There is a growing number of elderly patients, so it is necessary to create new standards of oncologic care for such individuals in order to provide them with the best possible treatment. An elderly woman was treated for locally advanced small-cell lung cancer. Due to the suspicion of coronary disease, arterial hypertension and age, anti-cancer treatment with carboplatin and etoposide was recommended. When carboplatin infusion came to a stop, signs of myocardial infarction in ECG as well as elevated levels of troponin I were reported. Originally, non-invasive treatment was introduced, but several days later three DES stents were placed in coronary arteries. An attempt was made to treat the patient with cisplatin and etoposide, after which respiratory failure, tumor lysis syndrome and pancytopenia occurred. That is why chemotherapy was discontinued at the time. The patient’s tumor area and brain was irradiated. 16 months later, she is still alive without signs of disease progression. New oncologic standards should be elaborated in order to ensure appropriate treatment for elderly patients.
Introduction: Acute appendicitis (AA) is the most common indication for emergency surgery and it occurs more often in children and young adults than in patients of advanced age. AA in older patients is a challenging surgical problem because of its atypical presentation. This study was performed to determine whether the age of a patient impacts the outcomes and whether laparoscopic appendectomy (LA) is a feasible method for treatment of patients > 65 years. Material and methods: We performed a retrospective study of 355 patients with AA who were admitted to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn from 2014 to 2017. The patients were divided into three age groups: 18 to 40, 41 to 65 and >65 years. The histopathological diagnoses were divided into three types: simple AA, phlegmonous AA, and gangrenous AA. Results. LA was performed in 96% of young adults and in 67% of older patients. The patients older than 65 years had higher preoperative white blood cell counts, higher C-reactive protein (CRP) levels and had a longer length of stay (LOS) than younger patients (P=0.05, P=0.03, and P=0.03, respectively). We found a positive correlation among the CRP levels, open appendectomy (OA), and gangrenous appendicitis. Conclusions: Patients older than 65 years more frequently underwent OA than LA, had higher preoperative CRP levels and had a longer LOS than younger patients. Higher CRP levels were associated with a greater risk of gangrenous appendicitis. LA is a safe and feasible treatment method for patients older than 65 years.
was to evaluate the clinical spectrum of emergency surgery for acute abdominal disorders and their outcome. Material and methods. The study group comprised 1426 patients, aged between 10 and 92 years subject to emergency surgery, due to an acute abdomen during the period 2001-2004. Analysis comprised age, sex, concomitant diseases, ASA scale classification, postoperative diagnosis, type of surgery, complications, mortality and duration of hospitalization. Patients were divided into two age groups: <60 and ≥60 years. Results. Appendicitis was the most common diagnosis (52.9%) in patients under 60 years, while cholecystitis (32.5%) and ileus (30.9%) in patients over 60 years. Complications were observed in 14.8% patients, the most common being related with wound healing (5.6%). The mortality rate amounted to 5.7%. Mortality was most often associated with bowel obstruction (29.2%), surgery for acute bowel ischemia (25.5%), and bowel perforation (20.7%). The mean duration of hospitalization was 7.9 days. Conclusions. 1. In comparison to elective surgery, emergency abdominal operations, particularly in elderly patients are related with a higher mortality rate. 2. In elderly patients, the high mortality rate and substantial number of complications is associated with the advanced primary disease and severe coexisting comorbidities, which significantly reduce the overall health condition.
The aging of the population is associated with the increased risk of chronic diseases, and greater consumption of drugs used in their treatment, which may lead towards gastrointestinal bleeding.The aim of the study was to analyze the reasons, treatment results, complications and mortality connected with gastrointestinal bleeding in patients aged 85 years and older.Material and methods. The study comprised the retrospective analysis of 84 patients, aged between 85 and 97 years admitted to the Department of General Surgery with diagnosis of gastrointestinal bleeding, during the period between 2005 and 2010. The results were compared to a younger control group of 151 patients (mean age-53 years) with gastrointestinal bleeding, admitted to the department during the same period. Diagnosis was based on the history, physical examination, endoscopy, morphology and biochemical lab results. Analysis considered the therapeutic method used, treatment results, complications and hospital mortality. The endoscopic picture and risk of recurrent bleeding in patients with upper gastrointestinal hemorrhage was evaluated by means of the clinical Forrest scale. Results were subject to statistical analysis.Results. Most of the gastrointestinal bleeding cases considering patients aged 85 years and older concerned the upper gastrointestinal tract (41.67%). Thirty (35.71%) patients were on drugs affecting the coagulation system. On admission, the average hemoglobin concentration level in the elderly was comparable to results observed in case of the control group. Considering patients aged 85+, drugs affecting the coagulation system were used statistically more frequently, as compared to younger patients. Recurrence of bleeding was observed in 10 (11.9%) study group patients.Overall mortality due to gastrointestinal bleeding in elderly patients amounted to 20.24% and was statistically higher, as compared to the control group- 7.2%.Conclusions. Treatment results in case of gastrointestinal bleeding in the elderly patients (above 85 years) are burdened with a higher mortality rate. Different diagnostic and therapeutic methods should be applied in case of elderly patients (above 85 years), in order to increase their chance of survival. The problem of aging is an epidemiological phenomenon and gastrointestinal bleeding will become an increasing problem, needing to be solved in everyday clinical practice.
