scholarly journals Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 659
Author(s):  
Nicole Welch ◽  
Amy Attaway ◽  
Annette Bellar ◽  
Hayder Alkhafaji ◽  
Adil Vural ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Older Patients ◽  
Hospitalized Patients ◽  
Muscle Loss ◽  
Term Care ◽  
Old Patients ◽  
Younger Patients ◽  
Age Related ◽  
Number Of Patients ◽  
The Impact

Background: There are limited data on outcomes of older patients with chronic diseases. Skeletal muscle loss of aging (primary sarcopenia) has been extensively studied but the impact of secondary sarcopenia of chronic disease is not as well evaluated. Older patients with chronic diseases have both primary and secondary sarcopenia that we term compound sarcopenia. We evaluated the clinical impact of compound sarcopenia in hospitalized patients with cirrhosis given the increasing number of patients and high prevalence of sarcopenia in these patients. Design: The Nationwide Inpatients Sample (NIS) database (years 2010–2014) was analyzed to study older patients with cirrhosis. Since there is no universal hospital diagnosis code for “muscle loss”, we used a comprehensive array of codes for “muscle loss phenotype” in the international classification of diseases-9 (ICD-9). A randomly selected 2% sample of hospitalized general medical population (GMP) and inpatients with cirrhosis were stratified into 3 age groups based on age-related changes in muscle mass. In-hospital mortality, length of stay (LoS), cost of hospitalization (CoH), comorbidities and discharge disposition were analyzed. Results. Of 517,605 hospitalizations for GMP and 106,835 hospitalizations for treatment of cirrhosis or a cirrhosis-related complication, 207,266 (40.4%) GMP and 29,018 (27.7%) patients with cirrhosis were >65 years old, respectively. Muscle loss phenotype in both GMP and inpatients with cirrhosis 51–65 years old and >65 years old was significantly (p < 0.001 for all) associated with higher mortality, LoS, and CoH compared to those ≤50 years old. Patients >65 years old with cirrhosis and muscle loss phenotype had higher mortality (adjusted OR: 1.06, 95% CI [1.04, 1.08] and CoH (adjusted odds ratio (OR): 1.10, 95% confidence interval (CI) [1.04, 1.08])) when compared to >65 years old GMP with muscle loss phenotype. Muscle loss in younger patients with cirrhosis (≤50 years old) was associated with worse outcomes compared to GMP >65 years old. Non-home discharges (nursing, skilled, long-term care) were more frequent with increasing age to a greater extent in patients with cirrhosis with muscle loss phenotype for each age stratum. Conclusion: Muscle loss is more frequent in older patients with cirrhosis than younger patients with cirrhosis and older GMP. Younger patients with cirrhosis had clinical outcomes similar to those of older GMP, suggesting an accelerated senescence in cirrhosis. Compound sarcopenia in older patients with cirrhosis is associated with higher inpatient mortality, increased LoS, and CoH compared to GMP with sarcopenia.

scholarly journals Hypoglycemia in Older People With Type 2 Diabetes: Prevention and Treatment Strategies for Outpatient and Long-Term Care Facility Settings

2021 ◽  
Vol 36 (2) ◽  
pp. 112-123
Author(s):  
Jacqueline V. Nguyen ◽  
Samantha Roseberry ◽  
Jennifer Alisha Rivas ◽  
Kimberly A.B. Cauthon
Keyword(s):  
Older Patients ◽  
Treatment Strategies ◽  
Care Facility ◽  
Term Care ◽  
Long Term Care Facility ◽  
Type 2 Diabetes Prevention ◽  
Age Related ◽  
The Impact ◽  
Care Costs

Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients at high risk for hypoglycemia.

Hypoglycemia in Older People With Type 2 Diabetes: Prevention and Treatment Strategies for Outpatient and Long-Term Care Facility Settings

2021 ◽  
Vol 36 (2) ◽  
pp. 112-121
Author(s):  
Jacqueline V. Nguyen ◽  
Samantha Roseberry ◽  
Jennifer Alisha Rivas ◽  
Kimberly A.B. Cauthon
Keyword(s):  
Older Patients ◽  
Treatment Strategies ◽  
Care Facility ◽  
Term Care ◽  
Long Term Care Facility ◽  
Type 2 Diabetes Prevention ◽  
Age Related ◽  
The Impact ◽  
Care Costs

Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients at high risk for hypoglycemia.

