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de la Merced Díaz-González C, Pérez-Bello C, De la Rosa-Hormiga M, González-Henríquez JJ, de las Mercedes Reyes-Noha M. Hospital Environmental Factors That Influence Peripheral Oxygen Saturation Measurements: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:940. [PMID: 38727497 PMCID: PMC11083166 DOI: 10.3390/healthcare12090940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Pulse oximetry is a non-invasive, cost-effective, and generally reliable instrument measuring pulse rate and peripheral oxygen saturation (SpO2). However, these measurements can be affected by the patient's internal or external factors, including the type of pulse oximeter device (POD). (1) This study's objective was to identify potential environmental factors that may impact the measurements taken by three PODs. (2) Methods: A descriptive-analytical cross-sectional study was designed. The patients' SpO2 levels were measured using a standard monitor and two PODs owned by the professionals. The measurements were taken on the patients' fingers. Concurrently, we evaluated the surrounding environmental conditions, encompassing temperature, humidity, illuminance, and noise. (3) Results: This study involved 288 adult participants in the sample. For each 20-decibel increment in noise, there was a reduction in SpO2 by an average of 1%, whereas for every additional degree of ambient temperature, SpO2 decreased by an average of 2% (4) Conclusions: Significant correlations between SpO2 and age, as well as with noise and ambient temperature, were observed. No significant differences between oxygen saturation and lighting or humidity were observed. This study was prospectively registered with the Clinical Research Ethics Committee of Gran Canaria at the Dr. Negrín University Hospital, with protocol code 2019-247-1, and approved on 24 May 2019.
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Affiliation(s)
- Candelaria de la Merced Díaz-González
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
| | - Cristina Pérez-Bello
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
- Hospital Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Milagros De la Rosa-Hormiga
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
| | - Juan José González-Henríquez
- Department of Mathematics, Faculty of Mathematics, University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Canary Islands, Spain;
| | - María de las Mercedes Reyes-Noha
- Continuous Training Department, Primary Care Management, Gran Canaria Health Area, 35006 Las Palmas de Gran Canaria, Canary Islands, Spain;
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P16INK4A—More Than a Senescence Marker. Life (Basel) 2022; 12:life12091332. [PMID: 36143369 PMCID: PMC9501954 DOI: 10.3390/life12091332] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Aging is a biological feature that is characterized by gradual degeneration of function in cells, tissues, organs, or an intact organism due to the accumulation of environmental factors and stresses with time. Several factors have been attributed to aging such as oxidative stress and augmented production or exposure to reactive oxygen species, inflammatory cytokines production, telomere shortening, DNA damage, and, importantly, the deposit of senescent cells. These are irreversibly mitotically inactive, yet metabolically active cells. The reason underlying their senescence lies within the extrinsic and the intrinsic arms. The extrinsic arm is mainly characterized by the expression and the secretory profile known as the senescence-associated secretory phenotype (SASP). The intrinsic arm results from the impact of several genes meant to regulate the cell cycle, such as tumor suppressor genes. P16INK4A is a tumor suppressor and cell cycle regulator that has been linked to aging and senescence. Extensive research has revealed that p16 expression is significantly increased in senescent cells, as well as during natural aging or age-related pathologies. Based on this fact, p16 is considered as a specific biomarker for detecting senescent cells and aging. Other studies have found that p16 is not only a senescence marker, but also a protein with many functions outside of senescence and aging. In this paper, we discuss and shed light on several studies that show the different functions of p16 and provide insights in its role in several biological processes besides senescence and aging.
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Home-Based Pulmonary Rehabilitation in Aged Individuals With Lung Tumor After Thoracoscopic Surgery. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dynamic Spatiotemporal Expression Pattern of the Senescence-Associated Factor p16Ink4a in Development and Aging. Cells 2022; 11:cells11030541. [PMID: 35159350 PMCID: PMC8833900 DOI: 10.3390/cells11030541] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
A plethora of factors have been attributed to underly aging, including oxidative stress, telomere shortening and cellular senescence. Several studies have shown a significant role of the cyclin-dependent kinase inhibitor p16ink4a in senescence and aging. However, its expression in development has been less well documented. Therefore, to further clarify a potential role of p16 in development and aging, we conducted a developmental expression study of p16, as well as of p19ARF and p21, and investigated their expression on the RNA level in brain, heart, liver, and kidney of mice at embryonic, postnatal, adult, and old ages. P16 expression was further assessed on the protein level by immunohistochemistry. Expression of p16 was highly dynamic in all organs in embryonic and postnatal stages and increased dramatically in old mice. Expression of p19 and p21 was less variable and increased to a moderate extent at old age. In addition, we observed a predominant expression of p16 mRNA and protein in liver endothelial cells versus non-endothelial cells of old mice, which suggests a functional role specifically in liver endothelium of old subjects. Thus, p16 dynamic spatiotemporal expression might implicate p16 in developmental and physiological processes in addition to its well-known function in the build-up of senescence.
