Comparison of R-CHOP-14 and R-mini-CHOP in older adults with diffuse large B-cell lymphoma-A retrospective multicenter cohort study.

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma entity, and its incidence increases with age. There is a paucity of data regarding use of biweekly R-CHOP (R-CHOP-14) in patients ≥80 years of age. We performed a retrospective cohort study of patients with DLBCL aged ≥80 years treated with R-CHOP-14 and R-miniCHOP in two academic tertiary centers in Germany between 01/01/2005 and 12/30/2019. Overall, 79 patients were included. Median age was 84 years (range 80-91). Despite higher CR rates with R-CHOP-14 (71.4% vs. 52.4%), no statistically significant difference could be found between patients treated with R-CHOP-14 and R-miniCHOP regarding overall survival (OS) (p = .88, HR 0.94, 95% CI = 0.47-1.90) and progression-free survival (PFS) (p = .26, HR 0.66, 95% CI = 0.32-1.36). At a median follow-up of 40 months, the 2-year OS rates were 56% with R-CHOP-14 and 53% with R-miniCHOP. Two-year PFS rates were 46% for R-CHOP-14 and 50% for R-mini-CHOP. Relative dose intensity of chemotherapy did not correlate with OS (p = .72). With the caveat of a retrospective cohort study, we conclude that lacking a difference in OS, R-miniCHOP should be preferred for most patients with untreated DLBCL aged ≥80 years.

A phase 2 open-label study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (EMPOWER-CSCC-1): Final long-term analysis of groups 1, 2, and 3, and primary analysis of fixed-dose treatment group 6.

BACKGROUND: In the phase 2 EMPOWER-CSCC-1 study (NCT02760498), cemiplimab demonstrated antitumor activity against metastatic cutaneous squamous cell carcinoma (mCSCC) and locally advanced cutaneous squamous cell carcinoma (laCSCC). OBJECTIVES: To report final analysis of weight-based cemiplimab in mCSCC and laCSCC (groups 1 and 2), fixed-dose cemiplimab in mCSCC (group 3), and primary analysis of fixed-dose cemiplimab in mCSCC/laCSCC (group 6). METHODS: Patients received cemiplimab (3 mg/kg intravenously every 2 weeks [groups 1 and 2]) or cemiplimab (350 mg intravenously [groups 3 and 6]) every 3 weeks. The primary end point was objective response rate (ORR). Duration of response (DOR) and progression-free survival (PFS) are presented per protocol, according to post-hoc sensitivity analyses that only include the period of protocol-mandated imaging assessments. RESULTS: At 42.5 months, ORR for groups 1-3 (n = 193) was 47.2%, estimated 12-month DOR was 88.3%, and median PFS was 26.0 months. At 8.7 months, ORR for group 6 (n = 165 patients) was 44.8%; median DOR and median PFS were not reached. Serious treatment-emergent adverse event rates (grade ≥3) were groups 1-3: 31.1% and group 6: 34.5%. LIMITATIONS: Nonrandomized study, nonsurvival primary end point. CONCLUSION: EMPOWER-CSCC-1 provides the largest prospective data on long-term efficacy and safety for anti-programmed cell death-1 therapy in advanced CSCC.

Pharmacist-Led Medication Management in Acute Geriatric Medicine and Its Associations with Rehospitalizations: A Cohort Study.

INTRODUCTION: Hospitalization and discharge in older patients are critical and clinical pharmacists have shown to ameliorate risks. Our objective was to assess their benefit as part of the geriatric team regarding rehospitalizations and related outcomes after discharge focusing on general practitioners' decision to continue or change discharge medication (GPD). METHODS: Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations. RESULTS: One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%). DISCUSSION: Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist's acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.

Predictors of dementia among the oldest old: longitudinal findings from the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)".

