Journal of Gerontology and Geriatrics

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Open AccessCase Report

Atypical Presentation of Eosinophilic Granulomatosis - Typical Presentation in an Ageing Population?

by Catriona Reddin, Kevin Kitt, Bernadette Lynch and Eamon Mulkerrin

J. Gerontol. Geriatr. 2020, 68(3), 194-196; https://doi.org/10.36150/2499-6564-411 - 15 Jul 2020

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Severe systemic vasculitis presenting in an 80 year old female involving a presentation with recurrent pyrexia, eosinophilia, mononeuritis multiplex against a background of late onset asthma, consistent with eosinophilic vasculitis with angiitis is described. Despite appropriate management with resolution of systemic symptoms, she [...] Read more.

Severe systemic vasculitis presenting in an 80 year old female involving a presentation with recurrent pyrexia, eosinophilia, mononeuritis multiplex against a background of late onset asthma, consistent with eosinophilic vasculitis with angiitis is described. Despite appropriate management with resolution of systemic symptoms, she failed to return to baseline functionality. Systemic vasculitis is rare in this population cohort, but it is important to consider as it is treatable albeit with a guarded outlook for full neurological recovery. Full article

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Open AccessCase Report

Unusual Case of Rosacea Fulminans in Older Man

by Adrian D. Meehan, Helena Pellrud and Anna Josefson

J. Gerontol. Geriatr. 2020, 68(3), 190-193; https://doi.org/10.36150/2499-6564-390 - 15 Jul 2020

Cited by 1 | Viewed by 289

Abstract

Rosacea fulminans (RF) is characterised by the abrupt onset of discomforting and consolidating pustules and nodules, oedema, cysts and erythema. The condition is considered rare, even rarer in men. Controversy exists whether RF should be categorised as rosacea. The aetiopathogenesis of RF remains [...] Read more.

Rosacea fulminans (RF) is characterised by the abrupt onset of discomforting and consolidating pustules and nodules, oedema, cysts and erythema. The condition is considered rare, even rarer in men. Controversy exists whether RF should be categorised as rosacea. The aetiopathogenesis of RF remains largely unknown. We present a case of an 87-yr-old man with no previous history of rosacea or acne, admitted for a suspected systemic bacterial infection and who rapidly developed tender ocular, facial and extrafacial lesions. The patient had subfebrile temperatures, leukocytosis and moderate anaemia, but also general fatigue. The features of gender, location and extent of lesions, and biochemical response are all atypical with regards RF. The condition was successfully treated with a combination of antibiotics and oral corticosteroids. Specific management guidelines regarding RF are yet to be established, further warranting the need for continued research to determine RF’s aetiology, natural course and its optimal treatment. Full article

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Open AccessCase Report

Pitfalls in Managing Depression in Older Persons - Electroconvulsive Therapy Retains a Vital Role?

by Kevin Kitt, Sabina Fahy, Anne Doherty, Shaun O’keeffe, Aoife Murray and Eamon Mulkerrin

J. Gerontol. Geriatr. 2020, 68(3), 188-189; https://doi.org/10.36150/2499-6564-400 - 15 Jul 2020

Cited by 1 | Viewed by 129

Abstract

A 73 year old bachelor had multiple presentations to secondary and tertiary care facilities. His symptoms were varied, including headache, falls, marked weight loss and dysarthria. He was investigated as a possible stroke but with subsequent major functional decline. Following extensive investigations and [...] Read more.

A 73 year old bachelor had multiple presentations to secondary and tertiary care facilities. His symptoms were varied, including headache, falls, marked weight loss and dysarthria. He was investigated as a possible stroke but with subsequent major functional decline. Following extensive investigations and after four months in residential care, major depressive disorder (MDD) was diagnosed. A physical diagnostic label, side effects of, and poor response to, medications complicated the clinical course. Ultimately he was successfully treated with electroconvulsive therapy (ECT). Despite response to ECT, the protracted course contributed to the institutionalisation of the patient. This case highlights the importance of early, accurate diagnosis and effective treatment of depression in older patients. Full article

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Open AccessCase Report

Unusual Presentation of Bilateral Inferior Shoulder Dislocation Following a Trivial Fall in an Elderly Female: A Case Report

by Umesh Jayarajah, Chamikara Palkumbura, Arulprashanth Arulanantham, Aadil Faleel and Rukshan Sooriyarachchi

J. Gerontol. Geriatr. 2020, 68(3), 184-187; https://doi.org/10.36150/2499-6564-431 - 15 Jul 2020

Cited by 1 | Viewed by 241

Abstract

Background. Bilateral inferior dislocation of the shoulder joint is infrequent. This usually results following significant impact from forceful hyperabduction or direct axial loading in the abducted position. We describe the case of bilateral inferior shoulder dislocation following a trivial fall on outstretched arms [...] Read more.

