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PubMed1995

[Special aspects of malnutrition in geriatrics].

In 1992 people aged 65 years and over represented 11.9% (men) and 17.2% (women) of the Swiss population, and in 2000 the average 65-year-old man or woman can expect to live about 12 more years. Old age is characterized by multimorbidity, an accumulation of chronic conditions and diseases, and by social isolation. Multimorbidity and isolation (living alone) are the major risk factors for malnutrition. 30-60% of all persons aged 65 years and over show one or more subnormal nutritional parameters. The unspecific and oligosymptomatic clinical picture of malnutrition in the elderly often hinders an early diagnosis, and malnutrition is often misdiagnosed as "wasting away syndrome" of the old. Thus, the nutritional assessment of the elderly should become a routine diagnostic procedure. Detection of malnutrition involves assessment of nutritional parameters including history (eating habits, appetite), anthropometric measurements (weight, height, body mass index, triceps skinfold, midarm circumference), serum proteins (albumin, transferrin, prealbumin, cholinesterase, retinol binding protein), vitamins (B12, folic acid, B1, B2, B6, C and D), minerals and trace elements (zinc, magnesium, calcium, iron), immunologic skin tests and lymphocyte count. Depending on the history and the clinical symptoms, a selected number of these nutritional parameters are assessed. When assessing the nutritional status of the elderly it is important to define the etiologic factors involved. Thus, treatment of underlying causes and refeeding can be streamlined, so that maximum benefit can be obtained for the quality of life of the elderly.

Aged↗

PubMedDate not supplied

[Use of supportive autogenic training in multiple morbidity in geriatric psychiatry patients].

23 multimorbid, geronto-psychiatric patients, aged 60 years or older, participated in a "supportive" course of autogenic training according to Schultz. Participating in the course an average of 7 +/- 3 weeks, 17 (76%) of the subjects were able to learn the training. In general, subjects reported a better general condition after the training sessions, measured with visual analogue scales (p < 0.001). The psychopathological status improved significantly during the time of the course (BPRS: p < 0.001; GDS: p < 0.001). No significant change was found in the cognitive state (MMSE) and the statements on the "list of complaints" ("Beschwerdenliste"). The global training success was better in the psychopathological less affected than in the more severely ill (BPRS prior r = 0.64, p = 0.001, GDS prior r = 0.46, p < 0.05). No correlation was found between training success and age, number of somatic diseases, number of medication, MMSE and the "Beschwerdenliste". Autogenic training is a useful component in psychotherapeutic and psychiatric therapy for elderly multimorbid in- and outpatients. A half-open group, two therapy sessions per week, reciting the training formulae aloud, a structured, simple setting and co-therapists proved to be worthwhile.

Aged↗

PubMed2026

Height variation independent of known genetic variants and health in later life: a cohort study.

BACKGROUND: Adult-attained height is associated with later-life health, but it reflects both genetic and nongenetic influences. The health implications of height variation not explained by known common height-associated genetic variants remain unclear. OBJECTIVES: This study aimed to examine associations of residual height (height variation independent of known genetic variants) with multiple disease incidence and all-cause mortality in later life. METHODS: In this cohort study of 407,366 adults of European ancestry (aged 40-70 y) in the United Kingdom Biobank (2006-2010), sex- and age-specific genetically predicted height was estimated from 9863 height-associated variants, adjusted for 30 principal components of ancestry. Residual height was calculated as the difference between observed and genetically predicted height. Plasma proteomics (2054 proteins; Olink Explore) were profiled. Deaths and 49 incident diseases were ascertained through national registries. Multivariable Cox models estimated associations of residual height and related proteins with disease incidence and mortality. RESULTS: Higher residual height [mean (standard deviation, SD), 0.0 (4.8)] was associated with more favorable self-reported preadulthood exposures (e.g., later birth years, no maternal smoking around birth, being breastfed as an infant, no adoption experience, and lower childhood adversity scores) and lower hazard ratios (HRs) of 32 out of 49 diseases (median follow-up = ∼12.5 y). Using participants with residual height within ±0.5 SDs from the mean as reference, those with residual height < -2 SDs had higher adjusted HRs of mortality [1.61; 95% confidence interval (CI): 1.50, 1.72], multimorbidity (1.28; 95% CI: 1.12, 1.46), cardiovascular disease (1.45; 95% CI: 1.32, 1.60), psychiatric/neurological disease (1.38; 95% CI: 1.28, 1.48), and other disease categories (e.g., diabetes, digestive, and musculoskeletal diseases). In contrast, higher genetically predicted height was associated with a higher incidence of 19 diseases, including subtypes of cancer, non-atherosclerotic cardiovascular diseases, and musculoskeletal diseases, as well as higher all-cause mortality. We identified 806 plasma proteins related to inflammation, immune response, and autophagy via tumor necrosis factor, Nuclear factor-kappa B, phosphoinositide-3 kinase/protein kinase B, and Janus kinase/signal transducer and activator of transcription signaling pathways, which were associated with residual height and multiple diseases and mortality. CONCLUSIONS: Higher residual height is associated with lower disease incidence and mortality, with associations that are distinct from those for genetically predicted height.