BACKGROUND/AIMS: Our current study aimed to investigate the determinants of dementia among the oldest old using longitudinal data from a representative sample covering both community-dwelling and institutionalized individuals. METHODS/DESIGN: Longitudinal representative data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" that surveyed community-dwelling and institutionalized individuals aged 80 years and above (n = 1,296 observations in the analytic sample), living in North Rhine-Westphalia (most populous state of Germany). The established DemTect was used to measure cognitive impairment (i.e., probable dementia). A logistic random effects model was used to examine the determinants of probable dementia. RESULTS: The mean age was 86.3 years (SD: 4.2 years). Multiple logistic regressions revealed that a higher likelihood of probable dementia was positively associated with lower education (e.g., low education compared to medium education: OR: 3.31 [95% CI: 1.10-9.98]), a smaller network size (OR: 0.87 [95% CI: 0.79-0.96]), lower health literacy (OR: 0.29 [95% CI: 0.14-0.60]), and higher functional impairment (OR: 13.45 [3.86-46.92]), whereas it was not significantly associated with sex, age, marital status, loneliness, and depressive symptoms in the total sample. Regressions stratified by sex were also reported. DISCUSSION: Our study identified factors associated with dementia among the oldest old. This study extends current knowledge by using data from the oldest old; and by presenting findings based on longitudinal, representative data (also including individuals residing in institutionalized settings). CONCLUSIONS: Efforts to increase, among other things, formal education, network size, and health literacy may be fruitful in postponing dementia, particularly among older women. Developing health literacy programs, for example, may be beneficial to reduce the burden associated with dementia.

Validity and test-retest reliability of the Swedish version of the Geriatric Depression Scale among very old adults.

BACKGROUND: The Geriatric Depression Scale (GDS) has shown good validity and reliability, but few studies have examined the GDS among very old adults or the Swedish translation. OBJECTIVES: Evaluate the validity and reliability of the Swedish version of GDS-15 among very old adults. METHODS: In the Umeå85 + /GErontological Regional DAtabase (GERDA) study, 387 participants were assessed with both the GDS-15 and the Montgomery-Åsberg Depression Rating Scale (MADRS). The mean age was 91 years. Concurrent validity between the scales was calculated using Spearman's correlation. We used the Diagnostic and Statistical Manual of Mental Disorders (DSM) V symptom criteria for depression based on MADRS item scores to define depression. We calculated the Area Under the Curve (AUC) and found an optimal cut-off. A convenience sample with 60 individuals was used to calculate test-retest reliability with Cohen's kappa and Intraclass Correlation Coefficient (ICC). RESULTS: Spearman's correlation coefficients between total scores for GDS-15 and MADRS were 0.60. Cronbach's alpha for the whole scale was 0.73. The AUC was 0.90 for distinguishing major depression, and the recommended cut-off of ≥ 5 showed a sensitivity of 95.2% and specificity of 65.8%. The test-retest showed that Cohen's kappa was substantial (0.71) and the ICC was excellent (0.95). CONCLUSIONS: The Swedish version of the GDS-15 showed good validity and reliability among very old adults. The generally recommended cut-off of ≥ 5 seems reasonable to use with the Swedish version and among very old adults.

Pain: its prevalence and correlates among the oldest old.

BACKGROUND: There is very limited knowledge regarding pain among the oldest old. AIMS: To investigate the prevalence and correlates of pain among the oldest old. METHODS: Data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)", including individuals living in North Rhine-Westphalia aged 80 years and over. Pain was categorized as no pain, moderate pain and severe pain. Its prevalence was stratified by sex, age groups, marital status, place of residence and education. A multinomial logistic regression analysis was conducted. RESULTS: 28.50% of the participants reported no pain, 45.06% moderate pain and 26.44% severe pain. Regressions showed that being 85 years or older and a better self-rated health status decreased the likelihood of moderate pain. Being 85-89 years old, being male, highly educated and a better self-rated health status decreased the likelihood of severe pain. The likelihood of moderate and severe pain increased with a higher number of chronic diseases. DISCUSSION: Study findings showed a high prevalence of pain in the oldest old living in North Rhine-Westphalia, Germany. The likelihood of having moderate or severe pain was reduced among those who were older and presented with a better self-rated health but increased with a growing number of comorbidities. Severe pain was less likely among men and those with a higher education. CONCLUSION: This cross-sectional representative study adds first evidence of prevalence and correlations of pain among the oldest old. Longitudinal studies are required to further explore the determinants of pain in this age group.

