Latest & greatest articles for elderly

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Top results for elderly

881. Functional status of elderly adults before and after initiation of dialysis. (Full text)

Functional status of elderly adults before and after initiation of dialysis. It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD).Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998

2009 NEJM PubMed abstract

882. Hospital at home for elderly patients with acute decompensation of chronic heart failure: a prospective randomized controlled trial (Full text)

Hospital at home for elderly patients with acute decompensation of chronic heart failure: a prospective randomized controlled trial Although the hospital is the standard venue for short-term medical care, it may be hazardous for older persons. This study was performed to evaluate the feasibility and effectiveness of a physician-led hospital-at-home service for selected elderly patients with acute decompensation of chronic heart failure (CHF).Prospective, single-blind, randomized controlled (...) differences between the 2 settings of care. The number of subsequent hospital admissions was not statistically different in the 2 groups, but the mean (SD) time to first additional admission was longer for the GHHS patients (84.3 [22.2] days vs 69.8 [36.2] days, P = .02). Only the GHHS patients experienced improvements in depression, nutritional status, and quality-of-life scores.Substitutive hospital-at-home care is a viable alternative to traditional hospital inpatient care for elderly patients

2009 EvidenceUpdates Controlled trial quality: uncertain PubMed abstract

883. Risk factors for death in elderly emergency department patients with suspected infection (Full text)

Risk factors for death in elderly emergency department patients with suspected infection To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortality-prediction rule for such patients.Prospective cohort study.Tertiary hospital ED with 55,000 annual visits.ED patients aged 65 and older admitted for infection between December 2003 and September 2004 in the derivation cohort and October 2005 and October (...) ). Mortality increased with the number of factors: 0.51% for no factors, 3.1% for one factor, 14% for two factors, 47% for three or more risk factors. The c-statistic was 0.87 for the derivation model and 0.74 for the validation model. Almost 80% of patients in both cohorts were in low-risk groups (0 or 1 factor).A rule derived from five readily available variables predicts mortality in infected elderly ED patients and allows identification of a large low-risk subgroup.

2009 EvidenceUpdates PubMed abstract

884. Comparison of vildagliptin and metformin monotherapy in elderly patients with type 2 diabetes: a 24-week, double-blind, randomized trial (Abstract)

Comparison of vildagliptin and metformin monotherapy in elderly patients with type 2 diabetes: a 24-week, double-blind, randomized trial The study evaluated the efficacy and tolerability of the dipeptidyl peptidase-4 inhibitor, vildagliptin, and metformin in drug-naïve elderly patients with type 2 diabetes. The primary objective was to demonstrate non-inferiority of vildagliptin vs. metformin in glycated haemoglobin (HbA1c) reduction.This was a double-blind, randomized, multicentre, active (...) with vildagliptin (15.0%, p=0.028), mainly driven by a 4.4-fold higher incidence of diarrhoea. A low incidence of hypoglycaemia was observed in both treatment groups (0% with vildagliptin and 1.2% with metformin).Vildagliptin is an effective and well-tolerated treatment option in elderly patients with type 2 diabetes, demonstrating similar improvement in glycaemic control as metformin, with superior GI tolerability.

2009 EvidenceUpdates Controlled trial quality: uncertain

885. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. (Full text)

Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival.We examined fee-for-service Medicare data from 1992 through 2005 to identify beneficiaries 65 years of age or older who underwent CPR in U.S. hospitals. We examined temporal trends in the incidence of CPR and the rate of survival after CPR

2009 NEJM PubMed abstract

886. Postoperative neurocognitive dysfunction in elderly patients after xenon versus propofol anesthesia for major noncardiac surgery: a double-blinded randomized controlled pilot study (Full text)

Postoperative neurocognitive dysfunction in elderly patients after xenon versus propofol anesthesia for major noncardiac surgery: a double-blinded randomized controlled pilot study Postoperative cognitive dysfunction (POCD) in elderly patients after noncardiac surgery is a common problem. The noble gas xenon has been demonstrated to exert substantial neuroprotective properties in animal studies. Therefore, this study was designed to assess POCD after xenon anesthesia in comparison to propofol (...) in elderly patients undergoing major noncardiac surgery.After approval of the local ethical committee was obtained, 101 patients (American Society of Anesthesiologists physical status I-III; age, 65-83 yr) undergoing elective abdominal or urologic surgery (duration, > 2 h) were enrolled into this randomized, double-blinded controlled pilot study. Patients received anesthesia with sufentanil and either propofol or xenon and were assessed before treatment and 1, 6, and 30 days after treatment using

2009 EvidenceUpdates Controlled trial quality: uncertain PubMed abstract

887. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: Data From SENIORS (Full text)

Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: Data From SENIORS In this pre-specified subanalysis of the SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) trial, which examined the effects of nebivolol in elderly heart failure (HF) patients, we explored the effects of left ventricular ejection fraction (EF) on outcomes, including the subgroups (...) and 0.81 (95% confidence interval: 0.63 to 1.04) in preserved EF (p = 0.720 for subgroup interaction). Effects on all secondary end points were similar between groups (HR for all-cause mortality 0.84 and 0.91, respectively), and no p value for interaction was <0.48.The effect of beta-blockade with nebivolol in elderly patients with HF in this study was similar in those with preserved and impaired EF.