Outcomes of radiocephalic arteriovenous fistula in octogenarians

2021 ◽  
pp. 112972982110154
Author(s):  
Raffaella Mauro ◽  
Alessia Pini ◽  
Rodolfo Pini ◽  
Mohammad Abualhin ◽  
Chiara Mascoli ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Previous History ◽  
Venous Catheter ◽  
Dialysis Session ◽  
Old Patients ◽  
Younger Patients ◽  
First Choice ◽  
Clinical Surveillance ◽  
History Of ◽  
The Impact

Background: Current guidelines recommend radiocephalic arteriovenous fistula (RCAVF) as a first choice access for hemodialysis, without specific indication for octogenarians .This study was undertaken to assess the efficacy of RCAVF in octogenarians compared with younger patients. Material and methods: All patients treated by RCAVF from January 2013 to December 2017 were included in a prospective database for a retrospective analysis. Patient demographics, comorbidities, and dialytic treatment data were collected prospectively and compared in patients <80 year-old and ⩾80 years-old. Clinical surveillance was performed during each dialysis session. The main endpoints were primary (PP) and assisted patency (AP). Results: Within the study period, a total of 294 RCAVF were analyzed: 245 (83.3%) RCAVF were performed in <80 year-old and 49 (16.7%) ⩾80 years old. The overall PP and AP at 2-year was 69% ± 2% and 73% ± 3%, respectively. Patients ⩾ 80 years-old had a significantly reduced 2-year PP, AP of RCAVF compared with the younger patients: 50% ± 8% and 62% ± 7% versus 73% ± 3% and 75% ± 3%, p = 0.01 and p = 0.03, respectively. The analysis for possible risk factors for reduction of PP in patients ⩾80 years identified in the central venous catheter(CVC) a predictor of earlier RCAVF failure: HR 3.03(95% CI 1.29–7.13), p = 0.01.Kaplan–Meier curve confirms the reduction of PP in ⩾80 years old patients at 2-year follow-up with previous CVC compared patients without history of CVC: 59% ± 10% versus 24% ± 11%, p = 0.01. A comparison between the two groups was made in order to evaluate the impact of previous history of CVC .In absence of a history of CVC use older patients had a similar 2-year PP compared with younger patients: 59% ± 10% versus 72% ± 4%, p = 0.46. Otherwise, the history of a previous CVC reduced significantly the 2-year PP in ⩾80 years old patients compared the younger: 24% ± 12% versus 75% ± 5%, p = 0.0001. Conclusions: Despite lower overall primary and primary assisted patency, RCAVF are associated with satisfactory results also in octogenarians if performed in absence of history of CVC. Under these circumstances RCAVF can be considered a first choice treatment.

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

Abstract 14178: Characteristics and Outcomes of Young ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Benjamin W Tung ◽  
Zhe Yan Ng ◽  
William Kristanto ◽  
Kalyar W Saw ◽  
winnie C sia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Patients ◽  
Young Patients ◽  
Percutaneous Intervention ◽  
Old Patients ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Primary Percutaneous Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality leading to loss of productivity and productive life years, especially in younger patients. Understanding the characteristics of younger patients with STEMI and their outcomes could help focus public health efforts in STEMI prevention within a population. Aim: This study aims to compare the characteristics and outcomes of younger versus older patients with STEMI undergoing primary percutaneous intervention (PPCI). Methods: Data from the Coronary Care Unit database of the National University Hospital between July 2015 to June 2019 was reviewed. Patients were divided into Young (<50 years old) or Old (≥50 years old) groups. Results: Of the 1818 consecutive patients with STEMI and underwent PPCI, 465 (25.6%) were Young patients with mean age 43±4.9 years old as compared to Old patients with mean age 63.2±9.4 years old. Young patients were more likely to be male (94% vs. 85%, p<0.0001), current smokers (61.1% vs. 42.6%, p<0.0001), of Indian ethnicity (32% vs. 16.3%, p<0.0001), and had family history of myocardial infarction (MI) (18.1% vs. 9.5%, p<0.0001). Compared to Old patients, Young patients had better post-MI left ventricular ejection fraction (49.5±10.7 vs. 47.8±11.6, p=0.007) with fewer of them suffered from cardiogenic shock (7.1% vs. 13.2%, p<0.0001), and had lower mortality at one year (3.4% vs. 10.4%, p<0.0001). Although diabetes, hypertension and hyperlipidemia was less common among the Young patients when compared to the Old, the prevalence was high in the range of 28 to 38% (Table 1). Conclusions: A sizable proportion of STEMI patients are younger than 50 years old. The risk profile of these younger patients can be attributed to constitutional factors and smoking but other cardiovascular risk factors are also prevalent among them. Although mortality is lower among the younger than the older patients, it is not negligible.

