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266条结果
  • 机译 总前循环卒中后住院时间的决定因素
    摘要:Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The study sample population was drawn from the Norfolk and Norwich Stroke and Transient Ischemic Attack (TIA) Register (1996–2012), a prospective registry. 2965 patients admitted with TACS verified by a stroke specialist team were included. Primary analysis identified predictors of length of stay (LOS) in either haemorrhagic or ischaemic TACS. Secondary analyses identified predictors of LOS in patients who were discharged alive or who died during admission separately. Moderate (p = 0.014) to severe disability (p = 0.015) and history of congestive heart failure (p = 0.027) in the primary analysis and pre-stroke residence in a care facility among patients who survived to discharge (p = 0.013) were associated with a shorter length of stay. Factors associated with increased length of stay included presence of neurological lateralisation in the primary analysis (p = 0.004) and amongst patients who died (p = 0.003 and p = 0.014 for ischaemic and haemorrhagic stroke, respectively). Patients with advanced age (≥85 years) with haemorrhagic stroke had longer LOS regardless of mortality outcome. Patients with low pre-morbid disability (modified Rankin score ≤2 who died following haemorrhagic TACS also had longer LOS. Our study found predictors of LOS following TACS include neurological lateralisation, pre-stroke disability status, congestive heart failure, pre-morbid residence and age. The identification of such factors would assist in resource allocation and discharge planning.
  • 机译 老年人急性中风的管理
    摘要:The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However, acute, interventional and preventative treatments have mostly been trialled in younger age groups. In this article we will provide an overview of the evidence for acute stroke treatments in relation to age, discuss special considerations in the older person, and contemplate patient choice, quality of life, and end-of-life-decisions.
  • 机译 老年患者出院后口腔状况与返乡的关系
    摘要:For elderly inpatients, it may be preferable to return back to their homes after discharge. Therefore, it is important to predict whether elderly patients are able to return home after discharge. Our purpose is to examine the association between geriatric factors including oral conditions and returning home after discharge in elderly patients. A total of 257 elderly patients were enrolled (returned home: N = 116; changed to hospital/nursing home: N = 141). Oral conditions were evaluated by trained dentists. Cognitive impairment was evaluated using the clinical dementia rating scale. Odds ratios (OR) and 95% confidence intervals (CI) to predict the destination after discharge were obtained by unconditional logistic regression analysis. Impaired tongue movement and edentulous were significant oral factors that elderly patients cannot return home (Impaired tongue movement, OR: 2.72; Edentulous, OR, 1.89), whereas presence of loss of posterior occlusion and mobile teeth were not associated statistically. Cognitive impairment, but not aftereffect of cerebrovascular disease, was a significant problem to predict the destination after discharge in elderly patients (Cognitive impairment, OR: 3.58; Cerebrovascular disease, OR: 1.27). Simple, reliable and inexpensive evaluation including oral examination may better predict whether elderly patients can return home after discharge.
  • 机译 中风衰弱的老年人
    摘要:The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but at the same time they suffer increased mortality. Their outcome following stroke and intervention is more often predicted by the presence of frailty rather than age alone. Intervention both in primary prevention and hyperacute stroke management needs to allow for preexisting morbidity and frailty in deciding what is and what is not appropriate, rather than an arbitrary decision on age. Frail older people are more likely to develop delirium and dysphagia combined with poor mouthcare and die, yet all of these issues are managed badly. An increased awareness of these complications of stroke in the frail older person is necessary.
  • 机译 永远不会太晚:一位97岁患者经导管主动脉瓣植入的病例报告
    摘要:Aortic valve stenosis is a well-recognized valvular problem in the aging population. Transcatheter aortic valve implantation (TAVI) is becoming an increasingly popular treatment alternative to surgical aortic valve replacement for frail elderly individuals with symptomatic severe aortic valve stenosis. There are multiple research reports documenting the effectiveness of TAVI in octogenarians; however, few authors discuss the success of this procedure in nonagenarians. This case report depicts the successful transfemoral implantation of a prosthetic aortic valve in a 97-year-old man. Moreover, the current literature on TAVI outcomes in nonagenarians is reviewed.
