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"Fragility" and "elderly"

Luke S Howard
Acute pulmonary embolism (PE) is a relatively common cardiopulmonary emergency that is a major cause of hospitalization and morbidity and is the primary cause of mortality associated with venous thromboembolism (VTE). During the last decade, one of the biggest changes in the management of PE has been the approval of four non-vitamin K antagonist oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban and rivaroxaban) for the treatment of PE and deep vein thrombosis and secondary prevention of VTE. Areas covered: This article reviews the evolving management of PE in the NOAC era and addresses three fundamental questions: who should receive NOACs over conventional heparin/vitamin K antagonist regimens for the treatment of acute PE; whether patients should be treated as inpatients or outpatients; and how long patients should be treated to reduce the risk of recurrence? Expert commentary: The management of PE is changing...
March 15, 2018: Expert Review of Respiratory Medicine
Anne Dang, Stéphane Sanchez, Michèle Collart, Rachid Mahmoudi, David Laplanche
The care provided to elderly people aged over 75 must be specific and multidisciplinary. An emergency department, which is seeing increasing numbers of patients passing through its doors, notably with the provision of an ambulatory care service, would not appear to be a suitable place for this fragile population, often with multiple pathologies. A study is looking at the suitability of the emergency department for nursing home residents, who have regular access to medical care, unlike elderly people living at home...
March 2018: Soins. Gérontologie
Shyam Kumar, Ulhas Sonar, Iqbal Singh
The incidence of fragility fractures of the humerus is increasing worldwide. Although clinicians are aware of fractures of hips and wrists, fractures of the shoulder and elbow do not receive much attention. A considerable proportion of the elderly population (estimated at 10-24%) is dependent on walking aids. A well-functioning and pain-free shoulder and elbow is essential for use of these aids. The impact of loss of mobility in the elderly is well known, hence the overall impact of these fractures on the individual can be considerable...
March 2, 2018: British Journal of Hospital Medicine
Francesco Scaglione, Claudio Vampini, Liborio Parrino, Orazio Zanetti
Insomnia is the most common and widespread sleep disorder. Managing insomnia in the elderly patient becomes a difficult challenge for the presence of a multi-disease and multi-drug condition. An organic and functional background that becomes even more fragile when the picture is complicated by psychomotor agitation and cognitive impairment. From the contribution of four experts of different fields and disciplines, stems the need to share an integrated vision that starts from the pharmacological basis of hypnotic drugs, delineates the features of depression in the elderly, addressed the delicate issue of chronic use/abuse of benzodiazepines and ultimately arrives to the management of behavioral disturbances...
January 2018: Rivista di Psichiatria
Matthias Barral, Louis Lassalle, Cyril Dargazanli, Mikael Mazighi, Hocine Redjem, Raphael Blanc, Georges Rodesch, Bertrand Lapergue, Michel Piotin
INTRODUCTION: Mechanical thrombectomy for anterior circulation large vessel occlusion (LVO) improves functional outcome at three months. This therapeutic approach is the new gold standard, with a benefit being also observed in elderly patients. However, data are limited in this heterogeneous and fragile population. The objectives of this study were, first, to describe outcome after mechanical thrombectomy in a representative group of patients over 80. Second, to evaluate factors associated with a favorable functional outcome after thrombectomy for anterior circulation LVO in elderly patients (aged≥ 80 years)...
February 19, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
André Jacques Scheen
Dipeptidyl peptidase-4 inhibitors (DPP-4is) are generally considered as glucose-lowering agents with a safe profile in type 2 diabetes. Areas covered: An updated review of recent safety data from randomised controlled trials, observational studies, meta-analyses, pharmacovigilance reports regarding alogliptin, linagliptin, saxagliptin, sitagliptin, and vildagliptin, with a special focus on risks of hypoglycemia, pancreatitis and pancreatic cancer, major cardiovascular events, hospitalisation for heart failure and other new safety issues, such as bone fractures and arthralgia...
