Mortality and Outcome in Patients Older Than 80 Years of Age Undergoing Burr-Hole Drainage of Chronic Subdural Hematoma.

OBJECTIVE: Chronic subdural hematoma is frequently seen within the elderly population and neurosurgeons are confronted with patients older than 80 years presenting with symptomatic chronic subdural hematoma. However, data on surgical outcome are scarce. The aim of this study is to analyze the mortality and outcome after burr-hole drainage in patients older than 80 years. METHODS: This is a single-center retrospective study including patients who underwent burr-hole drainage of chronic subdural hematoma between the years 2016 and 2019. The cohort was divided into 3 age groups (80-84 years; 85-89 years; >90 years). Primary outcome was 30-day and overall mortality, whereas secondary outcome measures were recurrence rates, postoperative bleeding rates, and outcome measured by the modified ranking scale. Uni- and multivariate analysis was conducted to assess for potential risk factors for mortality, recurrence and postoperative bleeding rates. RESULTS: In total, 107 patients with a mean age of 85.5 ± 3.9 years were included. Mortality rate was less than 10% in each group, showing no significant difference between them (P = 0.455). No significant difference in recurrence and postoperative bleeding rates was seen (P = 0.491 and P = 0.532). Modified Ranking scale score differed significantly at release, whereas at follow-up no difference was seen. After uni- and multivariate analysis, age was not correlated with higher recurrence, postoperative bleeding, or mortality rates. Preoperative midline shift was found to be an independent risk factor for recurrence. CONCLUSIONS: In patients older than 80 years undergoing burr-hole drainage for chronic subdural hematoma, age was not directly correlated with higher recurrence, postoperative bleeding, or mortality rates.

Hip fractures in centenarians: a multicentre review of outcomes.

INTRODUCTION: Advances in healthcare have resulted in an increasing UK population, with the proportion of elderly individuals expanding significantly, including centenarians. Hospitals can expect to see growing numbers of so-called 'super-elderly' patients with trauma, a majority of whom will have hip fractures. We performed a multicentre review of hip fracture outcomes in centenarians to assess whether being an outlier in age correlates with poorer prognosis. METHODS: Centenarians admitted to Basingstoke, Southampton, Dorset, and Salisbury district hospitals with hip fractures between January 2014 and June 2019 were included. Electronic records were searched to obtain demographics, functional status, and admission details. RESULTS: A total of 60 centenarians were included, with a median age of 101 years (range 100-108 years), 85% of whom were female; 29 were admitted from their own home or sheltered housing and 31 from nursing or residential care; 33 had some outdoor mobility, 26 only mobilised indoors, and 1 had no mobility. Common comorbidities were renal and heart disease and dementia. Of the total, 56 underwent surgery, 51 within 36 hours. In terms of accommodation, 63.4% returned to their pre-injury level of independence. At 30 days, three months, and one year, mortality rates were 27% (n = 16), 40% (n = 24) and 55% (n = 33), respectively. CONCLUSION: Trauma in the elderly population is an area of growing interest, yet few studies address centenarians with hip fractures. This work demonstrates that mortality rates within one year of injury were high, but almost half survived beyond a year. Two-thirds of patients regained their pre-injury level of independence, suggesting that functional recovery may not be as poor as previously reported.

Resilience in Very Advanced Ages: A Study With Centenarians.

This study intends to assess the relationship between resilience in extremely long-lived individuals and sociodemographic, cognitive and health status variables, and significant life events. A selected sample of 48 centenarians (mean age = 100.8 years, SD = 1.2; 83.3% female) from two centenarian studies was considered. A resilience score covering five items (aging and usefulness, hopefulness, worryness, loneliness, and control) was considered. Multivariable linear regression analyses were conducted in order to identify predictors of resilience. No significant differences in the resilience score regarding sociodemographic variables or typology of significant life events were found. Our findings underscore that health perception (better) and pain (less frequent) were associated with higher levels of resilience. In being present in extremely long-lived individuals, resilience should be object of interest in further research.

A Cultural Comparison of Personality Profiles of U.S. and Japanese Centenarians.

