International Journal of Gerontology最新文献

Spasticity is a common condition in stroke survivors, and may be associated with pain and joint contracture, leading to poor quality of life and increased caregiver burden. Although the underlying mechanisms are not well-understood, it may be due to disruption of the balance of supra-spinal inhibitory and excitatory sensory inputs directed to the spinal cord, leading to a state of disinhibition of the stretch reflex. The treatment options include physical therapy, modality and pharmacological treatments, neurolysis with phenol and botulinum toxin, and surgical treatment. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, natural history, and impact on patient's performances. This review focuses on the epidemiology, presumed mechanism, clinical manifestation, and recent evidences of management.

Background

Diabetes is characterized by increased insulin resistance (IR) and decreased insulin secretion. The roles of glucose effectiveness (GE), first- and second-phase insulin secretion (FPIS, SPIS) are often overlooked. We denote these factors as diabetic factors (DF). Hemoglobin (Hb) has been shown to be related to IR and FPIS, but not to SPIS and GE. The aims of this study are to investigate the relationships between Hb and DFs and to compare which one has the tightest correlation with Hb in old Chinese.

Methods

We randomly enrolled 5109 men and 5851 women, whose age were over 65 years old. Subjects, who were obese or on medications, were excluded. Simple correlation was applied to evaluate the relationships between Hb and 4 DFs. To compare the relative tightness between each correlation lines, all the units of the DFs were transformed into percentage.

Results

All the biochemistry data were higher in subjects with metabolic syndrome (MetS) in both genders, except for GE and HDL. Similar trends were also noted when dividing subjects into quartiles of Hb. The results of simple correlation showed that all the DFs are significantly related to Hb except for FPIS in women. The association between Hb and GE is negative. After transforming the different units into percentage, the relationships with Hb, from the highest to lowest, were IR, SPIS, GE and FPIS in both genders.

Conclusion

Our data show that all DFs are almost related to Hb. IR has the tightest correlation with Hb in old Chinese.

Background

Elderly are mostly affected by polypharmacy induced adverse drug events as they are vulnerable due to numerous comorbidities. Deprescribing is a series of medicine ceasing process introduced to solve the problem arisen from polypharmacy. This study aimed to investigate the attitudes, beliefs and experiences towards polypharmacy among elderly with chronic diseases and their willingness to be deprescribed.

Methods

A cross-sectional study was conducted among elderly patients in a tertiary hospital in Malaysia from August 2017 to October 2017 using a researcher assisted and validated questionnaire.

Results

A total number of 222 elderly patients were included in this study. 45.5% (n = 101) of the participants agreed that they were taking a large number of medicines (95% CI = 38.89%–52.10%). 56.3% (n = 125) of the participants had the desire to reduce their number of medications (95% CI = 49.73%–62.88%). Majority of them (n = 185, 83.33%) agreed to involve themselves in deprescribing process if permitted by their health care provider. 86.9% (n = 193) of the participants tended to not be afraid of deprescribing of their regular medications after a series of investigations by their health care provider (95% CI = 81%–89%).

Conclusion

Majority of the elderly would like to participate in deprescribing process. Major factors that will affect patients' willingness to deprescribe were physicians' time and support as well as possible future benefits of their regular medications.

Background

Finding a new method to get the Chinese healthy adult male LVEF reference values with heart rate & geo graphical environment factors. It is more accurate and simpler while considering different areas and individual differences.

Methods

Collecting 3502 cases from more than 44 cities healthy adult male LVEF reference values and heart rate reference values (X₁) within 10 years published articles in CNKI. A correlation analysis and ridge regression were employed to extract dependent geographical environment factors and predict the reference values of LVEF. The Kriging interpolation of geostatistical analysis were developed to reveal the spatial distribution characteristics of the LVEF values.

Results

It has a correlation between LVEF and heart rate (X₁)& geographical environment factors. The ridge regression equation of LVEF reference values and geographical environment factors is formula(1). The equation of LVEF reference values with heart rate and geographical environment factors is formula(2).

Conclusion

The Chinese healthy adult male LVEF distribution showed a downward trend from south to north. Some geographical environment factors have impact on LVEF reference values including latitude, annual precipitation amount and mean air temperature distribution. LVEF is negative correlation with heart rate. When geographical environment factors and individual's heart rate are known, the local and individual's LVEF reference values can be derived from the formulas.

Background

Plantar hyperkeratotic lesions are one of the most prevalent foot problems among older people. Because of its simplicity, the most common treatment is scalpel debridement. While some studies have analysed its effectiveness in the short term or among other population groups, none has analysed its effects in the medium term. The aim of this study is to assess the effectiveness of plantar hyperkeratosis debridement compared to a control group receiving sham debridement among an older population group.

Methods

Two hundred older participants (76.4 ± 4.8 years) were randomly assigned to two groups: scalpel debridement of plantar hyperkeratoses (experimental group) or sham debridement (control group). Plantar hyperkeratotic pain was measured on a visual analogue scale.

Results

The results suggest that there were no significant differences between the groups studied just after treatment (p = 0.27), although significant differences between them were found as from 24 h after treatment (p = 0.05) and 2 (p = 0.03), 3 (p = 0.04), 4 (p = 0.04) and 5 days after treatment (p = 0.04).

Conclusions

The results of this study suggest that there were significant differences in self-perception of pain levels between the group of older people treated for plantar hyperkeratoses with scalpel debridement and the control group as from 24 h after treatment.

Background

The objective of this study was to investigate whether the nutrition intake from enteral nutrition (EN) and parenteral nutrition (PN) created a better clinical outcome than EN alone in high nutritional risk (HNR) mechanically ventilated critically ill elderly patients.

Methods

We included patients ≥ 65 years on mechanical ventilation ≥ 48 h and received EN. Nutritional status was evaluated by Modify NUTrition Risk in Critical ill score (mNUTRIC). We calculated the energy and protein requirements as Harris-Benedict equation × 1.0–1.3 and 1.0–2.0 gm/kg body weight respectively. Nutrition intake from EN and PN was recorded within 7 days. ICU and hospital mortalities in HNR elderly patients who could achieve more or less 80% prescribed nutrition were compared.

Result

Among 190 critically ill elderly patients, 173 (91.1%) HNR patients had mNUTRIC ≥ 5. HNR patients who achieved ≥80% prescribed calorie had lower ICU mortality (13.5% vs 25.8%; P = 0.04) and hospital mortality (23.4% vs 40.3%; P = 0.02) compared to those who achieved <80% prescription. For those who EN protein achieved ≥80% prescription had a lower hospital mortality (23.4% vs 40.3%; P = 0.02). For each point increase of mNUTRIC, ICU length of stay (LOS) increased 1.18 days, Days of Mechanical Ventilation (MVDs) increased 1.54 days, hospital LOS increased 1.52 days, the ICU mortality OR = 1.71 (1.22–2.39) and hospital mortality OR = 1.64 (1.24–2.15).

Conclusion

Very high percentage (91.1%) of medical intensive care (MICU) elderly patients were in HNR. Those who EN calorie achieved ≥80% prescription had lower ICU and hospital mortality. Increased EN protein intake only lowered hospital mortality.