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1.
Rev Med Suisse ; 16(676-7): 37-40, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961081

RESUMO

Up-dated recommendations published in 2019 about inappropriate medications in older persons and management for type 2 diabetes mellitus are discussed. New evidence has also been published regarding the benefits of physical activity in secondary prevention for falls as well as in the prevention of cognitive decline and dementia, independent of genetic and vascular risk profile. SPRINT MIND study reports a significant 19 % decreased risk of minor neurocognitive impairment with intensive BP treatment. A meta-analysis about prevention of delirium with antipsychotics report benefits only in cardiac and orthopedic post-operative settings, whereas another meta-analysis about delirium treatment did not find any benefits from antipsychotics.


Assuntos
Antipsicóticos , Delírio , Demência , Diabetes Mellitus Tipo 2 , Geriatria , Idoso , Idoso de 80 Anos ou mais , Geriatria/tendências , Humanos , Metanálise como Assunto
2.
Adv Gerontol ; 32(4): 652-657, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800196

RESUMO

This study examines older adults' perceptions about their participation in vigorous physical activity (VPA) and the association between VPA and self-related health. A total of 686 older adults responded to self-reported questionnaires, and Pearson's ꭓ2 test and binary logistic regression were used to present findings. About 74% of older adults reported experiencing dislocations, fractures, or/and other forms of injury in intense physical activities lasting 30 minutes or more a day. After controlling for relevant socio-demographic factors, older adults who participated in VPA for 30 or more minutes a day were less likely (OR=0,129; p=0,000) to report good health compared with those who participated in VPA for less than 30 minutes. It is concluded that VPA in older populations can result in casualties that may compel older adults to underrate their health, which can discourage active living habits in older populations and discredit PA/health promotion programs.


Assuntos
Exercício , Geriatria , Promoção da Saúde , Ferimentos e Lesões , Idoso , Exercício/psicologia , Geriatria/tendências , Promoção da Saúde/estatística & dados numéricos , Promoção da Saúde/tendências , Humanos , Luxações Articulares/psicologia , Autoimagem , Autorrelato , Inquéritos e Questionários , Ferimentos e Lesões/psicologia
3.
Adv Gerontol ; 32(3): 375-382, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512424

RESUMO

The review article presents data on common dermatoses in elderly patients. At present, this topic is practically not discussed in the Russian geriatrics. The urgency of the problem is increasing due to the increase in life expectancy and the deterioration in the availability of specialized care (in particular, dermatological care), especially for elderly patients. The review discusses a number of clinical cases in elderly patients. This article is addressed to geriatrics, general practitioners, general practitioners (family doctors).


Assuntos
Dermatopatias , Geriatria/tendências , Humanos , Expectativa de Vida/tendências , Federação Russa , Dermatopatias/diagnóstico , Dermatopatias/patologia
4.
Geriatr Gerontol Int ; 19(8): 699-704, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31397060

RESUMO

The number of older adults is increasing worldwide, including in Asian countries. Various problems associated with medical care for older adults are being highlighted in aging societies. As the number of chronic diseases increases with age, older adults are more likely to have multiple chronic diseases simultaneously (multimorbidity). Multimorbidity results in poor health-related outcomes, leading to increased use and cost of healthcare. Above all, it leads to deterioration in older adults' quality of life. However, it is unclear whether any medical interventions are effective for multimorbidity, which means medical practitioners currently offer medical care "in the dark." It is therefore necessary for researchers and medical professionals involved in geriatric medicine to establish ways to manage multimorbidity among older adults. This means that the development of research in this field is essential. Geriatr Gerontol Int 2019; 19: 699-704.


Assuntos
Geriatria , Multimorbidade/tendências , Múltiplas Afecções Crônicas , Qualidade de Vida , Idoso , Geriatria/métodos , Geriatria/tendências , Saúde Global , Serviços de Saúde para Idosos , Transição Epidemiológica , Humanos , Múltiplas Afecções Crônicas/economia , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Pesquisa
6.
PLoS One ; 14(7): e0219399, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291339

RESUMO

In epidemiology, gerontology, human development and the social sciences, age-period-cohort (APC) models are used to study the variability in trajectories of change over time. A well-known issue exists in simultaneously identifying age, period and birth cohort effects, namely that the three characteristics comprise a perfectly collinear system. That is, since age = period-cohort, only two of these effects are estimable at a time. In this paper, we introduce an alternative framework for considering effects relating to age, period and birth cohort. In particular, instead of directly modeling age in the presence of period and cohort effects, we propose a risk modeling approach to characterize age-related risk (i.e., a hybrid of multiple biological and sociological influences to evaluate phenomena associated with growing older). The properties of this approach, termed risk-period-cohort (RPC), are described in this paper and studied by simulations. We show that, except for pathological circumstances where risk is uniquely determined by age, using such risk indices obviates the problem of collinearity. We also show that the size of the chronological age effect in the risk prediction model associates with the correlation between a risk index and chronological age and that the RPC approach can satisfactorily recover cohort and period effects in most cases. We illustrate the advantages of RPC compared to traditional APC analysis on 27496 individuals from NHANES survey data (2005-2016) to study the longitudinal variability in depression screening over time. Our RPC method has broad implications for examining processes of change over time in longitudinal studies.


