Resultados quirúrgicos de la herniorrafia inguinal en los pacientes mayores de 80 años: Revisión sistemática y metaanálisis / Surgical outcomes of inguinal herniorrhaphy in patients over 80 yearsof age: Systematic review and meta-analysis

Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.

Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 ­ 0.678), seroma of 8.7% (95% CI 6.212 ­ 11.842), hematoma of 2.6% (95% CI 2.397 ­ 2.893), chronic pain 2.1% (95% CI 0.778 ­ 4.090), recurrence 1.2% (95% CI 0.425 ­ 2.284), and morbidity 14.7% (95% CI 9.525 ­ 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.

Programa de exercícios multicomponentes domiciliar (VIVIFRAIL®) para longevos durante a pandemia da covid-19 / Acceptability of a home-based multicomponent exercise program (Vivifrail®) for the oldest-old via videoconferencing during the Covid-19 pandemic

Resumo Objetivo Investigar a aceitação e adequação de um programa de exercícios multicomponentes por videoconferência para longevos em Porto Alegre (RS), Brasil. Método Estudo Quase experimental. Os participantes realizaram o protocolo de exercícios multicomponentes ViviFrail® durante 12 semanas, com a aceitação e adequação avaliadas semanalmente por videoconferência. O questionário de aceitação e adequação foi baseado em uma escala Likert (de 0 a 4) de seis barreiras que os participantes enfrentam ao fazer exercício físico, com pontuação máxima de 24 pontos (aceitação máxima). Resultados A aceitação foi de 70%, com 14 participantes concluindo o protocolo (89,07±6,30 anos). A consistência interna, (alfa de Cronbach) para o questionário, foi de 70%, considerada moderada. Os participantes mostraram um aumento geral na aceitação dos 17,8±3,51 pontos iniciais, para 22,0±2,94 pontos no final. Quatro (28.6%) necessitaram de adequação no protocolo de exercício. Conclusão O programa de exercícios multicomponente ViviFrail®, com acompanhamento através de videoconferência, foi bem aceito e adequado, podendo ser uma importante ferramenta para a promoção da qualidade de vida, principalmente em longevos com dificuldade de sair de casa, tanto por problemas de mobilidade, quanto por ambientes sociais desfavoráveis (violência urbana e situações sanitárias). O questionário de aceitação e adequação, que necessitou ser criado, foi capaz de detectar barreiras do

Abstract Objective To investigate the acceptability and adequacy of a multicomponent exercise program via videoconferencing for the oldest-old in Porto Alegre, a city in southern Brazil. Method This is a quasi-experimental study. Fourteen participants were enrolled in the multicomponent exercise program Vivifrail® for 12 weeks, 5 days a week, with weekly video calls for assessment of acceptability and adequacy. The acceptability and adequacy questionnaire was based on 6 barriers that older adults face when engaging in physical exercise. Responses were measured using a 5-point Likert scale ranging from 0 to 4 points, with a maximum score of 24 points (maximum acceptability). Results Fourteen participants (89.07±6.30 years) concluded the protocol, with an acceptability rate of 70%. Internal consistency was moderate, with a Cronbach's coefficient alpha of 0.7. Participants showed an overall increase in acceptability and adequacy (from 17.8±3.51 points in the first week to 22.0±2.94 in the 12th week). Four participants (28.6%) required some modification to the exercise protocol. Conclusion The Vivifrail® protocol, together with weekly follow-up via videoconferencing, was well accepted and adequate. It could be an important tool for promoting quality of life, especially in the oldest-old with difficulty leaving home. The acceptability questionnaire was able to detect exercise barriers and suggest possible modifications to the training program and could be presented as a suggestion for the evaluation of intervention protocols in the oldest-old population. Therefore, the Vivifrail® protocol, with weekly follow-up via videoconferencing, could be a new field of intervention for health professionals.

Prevalence of Smartphone Addiction and its Relation with Depression among School-going Adolescents

Background: Smartphone addiction among adolescents is an increasingly recognized problem worldwide. It affects the psychological well-being of an individual. Aim and objective: The current study aimed to assess smartphone addiction’s prevalence and its relation to depression among adolescents. Methods: This cross-sectional study was conducted among 400 school-going adolescents. Smartphone Addiction Scale - Short version (SAS-SV) and Patient Health Questionnaire (PHQ-9) were used to assess the prevalence of smartphone addiction and depression. Data were analyzed using Epi info software for windows (CDC, Atlanta). Statistical significance was set at p < 0.05. Results: The mean age of study participants was 14.4 years (SD=1.5 years). The prevalence of smartphone addiction was 23%, while depression was present among 45% of the study participants. Comparatively higher duration of smartphone use was significantly associated with smartphone addiction. Depression was significantly higher among smartphone addicts (77.2%) as compared to their counterparts (35.4%). Conclusion and Recommendation: The smartphone usage of adolescents, if not monitored, could lead to its addiction and thus increase the risk of depression among them. To prevent smartphone addiction, limiting children’s screen time is recommended. In this regard, parents can play a pivotal role by becoming responsible digital role models for their children.

