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1.
Bone Joint J ; 102-B(2): 155-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009440

RESUMO

AIMS: Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. METHODS: We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). RESULTS: The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d'Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. CONCLUSION: The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155-161.


Assuntos
Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Idoso Fragilizado , Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Comores , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suporte de Carga
2.
Medicine (Baltimore) ; 99(5): e18935, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000408

RESUMO

The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease.This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk.FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414).


Assuntos
Doença das Coronárias/diagnóstico , Fragilidade/diagnóstico , Estudos Observacionais como Assunto , Atividades Cotidianas , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/mortalidade , Fragilidade/terapia , Avaliação Geriátrica , Humanos , Seleção de Pacientes
3.
Adv Exp Med Biol ; 1216: 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894541

RESUMO

Over the past decades, a progressive and exponential aging of the population has been observed. In particular, an absolute e relative increase of old and very old persons is also projected for the next 30 years. This demographic phenomenon is substantially responsible for the growing prevalence of frailty in our societies. Frailty is a clinical condition characterized by an excessive vulnerability of the individual to endogenous and exogenous stressors. This status generates a high risk of developing negative health-related events. Shifting to a construct as frailty to biologically define the perimeter of action for geriatric medicine will probably concur at modernizing the old way of practicing medicine. In this chapter the concept of frailty, its impact on the evolving healthcare systems, the controversies associated with its assessment and, ultimately, the role it plays in the management of older persons are discussed.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Assistência à Saúde , Avaliação Geriátrica , Humanos
4.
Adv Exp Med Biol ; 1216: 9-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894542

RESUMO

The general notion of frailty is widely understood to be a state of increased vulnerability to stressors, following age-related declines in function and reserves across multiple physiological systems. Frailty is clinically characterised by slower and/or incomplete recovery from stressors such as infection, injury, surgery or psychosocial distress. There is however no consensus on a single operational definition. Numerous assessment tools and scores are promoted to detect or measure frailty but two have widest research background and acceptance, the Frailty Phenotype and the deficit based Frailty Index. We describe these and other approaches in the context of a description of the psychometric properties, types of scaling, uses and misuses of assessment tools. We advocate the choice of an appropriate measurement tool be based on the population characteristics and the purpose for which it is to be used and illustrate how an understanding of the properties of different tools helps to inform this choice.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Humanos , Fenótipo , Psicometria
5.
Adv Exp Med Biol ; 1216: 21-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894543

RESUMO

Frailty is a complex of symptoms that is characterized by impaired stress tolerance due to a decline in the functionality of different organs. Due to its multifactorial aetiology, several definitions and assessments of this symptom complex have been developed, of which the Fried Frailty Score (Phenotype Score) and the broader Frailty Index (Deficit Accumulation Index) are the most commonly used. The prevalence of frailty increases with age independently of the assessment instrument and ranges between 4 and 59% in community-dwelling elderly populations and is higher in women than in men. The actual prevalence rate in a population depends on the prevalence of chronic diseases including depression, nutritional status, and inherently socio-economic background and education. Frailty is, however, not a steady state and progression, but also reversion is common. Although numerous studies on the prevalence of frailty have been conducted, systematic assessments in different populations are rare, which reduces the comparability of results. Similarly heterogeneous, but less frequent are studies on the incidence and on trajectories and transitions of frailty, calling for further, more systematic studies on this topic.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica , Humanos , Vida Independente , Estado Nutricional , Prevalência
6.
Adv Exp Med Biol ; 1216: 29-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894544

RESUMO

This chapter focuses on the epidemiology of cardiovascular diseases in elderly adults who are 65 or older. Risk factors for morbidity and mortality, as well as variables associated with disability and physical and social functional decline in the elderly individuals are considered. Modifiable risk factors, such as life habits are differentiated from unmodifiable ones, such as age and sex. The chapter concentrates in particular on the impact of hypertension, dyslipidemia and diabetes on cardiovascular diseases and mortality, as well as the effect of cigarettes smoking, physical activity, obesity and isolation on cardiovascular diseases and quality of life. The results demonstrate that cardiovascular diseases are not necessarily a consequence of aging; instead, they are often linked to modifiable risk factors. We can conclude that specific, targeted prevention interventions should preferably be implemented when individuals are young, but they are also useful in the elderly not only to prolong life but also to improve their quality of life.