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Tapper CX, Curseen K. Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 1. Crit Care Clin 2020; 37:117-134. [PMID: 33190765 DOI: 10.1016/j.ccc.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Elderly patients who are critically ill have unique challenges that must be considered when attempting to prognosticate survival and determine expectations for physical rehabilitation and meaningful recovery. Furthermore, frail elderly patients present unique rehabilitation and clinical challenges when suffering from critical illness. There are multiple symptoms and syndromes that affect morbidity and mortality of elderly patients who require intensive care unit management including delirium, dementia, pain, and constipation. Rehabilitation goals should be based on patient values, clinical course, and functional status. Patients and families need accurate prognostic information to choose the appropriate level of care needed after critical illness.
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Affiliation(s)
- Corey X Tapper
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 8021, Baltimore, MD 21287, USA.
| | - Kimberly Curseen
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Supportive and Palliative Care Outpatient Services, Emory Healthcare, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA
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Comparison of Postoperative Acute Kidney Injury Between Laparoscopic and Laparotomy Procedures in Elderly Patients Undergoing Colorectal Surgery. Surg Laparosc Endosc Percutan Tech 2020; 31:160-164. [PMID: 32890248 DOI: 10.1097/sle.0000000000000858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Postoperative acute kidney injury (AKI) has an unfavorable impact on both short-term and long-term outcomes. The aim of this retrospective study was to compare the incidence of postoperative AKI between laparoscopic and laparotomy procedures in elderly patients undergoing colorectal surgery. METHODS Medical records of elderly (65 y and older) patients who underwent colorectal cancer surgery between May 2016 and July 2018 at our tertiary hospital were reviewed. Patients with Union Internationale Contre le Cancer (UICC) stage II and III colorectal cancer, without neoadjuvant treatment, were divided into laparoscopic procedure group and laparotomy group. AKI, determined by the Acute Kidney Injury Network criteria, was compared between the 2 groups, before and after propensity matching. Multivariable analysis was made to identify independent risk factors of AKI. RESULTS In all, 285 patients met the study inclusion criteria. Postoperative AKI occurred only in 16 patients from the laparotomy group (n=212). The incidence of AKI was significantly lower in the laparoscopic procedure group (n=73) compared with the laparotomy group (0% vs. 7.5%; P=0.015). Seventy-three patients who underwent laparoscopic surgery were matched with 73 of 212 patients who underwent open surgery, by using propensity score analysis, and the incidence of AKI in the 2 groups was similar (0% vs. 8.3%; P=0.028). Multivariable analysis showed that intraoperative metaraminol dose >1 mg (odds ratio=2.742, P=0.042) is an independent risk factor for postoperative AKI. CONCLUSION In elderly patients, the incidence of AKI after colorectal cancer surgery is lower in the laparoscopic procedure group, maybe related to hemodynamic stability and less vasoconstriction.
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Abstract
The older population is expected to nearly double across the globe by 2050, and the baby boom cohort is expected to represent at least 20% of the US population by 2030. Geriatric patients will increasingly utilize the health-care system, and therefore surgical and perioperative care must be tailored to this sensitive group given the increased risk for perioperative complications. The literature was reviewed to highlight fundamental components of the preoperative evaluation as well as cardiac, pulmonary, and renal complications. Frailty is a multidimensional process that can lead to the physiologic effects of aging and estimates the risk of perioperative morbidity and mortality better than chronologic age alone. Health-care providers should assess a geriatric patient's cognitive status, decision-making capacity, frailty, advance care planning, medications, and anesthetic approach in a multidisciplinary fashion to ensure optimal care. The risks of postoperative cardiac, pulmonary, and renal complications should be evaluated and optimized preoperatively to reduce the potential for adverse outcomes.
