The Vulnerable Elders Survey-13 scale is superior to the simplified Pulmonary Embolism Score Index in predicting 3-month postdischarge mortality in elderly survivors of acute pulmonary embolism.

INTRODUCTION: Acute pulmonary embolism (APE) is the most serious manifestation of venous thromboembolism. The simplified Pulmonary Embolism Severity Index (sPESI) is employed for prediction of 30-day mortality in APE. The Vulnerable Elders Survey (VES-13) is used to identify participants at a risk of health impairment. OBJECTIVES: We aimed to compare the VES-13 and sPESI scales for prediction of 3-month mortality inelderly patients hospitalized for APE. PATIENTS AND METHODS: All patients with APE were managed according to the European Society of Cardiology (ESC) guidelines and followed up for at least 3 months after discharge. Clinical evaluation of all patients involved the Charlson Comorbidity Index (CCI) and biochemical tests. The patients with VES-13 score equal to or above 3 (VES-13≥3) were evaluated with comprehensive geriatric assessment (CGA). RESULTS: A total of 164 patients met the inclusion criteria. There were significantly fewer men in the VES-13≥3 than the VES-13<3 group (34% vs 54.5%; P <0.01). The patients in the VES-13≥3 group had lower median (interquartile range [IQR]) body mass index and higher sPESI score than those in the VES-13<3 group (25.6 [21.8-28.4] kg/m2 vs 28 [25.3-31] kg/m2; P = 0.001 and 2 [1-2] points vs 1 [0-1] point; P <0.001, respectively). There were no differences in APE severity according to the ESC stratification and CCI. Logistic regression analysis identified the VES-13 score as a significant independent risk factor for 3-month mortality. CONCLUSIONS: The VES-13 score is a better tool than sPESI for predicting 3-month mortality. Geriatric survivors of APE characterized with VES-13≥3 points should be closely monitored after discharge. The Norton Scale Score in a combination with the VES-13 may be useful in predicting 3-month mortality among numerous tests used in the CGA.

Prevalence of chronic pain in the elderly Polish population - results of the PolSenior study.

INTRODUCTION: Pain is the most common complaint of elderly people. In Poland, no large studies on the prevalence of chronic pain in the elderly were conducted until recently. MATERIAL AND METHODS: The study was a part of the PolSenior project, a cross-sectional multidisciplinary study on ageing of the Polish population, and included a randomly selected group of 716 people aged 55-59 years, and 4979 people over 65 years. The survey was conducted through a standardized questionnaire. An evaluation of pain occurrence, location, intensity and coexistence of pains in relation to gender, age and use of health care was performed. RESULTS: Chronic pain affected 42.0% of respondents aged 65 years and over (48.6% of women and 35.8% of men) as compared to 35.2% of the pre-elderly. The most common pain locations were the lumbar region (51.6%) and knees (41.0%). The average number of pain sites was 3.1 ±2.3. Average intensity of pain was 6.2 points on the VAS scale in people over 65 years and 6.0 points in the pre-elderly (NS). Average pain intensity increased significantly from 5.7 points in patients reporting pain in one place to 7.2 points in those reporting six pain sites. Elderly respondents with pain compared to those without pain more frequently reported physician visits performed at least once a month (54.6% vs. 48.4%, p < 0.001). CONCLUSIONS: Polish elderly most frequently complained of low back and lower limb pain. In respondents reporting many sites of pain, an increase in the intensity of pain was observed. Elderly patients with chronic pain often use medical care.

Analgesic use among nursing homes residents, with and without dementia, in Poland.

Many age-associated diseases are accompanied by pain. There is no doubt that pain is underrecognized among elderly nursing home residents and the diagnosing of pain is a real challenge in subjects with dementia. The aim of the study was to characterize analgesic use among nursing home residents and to delineate the putative associations between pain management and cognitive functions of elderly persons. The study involved 392 subjects (males:females - 81:311) with a mean age of 83.6±5.9 years. The residents' medical files in relation to diagnoses and drug consumption were analyzed, and the screening of cognitive functions was performed using the Mini-Mental State Examination (MMSE). One hundred and thirteen residents (28.8%) received some analgesics. Among them 84 (21.4%) used them routinely, 25 (6.4%) - pro re nata (PRN) and four (1.0%) - both routinely and PRN. Non-opioid analgesics were taken routinely by 53 residents, weak opioids by nine subjects, and one person was receiving strong opioids. Additionally, three individuals were taking a combination preparation of tramadol and acetaminophen. The rate of subjects who were not receiving any pain treatment was higher in residents with MMSE between 0 and 9 points than in those with MMSE between 24 and 30 points (P=0.0151). Furthermore, ten residents (9.1%) with severe dementia were treated with analgesics PRN. The results of our study point to a remarkably low use of analgesics in nursing home residents in Poland and indicate a need to introduce pain evaluation and monitoring of drug treatment appropriateness as a standard procedure in the geriatric assessment in nursing homes.

[Assessment of the influence of rehabilitation in patients treated in a hospital rehabilitation ward due to consequences of neurological diseases]. / Ocena wplywu rehabilitacji u chorych leczonych w szpitalnym oddziale rehabilitacji z powodu nastepstw chorób neurologicznych.