  • 机译 胆碱酯酶抑制剂对阿尔茨海默氏病,血管性痴呆或混合性痴呆中国裔患者认知和行为症状的系统评价
    摘要:Cholinesterase inhibitors (ChEIs) are the primary pharmacologic treatment for dementia. Their efficacy in patients of Chinese descent is not well described. We reviewed how ChEIs could affect cognition and behavioral and psychological symptoms (BPSD) in Chinese patients with Alzheimer’s disease (AD), vascular dementia (VaD), or mixed (AD with vascular component) dementia. MEDLINE, PsycINFO, EMBASE and CINAHL were systematically searched for controlled trials of ChEIs, including donepezil, galantamine, and rivastigmine, for Chinese patients with AD, VaD, or mixed dementia. Outcomes for cognition and BPSD were extracted for discussion. Fifty-four studies were identified. While one larger study found that dementia patients of Chinese descent treated with ChEIs had significantly higher mean Mini-Mental State Examination (MMSE) score, other studies showed no significant difference. Evidence on BPSD after use of ChEIs was also conflicting. ChEIs may be effective in improving cognition among patients of Chinese descent with dementia. Further studies are needed to examine the possible effects of ChEIs on BPSD in Chinese patients with dementia in view of the small number of studies and limitations in their methodologies.
  • 机译 肥胖,老年人身体健康和炎症
    摘要:Among the elderly, obesity is paradoxically associated with a lower mortality risk. Thus, this study describes fitness levels by Body Mass Index (BMI) category and the associations of high-sensitivity C-reactive protein (hs-CRP) and Vitamin D levels with muscle strength, in community-dwelling older adults. A cross-sectional study, with 1338 subjects having mean age of 78.3 years, were assessed in anthropometrics, muscle strength, and cardiorespiratory fitness. In a sub-sample, blood samples were collected and objective markers of inflammation were provided: high-sensitivity C-reactive protein (hs-CRP) and Vitamin D (25(OH) D). Obese women (BMI ≥ 30.0 kg/m2) showed significantly better results for grip strength than normal weight group (BMI between 18.5–24.9 kg/m2): 22.3 (7.0) vs. 20.0 (6.8); p = 0.002. After adjustment, higher levels of hs-CRP were an independent predictor of lower levels of grip strength (β = −0.213, 95% CI: −0.424; −0.002) and Vitamin D levels were positively associated with higher levels of muscle strength (β = 0.098, 95% CI: 0.008–0.189). The multivariate analysis found a significant and positive association between 25(OH) D and grip strength: (β = 0.098, 95% CI: 0.008–0.189). A positive pattern of higher levels of absolute strength among obese older subjects could have an important impact on morbidity and mortality risk, through the inverse association with acute inflammation and an increase in Vitamin D profile.
  • 机译 在日本我院医疗病房住院的老年患者生存的预后因素
    • 作者:Shuichi Abe
    • 刊名:Geriatrics
    • 2017年第4期
    摘要:It has been a long time since there were many elderly people in Japan. The medical care and costs for the elderly are enormous, and research to lower the mortality rate of the elderly is needed. We retrospectively investigated the prognostic factors for the survival of elderly patients who were hospitalized in the medical ward of our hospital. In total, 277 patients who were hospitalized between 1 January 2014 and 31 May 2017, were included in the retrospective study. Univariate and multivariate analyses of items (vital signs, laboratory data, and so on) were performed, and significant differences between the survival group and death group were subjected to receiver operating characteristic curve analysis. Serum urea nitrogen levels and serum albumin levels provided a relatively high area under the curve (AUC). However, there was no item for which AUC exceeded 0.70, and setting the cutoff value in this study was difficult. For treating the elderly, it is important to carefully evaluate each patient’s prognostic factors, including the demented state, renal function, and nutritional state; personalized treatment of each patient is also important.
  • 机译 利用STOPP 2版标准评估药物-疾病相互作用及其与计划外医院再次入院的关系
    摘要:Early hospital readmission is a common problem among geriatric patients, as they are more susceptible to adverse drug events, which are associated with increased hospital admission. The objective is to examine the association between exposure to potentially inappropriate medications under selected STOPP version 2 criteria related to drug-disease interactions and unplanned early hospitalization within 28 days of index admission in elderly patients prescribed a potentially inappropriate medication. This retrospective single-center study reviewed patients 75 years of age or older that were discharged with 5 or more medications, including at least one selected medication listed in the STOPP version 2 criteria relating to drug-disease interactions. 182 patients, with a mean age of 83.5 years, were included in the study, with anticholinergics being the most common potentially inappropriate medications (22.4%). Potentially inappropriate medications (57.1% vs. 17.1%, p < 0.001), gout (31% vs. 11.5%, p = 0.003), and gastrointestinal disease (11.9% vs. 2.5%, p = 0.026) were shown to increase risk of 28-day readmission, whereas no other factors assessed correlated with readmission. A rapid evaluation of elderly patient discharge medications and concomitant disease states with the aid of the STOPP version 2 criteria could potentially reduce hospital readmissions or emergency department visits.
