'Robbed out of mind': Reflections on Alzheimer's and gendered subjectivity in select Indian literary narratives.

Neurological degeneration is a potent signifier molding older lives, divesting them of 'personhood' and making them a 'target of care'. This article delineates the depictions of Alzheimer's and its associated losses in select Indian literary narratives- Jalsobi: In the Shadow of Light (2018) and Girl in White Cotton (2019) and seeks to understand how 'ageing into disability' for older women has severe implications that marginalize their embodied existence, foisting a symbolic death. Through the fictional accounts, the article explores two primary threads of consideration - how the 'selfhood' gets eroded/reclaimed while experiencing cognitive impairment and how the shift from the patient-centric to the person-centric approach alters the relational care dynamics in the Indian context. It also attempts to situate the conception and representation of age-induced cognitive loss within the framework of critical disability studies, which understates the reductionist biomedical perspective and fosters an alternative, inclusive, and empathetic understanding of dysfunctionality.

A Case of Pyometra Caused by Achromobacter xylosoxidans and γ-Streptococcus in an Elderly Frail Woman.

Pyometra is an easily overlooked disease with nonspecific symptoms; however, a delayed diagnosis can lead to severe complications. An 80-year-old frail woman presented to our hospital with a chief complaint of persistent fever for 10 days. Her blood tests showed an elevated inflammatory response, and computed tomography showed a 10-cm cystic lesion in the pelvic floor compressing the bladder. A catheter was inserted from the vagina into the uterine cavity, resulting in pus drainage and pyometra diagnosis. A pus culture was subsequently performed, which detected Achromobacter xylosoxidans, a common cause of respiratory tract infections in cystic fibrosis and bloodstream infections, andγ-streptococcus. To the best of our knowledge, this is the first report of pyometra caused by Achromobacter xylosoxidans. The patient was treated with drainage and piperacillin-tazobactam administration. Pyometra is especially prevalent in older women with impaired activities of daily living and dementia. Although fever, lower abdominal pain, and increased discharge may occur, symptoms are often nonspecific, and half of such cases are asymptomatic. Furthermore, delayed diagnosis can lead to perforation of the uterus and consequent pan-peritonitis. Thus, the diagnosis of pyometra should be considered in older women presenting with unknown fever, and imaging studies and gynecological consultation should be requested promptly.

[An older woman in the local community in Russia: the neighborhood, non-government organizations and the public utilities sector.]

The article probes into the development of local self-organization of retired women, actively involved in resolving housing issues at their place of residence in Saint-Petersburg. The socio-spatial approach to aging, also referred to as «aging in a place / in a community¼ serves the theoretical framework. This type of aging requires an active approach to the habitual environment of the elderly and their support. It is the groups of older women that generate activists who have free time and the necessary competencies and who are ready to promote the interests of all the residents of an apartment building, a neighborhood or a district. Therefore, the empirical basis of the article was mainly the materials of interviews with women activists. In the public utilities system full of intricate semi-legal schemes, invisible and incomprehensible to the majority of ordinary citizens, activists are not always able to enter into an equitable dialogue with the controlling bodies and public utilities managers. In order to make insignificant changes, older activists are sometimes required to take tremendous efforts and develop new competencies which help to overcome barriers and to defend the collective interests.

Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study.

To assess the efficacy, and the acute and late toxicity of hypofractionated radiotherapy (Hypo-RT), and the impact of age and comorbidities on disease progression and death in elderly breast cancer (BC) patients. Women aged ≥65 years who received Hypo-RT (42.4 Gy in 16 fractions, plus a boost for high-risk patients) were considered for the present analysis. Competing risk analysis was used to estimate the 5-year cumulative incidence of BC progression and BC-related death, calculating the adjusted subhazard ratios (SHR) with 95% confidence intervals (95%CI) in relation to age, hypertension-augmented Charlson Comorbidity Index (hCCI), tumor characteristics, and chemotherapy. The sample included 794 patients with a median age of 74 years (range 65-91 years). At the baseline, 70% of these patients had at least one comorbidity. With a median follow-up of 48.3 months, the 5-year cumulative incidence of BC progression and BC-related death was 6.7% (95%CI 4.8%-9.2%) and 2.3% (95%CI 1.2%-3.9%), respectively. Old age (≥80 years) and a high burden of comorbidity (hCCI ≥ 2) were independently associated with BC progression. Hypo-RT is safe in elderly BC patients, but age and comorbidities influence BC progression. Further studies are warranted.

Influence of current state of executive function and working memory on adherence to antimuscarinic therapy in older women with OAB.

