, Geriatric Depression Screening (GDS) scale, length of rehabilitation, and complications and mortality during rehabilitation. Results: Compared with patients aged 75 to 84 years, the older study group was in a worse mental state (P=.00005), even though the groups did not differ in their GDS scores. There were no significant differences between the groups in rehabilitation length of stay, in the rate of most postoperative complications, or in death rates during rehabilitation. FIM values before PFF, at the beginning of rehabilitation and at its end, and the difference between the beginning and end of rehabilitation were lower in the older group (P<.00001 for all tests). Conclusions: From the functional standpoint, rehabilitation after PFF surgery is much less successful in the 85+ age group than in the 75-to-84 age group but did not differ in its duration, rates of most complications, or mortality. Nonetheless, a significant percentage of patients in this age group have successful rehabilitation so they should not be deprived the chance. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Acute Care Costs of the Oldest Old

<h3>Background:</h3> The cost of acute hospital care is often believed to increase with age among older persons. Our clinical experience in the acute hospital setting suggested that people aged 90 years and older may be a distinct cohort who have different health care needs and who use health resources differently from younger aged groups. <h3>Methods:</h3> To determine the cost of care for the oldest old and younger old patients in Massachusetts acute care hospitals, 1992 and 1993 discharge data from all nonfederal Massachusetts hospitals were examined (678 954 discharges) according to five age groups: 60 to 69 years (n=210 270), 70 to 79 years (n=256 781), 80 to 89 years (n=171 725), 90 to 99 years (n=39 170), and 100 or more years (n=1008). Average estimated total and ancillary costs per discharge and per diagnosis related group were calculated. Differences by gender and survivorship were also examined. <h3>Results:</h3> Hospitalization costs peaked in the 70- to 79-year age group and declined with age thereafter. Case mix was an important determinant of this trend. Despite lower cost per stay, average length of stay was longer for the oldest age groups. Ancillary costs accounted for 53% of the total costs per stay among the 60- to 69-year-olds and only 32% among the 100 or more—year-olds. For hospitalizations during which the patient died, the average cost per discharge decreased 61%, from $16 886 for 60- to 69-year-olds to $6523 for centenarians. Costs were greater for decedents than for survivors, although these differences decreased dramatically with increasing age. Those aged 80 years and older tended to be hospitalized in nonteaching hospitals. <h3>Conclusions:</h3> In the acute hospital setting, the oldest old cost less per admission than younger elderly patients. This finding must be considered when future health care costs are predicted for this fastest growing segment of our population. (Arch Intern Med. 1996;156:754-760)

Acute care costs of the oldest old: they cost less, their care intensity is less, and they go to nonteaching hospitals

The cost of acute hospital care is often believed to increase with age among older persons. Our clinical experience in the acute hospital setting suggested that people aged 90 years and older may be a distinct cohort who have different health care needs and who use health resources differently from younger aged groups. To determine the cost of care for the oldest old and younger old patients in Massachusetts acute care hospitals, 1992 and 1993 discharge data from all nonfederal Massachusetts hospitals were examined (678 954 discharges) according to five age groups: 60 to 69 years (n=210 270), 70 to 79 years (n=256 781), 80 to 89 years (n=171 725), 90 to 99 years (n=39 170), and 100 or more years (n=1008). Average estimated total and ancillary costs per discharge and per diagnosis related group were calculated. Differences by gender and survivorship were also examined. Hospitalization costs peaked in the 70- to 79-year age group and declined with age thereafter. Case mix was an important determinant of this trend. Despite lower cost per stay, average length of stay was longer for the oldest age groups. Ancillary costs accounted for 53% of the total costs per stay among the 60- to 69-year-olds and only 32% among the 100 or more-year- olds. For hospitalizations during which the patient died, the average cost per discharge decreased 61%, from $16886 for 60- to 69-year-olds to $6523 for centenarians. Costs were greater for decedents than for survivors, although these differences decreased dramatically with increasing age. Those aged 80 years and older tended to be hospitalized in nonteaching hospitals. In the acute hospital setting, the oldest old cost less per admission than younger elderly patients. This finding must be considered when future health care costs are predicted for this fastest growing segment of our population.