Healthcare Seeking Behaviour of Hospitalised COVID-19 Patients During Second Wave in Tertiary Care Hospital of Northern India

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people’s perceptions of preventive and curative measures changed. Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients. Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients’ healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview. Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 ± 14.7 years. Self-medication was significantly associated with study subjects’ mortality (p=0.03). Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

Association between phase angle of bioelectrical impedance analysis and nutritional parameters in older adults

INTRODUCTION: Phase angle (PhA) is a Bioelectrical impedance analysis (BIA) parameter representing an indicator of cellular health and has been suggested as a biomarker of nutritional status. OBJECTIVE: To evaluate the association between PhA and nutritional parameters in older adults. METHODS: A cross-sectional study was conducted with community-dwelling older adults. Body mass index (BMI), arm muscle circumference (AMC), calf circumference (CC), body fat percentage (BF%), appendicular skeletal muscle mass (ASMM), serum albumin, mini-nutritional assessment (MNA), and PhA were assessed. Kolmogorov­Smirnov test, Spearman's correlation coefficient, chi-square test, and Poisson regression models were performed. RESULTS: 144 participants were included in the study, and most of them were female, aged ≥80 years, and underweight. Most older adults with lower PhA were women, aged range 80­89 years, and with reduced ASMM (p<0.05). PhA presented a significant correlation with age (r=­0.417; p<0.001), ASMM (r=0.427; p<0.001), AMC (r=0.195; p=0.019) and BF% (r=­0.223; p=0.007). Older adults with lower PhA present reduced ASMM (PR: 1.25; 95%CI: 1.04­1.50), and hypoalbuminemia (PR: 1.50; 95%CI: 1.11­2.03). CONCLUSION: PhA is related to commonly nutritional indicators used in clinical practice and could be an important biomarker of muscle mass reserves in community-living older adults of both sexes.

Cáncer gástrico en octogenarios ¿Es viable una cirugía con intención curativa?

El objetivo de la presente investigación es evaluar la asociación entre la edad octogenaria y la tasa de morbimortalidad posoperatoria y supervivencia a los 5 años en adultos mayores tratados mediante gastrectomía R0 D2 en el Instituto Nacional de Enfermedades Neoplásicas (INEN) durante el periodo 2000-2013. Se realizó un estudio observacional, retrospectivo, analítico de cohorte pareado, que incluye pacientes con diagnóstico de adenocarcinoma gástrico tratados mediante gastrectomía R0 D2 en el INEN durante los años 2000 a 2013. Un grupo compuesto por todos los pacientes octogenarios que cumplieron los criterios de inclusión (92) y otro grupo compuesto por pacientes no octogenarios, con edades entre 50 a 70 años por ser el pico de presentación para esta patología (276). En una proporción 1:3, pareados según sexo, estadio tumoral y tipo de gastrectomía, los cuales constituyen los principales factores que podrían influir en la sobrevida de esta población. Los octogenarios presentaron menor albúmina (p<0,002), menor hemoglobina preoperatoria (p<0,001) y mayor clase ASA (p<0,001). La tasa de mortalidad a 30 días fue mayor en los octogenarios, pero no estadísticamente significativa (4,1% vs 1,4%; p=0,099). La probabilidad acumulada de supervivencia a 5 años fue 56% para octogenarios y 58% para los controles (p=0,763). El estadio clínico ≥ III y complicación posoperatoria grado ≥3 por Clavien Dindo fueron factores asociados de supervivencia. En conclusión, los octogenarios presentan mayor tasa de morbilidad posoperatoria, principalmente de causa respiratoria. Las tasas de mortalidad posoperatoria y supervivencia global no difieren entre octogenarios y no octogenarios con cáncer de estómago tratados mediante gastrectomía R0 D2.

The objective was to evaluate the association between octogenarian age and the rate of postoperative morbidity and mortality and 5-year survival in older adults at the National Institute of Neoplastic Diseases (INEN) during the period 2000-2013. We developed an observational, retrospective, analytical, paired cohort study. It includes patients with gastric adenocarcinoma as diagnosis, treated by R0 D2 gastrectomy at INEN during the period 2000 to 2013. One group included all octogenarian patients who met the inclusion criteria (92) and the other group made up of non-octogenarian patients, aged between 50 to 70 years because it is the age peak for this pathology (276). In a 1:3 ratio, paired according to sex, tumor stage, and type of gastrectomy, which are the main factors that could influence survival in this population. Octogenarians had lower albumin level (p<0.002), lower preoperative hemoglobin (p<0.001) and higher ASA classification (p<0.001). 30 days mortality rate was higher in octogenarians but not statistically significant (4.1% vs 1.4%; p=0.099). The 5-year cumulative survival probability was 56% for octogenarians and 58% for non- octogenarians (p=0.763). Clinical stage ≥ III and postoperative complication grade ≥ 3 by Clavien Dindo scale were predictors of survival. In conclusion, octogenarians have a higher rate of postoperative morbidity, mainly for respiratory causes. Postoperative mortality and overall survival rates do not differ between octogenarians and non-octogenarians with stomach cancer treated by R0 D2 gastrectomy.

Pathogenic characteristics of elderly patients with urinary tract infection / 中华传染病杂志

Objective:To analyze the pathogenic distribution characteristics of elderly inpatients with urinary tract infection (UTI).Methods:Retrospective analysis of the clinical data and pathogen detection of 809 patients with UTI aged ≥60 years admitted to The First Affiliated Hospital of China Medical University from January 2019 to January 2023 was performed.The differences in the pathogen distribution of patients with UTI were compared between groups of 60 to 79 years old and ≥80 years old. The chi-square test was used for statistical analysis.Multivariate logistic regression analysis was used to analyze the risk factors for bacterial production of extended spectrum β lactamase (ESBL).Results:A total of 914 strains of pathogens were isolated from 809 patients, including 584 strains isolated from 60 to 79 years old patients, 330 strains isolated from ≥80 years old patients, and 62 patients had mixed infections with bacteria and fungi. In the group of patients ≥80 years old, there were 144(43.64%) Gram-negative bacteria. Escherichia coli (16.67%(55/330)), Klebsiella pneumoniae (9.70%(32/330)) and Proteus mirabilis (3.03%(10/330)) were the main members in Enterobacteriaceae. Pseudomonas aeruginosa (5.76%(19/330)) and Acinetobacter baumannii (4.55%(15/330)) were main members of non-fermentive bacteria. There were 104 strains (31.52%) of Gram-positive bacteria detected in the group of patients ≥80 years old, mainly Enterococcus faecium (21.21%(70/330)), and 63 strains (19.09%) of fungi were detected, mainly Candida albicans (9.09%(30/330)). Compared with the group of 60 to 79 years old, the detection rate of Escherichia coli was lower ( χ2=35.78, P<0.001), but Enterococcus faecium ( χ2=4.91, P=0.027) and fungi ( χ2=10.03, P=0.002) were higher in the group of patients ≥80 years old. Among the 375 strains of Enterobacteriaceae, 190 strains (50.67%) were ESBL positive, including 127 strains of Escherichia coli, 46 strains of Klebsiella pneumoniae and 17 strains of Proteus mirabilis. Multivariate logistic analysis found that the use of antibiotic before hospitalization (odds ratio ( OR)=18.528, 95% confidence interval (95% CI) 3.893 to 88.171, P<0.001), complicated with pulmonary infection ( OR=4.182, 95% CI 1.387 to 12.611, P=0.011) were independent risk factors for bacterial production of ESBL. Conclusions:The pathogens of elderly patients (aged≥80 years old) with UTI are mainly Gram-negative bacteria, and the detection rates of Enterococcus and fungi are also high. A considerable number of patients have mixed bacterial and fungal infections. The use of antibiotic before hospitalization and complicated with pulmonary infection are independent risk factors for bacterial production of ESBL.