Assuntos
Doenças Cardiovasculares/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Idoso Fragilizado , Humanos , Hipertensão/epidemiologia , Qualidade de Vida , Fatores de Risco
7.
Adv Exp Med Biol ; 1216: 39-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894545

RESUMO

Cardiovascular disease burden increases with the increasing age of populations. Also, with increasing longevity, some individuals are ageing along an unfavourable path developing frailty syndrome. Epidemiologic studies indicate that frailty is overrepresented among the persons with cardiovascular disease. On the other hand, frail subjects tend to be burdened with cardiovascular disease to a greater degree than their biologically better-off peers. Hypertension, diabetes, and obesity, especially abdominal, and at least some other risk factors appear to be shared between frailty and cardiovascular disease. The probable common underlying pathophysiologic feature is inflammation and associated phenomena, possibly having its root in the inflammageing. We discuss these issues based on the results of original studies, comprehensive literature reviews, and metaanalyses, by hundreds of dedicated researchers worldwide.


Assuntos
Doenças Cardiovasculares , Fragilidade , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Fragilidade/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Fatores de Risco
8.
Adv Exp Med Biol ; 1216: 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894546

RESUMO

The prevalence of frailty seems to be higher in people with cardiovascular disease (CVD) compared to those without, but also the prevalence of CVD is higher in people with frailty compared to robust ones. In longitudinal studies and meta-analyses dealing with the role of frailty as potential risk factor for incident CVD, we have an  increasing literature suggesting that frailty increases the risk of these conditions, particularly of fatal events, and independently from several potential confounding factors. Among the domains usually included in the definition of physical frailty, exhaustion, low physical activity, slow gait speed and weakness are significantly associated with the onset of CVD in older people. However, also CVD can be considered as potential risk factor for incident frailty even if the literature is more limited. In this chapter, I will therefore report and discuss the most recent and relevant findings in this topic, of extreme importance in actual geriatric medicine.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Prevalência , Fatores de Risco
9.
Adv Exp Med Biol ; 1216: 55-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894547

RESUMO

Chronic inflammation, which is called "inflamm-aging" , is characterized by an increased level of inflammatory cytokines in response to physiological and environmental stressors, and causes the immune system to function consistently at a low level, even though it is not effective. Possible causes of inflammaging include genetic susceptibility, visceral obesity, changes in gut microbiota and permeability, chronic infections and cellular senescence. Inflammation has a role in the development of many age-related diseases, such as frailty. Low grade chronic inflammation can also increase the risk of atherosclerosis and insulin resistance which are the leading mechanisms in the development of cardiovascular diseases (CVD). As it is well known that the risk of CVD is higher in older people with frailty and the risk of frailty is higher in patients with CVD, there may be relationship between inflammation and the development of CVD and frailty. Therefore, this important issue will be discussed in this chapter.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Inflamação/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/imunologia , Envelhecimento/patologia , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/patologia , Senescência Celular , Citocinas/imunologia , Fragilidade/imunologia , Fragilidade/patologia , Humanos , Inflamação/imunologia , Inflamação/patologia
10.
Adv Exp Med Biol ; 1216: 65-77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894548

