Development and validation of nomogram for predicting the cancer-specific survival among patients aged 80 and above with early-stage non-small cell lung cancer.

BACKGROUND: The use of nomograms in predicting the prognosis of early-stage non-small cell lung cancer (NSCLC), particularly in elderly patients, is not widespread. A validated prognostic model specifically for NSCLC patients over 80 years old holds promising potential for clinical application in forecasting patient outcomes. METHODS: The prognostic value of various factors for NSCLC patients aged 80 and above was evaluated using data from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2017). Kaplan-Meier (KM) curves, Cox proportional hazards regression models, and nomogram were utilized to evaluate the impact of each factor on cancer-specific survival (CSS). RESULTS: A cohort comprising 7045 individuals was selected for inclusion in the analysis. Through rigorous statistical analysis, 10 independent prognostic factors were identified and incorporated into the nomogram. The nomogram's receiver operating characteristic (ROC) curve area under the curve (AUC) was higher than that of the AJCC 7th edition TNM staging system's predicted CSS (0.744 versus 0.602), establishing the superior prognostic value of the nomogram. CONCLUSIONS: We have successfully created a highly accurate and discriminative nomogram that enables oncologists to predict the survival outcome of each individual patient with I/II NSCLC who is 80 years or older.

Preoperative nutritional status is a useful predictor of the feasibility of postoperative treatment in octogenarian-plus pancreatic ductal adenocarcinoma patients.

BACKGROUND: The suitability of radical surgery for very elderly pancreatic cancer (PC) patients remains controversial due to concerns about postoperative functional reserve. Inflammatory-nutritional status may help identify elderly patients at risk of compromised postoperative treatment tolerance. METHODS: This retrospective analysis included 121 patients over eighty who were diagnosed with PC in 2010-2019, 40 of whom underwent radical surgery. Surgical outcomes were compared with those of 205 younger patients (under 80 years-old) who underwent radical surgery. K-means cluster analysis was conducted with four inflammatory-nutritional indices (NLR, PLR, PNI, and mGPS) to define, and the indices using ordinal logistic analysis were evaluated in each cluster to create a formula named 'nutritional index (NTI)', which was then used to redefine the clusters. The predictive ability of the NTI was validated in other octogenarians who underwent pancreatectomy for PC between 2020 and 2023. RESULTS: Patients older than eighty exhibited comparable overall survival to younger patients (median survival time, 30.7/37.1 months, p = 0.20). However, octogenarian-plus patients had lower rates of adjuvant chemotherapy (AC) initiation (45/80 %) and treatment upon recurrence (52/84 %), resulting in shorter survival after recurrence (7.4/11.1 months, p = 0.06). Inflammatory-nutritional status was significantly associated with overall survival, with poor nutritional status being linked to lower rates of AC initiation and/or treatment upon recurrence. NTI effectively predicted AC feasibility. CONCLUSIONS: Radical surgery for octogenarian-plus PC patients meeting the current criteria was safe, but lower rates of postoperative treatment initiation may lead to poorer outcomes after recurrence. Inflammatory-nutritional status assessment could enhance surgical eligibility in octogenarian-plus PC patients.

Preoperative moderate to severe anemia is associated with increased postoperative major adverse cardiac and cerebral events and pulmonary complications: a propensity score-matched analysis in hip fracture surgery patients over 80 years old.

