Pub Date : 2023-06-01DOI: 10.29400/tjgeri.2023.342
G. Deniz, S. Mola, Bahadir Aytekin, G. Aşkın, Sabir Hasanzade, Naim Boran Tümer, H. Iscan
Introduction: Endovascular aortic repair outcomes in octogenarians remain unclear. We aim to investigate whether the results for octogenarians differ from those of the younger population in elective endovascular aortic repair. Materials and Methods: From January 2013 to January 2022, 313 patients were treated with elective endovascular aortic repairs. Patient demographics and perioperative and postoperative features were obtained from the hospital database. The primary goals were to explore the early mortality rates of patients aged 80 years and older and compare them with those under 80. The secondary goal was to analyze the comorbid factors. Results: A total of 245 patients were under 80 years old, and 68 patients were 80 years and older. The early mortality rate was 2.94% in the octogenarians and 0.81% in the rest, and there was no significant difference between the two (p = 0.24). However, being 80 years and older led to a significantly lower survival probability at the five-year follow-ups. The American Society of Anesthesiologists’ score was found to help predict late mortality risk and patient selection for elective endovascular aortic repair. Conclusion: As octogenarians are fragile and sensitive to complications, patient selection, careful consideration of life expectancy, and clinical assessment are key to repair. Furthermore, age should not be an independent exclusion criterion in the endovascular aortic repair treatment decision. Keywords: Aortic Aneurysm, Abdominal; Endovascular Procedure; Octogenarians.
{"title":"Midterm Outcomes of Elective Endovascular Aortic Repair in Octogenarians: When Is It Too Old?","authors":"G. Deniz, S. Mola, Bahadir Aytekin, G. Aşkın, Sabir Hasanzade, Naim Boran Tümer, H. Iscan","doi":"10.29400/tjgeri.2023.342","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.342","url":null,"abstract":"Introduction: Endovascular aortic repair outcomes in octogenarians remain unclear. We aim to investigate whether the results for octogenarians differ from those of the younger population in elective endovascular aortic repair. Materials and Methods: From January 2013 to January 2022, 313 patients were treated with elective endovascular aortic repairs. Patient demographics and perioperative and postoperative features were obtained from the hospital database. The primary goals were to explore the early mortality rates of patients aged 80 years and older and compare them with those under 80. The secondary goal was to analyze the comorbid factors. Results: A total of 245 patients were under 80 years old, and 68 patients were 80 years and older. The early mortality rate was 2.94% in the octogenarians and 0.81% in the rest, and there was no significant difference between the two (p = 0.24). However, being 80 years and older led to a significantly lower survival probability at the five-year follow-ups. The American Society of Anesthesiologists’ score was found to help predict late mortality risk and patient selection for elective endovascular aortic repair. Conclusion: As octogenarians are fragile and sensitive to complications, patient selection, careful consideration of life expectancy, and clinical assessment are key to repair. Furthermore, age should not be an independent exclusion criterion in the endovascular aortic repair treatment decision. Keywords: Aortic Aneurysm, Abdominal; Endovascular Procedure; Octogenarians.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46905203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.29400/tjgeri.2023.346
U. Sönmez, Y. Özdemir, A. Emecen
Introduction: In the coronavirus disease 2019 (COVID-19) pandemic, severe disease is predominantly seen in advanced-aged patients. In our study, we evaluated hospitalized youngest-old (65–74 years), middle-old (75–84 years) and oldest-old (≥85 years) COVID-19 patients in terms of mortality and risk factors. Materials and Methods: This retrospective study included hospitalized COVID-19 patients aged 65 years and older. Demographic characteristics, such as age, gender and comorbid conditions, baseline blood oxygen saturation levels, the necessity of oxygen treatments (nasal cannula,oxygen mask/reservoir oxygen mask), condition of the patients(mild, moderate, severe), baseline laboratory findings as C-reactive protein , white blood cell counts, thrombocyte counts, lymphocyte counts, D-dimer, alanine aminotransferase, aspartate aminotransferase and ferritin levels, pulmonary involvement on computerized tomography, the increase in oxygen requirements, the status of going to the intensive care unit and the status of receiving corticosteroids were recorded. Factors associated with mortality were analyzed. Results: A total of 399 geriatric COVID-19 patients were included in this study: 214(53.6%) were female and 185 (46.4%) were male. The mean age of the patients was 75±7.87(min:65–max:96). In our study, the mortality rate was found to be higher in the middle-old and oldest-old groups than in the youngest-old group (p=0.01). Other factors associated with mortality were as follows: lower baseline oxygen saturation levels (p=0.03), necessity of higher oxygen treatment (p<0.01), higher pulmonary involvement on computerized tomography (p<0.01), corticosteroid use (p<0.01) and having Alzheimer’s disease (p=0.03). Conclusion: Our findings emphasize that older patients are more vulnerable to COVID-19 infection and require special attention. Keywords: Geriatrics; SARS-CoV-2; Mortality.