Having Plans for the Future in Very Old People.

This study aimed to investigate the prevalence of having plans for the future among very old people and the factors associated with having such plans. A longitudinal population-based study with home visits for 85-, 90-, and ≥95-year-old participants in Sweden and Finland was used. Multivariate logistic regression and Cox proportional-hazards regression models with a maximum 5-year follow-up period were used. The prevalence of having plans for the future was 18.6% (174/936). More men than women and more people living in Sweden than in Finland had plans for the future. In multivariate models, having plans for the future was associated with speaking Swedish, being dentate, and living in the community in the total sample; speaking Swedish and being dentate among women; and speaking Swedish, having a lower Geriatric Depression Scale score, and urban residence among men. Having plans for the future was associated univariately, but not multivariately, with increased survival.

[Prevention of ischemic stroke in old age]. / Prävention des ischämischen Schlaganfalls im Alter.

Stroke is one of the main causes of permanent disability and death and the risk increases with age. Primary and secondary prevention therefore have a high priority. The treatment of risk factors, such as high blood pressure, diabetes mellitus and hyperlipidemia is just as important as anticoagulation in atrial fibrillation, in addition to optimization of lifestyle and diet. Platelet function inhibitors play a role in the prophylaxis of recurrence, carotid surgery and stenting are used in selected patients. There is little study evidence for old people, individualized treatment planning takes functional status and comorbidities into account.

Safety and efficacy of preoperative chemotherapy for muscle-invasive bladder cancer in elderly patients.

PURPOSE: This study aimed at describing the feasibility and oncological outcomes of standard cisplatin-based neoadjuvant chemotherapy (C-NAC) for muscle-invasive bladder cancer (MIBC) in patients aged ≥ 75 and assess the impact of baseline geriatric parameters. METHODS: This retrospective study included patients with stage cT2-4NanyM0 MIBC aged 75 and older treated with ≥ 1 cycle of C-NAC from 2011 to 2021 at a high-volume academic center. Primary outcome was overall survival (OS). Secondary outcomes were chemotherapy feasibility (administration of ≥ 4 cycles), safety, and pathological downstaging. RESULTS: Fifty-six patients were included. Median age was 79 (range 75-90). C-NAC regimen was ddMVAC in 41 patients and GC in 15. Seventy-three percent of patients received ≥ 4 cycles of C-NAC. Grade ≥ 3 toxicity was observed in 55% of patients. The febrile neutropenia rate was 7%. Thirty patients underwent cystectomy, and 13 underwent chemoradiotherapy. Three-year OS was 63%. Geriatric parameters polypharmacy, undernutrition, and age-adjusted Charlson comorbidity index ≥ 8 predicted worse OS. CONCLUSION: Standard-of-care C-NAC and local treatments are feasible in selected elderly MIBC patients, with efficacy and safety findings similar to that observed in pivotal trials with younger patients. The prognostic impact of geriatric parameters underlines the need for specialized evaluation before treatment initiation.

Patients Who Seek to Hasten Death by Voluntarily Stopping Eating and Drinking: A Qualitative Study.

PURPOSE: Voluntary stopping of eating and drinking (VSED) is a controversial method to hasten death. Little is known about why and how people come to VSED. This study assessed patients' motives, how patients decide on VSED, and the ways in which they prepare for VSED and involve others. METHODS: We conducted a qualitative study in the Netherlands of 29 patients; 24 started VSED and 19 died. Thirteen patients were included before or during VSED and 16 afterward. We interviewed 17 patients, 18 relatives, and 10 professional caregivers. Inductive ideal-type analysis was used to describe typologies. RESULTS: Three patient groups emerged. The first group (12 patients) were older people who felt life was completed, for whom control was important. They prepared well for VSED, but could overlook the need for help and the emotional burden their decision could place on relatives. The second group (11 patients) were older care-dependent patients with a poor quality of life. They sometimes started VSED suddenly, and they relied heavily on (informal) caregivers to prepare and execute their plan. The third group (6 patients) were psychiatric patients with a long-standing but fluctuating death wish, most of whom were younger. They often prepared for VSED in secrecy or started VSED unprepared. CONCLUSIONS: Patients embarking on a trajectory toward VSED are a very diverse group, with different care needs. Guidance for care during VSED needs to be applicable to all 3 groups.

Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy.

BACKGROUND: Impact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established. METHODS: This single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis. RESULTS: Of the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3. CONCLUSION: Advanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.

Prevalence of potentially inappropriate medication use in older population: comparison of the Finnish Meds75+ database with eight published criteria.

BACKGROUND: There are several national and international criteria available for identifying potentially inappropriate medications (PIMs) for older people. The prevalence of PIM use may vary depending on the criteria used. The aim is to examine the prevalence of potentially inappropriate medication use in Finland according to the Meds75+ database, developed to support clinical decision-making in Finland, and to compare it with eight other PIM criteria. METHODS: This nationwide register study consisted of Finnish people aged 75 years or older (n = 497,663) who during 2017-2019 purchased at least one prescribed medicine considered as a PIM, based on any of the included criteria. The data on purchased prescription medicines was collected from the Prescription Centre of Finland. RESULTS: The annual prevalence of 10.7-57.0% was observed for PIM use depending on which criteria was used. The highest prevalence was detected with the Beers and lowest with the Laroche criteria. According to the Meds75+ database, annually every third person had used PIMs. Regardless of the applied criteria, the prevalence of PIM use decreased during the follow-up. The differences in the prevalence of medicine classes of PIMs explain the variance of the overall prevalence between the criteria, but they identify the most commonly used PIMs quite similarly. CONCLUSION: PIM use is common among older people in Finland according to the national Meds75+ database, but the prevalence is dependent on the applied criteria. The results indicate that different PIM criteria emphasize different medicine classes, and clinicians should consider this issue when applying PIM criteria in their daily practice.

Prevalence and correlates of loneliness and social isolation in the oldest old: a systematic review, meta-analysis and meta-regression.

PURPOSE: Conducting a systematic review, meta-analysis and meta-regression regarding the prevalence and correlates of loneliness and social isolation amongst the community-dwelling and institutionalised oldest old (80 years and over). METHODS: Three electronic databases (PsycINFO, CINAHL and Medline) were searched, including studies from inception to January 5, 2023. An additional hand search was conducted by checking included studies' references, and studies that cited included studies. We included observational studies describing the prevalence and (ideally) the correlates of loneliness, or social isolation, amongst individuals aged 80 years and over. Study design, operationalization of loneliness and social isolation, statistical analysis, characteristics of the sample and key findings were extracted. A random-effects meta-analysis was conducted. RESULTS: We included 22 studies. The estimated prevalence of severe loneliness was 27.1% (95% CI: 23.7-30.4%). The estimated prevalence of moderate loneliness equalled 32.1% (95% CI: 15.8-48.4%). Moreover, the estimated prevalence of social isolation was 33.6% (95% CI: 28.9-38.2%). There was heterogeneity between the studies. Egger tests suggest the absence of potential publication bias. Meta-regressions showed that the heterogeneity could neither be attributed to the assessment of loneliness nor to the continent where the study was conducted. CONCLUSION: Loneliness and social isolation are important problems in the oldest old. In this age group, studies are required, in particular from regions outside Europe. Additionally, longitudinal studies are required to investigate the determinants of loneliness and social isolation amongst individuals aged 80 years and over. Studies using more sophisticated tools to quantify loneliness and social isolation are required.

A meta-synthesis on the older adults' perspective of advance care planning.