Prognostic accuracy of five common scoring systems for mortality in elderly patients with sepsis / 中国医师杂志

Objective:To assess the prognostic accuracy of five scoring systems for mortality in elderly patients (≥80 years old) with sepsis.Methods:A retrospective study was conducted on elderly patients with sepsis (≥80 years old, meeting Sepsis 3.0 diagnostic criteria) in Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ). The participants were divided into survival and death group according to the 28-day mortality. The baseline data of patients was collected based on the peak of vital signs and laboratory test results within 24 hours after admission to intensive care unit (ICU). Systemic Inflammatory Response Syndrome (SIRS) score, quick Sequential Organ Failure Assessment (qSOFA), Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS) and Oxford Acute Severity of Illness Score (OASIS) were calculated and prognosis was recorded. The accuracy of the above scoring systems in predicting 28-day mortality was calculated, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated and compared.Results:A total of 42 037 hospital records were screened, and 956 sepsis patients (456 males, 47.70%) who were aged ≥80 years and met the Sepsis 3.0 diagnostic criteria within 24 hours of admission to ICU were included. There were 696 patients (72.8%) in the survival group and 260 patients (27.2%) in the death group. There were no significant difference in age, gender, Charlson Comorbidity Index, length of stay before admission to ICU and length of stay in ICU between 2 groups (all P>0.05). The proportion of patients receiving mechanical ventilation and septic shock in the death group were higher comparing with those in the survival group (both P<0.001), and the total length of hospital stay in the survival group was longer than that in the death group ( P<0.001). The proportion of SOFA score≥7, qSOFA score≥2, SIRS score≥2, NEWS score≥8, OASIS score≥42 in the death group was higher than that in the survival group (all P<0.05). The AUC of qSOFA, SOFA, SIRS, NEWS and OASIS in predicting the mortality of elderly sepsis patients were 0.587 (95% CI: 0.556-0.617), 0.694 (95% CI: 0.655-0.732), 0.591 (95% CI: 0.555-0.627), 0.684 (95% CI: 0.646-0.721) and 0.718 (95% CI: 0.681-0.755), respectively. Conclusions:OASIS was superior than qSOFA, SOFA, SIRS and NEWS scores in predicting the mortality of elderly patients with sepsis, but the prognostic accuracy of all above scoring systems for elderly patients with sepsis was insufficient.

Early clinical efficacy of the orthopaedische chirurgie munchen approach to hemiarthroplasty in the treatment of femoral neck fractures in the elderly / 中华骨科杂志

Objective:To investigate the early clinical outcomes of a minimally invasive anterolateral approach (Orthopadische chirurgie munchen, OCM) versus a conventional (posterolateral approach, PLA) hemiarthroplasty in the treatment of senior femoral neck fractures.Methods:A retrospective analysis was performed on 90 elderly patients with femoral neck fractures who received anterolateral and posterolateral approaches for hemiarthroplasty in the Second Affiliated Hospital of Soochow University from December 2019 to June 2021 and were followed up. In the OCM group, there were 45 cases, including 18 males and 27 females, aged 83.33±5.29 years (range, 76-96 years); In the PLA group, there were 45 cases, including 13 males and 32 females, aged 81.87±5.00 years (range, 75-94 years). Postoperative, surgical indices, perioperative bleeding, and soft tissue injury were assessed; pain was assessed using the visual analogue scale (VAS), and hip function was evaluated using the Harris score and the University of California at Los Angeles (UCLA) score.Results:The incision length, postoperative hospital stay, hemoglobin reduction, and occult blood loss were lower in the OCM group than in the PLA group ( P<0.05), but there was no significant difference in intraoperative bleeding and postoperative transfusion rate ( P>0.05). Serum creatine kinase and C-reactive protein levels (232.98±83.70 IU/L and 81.67±48.85 mg/L) were lower in the OCM group than in the PLA group (296.93±124.58 IU/L and 104.79±36.75 mg/L) 1 day after surgery, and the differences were statistically significant ( t=2.86, P=0.005; t=2.54, P=0.013). Postoperative pain was significantly improved in all patients, and VAS scores were lower in the OCM group than in the PLA group at 12 h, 24 h, and 48 h postoperatively ( P<0.05). The time to get out of bed after surgery was 20.73±4.99 h in the OCM group compared with 41.69±13.58 h in the PLA group, with a statistically significant difference ( t=9.71, P<0.001). Harris scores (63.31±6.21 and 75.76±4.91) and UCLA scores (1.84±0.42 and 3.69±0.76) were higher in the OCM group on the day of discharge and at 1 month postoperatively than in the PLA group (52.69±10.01 and 71.33±3.66); (1.62±0.54 and 3.16±0.80) points, all with statistically significant differences ( P<0.05). However, the differences in Harris score and UCLA score between the two groups at 6 months postoperatively were not statistically significant ( P>0.05). There were two cases of intermuscular vein thrombosis in the OCM group, with a complication rate of 4% (2/45), and one case of dislocation in the PLA group, with a complication rate of 2% (1/45), there was no significant difference between the two groups ( P=1.000). Conclusion:The minimally invasive anterolateral approach is a more ideal procedure for elderly patients with femoral neck fractures undergoing hemiarthroplasty. It has the advantages of a short incision, small soft tissue damage, low occult blood loss, early removal from bed, a short postoperative hospital stay, an improvement in pain, and a good early recovery of hip function.

