Tuberculosis in elderly in the Czech Republic.

INTRODUCTION: The incidence of tuberculosis (TB) in the Czech Republic (CR) is decreasing since 1960s. (1965: 76.9; 1975: 60.4; 1985: 45.2; 1995: 17.7; 2005: 9.9; 2015: 4.9 per 100, 000 population). In 2017 men accounted for over than 70% of cases. People aged over 75 years are most frequently affected. Elderly patients tend to develop more of extrapulmonary and atypical manifestation of the disease, the diagnosis of TB can be difficult and consequently overlooked. Multimorbid seniors are suffering from chronic illnesses, malignancies and autoimmune diseases, which translate into higher degree of immunosuppression and add to the generally described process of immunosenescence. Furthermore, therapy of TB in the elderly is challenging because of the increased drug resistance and higher incidence of adverse drug reactions. This article reviews the epidemiology of TB in the CR, immunological aspects, clinical characteristics, diagnosis, management, prevention of TB infection and presents two clinical cases in hospitalized aging adults in the CR. CASE PRESENTATION: We present a case of a 79 year old female suffering from chronic obstructive pulmonary disease (COPD), who was repeatedly hospitalized for acute exacerbations of COPD and was consequently diagnosed with TB. Patient developed manifestation of treatment toxicity and drug interactions due to comorbidities and other medications. Secondly, we present a case of a 70 year old male, a lifelong smoker, who was initially admitted for collapsing. TB developed via the endogenic route from a Ghons complex in association with a slowly progressing bronchogenic carcinoma. CONCLUSION: Diagnosis and management of TB in the elderly person can be challenging. Age-related factors increase the risk of TB reactivation as well as enhance susceptibility to TB infection. In elderly population we find accumulation of risk factors for developing TB (malnutrition, low socio economic status, smoking and alcoholism). The people most at risk among elderly include fragile institutionalized seniors whose incidence of TB is 2-3 times higher than those living at home. Because the number of seniors is growing and the incidence of TB in this subpopulation is increasing, detailed knowledge of the epidemiological features of TB in this group is needed to optimize healthcare services.

Falls in anaemic and non-anaemic hospitalized elderly patients in 2012-2016 - mutual relationships.

Although falls are more prevalent as ageing proceeds, it cannot be assumed that they happen due to ageing alone. The retrospective cohort study of data was targeted to make an analysis of prevalence of falls in anaemic patients in comparison to the non-anaemic elderly admitted to the acute geriatric department and evaluation of pertinent influence of age, gender and immobility on occurrence of falls. During the considered period of four years (2012-2016) the authors treated 9 363 elderly patients aged 79,9±8,6 years (in the majority of them 65+ years). Among them there were 8 809 non-anaemic and subgroup of 551 old anaemic patients (aged 81±7 years) with decreased haemoglobin (<110 g/l). Falls at hospital admission in average was present in 1 766 non-anaemic persons (20%) in comparison to 380 falls among anaemic patients (68,6%). Prevalence in anaemic subgroup is statistically significant higher (p<0,005). Also relation between falls and age, ADL and MMSE test and mobility is highly statistically significant (p<0,001). Meaningfully higher is occurrence of repeated falls in the anaemic subgroup in comparison to the non-anaemic one (41,2 vs 1,7%). The occurrence of falls in female gender in comparison to men is statistically significant higher in non-anaemic patients, not in anaemic group. Authors emphasize that anaemia appears to us as significant risk factor for falls in the elderly.

Pulmonary embolism in the hospitalized patients 65+ in relation to presence of diabetes in 2007-2015.