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Affiliation(s)
- Aditya P Devalapalli
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Deanne T Kashiwagi
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Rommens PM. Paradigm shift in geriatric fracture treatment. Eur J Trauma Emerg Surg 2019; 45:181-189. [PMID: 30725152 DOI: 10.1007/s00068-019-01080-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/30/2019] [Indexed: 01/16/2023]
Abstract
The number of geriatric patients is increasing. These patients exhibit specific characteristics, which influence the type of fracture care. Many patients have comorbidities, which make them more vulnerable to surgical procedures. The soft tissue envelope around the fracture often is compromised due to pre-existing diseases such as diabetes, chronic venous insufficiency or peripheral vascular disease. Bone mineral density has decreased, which enhances the risk of implant loosening. The goals of treatment differ from those, which are valid for younger adults. Primary goal is preserving independency of the elderly patient in his activities of daily life. Advantages and drawbacks of surgical procedures have to be balanced with those of conservative treatment. Fractures of the lower extremities will more often need surgical treatment than fractures of the upper extremities. Patient´s autonomy is best obtained by creating high stability in the fracture plane, which enables motion and weight-bearing. Second priority is prevention of general and local post-operative complications by the use of less invasive surgical procedures. Restoring anatomy and optimal function are less important goals. The implants, which are used, are inserted through small incisions, placed deep under the skin and use long anatomic or osseous corridors. Intramedullary devices have important advantages. This paradigm shift takes the special challenges and requirements of geriatric patients into account.
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Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany.
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Lusczek ER, Myers C, Popovsky K, Mulier K, Beilman G, Sawyer R. Plasma metabolomics pilot study suggests age and sex-based differences in the metabolic response to traumatic injury. Injury 2018; 49:2178-2185. [PMID: 30266291 DOI: 10.1016/j.injury.2018.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/15/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Age and sex affect outcomes from trauma. Older patients tend to be under-triaged, consume more healthcare resources, and experience worse outcomes relative to younger patients. Sex has also been associated with different outcomes, with women experiencing better outcomes than men. While baseline metabolism differs with both age and sex, no study has examined how these differences affect the response to trauma. We used high-throughput metabolomics to assess metabolic differences associated with blunt trauma according to age and sex. METHODS Metabolic profiles were constructed using nuclear magnetic resonance spectroscopy for trauma patients age 21-40 years (n = 20, 55% male) and >65 years (n = 22, 41% male) from plasma samples obtained on Day 1 and Day 3 of each patient's hospital stay. These were compared to profiles constructed from plasma obtained from healthy controls of the same age (21-40: n = 23, 61% male; 65+: n = 26, 50% male). Differences in metabolic profiles were assessed with partial least squares discriminant analysis. RESULTS Trauma elicits an overwhelming global stress response that includes more subtle differences in metabolism related to age and gender. Significant differences due to normal aging were also identified. Many of the metabolites measured were present in similar levels in healthy controls age 65+ as they were in trauma patients of all ages. Sex-based differences in metabolism were observed in younger trauma patients on Day 3 but not in older patients. CONCLUSIONS Differences in energy metabolism and oxidative stress were implicated in the response to trauma in all patients. Older trauma patients may enter the trauma state with pre-existing oxidative stress and energy deficits that complicate recovery. Sex-based differences in recovery from trauma support the large body of work demonstrating the role of sex in recovery from trauma.
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Affiliation(s)
- Elizabeth R Lusczek
- University of Minnesota Department of Surgery, Minneapolis, MN 55455 United States.
| | - Cole Myers
- University of Minnesota Department of Surgery, Minneapolis, MN 55455 United States.
| | - Kimberly Popovsky
- University of Virginia Department of Surgery, Charlottesville, VA 22903 United States.
| | - Kristine Mulier
- University of Minnesota Department of Surgery, Minneapolis, MN 55455 United States.
| | - Greg Beilman
- University of Minnesota Department of Surgery, Minneapolis, MN 55455 United States.
| | - Robert Sawyer
- Western Michigan University School of Medicine, Department of Surgery, Kalamazoo, MI 49008 United States.
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Dalton A, Zafirova Z. Preoperative Management of the Geriatric Patient: Frailty and Cognitive Impairment Assessment. Anesthesiol Clin 2018; 36:599-614. [PMID: 30390781 DOI: 10.1016/j.anclin.2018.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As the population ages, more geriatric patients will be presenting for surgical procedures. Preoperative evaluation seeks to assess patients for geriatric syndromes: frailty, sarcopenia, functional dependence, and malnutrition. Age-related changes in physiology increase risk for central nervous system, cardiovascular, pulmonary, renal, hepatic, and endocrine morbidity and mortality. Identification of various comorbidities allows for preoperative optimization and for opportunities for intervention including nutritional supplementation and prehabilitation, which may improve postoperative outcomes.
