Browsing by Subject "Elderly"

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  • PERSARC Study Group; Acem, Ibtissam; Verhoef, Cornelis; Rueten-Budde, Anja J.; Grünhagen, Dirk; van Houdt, Winan; van de Sande, Michiel A. J.; Aston, Will; Bonenkamp, Han; Desar, Ingrid; Ferguson, Peter C.; Fiocco, Marta; Gelderblom, H.; van Ginkel, Robert; Van der Graaf, Winette; Griffin, Anthony; Haas, Rick; van der Hage, Jos A.; Hayes, Andrew; Jeys, Lee M; Keller, Johnny; Laitinen, Minna K.; Leithner, Andreas; Maretty-Kongstad, Katja; Ozaki, Toshifumi; Pollock, Rob; van Praag, Veroniek M.; Smith, Myles; Smolle, Maria; Styring, Emelie; Szkandera, Joanna; Tanaka, Kazuhiro; Tunn, Per-Ulf; Willegger, Madeleine; Windhager, Reinhard; Wunder, Jay S.; Zaikova, Olga (2020)
    Purpose: No studies extensively compared the young adults (YA, 18-39 years), middle-aged (40-69 years), and elderly (≥70 years) population with primary high-grade extremity soft tissue sarcoma (eSTS). This study aimed to determine whether the known effect of age on overall survival (OS) and disease progression can be explained by differences in tumour characteristics and treatment protocol among the YA, middle-aged and elderly population in patients with primary high-grade eSTS treated with curative intent. Methods: In this retrospective multicentre study, inclusion criteria were patients with primary high-grade eSTS of 18 years and older, surgically treated with curative intent between 2000 and 2016. Cox proportional hazard models and a multistate model were used to determine the association of age on OS and disease progression. Results: A total of 6260 patients were included in this study. YA presented more often after 'whoops'-surgery or for reresection due to residual disease, and with more deep-seated tumours. Elderly patients presented more often with grade III and larger (≥10 cm) tumours. After adjustment for the imbalance in tumour and treatment characteristics the hazard ratio for OS of the middle-aged population is 1.47 (95% confidence interval [CI]: 1.23-1.76) and 3.13 (95% CI: 2.59-3.78) in the elderly population, compared with YA. Discussion: The effect of age on OS could only partially be explained by the imbalance in the tumour characteristics and treatment variables. The threefold higher risk of elderly could, at least partially, be explained by a higher other-cause mortality. The results might also be explained by a different tumour behaviour or suboptimal treatment in elderly compared with the younger population. Keywords: Adolescents and young adults; Elderly; Extremities; Metastasis; Middle-aged; Recurrence; Soft tissue sarcoma; Survival.
  • Marttinen, Maiju K.; Kautiainen, Hannu; Haanpää, Maija; Pohjankoski, Heini; Hintikka, Jukka; Kauppi, Markku J. (2021)
    Background: Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults' prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods: One thousand four hundred twenty community-dwelling citizens aged 62-86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results: Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion: Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults' pain management.
  • Marttinen, Maiju K; Kautiainen, Hannu; Haanpää, Maija; Pohjankoski, Heini; Hintikka, Jukka; Kauppi, Markku J (BioMed Central, 2021)
    Abstract Background Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.