Presentation of stroke in the older person

2020 ◽  
pp. 25-32
Author(s):  
Jagdish Sharma
Keyword(s):  
Older People ◽  
Ischaemic Stroke ◽  
Older Patients ◽  
Clinical Presentation ◽  
Cerebral Haemorrhage ◽  
Older Person ◽  
Younger Patients ◽  
Age Related ◽  
Atypical Presentations ◽  
Symptoms And Signs

‘Presentation of stroke in the older person’ outlines the varied patterns of clinical presentation of stroke in the older person, looking at common and the less common syndromes. Symptoms and signs in older people can be very subtle, often difficult to diagnose, and challenge even the most astute of clinicians. Most stroke presentations in older patients are similar to those in younger patients with respect to Oxford Community Stroke Project classification. However, atypical presentations can lead to diagnostic challenges in older patients due to the interaction between age-related cerebral and circulatory changes and comorbidities. The presentation of ischaemic stroke with its different vascular patterns, is discussed. Cerebral haemorrhage is explored in the context of its presentation patterns.

scholarly journals Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027199
Author(s):  
Tomas Jernberg ◽  
Daniel Lindholm ◽  
Lars Pål Hasvold ◽  
Bodil Svennblad ◽  
Johan Bodegård ◽  
...  
Keyword(s):  
Heart Disease ◽  
Relative Risk ◽  
Ischaemic Heart Disease ◽  
Lower Risk ◽  
Older Patients ◽  
Cox Model ◽  
Younger Patients ◽  
Linear Association ◽  
The Impact ◽  
First Time

ObjectivesTo compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD).DesignCohort study linking morbidity, mortality and medication data from Swedish national registries.ParticipantsFirst-time users of GLD during 2007–2016.OutcomesPredicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled.Results260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD—prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients.ConclusionsT2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.

Uptake of adjuvant chemotherapy for colon cancer in older and younger patients in the Irish population.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 478-478
Author(s):  
Seamus Coyle ◽  
Zia Rehman ◽  
Chalen Lee ◽  
Sandra Deady ◽  
Harry Comber ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Older Patients ◽  
The Elderly ◽  
Stage Ii ◽  
Stage Iii ◽  
Younger Patients ◽  
The Impact

478 Background: Colon cancer is predominantly a disease of the elderly, with recent evidence supporting the use of adjuvant chemotherapy in the older population. However, it remains unclear to what degree such patients are receiving adjuvant therapy in clinical practice. We examined uptake of adjuvantchemotherapy and it’s impact on survival in older patients with stage II and stage III colon cancer in a national cohort. Methods: Using the National cancer Registry of Ireland, we identified 3,486 patients with stage II and III colon cancer who were treated with curative resection from 2004-2009. Clinopathological features and chemotherapy use were compared between those ≥70 years and those < 70 years. Results: A total of 2,026 patients with stage II disease were identified, 56% male and 60% ≥ 70 years. T3 tumors accounted for 81%, T4 19% and 89% were grade 2/3. Adjuvant chemotherapy was utilized in 10% and 40% of ≥ 70 and <70 years, respectively (p<0.0001). A benefit for chemotherapy over observation alone was seen in both the older [HR 0.36; 95% CI 0.36 – 0.68; p <0.0001] and younger patient groups [HR 0.43; 95% CI 0.2701 - 0.6881; p<0.0004]. Of 1,460 patients with stage III disease, 51% were ≥ 70 years, 54% male. 34% of older and 83% of younger patients received adjuvant therapy (p<0.0001). A similar magnitude of benefit from chemotherapy compared to observation was seen in patients ≥ 70 years [HR 0.30; 95% CI 0.29 - 0.45 ; p <0.0001] and <70 years [HR 0.22 95%CI 0.1 – 0.2; p<0.0001] with stage III disease. Conclusions: Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in older patients (age ≥ 70 years), however, is still underutilized in clinical practice. The impact of sociodemographic and clinicopathological features as potential drivers of treatment decisions in a cohort of this population will be reported.

scholarly journals Patient-Reported Disease Burden and Age: Results from a National Patient Advocacy Survey of Patients with Chronic Lymphocytic Leukemia, Diffuse Large B-Cell Lymphoma and Follicular Lymphoma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4778-4778
Author(s):  
Keith L. Dawson ◽  
Mark A. Price ◽  
Peggy Ann Torney ◽  
Victor Gonzalez ◽  
Maria Sae-Hau ◽  
...  
Keyword(s):  
Older Patients ◽  
Disease Burden ◽  
Negative Impact ◽  
Emotional Health ◽  
B Cell Lymphoma ◽  
Patient Advocacy ◽  
Younger Patients ◽  
Patient Reported ◽  
Equity Ownership ◽  
The Impact

