Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything

2016 ◽  
Vol 32 (9) ◽  
pp. 1132-1139 ◽  
Author(s):  
Deirdre E. O'Neill ◽  
Merril L. Knudtson ◽  
Teresa M. Kieser ◽  
Michelle M. Graham
Keyword(s):  
Elderly Patient ◽  
The Elderly ◽  
Patient Age ◽  
Patient Âgé ◽  
Cardiac Revascularization

Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment

2016 ◽  
Vol 34 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Georg Wiltberger ◽  
Babett Muhl ◽  
Christian Benzing ◽  
Hans-Michael Hau ◽  
Michael Bartels ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Elderly Patient ◽  
The Elderly ◽  
Patient Age ◽  
Patient Âgé

The Portrayal of the Elderly in Drug Advertisements: A Factor in Inappropriate Prescribing?

1990 ◽  
Vol 9 (3) ◽  
pp. 296-303 ◽  
Author(s):  
Joel Lexchin
Keyword(s):  
Inappropriate Prescribing ◽  
The Elderly ◽  
Personnes Âgées ◽  
Patient Age ◽  
Patient Âgé ◽  
Pour Cent

RÉSUMÉLe problème concernant les ordonnances contre-indiquées continue de prendre de l'ampleur et devient un des facteurs contribuant aux réactions néfastes que subissent les personnes âgées. De toute évidence, le médecin qui s'appuie sur les documents promotionnels pour rédiger une ordonnance sera porté à commettre plus d'erreurs. La présente étude se concentre sur deux revues médicales canadiennes importantes et elle examine les réclames publicitaires qui s'adressent aux personnes semblant avoir dépassé les 65 ans. Les gens âgés étaient représentés dans seulement 7 pour cent des annonces. Celles-ci ne semblaient pas tenir compte des besoins particuliers aux personnes âgées en ce qui a trait aux médicaments. Les textes et les illustrations contenus à l'intérieur de ces annonces pourraient être une des causes à l'origine des ordonnances contre-indiquées. Des études de recherche plus approfondies devraient être mises au point dans le but d'examiner plus attentivementles facteurs qui influencent le médecin lorsqu'il décide de rédiger une ordonnance pour un patient âgé. Entretemps, par égard à ce segment de leur pratique, les médecins devraient analyser prudemment les messages publicitaires et demeurer conscients des risques encourus lorsqu'ils s'en servent à titre d'information thérapeutique.

scholarly journals Renal transplantation in the elderly: does patient age determine the results?

2005 ◽  
Vol 34 (6) ◽  
pp. 583-587 ◽  
Author(s):  
Fernando Otero-Raviña ◽  
Mónica Rodríguez-Martínez ◽  
Francisco Gude ◽  
José Ramón González-Juanatey ◽  
Francisco Valdés ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
The Elderly ◽  
Patient Age ◽  
Patient Âgé

Impact of age on the likelihood of reaching a minimum clinically important difference in 374 three-column spinal osteotomies

2014 ◽  
Vol 20 (3) ◽  
pp. 306-312 ◽  
Author(s):  
Justin K. Scheer ◽  
Virginie Lafage ◽  
Justin S. Smith ◽  
Vedat Deviren ◽  
Richard Hostin ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Minimum Clinically Important Difference ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Patient Age ◽  
Patient Âgé ◽  
Health Related

