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Denise Baird Schwartz, Albert Barrocas, John R Wesley, Gustavo Kliger, Alessandro Pontes-Arruda, Humberto Arenas Márquez, Rosemarie Lembo James, Cheryl Monturo, Lucinda K Lysen, Angela DiTucci
Based on current scientific literature, gastrostomy tube (G-tube) placement or other long-term enteral access devices should be withheld in patients with advanced dementia or other near end-of-life conditions. In many instances healthcare providers are not optimally equipped to implement this recommendation at the bedside. Autonomy of the patient or surrogate decision maker should be respected, as should the patient's cultural, religious, social, and emotional value system. Clinical practice needs to address risks, burdens, benefits, and expected short-term and long-term outcomes in order to clarify practice changes...
December 2014: Nutrition in Clinical Practice
Marcel Arcand
OBJECTIVE: To answer frequently asked questions about management of end-stage pneumonia, poor nutritional intake, and dehydration in advanced dementia. SOURCES OF INFORMATION: Ovid MEDLINE was searched for relevant articles published until February 2015. No level I studies were identified; most articles provided level III evidence. The symptom management suggestions are partially based on recent participation in a Delphi procedure to develop a guideline for optimal symptom relief for patients with pneumonia and dementia...
April 2015: Canadian Family Physician Médecin de Famille Canadien
Patrizia D'Amelio, Giovanni Carlo Isaia
Osteoporosis is now recognized as an important public health problem in elderly men as fragility fractures are complicated by increased morbidity, mortality, and social costs. This review comprises an overview of recent findings in pathophysiology, diagnosis, and treatment of male osteoporosis, with particular regard to the old population.
2015: International Journal of Endocrinology
Faryal Mirza, Ernesto Canalis
Osteoporosis is a skeletal disorder characterized by decreased mass and compromised bone strength predisposing to an increased risk of fractures. Although idiopathic osteoporosis is the most common form of osteoporosis, secondary factors may contribute to the bone loss and increased fracture risk in patients presenting with fragility fractures or osteoporosis. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. This review focuses on some of the common causes of osteoporosis, addressing the underlying mechanisms, diagnostic approach and treatment of low bone mass in the presence of these conditions...
September 2015: European Journal of Endocrinology
J C Binns, P Isaacson
Ischaemic colitis due to non-occlusive mesenteric ischaemia is a disease of the elderly which commonly involves the left side of the colon; selective splenic flexure involvement is said to be especially common. In an attempt to explain these features postmortem angiograms were performed on the superior and inferior mesenteric arteries of 37 postmortem subjects. A distinct age-related tortuosity of the long colic arteries was noted which could account for the increasing incidence of ischaemic colitis with age...
May 1978: Gut
J M Kärkkäinen
No abstract text is available yet for this article.
September 2016: Expert Review of Gastroenterology & Hepatology
David B Wilson, Kian Mostafavi, Timothy E Craven, Juan Ayerdi, Matthew S Edwards, Kimberley J Hansen
BACKGROUND: To examine prospectively the relationship between stenosis or occlusion of the celiac and superior mesenteric arteries and symptoms of chronic intestinal ischemia in free-living elderly patients in the United States. METHODS: As part of an ancillary study to the Cardiovascular Health Study, participants in the Forsyth County (North Carolina) cohort underwent visceral duplex ultrasonography of the celiac and superior mesenteric arteries. Critical mesenteric artery stenosis (MAS) or occlusion was defined by Doppler flow ultrasound-derived criteria...
October 23, 2006: Archives of Internal Medicine
Robert L Maher, Joseph Hanlon, Emily R Hajjar
INTRODUCTION: Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years. AREAS COVERED: We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy...
January 2014: Expert Opinion on Drug Safety
Junqiang Yan, Qizhi Fu, Liniu Cheng, Mingming Zhai, Wenjuan Wu, Lina Huang, Ganqin Du
Parkinson's disease (PD) is one of the most common age‑related neurodegenerative diseases, which results from a number of environmental and inherited factors. PD is characterized by the slow progressive degeneration of dopaminergic (DA) neurons in the substantia nigra. The nigrostriatal DA neurons are particularly vulnerable to inflammatory attack. Neuroinflammation is an important contributor to the pathogenesis of age‑related neurodegenerative disorders, such as PD, and as such anti‑inflammatory agents are becoming a novel therapeutic focus...
November 2014: Molecular Medicine Reports
Zdenek Zadak, Radomir Hyspler, Alena Ticha, Jiri Vlcek
PURPOSE OF REVIEW: Malnutrition and polypharmacy increase with age and polymorbidity and their relationship is based on a number of mechanisms. The occurrence of malnutrition in both in-patients and out-patients and its dependence on polymorbidity and age are well known, but the interrelation of polypharmacy and malnutrition has been far less investigated. The countries with the highest occurrence of polypharmacy in Europe include the Czech Republic and Finland, whereas the lowest prevalence of polypharmacy is found in Norway and the Netherlands...