  • Romskaug, Rita; Molden, Espen; Straand, Jorund; Kersten, Hege; Skovlund, Eva; Pitkala, Kaisu H.; Wyller, Torgeir Bruun (2017)
    Background: Polypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or suboptimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient-relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people. Methods: This is a cluster randomised, single-blind, controlled trial where general practitioners are invited to participate with patients from their lists. The patients must be 70 years or older, use at least seven different medications and have their medications administered by the home nursing service. We plan to recruit 200 patients, with randomisation at physician level. The intervention consists of three main parts: ( 1) clinical geriatric assessment of the patient, combined with a thorough review of their medications; ( 2) a meeting between the geriatrician and general practitioner, where the two physicians combine their competence and knowledge and discuss the drug list systematically; ( 3) clinical follow-up, depending on the medication changes that have been done. The study period is 24 weeks, and the patients are assessed at baseline, 16 and 24 weeks. The primary outcome measure is health-related quality of life according to the 15D instrument. Secondary outcome measures include physical and cognitive functioning, medication appropriateness, falls, carer burden, use of health services ( hospital or nursing home admissions, use of home nursing services) and mortality. Discussion: Our choice of patient-relevant outcome measures will hopefully provide new knowledge on the potential for clinical improvements after performing comprehensive medication reviews in home-dwelling elderly people receiving polypharmacy.
  • Kuosma-Hämäläinen, Marlen (Helsingin yliopisto, 2021)
    Yhteiskunnassa näkemykset ikääntyneistä ja ikääntymisestä vaihtelevat ajasta riippuen. Viime aikana ikääntyneisiin liittyvä julkisuuskuva on liittynyt huoltosuhteeseen, hoitajapulaan ja ikääntyneiden heikkoon toimintakykyyn. Tämän näkemyksen rinnalle on tullut vahvasti ajatus aktiivisesta ja onnistuneesta ikääntymisestä, jolla ikääntymiseen liittyviä negatiivisia stereotypioita on pyritty yhteiskunnassamme heikentämään. Lähestymme ikääntymistä mistä tulokulmasta tahansa, vaikuttaa se siihen kuinka ikääntyneet itse itsensä näkevät. Ikääntymisen julkisuuskuvaa on käsitelty aikaisemmissa tutkimuksessa, mutta lähtökohtana ovat olleet pääsääntöisesti mediatekstit. Tämän tutkimuksen tarkoituksena onkin selvittää millainen kuva ikääntyneistä luodaan visuaalisten kuvien kautta. Tutkimuskysymykseni on: Millainen kuva ikääntyneistä muodostuu Instagram-kuvien perusteella. Aineisto koostui 316 Instagram-kuvasta, jotka kerättiin Instagram-tileiltä. Jokaisessa aineistoon valitussa kuvassa esiintyi tulkintani mukaan ikääntynyt henkilö. Aineisto analysoitiin Erving Goffmanin luoman kehysanalyysin avulla, jossa on hyödynnetty Eeva Luhtakallion sovellusta visuaalisesta kehysanalyysistä. Löysin kahdeksan erilaista kehystä, jotka kuvaavat ikääntyneistä esitettyjä kuvia; aktiivisuuden, oppimisen, hoivan, menestyksen, merkityksellisyyden, tunteiden, yhteisöllisyyden ja yksilöllisyyden kehykset. Ikääntyneistä voi siis kuvien avulla luoda heterogeenisen kuvan. Tärkeä tutkimuksen huomio oli, että näille kaikille kehyksille yhtenäinen piirre oli se, että ne kuvaavat ”onnistunutta ikääntymistä” monipuolisesti. Sen sijaan toimintakyvyltään hauraampia ikääntyneitä ei aineiston kuvissa näkynyt. Tässä tutkielmassa aktiivisuuden ja oppimisen kehykset olivat eniten edustettuina. Puolestaan menestyksen ja hoivan kehykseen sisältyviä kuvia löytyi aineistosta vähiten. Ikääntyneistä muodostuva kuva kaipaa edelleen ikääntyneiden kuvaston monipuolistumista. Vaikka tuloksista on selvästi nähtävissä se, että ikääntymistä voi lähestyä monesta eri näkökulmasta, on esimerkiksi vähemmistöt ja vanhimmat vanhat kuvissa harvoin edustettuina. Koenkin, että sosiaaliseen mediaan kaivataan ikääntyneiden kohdalla entistä enemmän sosiaalityön ja ikääntyneiden omaa näkökulmaa, joka voi tarjota tätä hetkeä rikkaamman ja todentuntuisemman lähestymistavan ikääntymiseen. Toisaalta on tärkeä vaalia voimavaralähtöistä kuvaa ikääntyneistä, joka voi edesauttaa yhteiskunnan suhtautumista ikääntyneisiin. On kuitenkin muistettava, että onnistunut ikääntyminen merkitsee yksilötasolla paljon enemmän kuin mitä tämän hetken visuaaliset kuvat antavat olettaa.
