Donors in lung transplantation: does age matter?

A best-evidence topic was written according to a structured protocol. The question addressed was the following: in patient undergoing lung transplantation, are lungs from donors of age >60 years old (yo) associated with equivalent outcomes-including primary graft dysfunction, respiratory function and survival-than lungs from donors ≤60yo? Altogether, >200 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journals, dates, country of publication, patients group studied, study type, relevant outcomes, and results of these papers were tabulated. Amongst the 12 papers reviewed, survival results were different depending on whether donor age was analysed raw or adjusted for recipients' age and initial diagnosis. Indeed, recipients with interstitial lung disease (ILD), pulmonary hypertension or cystic fibrosis (CF) had significantly inferior overall survival when receiving grafts from older donors. When older grafts are allocated to younger donors, a significant decrease in survival has been noticed in the case of single lung transplantation. In addition, 3 papers showed worse results regarding peak forced expiratory volume in 1 second (FEV1) in patients receiving older organs, and 4 showed comparable primary graft dysfunction incidence rates. We conclude that when carefully assessed and allocated to the recipient who could benefit most from the transplant (e.g., a patient with a diagnosis of chronic obstructive pulmonary disease (COPD), who would not require a prolonged cardiopulmonary bypass (CPB)), lung grafts from donors of >60yo offer comparable results to younger donors.

The Associations of Built Environment with Older People Recreational Walking and Physical Activity in a Chinese Small-Scale City of Yiwu.

Physical activity would bring in plenty of health benefits, especially recreational physical activity (RPA). Previous studies have suggested that built environment would affect older people's recreational walking (RW) and RPA, but how the effects exist in a small-scale Chinese city remains unclear. Two hundred and fifty-two older participants were recruited in the city of Yiwu using cross-sectional survey of random samples in 2019. RW and RPA level of participants and perceived scores of built environments were collected using the International Physical Activity Questionnaire and Neighborhood Environment Walkability Scale, respectively. Linear regression analysis was conducted to investigate the association of built environment with older people's RW and RPA. The results showed that two main factors affecting older people's RW and RPA were residential density and aesthetics. Additionally, access to services was related to RW, and street connectivity was correlated with RPA. The associations of RW with built environment varied slightly with demographic variables included in the regression model. All the results suggested that lower residential density, better aesthetics environment, and higher street connectivity would motivate older people to engage more in RW and RPA. The better access to services encourages only RW, not RPA, in older people. These findings would be helpful for policy decision makers in the urban construction process in Yiwu. More studies are needed to enlarge the scientific evidence base about small-scale cities in China.

The Effect of the Built Environment on Older Men's and Women's Leisure-Time Physical Activity in the Mid-Scale City of Jinhua, China.

Physical activity has been suggested to be beneficial in preventing disease and improving body function in older people. Older people's leisure-time physical activity (LTPA) is affected by various factors, especially environmental factors. However, the differences in the association between older people's LTPA and the built environment in different sex groups remain unclear. Perceived built environment scores and older people's LTPA were collected for 240 older people in Jinhua using the Neighborhood Environment Walkability Scale and International Physical Activity Questionnaire, respectively. A linear regression method was used to analyze the associations between older people's LTPA and the built environment in men, women, and all participants. The results showed that land use mix diversity was associated with LTPA in older people for both sexes. In men, LTPA was also associated with access to services. However, in women, LTPA was associated with residential density, street connectivity, and crime safety. The relationship varied when demographic variables were incorporated into the regression analysis. Those results indicated that a shorter perceived distance from home to destination would motivate older people to engage more in LTPA. Older people's LTPA was affected by various built environment factors according to different sex groups. Women's LTPA was generally more sensitive to the built environment. More studies are needed to confirm the association between LTPA in older people and the built environment in men and women in mid- or small-sized Chinese cities in the future.

Long-Term (Up to 27 Years) Prospective, Randomized Study of Mobile-Bearing and Fixed-Bearing Total Knee Arthroplasties in Patients <60 Years of Age With Osteoarthritis.