The purpose of this study was a cross-cultural examination of centenarians' personality through a person-centered approach to examine if there is a "resilient" personality profile consistent across cultures. Proxy reports information was obtained from family and close friends of 239 U.S. centenarians from the Georgia Centenarians Study and 272 Japanese centenarians from the Tokyo Centenarian Study. Latent profile analyses were conducted to identify personality profiles in centenarians from the United States and Japan. Two personality profiles were identified in both samples: a "resilient" personality profile and "nonresilient" personality profile. The "resilient" group had higher levels of positive personality traits with higher scores on agreeableness and extraversion and lower scores on neuroticism, conscientiousness, and openness. The "nonresilient" group had higher scores on neuroticism and lower scores on extraversion, openness, agreeableness, and conscientiousness. Fifty percent of U.S. centenarians and 65% of Japanese centenarians were in the "resilient" group.

Sistema de doble movilidad. La solución francesa en pacientes añosos con fractura intracapsular de cadera y alto riesgo de luxación / Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation

OBJETIVO: En la actualidad continúa la controversia respecto al tratamiento quirúrgico más adecuado de la fractura de cuello femoral desplazada en pacientes añosos o con alto riesgo de luxación. En nuestro estudio nos enfocamos en reportar resultados clínicos, funcionales y radiográficos de este tipo de pacientes tratados con artroplastia total de cadera usando el sistema de doble movilidad con un seguimiento mínimo de 2 años. MATERIALES Y MÉTODOS: En el periodo de enero de 2015 a enero de 2016 los pacientes con fractura del cuello femoral desplazada asistidos en las centrales de emergencia de los hospitales que participaron en el estudio fueron seleccionados. De 137 pacientes, 41 cumplían con uno o más de los criterios de inclusión y aceptaron la indicación terapéutica recomendada. Los pacientes fueron sometidos a artroplastia total de cadera utilizando prótesis con sistema de doble movilidad (cementada o no cementada). Todos los pacientes fueron evaluados con el Mini-Mental State Examination y la distancia de caminata en el preoperatorio, a las 3 y 6 semanas, a los 3 y 6 meses, al año y en años subsecuentes. Las evaluaciones radiográficas fueron programadas a tiempos similares. RESULTADOS: Se evaluaron 41 pacientes, con un seguimiento promedio de 2,4 años (rango 2 a 3,2 años). La media de edad fue de 85,2 (rango 80 a 96 años). Cuatro pacientes fallecieron en el periodo de seguimiento por causas no asociadas a la cirugía, con el implante funcionando. Hubo un solo caso de infección a los 8 meses de la cirugía, tratado con una revisión en un tiempo. No se reportaron casos de luxación en esta serie. CONCLUSIÓN: La utilización del sistema de doble movilidad para el tratamiento de fracturas del cuello femoral desplazadas en pacientes con alto riesgo de luxación y añosos ha demostrado buenos resultados clínicos y radiológicos, que fundamentan la indicación sistemática de uso en nuestros servicios

OBJECTIVE: Actually there is a controversy about the treatment of hip fractures on older patients with high risk of dislocation. Our study is focused on report clinico-functional and radiographic results in this population treated with total hip replacement using a dual mobility system after a minimum follow up of 2 years. MATERIALS AND METHODS: In the period from January 2015 to January 2016 patients assisted at the Emergency Unit at the participant hospital were recluted for participation. A total of 137 patients were assisted and 41 fulfilled the inclusion criteria and accepted to participate. All patients received a total hip replacement with a dual mobility system (cemented or uncemented). The patients were evaluated with the Mini-Mental State Examination, walking distance test, preop and postop at 3 and 6 weeks, 3 months, 6 months, one year and subsequent years. Radiographic evaluation was scheduled with clinico-functional review. RESULTS: Forty-one patients included, follow up average 2.4 years (range 2 to 3.2 years). Mean age 85.2 (range 80 to 96 years). Four patients died during follow up due to causes not related to the total hip replacement and the implant was functioning. One case have an infection and was revised in one stage procedure. One case have an infection at 8 months follow-up and was revised in one stage procedure. There were no dislocations. CONCLUSION: The use of dual mobility system in this high dislocation risk population has shown good clinical and functional results, and support the sistematic indication in our services

Why are antithrombotic drugs not prescribed to octogenarian patients with atrial fibrillation at risk of stroke? / ¿Por qué no se recetan medicamentos antitrombóticos a pacientes octogenarios con fibrilación auricular y riesgo de accidente cerebrovascular?