Background. Bilateral inferior dislocation of the shoulder joint is infrequent. This usually results following significant impact from forceful hyperabduction or direct axial loading in the abducted position. We describe the case of bilateral inferior shoulder dislocation following a trivial fall on outstretched arms in an elderly female. A 75-year-old female who was on treatment for type 2 diabetes and hypertension, presented to the emergency department with painful inability to move both shoulders following a trivial fall. Her both shoulders were fixed at the 90 degree abducted position, the acromion processes were prominently palpable and both humeral heads were palpable in the axillae. X-ray confirmed the diagnosis of bilateral inferior dislocation of the shoulder joint. Closed reduction was successfully achieved using a single step levering manoeuvre with one hand applying traction at 90 degree abduction and the other hand levering the humeral head towards the glenoid. Post-procedure was uneventful with satisfactory functional outcomes. We described an unusual presentation of bilateral inferior dislocation of the shoulder joint following a trivial fall in an elderly female. The single step levering manoeuvre was successful in achieving reduction. Full article

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Open AccessReview

Falls in the Elderly: A Major Public Health Challenge with Some Encouraging Developments. A Mini Review

by Thomas Mattig

J. Gerontol. Geriatr. 2020, 68(3), 180-183; https://doi.org/10.36150/2499-6564-428 - 15 Jul 2020

Cited by 4 | Viewed by 798

Abstract

Falls are among the major causes of morbidity and mortality in the elderly. Well-known risk factors are reduced physical activity, obstacles in the environment, balance and gait disorders, depression and neurological diseases. The gravity of trauma related to falls has been studied extensively, [...] Read more.

Falls are among the major causes of morbidity and mortality in the elderly. Well-known risk factors are reduced physical activity, obstacles in the environment, balance and gait disorders, depression and neurological diseases. The gravity of trauma related to falls has been studied extensively, the main predictors of a harmful development within 12 months of a fall being dementia, old age, the level of dependency and restricted mobility. Efficient prevention interventions do exist, especially exercise-based interventions and assessment and modification of the home environment. A shift in the trend of falls among the elderly has indeed been reported in several Western countries: since the 1990s, rates of fall-related injuries have declined in countries such as Finland, Sweden, Canada and Switzerland. Full article

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Open AccessArticle

Factors Influencing Stroke Patient Adherence to Physical Activity: A Systematic Review

by Fairuz Tasnim Dahlan Tabah, Fatimah Sham, Fatin Nadzirah Zakaria, Nina Keterina Hashim and Razif Dasiman

J. Gerontol. Geriatr. 2020, 68(3), 174-179; https://doi.org/10.36150/2499-6564-389 - 15 Jul 2020

Cited by 13 | Viewed by 1040

Abstract

Background. Stroke leads to physical problems, commonly paralysis, cognitive, sensory, perceptual and communication problem. Physical inactivity among stroke patients is high in the acute and chronic stage. The adherence of them towards exercise and rehabilitation therapy declined after discharge, thus lead to poor [...] Read more.

Background. Stroke leads to physical problems, commonly paralysis, cognitive, sensory, perceptual and communication problem. Physical inactivity among stroke patients is high in the acute and chronic stage. The adherence of them towards exercise and rehabilitation therapy declined after discharge, thus lead to poor outcomes of recovery. Objective. To review the literature on the factors that influence stroke patients’ adherence to physical activity (PA) and to identify the intrapersonal, interpersonal and environmental factors that affect the adherence of stroke patients’ towards PA. Methods. Four electronic databases (EBSCO: CINAHL Plus with Full text, Willey Online Library, and ScienceDirect) from 2008 to 2019 reporting any factors that affecting stroke people participate in the physical activity. The methodological quality of the studies was appraised using McMaster critical appraisal tools and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for online searching strategy. Results. 10 articles met the inclusion criteria. The intrapersonal factors include physical impairment, balance, and mobility, fear of fall, aging, forgetful, reduce in self-efficacy and exercise benefits. Interpersonal factors were social support, lack of attendant and support from healthcare, physiotherapist or gym trainer. Economic factors, transportation, and exercise facility were the environmental factors that influence stroke patient adherence to PA. Conclusions. These three factors were interrelated to change the individual perception towards exercise among stroke patients. This review enables the development of an intervention to improve participation in PA among stroke patients. Full article

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Open AccessReview

Sexual Differences Regarding Alzheimer’s Disease: A Narrative Review

by Immacolata Ambrosino, Marco Vacante, Cecilia Politi, Elena Barbagelata and Tiziana Ciarambino

J. Gerontol. Geriatr. 2020, 68(3), 168-173; https://doi.org/10.36150/2499-6564-376 - 15 Jul 2020

Cited by 3 | Viewed by 285

Abstract

Background. Actually, there are about 5.2 million people with Alzheimer’s dementia (AD) in the USA, 3.3 million are women and 1.9 million are men. Objective. We will find out the status on the Alzheimer disease in relation to the brain structure, diagnosis, symptoms [...] Read more.

