TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series.

Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to a confluence of factors. The remarkable technological development of transcatheter aortic valve replacement was studied initially on older adult populations with prohibitive or high-risk for surgical valve replacement. Through these trials, the cardiovascular community has recognized that stratification of these chronologically older adults can be improved incrementally by invoking the concept of frailty and other geriatric risks. Given the complexity of the aging process, stratification by chronological age should only be the initial step but is no longer sufficient to optimally quantify cardiovascular and noncardiovascular risk. In this review, we employ a geriatric cardiology lens to focus on the diagnosis and the comprehensive management of aortic stenosis in older adults to enhance shared decision-making with patients and their families and optimize patient-centered outcomes. Finally, we highlight knowledge gaps that are critical for future areas of study.

Mortality after surviving traumatic brain injury: risks based on age groups.

OBJECTIVE: To assess mortality, life expectancy, risk factors, and causes of death by age groups among persons who received inpatient traumatic brain injury (TBI) rehabilitation. DESIGN: Prospective cohort study. SETTING: The TBI Model Systems. PARTICIPANTS: 8573 individuals injured between 1988 and 2009, with survival status per December 31, 2009, determined. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Standardized mortality ratio, life expectancy, and cause of death. RESULTS: Moderate-severe TBI increases risk of mortality compared with the general population in all age groups, with the exception of those 85 years or older at the time of injury. Teenagers to middle-aged adults are at particular risk. Risk factors for death varied by age group and included gender, marital and employment status, year and cause of injury, and level of disability. External causes of death predominate in younger groups. For the youngest male participants in the sample, longevity was reduced up to 16 years. CONCLUSION: Risk factors and causes of death varied considerably by age group for individuals with moderate-severe TBI who were receiving acute care rehabilitation. Moderate-severe TBI is a chronic health condition.

Comparison of quadriceps angle measurements using short-arm and long-arm goniometers: correlation with MRI.

OBJECTIVE: To compare the reliability of quadriceps-angle (Q-angle) measurements performed using a short-arm goniometer and a long-arm goniometer and to assess the accuracy of goniometer-based Q-angle measurements compared with anatomic Q angles derived from magnetic resonance imaging (MRI). DESIGN: An intra- and interobserver reliability study. SETTING: University hospital. PARTICIPANTS: Eighteen healthy subjects with no history of knee pain, trauma, or prior surgery were examined. METHODS: Two physicians, blinded to subject identity, measured Q angles on both knees of all subjects using 2 goniometers: (1) a short-arm goniometer and (2) a long-arm goniometer. Q angles were derived from axial MRIs of the subjects' hip and knees. MAIN OUTCOME MEASUREMENTS: The intra- and interobserver reliabilities of each goniometer were assessed using the intraclass correlation coefficient (ICC). The comparison between clinical and MRI-based Q angles was assessed by using the ICC and a paired t-test. RESULTS: Intra- and interobserver reliabilities of the long-arm goniometer (intraobserver ICC, 0.92; interobserver ICC, 0.88) were better than those of the short-arm goniometer (intraobserver ICC, 0.78; interobserver ICC, 0.56). Although both goniometers measured Q angles that were moderately correlated to the MRI-based measurements (ICC, 0.40), the clinical Q angles were underestimated compared with the MRI-based anatomic Q angles (P < .05). CONCLUSION: The results of this study suggest that, although reproducible Q-angle measurements can be performed using standardized patient positioning and a long-arm goniometer, methods to improve the accuracy of clinical Q-angle measurements are needed.