Object Spinal osteotomies for adult spinal deformity correction may include resection of all 3 spinal columns (pedicle subtraction osteotomy [PSO] and vertebral column resection [VCR]). The relationship between patient age and health-related quality of life (HRQOL) outcomes for patients undergoing major spinal deformity correction via PSO or VCR has not been well characterized. The goal of this study was to characterize that relationship. Methods This study was a retrospective review of 374 patients who had undergone a 3-column osteotomy (299 PSOs and 75 VCRs) and were part of a prospectively collected, multicenter adult spinal deformity database. The consecutively enrolled patients were drawn from 11 sites across the United States. Health-related QOL outcomes, according to the visual analog scale (VAS), Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36, physical component score [PCS] and mental component score), and Scoliosis Research Society-22 questionnaire (SRS), were evaluated preoperatively and 1 and 2 years postoperatively. Differences and correlations between patient age and HRQOL outcomes were investigated. Age groupings included young (age ≤ 45 years), middle aged (age 46–64 years), and elderly (age ≥ 65 years). Results In patients who had undergone PSO, age significantly correlated (Spearman's correlation coefficient) with the 2-year ODI (ρ = 0.24, p = 0.0450), 2-year SRS function score (ρ = 0.30, p = 0.0123), and 2-year SRS total score (ρ = 0.30, p = 0.0133). Among all patients (PSO+VCR), the preoperative PCS and ODI in the young group were significantly higher and lower, respectively, than those in the elderly. Among the PSO patients, the elderly group had much greater improvement than the young group in the 1- and 2-year PCS, 2-year ODI, and 2-year SRS function and total scores. Among the VCR patients, the young age group had much greater improvement than the elderly in the 1-year SRS pain score, 1-year PCS, 2-year PCS, and 2-year ODI. There was no significant difference among all the age groups as regards the likelihood of reaching a minimum clinically important difference (MCID) within each of the HRQOL outcomes (p > 0.05 for all). Among the PSO patients, the elderly group was significantly more likely than the young to reach an MCID for the 1-year PCS (61% vs 21%, p = 0.0077) and the 2-year PCS (67% vs 17%, p = 0.0054), SRS pain score (57% vs 20%, p = 0.0457), and SRS function score (62% vs 20%, p = 0.0250). Among the VCR patients, the young group was significantly more likely than the elderly patients to reach an MCID for the 1-year (100% vs 20%, p = 0.0036) and 2-year (100% vs 0%, p = 0.0027) PCS scores and 1-year (60% vs 0%, p = 0.0173) and 2-year (70% vs 0%, p = 0.0433) SRS pain scores. Conclusions The PSO and VCR are not equivalent surgeries in terms of HRQOL outcomes and patient age. Among patients who underwent PSO, the elderly group started with more preoperative disability than the younger patients but had greater improvements in HRQOL outcomes and was more likely to reach an MCID at 1 and 2 years after treatment. Among those who underwent VCR, all had similar preoperative disabilities, but the younger patients had greater improvements in HRQOL outcomes and were more likely to reach an MCID at 1 and 2 years after treatment.

Community use of anthracyclines for adjuvant HER2-positive breast cancer (BC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11609-e11609
Author(s):  
Akhil Kumar ◽  
Marc L. Fishman ◽  
William S. Shimp ◽  
Laura Rose Bobolts ◽  
James Edward Krook ◽  
...  
Keyword(s):  
The Elderly ◽  
Cardiac Events ◽  
Her2 Positive ◽  
Chi Square ◽  
Adjuvant Trastuzumab ◽  
Patient Age ◽  
Patient Âgé ◽  
Chi Square Analysis ◽  
Improvement In Survival ◽  
Relationship Of

e11609 Background: Anthracyclines remain among the most active agents for the treatment of BC. NSABP B-31, NCCTG N9831 and HERA, each employing anthracyclines followed by trastuzumab in adjuvant HER2+ BC, demonstrated significant reduction in the risk of recurrence and improvement in survival. A fourth study, BCIRG-006, compared a non-anthracycline containing regimen, TCH, to an anthracycline based regimen, AC-TH. Both arms had similar overall survival, but there was a higher incidence of cardiac events in patients who received anthracycline. HER2-analyses in randomized adjuvant trials, in the pre-trastuzumab era, comparing anthracycline with non-anthracycline chemotherapy regimens, show that HER2+ BC derives greater benefit from anthracycline use. TOP2A coamplification, which occurs in 35% of HER2-positive patients, has shown a direct association with anthracycline benefit in several studies. We investigate and report, herein, the ways in which community oncologists are currently treating these patients. Methods: All treatment requests for adjuvant trastuzumab were examined, from 2009 through 2012. Chi-square analysis at 0.05α was used to test for interaction of age group to type of treatment. Results: During this span, oncologists requested adjuvant trastuzumab for 121 patients. In 10% (12/121) of patients, adjuvant trastuzumab alone, without chemotherapy and with or without hormonal therapy, was requested. Among patients who also received adjuvant chemotherapy (109), 35% (38/109), received anthracyclines. There was no relationship of anthracycline-usage with BC stage (data not shown) or patient age (Chi Sq p = 0.73). Adjuvant trastuzumab, without chemotherapy, was requested more often for the elderly (20% versus 4%; Chi Sq p = 0.003). Conclusions: Anthracyclines are utilized in adjuvant HER2+ BC in only about a third of patients, regardless of BC stage or patient age. The availability of a reliable, inexpensive, and convenient test to predict which patients are most likely to benefit from anthracyclines, over other options, would be useful. [Table: see text]

scholarly journals A Randomised Controlled Experimental Study on the Influence of Patient Age on Medical Decisions in Respect to the Diagnosis and Treatment of Depression in the Elderly

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Michael Linden ◽  
Guido Kurtz
Keyword(s):  
Experimental Study ◽  
The Elderly ◽  
Diagnosis And Treatment ◽  
Medical Decision ◽  
Medical Illness ◽  
Patient Age ◽  
Patient Âgé ◽  
Therapeutic Decisions ◽  
Randomised Controlled ◽  
Illness Concepts