April 2018: Expert Opinion on Drug Safety
Maria João Bárrios, Ana Alexandre Fernandes, António Manuel Fonseca
The aging population has an impact on health, social and economic issues in regards to individuals, communities and organizations. The challenge for local policies in response to aging is to create sufficient resources to meet the population's needs, wishes and rights as people age. Active aging constitutes one of the guiding perspectives on policies. Taking into account the local governance perspective, the instrument MALPA was created in order to convert the active aging paradigm into a practical approach, as a technique to evaluate and analyze local aging policies...
February 20, 2018: Journal of Aging & Social Policy
Kudret Keskin, Gökhan Çetinkal, Serhat Sığırcı, Süleyman Sezai Yıldız, Şükrü Çetin, Ahmet Gürdal, Betül Balaban Kocaş, Kadriye Orta Kılıçkesmez
BACKGROUND: The prevalence of coronary artery disease is on the rise as the life expectancy of the population increases. However, treatment of acute coronary syndrome in the elderly patients has its own problems that have not been thoroughly addressed in the clinical trials. Since these patients are generally fragile and have multiple co-morbidities, the course of acute coronary syndrome can frequently be complicated. Infection, which co-exists either at the initial presentation or is acquired during the hospital stay, is a condition about which there is little published data...
February 10, 2018: Archives of Gerontology and Geriatrics
J Remon, N Vilariño, N Reguart
Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment strategy of advanced non-small cell lung cancer (NSCLC). Beyond the already approved indications in first- and second-line setting of advanced NSCLC, new data has recently emerged demonstrating its efficacy in locally advanced disease as maintenance after chemo-radiotherapy and currently several trials are also exploring its efficacy in earlier stages of the disease to evaluate whether these results could be extrapolated to the adjuvant setting...
February 8, 2018: Cancer Treatment Reviews
Hua-Jun Yu, Gou-Ping Ma, Qiao-Feng Guo, Xiao-Wen Zhang, Chun Zhang
OBJECTIVE: To evaluate the middle-long-term clinical effects of unilateral and bilateral percutaneous kyphoplasty(PKP) for vertebral fragility fracture in the elderly. METHODS: The clinical data in elderly patients with vertebral fragility fracture treated by unilateral and bilateral PKP between January 2008 and January 2010 was retrospective analyzed. According to a unified criteria to divided into two groups for 104 patients(44 males and 60 females), of them, 50 cases were divided in unilateral group using unilateral pedicle surgical approach for PKP and 54 cases were in bilateral group using bilateral pedicle approach...
May 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Konstantinos I Alexiou, Andreas Roushias, Sokratis E Varitimidis, Konstantinos N Malizos
Fractures due to fragility of the bone around the hip joint have become a major public health issue, presenting with an increasing incidence due to the growth of the elderly population. The purpose of this review was to evaluate the impact of hip fractures on the quality of life (QoL), health status (HS), functioning, and psychological parameters, and factors influencing the outcome and the appropriate interventions for improvement of elderly patients. A systematic electronic search of the relevant literature was carried out using the CINAHL, Cochrane, EMBASE, Medline (OvidSP), and PubMed databases spanning the time period from their establishment up to January 2017...
2018: Clinical Interventions in Aging
Carmine Izzo, Albino Carrizzo, Antonia Alfano, Nicola Virtuoso, Mario Capunzo, Mariaconsiglia Calabrese, Eros De Simone, Sebastiano Sciarretta, Giacomo Frati, Marco Oliveti, Antonio Damato, Mariateresa Ambrosio, Francesco De Caro, Paolo Remondelli, Carmine Vecchione
A growing number of evidences report that aging represents the major risk factor for the development of cardio and cerebrovascular diseases. Understanding Aging from a genetic, biochemical and physiological point of view could be helpful to design a better medical approach and to elaborate the best therapeutic strategy to adopt, without neglecting all the risk factors associated with advanced age. Of course, the better way should always be understanding risk-to-benefit ratio, maintenance of independence and reduction of symptoms...