Propensity score matching study of outcomes of elderly patients over 80 years of age with preoperative combined type 2 diabetes mellitus following laparoscopic colorectal cancer resection / 国际外科学杂志

Objective:To investigate the outcome after laparoscopic radical surgery for colorectal cancer in patients over 80 years of age with preoperative combined type 2 diabetes (T2DM).Methods:Clinical data of 919 patients who underwent colorectal cancer laparoscopic resection surgery in Shaanxi Provincial People′s Hospital from January 2015 to January 2019 were retrospectively analyzed. The propensity score matching (PSM) method was used for 1∶1 matching of gender, ASA score, preoperative serum albumin level, body mass index(BMI), preoperative haemoglobin level, clinical tumour pathology TNM staging, tumour location, other medical comorbidities and history of abdominal surgery and finally group of 104 elderly diabetic patients aged ≥80 years with combined T2DM were successfully matched with another 104 non-elderly non-diabetic patients <80 years without combined diabetes group. (1) To compare the differences in operating time, intraoperative bleeding, number of intraoperative blood transfusions, number of lymph nodes dissected, number of ICU treatments, postoperative time to exhaustion and postoperative hospital stay, and postoperative adjuvant chemotherapy between the two groups after matching. (2)To observe the difference in major postoperative complications between the two groups. (3) Patients in both groups were observed for three years post-operative survival rate during the follow-up period. SPSS 25.0 statistical software was used for data analysis. The survival analysis was carried aut by the Kaplan-Meier curve method in parallel and the Log-Rank test.Results:Both groups were balanced in terms of baseline variable after PSM ( P>0.05). There was no difference between the two groups in terms of operative time, intraoperative bleeding, number of intraoperative blood transfusions, number of lymph nodes dissected, or time to postoperative evacuation ( P>0.05). There was a statistically significant difference between two groups in the number of people admitted to the ICU for treatment ( χ2=4.04, P=0.042), and ≥80 years diabetic group was higher. The difference in the incidence of postoperative complications between the two groups was not statistically significant [34.6% (36/104) vs 25.0% (26/104), χ2=2.30, P=0.130]; according to the Clavien-Dindo classification of postoperative complications, the incidence of Clavien-Dindo grade Ⅲ complications in the group ≥80 years with diabetes mellitus were was higher than that in the group <80 years without diabetes [12.5% (13/104) vs 4.8% (5/104), χ2=3.89, P=0.049]. For local surgical complications, the incidence of postoperative anastomotic leak was significantly higher in the ≥80 years diabetic group than in the <80 years non-diabetic group ( χ2=4.70, P=0.030), and the incidence of postoperative wound infection was no statistical significance in the two group. For non-surgical local complications, there was a statistically significant difference in pulmonary infection in the ≥80 years diabetic group compared to the <80 non-diabetic group ( χ2=4.68, P=0.031) and in acute coronary syndrome ( χ2=4.02, P=0.045). Compared with the <80 years non-diabetic group, patients in the ≥80 years diabetic group had significantly longer postoperative hospital stay [(13.3±4.4)d vs (9.2±3.2) d, t=3.41, P=0.019]. The difference in adjuvant chemotherapy after surgery between the two groups was not statistically significant (67.3% vs 76.0%, χ2=1.92, P=0.166). The survival rate at 3 years after surgery was not statistically significant in both groups [68.9% vs 74.2%, χ2=4.34, P=0.085]. Conclusions:The short-term and long-term outcomes of colorectal cancer in advanced age with type 2 diabetes are satisfactory. Adequate preoperative assessment of the patient's physical condition should be carried out, close intraoperative control of blood glucose, and close postoperative monitoring and regulation of blood glucose should be performed, except for patients with severe comorbidities and coexisting diseases that cannot tolerate surgery and advanced tumours that have lost their surgical significance.

Uso ambulatorio de medicamentos potencialmente inapropiados en adultos mayores usuarios de la RAP Metropolitana de ASSE durante 2019 / Potentially inappropriate medication use in older adults assisted as outpatients in ASSE's Metropolitan RAP (Primary Health Care) during 2019 / Uso ambulatorial de medicamentos potencialmente inapropriados em idosos usuários da RAPE Metropolitana da ASSE durante 2019

Introducción: los adultos mayores son una población de riesgo para el desarrollo de reacciones adversas a los medicamentos. Los medicamentos potencialmente inapropiados son aquellos que representan mayores riesgos que beneficios en este grupo etario. Se cuenta con herramientas de apoyo a la prescripción en geriatría que permiten identificar a estos medicamentos y mediante la aplicación de estudios de utilización de medicamentos, podemos describir o analizar el uso de los mismos en una población. Objetivos: reconocer disponibilidad de medicamentos potencialmente inapropiados para adultos mayores en la RAP metropolitana de ASSE durante 2019 y establecer un diagnóstico de situación de consumo de los mismos durante ese año. Método: se realizó un análisis del vademécum institucional mediante la aplicación de los Criterios de Beers 2019 y dos escalas de riesgo anticolinérgico para identificar medicamentos potencialmente inapropiados. Posteriormente se realizó un estudio de utilización de los medicamentos identificados, mediante datos de dispensación de farmacia entre el 1 de enero y 31 de diciembre de 2019. El consumo se expresó en Dosis Diarias Definidas por cada 1000 adultos mayores-año (DHD). Resultados: se identificaron 16 medicamentos potencialmente inapropiados, de los cuales los más usados fueron clonazepam (DHD 69), quetiapina (65,6), alprazolam (DHD 43,7), flunitrazepam (DHD 42,7) y zolpidem (DHD 36,4). Conclusiones: la aplicación de herramientas explícitas facilita la identificación de medicamentos potencialmente inapropiados para adultos mayores y se evidenció un consumo elevado de los mismos durante el año 2019 a expensas de derivados benzodiazepínicos y quetiapina.