OBJECTIVE: In non-valvular atrial fibrillation (NVAF) patients at risk of stroke, anticoagulant drugs are less likely to be received by older patients than younger patients. In this study, an attempt is made to discover whether the reasons reported by physicians for denying anticoagulant drugs prescription differ between older and younger atrial fibrillation patients. MATERIALS AND METHODS: A retrospective, cross-sectional, multicentre study was conducted from October 2014 to July 2015. The study comprised patients aged ≥18 years diagnosed with NVAF, with a moderate to high stroke risk (CHADS2 score ≥2). Patients were stratified according to age (<80 and ≥80 years). RESULTS: A total of 1309 NVAF patients were evaluated, of whom 40.1% were ≥80 years old. Older patients were predominantly women with higher mean time since diagnosis of AF, with a higher rate of permanent NVAF, and with higher thromboembolic risk. In patients for whom physicians decided not to prescribe any anticoagulant agents, the following reasons were significantly more frequent in patients aged ≥80 years compared to younger patients: cognitive impairment, perceived high bleeding risk, falls, difficult access to monitoring, non-neoplastic terminal illness, and perceived low thromboembolic risk. Uncontrolled hypertension was a significantly more frequent reason for non-prescription of anticoagulant agents in patients aged <80 year. CONCLUSIONS: Octogenarian patients with NVAF and a moderate to high risk of stroke had a different as regards reasons for not being prescribed anticoagulant agents, which should be taken into account in order to improve

OBJETIVO: Los pacientes con fibrilación auricular no valvular (FANV) y riesgo de accidente cerebrovascular de mayor edad tienen menor probabilidad de recibir tratamiento anticoagulante que los de menor edad. En este estudio tratamos de identificar si las razones reportadas de los médicos para negar la prescripción de medicamentos anticoagulantes difieren entre los pacientes con fibrilación auricular de menor y mayor edad. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal, multicéntrico realizado entre octubre de 2014 y julio de 2015. El estudio incluyó pacientes ≥18 años, diagnosticados con FANV, y riesgo de accidente cerebrovascular de moderado a alto (puntuación CHADS2≥2). Los pacientes fueron estratificados según edad (<80 y ≥80 años). RESULTADOS: Se evaluaron 1.309 pacientes con FANV (el 40,1% era ≥80 años). Los pacientes de mayor edad eran predominantemente mujeres con un mayor tiempo medio desde el diagnóstico de FA, mayor tasa de FANV permanente y mayor riesgo tromboembólico. Las razones significativamente más frecuentes para no prescribir tratamiento anticoagulante en pacientes ≥80 años, en comparación con pacientes <80 años, fueron: deterioro cognitivo, riesgo percibido de sangrado elevado, caídas, difícil acceso a la monitorización, enfermedad terminal no neoplásica y riesgo tromboembólico percibido bajo. La hipertensión no controlada fue un motivo significativamente más frecuente para la no prescripción de tratamiento anticoagulante en pacientes <80 años. CONCLUSIONES: Los pacientes octogenarios con FANV y riesgo de accidente cerebrovascular moderado a alto presentan un perfil diferencial con respecto a los motivos para la no prescripción de tratamiento anticoagulante y que deben tenerse en cuenta para mejorar

Supervivencia y funcionalidad en ancianos mayores de 85 años con fractura de cadera / Survival and functionality in the elderly over 85 years of age with hip fracture

INTRODUCCIÓN: Hay una tendencia al envejecimiento de la población que se fractura la cadera. Nuestro objetivo fue comparar la supervivencia y la funcionalidad al año, entre ancianos y muy ancianos con fractura de cadera. MATERIAL Y MÉTODOS: Cohorte prospectiva de pacientes incluidos en el Registro Institucional de Ancianos con Fractura de Cadera entre los años 2014 y 2017. La población se clasificó: ancianos (A) entre los 65 y 85 años, y pacientes muy ancianos (MA) mayor o igual a 85 años. RESULTADOS: Se incluyó a 952 pacientes, el 43% fueron A y el 57% fueron MA. De estos, hubo un 84% y un 86% de mujeres (p = 0,33) y con 2o más puntos en el índice de comorbilidades de Charlson (el 28 y el 31%, p = 0,36), respectivamente. Los MA fueron más dependientes por la puntuación de Barthel (el 34 y el 62%, p <0,01) y más frágiles (el 30 y el 61%, p <0,01). La supervivencia a un año fue del 91% (IC del 95%, 86-93) en ancianos y del 76% (IC del 95%, 70-89) en muy ancianos. Las complicaciones intrahospitalarias fueron más frecuentes en MA 12% (7% en A, p <0,01). La edad fue un factor de riesgo independiente para la supervivencia a un año (HR 2,11; IC del 95%, 1,36-3,29, p <0,001). CONCLUSIÓN: La edad es un factor de riesgo para la supervivencia del grupo MA a pesar de la fragilidad y las comorbilidades. Debido a su vulnerabilidad, se debe considerar un plan de cuidado adecuado para los pacientes MA

BACKGROUND: There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS: A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS: We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS: Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP

Analyzing functional status and its correlates in Chinese centenarians: A cross-sectional study.

Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study was to examine the state and factors affecting activities of daily living independence in centenarians who resided in Guangxi Province, China. A cross-sectional design was used. Activities of daily living, physical activity, mobility, and physical performance were measured by the Population Study of ChINese Elderly study instruments, and demographics and cognition were assessed. Of the 228 participants, 57% were independent in basic activities of daily living and 5.7% in instrumental activities of daily living. Stepwise regression showed physical activity, cognition, calf circumference, and self-reported health were associated with basic activities of daily living. Physical activity, mobility, cognition, and physical performance were correlated with instrumental activities of daily living. In conclusion, the Chinese centenarians showed impaired instrumental activities of daily living but mostly maintained basic functioning. Physical activity and cognition were associated with activities of daily living independence.

Negative Self-perception of Aging and Mortality in Very Old Chinese Adults: The Mediation Role of Healthy Lifestyle.

OBJECTIVES: Previous literature has consistently shown a positive association between negative self-perception of aging and mortality in middle-aged and older adults. However, two questions remain unsolved: (a) whether such association holds among very old people (i.e., the fourth age) and (b) the potential mediators that could contribute to the positive association. This study sought to fill in the research gap by examining the association between self-perception of aging and mortality in a group of very old Chinese participants (i.e., aged over 78 years). METHODS: Four waves of data across a span of 8 years (2000-2008) were obtained from the Chinese Longitudinal Healthy Longevity Survey, which measured a total of 9,683 participants' negative self-perception of aging, survival status, cognitive functioning, diet, as well as other demographic information. RESULTS: Latent growth models with survival analysis were conducted, and the results replicated previous findings indicating an association between negative self-perceptions of aging and reduced survival. Moreover and more importantly, a potential mediator-healthy lifestyle (e.g., eating fresh vegetables and fruits, exercising regularly, and no smoking)-was identified, such that older adults with more negative self-perception of aging tended to engage in less healthy lifestyle, which could lead to increased risk of mortality. DISCUSSION: The findings provided support for a longitudinal behavioral pathway of health, linking negative perceptions of aging to mortality, and also yielded important practical implications for older adults to reach longevity.

Operative versus non-operative treatment of traumatic brain injuries in patients 80 years of age or older.

Traumatic brain injury (TBI) in older adults is an increasing issue in modern medicine. Nevertheless, it remains unclear which patients presenting with TBI and 80 years of age or older benefit from an operative treatment. The aim of this study was to explore the effect of an operative treatment in isolated TBI patients ≥ 80 years of age. Data were derived from the TraumaRegister DGU® from 2002 to 2016. Inclusion criteria were ≥ 80 years of age, an Abbreviated Injury ScaleHead (AIS) ≥ 3, and an AISNon-Head ≤ 1. The cohort was split in operatively and non-operatively treated patients, and outcome was assessed at discharge using the Glasgow Outcome Scale (GOS). A favorable outcome was defined as a GOS of 4 or 5. A total of 1.693 patients (431 operatively and 1.262 non-operatively treated patients) were analyzed. Mortality rate was 54.4% (687 patients) in the non-operative group and 49.4% in the operative group. Simultaneously, there were more patients discharged with a GOS 2 (persistent vegetative state) in the operative group (7.9%, 34 patients) than in the non-operative group (1.0%, 13 patients). An analysis of the operatively treated patients showed an association between a higher mortality risk and brainstem hemorrhage (p = 0.04), fixed pupils (p = 0.001), initial intubation (p = 0.03), and an AISHead of 5/6 (p = 0.03). Patients 80 years of age or older seem to benefit from an operative treatment regarding mortality rate. However, there has been a higher rate of a poor neurological outcome particularly with regard to persistent vegetative state in the operative treatment group at discharge.

Age, Period, and Cohort Effects on Activities of Daily Living, Physical Performance, and Cognitive Functioning Impairment Among the Oldest-Old in China.