The aim was to compare an occurrence of acute PE in hospitalized patients 65+ years old with diabetes mellitus (DM) with those without any DM. It was a retrospective analysis of data collected in documentation of patients who were hospitalized at the geriatric department in the years 2007-2015. In this period we had 11 947 patients of an average age of 79,9±8,5 years (min - 65, max - 103 years). Out of this number there were 4 069 diabetics. Acute PE was found in 344 patients of an average age 80,3±7,4 years. 121 of them died (35,3%) and 223 survived (64,7%). From total patients 88 were diabetics with PE. Mortality on PE did not influence the presence of DM. She was the same in both groups of patients (p=NS) - with and without DM. RESULTS: Prevalence PE in the hospitalized 65+ years old was 2,9%. Mortality of PE among all the hospitalized 65+ was 1,0%. Higher prevalence of PE was found in non-diabetics - 3,2%, as compared to the diabetics - 2,3% (p<0,025). The average age of patients with diabetes both with and without PE was lower as compared to the non-diabetics (p<0,01). Among risk factors we found significantly more frequently obesity in the diabetics as compared to the non-diabetics both surviving (p<0,001) and those who died (p<0,05). The most important risk factor of PE was in all the patient's immobility. One risk factor appeared in the set of survivors more frequently in the non-diabetics as compared to the diabetics (p<0,05). Simultaneous occurrence of three risk factors appeared more frequently in the surviving diabetics (p<0,001) as compared to the non-diabetics. Although overall presence of risk factors was higher in the diabetics, PE prevalence in the DM patients was lower as compared to the non-diabetics. The immobility in general was the most important risk factor for PE occurrence, in the diabetics then also obesity.

Geriatric giants--contemporary occurrence in 12,210 in-patients.

OBJECTIVES: With advancing age, the degree of dependency and occurrence of great geriatric syndromes (GS), also referred to as geriatric giants, grow substantially. DESIGN: The prospective cohort study was aimed at conducting an analysis and comparison of geriatric syndromes (geriatric giants) among different age groups at admission to the acute geriatric department. SETTING, PARTICIPANTS: Between 1995 and 2012, we had altogether 12,210 elderly patients at an average age of 80.5 ± 7.0 y (range 65-103 y) hospitalised at the Department of Geriatrics. We divided the patient set into three different age subgroups (65-74 y; 75-84 y and ≥85 y; e.g. 21.4%; 47.9% and 30.7%) and compared the results among them. RESULTS: 3,787 persons (31.0%) were without any GS. The growing tendency of the occurrence of all geriatric syndromes in combinations with increased age (p<0.001) is obvious. Their occurrence in the above mentioned different age sets was examined in relation to individual geriatric syndromes and sex (female and male), namely falls 22.0%, 27.8%, 39.9% and 20.5%, 27.0%, 36.1%; immobility 26.4%, 29.3%, 42.5% and 30.3%, 30.1% and 39.2%; incontinence 38.4%, 50.6%, 69.5% and 38.2%, 47.4%, 61.8 %; dementia and cognitive impairment 13.4%, 23.4%, 38.1% and 15.8%, 24.3%, 33.2% respectively. Age cut-off for geriatric syndromes occurrence based on ROC analysis is 83.5-84.5 y for females and 78.5-82.5 y for males. CONCLUSION: The occurrence of geriatric giants increasing with age and female gender is of crucial importance not only for individuals and families but also for demands on costs of health and social care in oncoming decades (Tab. 6, Fig. 3, Ref. 52).

Occurrence of pulmonary embolism among 260 in-patients of acute geriatric department aged 65+ years in 2005-2010.