Introduction. In Poland, it is estimated that HF is observed in approximately 0,7 million of patients. The aim of the study was to assess health behaviour in geriatric patients diagnosed with HF regarding pharmacotherapy and non-pharmacological treatment. Material and methods. The study group comprised 72 patients with diagnosed HF, over 65y. The study was performed using a questionnaire survey including 20 closed-ended questions. Results. The mean number of medicinal products prescribed by physicians for the treatment of HF and other diseases was 6.59±1.8. 50% of subjects were additionally taking medications and supplements for self-treatment, 63% declared they managed to take medications prescribed on their own. A diet is followed only by 50%, but only 18% limit their sodium intake. 46% still consume alcohol, and 10% of still smoke cigarettes. 46% declared the use of body weight monitoring, but none of them measured their body weight every day. Conclusion. Health behaviour of geriatric patients with HF in Poland indicates their low compliance with medical guidelines and it may explain a high hospitalisation rate and increasing costs of treatment.
The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide. The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT. Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models. Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS. Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.
INTRODUCTION: Patients over 79 years of age represent a growing proportion of patients admitted to intensive care units. The aim of the study was to evaluate the characteristics of patients over 79 years of age admitted to the ICU, the course and the results of their treatment as well as survival after discharge from the unit, and to compare these results to those obtained in the remaining population treated at this time in the ICU. MATERIAL AND METHODS: A retrospective analysis was performed of 870 consecutive patients admitted to the ICU in the Silesian Centre for Heart Diseases in the period of 8 consecutive years. We analysed only the first admissions – all repeat and subsequent hospitalizations were excluded from the analysis. Within this population, we identified 75 patients over 79 years of age (8.6%). For all the analyses, it was assumed that p < 0.05 is statistically significant. RESULTS: The reasons for admission in patients over 79 years of age and younger were similar – except for a significantly higher proportion of patients admitted due to complications of acute coronary syndromes (38.7% vs 26.7%, p = 0.03) and pneumonia (8.0% vs. 2.9%, p = 0.04). Overall, 44.0% of elderly and 41.4% of younger patients died in the ICU (p = 0.75). Mortality 30 days after discharge, however, was significantly higher in the elderly patients (45.2% vs 27.3%, p = 0.02). One year mortality according to Kaplan-Meier analysis was 82% in elderly patients and 48% of patients in the remaining population (p = 0.00003). CONCLUSIONS: Patients over 79 years of age represent a significant group requiring treatment in the ICU. Hospital mortality among the oldest patients is similar to the remaining population, but their long-term outcomes are very poor, which may result from the low quality of care after discharge from the ICU.
