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frailty and comorbidity

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https://www.readbyqxmd.com/read/27913981/the-challenges-of-anaesthesia-and-pain-relief-in-hip-fracture-care
#1
Rachel Cowan, Jun Hao Lim, Terence Ong, Ashok Kumar, Opinder Sahota
The care of the older person with hip fracture is complicated by their comorbid condition, limited physiological reserve, cognitive impairment and frailty. Two aspects of hip fracture management that have received considerable attention are how best to manage the pain associated with it and the ideal mode of anaesthesia. Existing literature has reported on the suboptimal treatment of pain in this orthogeriatric cohort. With recent advancements in medical care, a number of options have emerged as alternatives to conservative systemic analgesia...
December 3, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27913517/treatment-of-low-risk-myelodysplastic-syndromes
#2
Valeria Santini
The majority of myelodysplastic syndrome (MDS) patients belong to the International Prognostic Scoring System (IPSS) and IPSS-revised (IPSS-R) lower-risk categories. Their precise diagnostics and prognostic stratification is often a challenge, but may ensure the optimization of therapy. The availability of diverse treatment options has significantly improved the quality of life and survival of this group of patients. Anemia is the most relevant cytopenia in terms of frequency and symptoms in lower-risk MDS, and may be treated successfully with erythropoietic stimulating agents, provided a careful selection is performed on the basis of IPSS-R, endogenous erythropoietin levels, and transfusion independence...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27905087/robot-assisted-surgery-in-elderly-and-very-elderly-population-our-experience-in-oncologic-and-general-surgery-with-literature-review
#3
Graziano Ceccarelli, Enrico Andolfi, Alessia Biancafarina, Aldo Rocca, Maurizio Amato, Marco Milone, Marta Scricciolo, Barbara Frezza, Egidio Miranda, Marco De Prizio, Andrea Fontani
BACKGROUND: Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥65 or 75 years is used. Nowadays most of malignancies requiring surgical treatment are diagnosed in old population. Comorbidities and frailty represent well-known problems during and after surgery in elderly patients. Minimally invasive surgery offers earlier postoperative mobilization, less blood loss, lower morbidity as well as reduction in hospital stay and as such represents an interesting and validated option for elderly population...
November 30, 2016: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/27892670/impact-of-adjuvant-chemotherapy-in-elderly-breast-patients-in-taiwan-a-hospital-based-study
#4
Hsiu-Chuan Lee, Wei-Yu Chen, Wen- Tsung Huang, Kuo- Chen Cheng, Yu-Feng Tian, Chung-Han Ho, Chao- Jung Tsao, Yin- Hsun Feng
Purpose: Decisions as to whether to provide adjuvant treatment in older breast cancer patients remains challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty. To aid decision-making, we retrospectively analyzed 110 women with breast cancer treated with a curative intention from 2006 to 2012. Survival data with clinical and pathological parameters were evaluated to address the role of adjuvant chemotherapy in this study population. Method: A total of 110 elderly (>70 years) patients that received mastectomy at two hospitals in Taiwan were observed retrospectively for a medium of 51 months...
January 10, 2016: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/27884130/a-profile-of-the-clinical-course-of-cognition-and-comorbidity-in-mild-cognitive-impairment-and-dementia-study-the-4c-study-two-complementary-longitudinal-clinical-cohorts-in-the-netherlands
#5
Weiqi Liao, Renske E G Hamel, Marcel G M Olde Rikkert, Saskia M Oosterveld, Pauline Aalten, Frans R J Verhey, Philip Scheltens, Nicole Sistermans, Yolande A L Pijnenburg, Wiesje M van der Flier, Inez H G B Ramakers, René J F Melis
BACKGROUND: Heterogeneous disease trajectories of mild cognitive impairment (MCI) and dementia are frequently encountered in clinical practice, but there is still insufficient knowledge to understand the reasons and mechanisms causing this heterogeneity. In addition to correlates of the disorder, patient characteristics such as their health status, social environment, comorbidities and frailty may contribute to variability in trajectories over time. The current paper outlines the study design and the study population of and provides an overview of the data collected in the Clinical Course of Cognition and Comorbidity in Mild Cognitive Impairment (4C-MCI cohort, n = 315) and Dementia (4C-Dementia cohort, n = 331) Study...