  • Holmström, Ester; Efendijev, Ilmar; Raj, Rahul; Pekkarinen, Pirkka T.; Litonius, Erik; Skrifvars, Markus B. (2021)
    BackgroundCardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital.MethodsThis single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital's ICU between 2005 and 2013. We stratified the study population into two age groups: 75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1-2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent associations between age group, mortality and neurological outcome.ResultsThis study included a total of 1,285 patients, of which 212 (16%) were >= 75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p
  • Nammas, Wail; de Belder, Adam; Niemela, Matti; Sia, Jussi; Romppanen, Hannu; Laine, Mika; Karjalainen, Pasi P. (2017)
    Background: The BASE ACS trial demonstrated an outcome of titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior to everolimus-eluting stents (EES) in patients presenting with acute coronary syndrome (ACS). We performed a post hoc analysis of elderly versus non-elderly patients from the BASE ACS trial. Methods: We randomized 827 patients (1:1) presenting with ACS to receive either BAS or EES. The primary end-point was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR). Follow-up was planned at 12 months and yearly thereafter for up to 7 years. Elderly age was defined as >= 65 years. Results: Of the 827 patients enrolled in the BASE ACS trial, 360 (43.5%) were elderly. Mean follow-up duration was 4.2 +/- 1.9 years. MACE was more frequent in elderly versus younger patients (19.7% versus 12.0%, respectively, p = 0.002), probably driven by more frequent cardiac death and non-fatal MI events (5.3% versus 1.5%, and 9.7% versus 4.5%, p = 0.002 and p = 0.003, respectively). The rates of ischemia-driven TLR were comparable (p > 0.05). In propensity score-matched analysis (215 pairs), only cardiac death was more frequent in elderly patients (6% versus 1.4%, respectively, p = 0.01). Diabetes independently predicted both MACE and cardiac death in elderly patients. Conclusions: Elderly patients treated with stent implantation for ACS had worse long-term clinical outcome, compared with younger ones, mainly due to a higher death rate. (C) 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  • Raj, Rahul; Mikkonen, Era D.; Kivisaari, Riku; Skrifvars, Markus B.; Korja, Miikka; Siironen, Jari (2016)
    BACKGROUND: Surgery for elderly patients with acute subdural hematomas (ASDH) is controversial, because postoperative mortality rates are reported to be high and long-term outcomes unknown. Thus, we aimed to describe midterm and long-term mortality rates of elderly patients operated for an ASDH. METHODS: We reviewed all consecutive >= 75-year-old patients operated on for an ASDH between 2009 and 2012. We recorded data on preadmission functional status (independent or dependent) and use of antithrombotic medication. Patients were followed up a median of 4.2 years (range, 2.5-6.4 years). RESULTS: Forty-four patients were included. The majority of the patients (70%) were independent and taking antithrombotic medication (77%). Independent patients had a 1-year mortality of 42%, compared to 69% for dependent patients; 56% of patients taking antithrombotics and 30% of those without antithrombotics died within the first postoperative year. All patients with an admission Glasgow coma scale score of 3-8 died within the first postoperative year, if they used antithrombotics or were dependent before the injury. Of all 1-year survivors, 77% were alive at the end of follow-up. CONCLUSION: In this first surgical case series of 75-year-old or older patients with ASDH, the overall mortality rate appears to be relatively low, especially for preoperatively conscious and independent patients without antithrombotic medication. Patients alive at 1-year after surgery had a life expectancy comparable to their age-matched peers. The prognosis seems to be detrimental for preoperatively unconscious patients who were functionally dependent or used antithrombotic medication before the injury.