BACKGROUND: The aim of this study was to examine the trends in impairment regarding activities of daily living (ADL), physical performance, and cognitive function among the oldest-old (those aged 80 and older) in China between 1998 and 2014. METHODS: We used data on 34,297 oldest-old individuals from the seven waves of the Chinese Longitudinal Healthy Longevity Study. We estimated age, period, and cohort effects on the prevalence of self-reported ADL impairment, tested physical performance and cognitive function impairment using the age-period-cohort model. RESULTS: Regarding age, the prevalence of ADL, physical performance, and cognitive function impairment were highest in the centenarians, but they did not increase with age in this population. Among the literate subgroup, the prevalence of cognitive impairment increased more rapidly with age than that in the illiterate subgroup. Regarding period, the prevalence of self-reported and tested physical impairment slowly increased between 1998 and 2014, but cognitive impairment remained stable. Regarding cohort, ADL impairment continuously decreased. However, physical and cognitive impairment remained stable after a brief decline in the early birth cohorts. CONCLUSIONS: The results suggest that the age effect is still the most obvious effect regarding several types of functional impairment. The likelihood of a younger person experiencing functional impairment may not change significantly, but ADL is likely to be amenable to improvement resulting from improved medical and social care. Therefore, increased care for the oldest-old may considerably improve their quality of life, particularly regarding their basic ADL.

Impacto de la hospitalización en pacientes centenarios ingresados por enfermedad aguda. Descripción de una serie de 165 casos y comparación con la literatura / Impact of hospital admission on centenarians admitted due to an acute illness. A description of a series of 165 cases and comparison with the literature

Introducción: El envejecimiento de la población está suponiendo un aumento de pacientes centenarios, cuyas características podrían diferenciarse de las de los pacientes de menor edad. Este estudio se realizó para conocer el impacto de la hospitalización en los pacientes de 100 o más años ingresados por enfermedad aguda. Material y métodos: Se realizó un estudio observacional retrospectivo que incluyó a los pacientes con edad ≥ 100 años atendidos por el Servicio de Geriatría (SG) de un hospital universitario de tercer nivel desde 1995 hasta 2016. Se consultaron las bases de datos clínico-administrativas del SG, que incluían datos demográficos, clínicos, funcionales, cognitivos y administrativos. Se incluyó a pacientes atendidos en la Unidad Geriátrica de Agudos (UGA), en la Unidad de Ortogeriatría y como Interconsultas. Resultados: Se estudió a 165 pacientes, de 101,6 +/- 1,7 años de edad media +/- desviación estándar (rango 100-109), de los que 140 (85%) fueron mujeres. La estancia media fue de 10,3 +/- 7,4 días. El motivo de ingreso más frecuente en la UGA fueron las infecciones respiratorias (41%). La mortalidad global fue del 16%, pero en la UGA aumentó al 31%. La incapacidad funcional moderada-grave aumentó del 51% basal al 96% al alta y la incapacidad para la deambulación aumentó del 52% basal al 99% al alta. El porcentaje de pacientes residentes en domicilio disminuyó del 71 al 29% al alta. Conclusiones: En los pacientes centenarios, la hospitalización provoca una tasa elevada de mortalidad, un deterioro importante en su situación funcional y una reducción de la probabilidad de volver a su domicilio previo

Introduction: The number of centenarians is increasing with the aging of the Spanish population. This age group might present different clinical features from younger groups. This study was carried out to determine the impact hospital admission on centenarians with an acute disease. Materials and methods: A retrospective observational study was conducted that included patients ≥100 years-old admitted from 1995 to 2016 to a third level university hospital and attended by the Geriatrics department in the acute ward, the Orthogeriatric ward, and by request. An analysis was made using the clinical-administrative databases containing information about the demographics, clinical, functional and cognitive features, length of hospital length, as well as discharge destination. Results: The study included 165 patients with a mean age of 101.6 +/- 1.7 (range 100-109) years, of whom 140 (85%) were female. The mean hospital stay was 10.3 +/- 7.4 days. Respiratory infections (41%) were the most common cause of admission to the Acute Geriatric Unit (AGU). The overall in-hospital mortality was 16%, but mortality in AGU reached up to 31%. There was an increase on moderate-severe functional disability (51% to 96%), and on the inability to walk independently (52% to 99%) from baseline to admission. There was a reduction in people living in their own home from 71% prior to admission to 29% at hospital discharge. Conclusions: Centenarians who required hospital admission showed a high rate of mortality, a significant deterioration in their functional capacity, and a decrease in their chances of going back to their own home at discharge

Successful ageing from old to very old: a longitudinal study of 12,432 women from Australia.