UNLABELLED: THE AIM OF THE STUDY was evaluation effects of rehabilitation in patients with consequences of neurological diseases. MATERIAL AND METHODS: The study was conducted in the hospital department of rehabilitation. The study involved group of 30 patients consisting of 12 men aged from 48 to 76 years (mean age 64.3 +/- 7.9), and 18 women aged from 45 to 82 years (mean age 65.4 +/- 13,2). These were patients mostly after stroke, multiple sclerosis or Parkinson's disease enrolled in rehabilitation. TESTS were performed before and after 21 days rehabilitation, using the following scales and ratings: Activities of Daily Living (ADL), Instrumental Activities of Daily Living Scale (IADL), Scale Barthel, test Tinetti, Expanded "Get-Up-and-Go" Test (ETGUG) and Geriatric Depression Scale (GDS). RESULTS. In men, the average number of points in the scale of ADL, IADL, Barthel increased statistically significant, the results obtained in the test Tinetti, ETGUG, GSD were changed not significant statistically. In women, the average number of points in the IADL scale, Barthel scale and GDS increased, and the test ETGUG were reduced, all statistically significant. The results of the scale ADL and test Tinetti, improved statistically not significant. CONCLUSIONS. The physical rehabilitation in patients with neurological consequences had a positive impact on the ability to perform simple and complex activities of daily living, physical and mental condition. TESTS: ADL, IADL, Barthel scale, GDS, test Tinetti and ETGUG can be used for evaluation of rehabilitation results.

The prevalence of falls and their relation to visual and hearing impairments among a nation-wide cohort of older Poles.

Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65 years and older in comparison to younger respondents aged 55-59 years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7 years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p<0.001 in the older group). In the group of older subjects falls occurred most often during walking (66.7% vs. 50.7% in the group of 55-59 years old), p=0.005), while the younger more often fell while practicing sports (5.48% vs. 0.8% in the group 65+, p<0.001) and risky activities (respectively: 13.7% vs. 4.9%, p=0.002). A similar percentage of younger and older fallers reported one (44.0% and 46.1% respectively) or more falls (56.1% and 53.9%; p=0.6). The percentage of recurrent fallers grew with increasing age (Cc=0.177; p<0.001). The prevalence of injurious falls was similar in the younger and older groups (45.4% and 42.8%, p=0.53). In both genders fall-related injuries were more frequent in younger elderly (65-74 years old) and in subjects 90 years old and older. In the non-standardized analysis and after adjustment for age and gender visual and hearing impairments and its degree were associated with falls but both relations lost statistical significance after adjustment for a set of explanatory variables. Despite somewhat lower estimates, falls in older Poles are no less an important factor influencing overall health than in other populations. The higher prevalence of multiple falls should draw attention of the health-care policy makers. Sensory impairment may add to the risk of falls and should be adequately taken care of, however the priority in the future fall prevention initiative should be given to stronger factors, such as age, type of activity, overall health, cognitive function and functional status.

[Influence of antidepressant therapy on psychic state and functional and cognitive abilities elderly patients treated in psychiatric ward]. / Wplyw terapii przeciwdepresyjnej na stan psychiczny, umyslowy i funkcjonalny pacjentów w wieku podeszlym, leczonych w oddzale psychiatrycznym.

UNLABELLED: Depression and cognitive disfunctions are the most common psychopathological disorders of older adults. THE AIM OF THE STUDY: To asses effects of a pharmacological and psychological treatment performed in psychiatric ward on psychic state and functional and cognitive abilities in elderly patients with depression. MATERIAL AND METHODS: The study included group of 35 patients with depression (22 women and 13 men) above 65 years old, consecutively admitted to the psychiatric ward. Examination of the psychical, mental and functional abilities was performed at the beginning and end of 4-6 weeks treatment in psychiatric ward, by means of the following scales: Katz activities of daily living (ADL), Lawton instrumental activities of daily living scale (IADL), Folstein mini mental state examination (MMSE), Yesavage Geriatric Depression Scale (GDS). RESULTS: In women, after treatment the average scores in ADL test increased 0.3 point (statistically insignificant); in IADL test--increased 2.6 points (statistically significant); in MMSE test--increased 6 points (statistically significant), in GDS scale--reduced 13.45 points (statistically significant). In men after therapy the mean value of points in ADL test increased 0.4 points (statistically insignificant); in the test of IADL increased 3.5 points (statistically significant); in MMSE test--increased 6.5 points (statistically significant); in the scale of the GDS decreased 13.7 points (statistically highly significant). CONCLUSIONS: In elderly patients with depression mental state improved after pharmacological and psychological treatment in psychiatric ward. Improvement of mood in elderly patients treated for depression leads to increased functional and cognitive abilities.

[Diagnosis, prevention and treatment of sarcopenia]. / Rozpoznawanie, zapobieganie i leczenie sarkopenii.

Mass and power muscle declines with age, and is connected with impairment of their function. Every our proceedings associated with recognizing and curing elderly people should contain the evaluation of mass and muscle power. At the paper is presented causes, recognizing, preventive proceedings in older persons with sarcopenia. Adequate diet, physical exercises, giving the vitamin D has the beneficial influence on mass and strength of muscles, as well as they are improving the functional condition of older persons.