Factors Affecting Reaction and Movement Times in Hemiparetic Patients and in Healthy Subjects

The effects of body side, joint location (proximal and distal) and movement type (uni lateral and bilateral) on reaction and movement times (RT, MT) were studied in three groups of subjects: aged and young healthy subjects and hemiparetic elderly patients. Reaction time was measured relative to an auditory signal. Movement time was mea sured for 20° of elbow flexion and for a linear movement of 3 mm performed by the thumb. Each movement was repeated five times unilaterally on each side and five times bilaterally. The findings pointed to longer RTs and MTs in the aged subjects than in the young subjects and in the proximal joints than in the distal joints. Both RT and MT were lengthened on the paretic extremity in the patients, while no right-left differences were encountered in the healthy subjects. Bilateral movements caused slowing of RT in the hemiparetic patients and significant slowing of MT in all three groups. The sep arate as well as interactive effects of these variables on movement speed, as ref...

Burden of dietary therapy on elderly patients with diabetes mellitus

As a part of a QOL study in elderly diabetes mellitus, we performed an interview conducted by professional interviewers on the sense of burden of dietary therapy in 383 elderly outpatients with diabetes mellitus aged over 60 years old. We used a scale on Burden of Dietary Therapy (BDT) that consisted of 7 questions (calorie restriction, dietary balance, regular dietary habits, restriction of favorite food, restriction of amounts of snacks, restrictions when eating out, burden of total dietary therapy). The sense of burden was rated from 1 (never burdened) to 4 (heavily burdened) for each question and the alpha coefficiency of the BDT scale was 0.80. Women, relatively younger elderly patients, hyperglycemic patients, or tablet-treated patients had higher BDT scale scores. The lower the positive family support scores and the higher the negative social support scores the greater was the BDT score. High BDT scores were significantly associated with low PGC moral scales (p < 0.001). The results suggest that the burden of dietary therapy could lower the quality of life in elderly patients with diabetes mellitus.

腹直筋せん通動脈皮弁による頭頚部再建

During the past eight years, tissue defects of the head and neck region in a total of 45 patients were repaired with free rectus abdominis muscle perforating artery flaps. These flaps are subclassified into (1) reduced musculocutaneous flaps, (2) thin reduced musculocutaneous flaps, (3) paraumbilical perforator-based flaps, and (4) thin paraumbilical perforator-based flaps. The advantages of these flaps are as follows. Since the flaps involve no or only a small portion of the rectus abdominis muscle, (1) the muscle can be left intact on the abdominal wall, and (2) a thin flap can be easily created by simple defatting of the flap. These flaps overcome the major disadvantages of the conventional rectus abdominis musculocutaneous flap, i.e., bulkiness of the flap and frequent postoperative abdominal herniation. The territory of the thin flaps is within 10 cm around the perforator. These flaps are suitable for defects in the head and neck region, because simultaneous flap elevation is possible at the time of tumor resection. Paraumbilical perforator-based flaps are suitable for young females and elderly patients.

A Comparison of the Cardiac Safety and Therapeutic Efficacy of Trimipramine versus Doxepin in Geriatric Depressed Patients

To compare the cardiac safety and therapeutic efficacy of trimipramine and doxepin. A 1-week single-blind placebo period followed by a 5-week randomized double-blind parallel group clinical trial. Psychiatric out-patient clinic of a general hospital. 37 young-elderly patients with a diagnosis of Major Depressive Episode (DSM-III criteria). Placebo for 1 week, 2 weeks of titration with either drug in the dosage range of 75 mg/day up to a maximum of 200 mg/day. We measured the psychiatric effects with the Hamilton Rating Scale for Depression, the Hamilton Anxiety Rating Scale, and the Clinical Global Impression Scale. Cardiovascular effects were assessed on 12-lead standard electrocardiograms plus 1-minute rhythm and high speed recordings; orthostatic (lying/standing) blood pressures were also taken. Physical exams, lab tests, cognitive functions (Buschke Selective Reminding Test, Hierarchic Dementia Scale, Word Fluency) and adverse reactions were also noted. Both drugs were equally effective in relieving symptoms of depression and anxiety. The cardiovascular effects of both drugs were minimal. Trimipramine did lower blood pressure but this was without clinical significance. Three trimipramine patients and five doxepin patients developed occasional premature ventricular or atrial contractions. Of these, two trimipramine patients and one doxepin patient were among those with abnormal ECG's at entry. The doxepin patient was withdrawn from the study after 21 days of treatment when the PVC's became increasingly frequent. Trimipramine and doxepin are equally safe and effective antidepressants in the young-elderly.

The Pharmacokinetics of Benorylate in Young Volunteers and Elderly Patients with Osteoarthritis and Rheumatoid Arthritis

Benorylate is an ester which is readily absorbed and rapidly hydrolysed in the blood to aspirin (acetylsalicylic acid) and paracetamol (acetaminophen). It was given in full dosage [10ml twice daily (8g)] for 15 days to 12 elderly arthritic patients and the pharmacokinetics of salicylic acid and paracetamol compared with those in 12 young volunteers.

