Background: oropharyngeal dysphagia is a common condition among the elderly but not systematically explored. Objective: to assess the prevalence and the prognostic significance of oropharyngeal ...dysphagia among elderly patients with pneumonia. Design: a prospective cohort study. Setting: an acute geriatric unit in a general hospital. Subjects: a total of 134 elderly patients (>70 years) consecutively admitted with pneumonia. Methods: clinical bedside assessment of oropharyngeal dysphagia and aspiration with the water swallow test were performed. Demographic and clinical data, Barthel Index, Mini Nutritional Assessment, Charlson Comorbidity Index, Fine's Pneumonia Severity Index and mortality at 30 days and 1 year after admission were registered. Results: of the 134 patients, 53% were over 84 years and 55% presented clinical signs of oropharyngeal dysphagia; the mean Barthel score was 61 points indicating a frail population. Patients with dysphagia were older, showed lower functional status, higher prevalence of malnutrition and comorbidities and higher Fine's pneumonia severity scores. They had a higher mortality at 30 days (22.9% vs. 8.3%, P = 0.033) and at 1 year of follow-up (55.4% vs. 26.7%, P = 0.001). Conclusions: oropharyngeal dysphagia is a highly prevalent clinical finding in elderly patients with pneumonia and is an indicator of disease severity in older patients with pneumonia.
Purpose/Significance This paper aims to explore the acceptance behavior of the elderly for the application of new technologies and find out its regular pattern.Method/Process Based on the UTAUT2 and ...TRI, this paper constructed a behavior model of the elderly for the use of augmented reality tourism scenarios, put forward research hypotheses, collected data by means of questionnaire survey, and verified hypotheses by using structural equation model, SPSS and AMOS software, to verify the influencing factors of augmented reality tourism scene acceptance behavior among the elderly. Result/Conclusion The results show that: the contributing factors in the elderly group cannot significantly affect the use intention, but significantly affect the use behavior. Performance expectation, effort expectation, social impact, price value and discomfort are the main antecedents of use intention in the elderly group. The use intention of the elderly is a significant influencing factor of use behavior, and hedonic motivat
delirium and frailty are common among hospitalised older people but delirium is often missed and frailty considered difficult to measure in clinical practice.
to explore the relationship between ...delirium and frailty in older inpatients and determine their impact on survival.
the prospective cohort study of 273 patients aged ≥75 years.
patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Frailty status was measured by an index of accumulated deficits (FI), giving a potential score from 0 (no deficits) to 1.0 (all 33 deficits), with 0.25 used as the cut-off between 'fit' and 'frail'.
delirium was detected in 102 patients (mean FI: 0.33) and excluded in 171 (mean FI: 0.18) (P < 0.005); 111 patients were frail. Among patients with delirium, the median survival in fit patients was 359 days (95% CI: 118-600) compared with 88 days for those who were frail (95% CI: 5-171; P < 0.05).
delirium was associated with higher levels of frailty: the identification of frail patients may help to target those at a greatest risk of delirium. Survival following delirium was poor with the combination of frailty and delirium conferring a particularly bleak prognosis.
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•Ventilation and air quality play crucial roles in affecting the elderly’s health.•Stratum ventilation can effectively improve air quality in ECC bedrooms.•Contaminant removal by SV ...was 2.58, 3.22 and 2.12 times higher than MV, DV, and ZV.•SV reduced health risks by 46.3%, 53.7%, and 41.7% compared to MV, DV, and ZV.•Privacy of the elderly was important and need to be considered in ventilation design.
Ventilation and indoor air quality are important factors that affect the health of the elderly. The purpose of this study was to find effective ventilation design measures for improving ventilation and air quality in typical two-bed bedrooms in elderly care centres (ECCs). Mixing ventilation (MV), displacement ventilation (DV), zone ventilation (ZV) and stratum ventilation (SV) were analysed with twelve scenarios to find the most effective ventilation design solutions including six scenarios with curtains between the beds and six scenarios without curtains between the beds. Airflow distribution, CO2 concentration, ventilation efficiency and health risk assessment were adopted for discussion. SV was found to be an effective method for improving air quality in the ECC bedroom while also taking into account the needs and rights of elderly residents, such as privacy. Comparing scenarios with and without curtains between beds under same types of ventilation, scenarios without curtains showed a slight (≤8%) decrease in CO2 concentration in the pillow area. However, this could increase virus transmission risk and compromise elderly privacy, so it is not recommended. Regarding the scenarios with curtains between the beds, the contaminant removal efficiency (CRE) of scenarios using SV was increased by 2.58, 3.22 and 2.12 times compared to the scenarios using MV, DV, and ZV respectively. Additionally, the health ratio (HR) of SV was reduced by 46.3 %, 53.7 %, and 41.7 %. Hence, it is recommended to install curtains between the beds and apply SV in ECC bedrooms. This study can be used as a guide for systematically designing ventilation systems in ECC bedrooms. Furthermore, collaboration among environmental engineers, designers, policymakers, and the wider community is essential to develop sustainable indoor environments for the elderly.
