Pub Date : 2015-02-01DOI: 10.1017/S0959259815000039
C. Benavente, C. Seri, B. Íñigo, R. Martínez
{"title":"Lymphoma in older patients: clinical and therapeutic characteristics","authors":"C. Benavente, C. Seri, B. Íñigo, R. Martínez","doi":"10.1017/S0959259815000039","DOIUrl":"https://doi.org/10.1017/S0959259815000039","url":null,"abstract":"","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"25 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259815000039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-02-01DOI: 10.1017/S0959259815000027
M. Middleton, M. Stechman, S. Moug, K. McCarthy, J. Hewitt
This review identifies and examines the clinical application of risk prediction tools, including the American Society of Anaesthesiology (ASA) Classification System and POSSUM-based scores, in the older general surgical patient. Predicting outcomes in this patient group remains difficult; it is challenging to design a risk prediction tool that will apply to both emergency and elective surgery and that remains valid across the wide age range that this patient group encompasses. Risk prediction tools can have benefit but should be used in conjunction with the clinical assessment of those experienced in the care of this challenging patient group.
{"title":"Risk prediction tools for older general surgical patients","authors":"M. Middleton, M. Stechman, S. Moug, K. McCarthy, J. Hewitt","doi":"10.1017/S0959259815000027","DOIUrl":"https://doi.org/10.1017/S0959259815000027","url":null,"abstract":"This review identifies and examines the clinical application of risk prediction tools, including the American Society of Anaesthesiology (ASA) Classification System and POSSUM-based scores, in the older general surgical patient. Predicting outcomes in this patient group remains difficult; it is challenging to design a risk prediction tool that will apply to both emergency and elective surgery and that remains valid across the wide age range that this patient group encompasses. Risk prediction tools can have benefit but should be used in conjunction with the clinical assessment of those experienced in the care of this challenging patient group.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"25 1","pages":"12-21"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259815000027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-02-01DOI: 10.1017/S0959259815000052
N. Smith, D. Tiwari
Epilepsy is the third most common neurological disorder of older adults, with huge functional and psychological implications. It is often difficult to diagnose in the presence of cognitive impairment and lack of a witness account. The most common identifiable causes of epilepsy in old age are cerebrovascular disease and dementia. New guidelines recommend starting treatment after first unprovoked seizure. If there is any doubt about the diagnosis, electroencephalography (EEG) should be considered, or ‘wait and watch’. The aim of treatment should be to fully control seizure activity with the most effective monotherapy and fewest possible side-effects. Drug compliance is often difficult to achieve in older adults.
{"title":"Epilepsy in older people","authors":"N. Smith, D. Tiwari","doi":"10.1017/S0959259815000052","DOIUrl":"https://doi.org/10.1017/S0959259815000052","url":null,"abstract":"Epilepsy is the third most common neurological disorder of older adults, with huge functional and psychological implications. It is often difficult to diagnose in the presence of cognitive impairment and lack of a witness account. The most common identifiable causes of epilepsy in old age are cerebrovascular disease and dementia. New guidelines recommend starting treatment after first unprovoked seizure. If there is any doubt about the diagnosis, electroencephalography (EEG) should be considered, or ‘wait and watch’. The aim of treatment should be to fully control seizure activity with the most effective monotherapy and fewest possible side-effects. Drug compliance is often difficult to achieve in older adults.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"39 1","pages":"53-59"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259815000052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-02-01DOI: 10.1017/S0959259814000197
I. Runkle, E. Gómez-Hoyos, M. Cuesta-Hernández, J. Chafer-Vilaplana, P. Miguel
Hyponatraemia is frequent in older people and induces marked motor and cognitive dysfunction, even in patients deemed ‘asymptomatic’. Nutritional status is worse than in euvolaemic-matched controls, and the risk of fracture is increased following incidental falls. Yet hyponatraemia is undertreated, in spite of the fact that its correction is accompanied by a clear improvement in symptoms. Both evaluation of neurological symptoms and classification by volaemia are essential for a correct diagnosis and treatment of the hyponatraemic elderly patient. The syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is the most common cause of hyponatraemia in older people. Nutritional status and chronicity of SIADH should be taken into account when deciding therapy. We propose an 8-step approach to the management of the elderly patient with hyponatraemia.