  • Podda, Mauro; Sylla, Patricia; Baiocchi, Gianluca; Adamina, Michel; Agnoletti, Vanni; Agresta, Ferdinando; Ansaloni, Luca; Arezzo, Alberto; Avenia, Nicola; Biffl, Walter; Biondi, Antonio; Bui, Simona; Campanile, Fabio C.; Carcoforo, Paolo; Commisso, Claudia; Crucitti, Antonio; De'Angelis, Nicola; De'Angelis, Gian Luigi; De Filippo, Massimo; De Simone, Belinda; Di Saverio, Salomone; Ercolani, Giorgio; Fraga, Gustavo P.; Gabrielli, Francesco; Gaiani, Federica; Guerrieri, Mario; Guttadauro, Angelo; Kluger, Yoram; Leppäniemi, Ari K.; Loffredo, Andrea; Meschi, Tiziana; Moore, Ernest E.; Ortenzi, Monica; Pata, Francesco; Parini, Dario; Pisanu, Adolfo; Poggioli, Gilberto; Polistena, Andrea; Puzziello, Alessandro; Rondelli, Fabio; Sartelli, Massimo; Smart, Neil; Sugrue, Michael E.; Tejedor, Patricia; Vacante, Marco; Coccolini, Federico; Davies, Justin; Catena, Fausto (2021)
    Background and aims Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
  • Aronen, Matti; Viikari, Laura; Kohonen, Ia; Vuorinen, Tytti; Hämeenaho, Mira; Wuorela, Maarit; Sadeghi, Mohammadreza; Söderlund-Venermo, Maria; Viitanen, Matti; Jartti, Tuomas (BioMed Central, 2019)
    Abstract Background In children suffering from severe lower airway illnesses, respiratory virus detection has given good prognostic information, but such reports in the elderly are scarce. Therefore, our aim was to study whether the detection of nasopharyngeal viral pathogens and conventional inflammatory markers in the frail elderly correlate to the presence, signs and symptoms or prognosis of radiographically-verified pneumonia. Methods Consecutive episodes of hospital care of patients 65 years and older with respiratory symptoms (N = 382) were prospectively studied as a cohort. Standard clinical questionnaire was filled by the study physician. Laboratory analyses included PCR diagnostics of nasopharyngeal swab samples for 14 respiratory viruses, C-reactive protein (CRP) and white blood cell count (WBC). Chest radiographs were systematically analysed by a study radiologist. The length of hospital stay, hospital revisit and death at ward were used as clinical endpoints. Results Median age of the patients was 83 years (range 76–90). Pneumonia was diagnosed in 112/382 (29%) of the studied episodes. One or more respiratory viruses were detected in 141/382 (37%) episodes and in 34/112 (30%) episodes also diagnosed with pneumonia. Pneumonia was associated with a WBC over 15 × 109/L (P = .006) and a CRP value over 80 mg/l (P < .05). A virus was detected in 30% of pneumonia episodes and in 40% of non-pneumonia episodes, but this difference was not significant (P = 0.09). The presence of a respiratory virus was associated with fewer revisits to the hospital (P < .05), whereas a CRP value over 100 mg/l was associated with death during hospital stay (P < .05). Respiratory virus detections did not correlate to WBC or CRP values, signs and symptoms or prognosis of radiographically-verified pneumonia episodes. Conclusion Among the elderly with respiratory symptoms, respiratory virus detection was not associated with an increased risk of pneumonia or with a more severe clinical course of the illness. CRP and WBC remain important indicators of pneumonia, and according to our findings, pneumonia should be treated as a bacterial disease regardless of the virus findings. Our data does not support routine virus diagnostics for the elderly patients with pneumonia outside the epidemic seasons.