AIM: Evaluation of the executive function and working memory influence, as well as the general state of memory, on adherence to treatment with antimuscarinic drugs in elderly women with overactive bladder (OAB). BACKGROUND: Antimuscarinic are effective and safe for the treatment of OAB, but adherence to treatment remains low. Demographic, socioeconomic, and medical factors which influence the medication adherence have been explored; however, the impact of executive function and working memory on adherence has not been evaluated yet. METHODS: In total 417 women from 65 to 88 years old with the diagnosis overactive bladder were selected to participate in the study. They were prescribed AM drugs: trospium 15 mg / day (n = 138), or Solifenacin 5 mg / day (n = 132), or Darifenacin 7.5 mg / day (n = 147). The observation was carried out for 12 weeks. The urodynamic state was investigated using the questionnaire OABq-SF, uroflowmetry was performed at the start and end of the study, voiding diary - during the whole time of observation. The state of mental health was investigated using MMSE and GDS. The assessment of executive function and working memory, as well as general memory estimation, was carried out using the Wisconsin Card Sorting Test, Wechsler Memory Scale subscale, and the California Verbal Learning Test. Hierarchical and simultaneous regressions were calculated to study the effect of executive function and working memory on medication adherence. RESULTS: The urodynamic state of patients significantly improved after the treatment, the cognitive functions did not change. The analysis of hierarchical and simultaneous regressions made it possible to establish that the predictor variables significantly influencing medication adherence of elderly women with OAB to AM treatment are executive function and working memory composite (ß = .39, p < .05), severe symptoms of lower urinary tract (ß =. -. 31, p < .05), and age (ß =. -. 25, p < .05). CONCLUSION: The status of executive function and working memory, as well as the age and severity of the pathological symptoms of lower urinary tract should be considered when predicting adherence to AM treatment in elderly patients with OAB.

Colpocleisis sitio-específica: 3 años de experiencia / Site-specific colpocleisis: 3 years of experience

RESUMEN El prolapso de órganos pélvicos es definido como el descenso de la pared anterior y /o posterior de la vagina y/ o la cúpula o útero a través de la vagina. Esta patología se ha visto asociada a disfunción urinaria, alteración de la defecación y disfunción sexual. El prolapso sintomático de órganos pélvicos es una condición que afecta negativamente la calidad de vida de las mujeres, encontrando una prevalencia de 3-6%. La cirugía obliterativa de vagina, tiene un menor tiempo quirúrgico, las tasas de morbilidad y pérdida de sangre son más bajas, la recuperación es más rápida, y el éxito anatómico mayor. Las pacientes que son ideales candidatas a la colpocleisis suelen presentar múltiples comorbilidades médicas que las descartan para llevar a una cirugía reconstructiva con una eficiencia de 90% en la literatura, refiriendo que mejora de la calidad de vida y la imagen corporal para la mayoría de pacientes. OBJETIVO: Realizar una revisión sobre el procedimiento de colpocleisis referente a los resultados anatómicos, resolución de los síntomas, satisfacción con los resultados quirúrgicos y la morbimortalidad asociada de pacientes que consultaron a una institución prestadora de salud privada de tercer nivel, ubicada en Medellín, (Colombia). METODOLOGÍA: Se realizó un estudio de cohorte retrospectivo en el cual se incluyen todas las pacientes con prolapso grado 3-4 a quienes se les haya realizado colpocleisis en el periodo de tiempo comprendido entre 2013 al 2016, en una institución prestadora de salud privada de III nivel en Medellín, Antioquia, que atiende régimen contributivo del sistema seguridad social en Colombia y pacientes particulares. Se usó la escala de cuantificación del Prolapso del Órgano Pélvico (POP-Q) para determinar los niveles de prolapso y que tipo de prolapso se identificaba antes y después de la cirugía. Se les solicitó a todas evaluación urodinámica multicanal preoperatoria con reducción del prolapso para evaluar incontinencia oculta o dificultades de micción. Y se realizó una evaluación subjetiva de la respuesta a la cirugía con la escala de Impresión Global de Mejora del paciente (PGI-I). RESULTADOS: Se realizó una recolección de datos entre enero de 2013 a diciembre de 2016. Fueron sometidas a colpocleisis 143 pacientes, 27 de ellas (18.8 %) tenían más de 80 años. 52 pacientes (36.3%) entre 60-70 años, 62 pacientes (43.3%) entre 70-80 años y 1 pacientes <60 años. La edad media del grupo de edad fue de 75 años, rango 58-94 años; el índice de masa corporal promedio fue de 27, la duración del seguimiento promedio fue 9 meses, y el número de partos vaginales 4. El 97.9% de las pacientes presentaban comorbilidades médicas. Hubo una tasa de curación de 97.9%. CONCLUSIÓN: El estudio de cohorte describe nuestra experiencia y agrega a los datos existentes que apoyan la viabilidad y seguridad de la colpocleisis. Encontramos alta eficacia de las cleisis en cuanto a la satisfacción de las pacientes, en mejoría de calidad de vida, independiente de la edad, con una baja tasa de complicaciones y fallas quirúrgicas. La colpocleisis es una buena opción de tratamiento para prolapso de órganos pélvicos estadio 3-4, en quienes no deseen conservar la función sexual, sin embargo este concepto debe ser individualizado para cada paciente.