{"title":"Evaluation of hospitalized youngest-old, middle-old and oldest-old COVID-19 patients in terms of mortality and risk factors","authors":"U. Sönmez, Y. Özdemir, A. Emecen","doi":"10.29400/tjgeri.2023.346","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.346","url":null,"abstract":"Introduction: In the coronavirus disease 2019 (COVID-19) pandemic, severe disease is predominantly seen in advanced-aged patients. In our study, we evaluated hospitalized youngest-old (65–74 years), middle-old (75–84 years) and oldest-old (≥85 years) COVID-19 patients in terms of mortality and risk factors. Materials and Methods: This retrospective study included hospitalized COVID-19 patients aged 65 years and older. Demographic characteristics, such as age, gender and comorbid conditions, baseline blood oxygen saturation levels, the necessity of oxygen treatments (nasal cannula,oxygen mask/reservoir oxygen mask), condition of the patients(mild, moderate, severe), baseline laboratory findings as C-reactive protein , white blood cell counts, thrombocyte counts, lymphocyte counts, D-dimer, alanine aminotransferase, aspartate aminotransferase and ferritin levels, pulmonary involvement on computerized tomography, the increase in oxygen requirements, the status of going to the intensive care unit and the status of receiving corticosteroids were recorded. Factors associated with mortality were analyzed. Results: A total of 399 geriatric COVID-19 patients were included in this study: 214(53.6%) were female and 185 (46.4%) were male. The mean age of the patients was 75±7.87(min:65–max:96). In our study, the mortality rate was found to be higher in the middle-old and oldest-old groups than in the youngest-old group (p=0.01). Other factors associated with mortality were as follows: lower baseline oxygen saturation levels (p=0.03), necessity of higher oxygen treatment (p<0.01), higher pulmonary involvement on computerized tomography (p<0.01), corticosteroid use (p<0.01) and having Alzheimer’s disease (p=0.03). Conclusion: Our findings emphasize that older patients are more vulnerable to COVID-19 infection and require special attention. Keywords: Geriatrics; SARS-CoV-2; Mortality.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46041330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.29400/tjgeri.2023.339
A. Akan, Semra Günay, R. Bademci, Necla Gürdal, Merve Nur Güven, O. Yalçın
Introduction: Although breast cancer is a type of cancer that is mainly seen in advanced ages, its incidence is increasing in early ages in developing countries. While advanced age may create limitations in treatment due to the person’s functional capacity and low life expectancy, treatments may be exaggerated at a young age due to the long-life expectancy and expectations from life. In this study, we aimed to examine possible differences in approach in two different age groups diagnosed with breast cancer. Materials and Methods: The retrospective study included 123 patients over the age of 70 or under 35 who applied to our hospital’s breast surgery outpatient clinic between 2016 and 2021 and were diagnosed with breast cancer. The patients’ complaints at the outpatient clinic, the histopathological features of the tumor, and the treatments applied were compared. Results: 64 (52%) of the patients included in the study were over 70 years old, and 59 (47%) were under 35 years old. Patients in both groups were applied to the outpatient clinic with a palpable mass. Histopathologically, invasive ductal cancer constituted the majority in both groups. While the elderly patients were lower grade and Estrogen receptor-positive, the younger patients were high grade, Estrogen receptor negative, and mostly triple negative. Conclusions: Regardless of age, breast cancer is a cancer type that can have better results with early diagnosis. While making the treatment decision the decision should be made according to the characteristics of the tumor, comorbidity, and life expectancy, regardless of the patient’s age. Keywords: Breast Neoplasms; Aged; Age Distribution; Therapeutics.