AIM: To synthesise the evidence regarding older adults' perception of advance care planning in preparation for end-of-life care. BACKGROUND: Advance care planning involves continuous communication of end-of-life care goals involving an individual's medical treatment preferences. However, its uptake among older adults remains low. DESIGN: The meta-synthesis was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative research (ENTREQ) guidelines and thematic synthesis was employed to synthesise the qualitative findings in an inductive manner. DATA SOURCE: A search was completed on six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus), for publications from 1 January 2000 to 4 December 2021. REVIEW METHOD: The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence (GRADE-CERQual) in the Evidence from Reviews of Qualitative research. Two independent reviewers conducted this process, and disagreements were resolved through discussions. RESULTS: Fourteen studies were analysed. Four major themes and eleven subthemes emerged from the thematic synthesis: (1) psychosocial preparedness, (2) medical preparedness, (3) psychological barriers towards advance care planning and (4) extrinsic barriers towards advance care planning. DISCUSSION: These themes consolidated older adults' views of advance care planning and how engagement in this planning affected their end-of-life preparedness. CONCLUSION: This review suggested psychological and extrinsic factors were barriers to the uptake of advance care planning and provided directions for future research to achieve a holistic understanding of the impact of advance care planning on end-of-life preparedness. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals could maintain close communication with older adults and families periodically to evaluate their readiness to discuss advance care planning to improve their preparedness. Healthcare professionals could also provide psychological support during the discussion of clinical decision-making to enhance readiness and confidence among older adults and their families.

Safeguarding survival: Older persons with multiple chronic conditions' unplanned readmission experiences: A mixed methods systematic review.

AIMS AND OBJECTIVES: The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. DESIGN: Mixed methods systematic review. DATA SOURCES: Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). REVIEW METHODS: Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. RESULTS: Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. CONCLUSIONS: Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. RELEVANCE TO CLINICAL PRACTICE: Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. REPORTING METHOD: PRISMA guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution due to design.

Functional dentition and well-being among Chilean 80-year-olds.

BACKGROUND: The Decade of Healthy Aging 2021-2030 calls for a strengthening of the policies for older people in Latin America. An example of successful oral aging is the Japanese "8020" campaign, which achieved 50% of people aged 80 years having ≥20 teeth by 2016. OBJECTIVE: To evaluate the association between having a functional dentition (≥20 teeth) and cognitive health, social participation, and quality of life in people aged ≥80 years. METHODS: Cross-sectional data from 299 complete observations (weighted N = 436 981) of individuals aged ≥80 years from Chile's National Health Survey 2016-2017 were included (3% of the population; total = 5520 clinical observations/weighted N = 14 518 969). Generalised structural equation models (GSEM) evaluated the association between having a functional dentition and cognitive health, measured with the Mini-mental score, between having a functional dentition and social participation, and between having a functional dentition and quality of life, measured with the EQ-5D-3L. Models included the effect of mediators (daily fruit and vegetable consumption; oral health-related quality of life score) and controlled for the exposure-induced mediator-outcome variables: sex, educational level, and location. Data were analysed using the STATA-17 survey module. Statistical significance was set at P < .05 (95% confidence interval [CI]). RESULTS: The sample was mostly female, had <8 years of education, and lived in urban areas. The prevalence of a functional dentition was 9.2% (95% CI 3.6,21.3/n = 21). GSEM demonstrated that the association between functional dentition and cognitive health was mediated by daily fruits and vegetables consumption (ß = 0.12/95% CI 0.02,0.21/P = .015), with moderate strength of evidence. Additionally, there was strong evidence of an association between functional dentition and social participation frequency (ß = 2.76/95% CI 0.60,4.73/P = .009). Finally, the association between functional dentition and quality of life was mediated by cognitive health (ß =0.05/95% CI 0.02,0.09/P = .002) and oral health-related quality of life (ß = -0.04/95% CI -0.08 to -0.01/P = .025), with strong and moderate evidence, respectively. CONCLUSION: Given the beneficial implications of functional dentition in social participation, nutritional benefits and quality of life and well-being of individuals aged ≥80 years.

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient.

A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

Characteristics of desirable ambulatory health and oral healthcare from the perspective of community-dwelling people aged 80 and over-a qualitative examination.

