Clonal hemopoiesis driven by leukemia-associated gene mutations can occur without evidence of a blood disorder. To investigate this phenomenon, we interrogated 15 mutation hot spots in blood DNA from ...4,219 individuals using ultra-deep sequencing. Using only the hot spots studied, we identified clonal hemopoiesis in 0.8% of individuals under 60, rising to 19.5% of those ≥90 years, thus predicting that clonal hemopoiesis is much more prevalent than previously realized. DNMT3A-R882 mutations were most common and, although their prevalence increased with age, were found in individuals as young as 25 years. By contrast, mutations affecting spliceosome genes SF3B1 and SRSF2, closely associated with the myelodysplastic syndromes, were identified only in those aged >70 years, with several individuals harboring more than one such mutation. This indicates that spliceosome gene mutations drive clonal expansion under selection pressures particular to the aging hemopoietic system and explains the high incidence of clonal disorders associated with these mutations in advanced old age.
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•Clonal hemopoiesis is an almost inevitable consequence of aging in humans•Spliceosome gene mutations drove clonal hemopoiesis only in persons aged ≥70 years•NPM1 mutations behave as gatekeepers for leukemogenesis
McKerrell et al. employ ultra-deep sequencing to show that age-related clonal hemopoiesis is much more common than previously realized. They find that clonal hemopoiesis, driven by mutations in spliceosome genes SF3B1 and SRSF2, was noted exclusively in individuals aged 70 years or older and that NPM1 mutations are not seen in association with this phenomenon, endorsing their close association with leukemogenesis.
Intermediate care services have developed internationally to expedite discharge from hospital and to provide an alternative to an emergency hospital admission. Inconsistencies in the evidence base ...and under-developed governance structures led to concerns about the care quality, outcomes and provision of intermediate care in the NHS. The National Audit of Intermediate Care was therefore established by an interdisciplinary group. The second national audit reported in 2013 and included crisis response teams, home-based and bed-based services in approximately a half of the NHS. The main findings were evidence of weak local strategic planning, considerable under-provision, delays in accessing the services and lack of mental health involvement in care. There was a very high level of positive patient experience reported across all types of intermediate care, though reported involvement with care decisions was less satisfactory.
Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital.
To study the association of frailty (≥6 points in the Clinical Frailty Scale ...CFS), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery).
Retrospective observational study.
Large university hospital in England.
We analyzed 8202 first nonelective inpatient episodes of people aged 75 years and older between October 2014 and October 2015.
The outcomes studied were prolonged length of stay (LOS ≥10 days), inpatient mortality, delayed discharge, institutionalization, and 30-day readmission. Statistical analyses were based on multivariate regression models.
Independently of controlling variables, prolonged LOS was predicted by CFS ≥6: odds ratio (OR) =1.55; 95% confidence interval CI, 1.36-1.77; P ⟨ 0.001; HoD: OR = 2.16; 95% CI, 1.79-2.61; P ⟨ 0.001; and ACS: OR = 3.31; 95% CI, 2.64-4.15; P ⟨ 0.001. Inpatient mortality was predicted by CFS ≥6: OR = 2.29; 95% CI, 1.79-2.94; P ⟨ 0.001. Delayed discharge was predicted by CFS ≥6: OR = 1.46; 95% CI, 1.27-1.67; P ⟨ 0.001; HoD: OR = 2.17; 95% CI, 1.80-2.62; P ⟨ 0.001; and ACS: OR = 2.29; 95% CI: 1.83-2.85; P ⟨ 0.001. Institutionalization was predicted by CFS ≥6: OR = 2.56; 95% CI, 2.09-3.14; P ⟨ 0.001; HoD: OR = 2.51; 95% CI, 2.00-3.14; P ⟨ 0.001; and ACS: OR 1.93; 95% CI, 1.46-2.56; P ⟨ 0.001. Readmission was predicted by ACS: OR = 1.36; 95% CI, 1.09-1.71; P = 0.006.
Routine screening for frailty, HoD, and ACS in hospitals may aid the development of acute care pathways for older adults. Journal of Hospital Medicine 2017;12:83-89.