Assuntos
Geriatria/tendências , Modelos Estatísticos , Risco , Fatores de Tempo , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Efeito de Coortes , Estudos de Coortes , Feminino , Previsões , Humanos , Estudos Longitudinais , Masculino , Método de Monte Carlo , Inquéritos Nutricionais , Fatores Socioeconômicos
7.
Anesthesiol Clin ; 37(3): 475-492, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337479

RESUMO

An aging worldwide population demands that anesthesiologists consider geriatrics a unique subset of patients requiring customization of practice. This article reviews the current literature investigating physiologic changes of the elderly that affect pharmacokinetics and pharmacodynamics. Changes in drug absorption, distribution, metabolism, and excretion are discussed as well as the ultimate effects of medications. Implications for practice regarding specific anesthetic and analgesic drugs are addressed. Despite the immense body of research that contributes to understanding of geriatric pharmacology, elderly patients often are excluded from rigorous research trials, and further scientific investigation to inform best practices for this group of patients is needed.


Assuntos
Geriatria/tendências , Farmacologia/tendências , Idoso , Idoso de 80 Anos ou mais , Tratamento Farmacológico/tendências , Humanos , Preparações Farmacêuticas/administração & dosagem , Farmacocinética , Dinâmica Populacional
8.
Anesthesiol Clin ; 37(3): 537-546, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337483

RESUMO

Geriatric admissions to the intensive care unit (ICU) are common and require unique considerations for ICU clinicians. Admission to the ICU should be considered on an individual-patient basis. It is reasonable to consider a "trial of critical care" for many patients, even those who have uncertain chances of meaningful recovery. Quality of life and functional independence are especially important to older adults, and these outcomes should be considered when weighing the risks and benefits of admission or continuing ICU care.


Assuntos
Tomada de Decisão Clínica , Cuidados Críticos , Geriatria/tendências , Cuidados Paliativos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Humanos , Recuperação de Função Fisiológica , Assistência Terminal
9.
Anesthesiol Clin ; 37(3): 581-592, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337487

RESUMO

"With a rapidly aging world population, it is critical for physicians of every specialty to adapt the ways they provide medical and perioperative care to patients. Older adults represent the largest population of health care users, and they have very different needs and preferences compared with their younger counterparts. In this article, the authors discuss some of the current gaps in geriatric anesthesia and perioperative care, as they elaborate on what can be expected in the near future at different levels of the health care system: the patient, the environment, and the anesthesia specialty."


Assuntos
Anestesiologia/tendências , Geriatria/tendências , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Tomada de Decisão Clínica , Humanos , Assistência Perioperatória
11.
Expert Opin Pharmacother ; 20(12): 1471-1481, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107109

RESUMO

Introduction: As our population ages, the prevalence of angina is growing, leading to increased morbidity and decreased quality of life. The management of angina in the elderly is challenging due to drug intolerance and/or drug resistance as well as frailty. Over the past decades, many new therapeutic small molecules have been investigated for the management of angina. Although none of these studies have specifically focused on the therapies for the elderly, they offer promising new avenues for the treatment of angina in the elderly. Areas covered: Herein, the authors provide a review of the recently published literature on the use of small-molecule therapies for angina management in the elderly and provide a brief overview of these therapies. Expert opinion: A variety of therapeutic classes of existing and newer small molecules are emerging for the management of angina in the elderly. An individualized approach to the management of angina in this growing population is critical for good outcomes. Many small molecules are in their initial stages of clinical use, and further research should be conducted on their utility, especially in the elderly.


Assuntos
Angina Pectoris/tratamento farmacológico , Descoberta de Drogas/tendências , Geriatria/tendências , Bibliotecas de Moléculas Pequenas , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/epidemiologia , Descoberta de Drogas/métodos , Drogas em Investigação/uso terapêutico , Geriatria/métodos , Humanos , Qualidade de Vida , Bibliotecas de Moléculas Pequenas/uso terapêutico
15.
BMC Anesthesiol ; 19(1): 74, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092206

RESUMO

BACKGROUND: Perioperative cognitive impairment (CI) following surgeries is prevalent in geriatric surgical population aged 60 and older. This meta-analysis was designed to investigate whether the Mini-Mental State Examination (MMSE) has prognostic value on adverse outcomes in aged surgical patients. METHODS: PubMed, Cochrane, Embase and Medline through the Ovid were searched. Meta-analyses were carried out for CI versus non-cognitive impairment (NCI). Quality of evidence was assessed by the GRADE approach. RESULTS: One randomized controlled trial, two retrospective cohort trials, and 18 prospective cohort trials were included in the meta-analysis. Perioperative diagnosis of CI by the MMSE had higher rates of patients suffering from postoperative delirium (POD) [odd ratio (OR) 5.02, 95% confidence interval (CI) 3.27, 7.71, P < 0.00001], in-hospital mortality (OR 7.51, 95% CI 2.17, 26.02, P = 0.001), mortality within 1 year (OR 2.53, 95% CI 1.95,3.29, P < 0.00001). Postoperative CI patients had no extended length of stay in orthopedic [standardized mean difference (SMD) -0.10, 95% CI -0.20, 0.17, P = 0.91)] nor rehabilitation wards ((SMD, 0.04; 95% CI, - 0.23 to 0.31; P = 0.78). CONCLUSION: Older patients with perioperative CI were more likely to suffer from POD and mortality. The MMSE showed certain value on risk stratification and prognosis evaluation in geriatric surgical population. TRIAL REGISTRATION: PROSPERO CRD42018108739 .