BACKGROUND: Anemia is a common health problem in the elderly. Preoperative anemia is a risk factor for postoperative outcomes in the elderly for hip fracture. The objective of the study was to explore the relationship between preoperative moderate to severe anemia and postoperative morbidity and mortality in hip fracture patients over 80 years old. METHODS: We performed a retrospective cohort study exploring preoperative moderate to severe anemia and postoperative morbidity and mortality. Patients over 80 years old undergoing hip fracture surgery were included in the study. Data were collected for major adverse cardiac and cerebral events (MACCE), postoperative pulmonary complications (PPCs), in-hospital mortality, delirium, gastrointestinal complication, deep venous thrombus (DVT), acute renal failure, ICU admission, and perioperative transfusion > 2 units rate. RESULTS: A total of 912 eligible patients were included for unmatched cohort analysis, and 512 patients were included for matched cohort analysis after propensity score matching. Baseline characteristics between the normal to mild anemia and moderate to severe anemia groups were significantly different. More patients in the moderate to severe cohort had a higher ASA classification grade III and female ratio. Patients in the moderate and severe anemia cohorts had more MACCE (unadjusted: odds ratio [OR] 1.968, 96% CI 1.090-3.555, P 0.023; adjusted: OR 1.929, 95% CI 1.014-3.668, P 0.045) and PPCs (unadjusted: OR 2.616, 95% CI 1.442-4.748, P 0.001; adjusted: OR 2.352, 95% CI 1.225-4.516, P 0.010) than patients with normal or mild anemia. However, the transfusion > 2 units rate was not significantly different between the two cohorts (unadjusted: OR 0.967, 95% CI 0.737-1.270, P 0.811; adjusted: OR 0.941, 95% CI 0.693-1.278, P 0.697). The in-hospital mortality, delirium rate, gastrointestinal complication, ICU admission, and DVT were similar. However, the in-hospital mortality was much higher (3.6%, 21/591 vs 1.6%, 5/321) in the moderate to severe anemia cohort. Furthermore, after propensity score-matched analysis, MACCE and PPCs were also significantly increased in the moderate to severe anemia cohort (OR 2.196 & 3.171, 95% CI 1.0794.470 & 1.563-6.436, P 0.027 & 0.001), which were in accordance with the unadjusted and adjusted results in the unmatched cohorts. CONCLUSIONS: Moderate to severe preoperative anemia (< 11 g/dl) is associated with increased postoperative major adverse cardiac and cerebral events and pulmonary complications. Additionally, in-hospital mortality was not significant but was higher in the preoperative moderate to severe anemia cohort. Preoperative assessment and correction of hemoglobin level to above 11 g/dl might reduce MACCE, PPCs, and in-hospital mortality in hip fracture patients over 80 years old.

Ninety-day mortality of extremely elderly patients undergoing hip fracture surgery and its association with preoperative cardiac function: a single-center retrospective study.

PURPOSE: We investigated the 90-day mortality rate in elderly patients who underwent hip fracture surgery and the association of preoperative cardiac function with mortality. METHODS: We retrospectively enrolled 133 consecutive patients aged 80 years or older who underwent hip fracture surgery. We obtained information for patient sex, age, comorbidities, medications, anesthesia method, left ventricular systolic and diastolic functions assessed by echocardiography, and preoperative brain natriuretic peptide (BNP) levels. Multivariate logistic regression analysis was performed. RESULTS: The 90-day mortality rate in patients with a mean age of 88.9 years was 7.5% (10/133). More than half of the patients had diastolic dysfunction of the left ventricle. There were no significant differences in preoperative cardiac systolic and diastolic functions between the mortality group and non-mortality group. The preoperative BNP level in the mortality group was significantly higher than that in the non-mortality group (p = 0.038). Preoperative BNP level was not an independent risk factor for 90-day mortality (p = 0.081) in the primary multivariate logistic regression analysis but was an independent risk factor (p = 0.039) with an odds ratio of 1.004 (95% CI 1.000-1.008) in the sensitivity analysis with different explanatory variables. CONCLUSION: The 90-day mortality rate in patients over 80 years old after hip fracture surgery was 7.5%. There were no significant differences in preoperative cardiac function assessed by echocardiography between the mortality and non-mortality groups. Our results suggest that there is no association or only a weak association of high BNP level with 90-day mortality in this age population.

Preoperative Hemoglobin <10 g/DL Predicts an Increase in Major Adverse Cardiac Events in Patients With Hip Fracture Over 80 Years: A Retrospective Cohort Study.