Introduction: older adults are at higher risk for developing adverse drug reactions. Potentially inappropriate medications are drugs that have more risks than benefits in this age group. There are a number of tools to support the prescription of medication in geriatrics that allow the identification of these medications, and by applying studies developed on the use of medications we may describe or analyze their impact on a given population. Objectives: to recognize availability of potentially inappropriate medications in older adults in ASSE's Metropolitan RAP during 2019 and to draw conclusions about the current situation in terms of the consumption of this kind of medications. Method: an institutional analysis of medications available in each healthcare provided was conducted through the application of Beers Criteria 2019, and two anticholinergic risk scales were used to identify potentially inappropriate medications. Subsequently, the use of the medications identified was studied by applying pharmacy dispensing data between January 1 and December 31, 2019. Consumption was expressed in defined daily doses every 1000 adults per year (DHD). Results: 16 potentially inappropriate medications were identified, the most widely used of which were clonazepam (DHD 69), quetiapine (65.6), alprazolam (DHD 43.7), flunitrazepam (DHD 42.7) and zolpidem (DHD 36.4). Conclusions: Applying explicit tools makes it easier to identify potentially inappropriate medications for older adults. An increased consumption of these kinds of drugs was noticed during 2019, as a result of benzodiazepine derivatives and quetiapine.

Introdução: os idosos são uma população de risco para o desenvolvimento de reações adversas a medicamentos. Medicamentos potencialmente inapropriados são aqueles que apresentam maiores riscos do que benefícios nessa faixa etária. Existem ferramentas de apoio à prescrição em geriatria que permitem identificar esses medicamentos e, por meio da aplicação de estudos de utilização de medicamentos, descrever ou analisar seu uso em uma população. Objetivos: reconhecer a disponibilidade de medicamentos potencialmente inapropriados para idosos na RAP metropolitana da ASSE durante o ano de 2019 e estabelecer um diagnóstico de consumo durante esse ano. Método: o formulário institucional foi analisado utilizando os Critérios de Beers 2019 e duas escalas de risco anticolinérgico para identificar medicamentos potencialmente inapropriados. Posteriormente, foi realizado um estudo de consumo dos medicamentos identificados, através dos dados de dispensação da farmácia entre 1 de janeiro e 31 de dezembro de 2019. O consumo foi expresso em Doses Diárias Definidas por 1000 idosos-ano (DHD). Resultados: foram identificados 16 medicamentos potencialmente inapropriados, sendo clonazepam (DHD 69), quetiapina (65,6), alprazolam (DHD 43,7), flunitrazepam (DHD 42,7) e zolpidem (DHD 36,4) os mais utilizados Conclusões: a aplicação de ferramentas explícitas facilita a identificação de medicamentos potencialmente inapropriados para idosos; foi observado um alto consumo dos mesmos em detrimento dos derivados benzodiazepínicos e da quetiapina durante o período do estudo.

Comparação da fragilidade em pessoas idosas longevas pelo Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e pela Edmonton Frail Scale (EFS) / Comparison of frailty in oldest-old people using the Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS)

Resumo Objetivo Comparar os escores do Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e da Edmonton Frail Scale (EFS) entre pessoas idosas com 80 anos ou mais de idade que vivem na comunidade, considerando a prevalência e o grau de concordância. Método Trata-se de estudo transversal, aninhado a uma coorte de base populacional. A amostragem na linha de base foi probabilística, por conglomerados, em dois estágios. No primeiro, utilizou-se como unidade amostral o setor censitário. No segundo, definiu-se o número de domicílios segundo a densidade populacional de pessoas idosas. Foram determinados a sensibilidade, a especificidade e os valores preditivos. A estatística Kappa analisou o grau de concordância entre os instrumentos. Resultados Foram avaliadas 92 pessoas idosas longevas. A prevalência do alto risco de vulnerabilidade clínico-funcional, considerado pessoa idosa frágil, foi de 45,7% pelo IVCF-20 e a prevalência de fragilidade pela EFS foi de 44,6%. Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram, respectivamente, 88,23%, 87,80%, 90,0% e 85,71%. A acurácia foi de 88,04%. A estatística Kappa foi 0,759 (p<0,001). Conclusão Os instrumentos IVCF-20 e EFS possuem boa acurácia e concordância forte, quando aplicado em pessoas idosas longevos que vivem na comunidade. A identificação da fragilidade foi superior, quando utilizado o IVCF-20. O resultado indica que os instrumentos avaliados possuem similaridade na prevalência da fragilidade em pessoas idosas longevas comunitárias.

Abstract Objective To compare Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS) scores among community-dwelling older people aged ≥80 years for prevalence and degree of agreement. Method A cross-sectional study nested within a population-based cohort, was conducted. Baseline sampling was probabilistic by two-stage clustering. In the first stage, the census tract was used as the sampling unit. In the second stage, the number of households was defined according to the population density of individuals aged ≥60 years. Sensitivity, specificity and predictive values ​​were determined and Kappa statistics expressed degree of agreement between the instruments. Results 92 oldest-old people were evaluated. The prevalence of high risk of clinical and functional vulnerability on the IVCF, indicating frailty, was 45,7%, whereas the prevalence of frailty using the EFS was 44,6%. Sensitivity, specificity, positive predictive value and negative predictive values were 88,23%, 87,80%, 90,0% and 85,71%, respectively. Accuracy was 88,04% and the Kappa statistic 0.759 (p<0.001). Conclusion The IVCF-20 and EFS instruments showed good accuracy and strong agreement when applied to community-dwelling oldest-old people. The identification of frailty was superior using the IVCF-20. These results show that the instruments detected similar frailty prevalence in community-dwelling oldest-old people.