Humans↗

PubMed2005

Conventional microsurgical endarterectomy.

In the 1990's, carotid endarterectomy (CEA) has matured to a widely performed, standard intervention with well defined successive steps. The key feature of microsurgical CEA is the use of the operating microscope for magnification of the surgical field and microsuture of the arteriotomy. Further measures contributing to the success of microsurgical CEA include intraoperative monitoring of cerebral blood flow, selective shunt placement and neuroprotection during arterial cross-clamping. In experienced hands, the operation is not difficult and goes without complication in the great majority of patients. An overall complication rate of 6-8% combining mortality, major morbidity and minor morbidity is acceptable in view of the often multimorbid patients undergoing the operation. However, a rate of major morbidity/mortality not exceeding 1-2% is a realistic goal for microsurgical CEA. On the long-term, the rate of restenosis needing treatment should not exceed 1-2%. To preserve objectivity and quality control of CEA, the clinical results should be assessed independently of the surgeon by a neutral observer, ideally a neurologist.

Carotid Stenosis↗

PubMed1990

[Incidence of complications and early mortality in surgical management of coxal femoral fractures].

In a retrospective study the clinical course of 393 patients treated for proximal femur fractures is evaluated. Intraoperative complications occurred in 2% whereas early complications related to the operative procedure were seen in 19.8% and unspecific complications in 36.8%. Factor analysis proved the following items to be associated with a high risk of complication: age (p less than 0.01), preexistent diseases, kind of operative procedure (p less than 0.05) and the lapse of time between trauma and operation. The extraordinary high incidence of unspecific complications is explained by the prevailing proportion of elderly patients with a corresponding multimorbidity. A decrease in complications and lethality can be achieved by early operative treatment. With regard to the necessity of early mobilization we prefer a hemiarthroplasty in fractures of the femoral neck for elderly patients. Stable pertrochanteric fractures are treated by a dynamic hip screw whereas instable pertrochanteric fractures are an indication for Ender nailing.

Aged↗

PubMed1987

[Processes in perioperative risk--from the viewpoint of the surgeon].

The perioperative risk largely depends on three factors: a) the patient with regard to his physical condition (multimorbidity) in relation to age; b) the underlying disease (benign, malignant; chronic, acute); c) the required operative treatment with respect to time (elective or emergency) extent and radicality (curative, palliative). Knowledge of general risk or of separate risk factors for a given situation resulting from critical analysis of larger collectives has to guide any individual decision. Pre- and postoperative measures with interdisciplinary participation have to improve or avoid risk factors in order to achieve better overall results.

Esophageal Neoplasms↗

PubMed1987

[Cardiovascular operations in patients with perioperative reduced kidney function].

Acute renal failure (ARF) following cardiovascular surgery represents a serious complication in view of the multimorbidity in such patients. 8 out of 16 patients with ARF requiring hemodialysis after cardiac surgery died; the degree of preoperative renal insufficiency could not be recognized as predisposing factor. 17 out of 21 patients with ARF following aortic vascular surgery died; the severity of the preoperative disease seems to be of prognostic value. Open heart surgery had to be performed in 9 patients out of the chronic dialysis program; perioperative complications did not occur, suggesting that cardiovascular operations can be performed without increased risk in this patient group.

Acute Kidney Injury↗

PubMed1985

[Value of EEG monitoring in operations of the supra-aortic arteries].