BACKGROUND: people aged 80 and over frequently have diverse and complex health trajectories, which has been well studied. But their oral health is seldom included in care models. To realise comprehensive healthcare, both general and oral ambulatory (i.e. outpatient) healthcare need to be explored and conceptualised equally. OBJECTIVE: to elicit what matters to very old people regarding ambulatory health and oral healthcare. METHODS: interviews were conducted with non-institutionalised people aged 80 and over living in the area of Cologne, Germany. They were interviewed regarding their experiences of and views on ambulatory healthcare and oral healthcare care, respectively. Thematic analysis was performed to understand their motives and elicit relevant characteristics of desirable health services. RESULTS: from the interviews with 22 participants, 16 characteristics of good healthcare were described. These were generally similar for both general and oral healthcare and had a particular focus on patient-provider interaction and the organisation of care. However, regarding oral healthcare, the participants focused more strongly on the technical-medical skills of professionals and the perceptible treatment results and were more concerned about costs. It was noticeable that older people had the urge to differentiate themselves from 'others unnecessarily using health services'. They were unaware of possible future oral health deterioration and the resulting future needs. CONCLUSIONS: characteristics of good health and oral healthcare from the perspective of older people should be incorporated to ensure patient-centredness in care models. Older patients, as well as healthcare providers, need to be sensitised to their oral health needs to realise comprehensive healthcare.

Factors Leading to Institutionalization among the Oldest Old: Longitudinal Findings from the AgeCoDe-AgeQualiDe Study.

INTRODUCTION: Due to the strong association between old age and the need for long-term care, the number of individuals in need for care is projected to increase noticeably. The aim of this study was to examine the determinants of institutionalization among the oldest old longitudinally. METHODS: Longitudinal data (follow-up [FU] wave 7-9) were gathered from a multicenter prospective cohort study ("Study on needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients [85+]," AgeQualiDe). At FU wave 7, in 2014, complete measures were available for 763 individuals. The average age was 88.9 (standard deviation 2.9) years (range 85-100), and 68% were female. Sociodemographic and health-related independent variables (e.g., depressive symptoms or functioning) were included in the regression model. Institutionalization (admission to assisted living home or nursing home) was used as an outcome measure. Logistic random-effects models were used. RESULTS: Regressions revealed that among oldest old, the odds of being institutionalized were lower for men (odds ratio [OR] = 0.03; 95% confidence interval [CI] 0.00-0.16). Institutionalization was associated with an increased age (OR = 1.27; 95% CI 1.04-1.55). Additionally, widowed individuals (ref. non-widowed) had higher odds of being institutionalized (OR = 8.95; 95% CI 1.61-49.81). Institutionalization was also associated with functional decline (OR = 0.16; 95% CI 0.11-0.23), whereas it was not significantly associated with cognitive decline, depressive symptoms, and social support. CONCLUSION: Our findings stress the importance of gender, age, widowhood, and functional decline for institutionalization among the oldest old. Preventing or at least postponing functional decline might help to delay institutionalization as far as possible.

Relationships among mental health, social capital and life satisfaction in rural senior older adults: a structural equation model.

BACKGROUND: Literature about life satisfaction in rural senior older adults is scarce. The aim of this research was to examine the relationships among mental health, social capital and life satisfaction in rural senior older adults. METHODS: This was a cross-sectional study. From July to October 2017, 245 senior older adults from 14 villages of Jinhua City in China were recruited. The Satisfaction with Life Scale (SWLS), the Chinese Version of the 12-item General Health Questionnaire (GHQ-12), the Social Capital Questionnaire (SCQ) and a self-designed questionnaire was administered to the participants. Structural equation modelling was implemented to analyse the relationships between mental health, social capital and life satisfaction in rural senior older adults. RESULTS: The structural equation model was fitting adequately (χ2/df = 1.785, P < 0.001; RMSEA = 0.059; CFI = 0.963). Life satisfaction was positively affected by income (ß = 0.243, P = 0.01). Likewise, community canteen services improved life satisfaction (ß = 0.288, P = 0.001). Social capital had direct positive prediction on life satisfaction (ß = 0.342, P = 0.003) and indirectly improved life satisfaction through mental health (ß =0.183, P = 0.007). Life satisfaction was impaired by poor mental health among senior older adults (ß = - 0.395, P < 0.026). CONCLUSIONS: Life satisfaction among rural senior older adults is a multifaceted well-being construct affected by income, community canteen services, social capital and mental health. The presented model highlights the positive effect of income, community canteen services, social capital and mental health. Appropriate home-based aged care, programs and policies are needed.