Background. Elderly patients are often treated differently than younger patients, even when suffering from the same disorder.Objective. The study examines the influence of “patient age” on the perception of symptoms and conclusions of physicians in respect to diagnosis and treatment.Methods. In a randomised controlled experimental study on medical decision-making, 121 general practitioners were given two case vignettes which contained all the criteria for major depression according to ICD-10, but differed in respect to the age of the patient (39 or 81). Reaction time, diagnostic conclusions and therapeutic recommendations were assessed by computer.Results. Depression and anxiety were significantly seen as more probable in the young cases and dementia and physical illness in the old. In young age, psychotherapy, pharmacotherapy and referral to a specialist or inpatient treatment were significantly more recommended than in old age, for whom supportive counselling was significantly more recommended. The time needed for a decision was significantly longer in the older patients.Conclusion. Ageing stereotypes can also form medical illness concepts and have a significant influence on diagnostic and therapeutic decisions.

scholarly journals Prognostic Indices of Surgical Outcome in Cervical Spondylotic Myelopathy: A Clinical Prospective Study

2021 ◽  
Vol 9 (B) ◽  
pp. 438-443
Author(s):  
Ahmed A. Marei ◽  
Mohamed Reda Rady ◽  
Hazem Mostafa Kamal ◽  
William C. Welch ◽  
Mohamed A. Hafez
Keyword(s):  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
The Elderly ◽  
Significant Prognostic Factor ◽  
Mr Images ◽  
University Hospitals ◽  
Patient Age ◽  
Duration Of Symptoms ◽  
Patient Âgé ◽  
Prognostic Indices

BACKGROUND: One of the most common causes of spinal cord dysfunction is cervical spondylotic myelopathy (CSM) especially in the elderly. Prognostic indices can aid the surgeon preoperatively to detect the patients’ prognosis. AIM: The aim of the work is to better assess patients and to find possible indicators for post-operative improvement or deterioration in CSM patients. METHODS: Forty patients with multiple levels CSM, admitted and operated on in the Neurosurgery Department of Cairo University Hospitals, have been enrolled randomly in this study after fulfilling the criteria for CSM surgical intervention. The patient age, complaint duration, number of levels affected, signal intensity on T1-weighted and T2-weighted magnetic resonance (MR) images, Japan Orthopedic Association (JOA) scoring system, and Nurick’s score were evaluated before surgery and correlated with outcome after 1 year follow-up. RESULTS: About 80% of patients improved after operation with average pre- and post-operative JOA and Nurick scores about 11.23 and 3.12; 14.1 and 1.6, respectively. Patient age, sex, number of levels affected, and signal intensity on T1- weighted and T2-weighted MR images were not significantly associated with post-operative improvement, p > 0.05. However, the only significant prognostic factor was the duration of symptoms if less than 1 year with p < 0.05. CONCLUSION: Short complaint duration coupled with close intra-operative monitoring was directly correlated with good CMS operation outcome while age, sex, number of levels affected, presence of cord signal on MR imaging, and surgical approach appear to have no significant effect on outcome.

Influenza Immunizations in the Elderly: A Continuous Quality Improvement Project

2000 ◽  
Vol 39 (03) ◽  
pp. 217-222 ◽  
Author(s):  
M. F. Evans ◽  
J. Bloom ◽  
A. Juma
Keyword(s):  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
The Elderly ◽  
Community Medicine ◽  
Patient Age ◽  
Influenza Immunization ◽  
Continuous Quality ◽  
Immunization Rates ◽  
Patient Gender ◽  
Patient Âgé

AbstractAs part of the continuous quality improvement program at The Toronto Hospital’s Department of Family & Community Medicine (TTH-DFCM), it was considered necessary to examine the structures, processes and outcomes of influenza immunization for the elderly. Objective: The study sought to (a) document the current influenza immunization process; (b) quantify influenza immunization rates for elderly patients during two consecutive immunization seasons (1996 and 1997), and compare these rates across physician teams, attending staff vs. residents, patient gender, and patient age groups; (c) compare influenza immunization rates with other centers; and (d) identify barriers and propose solutions to improve influenza immunization rates in the elderly. Design: Evaluation Formative Research. Setting: A computerized roster of 15,000 patients at The Toronto Hospital, Department of Family and Community Medicine, a University of Toronto academic teaching center. Participants: Active patients age 65 years and over. Dependent variable: Influenza immunization. Independent variables: Physician Teams, Physician status, Patient gender, and Patient age group. Results: Immunization rates of attendees increased from 75.4% to 78.7%; over 3% increase from 1996 to 1997. Major subgroups which benefited from increased immunization rates were patients in the Blue team, patients age 70-74 years, and female patients. Conclusion: This study presents a rigorous examination of the components of the influenza immunization program, and demonstrates improved immunization rates over a two-year period. Suggestions for future action have been identified. The study design can also serve as a model for future clinical quality improvement projects.

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