Background. Actually, there are about 5.2 million people with Alzheimer’s dementia (AD) in the USA, 3.3 million are women and 1.9 million are men. Objective. We will find out the status on the Alzheimer disease in relation to the brain structure, diagnosis, symptoms and therapy by gender. We analyzed, in this narrative review, the literature between 1989-2019 published on the Pubmed about Alzheimer disease and gender. The keywords were: Alzheimer disease and sex differences. Conclusions. Women over 80 years have a higher incidence of AD than men. Women have a faster age-related decline and are more likely to respond to donepezil and rivastigmina leading to less cognitive decline. At more advanced ages, women incurred greater costs than men of the same age. Woman gender could be a risk factor for evolution of AD. We will emphasize the importance of considering sex as a biological variable in the design of preclinical and clinical studies that investigate underlying pathologies or response to pharmacological interventions in AD. Full article

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Open AccessArticle

Risk Factors of Intraoperative and 24-Hour Postoperative Cardiac Arrest in Geriatric Patients in Non-Cardiac Surgery

by Kanlayanee Yongyukantorn and Maliwan Oofuvong

J. Gerontol. Geriatr. 2020, 68(3), 159-167; https://doi.org/10.36150/2499-6564-381 - 15 Jul 2020

Cited by 2 | Viewed by 294

Abstract

Background & aim. The study aimed to identify preventable risk factors for the occurrence of intraoperative and 24-hour postoperative cardiac arrest in geriatric patients. Methods. This was a matched case-control study. Patients aged 65 and older who experienced intraoperative and 24-hour postoperative cardiac [...] Read more.

Background & aim. The study aimed to identify preventable risk factors for the occurrence of intraoperative and 24-hour postoperative cardiac arrest in geriatric patients. Methods. This was a matched case-control study. Patients aged 65 and older who experienced intraoperative and 24-hour postoperative cardiac arrest between 2011 and 2018 were consecutively recruited into the case group. Cases were matched with controls by sex, age range, and in the same year of surgery in the ratio of 1:3. The outcome was the occurrence of intraoperative and 24-hour postoperative cardiac arrest. Univariate and multivariate logistic regression analyses were carried out to identify factor related outcomes. Results. From a total of 20,024 geriatric patients, 98 cases and 294 controls were recruited. The risk factors of intraoperative and 24-hour postoperative cardiac arrest were ASA classifications 3 (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.24-12.62) and 4 (OR 8.46, 95% CI 2.15-33.36) compared to ASA classification 2, aortic surgery (OR 16.86, 95% CI 2.9-97.99) compared to trunk and perineal surgery, potassium imbalance (OR 2.71, 95% CI 1.02-7.22), and receiving preoperative benzodiazepine (OR 3.92, 95% CI 1.36-11.28). Regional anesthesia (OR 0.18, 95% CI 0.04-0.83) and propofol (OR 0.09, 95% CI 0.03-0.24) were found to be protective factors. Conclusions. The study found that potassium imbalance might be a preventable risk factor. If feasible, performing regional anesthesia while avoiding preoperative benzodiazepine is recommended. Full article

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Open AccessArticle

Prognostic Factors in Older Patients Admitted in ICU with Diagnosis of Abdominal Sepsis (Sepsis-3 Criteria)

by Francesca Remelli, Alberto Fogagnolo, Amedeo Zurlo, Carlo Alberto Volta, Savino Spadaro and Stefano Volpato

J. Gerontol. Geriatr. 2020, 68(3), 152-158; https://doi.org/10.36150/2499-6564-391 - 15 Jul 2020

Cited by 2 | Viewed by 258

Abstract

Background & aims. In septic older patients, hospitalization in Intensive Care Unit (ICU) is often associated with unfavourable outcomes. The aim of this study was to estimate the prevalence of geriatric age in patients admitted to ICU for abdominal sepsis and to investigate [...] Read more.

