Browsing by Subject "Elderly"

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  • Avellan-Hietanen, Heidi; Aalto, Tiina; Maasilta, Paula; Ask, Oili; Bachour, Adel (2022)
    Purpose Adherence to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) syndrome has not been established in patients over 70 years of age, whereas several studies have reported adherence below that age. This trial was designed to address this evidence gap. Methods Consecutive senior (> 70 years) patients with OSA, mean respiratory event index (REI) 34/h, body mass index (BMI) 31 kg/m(2), and junior (< 50 years) patients (REI 37/h, BMI 31 kg/m(2)) were included. Results At year follow-up among 72 senior patients (35 women) and 71 junior patients (17 women), there was no difference in the percentage of patients abandoning CPAP (senior 47% vs. junior 43%) or in CPAP daily use (4:53 +/- 2:44 hh:min vs. 4:23 +/- 3:00 hh:min). Conclusions CPAP adherence in senior patients with OSA was not poorer than that of a younger group of OSA patients. Advanced age should not be an obstacle to CPAP initiation.
  • 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.
  • Strandberg, Timo E. (2022)
    The status of low‑density lipoprotein (LDL) cholesterol is strong as an essential cause of atherosclerotic vascular disease (ASCVD) and primary target of lipid lowering. Drugs affecting primarily LDL choles‑ terol through an increase of LDL receptor expression are the backbone of current therapy, and generic statins are generally safe, effective, and inexpensive drugs serving this purpose. Statins are indicated for practically all patients in secondary prevention, whereas treatment in primary prevention (healthy individuals) is based on a calculated 10‑year risk of ASCVD. At “borderline” (from 5% to “intermediate” (from 7.5% to for accurate assessment of the individual risk. The calculation of a lifetime risk instead of the 10‑year risk can be especially useful in younger people. More information about the benefits and risks of statins in primary prevention in older people (>70 years of age) will be provided by ongoing randomized and controlled trials (STAREE and PREVENTABLE). In this narrative review, I shall present recent advances in the use of statins in younger and older healthy people, and discuss their benefits and potential risks. I also raise a question whether with the current evidence base, most people in affluent societies would benefit from taking statins.
  • Tiainen, Marjaana; Martinez-Majander, Nicolas; Virtanen, Pekka; Räty, Silja; Strbian, Daniel (2022)
    Objectives: Data concerning the results of endovascular thrombectomy (EVT) in old patients is still limited. We aimed to investigate the outcomes in thrombectomytreated ischemic stroke patients aged > 80 years, focusing on frailty as a contributing factor. Patients and methods: We performed a single-centre retrospective cohort study with 159 consecutive patients aged > 80 years and treated with EVT for acute ischemic stroke between January 1st 2016 and December 31st 2019. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS). Patients with CFS > 5 were defined as frail. The main outcome was very poor outcome defined as mRS 46 at three months after EVT. Secondary outcomes were recanalization status, symptomatic intracerebral haemorrhage (sICH), and one-year survival. Finally, we recorded if the patient returned home within 12 months. Results: Very poor outcome was observed in 57.9% of all patients (52.4% in non-frail and 79.4% in frail patients). Rates of recanalization and sICH were comparable in frail and non-frail patients. Of all patients, 46.5% were able to live at home within 1 year after stroke. One-year survival was 59.1% (65.6% in non-frail and 35.3% in frail patients). In logistic regression analysis higher admission NIHSS, not performing thrombolysis, lack of recanalization and higher frailty status were all independently associated with very poor three-month outcome. Factors associated with one-year mortality were male gender, not performing thrombolysis, sICH, and higher frailty status. Conclusion: Almost 60% of studied patients had very poor outcome. Frailty significantly increases the likelihood of very poor outcome and death after EVT-treated stroke.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
  • 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.
  • de Bree, Remco; Meerkerk, Christiaan D. A.; Halmos, György B.; Mäkitie, Antti A.; Homma, Akihiro; Rodrigo, Juan P.; Lopez, Fernando; Takes, Robert P.; Vermorken, Jan B.; Ferlito, Alfio (2022)
    In head and neck cancer (HNC) there is a need for more personalized treatment based on risk assessment for treatment related adverse events (i.e. toxicities and complications), expected survival and quality of life. Sarcopenia, defined as a condition characterized by loss of skeletal muscle mass and function, can predict adverse outcomes in HNC patients. A review of the literature on the measurement of sarcopenia in head and neck cancer patients and its association with frailty was performed. Skeletal muscle mass (SMM) measurement only is often used to determine if sarcopenia is present or not. SMM is most often assessed by measuring skeletal muscle cross-sectional area on CT or MRI at the level of the third lumbar vertebra. As abdominal scans are not always available in HNC patients, measurement of SMM at the third cervical vertebra has been developed and is frequently used. Frailty is often defined as an age-related cumulative decline across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to withstand stress, leading to increased risk of adverse health outcomes. There is no international standard measure of frailty and there are multiple measures of frailty. Both sarcopenia and frailty can predict adverse outcomes and can be used to identify vulnerable patients, select treatment options, adjust treatments, improve patient counselling, improve preoperative nutritional status and anticipate early on complications, length of hospital stay and discharge. Depending on the definitions used for sarcopenia and frailty, there is more or less overlap between both conditions. However, it has yet to be determined if sarcopenia and frailty can be used interchangeably or that they have additional value and should be used in combination to optimize individualized treatment in HNC patients.
  • 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.
