Premorbid functional status as an outcome predictor in intensive care patients aged over 85 years.

BACKGROUND: Poor premorbid functional status (PFS) is associated with mortality after intensive care unit (ICU) admission in patients aged 80 years or older. In the subgroup of very old ICU patients, the ability to recover from critical illness varies irrespective of age. To assess the predictive ability of PFS also among the patients aged 85 or older we set out the current study. METHODS: In this nationwide observational registry study based on the Finnish Intensive Care Consortium database, we analysed data of patients aged 85 years or over treated in ICUs between May 2012 and December 2015. We defined PFS as good for patients who had been independent in activities of daily living (ADL) and able to climb stairs and as poor for those who were dependent on help or unable to climb stairs. To assess patients' functional outcome one year after ICU admission, we created a functional status score (FSS) based on how many out of five physical activities (getting out of bed, moving indoors, dressing, climbing stairs, and walking 400 m) the patient could manage. We also assessed the patients' ability to return to their previous type of accommodation. RESULTS: Overall, 2037 (3.3% of all adult ICU patients) patients were 85 years old or older. The average age of the study population was 87 years. Data on PFS were available for 1446 (71.0%) patients (good for 48.8% and poor for 51.2%). The one-year mortalities of patients with good and those with poor PFS were 29.2% and 50.1%, respectively, p < 0.001. Poor PFS increased the probability of death within 12 months, adjusted odds ratio (OR), 2.15; 95% confidence interval (CI) 1.68-2.76, p < 0.001. For 69.5% of survivors, the FSS one year after ICU admission was unchanged or higher than their premorbid FSS and 84.2% of patients living at home before ICU admission still lived at home. CONCLUSIONS: Poor PFS doubled the odds of death within one year. For most survivors, functional status was comparable to the premorbid status.

Life as Experienced Within and Through the Body After the Age of 85 Years: A Metasynthesis of Primary Phenomenological Research.

The body is central to the experience of aging. In this metasynthesis, the authors located, analyzed, and reconceptualized phenomenological research on how life is experienced within and through the body after 85 years. Sandelowski and Barroso's metasynthesis method was employed. Seven databases were searched for primary phenomenological studies. After systematic screening and quality appraisal, 19 studies were included for review. Analysis was guided by Maurice Merleau-Ponty's existential philosophy of embodiment. Findings were organized using Max van Manen's reflective lifeworld existentials. Four ontological dimensions emerged, namely, being in a body (corporeality), being in time (temporality), being in place (spatiality), and being with others (relationality). Each dimension captures a distinct experiential dimension of this stage of the life course. The results suggest vast heterogeneity in the ontological experience of aging, supporting the view that diversity grows with age. The ability to adapt to multidimensional losses was identified as a source of resilience.

Importance rating of risk factors of ischemic stroke in patients over 85 years old in the polish population.

INTRODUCTION: The European population is aging and the number of elderly patients suffering from ischemic brain stroke increases. A better knowledge of the correlation between the risk factors and the course of the disease in old people may be useful for planning medical care and prophylactic strategies. AIM: This prospective study aimed to perform a demographic and clinical analysis of the etiology of ischemic stroke, survival rate and severity of post-stroke disability in patients who developed ischemic stroke at the age of over 85 years in the Polish population. METHOD: The study group consisted of 159 patients over 85 years old with ischemic stroke. The prevalence of risk factors such as sex, hypertension, hyperlipidemia, atrial fibrillation, heart failure and diabetes was evaluated. The outcome was assessed using the Barthel scale and the National Institutes of Health Stroke Scale. RESULTS: The most common risk factors of ischemic stroke were hypertension and atrial fibrillation. Patients with atrial fibrillation had a more severe course of ischemic stroke. CONCLUSION: The course of brain stroke in the Polish population is more severe in patients over 85 years old than in younger ones. The key risk factor in this group is atrial fibrillation.

Malignant middle cerebral artery (MCA) infarction in people over 85 years old - Diagnosis, management and risk factors.

INTRODUCTION: Malignant ischemic stroke of the middle cerebral artery (MCA) territory causes neurological deterioration due to the effects of space occupying cerebral edema. The prognosis is poor, and death usually occurs as a result of brainstem compression. There is no information on ischemic stroke, especially the malignant ones, in patients over 85 years old. AIM: The aim of this retrospective study was to evaluate the disease course, risk factors, survival rate and treatment of MCA malignant infarction in people over 85 years old. METHOD: The medical history of 66 patients with malignant MCA stroke was analyzed. The frequency of the occurrence of the risk factors like hypertension, hyperlipidemia, atrial fibrillation, heart failure, diabetes was evaluated. Disability was measured with the use of the National Institutes of Health Stroke Scale (NIHSS). Safety and effectiveness of the anticoagulants used in the group of patients with atrial fibrillation were analyzed. Chi-quadrat test and Mann-Whitney U test were used for statistical analysis of data. We also described 85 year-old patient with malignant brain stroke who was treated neurosurgically with a positive effect. RESULTS: Atrial fibrillation was diagnosed in 65% of patients of the investigated group. There were no statistically significant changes in the survival rate between the group of patients treated with the use of mannitol and patients without this treatment. CONCLUSION: The key risk factor in this group is the atrial fibrillation. The elderly patients require an intensive monitoring of the health condition by reference to brain stroke risk factors, especially atrial fibrillation.