OBJECTIVES: We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women's later life. METHODS: We used survey data from 12,432 participants of the 1921-26 birth cohort of the Australian Longitudinal Study of Women's Health from 1996 (age 70-75) to 2016 (age 90-95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants' baseline characteristics and membership of the latent classes. RESULTS: Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support. CONCLUSIONS: The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.

Pharmacists' influence on adverse reactions to warfarin: a randomised controlled trial in elderly rural patients.

Background Adverse reactions to warfarin may be serious and can lead to hospitalisation or death. Minimising the risk of adverse drug reactions through the intervention of community pharmacists is important for patients receiving warfarin, especially for elderly (≥ 65 years) patients living in rural areas. Objective To evaluate the impact of an intervention by community pharmacists on the risk of adverse drug reactions in elderly rural patients receiving warfarin. Setting: A community pharmacy in a rural area of Croatia. Method We conducted a prospective randomised trial. Eligible patients were recruited at the pharmacy and randomised into one of two groups. The participants were followed up every month for 6 months. Main outcome measure: The incidence and type of adverse drug reactions caused by warfarin and the time-to-event. Results In total, 140 patients were randomized and 131 patients completed the study; 65 patients were in the intervention group. The median age of patients was 73 years of age. The cumulative incidence of adverse drug reactions was significantly lower in the intervention group (6-months rate 29% vs. 85% for intervention and control, respectively; hazard ratio = 0.17, p < 0.001) than in the control group. Factors multivariately associated with the development of adverse drug reactions related to warfarin (p < 0.05) were the absence of pharmaceutical intervention, higher time in therapeutic range, change of warfarin dose, changes in dietary vitamin K intake, and marital status other than married. Conclusion Overall, the pharmacist's intervention significantly prolonged the time to occurrence of adverse drug reactions and reduced their incidence.

[Impact of hospital admission on centenarians admitted due to an acute illness. A description of a series of 165 cases and comparison with the literature]. / Impacto de la hospitalización en pacientes centenarios ingresados por enfermedad aguda. Descripción de una serie de 165 casos y comparación con la literatura.

INTRODUCTION: The number of centenarians is increasing with the aging of the Spanish population. This age group might present different clinical features from younger groups. This study was carried out to determine the impact hospital admission on centenarians with an acute disease. MATERIALS AND METHODS: A retrospective observational study was conducted that included patients ≥100 years-old admitted from 1995 to 2016 to a third level university hospital and attended by the Geriatrics department in the acute ward, the Orthogeriatric ward, and by request. An analysis was made using the clinical-administrative databases containing information about the demographics, clinical, functional and cognitive features, length of hospital length, as well as discharge destination. RESULTS: The study included 165 patients with a mean age of 101.6 ± 1.7 (range 100-109) years, of whom 140 (85%) were female. The mean hospital stay was 10.3 ± 7.4 days. Respiratory infections (41%) were the most common cause of admission to the Acute Geriatric Unit (AGU). The overall in-hospital mortality was 16%, but mortality in AGU reached up to 31%. There was an increase on moderate-severe functional disability (51% to 96%), and on the inability to walk independently (52% to 99%) from baseline to admission. There was a reduction in people living in their own home from 71% prior to admission to 29% at hospital discharge. CONCLUSIONS: Centenarians who required hospital admission showed a high rate of mortality, a significant deterioration in their functional capacity, and a decrease in their chances of going back to their own home at discharge.

Medication in older patients reviewed multiple ways (MORE) study.