Background & aims. In septic older patients, hospitalization in Intensive Care Unit (ICU) is often associated with unfavourable outcomes. The aim of this study was to estimate the prevalence of geriatric age in patients admitted to ICU for abdominal sepsis and to investigate predictors of mortality, including quickSOFA, a recent prognostic index proposed for septic patients. Methods. Prospective observational study on patients admitted to ICU of St. Anna Hospital (Ferrara) between January and July 2016 with the following inclusion criteria: 1) adults (18 years); 2) abdominal infection treated with surgically techniques; 3) admission to ICU. Demographic, clinical data and survival at 30 and 90-day were collected for each patient. Results. Thirty patients were enrolled, and the majority of geriatric patients (80% ≥ 65 years and 53% ≥ 75 years). The 30 and 90-day mortality was 17 and 37%, respectively. Almost all deaths occurred in older age (mortality rate of 42%). SOFA (Sepsis Related Organ Failure Assessment) score was the prognostic index most frequently associated with exitus at 30 (AUC = 0.702) and 90 days (AUC = 0.730). quickSOFA was only related to early mortality (AUC = 0.640). Conclusions. Our data confirm the high geriatric prevalence among patients admitted to ICU for abdominal sepsis, underlining the advanced age as a negative prognostic factor. SOFA score appears a reliable prognostic indicator of mortality, also in older population, while quickSOFA proved effective only for short-term mortality. Full article

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Open AccessArticle

Multidimensional Assessment of Caregiver Burden in Home-Based Nursing: A Cross-Sectional Study

by Ang Yi Han, Muhd Nurhasanuddin Abdullah Kelali and Hanif Abdul Rahman

J. Gerontol. Geriatr. 2020, 68(3), 146-151; https://doi.org/10.36150/2499-6564-403 - 15 Jul 2020

Cited by 1 | Viewed by 289

Abstract

Background. Caregivers experience a number of challenges when caring for a chronically ill patient which can affect their physical, emotional and psychological health. Aim. To assess caregiver burden and its relationship to health-related quality of life among primary caregivers of patients with long-term [...] Read more.

Background. Caregivers experience a number of challenges when caring for a chronically ill patient which can affect their physical, emotional and psychological health. Aim. To assess caregiver burden and its relationship to health-related quality of life among primary caregivers of patients with long-term illness in the community. Methods. A cross-sectional study using caregiver burden scale and SF-36 Survey on thirty-two caregivers of patients with long-term illness under a community health centre in Brunei from January to March 2019. Findings. Caregiver burden was highest for general strain, isolation and disappointment. Increased age of caregiver was significantly associated with reduced physical functioning. Male caregivers had significantly higher role functioning while female caregivers had significantly higher social functioning role. Increased caregiver burden showed decreased overall health-related quality of life. Caregiver burden should not be disregarded in patient treatment plan. Conclusions. Clinicians and relevant authorities should collaborate care plans with primary caregivers accounting for both patient and caregiver well-being. More detailed qualitative studies should be done to provide a better insight on caregiver burden. Full article

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Open AccessArticle

A Multicentre Survey on the Sociodemographic Characteristics of Italian Elderly Inmates

by Graziamaria Corbi, Carlo Alberto Romano, Carlo Pietro Campobasso, Anna Convertini, Liliana Dassisti, Antonella Rita Fanizza, Federica Misceo, Luisa Ravagnani, Luigi Ferrannini and Ignazio Grattagliano

J. Gerontol. Geriatr. 2020, 68(3), 136-145; https://doi.org/10.36150/2499-6564-409 - 15 Jul 2020

Cited by 2 | Viewed by 202

Abstract

Background & aim. In 2017, Italian inmates 60-69 years old were 3700, while 776 had an age >=70 years. This article aimed to analyse the socio-demographic characteristics and types of crimes committed by elderly subjects restricted in different Italian prisons. Methods. A survey [...] Read more.

Background & aim. In 2017, Italian inmates 60-69 years old were 3700, while 776 had an age >=70 years. This article aimed to analyse the socio-demographic characteristics and types of crimes committed by elderly subjects restricted in different Italian prisons. Methods. A survey has been conducted in 8 penitentiary institutes: 4 located in Lombardy, and 4 in Apulia. The participation was anonymous and voluntary. By using a standardised format, age, gender, nationality, marital status, last occupation, type of crime, and duration of the punishment were assessed. In the case of previous convictions, additional data were also collected. All records were analysed as aggregates to guarantee privacy preservation. Results. The population was mainly represented by males (93.6%), married or living with a partner (46.8%). The most prevalent crimes committed by the elderlies belongs to the category against the property (33.1%) followed soon after by those against the person (27.7%), other offences (14%), drug-related (13.8%) and mafia-type crimes (11.7%). The Southern inmates were more frequently responsible for crimes against the person (38%), while property crimes (61%) were more recurrent in the Northern inmates. Sixty-four prisoners (68.8%) were already found guilty in the past for other misconducts. The Northern inmates were more frequently recidivist, with a higher number of previous convictions (p = 0.010) and detentions (p = 0.012) compared to the Southern prisoners. Conclusions. Committing crimes in older age is strongly different from being a criminal in young or adult age, especially for the complexity that per se characterizes the older population. Full article