ABSTRACT Pelvic organ prolapse is defined as the descent of the anterior and / or posterior wall of the vagina and / or the dome or uterus through the vagina. This pathology has been associated with urinary dysfunction, altered defecation and sexual dysfunction. Symptomatic prolapse of pelvic organs is a condition that negatively affects the quality of life of women, finding a prevalence of lifetime prevalence is 3-6%. Obliterative vaginal surgery, has a shorter surgical time, morbidity and blood loss rates are lower, recovery is faster, and anatomic success greater. Patients who are ideal candidates for colpocleisis usually present multiple medical comorbidities that discard them to lead to reconstructive surgery. With an efficiency of 90% in the literature, indicating that improvement of the quality of life and body image for the majority of patients. OBJECTIVE: To perform a review of the colpocleisis procedure regarding anatomical results, resolution of symptoms, satisfaction with surgical results and associated morbidity and mortality of patients who consulted a third-level private health care institution located in Medellín, (Colombia). METHODOLOGY: A retrospective cohort study was carried out in which all patients with grade III-IV prolapse who underwent colpocleisis were included in the period from 2013 to 2016, in a private health institution of III level in Medellín, Antioquia, that attends contributory regime of the social security system in Colombia and private patients. The Pelvic Organ Prolapse (POP-Q) scale was used to determine prolapse levels and what type of prolapse was identified before and after surgery. All preoperative multichannel urodynamic evaluations with prolapse reduction were requested to evaluate occult incontinence or micturition difficulties. And a subjective evaluation of the response to surgery was performed with the Global Impression of Patient Improvement (PGI-I) scale. RESULTS: Data were collected between January 2013 and December 2016. Thirty-three patients were submitted to colpocleisis, 27 of which 18.8 (%) were older than 80 years. 52 (36.3%) patients between 60-70 years, 62 (43.3%) between 70-80 years and <60 years 1 patient. The mean age of the age group was 75 years, range 58-94 years; the mean body mass index was 27, the average follow-up duration was 9 months, and the number of vaginal deliveries was 4. (97.9%) of the patients had medical comorbidities. With a cure rate of 97.9%. CONCLUSION: The cohort study describes our experience and adds to existing data that support the viability and safety of colpocleisis. We found high efficacy of cleisis in terms of patient satisfaction, improvement in quality of life, independent of age, with a low rate of complications and surgical failures. Colpocleisis is a good treatment option for prolapse of pelvic organs stage III-IV, in those who do not wish to preserve sexual functionality, however this concept must be individualized for each patient.

Could Patients Older than 75 Years Benefit from a Systematic Breast Cancer Screening Program?

BACKGROUND/AIM: To assess prognosis of women aged 75 and older according to breast cancer (BC) diagnosis circumstances. PATIENTS AND METHODS: A retrospective cohort study was conducted in the Amiens, France, regional oncologic referral center between 2005 and 2015. Two groups were formed depending on whether the patients followed clinical manifestations (CM) or a prescribed systematic mammography (SM). RESULTS: Three hundred and ninenty-three patients were selected. CM and SM represented 72% and 14.5% of BC diagnosis circumstances, respectively. In the SM group statistically significant differences included: earlier stage cancer diagnosis (tumor stages 0 and 1 accounted for 6.3% and 61.4% of cases, respectively), less lymph node invasions (35.7% and 8.8%) and metastases (19.1% and 0%), more frequent possibility of conservative surgery (25.6% and 74.5%), improved global and disease-free survival rates (by 14.2 and 18.4 months). CONCLUSION: Screening seems to improve prognosis of older BC patients; this constitutes a strong argument for reconsidering age limits of national BC screening programs.

Relationships between intramuscular fat, muscle strength and gait independence in older women: A cross-sectional study.

AIM: The objectives of the present study were to examine the relationships between intramuscular fat, muscle strength and gait independence, as well as to clarify the intramuscular fat characteristics of dependent older women. METHODS: A total of 25 older women who were unable to walk with or without assistance (dependent group), 22 frail older women (frail group) and 22 healthy older women (healthy group) participated in the present study. The frail participants could walk independently, but showed three or more of the following characteristics: slowness, weakness, weight loss, exhaustion and low physical activity. Outcome measures were quadriceps intramuscular fat determined by ultrasound echo intensity, and quadriceps muscle strength of the dependent, frail and healthy groups. In addition, the degree of gait independence (functional independence measures gait score) was assessed in the dependent and frail groups. RESULTS: Echo intensity in the dependent group was significantly negatively correlated with muscle strength and the functional independence measure gait score (correlation coefficients -0.635 and -0.344, respectively). Furthermore, echo intensity in the dependent group was significantly higher than in the healthy group. There was no significant difference in echo intensity between the dependent and frail groups. CONCLUSIONS: The present results suggest negative relationships between intramuscular fat and muscle strength, and intramuscular fat and degree of gait independence in dependent older women. In addition, dependent older women have more intramuscular fat than healthy older women. Geriatr Gerontol Int 2017; 17: 1683-1688.