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Affiliation(s)
- Allison Dalton
- Department of Anesthesia and Critical Care, University of Chicago, 5041 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA.
| | - Zdravka Zafirova
- Section Critical Care, Department of Cardiovascular Surgery, Mount Sinai Hospital System, Icahn School of Medicine, Mount Sinai Medical Center, Box 1028, 1 Gustave L. Levy Place, New York, NY 10029, USA
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Talaminos Barroso A, Márquez Martín E, Roa Romero LM, Ortega Ruiz F. Factors Affecting Lung Function: A Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Talaminos Barroso A, Márquez Martín E, Roa Romero LM, Ortega Ruiz F. Factors Affecting Lung Function: A Review of the Literature. Arch Bronconeumol 2018; 54:327-332. [PMID: 29496283 DOI: 10.1016/j.arbres.2018.01.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
Lung function reference values are traditionally based on anthropometric factors, such as weight, height, sex, and age. FVC and FEV1 decline with age, while volumes and capacities, such as RV and FRC, increase. TLC, VC, RV, FVC and FEV1 are affected by height, since they are proportional to body size. This means that a tall individual will experience greater decrease in lung volumes as they get older. Some variables, such as FRC and ERV, decline exponentially with an increase in weight, to the extent that tidal volume in morbidly obese patients can be close to that of RV. Men have longer airways than women, causing greater specific resistance in the respiratory tract. The increased work of breathing to increase ventilation among women means that their consumption of oxygen is higher than men under similar conditions of physical intensity. Lung volumes are higher when the subject is standing than in other positions. DLCO is significantly higher in supine positions than in sitting or standing positions, but the difference between sitting and standing positions is not significant. Anthropometric characteristics are insufficient to explain differences in lung function between different ethnic groups, underlining the importance of considering other factors in addition to the conventional anthropometric measurements.
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Affiliation(s)
| | - Eduardo Márquez Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Laura María Roa Romero
- Departamento de Ingeniería Biomédica, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, España
| | - Francisco Ortega Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, España.
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Abstract
The doubling of the geriatric population over the next 20 years will challenge the existing health care system. Optimal care of geriatric trauma patients will be of paramount importance to the health care discussion in America. These patients warrant special consideration because of altered anatomy, physiology, and the resultant decreased ability to tolerate the stresses imposed by traumatic insult. Despite increased risk for worsened outcomes, nearly half of all geriatric trauma patients will be cared for at nondesignated trauma centers. Effective communication is crucial in determining goals of care and arriving at what patients would consider a meaningful outcome.
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Affiliation(s)
- Steven E Brooks
- Geriatric Trauma Unit, Division of Trauma, Surgical Critical Care, Acute Care Surgery, Department of Surgery, John A. Griswold Trauma Center, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA; Pediatric Intensive Care Unit, Division of Trauma, Surgical Critical Care, Acute Care Surgery, Department of Surgery, John A. Griswold Trauma Center, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA.
| | - Allan B Peetz
- Emergency General Surgery, Division of Trauma, Surgical Critical Care, Vanderbilt University Medical Center, Medical Arts Building Suite 404, 1211 21st Avenue South, Nashville, TN 37212, USA
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Obstructive sleep apnea does not impair cardiorespiratory responses to progressive exercise performed until exhaustion in hypertensive elderly. Sleep Breath 2017; 22:431-437. [DOI: 10.1007/s11325-017-1557-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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Peterss S, Mansour AM, Zafar MA, Thombre K, Rizzo JA, Ziganshin BA, Darr UM, Elefteriades JA. Elective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off?†. Eur J Cardiothorac Surg 2017; 51:965-970. [DOI: 10.1093/ejcts/ezw437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
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Abstract
Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered.
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Affiliation(s)
- Casper Reske-Nielsen
- Emergency Medicine, Boston Medical Center, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Ron Medzon
- Emergency Medicine, Boston Medical Center, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA.
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Lamster IB, Asadourian L, Del Carmen T, Friedman PK. The aging mouth: differentiating normal aging from disease. Periodontol 2000 2016; 72:96-107. [DOI: 10.1111/prd.12131] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/02/2023]
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Kenny GP, Groeller H, McGinn R, Flouris AD. Age, human performance, and physical employment standards. Appl Physiol Nutr Metab 2016; 41:S92-S107. [DOI: 10.1139/apnm-2015-0483] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The proportion of older workers has increased substantially in recent years, with over 25% of the Canadian labour force aged ≥55 years. Along with chronological age comes age-related declines in functional capacity associated with impairments to the cardiorespiratory and muscular systems. As a result, older workers are reported to exhibit reductions in work output and in the ability to perform and/or sustain the required effort when performing work tasks. However, research has presented some conflicting views on the consequences of aging in the workforce, as physically demanding occupations can be associated with improved or maintained physical function. Furthermore, the current methods for evaluating physical function in older workers often lack specificity and relevance to the actual work tasks, leading to an underestimation of physical capacity in the older worker. Nevertheless, industry often lacks the appropriate information and/or tools to accommodate the aging workforce, particularly in the context of physical employment standards. Ultimately, if appropriate workplace strategies and work performance standards are adopted to optimize the strengths and protect against the vulnerability of the aging workers, they can perform as effectively as their younger counterparts. Our aim in this review is to evaluate the impact of different individual (including physiological decline, chronic disease, lifestyle, and physical activity) and occupational (including shift work, sleep deprivation, and cold/heat exposure) factors on the physical decline of older workers, and therefore the risk of work-related injuries or illness.