RESUMO

The aim of this chapter is to review the results of recent studies analyzing the role of oxidative stress and systemic inflammation as potential contributors to frailty and CVD, and to explain a possible pathogenic relationship between the latter two conditions. Available evidence suggests that frail patients have elevated levels of oxidative stress biomarkers and proinflammatory cytokines, as well as with reduced concentrations of endogenous antioxidants. This implies that oxidative stress and systemic inflammation might play a role in the pathogenesis of frailty, but an underlying mechanism of this relationship is still mostly hypothetical. Oxidative stress and systemic inflammation are also involved in the pathogenesis of CVD. Cardiovascular conditions are established risk factor for frailty and in turn, presence of frailty constitutes an unfavorable prognostic factor in cardiac patients. Finally, some cardiovascular risk factors, such as lack of physical activity, smoking, obesity and inappropriate diet, are also involved in the etiology of oxidative stress, chronic inflammation and frailty. This complex interplay between intrinsic and extrinsic elements should be considered during holistic management of older persons with frailty and/or cardiovascular conditions.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/metabolismo , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/metabolismo , Inflamação/complicações , Inflamação/metabolismo , Estresse Oxidativo , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/patologia , Fragilidade/patologia , Humanos , Inflamação/patologia
11.
Adv Exp Med Biol ; 1216: 79-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894549

RESUMO

Frailty is a complex clinical syndrome, progressively described in the last thirty years, resulting from multiple impairments across many organs and systems and characterized by a reduction in physiological reserves and increased vulnerability to stressors, as well. Cardiovascular diseases (CVDs) are a common health problem in very old populations. Age-related changes occur throughout the body and in all organs, including the cardiovascular system. Cellular senescence links age-related CVDs and frailty by many mechanisms of particular interest in the aging biology and geriatric syndromes. Cellular senescence may represent the pivotal factor with its senescence-associated secretory phenotype (SASP) leading to systemic inflammation. In this context, SASP may represent the key element in the association between aging, frailty and the development of age-related CVDs.


Assuntos
Envelhecimento/patologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/patologia , Senescência Celular , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/patologia , Idoso , Humanos , Inflamação/complicações , Inflamação/patologia
12.
Adv Exp Med Biol ; 1216: 87-97, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894550

RESUMO

Frailty and cardiovascular disease (CVD) are both highly prevalent in older adults. Cardiovascular disease has been identified as the most frequent cause of death, while frailty has been identified as one of geriatric giants characterized by decreased physiological reserves and increased vulnerability. However, the exact pathobiological links between the two conditions have not been fully elucidated. Consequently, we observe a relevant difficulty not only in accurately defining cardiovascular risk in vulnerable elderly patients (and the other way around), but also a lack of consensus regarding CVD management in the very old. Nowadays, considering the enormous technical innovation, many elderly patients, if appropriately selected, could be eligible even for the most complex treatments, including invasive cardiological procedures. Identification of frail patients at risk of negative outcomes can allow the customization of therapeutic interventions in elderly patients with CVD, allowing the elderly who can benefit from them to undergo even invasive procedures and avoiding futile or dangerous treatments for the most vulnerable patients. A large number of tools and definitions for assessing frailty have been proposed; different scales and assessment tools can be useful for different purposes, but at present there is no clear indication for their use in CVD. In this chapter, we will describe the main geriatric approach to ascertain frailty, the assessment tools used in patients with cardiovascular diseases, and propose an operational strategy to evaluate frailty and identify patients eligible for pharmacologic or surgical interventions.


Assuntos
Doenças Cardiovasculares , Idoso Fragilizado , Avaliação Geriátrica , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Medição de Risco
13.
Adv Exp Med Biol ; 1216: 99-113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894551

RESUMO

The number of older people candidates for interventional cardiology, such as PCI but especially for transcatheter aortic valve implantation (TAVI) , would increase in the future. Generically, the surgical risk, the amount of complications in the perioperative period, mortality and severe disability remain significantly higher in the elderly than in younger. For this reason it's important to determine the indication for surgical intervention, using tools able to predict not only the classics outcome (length of stay, mortality), but also those more specifically geriatrics, correlate to frailty: delirium, cognitive deterioration, risk of institutionalization and decline in functional status. The majority of the most used surgical risks scores are often specialist-oriented and many variables are not considered. The need of a multidimensional diagnostic process, focused on detect frailty, in order to program a coordinated and integrated plan for treatment and long term follow up, led to the development of a specific geriatric tool: the Comprehensive Geriatric Assessment (CGA). The CGA has the aim to improve the prognostic ability of the current risk scores to capture short long term mortality and disability, and helping to resolve a crucial issue providing solid clinical indications to help physician in the definition of on interventional approach as futile. This tool will likely optimize the selection of TAVI older candidates could have the maximal benefit from the procedure.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/cirurgia , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Humanos , Intervenção Coronária Percutânea , Medição de Risco , Substituição da Valva Aórtica Transcateter
14.
Adv Exp Med Biol ; 1216: 115-129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894552