  • Aronen, Matti; Viikari, Laura; Kohonen, Ia; Vuorinen, Tytti; Hämeenaho, Mira; Wuorela, Maarit; Sadeghi, Mohammadreza; Söderlund-Venermo, Maria; Viitanen, Matti; Jartti, Tuomas (2019)
    Background: In children suffering from severe lower airway illnesses, respiratory virus detection has given good prognostic information, but such reports in the elderly are scarce. Therefore, our aim was to study whether the detection of nasopharyngeal viral pathogens and conventional inflammatory markers in the frail elderly correlate to the presence, signs and symptoms or prognosis of radiographically-verified pneumonia. Methods: Consecutive episodes of hospital care of patients 65years and older with respiratory symptoms (N = 382) were prospectively studied as a cohort. Standard clinical questionnaire was filled by the study physician. Laboratory analyses included PCR diagnostics of nasopharyngeal swab samples for 14 respiratory viruses, C-reactive protein (CRP) and white blood cell count (WBC). Chest radiographs were systematically analysed by a study radiologist. The length of hospital stay, hospital revisit and death at ward were used as clinical endpoints. Results: Median age of the patients was 83years (range 76-90). Pneumonia was diagnosed in 112/382 (29%) of the studied episodes. One or more respiratory viruses were detected in 141/382 (37%) episodes and in 34/112 (30%) episodes also diagnosed with pneumonia. Pneumonia was associated with a WBC over 15 x 10(9)/L (P = .006) and a CRP value over 80 mg/l (P <.05). A virus was detected in 30% of pneumonia episodes and in 40% of non-pneumonia episodes, but this difference was not significant (P = 0.09). The presence of a respiratory virus was associated with fewer revisits to the hospital (P <.05), whereas a CRP value over 100 mg/l was associated with death during hospital stay (P <.05). Respiratory virus detections did not correlate to WBC or CRP values, signs and symptoms or prognosis of radiographically-verified pneumonia episodes. Conclusion: Among the elderly with respiratory symptoms, respiratory virus detection was not associated with an increased risk of pneumonia or with a more severe clinical course of the illness. CRP and WBC remain important indicators of pneumonia, and according to our findings, pneumonia should be treated as a bacterial disease regardless of the virus findings. Our data does not support routine virus diagnostics for the elderly patients with pneumonia outside the epidemic seasons.
  • Schwartz, Christoph; Romagna, Alexander; Stefanits, Harald; Zimmermann, Georg; Ladisich, Barbara; Geiger, Philipp; Rechberger, Julian; Winkler, Sophie; Weiss, Lukas; Fastner, Gerd; Trinka, Eugen; Weis, Serge; Spiegl-Kreinecker, Sabine; Steinbacher, Juergen; McCoy, Mark; Johannes, Trenkler; Gruber, Andreas; Jahromi, Behnam Rezai; Niemelä, Mika; Winkler, Peter A.; Thon, Niklas (2020)
    OBJECTIVE: To assess the prognostic profile, clinical outcome, treatment-associated morbidity, and treatment burden of elderly patients with glioblastoma (GBM) undergoing microsurgical tumor resection as part of contemporary treatment algorithms. METHODS: We retrospectively identified patients with GBM >= 65 years of age who were treated by resection at 2 neuro-oncology centers. Survival was assessed by Kaplan-Meier analyses; log-rank tests identified prognostic factors. RESULTS: The study population included 160 patients (mean age, 73.1 +/- 5.1 years), and the median contrastenhancing tumor volume was 31.0 cm(3). Biomarker analyses revealed 0(6)-methylguanine-DNA methyltransferase-promoter methylation in 62.7% and wild-type isocitrate dehydrogenase in 97.5% of tumors. The median extent of resection (EOR) was 92.3%, surgical complications were noted in 10.0% of patients, and the median postoperative hospitalization period was 8 days. Most patients (60.0%) received adjuvant radio-/chemotherapy. The overall treatment-associated morbidity was 30.6%. The median progression-free and overall survival were 5A months (95% confidence interval [Cl], 4.6-6.4 months) and 10.0 months (95% CI, 7.9-11.7 months). The strongest predictors for favorable outcome were patient age = 80% (P = 0.0179), postoperative modified Rankin Scale score CONCLUSIONS: Clinical outcome for elderly patients with GBM remains limited. Nonetheless, the observed treatment-associated morbidity and treatment burden were moderate in the patients, and patient age and performance status remained the strongest predictors for survival. The risks and benefits of tumor resection in the age of biomarker-adjusted treatment concepts require further prospective evaluation.