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WSTĘP: Pacjenci powyżej 79 roku życia stanowią rosnący odsetek chorych przyjmowanych na oddziały anestezjologii i intensywnej terapii (OAiIT). Celem pracy była ocena charakterystyki pacjentów po 79 roku życia przyjmowanych na OAiIT, przebiegu i wyników ich leczenia oraz czasu przeżycia po wypisie z oddziału, a także zbadanie korelacji tych wyników z uzyskanymi w pozostałej populacji leczonej w tym czasie w OAiIT. MATERIAŁ I METODY: Retrospektywną analizę przeprowadzono u 870 kolejnych chorych przyjętych na OAiIT w Śląskim Centrum Chorób Serca w kolejnych 8 latach. Analizowano wyłącznie pierwsze przyjęcia – z analizy wykluczono wszystkie powtórne i kolejne hospitalizacje. Do badanej grupy włączono 75 chorych powyżej 79 roku życia (8,6%). Na potrzeby wszystkich obliczeń przyjęto, że istotność statystyczna występuje przy wartości współczynnika p < 0,05. WYNIKI: Przyczyny przyjęcia chorych powyżej 79 roku życia i młodszych były podobne, wyjątek stanowił istotnie wyższy odsetek chorych przyjmowanych z powodu powikłań ostrego zespołu wieńcowego (38,7% vs 26,7%; p = 0,03) i zapalenia płuc (8,0% vs 2,9%; p = 0,04). Na OAiIT zmarło 44,0% starszych chorych i 41,4% pozostałej populacji (p = 0,75). Śmiertelność do 30 dnia po wypisie była jednak znacznie wyższa w najstarszej grupie chorych (45,2% vs 27,3%; p = 0,02). Śmiertelność roczna, według analizy Kaplana-Meiera, wyniosła 82% w grupie chorych powyżej 79 roku życia i 48% chorych w pozostałej populacji (p = 0,00003). WNIOSKI: Pacjenci powyżej 79 roku życia stanowią znaczącą grupę chorych wymagających leczenia na OAiIT. Śmiertelność szpitalna wśród najstarszych chorych jest zbliżona do pozostałej populacji, jednak odległe wyniki leczenia są bardzo złe, co może wynikać z niskiej jakości opieki po wypisie z OAiIT.
Cele badania: Badanie to miało na celu ocenę czynności serca u pacjentów w podeszłym wieku przyjętych na oddział rehabilitacji w okresie rekonwalescencji. Wraz z innymi zmiennymi laboratoryjnymi oraz demograficznymi, analizie statystycznej poddano N-końcowy fragment propeptydu natriuretycznego typu B (NT-proBNP). Metody: Parametry laboratoryjne obejmowały: NT-proBNP, albuminy w surowicy, hemoglobinę (Hb), cholesterol w lipoproteinach o niskiej gęstości, hemoglobinę Hb A1c oraz szacowany współczynnik filtracji kłębuszkowej (eGFR). Ponadto, przeanalizowano ilość oraz trendy stosowania leków działających na układ sercowo-naczyniowy. Wyniki: Czterystu pięćdziesięciu siedmiu pacjentów przyjęto w ciągu całego roku 2017 (188 mężczyzn i 269 kobiet, w wieku 83 ±10,1 lat). Liczba pacjentów z poziomami NT-proBNP powyżej 125, 400 oraz 900 pg/mL wynosiła odpowiednio 347 (75,9%), 204 (44,6%), oraz 109 (23,9%). Odsetek pacjentów leczonych na nadciśnienie, cukrzycę, oraz na hipercholesterolemię wynosił odpowiednio 51,8%, 20,5% oraz 18,0%. N-końcowy fragment propeptydu natriuretycznego typu B dodatnio korelował z wiekiem (p=0,003), a ujemnie z albuminami (p<0,0000) oraz Hb (p=0,0000). Analiza regresji wielokrotnej NT-proBNP z wiekiem, albuminami, eGFR, Hb, cholesterolem w lipoproteinach o niskiej gęstości oraz licznymi lekami, jako zmiennymi niezależnymi, wykazała tylko istotną statystycznie ujemną korelację niezależnie z albuminami (p<0,0000) i eGFR (p<0,0000). Wnioski: Wyniki te wskazują, że 3 na 4 pacjentów w starszym wieku w czasie rehabilitacji w fazie rekonwalescencji cierpi na przewlekłą zastoinową niewydolność serca, a odpowiednie odżywianie jest kluczowe w zapobieganiu zwiększania się niewydolności serca w tej grupie ludzi.
EN
Objectives: This study aimed to evaluate cardiac function in elderly inpatients admitted to a recovery phase rehabilitation ward. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was statistically analyzed, along with other laboratory and demographic variables. Methods: Laboratory parameters included NT-proBNP, serum albumin, hemoglobin (Hb), low-density lipoprotein cholesterol, hemoglobin A1c, and estimated glomerular filtration rate (eGFR). In addition, a number of medications and trends in the use of cardiovascular agents were examined. Results: Four hundred and fifty-seven patients were admitted throughout the year 2017 (188 men and 269 women, aged 83 ±10.1 years). The number of patients with NT-proBNP levels of more than 125, 400, and 900 pg/mL were 347 (75.9%), 204 (44.6%), and 109 (23.9%), respectively. The percentage of patients that had been treated for hypertension, diabetes mellitus, and hypercholesterolemia were 51.8%, 20.5%, and 18.0%, respectively. N-terminal pro-B-type natriuretic peptide positively correlated with age (p=0.003), and negatively with albumin (p<0.0000) and with Hb (p=0.0000). Multiple regression analysis of NT-proBNP with age, albumin, eGFR, Hb, low-density lipoprotein cholesterol, and number of medications as independent variables revealed significant negative correlation only with albumin (p<0.0000) and eGFR (p<0.0000) independently. Conclusions: These results indicate that 3 out of 4 elderly inpatients in the recovery phase of rehabilitation are affected by chronic congestive heart failure, and management of nutrition is essential for prevention and progression of heart failure in this group.