BACKGROUND: Our study determined long-term (up to 27 years) results of fixed-bearing vs mobile-bearing total knee arthroplasties (TKAs) in patients <60 years with osteoarthritis. METHODS: This study included 291 patients (582 knees; mean age 58 ± 5 years), who received a mobile-bearing TKA in one knee and a fixed-bearing TKA in the other. The mean duration of follow-up was 26.3 y (range 24-27). RESULTS: At the latest follow-up, the mean Knee Society knee scores (91 ± 9 vs 89 ± 11 points, P = .383), Western Ontario and McMaster Universities Osteoarthritis Index (35 ± 7 vs 37 ± 6 points, P = .165), range of knee motion (128° ± 13° vs 125° ± 15°, P = .898), and University of California, Los Angeles activity score (6 ± 4 vs 6 ± 4 points, P = 1.000) were below the level of clinical significance between the 2 groups. Revision of mobile-bearing and fixed-bearing TKA occurred in 16 (5.5%) and 20 knees (6.9%), respectively. The rate of survival at 27 years for mobile-bearing and fixed-bearing TKA was 94.5% (95% confidence interval 89-100) and 93.1% (95% confidence interval 88-98), respectively, and no significant differences were observed between the groups. Osteolysis was identified in 4 knees (1.4%) in each group. CONCLUSION: There were no significant differences in functional outcomes, rate of loosening, osteolysis, or survivorship between the 2 groups.

Efficacy and adherence of sublingual immunotherapy in patients aged 60 to 75 years old with house dust mite-induced allergic rhinitis.

PURPOSE: This study aimed to evaluate the efficacy and adherence of sublingual immunotherapy (SLIT) for house dust mite (HDM)-induced allergic rhinitis (AR) patients over 60 years old. MATERIALS AND METHODS: Eighty-six AR patients aged 60-75 years old were randomly divided in the control and treatment group as 1:1 ratio. The control group was treated with standard pharmacotherapy while the treatment group was treated with SLIT plus pharmacotherapy on demand. Patients adherence, combined symptom and medication score (CSMS), visual analog scale (VAS), and presence of adverse events were evaluated in the baseline and after 6-months, 12-months and 24-months treatment. RESULTS: Twenty-five (58.1%) subjects in the treatment group and 20 (46.5%) subjects in the control group completed the study (P > 0.05). The major reasons for premature cessation were out of touch and relieved symptoms. At the same time, CSMS and VAS of the patients over 60 years old in both groups significantly decreased from baseline to any post-baseline time point (all P < 0.05). The comparison of CSMS and VAS between the two groups revealed statistically significant differences in favor of the SLIT group at month 24 (P < 0.05), whereas no differences at month 6 and month 12 (all P > 0.05). CONCLUSION: 41.9% of the patients dropped out within 2 years of SLIT treatment and the major reasons for premature cessation were out of touch and relieved symptoms. This study suggested that SLIT plus pharmacotherapy provided a greater clinical benefit than pharmacotherapy alone at two years.

Is There Any Benefit in Anterior Cruciate Ligament Reconstruction in Patients Older Than 60 Years?

BACKGROUND: Results of anterior cruciate ligament (ACL) reconstruction are traditionally excellent in younger and nonarthritic patients. During the past few decades, people older than 60 years have become more active than ever, with more demanding physical lifestyles. An increase also has been noted in active patients with diagnosed ACL injuries. More patients are requesting treatment for ACL deficiency in hopes of returning to preinjury levels of activity. PURPOSE: The aims of this study were to evaluate the results of ACL reconstruction in patients older than 60 years in terms of functional recovery, return to sports, and postoperative incidence of osteoarthritis and to compare their results with published results of different age groups. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive patients older than 60 years with isolated ACL tear and no established osteoarthritic lesions (Ahlbäck grade 1 or no arthritis) who were treated from 2008 to 2013 were retrospectively included in this study. Primary ACL reconstruction was performed with the same technique in all patients by means of single-bundle autologous hamstring tendon graft. Meniscal injuries were treated with partial debridement when required. No further treatment on cartilage lesions was performed. Postoperative rehabilitation was the same in every case. The International Knee Documentation Committee (IKDC) objective grade, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed before and after surgery, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) score was recorded during the final follow-up. Postoperative incidence of osteoarthritis was evaluated on weightbearing radiographs during final follow-up, and anteroposterior laxity was measured pre- and postoperatively with the use of stress radiographs. RESULTS: Twelve patients with mean age (±SD) of 61.0 ± 1.4 years at the time of surgery were included. They were followed-up for a mean period of 49.6 ± 24.0 months. Eight patients had associated meniscal tears, and 6 patients had International Cartilage Repair Society stage 1 or 2 chondral lesions. Preoperatively, the objective IKDC grades were B in 4 patients, C in 5, and D in 3. After surgery, the IKDC grades were A in 4 patients, B in 7, and grade C in 1. The mean subjective IKDC and Lysholm scores were a respective 43.4 ± 8.4 and 55.7 ± 12.4 preoperatively and 83.8 ± 9.4 and 93.2 ± 9.0 at the final follow-up ( P < .05). Ten patients (83%) reported recovery of sports activities, with 6 patients (50%) reaching the same level as before injury. The mean ACL-RSI score was 76.2%. Preoperatively, 50% (n = 6) of patients had Ahlbäck stage 1 medial compartment arthritis, versus 58% (n = 7) at the final follow-up ( P = nonsignificant). The side-to-side difference in anterior tibial translation on stress radiographs was 7.2 ± 6.4 mm preoperatively and 1.9 ± 4.3 mm postoperatively ( P < .05). No major complications were reported. CONCLUSION: ACL reconstruction in active patients older than 60 years without arthritis restored knee stability in all treated cases. In these patients, as in younger age groups, ACL reconstruction showed good results on functional recovery while not increasing the risk of midterm functional knee deterioration or evolution of knee arthritis. The majority of patients returned to activities at their preinjury level. These data show that older and active patients with nonarthritic ACL-deficient knees need not be excluded from surgical treatment.

