Predictors of Catastrophic Outcome after Endovascular Thrombectomy in Elderly Patients with Acute Anterior Circulation Stroke

Study on factors affecting mortality in nonagenarian patients in orthopaedic surgery

Background: With medicine advancing, population is aging in the world. We encounter elderly patients in operating rooms more often. In this study, the aim was to investigate mortality and morbidity rates of patients 90 years of age or older within 1 year from the date of operation due to fractures.Methods: The study was performed retrospectively in the 3rd stage health institution. All patients that had fracture operation in the operating rooms of the orthopaedics department between 2011 and 2017 and that were 90 years or older on the day of operation were included in the study. Patients who were operated twice were excluded from the study.Results: Around 83 patients of which were included in the study. The mean age of the patients was 92.89±2.84. In-hospital mortality rate was 8.4%. The mortality rate within 3 months from the operation was 18.1%, 25.3% within 1 year, and 61.4% within 5 years or above. Author found that the mean survival period for the total of the surviving patients was 23.87±18.96 months. Author found that there was a meaningful causation between morbidity developing post-operation and in-hospital mortality, 3-month mortality, and 1-year mortality (p<0.05).Conclusions: Author think that it was important to recognize the fact that despite being more vulnerable, patients 90 years of age or older have a significant life expectancy post-hospital discharge. Author think that post-operation acute morbidity affects mortality rates and it was important to avoid factors that may cause acute morbidity in patients 90 years of age and older.

Impacto da autopercepção de saúde em longevos com incontinência urinária / Impact of self-perceived health on long-lived subjects with urinary incontinence

OBJETIVOS: Verificar o impacto da autopercepção de saúde sobre a chance de desenvolver incontinência urinária em longevos. MÉTODOS: Trata-se de um estudo transversal e analítico com idosos de 90 anos ou mais. Foi realizada análise estatística analítica e descritiva (frequências, média e desvio padrão, análise de regressão logística univariada e ajustada pela autopercepção de saúde) das variáveis sociodemográficas e clínicas (sexo, estado conjugal, continência, idade, sintomas depressivos, cognição, comorbidades e facilidade de realizar atividades básicas e funcionais). RESULTADOS: Participaram 182 longevos, 71% mulheres. O diagnóstico prévio de depressão, o escore de sintomas depressivos e o percentual de facilidade para atividades funcionais e básicas foram relacionados com a autopercepção de saúde (p<0,05). A perda de urina, contudo, não foi relacionada à autopercepção de saúde. A autopercepção de saúde influenciou o efeito das variáveis diagnóstico prévio de depressão, número de sintomas depressivos, pontuação do Mini Exame do Estado Mental e número de comorbidades sobre a chance de incontinência urinária na presença das mesmas. O sexo masculino, a viuvez e a facilidade no desempenho de atividades básicas e funcionais foram variáveis significativamente relacionadas com a incontinência urinária independentemente do ajuste da autopercepção de saúde. CONCLUSÕES: Não houve relação entre incontinência urinária e autopercepção de saúde, contudo, a autopercepção de saúde influenciou no efeito das variáveis sociodemográficas e clínicas sobre a chance de ter incontinência urinária.

AIMS: To verify the impact of self-perceived health on the chance of developing urinary incontinence in very-old. METHODS: This is a cross-sectional and analytical study with elderly individuals aged 90 years and over. The statistical and analytical variables (sex, marital status, continence, age, depressive symptoms, cognition, comorbidities and ability to perform activities) were analyzed analytical and descriptive statistics (frequencies, mean and standard deviation, univariate and health self-perception adjusted logistic regression analysis). RESULTS: There were 182 participants, 71% women. The previous diagnosis of depression, the score of depressive symptoms and the percentage of ease for functional and basic activities were related to self-perception of health (p<0.05). The loss of urine, however, was not related to self-perceived health. The self-perception of health influenced the effect of the variables previous diagnosis of depression, number of depressive symptoms, Mini-Mental State Examination score and number of comorbidities on the chance of urinary incontinence in the presence of these variables. Males, widowhood and ease of performance of basic and functional activities were significantly related to urinary incontinence regardless of the adjustment of health self-perception. CONCLUSIONS: There was no relationship between urinary incontinence and health self-perception. However, health self-perception influenced the effect of sociodemographic and clinical variables on the chance of having urinary incontinence.