{"title":"Hyponatraemia in older patients: a clinical and practical approach","authors":"I. Runkle, E. Gómez-Hoyos, M. Cuesta-Hernández, J. Chafer-Vilaplana, P. Miguel","doi":"10.1017/S0959259814000197","DOIUrl":"https://doi.org/10.1017/S0959259814000197","url":null,"abstract":"Hyponatraemia is frequent in older people and induces marked motor and cognitive dysfunction, even in patients deemed ‘asymptomatic’. Nutritional status is worse than in euvolaemic-matched controls, and the risk of fracture is increased following incidental falls. Yet hyponatraemia is undertreated, in spite of the fact that its correction is accompanied by a clear improvement in symptoms. Both evaluation of neurological symptoms and classification by volaemia are essential for a correct diagnosis and treatment of the hyponatraemic elderly patient. The syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is the most common cause of hyponatraemia in older people. Nutritional status and chronicity of SIADH should be taken into account when deciding therapy. We propose an 8-step approach to the management of the elderly patient with hyponatraemia.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"25 1","pages":"31-52"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259814000197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-01DOI: 10.1017/S0959259815000015
P. Nash, Pauline Willis, A. Tales, Thomas Cryer
The population is ageing and the rights, welfare and wellbeing of this age cohort are becoming more globally prominent and the focus of much policy development. Whilst research is leading the way and informing this in many spheres of an older person's life, this is not the case for sexual health. Campaigns of sexual health literacy and intervention are targeted at ‘at-risk’ cohorts, largely ignoring those over 60 years of age. With increases in sexually transmitted infections (STIs) in this age group and the potentially serious nature of untreated conditions, this review highlights the need for increased research, health literacy and targeted interventions. Social, societal and physical barriers preventing older adults engaging with safer sex have been identified, highlighting the extent of the attitudinal and policy shifts required to provide age parity.
{"title":"Sexual health and sexual activity in later life","authors":"P. Nash, Pauline Willis, A. Tales, Thomas Cryer","doi":"10.1017/S0959259815000015","DOIUrl":"https://doi.org/10.1017/S0959259815000015","url":null,"abstract":"The population is ageing and the rights, welfare and wellbeing of this age cohort are becoming more globally prominent and the focus of much policy development. Whilst research is leading the way and informing this in many spheres of an older person's life, this is not the case for sexual health. Campaigns of sexual health literacy and intervention are targeted at ‘at-risk’ cohorts, largely ignoring those over 60 years of age. With increases in sexually transmitted infections (STIs) in this age group and the potentially serious nature of untreated conditions, this review highlights the need for increased research, health literacy and targeted interventions. Social, societal and physical barriers preventing older adults engaging with safer sex have been identified, highlighting the extent of the attitudinal and policy shifts required to provide age parity.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"25 1","pages":"22-30"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259815000015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-19DOI: 10.1017/S0959259814000173
G. Windle
Exercise and physical activity are thought to be among the most important lifestyle factors for the maintenance of health and prevention of premature disease and mortality. Yet sedentary lifestyles are common. Many people avoid exercise, and have done so across their lifespan. Exercise and physical activity are also considered important for positive psychological functioning; however, this has received limited research attention. This mini-review discusses the effects of exercise and physical activity on mental health and well-being in later life. It draws on international peer reviewed research, summarized in systematic reviews and/or meta-anlaysis, and presents the key findings. Systematic reviews and meta-analyses generally confirm the importance of exercise for mental well-being; however, there is a lack of good quality research. The review discusses some of the barriers to exercise, and identifies strategies that may facilitate uptake and adherence in later life. Limitations in the current evidence are discussed. Based on the current evidence, it is recommended that health practitioners should encourage exercise or physical activity of low to moderate intensity, and leisure time activity such as walking, especially at retirement. Future intervention research would benefit by focusing on people who have not self-selected into studies so as to understand the causal direction, and include theory driven approaches to behaviour change.
{"title":"Exercise, physical activity and mental well-being in later life","authors":"G. Windle","doi":"10.1017/S0959259814000173","DOIUrl":"https://doi.org/10.1017/S0959259814000173","url":null,"abstract":"Exercise and physical activity are thought to be among the most important lifestyle factors for the maintenance of health and prevention of premature disease and mortality. Yet sedentary lifestyles are common. Many people avoid exercise, and have done so across their lifespan. Exercise and physical activity are also considered important for positive psychological functioning; however, this has received limited research attention. This mini-review discusses the effects of exercise and physical activity on mental health and well-being in later life. It draws on international peer reviewed research, summarized in systematic reviews and/or meta-anlaysis, and presents the key findings. Systematic reviews and meta-analyses generally confirm the importance of exercise for mental well-being; however, there is a lack of good quality research. The review discusses some of the barriers to exercise, and identifies strategies that may facilitate uptake and adherence in later life. Limitations in the current evidence are discussed. Based on the current evidence, it is recommended that health practitioners should encourage exercise or physical activity of low to moderate intensity, and leisure time activity such as walking, especially at retirement. Future intervention research would benefit by focusing on people who have not self-selected into studies so as to understand the causal direction, and include theory driven approaches to behaviour change.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"24 1","pages":"319-325"},"PeriodicalIF":0.0,"publicationDate":"2014-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259814000173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1017/S095925981400015X
M. Crane, L. Joly
Evidence from England, Australia, Canada, Japan and the USA indicates that the single homeless population is ageing, and that increasing numbers of older people are homeless. This paper reviews evidence of changes in the age structure of the single homeless population, and the factors that are likely to have had an influence on the growth of the older homeless population. In many Western cities, the housing situation of older people is changing and there is a growing reliance on the private rented sector. Unemployment is also having an impact on older people who are under the official retirement age. An increasing number of older people are experiencing problems linked to alcohol, drugs, gambling and criminality, and these are all behaviours that can contribute to homelessness. Despite high levels of morbidity and disability among older homeless people, they are a relatively neglected group and receive little attention from policy makers and mainstream aged care services.