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Delírio do Despertar/diagnóstico , Delírio do Despertar/psicologia , Geriatria , Testes de Estado Mental e Demência , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/complicações , Delírio do Despertar/etiologia , Geriatria/tendências , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Estudos Retrospectivos , Resultado do Tratamento
16.
Crit Care Nurs Clin North Am ; 31(2): 211-224, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047094

RESUMO

This article expands on the Gerontological Society of America leaders' work to explore challenges facing healthcare providers in preparing for an aging population. Traditional medicine and models of care may no longer meet complex patient needs. Older patients present with multifaceted issues while living longer with chronic health conditions. The changing environment requires a cross-disciplinary perspective. Changes in reimbursement are in the early stages of implementation and will be used to evaluate measurable outcomes. Preparing to care for this population can only occur with enough health professionals and expanded use of advance practice nurses. Health improvement is economically advantageous.


Assuntos
Envelhecimento/fisiologia , Enfermagem Geriátrica/estatística & dados numéricos , Geriatria/estatística & dados numéricos , Geriatria/tendências , Idoso , Doença Crônica , Humanos , Enfermeiras e Enfermeiros/provisão & distribução , Médicos/provisão & distribução
17.
World J Emerg Surg ; 14: 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30867674

RESUMO

Background: Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim: The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods: The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results: The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions: The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.


Assuntos
Colecistite Aguda/cirurgia , Colecistostomia/métodos , Idoso , Idoso de 80 Anos ou mais , Colecistostomia/tendências , Feminino , Geriatria/métodos , Geriatria/tendências , Guias como Assunto/normas , Humanos , Masculino
19.
Eur J Trauma Emerg Surg ; 45(2): 181-189, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30725152

RESUMO

The number of geriatric patients is increasing. These patients exhibit specific characteristics, which influence the type of fracture care. Many patients have comorbidities, which make them more vulnerable to surgical procedures. The soft tissue envelope around the fracture often is compromised due to pre-existing diseases such as diabetes, chronic venous insufficiency or peripheral vascular disease. Bone mineral density has decreased, which enhances the risk of implant loosening. The goals of treatment differ from those, which are valid for younger adults. Primary goal is preserving independency of the elderly patient in his activities of daily life. Advantages and drawbacks of surgical procedures have to be balanced with those of conservative treatment. Fractures of the lower extremities will more often need surgical treatment than fractures of the upper extremities. Patient´s autonomy is best obtained by creating high stability in the fracture plane, which enables motion and weight-bearing. Second priority is prevention of general and local post-operative complications by the use of less invasive surgical procedures. Restoring anatomy and optimal function are less important goals. The implants, which are used, are inserted through small incisions, placed deep under the skin and use long anatomic or osseous corridors. Intramedullary devices have important advantages. This paradigm shift takes the special challenges and requirements of geriatric patients into account.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Geriatria , Fraturas por Osteoporose/terapia , Complicações Pós-Operatórias/fisiopatologia , Lesões dos Tecidos Moles/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Consolidação da Fratura/fisiologia , Geriatria/tendências , Humanos , Fraturas por Osteoporose/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Lesões dos Tecidos Moles/fisiopatologia , Resultado do Tratamento
20.
Isr J Health Policy Res ; 8(1): 22, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30782215

RESUMO

Dementia is one of the main causes of disability among older adults and is viewed as one of the most distressing and devastating of conditions. Dementia has a profound impact on those who suffer from the disease and on their family caregivers. In this article, we describe the added benefit of implementing top-down and bottom-up strategies in the process of influencing and developing healthcare services. We use Israel as an example to argue that breakthroughs in care implementation and development of services are more likely to occur when there is a convergence of top-down and bottom-up processes. In the first section of the article, we present the top-down plans, initiated to address the needs of people with dementia and their families. In the second section, we present examples of bottom-up projects that developed in Israel before and after the top-down plans were initiated. In the third section, we contend that it is the combination of these top-down and bottom-up strategies that led to a breakthrough and the expansion of services for people with dementia and their families, and we argue that the Israeli case study is applicable to other health systems.


Assuntos
Demência/terapia , Geriatria/métodos , Geriatria/legislação & jurisprudência , Geriatria/tendências , Política de Saúde , Humanos , Israel , Planejamento Estratégico
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