{"title":"Comparison of breast cancer patients over the age of 70 and under the age of 35","authors":"A. Akan, Semra Günay, R. Bademci, Necla Gürdal, Merve Nur Güven, O. Yalçın","doi":"10.29400/tjgeri.2023.339","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.339","url":null,"abstract":"Introduction: Although breast cancer is a type of cancer that is mainly seen in advanced ages, its incidence is increasing in early ages in developing countries. While advanced age may create limitations in treatment due to the person’s functional capacity and low life expectancy, treatments may be exaggerated at a young age due to the long-life expectancy and expectations from life. In this study, we aimed to examine possible differences in approach in two different age groups diagnosed with breast cancer. Materials and Methods: The retrospective study included 123 patients over the age of 70 or under 35 who applied to our hospital’s breast surgery outpatient clinic between 2016 and 2021 and were diagnosed with breast cancer. The patients’ complaints at the outpatient clinic, the histopathological features of the tumor, and the treatments applied were compared. Results: 64 (52%) of the patients included in the study were over 70 years old, and 59 (47%) were under 35 years old. Patients in both groups were applied to the outpatient clinic with a palpable mass. Histopathologically, invasive ductal cancer constituted the majority in both groups. While the elderly patients were lower grade and Estrogen receptor-positive, the younger patients were high grade, Estrogen receptor negative, and mostly triple negative. Conclusions: Regardless of age, breast cancer is a cancer type that can have better results with early diagnosis. While making the treatment decision the decision should be made according to the characteristics of the tumor, comorbidity, and life expectancy, regardless of the patient’s age. Keywords: Breast Neoplasms; Aged; Age Distribution; Therapeutics.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41874433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.333
Arda Işıker, M. Onay, A. Akcan, Ümit Akkemik, M. Güleç
Introduction: This study evaluated the importance of examining neuraxial anatomy by preprocedural ultrasonography to ensure effective spinal anesthesia administration, which can be technically challenging in geriatric patients owing to their physiological and pathological conditions. Materials and Methods: Geriatric patients with an American Society of Anesthesiologists’ physical classification of I–III undergoing elective surgery under spinal anesthesia were included. The patients were divided into two groups: the anatomical landmark-guided group and the ultrasound-assisted group. Spinal block application times, number of attempts and number of needle redirections were recorded. Results: Among the studied patients, 29 and 30 patients were included in the anatomical landmark-guided group and the ultrasound-assisted group groups, respectively. There was no significant difference in the mean age of the patients in the ultrasound-assisted group (74.6 ± 7.41 years) and the anatomical landmark-guided group (75.6 ± 7.52 years). Assisted procedure time and total operative time were significantly shorter in the anatomical landmark-guided group than in the ultrasound-assisted group (p<0.001 and p<0.05, respectively); however, spinal application times and number of trials and needle redirections were significantly lower in the ultrasound-assisted group than in the anatomical landmark-guided group (p<0.05 and p <0.05, respectively). Conclusion: Preprocedural ultrasonography before spinal anesthesia administration increases the first-attempt success rate and decreases the number of attempts and needle redirections in geriatric patients. Keywords: Geriatrics; Anesthesia, Spinal; Ultrasonography
{"title":"Evaluating the Role of Vertebral Anatomy Examination by Ultrasonography Before Administering Spinal Anesthesia in Geriatric Patients: A Prospective Randomized Trial","authors":"Arda Işıker, M. Onay, A. Akcan, Ümit Akkemik, M. Güleç","doi":"10.29400/tjgeri.2023.333","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.333","url":null,"abstract":"Introduction: This study evaluated the importance of examining neuraxial anatomy by preprocedural ultrasonography to ensure effective spinal anesthesia administration, which can be technically challenging in geriatric patients owing to their physiological and pathological conditions. Materials and Methods: Geriatric patients with an American Society of Anesthesiologists’ physical classification of I–III undergoing elective surgery under spinal anesthesia were included. The patients were divided into two groups: the anatomical landmark-guided group and the ultrasound-assisted group. Spinal block application times, number of attempts and number of needle redirections were recorded. Results: Among the studied patients, 29 and 30 patients were included in the anatomical landmark-guided group and the ultrasound-assisted group groups, respectively. There was no significant difference in the mean age of the patients in the ultrasound-assisted group (74.6 ± 7.41 years) and the anatomical landmark-guided group (75.6 ± 7.52 years). Assisted procedure time and total operative time were significantly shorter in the anatomical landmark-guided group than in the ultrasound-assisted group (p<0.001 and p<0.05, respectively); however, spinal application times and number of trials and needle redirections were significantly lower in the ultrasound-assisted group than in the anatomical landmark-guided group (p<0.05 and p <0.05, respectively). Conclusion: Preprocedural ultrasonography before spinal anesthesia administration increases the first-attempt success rate and decreases the number of attempts and needle redirections in geriatric patients. Keywords: Geriatrics; Anesthesia, Spinal; Ultrasonography","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43306021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.334