RESUMO

Cardiovascular diseases (CVD) and frailty syndrome are major problems for successful aging. These conditions share many biological aspects, symptoms and adverse effects. Aerobic capacity and muscle strength, that are important characteristics for independence in daily activity, are markedly reduced in older adults with CVD and frailty. There are evidence and recommendations of physical activity and exercises to prevent, treat and manage these conditions. However, the exact dose-response (type, intensity and duration) of exercises is still uncertain for these population. A good physical exercise program should consider the aging physiologic alterations, the vulnerability of the frail syndrome, and the functional-structural changes of CVD. Therefore, a multicomponent program with aerobic and strength training is desirable to improve these conditions. For long term results it is important to older adults with these conditions to change lifestyle and be more active during daily living to reduce sedentary behavior. Being frail with CVD it is not a contraindication for older adults to be engaged in physical activities.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Terapia por Exercício , Exercício/fisiologia , Idoso Fragilizado , Fragilidade/prevenção & controle , Idoso , Humanos
15.
Adv Exp Med Biol ; 1216: 131-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894553

RESUMO

Comprehensive cardiac rehabilitation programmes include multifactorial components to optimise cardiovascular risk reduction, promote healthy behaviours and an active lifestyle, reduce disability and improve health and wellbeing. There is compelling evidence that older people with certain cardiovascular conditions, such as heart failure, can benefit both physically and mentally from cardiac rehabilitation. This chapter discusses the evolution of cardiac rehabilitation, frailty assessment in cardiac rehabilitation and guideline recommendations in the context of ageing populations. Contemporary cardiac rehabilitation service models are presented along with potential solutions to meeting older people's preferences and improving access to effective treatment for those with frailty. Innovations in catheter-based surgical interventions mean that more people with frailty are undergoing cardiovascular surgery than ever before. Although traditionally, cardiac rehabilitation has been associated with secondary prevention after cardiac diagnoses, events and interventions, new models of preconditioning rehabilitation or 'prehab' are being offered to frail older people before surgery to improve functional outcomes and reduce hospital stay. Individual tailoring of cardiac rehabilitation programme components is a cornerstone of high-quality care. Importantly, participation in core components, such as exercise and nutritional interventions, can impact on both cardiac vascular disease and frailty, providing the potential to change the trajectory of both conditions.


Assuntos
Reabilitação Cardíaca , Idoso Fragilizado , Cardiopatias/reabilitação , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/reabilitação , Humanos
16.
Adv Exp Med Biol ; 1216: 149-152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894554

RESUMO

Frailty is a clinical concept which is gaining increased momentum not only in geriatrics, but in all specialties treating adult patients. In these Future Perspectives, the following roles of frailty in the field of cardiovascular diseases (CVD) will be discussed as a narrative review: (1) Frailty as an adjunct to assess CVD patients in addition to traditional risk scores; (2) bidirectional relationship between frailty and CVD; (3) widening the scope of endpoints in CVD trials-inclusion of frailty; (4) finally, the relationship between geriatrics and cardiology will be shortly discussed.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Idoso , Cardiologia , Geriatria , Humanos , Narração
17.
Nurs Older People ; 32(1): 21-25, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990162

RESUMO

With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.