February 6, 2018: International Journal of Molecular Sciences
R W Jordan, A W P Chapman, D Buchanan, P Makrides
BACKGROUND: Ankle fractures are one of the most commonly occurring fractures in the elderly population. The overall incidence has been reported to be up to 184 fractures per 100,000 persons per year, of which 20-30% occur in the elderly. Medical co-morbidities, osteoporosis, suboptimal skin quality and poor toleration of non-weight bearing status all contribute to difficulties in managing these injuries in this population. Intramedullary implants are advantageous as they utilise smaller incisions, minimise soft tissue disruption and may allow early weight bearing...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Joseph M Dyer, Richard A Miller
Thin skin and the appearance of bruises, seemingly unprovoked, are frequent complaints of elderly patients. Chronic cutaneous insufficiencies such as these are termed dermatoporosis . Although it is seldom the primary reason for consultation, dermatoporosis is associated with bleeding and healing complications and presents an opportunity for patient education and prevention. In this review, the authors explore the risk factors, pathogenetic mechanisms, clinical expression, and evidence-based therapies reported for chronic skin fragility due to aging...
January 2018: Journal of Clinical and Aesthetic Dermatology
Naoto Endo
No abstract text is available yet for this article.
January 30, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Maria Mattera, Alfonso Reginelli, Silvia Bartollino, Claudio Russo, Antonio Barile, Domenico Albano, Giovanni Mauri, Carmelo Messina, Salvatore Cappabianca, Giuseppe Guglielmi
Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures...
January 19, 2018: Acta Bio-medica: Atenei Parmensis
Sheila Sprague, Kim Madden, Gerard Slobogean, Brad Petrisor, Jonathan D Rick Adachi, Earl Bogoch, Ydo V Kleinlugtenbelt, Mohit Bhandari
Introduction: Introduction: Adequate calcium and vitamin D from diet and supplementation is recommended for elderly hip fracture patients. Using data from the multinational hip fracture arthroplasty trial (HEALTH), we determined the proportion of patients who consistently took vitamin D and calcium and which characteristics/prescribing practices were associated with consistency of supplement use. Methods: HEALTH is a multicenter randomized trial of elderly hip fracture patients treated with hemi-arthroplasty and total hip arthroplasty...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Cristiana Forni, Fabio D'Alessandro, Pina Gallerani, Rossana Genco, Andrea Bolzon, Caterina Bombino, Sandra Mini, Laura Rocchegiani, Teresa Notarnicola, Arianna Vitulli, Alfredo Amodeo, Guglielmo Celli, Patrizia Taddia
Hip fractures in the elderly are a serious problem for the health service due to the high rate of complications. One of these complications is pressure ulcers that, according to the literature, occur in 8.8% to 55% of patients and mainly arise in the sacral area. The present randomised controlled trial tests whether applying a new innovative multi-layer polyurethane foam dressing (ALLEVYN LIFE™), reduces the onset of pressure ulcers in the sacral area. From March to December 2016, 359 fragility hip fracture patients were randomly divided into 2 groups: 182 in the control group and 177 in the experimental group...
January 4, 2018: International Wound Journal
Suneel B Bhat, Asif M Ilyas
Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction...
November 2017: Archives of Bone and Joint Surgery
Yale Liu, Liang Li, Yumin Xia
Bullous pemphigoid (BP) is by far the most common autoimmune blistering dermatosis that mainly occurs in the elderly. The BP180 is a transmembrane glycoprotein, which is highly immunodominant in BP. The structure and location of BP180 indicate that it is a significant autoantigen and plays a key role in blister formation. Autoantibodies from BP patients react with BP180, which leads to its degradation and this has been regarded as the central event in BP pathogenesis. The consequent blister formation involves the activation of complement-dependent or -independent signals, as well as inflammatory pathways induced by BP180/anti-BP180 autoantibody interaction...
2017: Frontiers in Immunology
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