Savaş Özarslantürk, M. Naharci, N. Aydın, S. Karaoğlanoğlu, E. Oktay
Introduction: This study aimed to evaluate the relationship between dental amalgam filling and cognition in older adults. Materials and Methods: A total of 169 patients aged 65 years and above were recruited from a geriatric outpatient clinic. Their socio-demographic and chronic disease data were recorded. All patients underwent oral examinations. Amalgam filling index scores were calculated for individuals with amalgam fillings. The participants were divided into a study group [amalgam (+)] and a control group [amalgam (–)] based on their amalgam-filling statuses. For sub-analysis, the amalgam-filled group was categorised according to high (≥4.191) and low (<4.191) mean index scores. Standardised mini-mental test, clock drawing test and Lawton–Brody instrumental activities of daily living scale were conducted for all patients. Results: About 46.2% (n=78) of participants were female, mean age was 69.6 ± 6.3 years and 53.7% (n=89) had amalgam fillings. There was no significant difference in the standardised mini-mental test, clock drawing test and Lawton–Brody instrumental activities of daily living scale scores between the study and control groups (all p>0.05), or in all test scores between participants with high and low amalgam scores in the group with amalgam fillings. Conclusions: This study showed that dental amalgam fillings were not associated with cognitive decline in older adults. Keywords: Aged; Cognitive Dysfunction; Dental Amalgam.
{"title":"Relationship Between the Amount of Amalgam Filling and Cognition in Older Adults","authors":"Savaş Özarslantürk, M. Naharci, N. Aydın, S. Karaoğlanoğlu, E. Oktay","doi":"10.29400/tjgeri.2023.334","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.334","url":null,"abstract":"Introduction: This study aimed to evaluate the relationship between dental amalgam filling and cognition in older adults. Materials and Methods: A total of 169 patients aged 65 years and above were recruited from a geriatric outpatient clinic. Their socio-demographic and chronic disease data were recorded. All patients underwent oral examinations. Amalgam filling index scores were calculated for individuals with amalgam fillings. The participants were divided into a study group [amalgam (+)] and a control group [amalgam (–)] based on their amalgam-filling statuses. For sub-analysis, the amalgam-filled group was categorised according to high (≥4.191) and low (<4.191) mean index scores. Standardised mini-mental test, clock drawing test and Lawton–Brody instrumental activities of daily living scale were conducted for all patients. Results: About 46.2% (n=78) of participants were female, mean age was 69.6 ± 6.3 years and 53.7% (n=89) had amalgam fillings. There was no significant difference in the standardised mini-mental test, clock drawing test and Lawton–Brody instrumental activities of daily living scale scores between the study and control groups (all p>0.05), or in all test scores between participants with high and low amalgam scores in the group with amalgam fillings. Conclusions: This study showed that dental amalgam fillings were not associated with cognitive decline in older adults. Keywords: Aged; Cognitive Dysfunction; Dental Amalgam.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46463610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.328
Savaş Sezi̇k
Introduction: The aim of this prospective observational study was to compare the predictive ability of the Triage Risk Stratification Tool and Identification of Seniors at Risk in identifying elderly people at risk of adverse outcomes (return to the emergency department, hospital admission, and death) within 30 days following discharge from the emergency department. Materials and Methods: 396 patients aged between 65 and 98 (mean 76.89±7.59) accessing the emergency department were evaluated over a 1-month period. Both screening tool were administered in the emergency department by emergency specialist physicians. Risk factors were assigned a score based on their regression co-efficient estimate and a total risk score was created. This score was evaluated for sensitivity and specificity. Results: Of the 396 participants, 198 (50%) were female. A significant correlation was not observed between risk of adverse outcomes and characteristics of the participant (p>0.005). The Identification of Seniors at Risk (cutoff of ≥3) was positive in 61.3% of the patients, whereas 79% were Triage Risk Stratification Tool-positive (cutoff of ≥2). The two scores were significantly correlated and had similar areas under the receiver operating characteristic curves in predicting hospital admission (Identification of Seniors at Risk, 0.63; Triage Risk Stratification Tool, 0.59). Conclusions: The predictive accuracy of the scoring systems for hospital admission after 30 days was significant at cutoff values of ≥3 for Identification of Seniors at Risk and ≥2 for Triage Risk Stratification Tool. The Identification of Seniors at Risk had slightly higher sensitivity and lower specificity than the Triage Risk Stratification Tool. Key Words: Emergency Service, Hospital; Geriatric Assessment; Risk Assessment; Aged.