Assuntos
Prática Avançada de Enfermagem , Fragilidade/enfermagem , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Hospitalização , Humanos , Masculino
18.
World Neurosurg ; 133: e646-e652, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568913

RESUMO

OBJECTIVES: With an aging population and advances in neuroanesthesia and critical care, an increasing subgroup of elderly patients have been undergoing neurosurgery. Of particular relevance is the cohort aged >80 years. The aim of the present study was to investigate the 30-day mortality and survival in this cohort after emergency and elective neurosurgery. METHODS: We performed a retrospective cohort study of all patients aged ≥70 years who had undergone a neurosurgical procedure from 2015 to 2017. The patient demographic data were identified, and independent predictors were found using logistic regression analysis. RESULTS: A total of 796 patients were included, of whom 622 were aged <80 years (group A) and 174 were aged >80 years (group B). Overall survival was 86.3% in group A and 79.9% in group B. The 30-day mortality between the elective (0.8%) and emergency (10.1%) patients was significantly different statistically (P < 0.001). Of the patients in groups A and B, 84.7% and 68.9% were discharged back to their usual residence, respectively. Logistic regression found emergency surgery to be an independent predictor of mortality. CONCLUSIONS: The current model for accepting elderly patients has been associated with good overall outcomes. The elderly should not be refused neurosurgery on the basis of their age alone. However, we applied fairly strict criteria, especially for those with subarachnoid hemorrhage, which should be factored into our results.


Assuntos
Procedimentos Neurocirúrgicos/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Idoso Fragilizado , Humanos , Masculino , Estudos Retrospectivos
19.
J Oral Rehabil ; 47(1): 61-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332828

RESUMO

No report has yet examined the impact of oral hypofunction on physical frailty in relation to intra-relationships of physical frailty assessment items. The purpose of this study was to verify the potential of a clinical cascade between oral hypofunction and physical frailty, and especially to support the hypothesis that the influence of oral hypofunction on physical frailty is greater than the intra-relationships among elements of physical frailty and that sex differences significantly affect these relationships. The participants were 272 older adults (101 men and 171 women; mean age 75.1 ± 7.5 years). Maximum occlusal force (MOF) and oral dryness (OD), as indicators of oral hypofunction, and grip strength (GS) and walking speed (WS), as indicators of physical frailty, were measured. Mutual relationship of four variables was verified using covariance structure analysis. In men, three paths from MOF to WS and GS and from WS to GS were confirmed, and those from MOF to WS and from WS to GS were found to be significant (P < .01). In women, three paths from MOF to WS and GS and from WS to GS were also confirmed, as with the men, and those from MOF to WS and from MOF to GS were found to be significant (P < .01). Model adaptability was shown to be good for both men and women. The results suggest our hypothesis was verified, and it is expected that the early detection of oral hypofunction, that is MOF, may be important for assessing physical frailty, especially in women.


Assuntos
Fragilidade , Idoso , Idoso de 80 Anos ou mais , Força de Mordida , Estudos Transversais , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Masculino
20.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31823589

RESUMO

BACKGROUND: The number of patients over 70 years old with cancer is growing. Chronological age provides limited information about tolerance for cancer treatment and life expectancy. We wanted to study frailty indicators of potential importance for making choices about therapy and the need for cross-disciplinary assessment for cancer patients aged ≥ 70 at an oncology outpatients clinic. MATERIAL AND METHOD: The study is a retrospective survey based on medical records of initial consultations for patients aged ≥ 70 at the Department of Oncology, Drammen Hospital, in 2017. Medication use, comorbidity and the results of the Geriatric 8 (G-8) screening tool were recorded. RESULTS: The median number of drugs taken regularly was four for the 235 patients aged ≥ 70 who were initially assessed in 2017. Cardiovascular disease was recorded in 101 patients (43 %), impaired renal function in 47 (20 %), pulmonary disease in 37 (16 %) and diabetes in 25 (11 %). A total score of < 15 was obtained for 100 (69 %) of the 144 patients scored by means of Geriatric 8, which indicates potential frailty. INTERPRETATION: Frailty indicators of potential importance for the choice of treatment and follow-up are frequently seen in older cancer patients.


Assuntos
Fragilidade , Avaliação Geriátrica , Neoplasias , Idoso , Idoso Fragilizado , Humanos , Oncologia , Estudos Retrospectivos
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