Results of surgical treatment of colorectal cancer in nonagenarian patients / Resultados do tratamento cirúrgico do câncer colorretal em pacientes nonagenários

ABSTRACT Purpose: The objective of the present study was to compare the results of surgical treatment of nonagenarian patients having colorectal cancer with patients younger than 90 years. Methods: A total of 622 patients who underwent curative surgery were included in the present study. The database of the surgical service, in the period from 2007 to 2013, was used to obtain the sample. This is a descriptive, retrospective study that compared the profiles of 17 nonagenarian patients (Group I) with 605 patients younger than 90 years (Group II). The groups were compared regarding surgical complications, length of hospital stay, type of surgery performed and ASA classification. Results: The mean age between the groups was 92.2 years and 61.2 years. The mean length of hospital stay in Groups I and II was 17.3 days and 8.75 days, respectively. The surgery performed most frequently was the right colectomy, in both groups. The most common postoperative complication was sepsis (11.8%) among the nonagenarians, and paralytic ileus (4.5%) among those younger than 90 years. Laparoscopic surgery was performed on 5 out of a total of 17 patients evaluated in Group I. Among the three mortalities registered in this latter group, two were classified as ASA III and only one as ASA I. Conclusion: The results indicate that colorectal surgery may be performed in this group, with acceptable morbidity and mortality rates, in patients with low preoperative risk (ASA I/II).

RESUMO Finalidade: O objetivo do presente estudo foi comparar os resultados do tratamento cirúrgico de pacientes nonagenários portadores de câncer colorretal versus pacientes com menos de 90 anos. Métodos: O estudo envolveu 622 pacientes que foram submetidos à cirurgia curativa. Para obtenção da amostra, utilizamos o banco de dados do serviço de cirurgia, abrangendo o período de 2007-2013. Este é um estudo retrospectivo descritivo que comparou os perfis de 17 pacientes nonagenários (Grupo I) versus 605 pacientes com menos de 90 anos (Grupo II). Os grupos foram comparados para complicações cirúrgicas, duração da permanência no hospital, tipo de cirurgia realizada e classificação ASA. Resultados: A média de idade para os Grupos I e II foi, respectivamente, 92,2 e 61,2 anos. A duração média de permanência no hospital nos Grupos I e II foi, respectivamente, 17,3 dias e 8,75 dias. A cirurgia mais frequentemente realizada foi colectomia direita, nos dois grupos. A complicação pós-operatória mais comum foi sepse (11,8%) entre os nonagenários, e íleo paralítico (4.5%) entre os pacientes com menos de 90 anos. Cirurgia laparoscópica foi realizada em 5 pacientes, em um total de 17 pacientes avaliados no Grupo I. Considerando as três mortalidades registradas nesse último grupo, duas foram classificadas como ASA III e apenas uma como ASA I. Conclusão: Os resultados obtidos indicam que, nesse grupo, a cirurgia colorretal é opção válida, com percentuais aceitáveis de morbidade e mortalidade, em pacientes com baixo risco pré-operatório (ASA I/II).

Is there any difference in American Society of Anesthesiologists physical status score between nonagenarian and septuagenarian patients?