{"title":"A 30-DAY RISK ASSESSMENT OF GERIATRIC PATIENTS IN THE EMERGENCY DEPARTMENT: A COMPARISON OF ISAR AND TRST SCORES","authors":"Savaş Sezi̇k","doi":"10.29400/tjgeri.2023.328","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.328","url":null,"abstract":"Introduction: The aim of this prospective observational study was to compare the predictive ability of the Triage Risk Stratification Tool and Identification of Seniors at Risk in identifying elderly people at risk of adverse outcomes (return to the emergency department, hospital admission, and death) within 30 days following discharge from the emergency department. Materials and Methods: 396 patients aged between 65 and 98 (mean 76.89±7.59) accessing the emergency department were evaluated over a 1-month period. Both screening tool were administered in the emergency department by emergency specialist physicians. Risk factors were assigned a score based on their regression co-efficient estimate and a total risk score was created. This score was evaluated for sensitivity and specificity. Results: Of the 396 participants, 198 (50%) were female. A significant correlation was not observed between risk of adverse outcomes and characteristics of the participant (p>0.005). The Identification of Seniors at Risk (cutoff of ≥3) was positive in 61.3% of the patients, whereas 79% were Triage Risk Stratification Tool-positive (cutoff of ≥2). The two scores were significantly correlated and had similar areas under the receiver operating characteristic curves in predicting hospital admission (Identification of Seniors at Risk, 0.63; Triage Risk Stratification Tool, 0.59). Conclusions: The predictive accuracy of the scoring systems for hospital admission after 30 days was significant at cutoff values of ≥3 for Identification of Seniors at Risk and ≥2 for Triage Risk Stratification Tool. The Identification of Seniors at Risk had slightly higher sensitivity and lower specificity than the Triage Risk Stratification Tool. Key Words: Emergency Service, Hospital; Geriatric Assessment; Risk Assessment; Aged.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43617853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.329
Dilara Göçmen, C. Köksal, S. Abitağaoğlu, Arzu Yıldırım Ar
Introduction: Avoiding undesirable effects of hyper- and hypovolemia is important in geriatric hip fracture patients perioperatively. In our study, we aimed to compare the effects of intraoperative goal directed and conventional fluid therapy on inferior vena cava collapsibility index, postoperative complications and 30-day mortality in these patients. Materials and Methods: 60 patients aged 65 and over who underwent proximal femoral nail surgery were included in the study.Patients were randomized into two groups; Goal Directed and Conventional Therapy groups. Patients in the Goal Directed Therapy Group were monitored with a MostcareTm (Vygon, VytechHealth, Padova, Italy) haemodynamic monitor. Fluid therapy was applied by targeting Pulse Pressure Variation <10%, Stroke Volume Variation <13%. In the Conventional Therapy group fluid management was administered to the patients according to the 4-2-1 rule. Before anesthesia and leaving the recovery room, inferior vena cava collapsibility index measurements was performed by ultrasonography. Results: Postoperative inferior vena cava collapsibility index was higher in the Conventional group. Total administered crystalloid fluid volumes were similar in both the groups and more colloids were used in the Goal Directed Therapy group. Intraoperative urine output was observed more in the Goal Directed Therapy group. Postoperative hospital stay was shorter in the Goal Directed Therapy group. There was no significant difference in terms of 30-day mortality and postoperative complications. Conclusion: According to our study, intraoperative targeted fluid herapy provides optimal postoperative intravascular volume and shortened the postoperative hospital stay. Keywords: Femoral Fractures; Vena Cava, Inferior; Hemodynamic Monitoring; Fluid Therapy; Postoperative Complications.