The elderly rheumatoid arthritis (RA) population consists of both elderly-onset RA that manifests after the age of 60 and individuals diagnosed with RA early in life who age naturally to become ...members of this group. The elderly RA population is expanding due to both increased life expectancy and an increased incidence of elderly onset RA. Elderly onset RA seems to have a characteristic clinical pattern and perhaps biological profile different to that of early onset RA. The management of RA in elderly patients can be challenging, as robust treat-to-target approaches must be balanced against the adverse events due to increased comorbidities in old age. This produces a tendency to prefer less aggressive treatment in elderly RA patients in clinical practice. Despite the concerns about adverse events, there is limited evidence on the best way to approach RA in this population, as elderly patients are often not well presented in the clinical trials. Herein, we review the literature to assess the efficacy and safety of RA therapies in this age group. We then suggest a tailored approach that can be adopted in clinical practice, based on the disease severity and risk profiles of elderly RA patients.
•The expanding elderly RA population consists of elderly onset RA patients & young onset RA patients who age naturally.•Elderly onset RA is more acute & has more joint involvement, systemic features & poorer outcomes than young onset RA.•Elderly RA are at particular risk of infections & comorbidities, due to the effect of age and RA on the immune system.•Elderly RA may be classified as low and high risk as per existing comorbidities, polypharmacy & cognitive impairment.•RA therapy is effective and safe among all age groups and must be balanced against the risk profile of elderly RA.
Evidence indicates that the use of sedative–hypnotics, including benzodiazepines and z-drugs, is linked to an increased risk of falls and fractures. Nonetheless, the potential exacerbation of this ...risk by orexin receptor antagonists, which are novel therapeutic agents for treating insomnia, remains uncertain despite their escalating prevalence in clinical practice. We systematically searched four electronic databases from inception to April 17, 2024. In addition, we performed a quality assessment; calculated pooled odds ratios (ORs) to assess the relationship between the use of orexin receptor antagonists and the occurrence of falls or fractures; evaluated heterogeneity across the included studies; and conducted sensitivity analyses. The meta-analysis encompassed eight papers, comprising a total of 46,636 subjects. These papers included 5 case-control studies and 3 randomized controlled trials (RCTs), collectively encompassing ten studies. Analysis of the included case-control studies (pooled adjusted OR = 0.75, 95% confidence interval CI = 0.00–1.50, I2 = 66.2%, k = 3) and RCTs (OR = 0.68, 95% CI = 0.31–1.50, I2 = 45.9%, k = 5) indicated that the use of orexin receptor antagonists did not elevate the risk of falls. Similarly, analysis of the included case-control studies revealed no significant increase in the risk of fractures associated with the use of orexin receptor antagonists (pooled adjusted OR = 1.01, 95% CI = 0.82–1.20, I2 = 40.1%, k = 2). This meta-analysis suggests that the use of orexin receptor antagonists for treating insomnia does not escalate the risk of falls or fractures, although the data for lemborexant and daridorexant are limited.
•The utilization of orexin receptor antagonists did not heighten the risk of falls.•The use of suvorexant did not elevate the risk of falls.•The use of orexin receptor antagonists did not increase the risk of fractures.
We aimed to assess the performance of common pneumonia severity scores, including Pneumonia Severity Index (PSI), CURB-65, CRB-65, A-DROP and SMART-COP, in predicting adverse outcomes in an elderly ...community-acquired pneumonia (CAP) cohort and to determine the optimal scoring system for specific outcomes of interest.
A total of 822 elderly inpatients were included in the retrospective cohort study. Clinical and laboratory results on admission were used to calculate above scores.
The primary outcome was 30-day mortality. Secondary outcomes were in-hospital mortality, need for mechanical ventilation (MV) and intensive care unit (ICU) admission. Model discrimination was evaluated by the area under receiver operating characteristic curves (AUCs).