Objectives: This study aimed to evaluate cardiac function in elderly inpatients admitted to a recovery phase rehabilitation ward. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was statistically analyzed, along with other laboratory and demographic variables. Methods: Laboratory parameters included NT-proBNP, serum albumin, hemoglobin (Hb), l ow-density lipoprotein cholesterol, hemoglobin A1c, and estimated glomerular filtration rate (eGFR). In addition, a number of medications and trends in the use of cardiovascular agents were examined. Results: Four hundred and fifty-seven patients were admitted throughout the year 2017 (188 men and 269 women, aged 83 ±10.1 years). The number of patients with NT-proBNP levels of more than 125, 400, and 900 pg/mL were 347 (75.9%), 204 (44.6%), and 109 (23.9%), respectively. The percentage of patients that had been treated for hypertension, diabetes mellitus, and hypercholesterolemia were 51.8%, 20.5%, and 18.0%, respectively. N-terminal pro-B-type natriuretic peptide positively correlated with age (p=0.003), and negatively with albumin (p<0.0000) and with Hb (p=0.0000). Multiple regression analysis of NT-proBNP with age, albumin, eGFR, Hb, low-density lipoprotein cholesterol, and number of medications as independent variables revealed significant negative correlation only with albumin (p<0.0000) and eGFR (p<0.0000) independently. Conclusions: These results indicate that 3 out of 4 elderly inpatients in the recovery phase of rehabilitation are affected by chronic congestive heart failure, and management of nutrition is essential for prevention and progression of heart failure in this group.
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Cele badania: Badanie to miało na celu ocenę czynności serca u pacjentów w podeszłym wieku przyjętych na oddział rehabilitacji w okresie rekonwalescencji. Wraz z innymi zmiennymi laboratoryjnymi oraz demograficznymi, analizie statystycznej poddano N-końcowy fragment propeptydu natriuretycznego typu B (NT-proBNP). Metody: Parametry laboratoryjne obejmowały: NT-proBNP, albuminy w surowicy, hemoglobinę (Hb), cholesterol w lipoproteinach o niskiej gęstości, hemoglobinę Hb A1c oraz szacowany współczynnik filtracji kłębuszkowej (eGFR). Ponadto, przeanalizowano ilość oraz trendy stosowania leków działających na układ sercowo-naczyniowy. Wyniki: Czterysta pięćdziesięciu siedmiu pacjentów przyjęto w ciągu całego roku 2017 (188 mężczyzn i 269 kobiet, w wieku 83 ±10.1 lat). Liczba pacjentów z poziomami NT-proBNP powyżej 125, 400, oraz 900 pg/mL wynosiła odpowiednio 347 (75.9%), 204 (44.6%), oraz 109 (23.9%). Odsetek pacjentów leczonych na nadciśnienie, cukrzycę, oraz na hipercholesterolemię wynosił odpowiednio 51.8%, 20.5%, oraz 18.0%. N-końcowy fragment propeptydu natriuretycznego typu B dodatnio korelował z wiekiem (p=0.003), a ujemnie z albuminami (p<0.0000) oraz Hb (p=0.0000). Analiza regresji wielokrotnej NT-proBNP z wiekiem, albuminami, eGFR, Hb, cholesterolem w lipoproteinach o niskiej gęstości oraz licznymi lekami, jako zmiennymi niezależnymi, wykazała tylko istotną statystycznie ujemną korelację niezależnie z albuminami (p<0.0000) i eGFR (p<0.0000). Wnioski: Wyniki te wskazują, że 3 na 4 pacjentów w starszym wieku w czasie rehabilitacji w fazie rekonwalescencji cierpi na przewlekłą zastoinową niewydolnością serca, a odpowiednie odżywianie jest kluczowe w zapobieganiu zwiększania się niewydolności serca w tej grupie ludzi. null