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Open AccessArticle

Sarcopenia Prevalence and Its Correlations with Age-Related Disorders Among Community-Dwelling Palestinian Older Adults

by Manal Badrasawi, Alaa Jarradat, Zaheera Khodour, Razan Lahaleh and Alma Irshaied

J. Gerontol. Geriatr. 2020, 68(3), 126-135; https://doi.org/10.36150/2499-6564-377 - 15 Jul 2020

Cited by 5 | Viewed by 247

Abstract

Background & aims. Sarcopenia is an age-related disorder characterized by gradual loss of muscle mass and strength. It has considerable prevalence and health implications among older adults. This study aims to determine the prevalence of Sarcopenia and its correlation with age-related disorders among [...] Read more.

Background & aims. Sarcopenia is an age-related disorder characterized by gradual loss of muscle mass and strength. It has considerable prevalence and health implications among older adults. This study aims to determine the prevalence of Sarcopenia and its correlation with age-related disorders among community-dwelling older adults in two rural areas in Hebron city, Palestine. Methods. A cross-sectional survey design was utilized to analyze data collected from 145 participants (72 males and 78 females) aged ≥ 60 years old. The EWGSOP criteria were used to define Sarcopenia, and the anthropometric measurements, body composition and Mini-Nutritional Assessment were used to assess participants’ nutrition status. The functional status assessment was done based on daily living activities and instrumental activity of daily living; the cognitive function was assessed using the validated Arabic version of MoCA-B; and screening for depressive symptoms was done using the Arabic version of GDS-15. Results. Sarcopenia prevalence was 26.9%, significantly higher among men 35.7% compared to women 18.7%. Sarcopenia was associated with higher BMI, lower cognitive function, lower functional status, and a higher score of depressive symptoms (p < 0.05). Conclusions. Sarcopenia has a considerable prevalence among the study sample, and it is associated with nutritional status, impaired functional status and cognitive status. The study recommends further research utilizing different study designs (quantitative and qualitative) to determine the prevalence of Sarcopenia, causes and risk factors in other areas of Palestine. Full article

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Open AccessArticle

Prevalence of Frailty in Surgical Older Patients and Its Impact on Assisted Discharge

by Silvia Ronchi, Matteo Cesari, Emanuela Racaniello, Elena De Rosa and Roberto Accardi

J. Gerontol. Geriatr. 2020, 68(3), 123-125; https://doi.org/10.36150/2499-6564-393 - 15 Jul 2020

Cited by 2 | Viewed by 196

Abstract

Background & aim. An increasing number of older persons is today undergoing emergency and elective surgical procedures. Frailty is a highly prevalent condition and a predictor of postoperative adverse outcomes. This study is aimed at measuring the prevalence of frailty among older persons [...] Read more.

Background & aim. An increasing number of older persons is today undergoing emergency and elective surgical procedures. Frailty is a highly prevalent condition and a predictor of postoperative adverse outcomes. This study is aimed at measuring the prevalence of frailty among older persons awaiting for surgical procedures, and the activation of services supporting protected discharge from the hospital in individuals with high vulnerability to stressors. Methods. A prospective observational study was conducted in patients aged 65 years and older waiting for surgery. Frailty was measured using the criteria proposed by Robinson and colleagues. Length of stay and care services activated at the discharge recorded. Results. A total of 1,144 patients were recruited. Two-hundred and seventeen (19%) patients were defined as frail, and 395 (34.5%) were pre-frail. The average length of post-operative stay was 5 days. Only 39 (3.4%) patients received care plan assuring a protected discharge. Among these, 35 (89.7%) were frail, 4 (10.3%) pre-frail. The variable most strongly correlated with the activation of services supporting an assisted discharge was the dependence in activities of daily living (ρ = 0.27, p < 0.001). Conclusions. Frailty is a highly prevalent condition among persons undergoing emergency and elected surgery procedures. Nevertheless, services supporting assisted discharge on the territory are quite infrequently activated. An improved integration of care services bridging hospital and community is necessary and therefore a lack of continuity of health and social care. Further research should focus on the postoperative management of the frail elderly patient. Full article

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J. Gerontol. Geriatr., Volume 68, Issue 3 (September 2020) – 13 articles , Pages 123-196

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