January 2013: Current Opinion in Clinical Nutrition and Metabolic Care
Andrew Clegg, Sally Barber, John Young, Steve Iliffe, Anne Forster
BACKGROUND: frailty is a state of vulnerability to stressor events. There is uncertainty about the beneficial effects of exercise interventions for older people with frailty. The Home-based Older People's Exercise (HOPE) programme is a 12-week-exercise intervention for older people with frailty designed to improve mobility and function. METHODS: we tested feasibility of the HOPE programme in a two arm, assessor blind pilot randomised controlled trial (RCT). Eligibility criteria included living at home and receiving case manager care, being housebound or attending day centres in Bradford, UK...
September 2014: Age and Ageing
Matteo Cesari, Bruno Vellas, Fang-Chi Hsu, Anne B Newman, Hani Doss, Abby C King, Todd M Manini, Timothy Church, Thomas M Gill, Michael E Miller, Marco Pahor
BACKGROUND: The frailty syndrome is as a well-established condition of risk for disability. Aim of the study is to explore whether a physical activity (PA) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability. METHODS: Exploratory analyses from the Lifestyle Interventions and Independence for Elders pilot, a randomized controlled trial enrolling 424 community-dwelling persons (mean age=76.8 years) with sedentary lifestyle and at risk of mobility disability...
February 2015: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Hee Ryung Wang, Young Sup Woo, Won-Myong Bahk
The aim of this study was to review the efficacy and safety of atypical antipsychotics, comparing within class, placebo, or compared to another active treatment for delirium. A literature search was conducted using PubMed, EMBASE, and the Cochrane database (1 January 1990-5 November 2012). Selection criteria for review were prospective, controlled studies (comparison studies), using validated delirium rating scales as outcome measures. A total of six prospective, randomized controlled studies were included in the review...
July 2013: Psychiatry and Clinical Neurosciences
Sandra Black, Gustavo C Román, David S Geldmacher, Stephen Salloway, Jane Hecker, Alistair Burns, Carlos Perdomo, Dinesh Kumar, Raymond Pratt
BACKGROUND AND PURPOSE: Clinical observations suggest that patients with vascular dementia (VaD) may benefit from treatment with cholinesterase inhibitors. This study evaluated the efficacy and safety of donepezil for relieving symptoms of dementia in VaD. METHODS: Patients (n=603; mean age, 73.9 years; 55.2% men) with probable (70.5%) or possible (29.5%) VaD, according to criteria of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), were randomized to 24 weeks of treatment with donepezil 5 mg/d (n=198), donepezil 10 mg/d (5 mg/d for first 28 days; n=206), or placebo (n=199)...
October 2003: Stroke; a Journal of Cerebral Circulation
Hon-Chi Lee, Kristin Tl Huang, Win-Kuang Shen
Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias...
September 2011: Journal of Geriatric Cardiology: JGC
Vera H M Deneer, Norbert M van Hemel
Aging is associated with electrical and structural changes of the myocardium. The response to catecholamines is also reduced and the baroreceptor reflex activity is blunted. These aspects conceivably affect the response to antiarrhythmic drugs in the elderly. Furthermore, physiological parameters change in older age, affecting the pharmacokinetics of drugs. In this article, the literature on the pharmacokinetics and pharmacodynamics of antiarrhythmic drugs in elderly subjects is reviewed with the purpose of improving their optimal and safe prescription...
August 1, 2011: Drugs & Aging
Juan Pedro-Botet, Elisenda Climent, Juan J Chillarón, Rocio Toro, David Benaiges, Juana A Flores-Le Roux
The elderly population is increasing worldwide, with subjects > 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older > 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data...
July 2015: Journal of Geriatric Cardiology: JGC
M Sano, K L Bell, D Galasko, J E Galvin, R G Thomas, C H van Dyck, P S Aisen
BACKGROUND: Lowering cholesterol is associated with reduced CNS amyloid deposition and increased dietary cholesterol increases amyloid accumulation in animal studies. Epidemiologic data suggest that use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may decrease the risk of Alzheimer disease (AD) and a single-site trial suggested possible benefit in cognition with statin treatment in AD, supporting the hypothesis that statin therapy is useful in the treatment of AD...
August 9, 2011: Neurology
Sonja L Rosen, David B Reuben
In addition to medical diseases, psychological, social, cognitive, and functional issues influence the health of older persons. Therefore, the traditional medical assessment alone is often not enough to evaluate the older population with multiple comorbidities. Out of this recognized need, the geriatric assessment has been developed, which emphasizes a broader approach to evaluating contributors to health in older persons. Geriatric assessment uses specific tools to help determine patient's status across several different dimensions, including assessment of medical, cognitive, affective, social, economic, environmental, spiritual, and functional status...
July 2011: Mount Sinai Journal of Medicine, New York
Afsaneh Barzi, Mikkael A Sekeres
The myelodysplastic syndromes (MDS) are clonal bone marrow disorders that lead to underproduction of normal blood cells. The consequent cytopenias result in infections and bleeding complications. MDS transform to acute myeloid leukemia in one-third of patients. The number of diagnoses has exploded in the past decade as a result of increased recognition and understanding of the disease and the aging of the population. New therapies can extend life. MDS are now considered the most common form of leukemia, and in some cases deserve immediate intervention...
January 2010: Cleveland Clinic Journal of Medicine
2015-09-27 18:46:19
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