  • Waller, Katja; Vähä-Ypyä, Henri; Lindgren, Noora; Kaprio, Jaakko; Sievänen, Harri; Kujala, Urho M. (2019)
    Background: Maintaining good fitness and good level of physical activity are important factors for maintaining physical independence later in life. The aim was to investigate the relationship between self-reported fitness and objectively measured physical activity and sedentary behavior in the elderly. Methods: Same-sex twin pairs born 1940-1944 in Finland were invited to the study. Altogether 787 individuals (mean age 72.9 years), of whom 404 were female, used a hip-worn triaxial accelerometer for at least 4 days and answered a question on perceived fitness. First, individual differences were studied between four fitness categories. Second, pairwise differences were examined among twin pairs discordant for fitness. Results: Self-reported fitness explained moderately the variation in objectively measured physical activity parameters: R-2 for daily steps 26%, for daily mean metabolic equivalent 31%, for daily moderate-to-vigorous activity time 31%, and lower for sedentary behavior time 14% (all p <.001). Better self-reported fitness was associated with more steps taken on average (8,558 daily steps [very good fitness] vs 2,797 steps [poor fitness], p <.001) and with a higher amount of moderate-to-vigorous activity (61 min vs 12 min p <.001, respectively) in the adjusted multivariable model. Among 156 twin pairs discordant for self-reported fitness, co-twins with better fitness took more steps, did more moderate-to-vigorous activity, and had less sedentary behavior (all, p <.05) compared to their less fit co-twins; however, difference was smaller among monozygotic than dizygotic pairs. Conclusion: One simple question on self-reported fitness is associated with daily activity profile among community-dwelling older people. However, genetic factors modulate this association to some extent.
  • Barengo, Noël C.; Antikainen, Riitta; Harald, Kennet; Jousilahti, Pekka (2019)
    Little information is available about the deleterious effect of smoking in older adults The objective of this study was to assess the relationship of smoking habits with cancer, CVD and all-cause mortality in late middle-age (45–64 years) and older (65–74) people. This cohort study of 6516 men and 6514 women studied the relationship of smoking habits with cancer, cardiovascular disease (CVD) and all-cause mortality among middle-aged and older Finnish men and women during 1997–2013. The study cohort was followed up until the end of 2013 (median follow-up time was 11.8 years). Mortality data were obtained from the National Causes of Death Register and data on incident stroke events from the National Hospital Discharge Register. Adjusted Hazard ratios (HR) for total mortality were 2.61 (95% Confidence interval 2.15–3.18) among 45–64 years-old men and 2.59 (2.03–3.29) in 65–74 years-old men. The corresponding HRs for women 45–64 years-of-age were 3.21 (2.47–4.19) and 3.12 (2.09–4.68) for those 65–74 years-old, respectively. Adjusted HRs for CVD mortality in the 45–64 years-old and 65–74 years-old groups were 2.67 (1.92–2.67) and 1.95 (1.33–2.86) in men, and 4.28 (2.29–7.99) and 2.67 (1.28–5.58) in women, respectively. Among men, the risk difference between never and current smokers was 108/100.000 in the age-group 45–64 years, and 324/100.000 in the age group 65–74 years. Among women the differences were 52/100.000 and 196/100.000, respectively. In conclusion, absolute risk difference between never and current smokers are larger among the older age group. Smoking cessation counseling should routinely target also older adults in primary health-care.