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme.

BACKGROUND: Complex PTSD (CPTSD) has been incorporated in the 11th edition of the International Classification of Diseases (ICD-11) as a mental health condition distinct from PTSD. OBJECTIVE: The objective of the current study is to determine whether individuals classified as having CPTSD can benefit from an intensive trauma-focused treatment, resulting in decreased PTSD and CPTSD symptoms, and loss of diagnoses. METHOD: Patients diagnosed with PTSD (N = 308) took part in an intensive 8-day treatment programme combining prolonged exposure, EMDR therapy, psycho-education, and physical activity. The treatment was not phase-based in that it did not contain a stabilization phase or skill training prior to therapy. CPTSD diagnosis was assessed by means of the International Trauma Questionnaire (ITQ) and PTSD diagnosis was assessed with both the ITQ and CAPS-5. Treatment response was measured with the CAPS-5, PCL-5, and ITQ. RESULTS: Symptoms of both PTSD and CPTSD significantly decreased from pre- to post-treatment resulting in a significant loss of CAPS-5 based PTSD (74.0%) and ITQ-based PTSD and CPTSD diagnoses (85.0% and 87.7%, respectively). No adverse events occurred in terms of suicides, suicide attempts, or hospital admissions. CONCLUSIONS: The results are supportive of the notion that the majority of patients classified as having CPTSD strongly benefit from an intensive trauma-focused treatment for their PTSD.

Antecedentes: El TEPT complejo (TEPT-C) se ha incorporado en la 11ª edición de la Clasificación Internacional de Enfermedades (CIE-11) como una condición de salud mental distinta del TEPT.Objetivo: El objetivo del presente estudio es determinar si las personas clasificadas como con TEPT-C pueden beneficiarse de un tratamiento intensivo centrado en el trauma, lo que resulta en una disminución de los síntomas de TEPT y TEPT-C y la pérdida de diagnóstico de TEPT.Método: Los pacientes diagnosticados con TEPT (N = 308) participaron en un programa de tratamiento intensivo de 8 días que combina exposición prolongada, terapia EMDR, psicoeducación y actividad física. El tratamiento no se dividió en fases, ya que no contenía una fase de estabilización o entrenamiento de habilidades antes de la terapia. El diagnóstico de TEPT-C se evaluó mediante el Cuestionario Internacional de Trauma (ITQ por sus siglas en ingles) y el diagnóstico de TEPT se evaluó tanto con el ITQ como con CAPS-5. La respuesta al tratamiento se midió con CAPS-5, PCL-5 e ITQ.Resultados: los síntomas de TEPT y TEPT-C disminuyeron significativamente del pretratamiento al postratamiento, lo que resultó en una pérdida significativa del diagnóstico de TEPT basado en CAPS-5 (74.0%) y diagnósticos de TEPT y TEPT-C basados en ITQ (85.0 y 87.7%, respectivamente). No se produjeron eventos adversos en términos de suicidios, intentos de suicidio o ingresos hospitalarios.Conclusiones: Los resultados apoyan la noción de que la mayoría de los pacientes clasificados con TEPT-C se benefician significativamente de un tratamiento intensivo centrado en el trauma para su TEPT.

Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old.

OBJECTIVES: Surgical aortic valve replacement (SAVR) for the treatment of in very old patients with severe aortic stenosis is associated with a high risk of morbidity and mortality. Transcatheter aortic valve implantation (TAVI) has become the preferred alternative. Therefore, we sought to evaluate outcomes in very old patients who underwent SAVR versus TAVI. METHODS: A total of 169 consecutive patients aged ≥85 years underwent TAVI (n = 68) or SAVR (n = 101). A propensity score adjustment was used to compare outcomes including cost analysis. RESULTS: The propensity score generated 40 pairs of patients with similar baseline characteristics. The TAVI group experienced atrioventricular block (37.5% vs 5%, P < 0.01) more frequently, a longer stay in the intensive care unit (median 5 days, range 1-35 vs median 2 days, range 1-6, P < 0.01) but a lower rate of new-onset atrial fibrillation (15% vs 47.5%, P < 0.01). The 30-day mortality rate was similar in the unmatched and matched cohorts (8.8% vs 5.0%, P = 0.32; 10% vs 7.5%, P = 0.69). One, 3- and 5-year overall survival rates (80% vs 90%, 56% vs 79%, 37% vs 71%, P < 0.01) and freedom from major adverse cardiac and cardiovascular events (72% vs 90%, 46% vs 76%, 17% vs 68%, P < 0.01) were lower in the TAVI group. An overall cost analysis indicated that TAVI was more expensive (€2084 vs €19 891). CONCLUSIONS: In patients 85 years and older, SAVR seems to offer good short- and mid-term clinical outcomes compared to TAVI. Advanced age alone would not be an indication for TAVI in old-old patients.