Introduction: Evaluation of patients' psychosocial burden related to their cancer and its treatment is important for shared decision making by patients and their healthcare team. We aimed to better understand the impact of age on this burden as reported by patients with chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma (FL) using data from a large US patient advocacy survey. Methods: We developed a survey to understand patients' perceptions of disease burden and impact on physical and emotional health. The survey was designed through consultation with medical experts, patient advocacy organizations and research team members. Concept elicitation and cognitive pretesting were conducted with patients to inform the survey content. The survey was administered electronically to patients with CLL, DLBCL, or FL who had received either initial or subsequent treatment within the past year. The survey consisted of categorical Likert options that quantified the impact of disease on physical function, sleep, cognition, work, emotional health and quality of life (QoL). The survey data were analyzed descriptively by patients' reported age: 60 years or older versus less than 60 years. Results: The survey was completed by 424 patients who were associated with The Leukemia & Lymphoma Society and/or the Lymphoma Research Foundation (309 patients with CLL, 59 patients with DLBCL and 69 patients with FL). Respondents had a mean age of 66 years (range: 22-95 with five patients electing not to report their age), 79% were 60 years or older, and 51% were female. A greater proportion of younger patients (<60 years) reported negative impact of the disease on various aspects of their lives as compared with older patients. Negative impact on emotional health, on personal relationships and on overall health-related QoL, as well as worry about disease returning or getting worse are highlighted in the following Table. Physical impacts of diseases were also reported in a greater proportion of younger patients versus older patients, specifically in reports of nausea, pain, appetite, sleep patterns, concentration and multi-tasking. Additionally, 95% of patients overall, regardless of age, agreed that delaying disease progression was important to them. Conclusions: Evaluation of disease burden is important as patients and healthcare providers are empowered to take more active roles in shared decision making for treatments that are aligned with patients' concerns and priorities. While patients with CLL, DLBCL, and FL report substantial disease burden, the negative impact of disease was reported in a greater proportion of younger patients (<60 years) than in older patients (≥60 years). Differences in patient-reported disease burden based on age and other patient circumstances should be explored as potential key concerns of patients for education of the clinical community. Disclosures Dawson: Roche/Genentech: Equity Ownership; Genentech: Employment. Price:RTI Health Solutions (RTI-HS): Employment. Sae-Hau:Genentech: Other: The Leukemia & Lymphoma Society received funding from Genentech to participate in this research and also receives programmatic funding from Genentech.. Weiss:Genentech: Other: The Leukemia & Lymphoma Society received funding from Genentech to participate in this research and also receives programmatic funding from Genentech.. Mange:Research Triangle Institute d/b/a RTI Health Solutions: Employment. Mansfield:RTI Health Solutions (RTI-HS): Employment. Comenencia-Ortiz:Genentech, Inc.: Employment. Masaquel:Roche: Equity Ownership; Genentech: Employment. Ravelo:Genentech: Employment, Equity Ownership.

scholarly journals Age as a prognostic factor in skin melanoma

2015 ◽  
Vol 67 (3) ◽  
pp. 935-940
Author(s):  
Aleksandar Martinovic ◽  
Marko Buta ◽  
Nada Santrac ◽  
Zelimir Jovanovic ◽  
Stevan Jokic ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Lymph Nodes ◽  
Older Patients ◽  
Statistical Significance ◽  
Tumor Thickness ◽  
Survival Outcomes ◽  
Skin Melanoma ◽  
Younger Patients ◽  
Number Of Patients ◽  
Negative Lymph Nodes

The aim of this study was to establish whether older patients with skin melanoma (in an analyzed group of 189 patients treated at the Institute for Oncology and Radiology of Serbia from 2004 to 2008), have worse survival compared to younger patients. In 100 men and 89 women with an average age of 58.9 years, the following parameters were observed and statistically analyzed in SPSS: gender, age, localization, tumor thickness, ulceration, lymphonodal status and invasion level. In the four age subgroups - quartiles, the best survival was shown in patients <50 years (85.7%), and the worst in patients >70 years (76.1%). Patients without ulcerations, with negative lymph nodes, thin melanomas and Clark levels I and II had significantly better survival outcomes. Although the results showed no statistical significance of age as a prognostic factor in the survival of patients with skin melanoma, further research on a larger number of patients is warranted.

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