  • Haeren, Roel H. L.; Rautalin, Ilari; Schwartz, Christoph; Korja, Miikka; Niemelä, Mika (2021)
    Purpose Surgical resection of intracranial meningiomas in patients that are 80 years old and older, i.e. very old patients, is increasingly considered. Meningiomas with a largest diameter of at least 5 cm-'giant meningiomas'-form a distinct entity, and their surgical resection is considered more difficult and prone to complications. Here, we evaluated functional outcome, morbidity and mortality, and the prognostic value of tumor size in very old patients who underwent resection of giant supratentorial meningiomas. Methods We retrospectively reviewed clinical and radiological data, functional performance (Karnofsky Performance Score), histopathological diagnosis and complications of very old patients who underwent surgery of a supratentorial meningioma at the Helsinki University Hospital between 2010 and 2018. Results We identified 76 very old patients, including 28 with a giant meningioma. Patients with a giant meningioma suffered from major complications more commonly than those with a non-giant meningioma (36% vs. 17%, p = 0.06), particularly from postoperative intracranial hemorrhages (ICH). At the 1-year follow-up, functional performance and mortality rate were comparable between patients with giant meningiomas and those with non-giant meningiomas. An exceptionally high rate of giant meningiomas were diagnosed as atypical meningiomas (WHO II) at an (11 out of 28 cases). Conclusions Giant meningioma surgery entails a high complication rate in frail, very old patients. The prevention of postoperative ICH in this specific patient group is of utmost importance. An atypical histopathology was notably frequent among very old patients with a giant meningioma, which should be taken into account when planning the surgical strategy.
  • Ojala, Kaisu; Meretoja, Tuomo J.; Mattson, Johanna; Leidenius, Marjut H. K. (2019)
    Background: The aim of this study was to investigate outcome of treatment in patients over 80 years of age with early breast cancer at the time of the diagnosis with special interest in surgical treatment. Materials and methods: Breast cancer patients older than 80 years of age, treated at the Breast Surgery Unit of Helsinki University Hospital in 2005-2010 were identified from electronic patient records. Patients were followed-up until the end of 2014. Patient and tumour characteristics, recurrences, co-morbidities and reasons for omission of surgery were collected from electronic patient records. Survival data was obtained from Finnish Cancer Registry. Results: 446 patients were eligible for the study: 401 (90%) received surgery. The median follow-up time was 52 months. In the entire study population, local and regional recurrences/disease progression were diagnosed in 16 (3.6%) and 6 (1.3%) patients, respectively. The five-year overall survival was 50.6% in the surgical treatment and only 15.2% in non-surgical treatment group, p <0.001. Also, the five-year breast cancer specific survival was significantly better in the patients with surgery, 82.0%, but 56.0% in the patients without surgery, p <0.001. There was no mortality related to the surgery, but 122 (30%) patients died within three years from surgery. Conclusion: Surgical treatment rate was high. OS and BCSS were better in surgically treated elderly patients. Local and regional disease control was excellent, probably due to high rate of surgical treatment. Surgical treatment also seemed safe in this elderly patient population. However, surgical overtreatment was obvious in some patients. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
  • Schwartz, Christoph; Rautalin, Ilari; Niemela, Mika; Korja, Miikka (2020)
    Purpose To assess the association of peritumoral brain edema (PTBE) with postoperative outcome in old (>= 80 years) meningioma patients. Methods All supratentorial meningioma patients (>= 80 years old) who underwent surgery between 2010 and 2018 were retrospectively identified. Patients were classified into poor (= 80) preoperative Karnofsky Performance Status (KPS) subgroups. Outcome was evaluated at 3 months and at last follow-up within the first year after surgery, and categorized as improved, stable, or deteriorated. Three-dimensional volumetric assessment of tumor and PTBE volume was conducted. Volumes were categorized as small (<10 cm(3)), medium (10-50 cm(3)), large (> 50 cm(3)). Results Seventy-two patients (mean age 83 +/- 3 years, median 83; median follow-up 3 years) were included. The mean tumor volume was 39 +/- 31 cm(3) (median 27), and mean PTBE volume was 57 +/- 79 cm(3) (median 27). The mean preoperative KPS and at last follow-up was 58 +/- 16 (median 60) and 59 +/- 30 (median 70). Thirty-three patients were classified as improved, 16 as stable, and 23 deteriorated; eleven patients died within the first year. Large PTBE volume was more common for patients with poor preoperative status (p = 0.001). However, patients with large PTBE and poor preoperative status improved most frequently following surgery (p = 0.037 at 3 months, p = 0.074 at last follow-up). Large PTBE volume was not associated with treatment-associated complications (p = 0.538) or mortality (p = 0.721). A decision support tool to predict outcome was developed (p = 0.038). Conclusion Elderly patients with large PTBE volumes usually had a poor preoperative performance status, but appeared to benefit most often from surgery.