November 25, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27883167/frailty-is-a-geriatric-syndrome-characterized-by-multiple-impairments-a-comprehensive-approach-is-needed
#6
L-K Chen, A-C Hwang, L-K Liu, W-J Lee, L-N Peng
OBJECTIVE: To evaluate the prevalence of frailty and the associated multimorbidity and functional impairments among community-dwelling middle-aged and elderly people in Taiwan. DESIGN: a cross-sectional study. SETTING: communities in I-Lan County of Taiwan. PARTICIPANTS: 1839 community-dwelling people aged 50 years and older. INTERVENTION: None. MEASUREMENTS: Frailty defined by Fried's criteria, Charlson's comorbidity index (CCI), Functional Autonomy Measurement System (SMAF), Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Nutrition Assessment (MNA), Mini-Mental State Examination (MMSE), and Short Form-12 quality of life questionnaire...
2016: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/27869899/-patients-with-non-st-elevation-acute-coronary-syndrome-managed-without-coronary-revascularization-an-undertreated-population
#7
Alberto Menozzi, Leonardo De Luca, Zoran Olivari, Roberta Rossini, Marco Ferlini, Daniela Lina, Maurizio Giuseppe Abrignani, Piera Capranzano, Nazario Carrabba, Marcello Galvani, Alfredo Marchese, Gianfranco Mazzotta, Luciano Moretti, Nicola Signore, Massimo Uguccioni, Stefano De Servi
Non-ST-elevation acute coronary syndromes (NSTE-ACS) represent one of the most common clinical presentations of ischemic heart disease. Patients with NSTE-ACS are a heterogeneous population, with different clinical features and prognosis. A significant proportion of this population is medically managed, without any revascularization. In the Italian EYESHOT and French FAST-MI registries, patients managed with a conservative strategy were 40% and 35%, respectively. NSTE-ACS patients not undergoing coronary revascularization are at higher risk of adverse cardiovascular events and have a worse prognosis, including short- and long-term mortality, compared with those receiving revascularization...
October 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27869890/-anmco-sic-sici-gise-sicch-consensus-document-risk-stratification-in-elderly-patients-undergoing-cardiac-surgery-and-transcatheter-aortic-valve-implantation
#8
Giovanni Pulignano, Michele Massimo Gulizia, Samuele Baldasseroni, Francesco Bedogni, Giovanni Cioffi, Ciro Indolfi, Francesco Romeo, Adriano Murrone, Francesco Musumeci, Alessandro Parolari, Leonardo Patanè, Paolo Giuseppe Pino, Annalisa Mongiardo, Carmen Spaccarotella, Roberto Di Bartolomeo, Giuseppe Musumeci
Aortic stenosis is one the most frequent valvular diseases in developed countries, and its impact on public healthcare resources and assistance is increasing. A substantial proportion of elderly patients with severe aortic stenosis is frequently not eligible for surgery because of advanced age, frailty and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy...
September 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27869882/-assessment-of-geriatric-patients-care-needs-based-on-sosia-classification-the-reality-of-the-lombardy-region-in-nursing-home
#9
Mariangela Vanalli
The increased demand to care that originates from demographic changes called in Italy a rapid development in Nursing Home with particular emergency the problem of programme the welfare response. It is essential the development of a classification system able to describe the stratification of the case mix on the basis of the care requirements, allowing a remuneration in function of the complexity care. Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty...
November 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27855417/testosterone-deficiency-and-testosterone-treatment-in-older-men
#10
Farid Saad, Gabriele Röhrig, Stephan von Haehling, Abdulmaged Traish
Frailty is a clinical condition related to changes in metabolism, to sarcopenia, and to decline in muscle mass and strength, bone mineral density, and physical function with aging. The pathophysiology of frailty is multifactorial and associated with comorbidities. Testosterone is implicated in regulating metabolic functions, maintenance of muscle and bone, and inhibition of adipogenesis. In older individuals, reduced testosterone is thought to contribute to an altered state of metabolism, loss of muscle and bone, and increased fat, leading to sarcopenia, sarcopenic obesity, and frailty...