2009 EvidenceUpdates Controlled trial quality: predicted high PubMed abstract

888. Framingham stroke risk function in a large population-based cohort of elderly people: the 3C study. (Full text)

Framingham stroke risk function in a large population-based cohort of elderly people: the 3C study. External validation of the Framingham stroke risk function has been rarely performed. We assessed its predictive ability in a population-based cohort of French elderly.The sample comprised 6913 subjects from the 3C Study, aged 65 to 84 at baseline, who were followed up to 6 years. Predictive accuracy of the original Framingham stroke risk function was assessed in a 3-step procedure: comparison (...) .The original Framingham stroke risk function strongly overestimated the stroke risk for 3C participants. Derived Framingham stroke score sheets should not be directly used by physicians in the French elderly population.

2009 EvidenceUpdates PubMed abstract

889. Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study. (Full text)

Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study. To examine the influence of age on the predictive value of N-terminal pro-brain natriuretic (NT-proBNP) peptide assay in acute myocardial infarction.Prospective observational study.All intensive care units in one French region.3291 consecutive patients admitted for an acute myocardial infarction, from the RICO survey (a French regional survey

2009 BMJ PubMed abstract

890. Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly (Abstract)

Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly A rising concern among clinicians is treatment of unplanned weight loss in the elderly, especially given the predicted growth of this population over the next few decades. Unexpected weight loss in the geriatric patient worsens overall health outcomes. A variety of pharmacotherapeutic options are available for treatment; however, evidence underlying their use is limited, and none has gained approval from (...) search of the MEDLINE and International Pharmaceutical Abstracts databases, we identified all published reports on the use of megestrol acetate or mirtazapine for the treatment of weight loss and on any adverse events associated with these drugs. Special emphasis was placed on trials performed in an elderly population. Results were conflicting, most likely because of differing study designs and small numbers of patients. Megestrol acetate and mirtazapine appear to be effective for appetite

2009 EvidenceUpdates

891. Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study (Full text)

Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study The race- and sex-specific epidemiology of incident heart failure (HF) among a contemporary elderly cohort are not well described.We studied 2934 participants without HF enrolled in the Health, Aging, and Body Composition Study (mean [SD] age, 73.6 [2.9] years; 47.9% men; 58.6% white; and 41.4% black) and assessed the incidence of HF, population-attributable risk (PAR

2009 EvidenceUpdates PubMed abstract

892. Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study (Full text)

Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study Excessive daytime sleepiness, one of the most frequent sleep complaints in the elderly, may affect survival, but inconsistent results have been observed in that population so far. We therefore estimated the risk of mortality for excessive daytime sleepiness (EDS) in community-dwelling elderly participating in the Three City Study.The Three City Study (...) symptoms slightly diminished the HRs. EDS was equally predictive of mortality in those who snored loudly and in those who did not. EDS was related to cardiovascular mortality but not to mortality attributable to cancer.EDS might be independently associated with total and cardiovascular mortality in community-dwelling elderly.

2009 EvidenceUpdates PubMed abstract

893. A meta-analysis of fear of falling treatment programs for the elderly (Abstract)

A meta-analysis of fear of falling treatment programs for the elderly This study examines the effectiveness of interventions for decreasing the fear of falling by synthesizing the results of individual studies of fear of falling prevention. The mean weighted effect sizes (MWES) of six studies are computed. The overall MWES is .21 (N = 957; 95% CI .068-.362). Results indicate that interventions are effective in reducing the fear of falling or increasing fall efficacy. The MWES is .249, .024

2009 EvidenceUpdates

894. Incidence and survival of dementia in a general population of Japanese elderly: the Hisayama study (Abstract)

Incidence and survival of dementia in a general population of Japanese elderly: the Hisayama study To estimate the incidence and survival rates of total and cause specific dementia in a general Japanese population.A total of 828 subjects without dementia, aged 65 years or over, were followed-up prospectively for 17 years. Dementia was subdivided into cause specific subtypes: namely, Alzheimer's disease (AD), vascular dementia (VD), dementia with Lewy bodies (DLB), combined dementia and other (...) with increasing age, particularly after the age of 85 years, but this tendency was not observed for VD or DLB. The survival curve of dementia cases aged 65-89 years was significantly lower than that of age and sex matched controls (10 year survival rate, 13.6% vs 29.3%; hazard ratio 1.67; 95% confidence interval 1.31 to 2.13). The 10 year survival rates were not significantly different among dementia subtypes.Our findings suggest that the Japanese elderly population has a high risk for the development