  • 机译 中国老年人癌症相关信息的搜寻和扫描行为:检验宿命信念和恐惧的作用
    摘要:Effective communication in health information plays an important role in health promotion and cancer prevention. Cancer-related information acquisition can happen via active and purposeful seeking, but may also happen less purposely via the routine use of media and interactions with other people (called scanning). We examined seeking and scanning behaviors regarding cancer prevention in older Chinese adults, identified commonly used sources of information of such behaviors, and examined their associations with fatalistic beliefs and cancer fear. A convenience sample of 224 community-dwelling adults aged ≥60 were recruited between May and July in 2013 in Hong Kong. Results suggested that cancer information scanning (79.5%) was more common than information seeking (30.4%) among our participants. Health professional was the most popular source for both scanning (78.7%) and seeking (58.8%) behaviors regarding cancer information. Fatalistic beliefs was significantly and negatively associated with seeking behaviors (OR = 0.50) but not scanning behaviors, and cancer fear showed no relationship with either behavior. This study shows that the cancer information seeking and scanning behaviors were still suboptimal in this age group and adds to the knowledge regarding the associations between fatalistic beliefs and fear with cancer information seeking and scanning behaviors among older Chinese adults.
  • 机译 进入湿疗护理之家后的医疗费用降低-案例系列
    摘要:Serious alcohol dependence is associated with high healthcare costs, especially when patients have chronic problems with alcohol, dementia and exhibit externalizing behavior. One option is to offer a wet nursing home for seriously ill patients for whom abstinence from alcohol is not a feasible option. In this case series, we present the healthcare costs 18 months before moving into a “wet nursing home”, and in the first 18 months of their stay, for three cases, one with low needs of care, one with medium needs, and one with high needs. Results: for all three patients, hospital costs were reduced by between 83.7 and 97.9% for patients with dementia, externalizing behavior, and chronic alcohol problems, a wet nursing home can produce substantial cost reductions in other parts of the healthcare sector.
  • 机译 从结构磁共振成像估计的脑萎缩,作为老年和中风大规模基于网络的神经变性的标志
    摘要:Brain atrophy is a normal part of healthy aging, and stroke appears to have neurodegenerative effects, accelerating this atrophy to pathological levels. The distributed pattern of atrophy in healthy aging suggests that large-scale brain networks may be involved. At the same time, the network wide effects of stroke are beginning to be appreciated. There is now widespread use of network methods to understand the brain in terms of coordinated brain activity or white matter connectivity. Examining brain morphology on a network level presents a powerful method of understanding brain structure and has been successfully applied to charting the course of brain development. This review will introduce recent advances in structural magnetic resonance imaging (MRI) acquisition and analyses that have allowed for reliable and reproducible estimates of atrophy in large-scale brain networks in aging and after stroke. These methods are currently underutilized despite their ease of acquisition and potential to clarify the progression of brain atrophy as a normal part of healthy aging and in the context of stroke. Understanding brain atrophy at the network level may be key to clarifying healthy aging processes and the pathway to neurodegeneration after stroke.
  • 机译 抑郁症的性别差异:老年妇女比老年妇女患抑郁症的风险更大吗?
    摘要:Numerous epidemiological reports have found that adolescent, young adult, and middle-aged adult girls and women are more likely to be diagnosed with unipolar depression and report greater symptoms of depression when compared to boys and men of similar ages. What is less well-known is whether this gender difference persists into late life. This literature review examines whether the well-known gender difference in unipolar depression continues into old age, and, if it does, whether the variables that are known to contribute to the gender difference in unipolar depression from adolescence through adulthood continue to contribute to the gender difference in the elderly, and/or whether there are new variables that arise in old age and contribute to the gender difference in the elderly. In this review of 85 empirical studies from every continent except for Antarctica, we find substantial support for the gender difference in depression in individuals who are 60 and older. More research is necessary to determine which factors are the strongest predictors of the gender difference in depression in late life, and particularly whether the factors that seem to be responsible for the gender difference in depression in earlier life stages continue to predict the gender difference in the elderly, and/or whether new factors come into play in late life. Longitudinal research, meta-analyses, and model-based investigations of predictors of the gender difference in depression are needed to provide insights into how and why the gender difference in depression persists in older age.