Os idosos e a habitação / The Elderly and a Housing

Este artigo discute as políticas urbanas que estão sendo implementadas no país, em específico, as políticas de habitação de interesse social e sua capacidade de responder às mudanças do perfil etário. Foram levantados os principais indicadores referentes à população idosa e às políticas urbanas e habitacionais no país; foram analisados os programas em vigência e sua atuação junto à população idosa, finalizando com considerações sobre exemplos de boas práticas destinadas a esse grupo etário.

This article discusses urban policies that are being implemented in the country, in particular, the policies of social housing and its ability to respond to changes in the age profile. We raised the key indicators for the elderly population and related policies and urban housing in the country, we analyzed the programs in force and their work with the elderly population. And presents considerations on examples of good practice for this age group.

Estado periodontal y necesidad de tratamiento en pacientes GES 60 años de Villa Alemana / Periodontal Status and Treatment Needs in 60 Years-old GES Patients from Villa Alemana

Introducción: El envejecimiento es un proceso fisiológico deteriorativo que se observa desde la sexta década de la vida. Si bien los cambios demográficos de Chile revelan un envejecimiento poblacional, no existe suficiente información sobre el estado periodontal de los adultos de 60 años en nuestro país. Actualmente el Programa GES “Salud Oral Integral para el Adulto de 60 Años” tiene como objetivo mejorar su calidad de vida. Objetivo: Determinar el estado periodontal de los adultos de 60 años pertenecientes a los consultorios municipalizados de Villa Alemana y su necesidad de tratamiento. Pacientes y Método: Se examinaron a 124 pacientes voluntarios, seleccionados de forma aleatoria simple. Se les realizó un examen registrándose: higiene oral, índice hemorrágico, pérdida de inserción clínica, profundidad de sondaje y PSR. Se realizó el análisis estadístico y test de Chi-cuadrado. Resultados: El 90.32 por ciento presentó una mala higiene oral, en promedio presentaron un índice hemorrágico de 68.42 por ciento, el 100 por ciento presentó pérdida de inserción clínica y el 14.51 por ciento presentó en promedio profundidades de sondaje mayores o iguales a 5 mm. La totalidad de los adultos de 60 años necesita algún tipo de tratamiento periodontal, siendo un 82.3 por ciento el que necesita un tratamiento periodontal complejo. Conclusiones: Los pacientes GES de 60 años presentaron un mal estado periodontal determinado por higiene oral, índice hemorrágico, pérdida de inserción clínica y profundidad de sondaje, mostrando un importante deterioro de la salud periodontal de dicha población. La totalidad de los adultos de 60 años necesita tratamiento periodontal de algún tipo, siendo un 82.3 por ciento el que necesita tratamiento periodontal complejo.

Introduction: Aging is a physiological and deteriorative process that begins in the sixth decade of life. Demographic changes in Chile reveal an aging population. In our country there is a lack of information about the periodontal status of the group of adults of 60 years-old. Nowadays, the GES Program “Integral Oral Health for 60 Years-old Adults” aims to improve their quality life. Objectives: Determine the periodontal status and treatment needs of adults aged 60 belonging to primary care health center of Villa Alemana. Patients and Methods: A total of 124 patients, randomly selected, were examined. It was effectuated an extra and intraoral examination, registering: oral hygiene, bleeding index, clinical attachment loss, probing depth and PSR. Statistical analysis and Chi-square test were done. Results: 90.32 percent of sample showed a poor oral hygiene, the patients presented a bleeding index of 68.42 percent on average, 100 percent of sample presented clinical attachment loss and 14.51 percent showed on average probing depths greater than or equal to 5 mm. All the patients need some periodontal treatment, and an 82.3 percent needs comprehensive periodontal treatment. Conclusions: 60 years-old adults showed a poor periodontal status determined by oral hygiene, bleeding index, clinical attachment loss and probing depths, showing an important deterioration of periodontal health of this population. All the 60 years-old adults need some kind of periodontal therapy, while an 82.3 percent needs a comprehensive periodontal treatment.