The 30-day and in-hospital mortality rates were 6.8% (56/822) and 8.6% (71/822), respectively. One hundred and ninety-eight (24.0%) received MV and 111 (13.5%) were admitted to the ICU. All five scoring systems showed the same trend of increasing rates of each adverse outcome with increasing risk groups (all p<0.001). PSI had the highest AUC, sensitivity, and negative predictive value (NPV) in predicting 30-day mortality and in-hospital mortality. SMART-COP had the highest AUC for predicting the need for MV and ICU admission, but PSI had the highest sensitivity and NPV for these two outcomes.
PSI performed well in identifying elderly patients at risk for 30-day mortality and its high NPV is helpful in excluding patients who are not at risk. Considering the effectiveness and simplicity, SMART-COP and CURB-65 are easier to perform in clinical practice than PSI.
The rising incidence of Human Papilloma Virus (HPV) related oropharyngeal squamous cell carcinoma (OPC) in the older population has been confirmed by recent epidemiologic reports. An increase of over ...50% is expected in the population aged older than 65 years in the next decade. Some authors have focused their investigations on the “late” elderly subgroup defined as patients (pts) aged 75 years or older, still underrepresented in clinical trials. Indeed, there is a significant lack of data on their disease trajectory. The purpose of our experience was to evaluate the pattern of clinical practice in this specific subgroup of pts within the Italian Association of Radiotherapy and Clinical Oncology (AIRO).
Display omitted An observational retrospective study was conducted over a 6-year period (2015-2021). Consecutive patients older than 75 years at diagnosis with a histologically-confirmed HPV positive (p16 immunohistochemistry/HPV DNA-in situ hybridization) OPC eligible for a curatively-intended treatment were included. Overall survival (OS) was defined as the time from OPC diagnosis to last follow-up or death from any cause. Progression-free survival (PFS) was defined as the time from the last day of curative-intended treatment to disease progression or death from any cause. Median OS and PFS was estimated by the Kaplan-Meyer method. A log-rank test was employed to test different variables: smoking history, presence of caregiver, employed treatment modality and age (< or > 80 years) correlated with longer OS. Hazard ratios (HR) for the association between the variables of interest and the risk of death were obtained by univariate Cox regression analysis. A p-value <0.05 was considered statistically significant. Acute toxicity was evaluated according to CTCAE v. 5.0
Display omitted A cohort of 95 pts was included in our analysis. The median age was 78 years (table 1). ECOG PS 0-1 and locally advanced disease were reported for the vast majority of patients, 92.6% and 89.4% (in stage III/IV according to TNM 7thedition) respectively. As expected, exclusive radiotherapy (RT) was the most common adopted strategy. After a median follow- up of 25 months (range: 0-116), 64 patients were alive (67.3%). The one and two-year PFS were 75% and 67%, the median PFS was not reached (Figure 1a). The one and two-year OS rates were 83% and 75%, respectively, whereas the median OS was not reached. Among the tested variables, belonging to the group of age >80 years was associated with a worse OS (p=0.0429; HR for death, 2.15, 95% CI 1.00-4.60, Figure 1b), whereas no impact on survival was associated to the smoking history (p=.011), treatment modality (p=0.32) and presence of caregiver (p=0.65). The toxicity profile was acceptable (>G3 toxicity of 29.4%), although 6 patients (6.3%) died due to potential treatment-related complications. Further analyses on radiation dose, target volumes and pattern of failure will be reported
To the best of our knowledge, our series represents one of the largest to date on “late” elderly population with non-metastatic HPV positive OPC treated with a curatively-intended, RT-based approach. Thanks to the appropriate selection of pts, an optimal survival outcome can be achieved with standard treatment options, in line with data reported for the younger population. Further prospective studies investigating larger series of older pts are warranted in order to confirm our conclusions.
The aim of the current study was to review the current state and characteristics of the elderly population in China in the context of aging, difficulties and challenges faced by older people, and ...efforts of the current Chinese Government in this area. The process of population aging in China began to accelerate in the late 1970s and has continued to increase at a rate of about 3.2% per year since then. This process took more than 45 years in developed countries, while it took only about 27 years in China, and aging may continue to increase for a long time. China is now moving toward a superannuated society due to declining fertility rates and increasing life expectancy. There is a great need for care due to the high disease burden among older people. However, more than 1 million "families have lost their only child", and this number is increasing annually by about 76,000; moreover, there are a large number of "deficient families with an injured family member" in China. These families face greater difficulties due to aging and need to rely on society for more support given the lack of care provided by their children or spouses. The current study has focused on improving the quality of life of older people, helping them achieve healthy aging, and to assist the country in further providing care for the elderly.
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