BACKGROUND: As the life expectancy increases, extreme old age is not a contraindication to surgery. Limited information is available regarding preoperative evaluation for very old patients in Korea. We hypothesized that the American Society of Anesthesiologists physical status (ASA PS) score would differ between nonagenarian and septuagenarian patients in Korea. METHODS: The medical records of 100 nonagenarian (90s group) and septuagenarian (70s group) patients who had received elective surgery under general or regional anesthesia were reviewed to investigate their nutritional status, coexisting diseases, surgical procedure related cardiac risk, and ASA PS before surgery. RESULTS: The body mass index, hemoglobin, arterial oxygen partial pressure and albumin levels were significantly lower in the 90s group than in the 70s group. The age-adjusted Charlson Comorbidity Index was significantly higher in the 90s group than in the 70s group. The intermediate cardiac risk associated with surgical procedures was significantly higher in the 90s group than in the 70s group. There was no significant difference in the ASA PS class between the 90s group and the 70s group. CONCLUSIONS: The nonagenarian patients did not present a significant difference from the septuagenarian patients in ASA PS classification. However, the comorbidity index scores and cardiac risk related to surgical procedures were higher in the 90s group than in the 70s group. Thus, in the preoperative evaluation of very old patients, a category assessing their physiologic reserve should be added.

Cardiac catheterisation in nonagenarians: Single center experience / 老年心脏病学杂志（英文版）

Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ≥ 90 years (93.0 ± 1.2 years) who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years). The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diabetes (P < 0.001), chronic obstructive pulmonary disease (P < 0.04), previous myocardial infarction (P < 0.02), and complex coronary anatomy (SYNTAX score 33 vs. 19) in nonagenarians. Patients < 90 years of age showed more hyperlipidemia (P < 0.01) and previous percutaneous coronary interventions (P < 0.015). Nonagenarians underwent coronary angiography more often for acute coronary syndrome (ACS) (P < 0.003), were presented more often in cardiogenic shock (P < 0.003), and were transferred faster to coronary angiography in cases of ACS (P < 0.0001). The observed in-hospital mortality rate (13% study group vs. 1% control group; P < 0.003) in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction (TIMI) and global registry of acute cardiac events (GRACE) mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. Conclusion Despite the common scepticism that cardiac catheterisation exposes patients ≥ 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.

Clinical Characteristics of Nonagenarian Stroke

BACKGROUND: As the elderly population is fast growing, the incidence of stroke is also increasing. We studied the clinical characteristics of nonagenarian stroke compared to a population of patients under the age of ninety. METHODS: Subjects included 44 nonagenarian stroke patients and 22,227 control patients aged under ninety. Clinical characteristics including age, sex, risk factors, stroke subtype, and outcome (one-year prognosis, evaluated by a modified Rankin scale) were analyzed. RESULTS: The proportion of nonagenarian stroke accounted for 0.2% of all cases of stroke. Ischemic stroke was more common than hemorrhagic stroke in the nonagenarian group. In addition, the female gender was more frequent (p<0.01). As the patients were older, their admission period was shorter, the discharge against medical advice was increased, and the mortality was higher. Hypertension and atrial fibrillation were significantly higher (p<0.05, p<0.001, respectively) in the nonagenarian ischemic stroke patients. CONCLUSIONS: Nonagenarian stroke patients have unique clinical characteristics compared with stroke patients under the age of ninety.

Nutritional Status of the Nonagenarian Population in Longevity Belt in Korea / 대한지역사회영양학회지

The nutrients intake and health-related habits of nonagenarian subjects in Korean representative longevity belts of Damyang, Gokseong, Kurye, Sunchang were evaluated for the purpose of providing the information on the desirable food selection and dietary pattern of elderly population. A survey was conducted with 91 subjects (26 males and 65 females) and their food intakes were measured by the combination of one meal weighing and 24-hr recall, and their general background information was collected by visit. The mean age of the subjects was 93.6 +/- 2.2 (male) and 97.6+/- 4.6 (female). The average smoking rate was 20.9%; the rate of regular drinking was 26.4%. The average energy intake was 1,284.9 kcal comprising 77.1% of RDA for elder people over 75. The energy ratio of carbohydrate, protein and fat were 66.5 :18.2 :15.3. The average intake of protein, calcium, iron and zinc were 107.4%, 59.9%, 106.3% and 60% of RDA respectively. The lower intake of vitamins as low as 70% was found except vitamin B6 and niacin. The majority of the subjects consumed rice as staple diet and mostly consumed white plain rice rather than mixed grain rice. The animal and plant food intakes were 88.4 :11.6 in males and those of females were 83.0 :17.0 showing a tendency of plant-based meals. Nutrients that showed NAR over 0.7 were protein, iron, vitamin B6, niacin and phosphate, but those with INQ over 1. Nutrient with INQ below 0.7 was only vitamin E. Even though their nutritional quantity did not appear to be enough, but their nutritional quality was relatively high. The adding dairy products, nuts and fruits for the purpose of proving sufficient vitamin and minerals can achieve the optimal nutritional intake patterns. Further research on RDA of this age population should be followed.