November 18, 2016: Gerontology
https://www.readbyqxmd.com/read/27834193/impact-of-polypharmacy-on-antiretroviral-prescription-in-people-living-with-hiv
#11
Giovanni Guaraldi, Marianna Menozzi, Stefano Zona, Andrea Calcagno, Ana R Silva, Antonella Santoro, Andrea Malagoli, Giovanni Dolci, Chiara Mussi, Cristina Mussini, Matteo Cesari, Saye H Khoo
OBJECTIVES: To evaluate the relationship between polypharmacy and ART, delivered as conventional multi-tablet three-drug regimens, single-tablet regimens or less-drug regimens (simplified mono or dual regimens). METHODS: We conducted a cross-sectional analysis of electronic data from the prospective Modena HIV Metabolic Clinic Cohort Study. We included the last clinical observation for each patient from January 2006 to December 2015. Polypharmacy was defined as the use of five or more medications (excluding ART)...
November 9, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27831968/poor-nutrition-status-and-lumbar-spine-fusion-surgery-in-the-elderly-readmissions-complications-and-mortality
#12
Varun Puvanesarajah, Amit Jain, Khaled Kebaish, Christopher I Shaffrey, Daniel M Sciubba, Rafael De la Garza-Ramos, A Jay Khanna, Hamid Hassanzadeh
STUDY DESIGN: Retrospective database review. OBJECTIVE: To quantify the medical and surgical risks associated with elective lumbar spine fusion surgery in patients with poor pre-operative nutritional status and to assess how nutritional status alters length of stay and readmission rates. SUMMARY OF BACKGROUND DATA: There has been recent interest in quantifying the increased risk of complications caused by frailty, an important consideration in elderly patients that is directly related to comorbidity burden...
November 9, 2016: Spine
https://www.readbyqxmd.com/read/27830393/chemotherapy-treatment-decision-making-experiences-of-older-adults-with-cancer-their-family-members-oncologists-and-family-physicians-a-mixed-methods-study
#13
Martine T E Puts, Schroder Sattar, Kara McWatters, Katherine Lee, Michael Kulik, Mary-Ellen MacDonald, Raymond Jang, Eitan Amir, Monika K Krzyzanowska, Natasha Leighl, Margaret Fitch, Anthony M Joshua, Padraig Warde, Ann E Tourangeau, Shabbir M H Alibhai
PURPOSE: Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. METHODS: A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted...
November 9, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/27815111/cross-cultural-adaptation-and-validation-of-the-spanish-language-version-of-the-sarc-f-to-assess-sarcopenia-in-mexican-community-dwelling-older-adults
#14
Lorena Parra-Rodríguez, Claudia Szlejf, Ana Isabel García-González, Theodore K Malmstrom, Esteban Cruz-Arenas, Oscar Rosas-Carrasco
OBJECTIVES: To cross-culturally adapt and validate the Spanish-language version of the SARC-F in Mexican community-dwelling older adults. DESIGN: Cross-sectional analysis of a prospective cohort. SETTING: The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. PARTICIPANTS: Participants were 487 men and women older than 60 years, living in the designated area in Mexico City...
December 1, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27797432/the-effect-of-frailty-on-30-day-mortality-risk-in-older-patients-with-acute-heart-failure-attended-in-the-emergency-department
#15
Francisco Javier Martín-Sánchez, Esther Rodríguez-Adrada, Christian Mueller, M T Vidán, Michael Christ, W Frank Peacock, Miguel Alberto Rizzi, Aitor Alquezar, Pascual Piñera, Paula Lázaro Aragues, Pere Llorens, Pablo Herrero, Javier Jacob, Cristina Fernández, Òscar Miró
OBJECTIVE: To determine the effect of frailty on risk of 30-day mortality in non-severely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). METHODOLOGY: The Frailty-AHF Study is a retrospective analysis of a multicentre, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients ≥ 65 years of age without severe functional dependence or dementia attended for AHF in 3 Spanish EDs during 4 months...