Accuracy of Pharmacokinetic Dose Determination of Gentamicin in Geriatric Patients

Gentamicin pharmacokinetics and the predictive performance of the Sawchuk-Zaske dosing method for gentamicin were compared in elderly and young patients with stable normal serum creatinine concentrations. The predicted peak gentamicin concentrations in both young and elderly patients were not significantly different from the actual measured concentrations. The predicted trough concentrations for both the young and elderly were significantly different from the measured trough concentrations. However, the magnitude of this difference (0.2 micrograms/mL) is not considered to be clinically significant. A trend toward greater underprediction of trough gentamicin concentrations in elderly patients was evident. The mean increase of 15 percent in the gentamicin half-life at steady-state compared with the initial pharmacokinetics analysis in elderly patients was significantly larger than the increase in half-life in the young patients. The Sawchuk-Zaske method was equally accurate in determining the gentamicin dosing regimen in young elderly patients with normal serum creatinine concentrations.

Aging and the stability of activation and sampling in cued recall.

Age effects in cued recall were investigated as a function of activation and sampling of preexisting associates of the test cue. Young adults, community-dwelling elderly, and elderly patients studied lists of unrelated words and were tested with extralist cues. Preexperimental strength between test cues and studied words was manipulated to discern differences in activation, and normative size of the set of associates was manipulated to discern differences in sampling. Test delay and prior testing were also manipulated in Experiment 1. Although large age effects were found with phonemic and taxonomic test cues, young and older subjects showed comparable effects of strength and set size, suggesting that age effects were not due to activation and sampling differences. Test delay and prior testing also had comparable effects. Implications for age effects in episodic cued recall are discussed.

Hypertension and Ageing

Hypertension is a common problem in the elderly with a prevalence approaching or exceeding 50%. The risk of cardiovascular disease and death is increased in elderly hypertensives aged 60-74 years, whereas this increased risk seems to be diminished or even nonexistent in those aged 75 and above. Hypotensive drug treatment has been shown to be beneficial for the younger elderly patients, but whether or not this is also true for the older elderly hypertensives is less clear. Isolated systolic hypertension increases the cardiovascular risk, but we lack data on the efficacy of treatment in this group.

Pharmacokinetics of loprazolam and its principal metabolite in young subjects and elderly hospital patients.

1. The pharmacokinetics of loprazolam and its principal pharmacologically active metabolite, the piperazine N-oxide, were compared in young subjects (aged 21-25 years) and elderly patients (aged 63-86 years) following single oral evening doses (0.5 mg and 1 mg). 2. Plasma loprazolam was assayed by a specific h.p.l.c./g.c. method. The N-oxide metabolite was assayed by gas chromography. 3. Mean times to peak plasma concentration of loprazolam did not differ significantly between young and elderly subjects and ranged from 1.6-2.7 h. There was, however, a longer mean time to peak concentration of the N-oxide metabolite in the elderly but this was only statistically different after the 0.5 mg dose (4.5 mg young, 6.4 h elderly). 4. Mean peak plasma concentrations of loprazolam did not differ significantly between young and elderly nor did plasma concentrations of the N-oxide metabolite. 5. Although the mean elimination half-life of loprazolam was not statistically significantly different between young and elderly subjects (range 10.9-16.0 h) there was a trend towards somewhat longer half-lives in the elderly. Furthermore, there was a small but significant increase in the half-life of the N-oxide metabolite in the elderly after the 1 mg dose from 11.7 h to 16.7 h. 6. The areas under the plasma concentration time curves for both loprazolam and its N-oxide were greater in the elderly being some 50-68% (mean 132.0 and 111.5 ng/ml h) above those found in young subjects (mean 89.8 and 66.0 ng/ml h).(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of pirprofen in young volunteers and elderly patients.

Plasma concentrations of pirprofen were measured in 11 elderly arthritic patients and 6 healthy young volunteers at the beginning and end of 8 days treatment with 400 mg doses twice daily. The mean ages of the two groups were 74.5 and 21.8 years, respectively. There were no statistically significant differences in peak concentrations, times to peak, areas under the curve or terminal elimination half-lives between the groups after single dosing. Repeated dosing increased plasma drug concentrations in both groups but the extent was as predicted from the single dose data. Again there were no statistically significant differences between the groups, although pre-dosing plasma concentrations were higher in the elderly compared with the young individuals. The results of this relatively small study suggest that advancing age and arthritic disease appear to have little influence on the pharmacokinetics of pirprofen and no modification in the dosage recommendation in elderly patients without overt renal or hepatic impairment is indicated.