J. Gerontol. Geriatr., Volume 70, Issue 3 (September 2022) – 8 articles , Pages 155-214

Tako-Tsubo syndrome is cardiological condition, mainly affecting postmenopausal women, that mimics an acute heart attack, because a similar clinical presentation, ECG changes and altered laboratory tests. There is general consensus that the common etiology is a sudden and strong emotional or physical stress. We report here the case of 80-year-old woman who developed a Tako-Tsubo syndrome during an episode of hyperkinetic delirium. Delirium is an acute, transient, usually reversible neuropsychiatric syndrome, considered a serious and stressful condition in older patients admitted to both medical and surgical setting. This clinical case expands our knowledge on the negative consequence of delirium in hospitalized patients and describes an additional risk factor for Tako-Tsubo syndrome in older people. Full article

In the most vulnerable people, especially among the elderly, the COVID-19 pandemic has brought to light complex ethical issues such as consent to receive health care, the relationship between risks and benefits of therapies, the choices to be made during the most serious phases of the disease and family relationships have been made extreme and heavily emphasized by the pandemic. Full article

To identify the facilitators and barriers to older adults’ participation in healthy aging or cardiovascular rehabilitation programs. We conducted a scoping review to identify healthy aging program evaluations which identified participant barriers and facilitators. We developed a search strategy in the following databases: MEDLINE, Embase, APA PsycInfo, and Cochrane CENTRAL, all on the Ovid platform and Ebsco CINAHL. We included 17 articles in this review. Our team categorized the barriers and facilitators of older adults’ participation in healthy aging programs into seven themes: attitudes, organizational structure, accessibility, social structure, knowledge, demographics, and program specifics. Understanding the facilitators and barriers that older adults face when deciding whether or not to participate or to continue participating in, healthy aging programs to promote in, cardiovascular health can help healthcare professionals provide optimal guidance for their patients and clients. Full article

Tuberculosis (TB) is an infectious disease in which the clinical course is influenced by age-related changes in the respiratory and immune systems. Cross sectional retrospective analysis of patients admitted with the diagnosis of tuberculosis between 2011 and 2016, comparing patients with ages under and above 65 years old. Inclusion of 591 patients, 16% of the individuals being over 65 years. Predominance of male gender, with white race preponderance in the elderly group (84%). Disease site at presentation was predominantly lung (74%), followed by disseminated disease (14%). As expected, the mortality registered was higher in the older population (20 vs 4%). TB remains a less frequent infection in the elderly. The infection characteristics are similar in both groups however with a more atypical presentation in the elderly. Full article

Stratification of heart failure (HF) severity in older adults may be difficult. We hypothesized that mean platelet volume (MPV) and platelet distribution width (PDW) may serve as inflammation markers and used for this purpose. The objective of the study is to analyze the association between MPV/PDW and HF severity in older adults. in this retrospective cross-sectional study, we enrolled 415 patients aged ≥ 65 years admitted for acute HF to an Acute Geriatric Ward. Participants were stratified according to the diagnosis of HF with preserved (HFpEF, N: 250) or non-preserved (HFmrEF/HFrEF, N: 165) ejection fraction. The association with ejection fraction (EF), NT-proBNP, right ventricular function (TAPSE), and diastolic function was analyzed using linear or multinomial regression models. mean age of the participants was 83.1 years (SD 7), 41.2% were male. MPV was positively associated with NT-proBNP in the total sample (Adjusted b: 0.16, p = 0.008) and in the HFmrEF/HFrEF group (Adjusted b: 0.215, p = 0.015), but not in the HFpEF group; no association was found with EF (analyzed only in HFmrEF/HFrEF group), or TAPSE. Using type I diastolic disfunction as reference, MPV was associated with an increased risk of monophasic pattern (Adj.OR: 1.44, 95% CI: 1.08-1.92) and III grade disfunction (Adj.OR: 1.54, 95% CI: 1.01-2.35) in the total sample, and in the HFmrEF/HFrEF group (Monophasic Adj.OR: 2.51, 95% CI: 1.33-4.74; III grade Adj.OR: 4.77, 95% CI: 2.05-11.1). Similar results were found analyzing PDW. MPV and PDW are inexpensive and simple potential markers of HFmrEF/HFrEF severity in older adults. Further studies are needed to clarify their classificatory and prognostic properties. Full article