Background: Preoperative anemia has been associated with perioperative morbidity and mortality in patients undergoing cardiac and non-cardiac surgery. Preoperative anemia is common in elderly hip fracture patients. The primary objective of the study was to explore the relationship between preoperative hemoglobin levels and postoperative major adverse cardiovascular events (MACEs) in hip fracture patients over 80 years. Methods: The retrospective study enrolled hip fracture patients over 80 years from January 2015 to December 2021 in our center. The data were collected from the hospital's electronic database after approval by the ethics committee. The primary objective of the study was to investigate MACEs, and the secondary objectives included in-hospital mortality, delirium, acute renal failure, ICU admission rate, and transfusion (>2 U). Results: 912 patients were entered for final analysis. Based on the restricted cubic spline, the risk of preoperative hemoglobin (<10 g/DL) was associated with an increased risk of postoperative complications. With univariable logistic analysis, a hemoglobin level <10 g/DL was associated with increased MACEs [OR 1.769, 95% CI (1.074, 2.914), P = .025], in-hospital mortality [OR 2.709, 95% CI (1.215, 6.039), P = .015] and transfusion >2 U risk [OR 2.049, 95% CI (1.56, 2.69), P < .001]. Even after adjustment for confounding factors, MACEs [OR 1.790, 95% CI (1.073, 2.985), P = .026], in-hospital mortality [OR 2.81, 95% CI (1.214, 6.514), P = .016] and transfusion >2 U rate [OR 2.002, 95% CI (1.516, 2.65), P < .001] were still higher in the lower hemoglobin level cohort. Moreover, a log-rank test showed increased in-hospital mortality in the cohort with a preoperative hemoglobin level of <10 g/DL. However, there was no difference in delirium, acute renal failure, and ICU admission rates. Conclusions: In conclusion, for hip fracture patients over 80 years, preoperative hemoglobin levels <10 g/DL might be associated with increased postoperative MACEs, in-hospital mortality, and transfusion >2 U.

Efficacy of Toric Intraocular Lens Implantation in Patients Older Than 80 Years with Cataracts and Corneal Astigmatism.

INTRODUCTION: This study analyzed the visual outcome following cataract surgery with toric intraocular lenses (IOLs) in patients older than 80 years with corneal astigmatism. METHODS: A total of 159 patients (159 eyes) older than 80 years with corneal astigmatism (≥ 0.75 D) were included. Fifty-three eyes received Acrysof IQ® toric IOLs (SN6AT2-5), while the others received non-toric IOLs: 51 eyes received Acrysof IQ® IOLs (SN60WF) and 55 eyes received A1-UV IOLs. The uncorrected distance visual acuity, corrected distance visual acuity, and refraction (spherical equivalent, refractive cylinder) were assessed at 3 months postoperatively. The prediction error of refractive outcome and percentages of eyes within ± 0.50 D and ± 1.00 D in the toric IOL group obtained using five toric IOL formulas (Barrett predicted posterior corneal astigmatism (PCA), Barrett measured PCA, Kane, EVO 2.0 and Næser-Savini) were compared. RESULTS: At 3 months postoperatively, the average uncorrected distance visual acuity was better in the toric IOL group than the non-toric IOL group (p < 0.001). The mean residual refractive cylinder was lower in the toric IOL group than the non-toric IOL group (p < 0.001). The Næser-Savini formula achieved the lowest mean absolute error (0.39 D) and had the highest percentages of eyes within an absolute error of 0.50 D and 1.00 D (72% and 98%) compared to the other formulas. CONCLUSION: The results demonstrate the efficacy of toric IOL implantation in patients older than 80 years with corneal astigmatism and provide strong evidence for cataract surgeons to encourage such patients to choose toric IOLs.

Systematic review and meta-analysis of reports of patients with gastric cancer aged 80 years and older.