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Affiliation(s)
- Glen P. Kenny
- Human Environmental Physiological Research Unit, Faculty of Health Sciences, University of Ottawa, ON K1N 6N5, Canada
| | - Herbert Groeller
- Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Ryan McGinn
- Human Environmental Physiological Research Unit, Faculty of Health Sciences, University of Ottawa, ON K1N 6N5, Canada
| | - Andreas D. Flouris
- Human Environmental Physiological Research Unit, Faculty of Health Sciences, University of Ottawa, ON K1N 6N5, Canada
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
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Britton D. The Impact of Aging and Progressive Neurological Disease on Swallowing: A Concise Overview. J Texture Stud 2016. [DOI: 10.1111/jtxs.12189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Deanna Britton
- Department of Speech & Hearing Sciences; Portland State University (PSU); P.O. Box 751 Portland OR
- NW Center for Voice & Swallowing; Department of Otolaryngology - Head & Neck Surgery; Oregon Health & Sciences University; Portland OR
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Khashan M, Lidar Z, Salame K, Mangel L, Lador R, Drexler M, Sapirstein E, Regev GJ. Minimally Invasive Spinal Decompression in Patients Older Than 75 Years of Age: Perioperative Risks, Complications, and Clinical Outcomes Compared with Patients Younger Than 45 Years of Age. World Neurosurg 2016; 89:337-42. [PMID: 26875656 DOI: 10.1016/j.wneu.2016.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Minimally invasive spinal decompression for the treatment of spinal stenosis or disk herniation is often indicated if conservative management fails. However, the influence of old age on the risk of postoperative complications and clinical outcome is not well understood. We therefore sought to compare complication rates and outcomes after minimally invasive surgery decompression and discectomy in elderly patients with a cohort of younger patients undergoing similar procedures. METHODS We evaluated medical records of 61 patients older than 75 years and 69 patients younger than 45 years that underwent minimally invasive lumbar decompression between April 2009 and July 2013 at our institute. Medical history, American Society of Anesthesiologists score, perioperative mortality, complications, and revision surgery rates were analyzed. Patient outcomes included visual analog scale and EuroQol-5 Dimension scores. RESULTS The average age was 78.66 ± 4.42 years in the elderly group and 33.59 ± 6.7 years in the younger group. No major postoperative complications were recorded in either group, and all recruited patients were still alive at the time of the last follow-up. No statistically significant difference existed in the surgical revision rate between the groups. Both groups showed significant improvement in their outcome scores after surgery. CONCLUSIONS Our results indicate that minimally invasive decompressive surgery is a safe and effective treatment for elderly patients and does not pose an increased risk of complications. Future prospective studies are necessary to validate the specific advantages of the minimally invasive techniques in the elderly population.
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Affiliation(s)
- Morsi Khashan
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Zvi Lidar
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Khalil Salame
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Laurence Mangel
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Lador
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michael Drexler
- Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eilat Sapirstein
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad J Regev
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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22
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Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg 2015; 103:e52-61. [PMID: 26620724 DOI: 10.1002/bjs.10044] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. METHODS This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. RESULTS The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. CONCLUSION Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.
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Affiliation(s)
- K F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - T Veen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
The impact of localized prostate cancer in the elderly depends on disease aggressiveness and life expectancy. In men with localized prostate cancer, those with low-risk disease or a shorter life expectancy should be managed expectantly, whereas those with long life expectancy or more aggressive disease may benefit from curative treatment. Comorbidity and quality-of-life concerns are key considerations during the selection of therapeutic modalities in the elderly in localized and metastatic settings. A variety of new agents have changed the therapeutic landscape in castrate-resistant prostate cancer, but their benefits need to be considered alongside their side effects and cost.
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Affiliation(s)
- Kae Jack Tay
- Division of Urology, Duke University Medical Center, DUMC Box 103861, Durham, NC 27710, USA
| | - Judd W Moul
- Division of Urology, Duke University Medical Center, DUMC Box 103861, Durham, NC 27710, USA
| | - Andrew J Armstrong
- Department of Medical Oncology, Duke University Medical Center, DUMC Box 103861, Durham, NC 27710, USA.
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