Nutritional Status of the Nonagenarian Population in Longevity Belt in Korea / 대한지역사회영양학회지

The nutrients intake and health-related habits of nonagenarian subjects in Korean representative longevity belts of Damyang, Gokseong, Kurye, Sunchang were evaluated for the purpose of providing the information on the desirable food selection and dietary pattern of elderly population. A survey was conducted with 91 subjects (26 males and 65 females) and their food intakes were measured by the combination of one meal weighing and 24-hr recall, and their general background information was collected by visit. The mean age of the subjects was 93.6 +/- 2.2 (male) and 97.6+/- 4.6 (female). The average smoking rate was 20.9%; the rate of regular drinking was 26.4%. The average energy intake was 1,284.9 kcal comprising 77.1% of RDA for elder people over 75. The energy ratio of carbohydrate, protein and fat were 66.5 :18.2 :15.3. The average intake of protein, calcium, iron and zinc were 107.4%, 59.9%, 106.3% and 60% of RDA respectively. The lower intake of vitamins as low as 70% was found except vitamin B6 and niacin. The majority of the subjects consumed rice as staple diet and mostly consumed white plain rice rather than mixed grain rice. The animal and plant food intakes were 88.4 :11.6 in males and those of females were 83.0 :17.0 showing a tendency of plant-based meals. Nutrients that showed NAR over 0.7 were protein, iron, vitamin B6, niacin and phosphate, but those with INQ over 1. Nutrient with INQ below 0.7 was only vitamin E. Even though their nutritional quantity did not appear to be enough, but their nutritional quality was relatively high. The adding dairy products, nuts and fruits for the purpose of proving sufficient vitamin and minerals can achieve the optimal nutritional intake patterns. Further research on RDA of this age population should be followed.

The Dietary Habits of the Nonagenarian Population in Longevity Belt in Korea / 대한지역사회영양학회지

The dietary habits and eating behaviors of nonagenarian subjects over 90 years old in Korean representative longevity belts of Damyang, Gokseong, Kurye, Sunchang were evaluated. The subjects of the study were 91 elderly people (26 males and 65 females) over 90 years old and their dietary habits, food preferences and meal patterns were collected by individual interview. The percentage of subjects, who answered "very good" or "good" for their health status, was 65.9%. In this study, 55% of subjects were without chronic diseases, and there was no significance difference in gender. Many subjects had performed regular exercise and outdoor activity. The rate of eating together with their family was 79.1%. Most of subjects (91.2%) had a regular mealtime consuming three meals a day, and they had good appetite and pleasure of eating. The higher preference of food group was fruits (95.6%), legumes (94.5%), mushrooms (93.4%) and vegetables (92.3%), but the amount of intakes is higher in vegetables than the others. Eating with family, regular exercise and self-rated good health are improved their nutrient intakes. Most frequently consumed meal pattern was rice plus soup and side dishes. The side dish consumed frequently was Namul (blanch and seasoned vegetables). From this study, the nonagenarian populations in longevity belt in Korea have good dietary habits such as regular mealtime, constant amount of meal and eat with pleasure. They are taking Korean traditional meal pattern, providing enriched antioxidant vegetable foods. Also, it can be concluded that the amount and quality of diet in the long-lived elderly are responsible for the Korean traditional family system.