The number of elderly patients in gastric cancer surgery is rapidly rising. Almost all data on gastric cancer in people over the age of 80 come from a single institution, and there is no systematic review of a large number of patients. Therefore, we conducted a comprehensive analysis of the prognosis of patients with gastric cancer surgery who were aged 80 years or older. From January 2010 to November 2021, reports on gastric cancer in the elderly aged 80 and over were gathered. We searched PubMed for "Gastric cancer and elderly and 80 years old" as a keyword, and 253 reports were extracted. The Ichushi-Web database was also searched using the phrase "stomach cancer and 80 years old," and 366 records were found. The random-effect model was used to determine the average 5-year survival rate, and the heterogeneity was evaluated. The proportion of male patients, patients who had surgery after 2010, patients with stage I, total gastrectomy, lymph node dissection, and the presence of complications were used as the explanatory variables in meta-regressions to investigate the cause of prognosis variability. More than 50 surgical cases were reported, 8 from PubMed and 2 from the Ichushi-Web database, with information on surgical procedures, prognosis, and complications, in a total of 1182 patients. Of the ten reports, eight were from Japan and two were from South Korea and Taiwan. The number of patients ranged from 55 to 217, with an average 5-year survival rate of 57%. In terms of the relationship between the time of surgery and prognosis, the overall prognosis for patients who had surgery before 2010 and those who had surgery after 2010 was almost similar. Reports with a high proportion of stage I showed a good prognosis. The rate of total gastrectomy, the proportion of lymph node dissection above D1 + , or surgical complications had no effect on prognosis. Patients with gastric cancer aged 80 years or older who underwent radical surgery had a 5-year survival rate of up to 57%. Postoperative complications appeared to have a minor impact.

Disfunção familiar em nonagenários e centenários: importância das condições de saúde e suporte social / Family dysfunction in nonagenarians and centenarians: the importance of health conditions and social support

Resumo O presente estudo tem como objetivo avaliar os fatores relacionados à disfunção familiar (DF) entre 227 nonagenários e centenários identificados e avaliados no domicílio, aleatoriamente selecionados, em Porto Alegre, Rio Grande do Sul. A DF foi avaliada pelo instrumento "APGAR da família", sendo considerado, no presente estudo, de zero a seis com DF e de sete a dez sem DF. Foram avaliados, entre abril e novembro de 2016, dados sociodemográficos, econômicos, funcionalidade física, autopercepção de saúde, comorbidades, sintomas depressivos, função cognitiva, suporte e interação social. A média do APGAR foi de 9,05±1,81, a DF ocorreu em 9,69% dos participantes. Foram relacionados à DF a autopercepção de saúde (p=0,0003), número de sintomas depressivos (p<0,0001), ter ajuda em caso de doença (p=0,0090) e necessidade de ajuda para administrar medicamentos (p=0,0602). Na análise ajustada, foram independentemente associados à DF em nonagenários e centenários a autopercepção de saúde, a presença de sintomas depressivos e a necessidade de ajuda para administrar medicamentos. Conclui-se que esses fatores parecem interferir na satisfação do nonagenário ou centenário com suas relações familiares.

Abstract The scope of this study is to evaluate factors related to family dysfunction (FD) among 227 randomly selected nonagenarians and centenarians in Porto Alegre, State of Rio Grande do Sul, who were visited and assessed in their homes. FD was evaluated by the "Family APGAR score," being considered with FD from 0 to 6, and without FD from 7 to 10 in this study. Sociodemographic and economic data, physical functionality, health self-perception, comorbidities, depressive symptoms, cognitive function, social support and interaction were evaluated. The mean APGAR score was 9.05±1.81, and FD occurred in 9.69% of the participants. Among the health conditions, the self-perception of health (p=0.0003), the number of depressive symptoms (p<0.0001), receiving visits (p=0.0994), having recourse to help in case of illness (p=0.0090), and the need for help to administer medication (p=0.0602), were significantly related to FD. In the adjusted analysis, self-perception of health, the presence of depressive symptoms and the need for help in administering medication were associated with FD among nonagenarians and centenarians. These factors may influence the satisfaction of nonagenarians and centenarians with their family relationships.

Is surgery justified for 80-year-old or older intracranial meningioma patients? A systematic review.