Elderly surgical patients are susceptible to development of postoperative delirium. Interventions for postoperative delirium have little effect on its progression, indicating the importance of early detection and prevention. This study investigated preoperative biomarkers to predict postoperative delirium. Delirium-related serum biomarkers were measured before the start of surgery in patients who underwent esophageal cancer surgery and were compared between patients who did and did not develop postoperative delirium. Fifteen of 96 patients (15.6%) developed postoperative delirium. Brain-derived phosphorylated neurofilament heavy subunit was preoperatively detected in 80% of patients with postoperative delirium. The preoperative interleukin-6 (IL-6) concentration was significantly higher whereas the concentrations of plasminogen activator inhibitor-1 (PAI-1) was significantly lower in patients with postoperative delirium. Detection of phosphorylated neurofilament heavy subunit was associated with postoperative delirium independent of age (adjusted odds ratio, 5.86; 95% confidence interval, 1.60-29.03; p = 0.0064). The sensitivity and specificity of postoperative delirium detection was increased when age was combined with detection of phosphorylated neurofilament heavy subunit. Preoperative evaluation of phosphorylated neurofilament heavy subunit can predict postoperative delirium independent of age. Early detection of serum phosphorylated neurofilament heavy subunit before surgery may enable clinicians to identify patients at risk for postoperative delirium and start early intervention. Full article

The objective of the study was to assess the various oral changes in geriatrics patients. This was a cross-sectional, observational study among the geriatric subjects visiting outpatient department of our institution. A total of 450 geriatric subjects visiting the dental clinic were examined for various oral changes The various oral changes were entered into a structured proforma by a trained dentist after recording the demographic details, habit history, systemic illness. Chi square test was applied to check the association between qualitative data and Student t-test was used for analysis of quantitative data. A total of 450 elderly patients in the age range of 60-90 years with a mean age of 67.12 years were enrolled in the study. Majority of them were males (66.4%). Oral manifestations were divided into hard tissue and soft tissue findings. Among the hard tissue, the prevalent findings were partially edentulous followed by periodontitis, wasting disease, dental caries, completely edentulous. Soft tissue manifestations were gingivitis followed by oral cancer, leukoplakia, candidiasis, smokers melanosis, gingival enlargement. The maintenance of oral health in the elderly population should be given importance not only on emergency basis but by encouraging them to pay regular visit to their dentists thereby they could lead a better quality of life. Full article

The frequency of peripherally inserted central catheter use is increasing in elderly patients. Multiple comorbidities and changes in consciousness due to long-term hospitalisation can cause several problems. We aimed to determine the feasibility and safety, including the incidence of and risk factors for complications and accidental withdrawal, of using a peripherally inserted central catheter in hospitalised elderly patients. A retrospective, single-centre study of elderly patients with peripherally inserted central catheters was performed between July 2015 and July 2020. We analysed the patient-, device-, and procedure-related characteristics to determine the feasibility and safety of the insertion procedure, including complications and accidental withdrawal. Odds ratios (ORs) with 95% confidence intervals were generated. Among 703 patients, insertion of peripherally inserted central catheters was successful in 689 (98.00%) patients. The procedure was unsuccessful in 14 (1.99%) patients. Among those who underwent successful catheter insertion, 52 (7.55%) patients developed procedure-related complications. Logistic regression analysis revealed that complications were associated with pneumonia (OR, 2.136), renal insufficiency (OR, 2.518), chronic obstructive pulmonary disease (OR, 3.050), and double-lumen catheters (OR, 5.524). Accidental withdrawal occurred in 63 (9.14%) patients and was associated with delirium (OR, 2.788) and admission for orthopedic surgery (OR, 2.400). Use of peripherally inserted central catheters are feasible and safe for hospitalised elderly patients. Comorbidities such as pneumonia, renal insufficiency, and chronic obstructive pulmonary disease were risk factors for complications, and delirium was a risk factor for accidental withdrawal. Full article