UNLABELLED: Pulmonary embolism (PE) is after myocardial infarction and cerebrovascular events the third most frequent cardiovascular cause of death. Simultaneously it belongs to at least often correctly diagnosed cardiovascular diseases. THE AIM OF THE STUDY: The retrospective analysis of the database of inpatients with the target assess the clinical course of PE according to prevalence, mortality, average duration of stay, risk factors, used diagnostic methods and kinds of therapy. Another aim of the study was a comparison of the data among the survivors and deceased persons. Patient's set and method: between 2005 and 2010 years we had altogether 6,323 elderly patients of an average age 80.7 +/- 6.9 y. (range 65-103 y.) treated at the Department of Geriatrics. Out of this number there were 4,163 women (66%) and 2,160 men (34%). We evaluated the course of PE in 260 cases of mean age 79.8 +/- 7.2 y. (165 women and 95 men). For the verification of the diagnosis of PE we used following usual procedures (anamnesis, clinical examination, ECG, X-ray, labs etc.) also ECHO-cardiography, perfusion scan or helical CT of lungs. Eighty per cent of the deceased had an autopsy. In the set of in-patients with PE 89 died (34.2%) and 171 survived (65.8%) with anticoagulant treatment. RESULTS: Prevalence of PE was 4.1% per year among all the hospitalized elderly in-patients (> or = 65 y.). Mortality among all the admitted patients to our department was 1.4%. Its occurrence was increasing with age to 81 y. and thereafter slightly decreasing. In one third of the deceased PE was an occasional finding in autopsy without any previous clinical signs. Mortality in the non-symptomatic group with PE in autopsy was significantly higher (chi2 = 57,293; p < 0.001). We didn't find any significant gender difference in prevalence of mortality according to gender structure of the set with PE. In 14 cases PE clinically demonstrated as sudden death. We determined the age significant difference between survivors and the deceased--79.1 +/- 7.1 y. vs. 81.3 +/- 7.0 (t = 1.997; p < 0.05). Average duration of hospital stay was significantly different between both groups: the deceased 9.2 +/- 9.6 vs. 12.4 +/- 7.4 in survivors (t = 4.256, p = 0.01). Risk factors were assessed and compared between both groups: the deceased and survivors. We found the most important risk factors in the group of the deceased immobility (p < 0.001) heart failure (p < 0.005) and stroke (p < 0.01). On the contrary in the survivor group there were more frequent risk factors obesity (p < 0.025); deep venous thrombosis (p < 0.025) and tumors (p < 0.05). Previous operations and traumas in the last month did not show any significant difference between both groups. Used treatment methods were evaluated, too. In the group of those who died multi-morbidity, often frailty and geriatric giants predominated even if the anticoagulant therapy was used comparably in both groups (survivors and the deceased). CONCLUSION: We would like to emphasize the need to think permanently in elderly persons with present risk factors of the possibility of PE and also the requirement of correctly assessed diagnosis and starting therapeutic procedures as soon as possible.

GAD antibodies in T1D and LADA--relations to age, BMI, c-peptide, IA-2 and HLA-DRB1*03 and DRB1*04 alleles.

The determination of GADA may be useful for clinical classification of diabetes mellitus (DM) in clinically unclear cases. This GADA positivity may persist in any diabetics Type 1 Diabetes Mellitus (T1D) with an onset in adulthood and Late Autoimmune Diabetes of Adults (LADA) many years after appearance of DM. The study was aimed at comparing the levels of GADA between both diabetic subsets with their clinical parameters, age of onset DM, period of insulin need, body mass index, HbA1C, fasting and postprandial C-peptide, risky HLA-DRB1* alleles, occurrence of micro- and macrovascular diabetic complications. Further analysis of GADA titers in different time consequences to the development of DM and relations to IA-2 were made. In the study, we included 130 diabetics with an onset of diabetes (T1D or LADA) 35+ y. who were hospitalized and afterwards long-term observed in the diabetological outpatient department. Out of this number there were 62 men and 68 women of the average age 65.5 +/- 14.0 y. (range 35-93 y.). 54 were assessed as the T1D patients and 76 as the LADA ones. Patients of the T1D subgroup were GADA positive 22 times and of the LADA subgroup 21 times. LADA 2 patients that were GADA negative were more obese than GADA positive LADA diabetics (p < 0.01). Also postprandial C-peptide was higher in LADA patients GADA negative (p < 0.05). Other clinical characteristics were without statistically significant differences. We found in our diabetic patients a relation between alleles HLA-DRB1*03 and particularly combination with HLA-DRB1*04 with positive GADA levels. In the GADA negative group obesity, coronary heart disease, hypertension, syndrome of diabetic foot and dyslipidaemia appeared more frequently (OR = 2.8; 3.1; 6.2 and 2.4). We found no significant differences in observed parameters--comparison GADA positivity and negativity according to the duration of DM. GADA positive were even 10 y. duration 16 times and after 20 y. even 6 times. Recent DM had positive GADA in 11 cases and 13 cases of recent DM had GADA negative. IA-2 antibodies were positive (> 1.0 U/ml) 18 times altogether and always with positive GADA, but only 7 times in recent DM. The presence of elevated GADA identifies patients unequivocally suitable for early insulin therapy. Our observations and experiences confirm that GADA can be found increased after more than 10-20 years duration of DM, although in decreasing trend.