Since the number of elderly people with intracranial meningiomas (IM) continues to rise, surgical treatment has increasingly become a considerable treatment option, even in very old (≥ 80 years old) meningioma patients. Since little is known about whether meningioma surgery in this age group is safe and justified, we conducted a systematic review to summarize the results of surgical outcomes in very old meningioma patients. We performed a systematic literature search in Pubmed, Cochrane Library, and Scopus databases. Primarily, we extracted 1-month and 1-year survival rates, and 1-year morbidity rates, as well as information about preoperative morbidity, operative complications, meningioma size, location, histology, and peritumoral edema. Quality of the included studies was evaluated by Cochrane Collaboration Handbook and Critical Appraisal Skills Program. From the 1039 reviewed articles, seven retrospective studies fulfilled our eligibility criteria. Motor deficits (27-65%) and mental changes (51-59%) were the most common indications for surgery. One-month and 1-year mortality rates varied between 0-23.5% and 9.4-27.3%, respectively. Most of the operated IM patients (41.2-86.5%) improved their performance during postoperative follow-up. Impaired preoperative performance and comorbidities were most commonly related to higher postoperative mortality. None of the studies fulfilled the criteria of high quality. Based on the evidence currently available, surgical treatment of very old IM patients seems to improve the performance of highly selected individuals. Given the rapid increase of the aging population, more detailed retrospective studies as well as prospective studies are needed to prove the outcome benefits of surgery in this patient group.

Patient outcomes in Anteromedial osteoarthritis patients over 80 years old undergoing Oxford Unicompartmental knee Arthroplasty in China.

BACKGROUND: The use of Oxford Unicompartmental Knee Arthroplasty (UKA) has increased rapidly in both Western and Asian populations, with excellent functional outcomes and high patient satisfaction. While previous evidence regarding clinical outcomes and survival rates after Oxford UKA was based on studies in Western populations, the results may be different in Asian patients. The relevance of age for postoperative function after Oxford UKA also remains unclear. Hence, the aim of our study was to clarify the effectiveness and safety of Oxford UKA in Asian patients aged over 80 years. METHODS: A retrospective review was performed and included 195 patients (209 knees) who underwent an Oxford UKA between June 2015 and July 2018. We divided the patients into three groups by age: Group 1, 60-69 years; Group 2, 70-79 years; and Group 3, over 80 years. We used the Hospital for Special Surgery (HSS) score and Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index score to evaluate the general condition of the patients' knees before surgery and at last follow-up. We also recorded perioperative and short-term complications. RESULT: Group 1 consisted of 60 patients (60 knees); Group 2, 70 patients (79 knees); and Group 3, 65 patients (70 knees). The mean follow-up was 21.34 ± 12.04, 22.08 ± 11.38, and 21.76 ± 10.20 months in groups 1, 2, and 3, respectively. At last follow-up, the patients in Group 3 showed lower function scores compared to groups 1 and 2 (P < 0.05), but the HSS scores and the WOMAC scores were significantly improved in all three groups. In terms of perioperative and other complications, the three age groups did not differ significantly. CONCLUSION: Oxford UKA is an effective and safe treatment for osteoarthritis, even in elderly patients in China. Elderly patients have lower knee function scores than younger patients. However, the knee joint pain of the elderly patients was relieved and function improved compared to the preoperative condition.

National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units.

BACKGROUND: To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings. METHODS: Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded. RESULTS: Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% (n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40-49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) ß-blockers, and 21.9% (324) ACEI or ARB with ß-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04-1.78)), stroke (1.42 (1.06-1.91)), and diabetes (1.54 (1.14-2.06)). ß blockers were more likely used in patients with myocardial infarction (2.06 (1.54-2.76)) and atrial fibrillation (1.70 (1.28-2.28)). CONCLUSION: In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved.

Clarification of psychosocial factors required for continuance of life of elderly men living alone in heavy snowfall and underpopulated areas.

Purpose: The aim of this study was to clarify psychosocial factors supporting elderly men who were living alone in a heavy snowfall area where the population aging rate exceeded 40%. Methods: The authors conducted semi-structured interviews with six elderly men living alone. As the method of analysis, we conducted a hierarchical cluster analysis of the contents of the interviews via text mining. Results: As a result, we found the psychosocial factors supporting the elderly men living alone. We divided the factors into six categories: "well-planned roof snow removal", "interaction with young people", "realization of the meaning of life via driving", "engagement in leisure and recreational activities", "living a life aligned with personal preference" and "insistence on living alone". Conclusion: Formal and informal networking that avoids debasing these psychosocial factors required for the continuance of living life alone is necessary.