Análise dos componentes para classificação da Síndrome Metabólica utilizados em idosos: revisão integrativa / Analysis of the components for classifying Metabolic Syndrome used in older people: an integrative review

Resumo Objetivo Analisar os componentes da Síndrome Metabólica (SM) e a racionalidade na adoção dos critérios utilizados para sua classificação em idosos por meio de uma revisão integrativa Método Trata-se de uma revisão integrativa da literatura nos idiomas português, inglês, espanhol e búlgaro com idosos ( idade ≥ 60 anos), nas bases de dados eletrônicas MEDLINE - via PubMed, Embase, Web of Science e Scopus, sem restrição de tempo de publicação e desenho de estudo, no período de agosto 2022 a janeiro de 2023. Utilizaram-se os descritores controlados do Medical Subject Headings (MeSH) e Descritores em Ciências da Saúde (DEcS) "idoso", "idoso 80 ou mais", "síndrome metabólica", "prevalência", "componente" e "critério". Foram excluídos estudos que não tratavam da temática, publicações não disponíveis na íntegra e que não atenderam à pergunta norteadora. Resultados Após a aplicação dos critérios de elegibilidade, dos 1340 estudos encontrados, foram incluídos quatorze estudos na revisão integrativa. Foram identificados sete critérios de avaliação da SM na população idosa e que a maioria dos estudos utilizou dois dos sete critérios, sendo o critério de IDF citado sete vezes nos quatorze artigos escolhidos e o do NCEP - ATP III mencionado oito vezes. Conclusões Embora as buscas tenham reunido diferentes estudos acerca do assunto, foi possível concluir que os critérios que têm sido propostos para a síndrome metabólica precisam ser revisados e terem seus pontos de corte definidos de acordo com a população estudada.

Abstract Objective To analyze the components of Metabolic Syndrome (MetS) and the rationale for adopting the criteria used for its classification in older individuals through an integrative review. Method an integrative review of the literature in Portuguese, English, Spanish and Bulgarian involving older people (age ≥60 years) on the electronic databases MEDLINE - via PubMed, Embase, Web of Science and Scopus, without restriction on publication date or study design, was conducted from August 2022 to January 2023. The Medical Subject Headings (MeSH) and Health Sciences Descriptors (DEcS) controlled descriptors "elderly", "elderly 80 or older", "metabolic syndrome", "prevalence", "component" and "criterion" were used. Studies that were off-topic, unavailable in full and that failed to answer the guiding question were excluded. Results Application of the eligibility criteria led to the retrieval of 1340 studies, of which 14 were included in the integrative review. Seven sets of criteria were identified for evaluating MetS in the older population were identified and most studies used two of these criteria. The IDF criterion was cited 7 times and the NCEP - ATP III criterion 8 times in the 14 article reviewed. Conclusions Although the searches retrieved different studies on the subject, the results suggest the criteria for MetS should be revised, with cut-off points defined according to the population studied.

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient / Uma nova técnica assistida por balão para assegurar a cateterização visceral durante o reparo endovascular, com a técnica de chaminé, de um aneurisma de aorta roto em um paciente centenário

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

Gasto energético de repouso em idosos longevos saudáveis: fatores associados e uso de fórmulas preditivas / Resting energy expenditure in healthy long-lived elderly individuals: associated factors and use of predictive formulas

Introdução: O processo de envelhecimento está associado a uma redução progressiva do gasto energético de repouso (GER). Embora a calorimetria indireta (CI) seja considerada padrão ouro para avaliar o GER, equações matemáticas preditivas são mais comuns na prática clínica. Objetivo: Avaliar a acurácia e a concordância entre o gasto energético de repouso (GER) medido (mGER) e o estimado (pGER), bem como suas associações com composição corporal, força e prática de atividade ou exercício físico, em pessoas idosas longevas saudáveis. Métodos: Estudo transversal com 74 pessoas idosas (45 mulheres e 29 homens), com idade ≥ 80 anos, saudáveis. O GER foi medido por CI (após jejum noturno de 12 horas) e estimado por 11 equações de predição. A composição corporal foi avaliada por impedância bioelétrica (BIA). Avaliou-se a normalidade das variáveis pelo teste Shapiro-Wilk. Os testes t Student e Mann Whitney foram utilizados para comparação das médias e medianas, respectivamente, entre os sexos. A comparação de proporções foi efetuada com auxílio do teste Qui-quadrado. A comparação entre os valores de mGER e pGER foi realizada por meio do teste Wilcoxon. O teste de correlação de Spearman e Pearson foi realizado para comparar associações. Variações de 10% do mGER foram usadas como medida de acurácia. A concordância individual dos GER's foi examinada por tercis e pelo Bland-Altman. Resultados: A mediana de idade foi de 85 anos (82,00 ­ 85,25). O mGER apresentou correlação moderada com todos os pGER (0,30 ≤ | r | < 0,60). Ao considerar os sexos, as correlações foram significativas apenas entre os homens. Todas as equações superestimaram os valores de GER. A menor diferença total entre mGER e pGER foi alcançada pela equação de Mifflin et al. (1990) (237,16 kcal/d), para as mulheres por Porter et al. (2023) (247,43 kcal/d) e para os homens por Anjos et al. (2014) (326,59 kcal/d). A maior acurácia entre as mulheres foi identificada pela equação de Porter et al. (2023) (26,7%), enquanto Anjos et al. (2014) propiciou maior acurácia total e nos homens (23,0% e 20,7%, respectivamente). Essa equação também apresentou melhor concordância individual na classificação por tercis (40,5%). Identificou-se baixa concordância em todas as fórmulas pelos gráficos de Bland-Altman. Houve correlação forte entre o mGER e a massa livre de gordura (r=0,329, p=0,008), a massa gorda em homens (r=607, p=<0,001), e o perímetro da panturrilha para o total (r=0,322, p=0,001) e para os homens (r=0,419, p=0,009). Conclusão: Identificamos a necessidade de cautela ao utilizar equações de estimativa do GER em pessoas idosas longevas, com a equação de Anjos et al. (2014) sendo a menos imprecisa, embora a acurácia geral e a concordância individual sejam limitadas. A composição corporal, em particular PP, MLG e MG, foram influenciadores do GER em pessoas idosas