  • 机译 老年人体弱综合症及其生理,认知和情感领域的研究进展
    摘要:Background: Frailty, a very important complication of increasing age, is a well-recognised concept although it has not been accurately measured in the clinical setting. The aim of this literature review is to summarise commonly used frailty screening tools, and to describe how new measurement methods have been developed recently. Methods: Several frailty measurement tools including the most cited and newly developed scales have been described in this review. We searched the MEDLINE using the search terms; “frailty score, scale, tool, instrument, index, phenotype” and then summarised selected tools for physical, cognitive, emotional and co-morbidity domains. Results: The most cited frailty measurement methods developed from 1999 to 2005 are primarily criteria for physical frailty (e.g., frailty phenotype). More recently developed tools (e.g., triad of impairment and multidimensional frailty score) consider cognitive and emotional domains in addition to physical deficit in measuring frailty. Co-morbidity has also been considered as a domain of frailty in several measurement tools. Conclusion: Although frailty tools have traditionally assessed physical capability, cognitive and emotional impairment often co-exist in older adults and may have shared origins. Therefore, newer tools which provide a composite measure of frailty may be more relevant for future use.
  • 机译 优化乳腺癌老年妇女护理的一项持续使命
    摘要:The majority of cases of breast cancer occur in the older population who are often un-represented in clinical trials. Given the growing ageing population globally, it becomes urgent and important to identify an optimal approach so that older women with breast cancer are neither under- or over-treated. An inter-disciplinary research program is ongoing to investigate differing tumor biology according to age, and the potential use of a geriatric assessment tool, aiming to help select older women with primary breast cancer for a personalized and optimal treatment. Full considerations of the biology of the patient’s cancer and the geriatric domains of the patient must be taken into account when making treatment decisions.
  • 机译 老年人脊髓灰质炎后综合症诊断
    摘要:Poliomyelitis is a disorder of the nervous system caused by an enterovirus. There are many survivors who, years later, develop a little-understood condition called Post-polio syndrome. Post-polio syndrome is a group of delayed sequalae of polio infection that can cause paralysis and bulbar symptoms in patients with a history of polio infection who have had a prolonged symptom-free period, often greater than two decades. Diagnosis of post-polio syndrome is difficult in the geriatric population because many of the symptoms overlap with other disease processes affecting older individuals. An extensive workup is necessary to exclude more concerning etiologies. Furthermore, several symptoms can be attributed to normal ageing. We present the case of an elderly patient with a history of poliomyelitis and multiple comorbidities who presented with complaints of weakness and fatigue.
  • 机译 与多发性老年人抑郁症有关的记忆和学习投诉
    摘要:Although current models of care are generally well-suited to providing treatment for individual medical conditions, the emergence of multimorbidity is becoming a serious concern for practitioners and policy researchers, particularly in developing countries. The challenges of tackling multimorbidity are further compounded when the multimorbidity co-occurs with psychiatric conditions such as cognitive and depressive disorders. Understanding the relationships between multimorbidity and psychiatric illnesses is therefore of considerable clinical importance. In the present study, we cross-sectionally examined whether multimorbidity has an association with perceived cognition—including memory, learning complaints, and depression—among elderly population in South Africa. Study subjects were 422 men and women aged 50 years and older. The prevalence of arthritis, asthma, cancer, diabetes, heart disease, chronic lung disease, hypertension, and stroke was respectively 31.5, 7.3, 1.7, 10.2, 1.2, 1.7, 52.1, and 31.5%, and that of multimorbidity was 30.8%. In the multivariate analysis, women with multimorbidity were 4.33 times (OR = 4.33, 95%CI = 2.96–14.633) more likely to report memory complaints. The odds of diagnosed depression were 1.4 times (OR = 1.4, 95%CI = 1.045–5.676), and the odds of self-reported depression were 1.7 times (OR = 1.7, 95%CI = 1.41–2.192) higher among women who had multimorbidity compared with those who had no morbid conditions. However, the association was not significant among men. Overall, the findings suggest that the occurrence of multimorbidity warrants special attention, especially regarding its compounding effects on psychological health. The findings need to be replicated through longitudinal studies that consider a broader range of chronic conditions.