Fall-risk increasing drugs and prevalence of polypharmacy in older patients discharged from an Orthogeriatric Unit after a hip fracture.

BACKGROUND: Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with injurious falls. We aimed to estimate the prevalence of polypharmacy and FRIDS in older patients discharged from an Orthogeriatric Unit after a hip fracture surgery. METHODS: This study describes the baseline findings of a 2-year retrospective cohort study. We included patients older than 80 years discharged from an Orthogeriatric Unit who were able to walk before surgery. Patient's baseline variables, total number of drugs, and FRIDS at hospital discharge were collected. RESULTS: We included 228 patients. The mean number of drugs and FRIDS prescribed at discharge was 11.6 ± 3.0 and 2.9 ± 1.6, respectively. Polypharmacy was prevalent in all patients except in three: 23.3% (5-9 drugs) and 75.9% (≥ 10 drugs). Only 11 patients had no FRIDS and 35.5% were on > 3 FRIDS. The most prevalent FRIDS were: agents acting on the renin-angiotensin system (43.9%) and anxiolytics (39.9%). The number of FRIDS was higher in patients with extreme polypharmacy (3.4 ± 1.5) than in those on 5-9 drugs (1.5 ± 1.0, p < 0.05). Independent people in performing instrumental activities had lower risk of extreme polypharmacy (≥ 10 drugs) or > 3 FRIDS: OR 0.39 (95% CI 0.18-0.83) and OR 0.41 (95% CI 0.20-0.84), respectively. People living in a nursing home had higher risk of > 3 FRIDS: OR 4.03 (95% CI 1.12-14.53). CONCLUSIONS: Polypharmacy and fall-risk increasing drugs are prevalent in patients discharged from orthogeriatric care after surgery for a hip fracture. Interventions on drug use at hospital discharge could have a potential impact on falls in this high-risk population.

Estilo de vida associado a níveis séricos de HDL colesterol em longevos: Estudo AMPAL / Estilo de vida asociado a niveles séricos de HDL colesterol en longevos: Estudio AMPAL / Lifestyle associated to serum levels of HDL cholesterol in oldest-old people: the AMPAL Study

O artigo buscou identificar os determinantes significativamente relacionados a níveis séricos de HDL colesterol em longevos (≥ 85 anos) de um município do Sul do Brasil. O aumento da frequência semanal no consumo de refrigerante, em um dia, resultou na diminuição de 2mg/dL no HDL colesterol. Ser homem, ter circunferência da cintura aumentada, possuir níveis séricos elevados de triglicerídeos e consumir frequentemente refrigerante, independentemente do tipo, foram fatores inversamente associados a níveis de HDL colesterol.

This article intended to identify significantly determinants related to HDL cholesterol serum levels in oldest-old (≥ 85 years) in a South city of Brazil. It could be expected the declining of 2mg/dL HDL cholesterol value by each one day of increasing on the weekly frequency refrigerant consumption. The HDL cholesterol levels were inversely associated with being man, to have higher waist circumference, serum triglyceride levels and frequency refrigerant consumption, regardless the kind of it.

El articulo deseo identificar determinantes significativamente relacionados con los niveles séricos de colesterol HDL en la longevidad (≥ 85 años) de un municipio del sur de Brasil. El aumento de la frecuencia semanal en el consumo de refrigerante en un día, resultaba en la disminución de 2mg/dL HDL. Ser hombre, tener circunferencia de la cintura aumentada, poseer niveles séricos elevados de triglicéridos y consumir frecuentemente refrigerante, independientemente del tipo, fueron factores inversamente asociados a niveles de HDL.

Patient Outcomes After Total Knee Arthroplasty in Patients Older Than 80 Years.