{"title":"Comparison Of The Effects Of Intraoperative Goal Directed And Conventional Fluid Management On The Inferior Vena Cava Collapsibility Index And Postoperative Complications In Geriatric Patients Operated From Proximal Femoral Nail Surgery","authors":"Dilara Göçmen, C. Köksal, S. Abitağaoğlu, Arzu Yıldırım Ar","doi":"10.29400/tjgeri.2023.329","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.329","url":null,"abstract":"Introduction: Avoiding undesirable effects of hyper- and hypovolemia is important in geriatric hip fracture patients perioperatively. In our study, we aimed to compare the effects of intraoperative goal directed and conventional fluid therapy on inferior vena cava collapsibility index, postoperative complications and 30-day mortality in these patients. Materials and Methods: 60 patients aged 65 and over who underwent proximal femoral nail surgery were included in the study.Patients were randomized into two groups; Goal Directed and Conventional Therapy groups. Patients in the Goal Directed Therapy Group were monitored with a MostcareTm (Vygon, VytechHealth, Padova, Italy) haemodynamic monitor. Fluid therapy was applied by targeting Pulse Pressure Variation <10%, Stroke Volume Variation <13%. In the Conventional Therapy group fluid management was administered to the patients according to the 4-2-1 rule. Before anesthesia and leaving the recovery room, inferior vena cava collapsibility index measurements was performed by ultrasonography. Results: Postoperative inferior vena cava collapsibility index was higher in the Conventional group. Total administered crystalloid fluid volumes were similar in both the groups and more colloids were used in the Goal Directed Therapy group. Intraoperative urine output was observed more in the Goal Directed Therapy group. Postoperative hospital stay was shorter in the Goal Directed Therapy group. There was no significant difference in terms of 30-day mortality and postoperative complications. Conclusion: According to our study, intraoperative targeted fluid herapy provides optimal postoperative intravascular volume and shortened the postoperative hospital stay. Keywords: Femoral Fractures; Vena Cava, Inferior; Hemodynamic Monitoring; Fluid Therapy; Postoperative Complications.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42032901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.325
A. Alp, H. Elbi̇, Aysun Toraman
Introduction: Chronic kidney disease and frailty are two crucial clinical conditions increasing in prevalence globally. Both lead to severe complications that increase mortality and morbidity in patients. Conditions that may potentiate frailty in chronic kidney disease patients may complicate the follow-up of chronic disease and complicate long-term survival in this patient group. In this study, we aimed to evaluate frailty and related factors in chronic kidney disease patients over 65 years of age who were on dialysis and who were not. Materials and Methods: This cross-sectional study was carried out in geriatric chronic kidney disease patients followed in nephrology outpatient clinics or undergoing routine hemodialysis. Frailty was assessed using a scoring scale. Laboratory findings and their relationship with demographic and epidemiological data were investigated. Results: One hundred eighty-eight patients aged 65 and over were included in our study. Of the patients, 92 were female, and 96 were male. The mean age was 72.86 years. We found frailty in 82 patients (43.6%). Female gender, over 75 years old, under dialysis treatment, low-income status, and low education level were parameters significantly associated with frailty. In the regression analysis, we found that economic status and dialysis were variables that independently affected frailty in chronic kidney disease patients. Conclusions: In our study, the frequency of frailty was found to be high. Practical management and early assessment of frailty seem rational with the basic nephrological approach in patients with chronic kidney disease. Considering the high mortality rate among frail patients, we think these patients should be followed up more closely. Keywords: Frailty; Aged; Renal Insufficiency, Chronic.