October 31, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27795518/current-treatment-of-refractory-and-relapsed-multiple-myeloma
#16
Makoto Sasaki
In the past decade, previously approved novel agents, such as proteasome inhibitors (bortezomib) and immunomodulatory drugs ([IMiDs]; e.g., lenalidomide), have led to significant improvement in the treatment of multiple myeloma in Japan. However, almost all patients will ultimately relapse, even when they have achieved a deep and prolonged therapeutic response with initial treatment. Next-generation IMiDs (pomalidomide) and deacetylase inhibitors (panobinostat) were approved for use as salvage therapy for refractory and relapsed multiple myeloma [RRMM] within the last year...
2016: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
https://www.readbyqxmd.com/read/27791226/predictors-of-frailty-in-old-age-results-of-a-longitudinal-study
#17
A Hajek, C Brettschneider, T Posselt, C Lange, S Mamone, B Wiese, S Weyerer, J Werle, A Fuchs, M Pentzek, J Stein, T Luck, H Bickel, E Mösch, K Heser, F Jessen, W Maier, M Scherer, S G Riedel-Heller, H-H König
OBJECTIVES: To investigate time-dependent predictors of frailty in old age longitudinally. DESIGN: Population-based prospective cohort study. SETTING: Elderly individuals were recruited via GP offices at six study centers in Germany. The course of frailty was observed over 1.5 years (follow up wave 4 and follow up wave 5). PARTICIPANTS: 1,602 individuals aged 80 years and older (mean age 85.4 years SD 3.2, with mean CSHA CFS 3...
2016: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/27782228/-treating-hiv-disease-back-to-the-patient
#18
Enrico Girardi, Antonella d'Arminio Monforte, Laura Camoni, Patrizio Pezzotti, Giovanni Guaraldi, Adriana Ammassari, Andrea Antinori, Stefano Bonora, Cristina Mussini, Antonella Cingolani, Giulio Maria Corbelli, Silvia Adami, Luca Degli Esposti, Margherita Andretta
HIV disease has dramatically changed in the last two decades from a progressive, lethal disease to a chronic manageable condition. These changes are due to the availability of potent antiretroviral combination therapy, which also have the potential to contribute significantly to the control of the epidemic. Among persons living with HIV, incidence of immunosuppression-related opportunistic illnesses has clearly decreased, while an increase was observed in the prevalence of age-related noncommunicable comorbidities, including cardiovascular, metabolic, renal, bone and hepatic disease, due to chronic inflammatory state and to an overall aging of the population of persons with HIV...
October 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27779975/predictors-of-mortality-in-trauma-patients-aged-80-years-or-older
#19
Kyle Mock, Jessica Keeley, Ashkan Moazzez, David S Plurad, Brant Putnam, Dennis Y Kim
The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27771713/frailty-in-chinese-peritoneal-dialysis-patients-prevalence-and-prognostic-significance
#20
Jack Kit-Chung Ng, Bonnie Ching-Ha Kwan, Kai-Ming Chow, Phyllis Mei-Shan Cheng, Man-Ching Law, Wing-Fai Pang, Chi-Bon Leung, Philip Kam-Tao Li, Cheuk-Chun Szeto
BACKGROUND/AIMS: Previous studies showed that frailty is prevalent in both pre-dialysis and dialysis patients. However, the prevalence and prognostic implication of frailty in Chinese peritoneal dialysis (PD) patients remain unknown. METHODS: We used a validated questionnaire to determine the Frailty Score of 193 unselected prevalent PD patients. All patients were then followed for 2 years for their need of hospitalization and mortality. RESULTS: Amongst the 193 patients, 134 (69...
October 24, 2016: Kidney & Blood Pressure Research
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