BACKGROUND: Patients aged 80 and above who suffer from end-stage osteoarthritis may benefit from total knee arthroplasty (TKA), but at high potential risk. Additionally, there is controversy about whether functional improvement in patients above age 80 is similar to younger patients. We compared functional improvement, length of stay (LOS), and facility discharge rates after TKA between this cohort and patients less than 80 years of age. METHODS: We completed a retrospective cohort study comparing TKA patients aged 80 and above with all patients younger than 80. We utilized data from a prospectively collected institutional repository of 2308 TKAs performed from April 2011 through July 2016 at an academic medical center in the United States. We performed multivariable logistic regression to determine the association between age group and clinically significant improvement in the Patient-Reported Outcome Measurement Information System (PROMIS)-10 physical component summary (PCS) score. Secondary outcomes included the magnitude of PCS change, LOS, and facility discharge. RESULTS: There were 175 (7.6%) TKAs in patients older than 80 years compared with 2133 TKAs in patients younger than 80. Patients over 80 had similar adjusted odds of achieving clinically significant PCS improvement following TKA (P = .366), and there was no statistical difference in adjusted postoperative PCS improvement between the 2 age groups. Age 80 and above was associated with a longer adjusted LOS and demonstrated increased odds of facility discharge (odds ratio 4.11, P < .001) after TKA. CONCLUSION: Following TKA, patients older than 80 years demonstrate similar adjusted functional improvement in comparison to younger patients. However, older patients did require substantially more resources as they remained in the hospital longer and were discharged to rehabilitation more often.

Investigation and analysis of osteoporosis, falls, and fragility fractures in elderly people in the Beijing area: a study on the bone health status of elderly people ≥ 80 years old with life self-care.

Among ≥ 80 years old and under life self-care in the Beijing area, the prevalences of osteoporosis, falls, and fragility fracture were high; and these prevalences were even higher in women. The treatment rate of osteoporosis is very low. Therefore, comprehensive and standardized prevention and treatment should be promoted. PURPOSE: The purpose of this study is to investigate prevalence of osteoporosis, falls, and fragility fractures in this population, and analyze related factors, in order to provide a basis for standardized prevention and treatment. METHODS: From August 2015 to August 2016 in Beijing City, a total of 175 elderly individuals, who were ≥ 80 years old and had good self-care ability, were included into this study. The questionnaire, risk of falls, grip force, and walking speed were measured, and the Timed Up and Go test (TUG) and chair-rising test (CRT) were performed. RESULTS: Compared to women, men have higher rates of smoking, drinking, drinking strong tea, longer outdoor activity time, as well as larger muscle strength and pace, and lower consumption of dairy products, fall risk assessment scale (FRA) score, 25OHD, administration rates of calcium and anti-osteoporosis drugs (P < 0.05, P < 0.01). Compared with men, women had higher bone turnover markers (P1NP, ß-CTx, and OC) (P < 0.05, P < 0.01) and lower levels of sex hormones (E2, T) (P < 0.01). The overall prevalence of osteoporosis was 24.6%, and this was significantly higher in women than in men (52.5 vs. 9.6%, P < 0.01). Among these subjects, 62.9% had a history of fall after 80 years old, and this rate was higher in women than in men (77 vs. 55.3%, P < 0.01). The overall prevalence of fragility fractures was 25.1%, which was higher in women than in men (45.9 vs. 14.0%, P < 0.01). Risk factors included falls after age 80, high FRA score, and reduction in bone density of lumbar vertebrae 1-4, and odds ratio (OR) was 12.195, 1.339, and 0.076, respectively (P < 0.01). Anti-osteoporosis therapy was only performed on a small number of patients with fractures. CONCLUSION: The prevalences of falls, prior fracture, and low BMD were high among ≥ 80 years old and under life self-care in the Beijing area. Therefore, a comprehensive approach to assessment and treatment should be promoted.

Clinical features and treatment outcome of very elderly patients over 80 years old with multiple myeloma: comparison with patients in different age groups in the era of novel agents.

We retrospectively analyzed the outcomes of 175 consecutive patients admitted to our hospital between April 2004 and June 2014, and identified 42 (24%), 80 (46%), and 53 (30%) patients ≥ 80, 66-79, and ≤ 65 years old, respectively. The median progression-free survival (PFS) and overall survival (OS) of the ≥ 80, 66-79, and ≤ 65 years old groups were 19.1, 26.3, and 54.3 months, and 31.9, 54.8, and 83.8 months, respectively. Patients ≥ 80 but not ≤ 79 years old with ECOG performance score (PS) ≥ 3 and/or Charlson comorbidity index (CCI) ≥ 5 showed significantly shorter survival. ECOG PS and CCI predicted the treatment outcome of patients ≥ 80 but did not predict ≤ 79 years old.