Background Polypharmacy in older patients can lead to potentially inappropriate prescribing. The risk of the latter calls for effective medication review to ensure proper medication usage and safety. Objective Provide insight on the similarities and differences of medication review done in multiple ways that may lead to future possibilities to optimize medication review. Setting This study was conducted in Zuyderland Medical Centre, the second largest teaching hospital in the Netherlands. Method This descriptive study compares the quantity and content of remarks identified by medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System. The content of remarks is categorized in seven categories of possible pharmacotherapeutic problems: 'indication without medication', 'medication without indication', 'contra-indication/interaction/side-effect', 'dosage problem', 'double medication', 'incorrect medication' and 'therapeutic drug monitoring'. Main outcome measure Number and content of remarks on medication review. Results The Clinical Decision Support System (1.8 ± 0.8 vs. 0.9 ± 0.9, p < 0.001) and outpatient pharmacist (1.8 ± 0.8 vs. 0.9 ± 0.9, p = 0.045) both noted remarks in significantly more categories than the geriatricians. The Clinical Decision Support System provided more remarks on 'double medication', 'dosage problem' and 'contraindication/interaction/side effects' than the geriatrician (p < 0.050), while the geriatrician did on 'medication without indication' (p < 0.001). The Clinical Decision Support System noted significantly more remarks on 'contraindication/interaction/side effects' and 'therapeutic drug monitoring' than the outpatient pharmacist, whereas the outpatient pharmacist reported more on 'indication without medication' and 'medication without indication' than the Clinical Decision Support System (p ≤ 0.007). Conclusion Medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System provides different insights and should be combined to create a more comprehensive report on medication profiles.

Where and How Centenarians Die? The Role of Hospice Care.

The effect of hospice care on place of death among centenarians remained unexplored. Using data obtained from National Health Insurance Research Database (2002-2010), we compared the differences in place and cause of death between centenarians and noncentenarians. These data were stratified into centenarian (n = 2495) and noncentenarian (n = 820 563) death. Data in place and cause of death and hospice care interventions were retrieved. Poisson regression models were used to evaluate factors associated with the centenarians' place of death. Time series models were used to predict the number of centenarian deaths until 2025. Most (63.8%) of the centenarians died at their own homes, followed by 30.5% who died in hospital. Hospice home care was involved in only 0.3% of the centenarian deaths but in 1.8% of the noncentenarian deaths. The leading causes of death among centenarians were respiratory diseases (16.6%), circulatory diseases (15.2%), and pneumonia (14.8%). Among the centenarians, those who died of circulatory disease, old age, and respiratory diseases were more likely to die at their own homes. We forecasted the number of annual centenarian deaths to reach 800 in 2025. Therefore, an increase in the provision of advanced care planning and earlier home hospice care intervention may enable centenarians to die at their own residence.

Clinical aspects of seizures in the elderly.

The population of France and the world is aging with an increase in the population of people aged over 65 years old. Old people are the second largest population affected by seizures. Hence, neurologists and geriatricians have to be able to identify and treat elderly that suffer from seizures. The current epileptic seizure classification is inappropriate for old people. It is difficult to identify seizures in this group of patients for many reasons and some semiological particularities are required to establish a diagnostic. Within the elderly, first generalized seizures are rare except when epilepsy begins in childhood. The most common type of epilepsy in the elderly is partial seizure but in most cases, the beginning of seizure is difficult to analyze. Seizures clinical description depends on functional areas concerned by the spread of the epileptic discharge. Keep in mind that most of functional areas are interconnected and because of the epileptic discharge speed, clinical expression is polymorph.

One hundred and counting: Centenarian use of emergency departments in New South Wales.

OBJECTIVE: To study ED utilisation by people aged 100 years and over with a focus on patient demographics, reasons for presentation and patient flow factors. METHODS: This is a retrospective descriptive analysis of linked ED Data Collection Registry for presentations to New South Wales (NSW) EDs over a 5 year period. Patients were included if they presented to an ED and were aged 100 years and over at the time of presentation. Demographics, triage category, presenting problem, ED length of stay, disposition and ED re-presentation were determined for this age group. RESULTS: A total of 4033 presentations to 115 NSW EDs during 2010-2014 were analysed. We found that 78% of the patients were females and 76% still living at home. This group were the second most common age group to present to ED, after the 90-99 year age group, with 87% arriving via ambulance. Most presentations were triaged as a category 3 or 4, with the most common presenting problem being because of injury (28.5%) followed by respiratory disease (11.4%) and cardiovascular disease (10.0%). Overall, 64% required hospital admission and the average length of stay for all patients was 5.7 h. CONCLUSIONS: Centenarians ED presentations are increasing over time with injuries as the most common reason for presentation. Most patients have prolonged ED length of stay and many require hospital admission. Early streaming of these patients through specialised geriatric assessment units may be more appropriate to reduce the demand on EDs and improve patient care. Models that facilitate rapid access to supported living arrangements and improved advanced care planning may be more realistic for many centenarians and different models of care need to be considered for this age group.