Wprowadzenie: Konieczne jest poszukiwanie prostych w zastosowaniu metod rehabilitacji zwiększających funkcjonalną sprawność oraz samodzielność osób w podeszłym wieku. Cel pracy: Zbadanie wpływu 6-tygodniowcgo programu treningowego o malej intensywności, realizowanego w ramach dziennej rehabilitacji geriatrycznej, na ocenianą za pomocą prostego toru przeszkód (TP) sprawność fizyczną starszych pacjentów. Materiał i metody: Retrospektywna analiza danych 208 kolejnych pacjentów (średni wiek 73±5,5 lat; 45 mężczyzn) uczestniczących w 6-tygodniowym programie rehabilitacyjnym na geriatrycznym oddziale pobytu dziennego. Program obejmował ćwiczenia ogólnousprawniające, terapię zajęciową, zabiegi fizykalne oraz masaŜ. Na początku i na końcu programu pacjenci pokonywali tor przeszkód, składający się z czterech stacji: l) otwieranie drzwi, 2) siadanie i wstawanie z niskiego fotela, 3) slalom między piłkami, 4) przekracza-nie 3 przeszkód o wzrastającej wysokości. Wyniki przedstawiono w postaci czasu pokonania całego TP oraz łącznej punktacji za wykonanie wszystkich zadań (0-3 punktów za kaŜdy element, w zależności od stopnia poprawności wykonania). Wyniki: Stwierdzono bardzo wysoką korelację pomiędzy czasem pokonania TP a wyraŜonym w punktach stopniem poprawności wykonania poszczególnych prób (r = -0,84 na początku badania i r = -0,81 na końcu badania, p < 0,05). Średni czas pokonania TP w całej grupie poprawił się o 5,5 ±9,68 s (z 45,3 ±2,09 s do 39,8 ±23,05 s, p < 0,0001). Mediana sumy punktów za wykonanie wszystkich stacji zwiększyła się z 9 do 11 punktów; p < 0,0001. Istotną (p < 0,01) poprawę czasu TP i punktacji stwierdzono takŜe w podgrupach wyodrębnionych ze względu na płeć, wiek (< 75 rż i > 75 rż), występowanie choroby niedokrwiennej serca, nadciśnienia tętniczego, niewydolności serca, przebytego udaru mózgu, oraz u pacjentów najmniej sprawnych (czas początkowego TP > górnego kwartyla). W grupie pacjentów najbardziej sprawnych (czas początkowego TP < dolnego kwartyla) czas TP nie uległ skróceniu. Uzyskany stopień poprawy czasu i punktacji u pacjentów najmniej sprawnych był większy (p < 0,0001) niŜ u osób najbardziej sprawnych. Wnioski: Sześciotygodniowy program treningowy o małej intensywności poprawia sprawność funkcjonalną starszych pacjentów, niezależnie od ich wieku, płci oraz współwystępujących chorób układu krąŜenia. Największe korzyści odnoszą pacjenci z najniższym początkowym poziomem sprawności.
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Introduction: The preservation of functional performance and the independence of elderly people is a challenge for rehabilitation today. Aim of the study: We aimed to investigate the effects of a 6-week, low-intensity rehabilitation program on functional fitness, assessed with a simple obstacle test, in elderly subjects.Material and Method: A retrospective analysis of data of 208 patients (mean age 73 ±5.5 yrs; 45 men) participating in a 6-week, ambulatory rehabilitation program for the older adults. The program included calisthenics, occupational and physical therapy, and massage. An obstacle test (OT) consisting of 4 stations (1. opening a door, 2. sitting and standing up from an armchair, 3. slalom, 4. crossing 3 obstacles of increasing height) was performed on admission and at discharge. The results are shown as total time (in seconds) and summarized score (0-3 points for each station).Results: The OT time strongly correlated to the score for the quality of the action (r = -0.84 at baseline and r = -0.81 at the end, p < 0.05). The mean OT time in the entire group improved by 5.5 ±9.68 s (from 45.3 ±2.09 to 39.8 ±23.05 s, p < 0,0001). The median OT score increased from 9 to 11; p < 0.0001. The OT time and the score improved significantly (p < 0.01) in subgroups of patients differing with sex, age (< 75 vs. ≥ 75 yrs), comorbidities (ischemic heart disease, hypertension, heart failure, stroke) and in the subjects with the lowest baseline fitness level (baseline OT time > upper quartile). The improvement in OT time and the score in patients with the lowest fitness level was greater (p < 0.0001) than in the subjects with the highest fitness level (baseline OT time < lower quartile).Conclusion: A six-week, low-intensity rehabilitation training program improves functional fitness of elderly subjects, independently on their age, sex and comorbidities. The biggest benefits were observed in patients with the lowest level of fitness.
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