Introduction: The aging process is associated with a progressive reduction in resting energy expenditure (REE). Although indirect calorimetry (IC) is considered the gold standard for assessing REE, predictive mathematical equations are more commonly used in clinical practice. Objective: To evaluate the accuracy and agreement between measured resting energy expenditure (mREE) and estimated resting energy expenditure (pREE), as well as their associations with body composition, strength, and engagement in physical activity or exercise in healthy long-lived elderly individuals. Methods: Cross-sectional study with 74 elderly individuals (45 women and 29 men) aged ≥ 80 years, who were healthy. REE was measured by IC (after a 12-hour overnight fast) and estimated by 11 prediction equations. Body composition was assessed by bioelectrical impedance analysis. The normality was assessed by the Shapiro-Wilk test. Student's t-tests and Mann-Whitney tests were used for comparing means and medians, respectively, between sexes. Proportion comparisons were made using the chi-square test. Comparison between mREE and pREE values was performed using the Wilcoxon test. Spearman and Pearson correlation was conducted to compare associations. Variations of 10% from mREE were used as an accuracy measure. Individual REE agreement was examined by tertiles and Bland-Altman analysis. Results: The median age was 85 years (82.00 ­ 85.25). The mREE showed moderate correlation with all pREE (0.30 ≤ | r | < 0.60). When considering genders, correlations were significant only among men. All equations overestimated REE values. The smallest total difference between mREE and pREE was achieved by the equation by Mifflin et al. (1990) (237.16 kcal/d), for women by Porter et al. (2023) (247.43 kcal/d), and for men by Anjos et al. (2014) (326.59 kcal/d). The highest accuracy among women was identified by the equation Porter et al. (2023) (26.7%), while Anjos et al. (2014) provided higher accuracy in the total group and men (23.0% and 20.7%, respectively). This equation also showed better individual agreement in tertile classification (40.5%). Low agreement was identified in all formulas by Bland-Altman plots. There was a strong correlation between mREE and lean body mass (r=0.329, p=0.008), fat mass in men (r=0.607, p=<0.001), and calf circumference for the total (r=0.322, p=0.001) and for men (r=0.419, p=0.009). Conclusion: We identified the need for caution when using REE estimation equations in long-lived elderly individuals, with the Anjos et al. (2014) equation being the least inaccurate, although overall accuracy and individual agreement are limited. Body composition, particularly fat-free mass, lean body mass, and fat mass, influenced REE in elderly individuals.

Frailty and physical activity in centenarians: a systematic review

There is a lack of studies evaluating frailty and physical activity in people aged 100 years or older. This review aimed to synthesize the evidence on frailty and physical activity in centenarians. A systematic review was conducted according to the PRISMA guidelines. We searched the PubMed, CINAHL, SCOPUS, Web of Science, and Lilacs databases for articles published until 18 June 2020. This review was registered with PROSPERO (CRD42020162913). Five studies were included in this review according to the eligibility and exclusion criteria. In summary, the reviewed studies show that centenarians are fragile and that frailty increases with age; however, women are frailer than men. The most common frailty criteria were low physical activity level (78% to 72.5%), muscle weakness (84.2% to 66%), and slow walking speed (77.6% to 48.4%). Most centenarians perform less exercise than younger older adults, have a low physical activity level, live in nursing homes, and exhibit functional disability. Regarding the methodological quality of the studies, one article was classified as regular and the other four as poor. Frailty and a low physical activity level are common in centenarians. Experimental studies with better methodological quality are necessary to better understand the causal relationship between variables.

Terapia Trombolítica em Octogenários com Embolia Pulmonar Aguda / Thrombolytic Therapy in Octogenarians with Acute Pulmonary Embolism

Resumo Fundamento Apesar da grande proporção de octogenários com embolia pulmonar aguda, há pouca informação indicando a estratégia de manejo ideal, especialmente medidas terapêuticas, como a terapia lítica. Objetivos O número de pacientes idosos diagnosticados com embolia pulmonar aguda aumenta constantemente. Porém, o papel do tratamento trombolítico não está claramente definido entre os octogenários. Nosso objetivo é avaliar a efetividade da terapia lítica em pacientes octogenários diagnosticados com embolia pulmonar. Métodos Cento e quarenta e oito indivíduos (70,3% de mulheres, n=104) com mais de 80 anos foram incluídos no estudo. Os pacientes foram divididos em dois grupos: tratamento trombolítico versus não-trombolítico. As taxas de mortalidade hospitalar e episódios de sangramento foram definidos como desfechos do estudo. Valor de p <0,05 foi considerado como estatisticamente significativo. Resultados A mortalidade hospitalar reduziu significativamente no grupo trombolítico em comparação ao não-trombolítico (10,5% vs. 24,2%; p=0,03). Episódios de sangramento menores foram mais comuns no braço que recebeu o tratamento trombolítico, mas grandes hemorragias não diferiram entre os grupos (35,1% vs. 13,2%, p<0,01; 7% vs. 5,5% p=0,71, respectivamente). O escore de PESI alto (OR: 1,03 IC95%; 1,01-1,04 p<0,01), a terapia trombolítica (OR: 0,15 IC95%; 0,01-0,25, p< 0,01) e níveis altos de troponina (OR: 1,20 IC95%; 1,01-1,43, p=0,03) estiveram independentemente associados a taxas de mortalidade hospitalar na análise de regressão multivariada. Conclusão A terapia trombolítica esteve associada à mortalidade hospitalar reduzida em detrimento do aumento geral das complicações de sangramento em octogenários.