{"title":"Frailty and Related Factors in Elderly Patients with Chronic Kidney Disease","authors":"A. Alp, H. Elbi̇, Aysun Toraman","doi":"10.29400/tjgeri.2023.325","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.325","url":null,"abstract":"Introduction: Chronic kidney disease and frailty are two crucial clinical conditions increasing in prevalence globally. Both lead to severe complications that increase mortality and morbidity in patients. Conditions that may potentiate frailty in chronic kidney disease patients may complicate the follow-up of chronic disease and complicate long-term survival in this patient group. In this study, we aimed to evaluate frailty and related factors in chronic kidney disease patients over 65 years of age who were on dialysis and who were not. Materials and Methods: This cross-sectional study was carried out in geriatric chronic kidney disease patients followed in nephrology outpatient clinics or undergoing routine hemodialysis. Frailty was assessed using a scoring scale. Laboratory findings and their relationship with demographic and epidemiological data were investigated. Results: One hundred eighty-eight patients aged 65 and over were included in our study. Of the patients, 92 were female, and 96 were male. The mean age was 72.86 years. We found frailty in 82 patients (43.6%). Female gender, over 75 years old, under dialysis treatment, low-income status, and low education level were parameters significantly associated with frailty. In the regression analysis, we found that economic status and dialysis were variables that independently affected frailty in chronic kidney disease patients. Conclusions: In our study, the frequency of frailty was found to be high. Practical management and early assessment of frailty seem rational with the basic nephrological approach in patients with chronic kidney disease. Considering the high mortality rate among frail patients, we think these patients should be followed up more closely. Keywords: Frailty; Aged; Renal Insufficiency, Chronic.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44823679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.332
Afife GÜLER KOL, Hacı Yusuf Güneş
Introduction: Aging is a physiological process and the elderly population is increasing. In parallel to the increasing of the elderly population, the number of geriatric patients who required an invasive procedure or surgical intervention under anesthesia are also increasing. The geriatric patients who are frailty and have a loss of functional reserve in all organ systems are more sensitive to anesthetic agents. The purpose of this research was to investigate whether low flow desflurane anesthesia also affects hepatic and kidney functions, in elderly patients. Methods: After approval from the local ethics committee, the patients were divided into two groups; as the low flow desflurane anesthesia group and the normal flow desflurane anesthesia group using the closed-envelope method. Calibration and leakage tests of the anesthesia device (Primus, Drager) were performed before anesthesia. Heamodynamics parametres, peripheral oxygen saturation, and bispectral index monitoring were performed to all patients in operating room. The blood samples were collected before anesthesia induction, after surgery, and at the postoperative 24th hour. The serum alanine aminotransferase and aspartate aminotransferase levels were measured to assess the liver damage. The serum creatinine, blood urea nitrogen, and cystatin C levels were measured to assess the kidney function. Results: The serum alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and cystatin C levels and hemodynamic parameters, peripheral oxygen saturation and bispectral index values were similar in both groups. Conclusions: It was concluded that low-flow desflurane anesthesia does not adversely affect liver and kidney functions in geriatric patients and is as safe as normal-flow desflurane anesthesia. Keywords: Anesthesia; Cystatin C; Desflurane; Aged; Kidney; Liver.