  • CardShock Study In; Hongisto, Mari; Lassus, Johan; Tarvasmäki, Tuukka; Sionis, Alessandro; San Rosello, Jordi; Tolppanen, Heli; Kataja, Anu; Jäntti, Toni; Sabell, Tuija; Lindholm, Matias Greve; Banaszewski, Marek; Silva Cardoso, Jose; Parissis, John; Di Somma, Salvatore; Carubelli, Valentina; Jurkko, Raija; Masip, Josep; Harjola, Veli-Pekka (2021)
    Aims This study aimed to assess the utility of contemporary clinical risk scores and explore the ability of two biomarkers [growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2)] to improve risk prediction in elderly patients with cardiogenic shock. Methods and results Patients (n = 219) from the multicentre CardShock study were grouped according to age (elderly >= 75 years and younger). Characteristics, management, and outcome between the groups were compared. The ability of the CardShock risk score and the IABP-SHOCK II score to predict in-hospital mortality and the additional value of GDF-15 and sST2 to improve risk prediction in the elderly was evaluated. The elderly constituted 26% of the patients (n = 56), with a higher proportion of women (41% vs. 21%, P <0.05) and more co-morbidities compared with the younger. The primary aetiology of shock in the elderly was acute coronary syndrome (84%), with high rates of percutaneous coronary intervention (87%). Compared with the younger, the elderly had higher in-hospital mortality (46% vs. 33%; P = 0.08), but 1 year post-discharge survival was excellent in both age groups (90% in the elderly vs. 88% in the younger). In the elderly, the risk prediction models demonstrated an area under the curve of 0.75 for the CardShock risk score and 0.71 for the IABP-SHOCK II score. Incorporating GDF-15 and sST2 improved discrimination for both risk scores with areas under the curve ranging from 0.78 to 0.84. Conclusions Elderly patients with cardiogenic shock have higher in-hospital mortality compared with the younger, but post-discharge outcomes are similar. Contemporary risk scores proved useful for early mortality risk prediction also in the elderly, and risk stratification could be further improved with biomarkers such as GDF-15 or sST2.
  • 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.
  • Välimäki, Vilja; Luostarinen, Teemu; Satopää, Jarno; Raj, Rahul; Virta, Jyri J. (2021)
    Background The mean age of actively treated subarachnoid hemorrhage (SAH) patients is increasing. We aimed to compare outcomes and prognostic factors between older and younger SAH patients. Methods A retrospective single-center analysis of aneurysmal SAH patients admitted to a neuro-ICU during 2014-2019. We defined older patients as >= 70 years and younger patients as
  • Kervinen, Kaarlo V.; Salmela, Mikko T.; Lähdeoja, Tuomas A. (2022)
    Background Modern treatment options of distal humerus fractures of active elderly patients are osteosynthesis and total elbow arthroplasty. The evidence of outcomes of ORIF after AO/OTA C-type fractures mostly predates the adoption of locking plates. We evaluated the results of open reduction and internal fixation of these fractures treated exclusively with anatomic locking plates. Methods A retrospective cohort of 39 patients aged 65 years or above with ORIF for AO/OTA C-type distal humerus fracture using locking plates was analysed. 23 provided follow-up data and 14 attended a follow-up visit. Primary outcome was the Oxford Elbow Score. Secondary outcomes were Mayo Elbow Performance Score, quickDASH, satisfaction, range of motion, complications and revision surgeries. Results Mean Oxford Elbow Score pain was 83 (SD 17), Oxford Elbow Score function 83 (17) and Oxford Elbow Score social-psychological 79 (20). Mean total Oxford Elbow Score was 81 (15). Among the 14 patients who attended a follow-up visit, Mayo Elbow Performance Score was 85 (17), qDASH 19 (16), active arc of motion 119 (19) degrees. Mayo Elbow Performance Score and arc of motion were worse than on the healthy side. One patient had a serious deep infection. Eleven patients had at least one revision surgery, of which 6 were implant removals and 2 subsequent total elbow arthroplasties. Conclusions Distal AO/OTA C-type distal humerus fractures in older adults can be treated reliably and with good outcomes with ORIF using modern locking plates. The mean qDASH scores are similar to population normal values, but when compared to the healthy arm, single-arm outcomes indicated somewhat impaired function. About 1 in 4 patients had at least one revision surgery.
  • Seppälä, T.; Grünthal, V.; Koljonen, V. (2021)
    In this retrospective cohort study, we analysed treatment and outcomes among >= 65-year-old patients who experienced a traumatic pretibial laceration in the province of Kymenlaakso, Finland, between 2015 and 2019. We reviewed computerised medical records for 116 patients with a pretibial laceration, 107 of whom we analysed in further detail. Patients were traced from injury to healing, including rehabilitation periods in health care centres. As expected, the majority of patients were elderly women (67%). Most lacerations were superficial and small, explaining why treatment was mostly conservative. Only 11 (9.48%) patients were treated operatively with surgical debridement or a split-thickness skin graft. The number of overall complications in wounds was high, with a complication rate of 30.2%. Most complications were local wound infections. We found that wound healing took more than 3 months in 32% of patients. Thorough patient tracing revealed numerous follow-up visits and long rehabilitative hospitalisation periods, indicating a significant decline in patient independence and the excessive use of resources. Successful wound healing was eventually observed in 89.66% patients. Furthermore, no terminology regarding pretibial lacerations was found in patient records. This study indicates that pretibial lacerations remain poorly recognised and understood in Finland. (C) 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
  • 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.