Analogous to the theory of damage and repair (which asserts that the surviving fraction of cells in a mutagen‐treated population is proportional to the number of potentially lethal lesions that are ...not removed by any repair process), the average number of deficits present in an individual is conceptualized as the product of the average intensity of the environmental stresses and the average recovery time. ...it is thought that by minimizing “hits” (stresses) and maximizing “post‐hit recovery rates,” individuals will accumulate fewer and less severe deficits, thereby benefiting their life expectancy. ...the specialty of Geriatric Medicine cannot and should not be defined by age alone. Perhaps another metaphorical expression would be that they are the walking wounded of the battle of living. Because people who become frail have generally been prudent, we should make every effort to know their values and wishes when it comes to how we should deal with their disability and dependency, and respect their wishes even when they can no longer express them.
The last decade has seen the prevention of healthcare-associated infections (HAIs) become a public and NHS priority. The resultant local and national targets have started to reap some benefits, with ...a fall in the rate of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemias and a decline in the rate of Clostridium difficile-associated diarrhoea (CDAD). Despite this, CDAD remains one of the most frequent nosocomial infections (annual incidence >50,000 cases in 2007).
This article describes the differences in training and departmental function between the specialties of emergency medicine in China and acute medicine in the UK, based on the experience of a visiting ...international medical graduate from Shanghai.
In Malaysia, there are many issues and challenges that face geriatric services including the recruitment, development, and retention of medical staff. Having enough clinical leaders who can work with ...other professionals to develop an integrated approach to the care of the elderly is the way to resolve many of these issues.
Tolterodine-induced hyponatraemia Juss, Jatinder K.; Radhamma, Ajish K. J.; Forsyth, Duncan R.
Age and ageing,
09/2005, Letnik:
34, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Management of electrolyte abnormalities is challenging in older people as the sensation of thirst, renal function and hormonal modulators of the milieu interior are often impaired. Furthermore, the ...complex effects of ageing upon these homeostatic mechanisms are often superimposed upon a background of chronic disease, malnutrition and co-existent medications. Hyponatraemia is one of the commonest electrolyte abnormalities, occurring in approximately 7% of healthy elderly persons. Hyponatraemia may only come to light when some other ailment prompts investigations or hospital admission. Drug-induced hyponatraemia is common in older people and is most commonly associated with diuretics and SSRI/SNRI antidepressants, but has also been reported with a wide range of other drugs. We believe this is the first case report of hyponatraemia due to tolterodine.
Sleep disturbance in Parkinson disease Roychowdhury, Samrat; Forsyth, Duncan R.
Journal of clinical gerontology & geriatrics,
June 2012, 2012-06-00, Letnik:
3, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Sleep disturbance is common in patients with Parkinson disease (PD), but it is often undetected due to inadequate history taking and poor self-reporting. Impaired sleep can have a severe impact on ...health, general well being, and quality of life. Sleep problems in PD have many potential causes, including the direct effect of PD itself, adverse events of anti-Parkinsonian medications, daytime sleep disturbance, age related causes, and other comorbidities. Patients with PD and their sleep partners should be asked about sleep disturbances and other night-time symptoms. Treatment strategies rely on identifying causal factors and need to be tailored to the individual and reviewed regularly.
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are closely related conditions of unknown etiology. Both are characterized by older age at onset, being more common in women, evidence of ...systemic inflammation, and generally responding well to corticosteroids. Controversy remains as to whether they are two different conditions or two ends of the spectrum of a single disease. Few population-based studies have evaluated the epidemiology of PMR because of lack of a universally accepted diagnostic and classification criteria. PMR and GCA are one of the commonest reasons for long-term corticosteroid therapy in older age. Newer therapies for these conditions have been evaluated, including conventional antirheumatic disease-modifying drugs as well as newer biologics. Vascular risk factors should be modified as patients with GCA suffer an increased number of cerebrovascular events. PMR and GCA cause significant morbidity and mortality, so it is important for general practitioners and geriatricians to recognize them early. There is increased recognition of a need for long-term follow-up for aortic aneurysm development and large vessel involvement.
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