2009 EvidenceUpdates

895. WITHDRAWN: Interventions for preventing falls in elderly people. (Abstract)

WITHDRAWN: Interventions for preventing falls in elderly people. Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care).We searched (...) with researchers in the field.Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded.Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate.Sixty two trials involving 21,668 people were included.Interventions likely

2009 Cochrane

896. Pulsatile perfusion with intra-aortic balloon pumping ameliorates whole body response to cardiopulmonary bypass in the elderly (Abstract)

Pulsatile perfusion with intra-aortic balloon pumping ameliorates whole body response to cardiopulmonary bypass in the elderly The growing life expectancy has led the elderly to be increasingly referred to coronary artery bypass grafting. Preexisting comorbidities may benefit from theoretical advantages of pulsatile perfusion during cardiopulmonary bypass (CPB).Prospective randomized trial.Cardiac surgery unit in a university hospital.Eighty consecutive patients older than 70 years.Elective (...) ) and intubation time (p = 0.031) in group B. Lower chest drainage (p < 0.05 at first and second day), transfusions (p < 0.05), activated partial thromboplastin time, international normalized ratio, white blood cells, and D-dimer (p < 0.05 from ITU admission to 48 hours), together with higher platelets, fibrinogen, and antithrombin III (p < 0.05 from ITU admission to 48 hours) were demonstrated in the pulsated group.IABP-induced pulsatile flow significantly improves whole body perfusion in the elderly

2009 EvidenceUpdates Controlled trial quality: uncertain

897. Plasma leptin levels and incidence of heart failure, cardiovascular disease and total mortality in the elderly (Full text)

Plasma leptin levels and incidence of heart failure, cardiovascular disease and total mortality in the elderly Obesity predisposes individuals to congestive heart failure (CHF) and cardiovascular disease (CVD). Leptin regulates energy homeostasis, is elevated in obesity, and influences ventricular and vascular remodeling. We tested the hypothesis that leptin levels are associated with greater risk of CHF, CVD, and mortality in elderly individuals.We evaluated 818 elderly (mean age 79 years, 62 (...) (hazard ratio [HR] per SD increment 1.26 [95% CI 1.03-1.55] and 1.28 [1.09-1.50], respectively). Additional adjustment for BMI nullified the association with CHF (0.97 [0.75-1.24]) but only modestly attenuated the relation to CVD incidence (1.23 [1.00-1.51], P = 0.052). We observed a nonlinear, U-shaped relation between log-leptin and mortality (P = 0.005 for quadratic term) with greater risk of death evident at both low and high leptin levels.In our moderate-sized community-based elderly sample

2009 EvidenceUpdates PubMed abstract

898. Validation of a model to predict perioperative mortality from lung cancer resection in the elderly (Abstract)

Validation of a model to predict perioperative mortality from lung cancer resection in the elderly Surgical resection is the mainstay therapy for localized non-small cell lung cancer (NSCLC), yet elderly patients are less likely to be treated due to concerns about morbidity and mortality related to surgery.To validate and refine a clinical model to predict 30-day perioperative mortality (POM) in elderly patients undergoing curative resection for lung cancer.We identified 14,297 patients aged 65 (...) were associated with increased risk for POM. These risk factors were similar to those observed in the prior model. When patients were stratified according to their predicted risk of POM, the observed mortality increased from 1.2 to more than 10%.Among elderly patients with lung cancer, a prediction rule can identify those patients at higher risk for fatal complications from surgery. Further studies should evaluate whether use of the model can lead to improvements in treatment decision making.

2009 EvidenceUpdates

899. Systematic review of hip fracture rehabilitation practices in the elderly (Abstract)

Systematic review of hip fracture rehabilitation practices in the elderly To address the need for a research synthesis on the effectiveness of the full range of hip fracture rehabilitation interventions for older adults and make evidence based conclusions.Medline, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched from 1980 to 2007 for studies published in English. The terms rehabilitation and hip fracture were exploded in order to obtain related search

2009 EvidenceUpdates

900. Leptin predicts diabetes but not cardiovascular disease: results from a large prospective study in an elderly population (Full text)

Leptin predicts diabetes but not cardiovascular disease: results from a large prospective study in an elderly population To clarify the association of circulating levels of leptin with risk for cardiovascular disease (CVD) events and new-onset diabetes in men and women.We related baseline leptin levels to CVD events (n = 864) and incident diabetes (n = 289) in an elderly population (n = 5,672) over 3.2 years of follow-up.In treatment-, age-, and country-adjusted models, leptin (...) to risk of diabetes than CVD in the elderly.

2009 EvidenceUpdates PubMed abstract