  • 机译 患者报告的中风后老年人的种族差异
    摘要:Longstanding disparities have been reported in stroke-related outcomes with blacks experiencing more post-stroke disabilities. Little is known about long-term disability outcomes among older stroke survivors. This study was a retrospective analysis of data from the 2015 National Health Interview Survey (NHIS). A group of 655 stroke survivors (541 white and 114 black) age 65 and older were asked to rate their ability to complete 10 functional tasks without special equipment. Univariate comparisons were completed using t-tests and chi-square statistics for racial comparisons of disability reports. Multinomial logistic regression was used to determine odds of reporting disability after controlling for relevant covariates. The mean age of the sample was 76.6 years. After controlling for relevant covariates, white stroke survivors were less likely to report the following tasks being “very difficult/can’t do at all” without using special equipment compared to blacks: reach overhead (OR = 0.39, 95% CI 0.23–0.65; p = 0.000) and grasp small objects (OR = 0.42, 95% CI 0.25–0.73; p = 0.002). Both black and white older stroke survivors experience significant post-stroke disability across a range of functional tasks. Slightly greater long term post-stroke disability appears to exist among older blacks.
  • 机译 脆性骨折和帕金森病:骨折与人口统计学,严重程度和不良结果预测因素的关系
    摘要:Background: The risk of falls is higher in patients with Parkinsonism (PwP) as compared to other older adults, leading to adverse outcomes including fragility fractures. Osteoporosis is under-recognised and the current prevalence of fragility fractures is not well-studied. The objectives of this study are to determine the prevalence of fragility fractures in PwP, to measure the relationship of fractures with demography, severity and to measure predictors of adverse outcomes in this population. Method/Description: This was a retrospective observational cohort study based on the analysis of existing data for all the patients attending Caerphilly Movement Disorder Clinic. Information on demographics, the severity of Parkinsonism and fragility fractures was extracted electronically from the clinical workstation, clinic letters and coding from January 2015 to October 2016. Results: 397 people (mean age = 77.1 ± 9.4, 46% females) were studied. Of these, 77% (306/397) had Parkinsonism and 80% (244/306) had idiopathic Parkinson’s disease (PD). The mean Hoehn & Yahr Score at the time assessment was 3.09 ± 1.16. Additionally, 23.5% (72/306) were deemed to have osteoporosis based on the radiological evidence of fragility fractures. The PwP who sustained fractures were comparatively older (80.4 ± 12.1) and 70% (50/72) were females. The most common site for fractures was vertebral (47.2%; 34/72). Also, 22.2% of the sample (16/72) had suffered a fragility fracture before the diagnosis of PD. However, a majority (77.8%; 56/72) had sustained a fracture during the course of PD with a mean lapse of 6 years (range = 0–13 years) from initial diagnosis. Only 40% (29/72) of patients were prescribed osteoporosis drugs as per guidelines. There is a significant correlation of advancing age, severity and duration of PD with fragility fractures. The single best predictor of mortality is severity of PD, followed by age and fractures. Conclusions: There is a high prevalence of fragility fractures in patients attending movement disorder clinics, although 60% do not receive evidence-based medical treatment for the underlying osteoporosis. The prevalence of fragility fractures is positively correlated with the duration and severity of PD. We acknowledge the relatively small sample size as the study’s limitation.
  • 机译 老年缺血性卒中幸存者中风:标准治疗还是其他?
    摘要:Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of “old” continues to evolve. Age alone should not influence the healthcare that a patient receives, however, evidence indicates that this does occur, especially in older patients. On the basis of the available evidence, it is time to reconsider whether or not stroke care should differ in older survivors of stroke and if so, why. This is a narrative review of stroke-related health care in those with a recent ischemic stroke. It seeks to answer the following question: Should patients aged ≥80 years who have experienced a recent ischemic stroke receive standard care or something different, and if they should receive something different, what should they receive and why? The review focusses on long-term survival, hyper-acute care, secondary prevention, and rehabilitation. The authors propose a number of recommendations in relation to stroke care in older survivors of a recent ischemic stroke.

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