Experiences with 207 patients operated under EEG monitoring have shown changes of EEG in 20% which made the application of an intraluminal shunt necessary. The majority of these patients had multimorbidity of supraaortic branches. Earliest changes could be seen after seven seconds of clamping time. In these cases an operation of the carotic artery should be avoided and an extra-intracranial bypass is recommended.

Brain Ischemia↗

PubMed1994

[The clinical course of surgically managed para-articular femoral fractures in geriatric surgery].

246 patients (average 82.4 years) with proximal femur fractures treated with bipolar endoprosthesis, sliding lag screw or Ender nailing, related to the fracture type were analysed in a retrospective study. Pre-existing diseases, duration of operation, postoperative complications, transfusions, hospital stay, mobility achieved and mortality were noted. In result we found a high multimorbidity related to the age, the highest requirement of transfusions in patients undergoing Ender nailing, a long period to achieve postoperative mobility, a long hospital stay and increasing mortality with average age and average hospital stay.

Aged↗

PubMed1994

[Mortality in proximal femur fractures in elderly people].

Retrospectively we studied 30 patients with fracture of the proximal femur, who were no less than 75 years old and who died during their hospitalization in the Department of Surgery of the Medical University of Lübeck from 1986 to 1991. Mortality was 6% (30/498). The mean time of death was the 13th day after administration. Nineteen patients have had 1, 7 patients 2 serious preexisting diseases. Twelve patients developed 1, 8 patients 2, and 1 patient 3 serious complications. The high amount of patients (30%, 9/30) who could not be operated reflects the great influence of the trauma itself on the mortality of the old multimorbid surgical patient. Intra-operative complications were seldom (1 pulmonary embolism), postoperative complications, however, were the limiting factors of the course of illness and are associated with a poor outcome.

Aged↗

PubMed1995

[Experiences with plate osteosynthesis in treatment of peri- and sub-prosthetic femoral fractures].

Plate-osteosynthesis proves to be an established procedure in our department for treatment of fractures of the femur in patients older than 70 years with total hip replacement even when loosened. It offers the advantages of comparably low aggressive standard operation techniques and acceptable success rates. This treatment allows for short preoperative period of the patients with their typical multimorbidity in many traumatological departments. In younger patients with symptomatical loosening, simultaneous exchange of the hip prosthesis should always be considered. Thus, individual therapy concept including the specific fracture type, general condition and age must be followed for each patient.

Aged↗

PubMed1997

[Primary radiotherapy of laryngeal carcinoma. An analysis of the therapeutic results and of the the relapse behavior in 283 patients].

PURPOSE: In the treatment of laryngeal carcinoma definitive radiotherapy results in a similar outcome as surgical treatment in the early stages with a lower morbidity rate and good functional results. In fact no randomized studies exist, so far, and the optimal treatment concept for the different stages is not well defined. The following study analyses retrospectively the treatment results and the recurrence data in patients with a squamous cell carcinoma of the larynx treated with definitive radiotherapy. PATIENTS AND METHOD: Two hundreds and eighty-three patients with carcinoma of the larynx were treated with radiation therapy in the department of radiology of the LMU München between September 1971 and June 1986. Twenty-six patients (9.2%) were female and 257 (73.1%) male. The median age was 68.5 years, respectively 70 years. All patients had a histologically confirmed squamous cell carcinoma of the larynx. No true subglottic cases were observed. Forty-one (14.5%) tumors were localized supraglottically, 207 (73.1%) glottically. Thirty-five patients had a T4 tumor with glottic and supraglottic involvement. In 147 patients the histopathological grading was evaluable: 32 tumors were classified as G1, 95 as G2, 15 as G3 and 5 as G4. According to the UICC classification of 1979 25 patients had a carcinoma in situ (Tis), 93 patients had a stage T1, 90 stage T2, 40 stage T3 and 35 stage T4. Two hundreds and thirty-three of 283 (82.3%) had no lymph node involvement. In 50 patients clinically a lymph node involvement was observed. 22 patients had a stage N1, 5 patients stage N2 and 23 patients stage N3. An external beam radiation mostly with cobalt-60 was performed with a mean dose of 61.9 Gy. RESULTS: The 5-years relapse-free survival for the whole group was 61.7%. The probability for "no evidence of disease" (NED) depended on tumor stage and localisation (glottic tumors: Tis/T1 90.5%: T2 59.4%: T3 39.6%: [5-year NED]; supraglottic tumors T1 64.2%: T2/3 28.6%: T4/N3 24.7% [3-year NED]). Other significant prognostic factors besides T-stage were N-stage (NO vs. N1-3: 3-year recurrence-free survival 68% vs. 37.2%, p < 0.001) and histopathologic grading (G1 vs. G3/4: 3-year recurrence-free survival 74% vs. 37.1%, p < 0.01). One hundred and twenty-two (43.1%) patients had a recurrence, which occurred in 75.4% local, in 12.3% loco regional, in 8.2%, with distant metastases and 4.1% combined. In 50 patients with a recurrent disease a salvage therapy was carried out. Thereby 17 patients achieved a complete response. CONCLUSION: Even for the here described negatively selected patient group with a high median age and multimorbidity, good local control rates could be achieved especially in early stages with definitive radiation therapy. In more advanced stages even in elderly patients a combined surgical-radiotherapeutic treatment should be performed.