  • Tuutti, Laura (Helsingin yliopisto, 2021)
    Krooniset tulehdukselliset suolistosairaudet, eli Crohnin tauti ja haavainen paksusuolentulehdus, ovat perinteisesti olleet nuorten ihmisten sairauksia. Viime aikoina tieteellisessä yhteisössä ja kliinisessä työssä on kuitenkin havaittu taudin puhkeamisen yleistyneen myös vanhemmalla iällä. Ensimmäiset tutkimukset aihepiiristä ehdottivat vanhuksilla lievempää taudinkuvaa, mutta tuoreimpien meta-analyysien mukaan taudinkuva on vähintään yhtä vakava kuin nuoremmilla. Uudet biologiset lääkehoidot ovat merkittävästi tehostaneet sairauksien hoitoa, mutta tutkimustulokset lääkkeiden tehosta ja turvallisuudesta vanhusväestöllä ovat hyvin vähäisiä. Tehokkaampien eli immunomoduloivien ja biologisten lääkkeiden käyttö vanhemmissa ikäryhmissä on ollut selvästi nuorempia vähäisempää, mutta tutkimuksissa vanhuksilla sairauden on yhtä usein tai jopa useammin todettu johtavan leikkaukseen ja sairaalahoitoon leikkauskomplikaatioiden ollessa vanhusväestöllä korostuneempia ja vakavampia. Tämän tutkimuksen tavoitteena oli tarjota suomalaiseen väestöön perustuvaa tietoa vanhuusiällä puhjenneiden tulehduksellisten suolistosairauksien diagnostiikasta, taudinkulusta sekä käytettyjen hoitomuotojen eroista ja yhtäläisyyksistä nuorempaan väestöön verrattuna. Tutkimuksessa havaittiin Suomessa diagnostiikan olevan tehokasta, sillä diagnoosiviive ei vanhusväestöllä ollut nuoria pidempi. Tauti oli diagnoosihetkellä ikäryhmien välillä pitkälti samanlainen laboratorioparametreihin ja taudin vakavuusluokitukseen perustuen. Vanhuksilla Crohnin taudissa suoliston ulkopuolisia oireita oli nuoria ikäryhmiä vähemmän ja haavaisessa koliitissa ripulia todettiin vanhemmilla nuoria harvemmin. Ensilinjan hoito oli ikäryhmien välillä pitkälti samankaltaista. Seurannassa sairaalahoitojen määrässä tai kestossa ei havaittu eroja, mutta Crohnin taudissa vanhusväestöllä tauti johti leikkaukseen selvästi useammin. Kortikosteroidien ja 5-ASA valmisteiden käyttö oli yhtäläistä, mutta vanhusväestössä käytettiin selvästi vähemmän immunomoduloivia sekä biologisia lääkkeitä.