{"title":"The Effects of Low Flow and Normal Flow Desflurane Anesthesia on Liver and Renal Functions and Serum Cystatin C Levels in Geriatric Patients: A Prospective Randomized Controlled Study","authors":"Afife GÜLER KOL, Hacı Yusuf Güneş","doi":"10.29400/tjgeri.2023.332","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.332","url":null,"abstract":"Introduction: Aging is a physiological process and the elderly population is increasing. In parallel to the increasing of the elderly population, the number of geriatric patients who required an invasive procedure or surgical intervention under anesthesia are also increasing. The geriatric patients who are frailty and have a loss of functional reserve in all organ systems are more sensitive to anesthetic agents. The purpose of this research was to investigate whether low flow desflurane anesthesia also affects hepatic and kidney functions, in elderly patients. Methods: After approval from the local ethics committee, the patients were divided into two groups; as the low flow desflurane anesthesia group and the normal flow desflurane anesthesia group using the closed-envelope method. Calibration and leakage tests of the anesthesia device (Primus, Drager) were performed before anesthesia. Heamodynamics parametres, peripheral oxygen saturation, and bispectral index monitoring were performed to all patients in operating room. The blood samples were collected before anesthesia induction, after surgery, and at the postoperative 24th hour. The serum alanine aminotransferase and aspartate aminotransferase levels were measured to assess the liver damage. The serum creatinine, blood urea nitrogen, and cystatin C levels were measured to assess the kidney function. Results: The serum alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and cystatin C levels and hemodynamic parameters, peripheral oxygen saturation and bispectral index values were similar in both groups. Conclusions: It was concluded that low-flow desflurane anesthesia does not adversely affect liver and kidney functions in geriatric patients and is as safe as normal-flow desflurane anesthesia. Keywords: Anesthesia; Cystatin C; Desflurane; Aged; Kidney; Liver.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49028591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.29400/tjgeri.2023.327
Yücel Olgun, Rekib Saçaklıdır, Yasin Okumuş, Savaş Şencan, O. Gündüz
Introduction: Epidural steroid injections are a preferred interventional pain treatment for patients with low back pain. Our aim was to investigate the effectiveness of epidural steroid injections treatment in elderly patients and to examine the effect of patients’ diagnosis on the treatment success. Materials and Methods: Patients over the age of 65 who underwent epidural injections between January 2020 and January 2022 were retrospectively screened. The patients were divided into three groups according to their diagnosis: disc herniation, spinal stenosis, and failed back surgery syndrome. Numeric rating scale scores of all patients before the procedure, at three weeks, and at three months were noted. Results: A total of 234 patients were included in the study. Of these, 89 had disc herniation, 98 had spinal stenosis, and 47 had a history of failed back surgery. There were no significant differences between the groups in terms of age, gender, symptom duration, pre-procedural pain score, medical treatment, radiation dose, and procedure duration. Although a significant improvement was detected in pain scores at all follow-ups in all groups, these scores were found to be significantly lower in the disc herniation group than the spinal stenosis and failed back surgery groups at the three-week and month follow-ups. Conclusions: Epidural steroid injections has been found to be effective in back pain in elderly. In addition, elderly patients with disc herniation had a better response to treatment than those with spinal stenosis and failed back surgery. Further prospective and long-term follow-up studies are needed to support these results. Keywords: Aged; Low Back Pain; Injections, Epidural; Spinal Stenosis; Failed Back Surgery Syndrome.
{"title":"Efficacy of Epidural Steroid Injection in Elderly Patients: Does Diagnosis Affect Treatment Success?","authors":"Yücel Olgun, Rekib Saçaklıdır, Yasin Okumuş, Savaş Şencan, O. Gündüz","doi":"10.29400/tjgeri.2023.327","DOIUrl":"https://doi.org/10.29400/tjgeri.2023.327","url":null,"abstract":"Introduction: Epidural steroid injections are a preferred interventional pain treatment for patients with low back pain. Our aim was to investigate the effectiveness of epidural steroid injections treatment in elderly patients and to examine the effect of patients’ diagnosis on the treatment success. Materials and Methods: Patients over the age of 65 who underwent epidural injections between January 2020 and January 2022 were retrospectively screened. The patients were divided into three groups according to their diagnosis: disc herniation, spinal stenosis, and failed back surgery syndrome. Numeric rating scale scores of all patients before the procedure, at three weeks, and at three months were noted. Results: A total of 234 patients were included in the study. Of these, 89 had disc herniation, 98 had spinal stenosis, and 47 had a history of failed back surgery. There were no significant differences between the groups in terms of age, gender, symptom duration, pre-procedural pain score, medical treatment, radiation dose, and procedure duration. Although a significant improvement was detected in pain scores at all follow-ups in all groups, these scores were found to be significantly lower in the disc herniation group than the spinal stenosis and failed back surgery groups at the three-week and month follow-ups. Conclusions: Epidural steroid injections has been found to be effective in back pain in elderly. In addition, elderly patients with disc herniation had a better response to treatment than those with spinal stenosis and failed back surgery. Further prospective and long-term follow-up studies are needed to support these results. Keywords: Aged; Low Back Pain; Injections, Epidural; Spinal Stenosis; Failed Back Surgery Syndrome.","PeriodicalId":51196,"journal":{"name":"Turkish Journal of Geriatrics-Turk Geriatri Dergisi","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41784828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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