Continuous glucose monitoring in older people with diabetes and memory problems: a mixed-methods feasibility study in the UK.

OBJECTIVES: Older people with diabetes are at increased risk of harm from hypoglycaemia, particularly where there are coexisting memory problems. Continuous glucose monitoring (CGM) offers important benefits in terms of detecting hypoglycaemia, but the feasibility of use and extent of data capture has not been tested in this patient group. Our objective was to investigate the feasibility of trialling a CGM intervention in the community setting in older people with diabetes and memory problems. DESIGN: Mixed-methods feasibility study. SETTING: Community dwellings in the UK. PARTICIPANTS: Patients aged ≥65 with diabetes and abbreviated mental test score ≤8 or known dementia. INTERVENTION: FreeStyle Libre CGM. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility criteria were numbers of eligible patients, recruitment, attrition, extent of capture of glucose readings and adverse events. Qualitative interview. RESULTS: We identified 49 eligible participants; 17 consented, but 5 withdrew before recording of data because they or their carers felt unable to manage study procedures. 12 participants (mean age 85 years) completed the study without adverse events. Data capture across 14 days ranged between 3% and 92% (mean 55%); 6 participants had <60% capture. Hypoglycaemic events were recorded in six out of nine insulin users. Qualitative interviews found: the device does not interfere with daily activities, usability and comfort was positive, and it was helpful for carers in monitoring participants' glucose concentrations. CONCLUSIONS: The device was acceptable to participants, and carers reported greater ease in monitoring the participant's glucose concentrations. However, completeness of data capture varied considerably with this device due to the need for users to conduct ≥3 scans per day. Real-time devices with automated data transfer may be more suitable in older people with memory problems.

Prevalence, characteristics and outcomes of people aged 65 years and over with an incidental rise in cardiac troponin I. An observational prospective cohort study.

BACKGROUND: Cardiac troponin I (cTnI) is a sensitive and specific marker of acute cardiac damage. We examined the prevalence, characteristics and outcome of incidental cTnI rises in older patients. METHODS: One hundred and eighty-seven consecutive patients aged 65 years or over with a raised cTnI on admission at least 8 h after symptom onset were categorised into: (1) ST-elevation myocardial infarction, (2) other acute coronary syndromes (ACS), (3) other recognised non-ACS causes of cTnI rise and (4) non-ACS with no other identifiable cause (an incidental finding). The number of readmissions and deaths for each group was measured at 30 and 90 days. RESULTS: Age range = 65-98 years. Male = 55.6%. Fifty-four percent had a raised cTnI due to non-ACS illnesses, whilst in 18% it was an incidental finding. The latter group was relatively older and had a significantly lower degree of cTnI rise (U = 1718.5, p = 0.002), but a higher readmission and mortality rate compared to the other groups (categories 1-3) for both follow-up periods. CONCLUSIONS: Incidental cTnI rise is common in older patients and is associated with a poorer prognosis compared to ACS or a recognised non-ACS condition. Future research should attempt to evaluate the significance of such incidental rises in elderly patients.

CT diagnosis and outcome of primary brain tumours in the elderly: a cohort study.

BACKGROUND: The incidence of primary brain tumours (PBT) increases with age. Survival outcome depends on the treatment modality and histological type of the tumour. OBJECTIVES: To compare the survival outcome between those who had brain biopsy and those who did not among those who had PBT diagnosed by computerised tomography (CT). METHODS: We analysed data from 82 elderly patients who were admitted to a UK centre with close links to a neurosurgical unit. RESULTS: Age range was 62-99 years (median 74 years); 49 males and 33 females. 44 cases (54%) had brain biopsies of which 2 (5%) were not PBT. Both cases were malignant conditions, 1 case of metastasis and 1 leiomyosarcoma. Of 42 PBT, 34 (77%) were malignant gliomas. The remaining 8 cases were 4 astrocytomas, 2 meningiomas, 1 cerebellar tumour and 1 cerebral lymphoma. Initial clinical misdiagnosis of cerebrovascular disease (CVA) or transient ischaemic attack (TIA) was very common, 70% in our cohort. Those who had brain biopsy were younger (median age 72, range 62-81) compared to those who did not have brain biopsy (median age 77, range 65-91). A survival analysis for those who died comparing biopsy-proven malignant tumours (combined gliomas and astrocytomas (n = 37)) and those who did not have a biopsy (n = 37) showed that the latter had a shorter median time to receive definitive treatment after diagnosis, 8.0 days (95% CI; 5.4, 8.6) (n = 20) compared to 40.0 days (95% CI; 32.5, 47.5) (n = 26) but shorter median length of survival, 47.0 days (95% CI; 32.3, 61.7) compared to 81.0 days (95% CI; 66.7, 95.3) for those who had brain biopsy. Subgroup analysis of malignant gliomas between patients aged < or =70 years and those >70 years showed no significant difference in median length of survival, 74.0 days (95% CI; 54.0, 94.0) vs. 85.0 days (95% CI; 59.0, 111.0), respectively. CONCLUSIONS: Our findings suggest that the older elderly are less likely to have aggressive therapy, and more likely to be diagnosed initially as cerebrovascular event (CVA/TIA). However, when they were given similar definitive treatment, their survival is comparable with their younger counterparts and therefore, age alone should not contraindicate radical treatment. Elderly patients should be selected for radical treatment on existing criteria, but age itself should not preclude radical treatment where it is otherwise appropriate to offer it.