Comparison of single-agent chemotherapy and targeted therapy to first-line treatment in patients aged 80 years and older with advanced non-small-cell lung cancer.

PURPOSE: The aim of this study was to compare single-agent chemotherapy with targeted therapy in initial treatment and to explore a better choice of treatment for patients aged 80 years and older with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: A retrospective chart review was conducted for 136 patients aged 80 years and older who were cytopathologically diagnosed and staged as advanced (stage IIIB or IV) NSCLC. The patient population was divided into two treatment groups: 78 patients were allocated to the chemotherapy group (group A, pemetrexed or gemcitabine or docetaxel as a single agent), and 60 patients were allocated to another group and received epidermal growth factor-receptor tyrosine-kinase inhibitors (group B, erlotinib or gefitinib as a single agent). The primary end points were overall survival (OS) and progression-free survival (PFS), and the secondary end points were response rate, disease-control rate, safety, and quality of life. RESULTS: In group A and group B, respectively, the median PFS was 2 versus 4 months (P=0.013), and the median OS was 8 versus 16 months (P=0.025). The 1- and 2-year survival rates of the two groups were 23.7% (group A, 18 of 76) versus 76.7% (group B, 46 of 60) and 13.2% (group A, ten of 76) versus 10% (group B, six of 60), respectively. The response rate and disease-control rate were 28.9% versus 36.7% (P=0.39) and 57.9% versus 76.7% (P=0.022) in group A and group B, respectively. CONCLUSION: Elders aged 80 years and over with advanced NSCLC in group B had longer PFS and OS compared with group A. It was well tolerated in group B because of the mild adverse effects. Targeted therapy can be considered primarily for patients aged 80 years and older with advanced NSCLC who cannot tolerate chemotherapy or radiotherapy.

Práticas culturais de cuidado com a saúde sob a ótica dos idosos longevos / Cultural practice so health care in the perspective of elderly people

As práticas culturais de cuidado incluem ações apreendidas entre as gerações, comas quais os idosos buscam cuidar da saúde. Trata-se de estudo qualitativo descritivo de abordagem cultural, cujo objetivo foi descrever as práticas, crenças e valores de cuidado com a saúde dos idosos longevos. A coleta das informações foi alicerçada no referencial teórico-metodológico de Leininger e McFarland, e as análises segundo Spradley e McCurdy. Participaram 34 informantes gerais e, desses, 12 longevos foram informantes-chaves, no período de fevereiro a setembro de 2012, no cenário domiciliar. Emergiram três domínios culturais: suporte para o cuidado da saúde dos mais velhos; maneiras dos longevos cuidarem da sua saúde; e passagens ao longo da vida, que refletiram no cuidado dos mais idosos. Como tema cultural, emergiu o sagrado e o afeto: âncora dos longevos para os cuidados à saúde. As práticas culturais revelaram que o cuidado à saúde dos idosos mais velhos está firmemente sustentado na religiosidade e na família, desse modo eles não vivem desamparados e perseveram até o fim

Cultural practices of care include actions learned between generations, with which the elderly seek health care. It is a qualitative and descriptive study of the cultural approach, which aims to describe the practices, beliefs and values of health care of elderly people. Data collection was based in the theoretical-methodological referential of Leininger and McFarland, and analyzes according to Spradley and McCurdy. Thirty-four general informants participated and, from those ones, 12 elderly people were key informants, in the period from February to September 2012, in the domestic scenery. Three cultural domains have emerged: support for the health care of elderly; Ways for elderly people to take care of their health; and life-long passages that have reflected in the care of older people. As a cultural theme the sacred and the affection emerged: the oldest anchor for health care. Cultural practices revealed that the health care of older seniors is firmly anchored in the religiosity and family, thus they do not live destitute and endure to the end