Aged↗

PubMed2004

Background morbidity of headache in an adult general population. Results of the Austrian SERMO (Self-Reported Morbidity) study.

STUDY OBJECTIVE: To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations. DESIGN: Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about. SETTING: The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population. PARTICIPANTS: The study population consisted of 7,162 Austrian people over 15 years of age. RESULTS: About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001). CONCLUSIONS: Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

Adolescent↗

PubMed2003

Predictors of falls in the elderly by location.

BACKGROUND AND AIMS: In the elderly, balance and walking impairments are assumed to play an important role in causing falls. We have assessed prospectively the predictive ability of health, function and balance variables regarding falls and their location. METHODS: Falls which occurred during one year in a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community were recorded and related to baseline registrations of health, medication and tests of walking and balance. RESULTS: In all, 155 women (50.5%) reported 308 falls. Outdoor falls were significantly more frequent than indoor falls (57.5 vs 42.5%). The variables having had a fall before the start of the study, osteoporosis, hypertension, feeling depressed, unable to climb 40 cm high steps and walking slowly, all independently predicted a higher number of falls overall. Regarding fall location, having experienced a fall before study start was associated with more falls indoors as well as outdoors. Vision impairment, symptoms of depression, a faster comfortable walking speed, and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure. A slower comfortable walking speed, a higher amplitude of the center of pressure movements in the frontal plane, a poorer score on the Timed Up & Go test, multimorbidity, poor cognition and hypertension were independent risk factors for indoor falls. Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study. CONCLUSIONS: The findings of this study suggest that risk factors for indoor and outdoor falls are different. Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information.

Accidental Falls↗

PubMed1997

Morbidity and health-related quality of life among ambulant elderly citizens.

Health-related quality of life (HRQL) was analyzed in relation to 16 different diagnoses common for ambulant, community living 76-year-old urban citizens participating in the longitudinal population study of elderly in Göteborg (H 70), Sweden. HRQL of the total sample was good, but was impaired by illness, mostly in the form of anginal pain, urinary incontinence, locomotor and mental disorders. The HRQL of those suffering from e.g. chronic lung disorders or under treatment for hypertension or cancer, however, seemed to be little influenced. Sleep was impaired regardless of being ill or healthy, except for anginal pain, upper extremity disorders and back pain which had a significantly detrimental impact on sleep. The degree of female complaints surpassed those of men for pain, emotions, sleep and mobility, and for household activities and hobbies. Within the separate diagnostic groups, however, gender differences were few. Generally, HRQL decreased with multimorbidity. In the emotional and social dimensions, however, HRQL was very little influenced until health was much impaired (reaching 4 or more diagnoses). The studied diagnoses did not explain more than up to 1/3 of the QL decrease, thus suggesting that factors other than health have an impact or that ill health is considered an acceptable component of aging. However, most of the diagnoses seemed to cause much distress in common daily life, especially anginal pain, urinary incontinence, locomotor problems, visual impairment, and mental disorders.

Aged↗

PubMed2001

[Preoperative risk assessment and perioperative management of HIV-infected patients].