Abstract Background Despite the high proportion of octogenarians with acute pulmonary embolism, there is little information indicating the optimal management strategy, mainly therapeutic measures, such as lytic therapy. Objectives The number of elderly patients diagnosed with acute pulmonary embolism increases constantly. However, the role of thrombolytic treatment is not clearly defined among octogenarians. Our objective is to evaluate the effectiveness of lytic therapy in octogenarian patients diagnosed with pulmonary embolism. Methods One hundred and forty eight subjects (70.3% women, n=104) aged more than eighty years were included in the study. The patients were divided in two groups: thrombolytic versus non-thrombolytic treatment. In-hospital mortality rates and bleeding events were defined as study outcomes. P-value <0.05 was considered as statistical significance. Results In-hospital mortality decreased significantly in the thrombolytic group compared to the non-thrombolytic group (10.5% vs. 24.2% p=0.03). Minor bleeding events were more common in the arm that received thrombolytic treatment, but major hemorrhage did not differ between the groups (35.1% vs. 13.2%, p<0.01; 7% vs. 5.5% p=0.71, respectively). High PESI score (OR: 1.03 95%CI; 1.01-1.04 p<0.01), thrombolytic therapy (OR: 0.15 95%CI; 0.01-0.25, p< 0.01) and high troponin levels (OR: 1.20 95%CI; 1.01-1.43, p=0.03) were independently associated with in-hospital mortality rates in the multivariate regression analysis. Conclusion Thrombolytic therapy was associated with reduced in-hospital mortality at the expense of increased overall bleeding complications in octogenarians.

Centenarian caregivers: perception of burden, sociodemographic data and physical activity

This study aimed to understand centenarian caregivers' perception of care burden according to sociodemographic characteristics and physical activity level. This is a descriptive study that used a mixed data (quantitative and qualitative) approach. Sixty-seven caregivers of centenarians from municipalities in Santa Catarina participated in this study. Interviews were held for application of questions about sociodemographic data, transport-related and leisure-time physical activity, caregiver burden, and suggestions for improving care. The data were collected in the centenarian's home where the caregiver worked. Quantitative data were analyzed using descriptive and inferential statistics and qualitative data by content analysis. The results showed that 58.2% of the caregivers were overburdened. Of these, 92.3% were females, 56.4% were 60-75 years old, 48.7% had 7 to 11 years of schooling, 53.8% were married, 66.7% were children of centenarians, the caregiving duration ranged from 1 to 5 years in 35.9%, and 69.2% cared for the older adult 24 hours/day. There was a statistically significant difference (p = 0.01) between the level of leisure-time physical activity and caregiving burden, with 64.9% of insufficiently active caregivers tending to be overburdened with the care demand. The suggestions of caregivers for improving centenarian care included having help from health professionals and relatives for care, infrastructure, and financial resources. Most burdened caregivers are insufficiently active and need assistance in taking care of their own health.

Analysis of clinical data of lower limbs deep vein thrombosis in inpatients with advanced age in internal medicine / 中华老年医学杂志

Objective:To analyze the treatment and prognosis of advanced age inpatients in Medical Department with lower limbs deep venous thrombosis(DVT).Methods:This was a retrospective study of elderly medical inpatients with DVT, including 58 males(54.7%)and 48 females(45.3%), aged from 80 to 99 years old, in Geriatric Medicine of Peking University Third Hospital from March 2016 to March 2019.There were 91 patients(85.9%)with DVT alone and 15 patients(15.2%)with pulmonary embolism.The clinical data of patients were analyzed, and treatment and prognosis within half a year after discharge were followed-up.Results:A total of 106 elderly medical patients were included, the ratio of male to female was 1.2∶1.0, the age range was 80-99 years old, the median age was 86 years old.Of a total of 106 DVT patients, forty-five cases(42.5%)developed symptoms, sixty-one cases(57.6%)were asymptomatic.Twenty-eight cases(26.4%)involved the proximal lower limb deep veins(popliteal veins and above), seventy-eight cases(73.6%)only involved distal deep veins.Except for advanced age, other DVT risk factors included sixty cases(56.6%)of lung infection, 58 cases(54.7%)being bedridden(>3 d), 50 cases(47.2%)of type 2 diabetes, 46 cases(43.4%)of cerebral infarction, 37 cases(34.9%)of heart failure, and 28 cases(26.4%)of active malignancies, etc.Of a total of 106 DVT patients, 80 cases(75.5%)had high risk of venous thrombosis score, and 68 cases(64.2%)had high risk of bleeding.74 cases received anticoagulant treatment, the rate of anticoagulant treatment was 69.8%.Compared with anticoagulant patients, non-anticoagulant group showed that renal insufficiency, being bedridden, heart failure, cerebral infarction prevalence, and all-cause mortality were increased( P<0.05 or P<0.01).The rate of high risk of bleeding was significantly higher in the non-anticoagulation group than in the anticoagulation group( P<0.01).The pulmonary embolism rate, proximal deep vein involvement rate and their improvement rate when timely rechecking were significantly higher in anticoagulation group than in non-anticoagulation group( P<0.05 or P<0.01, respectively).In the anticoagulation group, 26 patients received short term low-molecular heparin(LMH)treatment during hospitalization, 48 patients(45.3%)were prescribed oral anticoagulants at the time of discharge.Anticoagulation treatment rate is 31.1%(33 cases)at 3 months and 24.5%(26 cases)at 6 months.Non-fatal bleeding occurred in 4 patients in anticoagulation group, but there was no significant difference between the two groups( P>0.05). Conclusions:Great attention should be paid to the risk factors such as lung infection, being bedridden, cerebral infarction, and malignant tumor in the elderly medical inpatients.The rate of high risk of bleeding was high in elderly inpatients, and the rate of regular anticoagulant treatment is low.The risk versus benefit of anticoagulant therapy should be comprehensively evaluated, and individualized therapy should be given.