PROBLEM: Due to their impaired immune function, unusual multimorbidity, and extensive concomitant medication HIV-infected patients impose special and specific demands on those who deal with their perioperative care. PREOPERATIVE ASSESSMENT: Beside standardized diagnostic and therapeutic preparations the preoperative knowledge, quantification, and treatment of HIV-associated opportunistic disorders and chronic organ damage are of particular importance. This requires an extended problem-orientated work-up. Furthermore, antiretroviral medication may interact with perioperatively administered pharmaceutics and lead to hardly foreseeable synergistic and antagonistic adverse effects. In contrast, "drug holidays" favor the development of HIV drug resistance. OPERATIVE MANAGEMENT: Anesthetic and surgical procedures basically depend on the underlying indication and consequently follow common principles. Laparoscopic techniques do not have any specific advantage in HIV-infected subjects. PERIOPERATIVE MORBIDITY: During their postoperative course, HIV-infected patients have to be more often admitted to intensive care unit and kept on artificial respiration unplannedly. Perioperative morbidity of HIV-infected patients increases with the stage of their disease. It is, however, not significantly elevated compared to that of HIV-negative subjects in similar preoperative health condition.

Anti-HIV Agents↗

PubMed2001

[Long-term results of ultrasound-guided ethanol injections in patients with autonomous thyroid nodules and hyperthyroidism].

AIM: The aim of this study was to evaluate the long-term efficacy of treatment of autonomous thyroid nodules with percutaneous ethanol injection under ultrasound guidance. PATIENTS AND METHODS: In a period of 56 months, 20 patients (13 women and seven men, mean age 67.5 +/- 12.3 years) with autonomous toxic thyroid nodules were treated with percutaneous ethanol injection under ultrasound guidance. Ethanol was injected percutaneously on an outpatient basis for a mean of 2.85 +/- 1.1 injections per patient, mainly depending on the nodule's size. The mean volume of injected ethanol was 4.63 ml. The median follow-up time was 763 +/- 452 days. RESULTS: The injection was well tolerated by the patients, a mild to moderate local pain occurred in 21% of sessions. Undesirable effects were not serious and only transient and receded. Major complications like transient dysphonia or common jugular vein thrombosis have not been observed. After a mean time of 50 +/- 23 days an euthyroid state with normalized basal levels of TSH, fT3 and fT4 was maintained in 16 patients (80%), while four patients (20%) did not completely respond to the treatment. In this patients a therapy with methimazole was carried out. The rate of reduction in the nodular volume was 60.8%. CONCLUSION: The percutaneous ethanol injection appears to be an effective, harmless and low-cost alternative treatment of autonomous thyroid nodules, especially in older and multimorbid patients.

Adenoma↗

PubMed1997

Iopentol (Imagopaque) in vascular procedures. A multi-centre monitoring trial assessing adverse events and diagnostic information--results from 3,587 patients in Germany.

The aims of the present open, non-comparative survey were to study the safety and efficacy of iopentol (Imagopaque, Nycomed Imaging AS, Oslo, Norway) in a large patient group. In a series of German centres, 3,587 patients underwent various contrast-enhanced examinations with iopentol. The most frequent examinations were computed tomography (CT) (1,740), phlebography (462), and digital subtraction angiography (DSA) (493). Only 82 patients (2.3%) experienced one or more adverse events. Sixty-one (1.7%) of these events were possibly or probably caused by the contrast medium. A total of 111 adverse events were registered, 54 of mild, 42 of moderate and 12 of strong intensity, and 51 events required treatment. The most frequent adverse events were nausea (34), erythema (14) urticaria (9), taste sensation (6), circulatory reactions (5) and angina pectoris (5). The frequencies of adverse events were 2.9% in CT, 2.0% in DSA, 2.0% in phlebography, 1.6% in cardioangiography, and 0.4% in urography. Patients with arteriosclerosis, an earlier contrast medium reaction, multimorbidity or age over 70 years had a statistically significantly higher risk of experiencing an adverse event. Patient tolerance was very good; the mean score was 83% on a visual analogue scale (VAS) ranging from extremely bad (0%) to extremely good (100%). Efficacy, as measured on VAS, was determined. Technical quality was scored as 80%, contrast enhancement within the vessels as 80% and delineation of lesions as 79%. The results from this large patient population confirms the experience from clinical practice that iopentol is a safe, well tolerated and efficient contrast medium.

Angiography, Digital Subtraction↗