{"title":"Older homeless people: increasing numbers and changing needs","authors":"M. Crane, L. Joly","doi":"10.1017/S095925981400015X","DOIUrl":"https://doi.org/10.1017/S095925981400015X","url":null,"abstract":"Evidence from England, Australia, Canada, Japan and the USA indicates that the single homeless population is ageing, and that increasing numbers of older people are homeless. This paper reviews evidence of changes in the age structure of the single homeless population, and the factors that are likely to have had an influence on the growth of the older homeless population. In many Western cities, the housing situation of older people is changing and there is a growing reliance on the private rented sector. Unemployment is also having an impact on older people who are under the official retirement age. An increasing number of older people are experiencing problems linked to alcohol, drugs, gambling and criminality, and these are all behaviours that can contribute to homelessness. Despite high levels of morbidity and disability among older homeless people, they are a relatively neglected group and receive little attention from policy makers and mainstream aged care services.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"43 1","pages":"255-268"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S095925981400015X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1017/S0959259814000136
G. Heckman, C. Tannenbaum, Andrew P. Costa, K. Harkness, R. McKelvie
The heart failure epidemic predominantly affects older people, particularly those with concurrent co-morbid conditions and geriatric syndromes. Mortality and heath service utilization associated with heart failure are significant, and extend beyond the costs associated with acute care utilization. Over time, older people with heart failure experience a journey characterized by gradual functional decline, accelerated by unpredictable disease exacerbations, requiring greater support to remain in the community, and often ultimately leading to institutionalization. In this narrative review, we posit that the rate of functional decline and associated health care resource utilization can be attenuated by optimizing the management of heart failure and associated co-morbidities. However, to realize this objective, the manner in which care is delivered to frail older people with heart failure must be restructured, from the bedside to the level of the health care system, in order to optimally anticipate, diagnose and manage co-morbidities.
{"title":"The journey of the frail older adult with heart failure: implications for management and health care systems","authors":"G. Heckman, C. Tannenbaum, Andrew P. Costa, K. Harkness, R. McKelvie","doi":"10.1017/S0959259814000136","DOIUrl":"https://doi.org/10.1017/S0959259814000136","url":null,"abstract":"The heart failure epidemic predominantly affects older people, particularly those with concurrent co-morbid conditions and geriatric syndromes. Mortality and heath service utilization associated with heart failure are significant, and extend beyond the costs associated with acute care utilization. Over time, older people with heart failure experience a journey characterized by gradual functional decline, accelerated by unpredictable disease exacerbations, requiring greater support to remain in the community, and often ultimately leading to institutionalization. In this narrative review, we posit that the rate of functional decline and associated health care resource utilization can be attenuated by optimizing the management of heart failure and associated co-morbidities. However, to realize this objective, the manner in which care is delivered to frail older people with heart failure must be restructured, from the bedside to the level of the health care system, in order to optimally anticipate, diagnose and manage co-morbidities.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"24 1","pages":"269-289"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259814000136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1017/S0959259814000185
F. J. Martín-Sánchez, E. Rodríguez‐Adrada, José Manuel Ribera Casado
Acute heart failure is a highly prevalent geriatric syndrome presenting one of the most frequent reasons for visits to the emergency department and hospital admission, and is associated with a high morbidity and mortality and acute functional impact. The present study reviews some of the features that characterize diagnosis and immediate management of acute heart failure in older people, as well as recommendations about the management of co-morbidity, risk stratification and the decision-making process, and the design of care plans in this older age group within the setting of hospital emergency departments.
{"title":"Acute heart failure in the older patient in the emergency department","authors":"F. J. Martín-Sánchez, E. Rodríguez‐Adrada, José Manuel Ribera Casado","doi":"10.1017/S0959259814000185","DOIUrl":"https://doi.org/10.1017/S0959259814000185","url":null,"abstract":"Acute heart failure is a highly prevalent geriatric syndrome presenting one of the most frequent reasons for visits to the emergency department and hospital admission, and is associated with a high morbidity and mortality and acute functional impact. The present study reviews some of the features that characterize diagnosis and immediate management of acute heart failure in older people, as well as recommendations about the management of co-morbidity, risk stratification and the decision-making process, and the design of care plans in this older age group within the setting of hospital emergency departments.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"28 1","pages":"290-303"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259814000185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1017/S0959259814000124
J. Blodgett, O. Theou, S. Kirkland, P. Andreou, K. Rockwood
As the mean life expectancy of the population continues to increase, the challenge for individuals is to remain healthy and fit throughout their life span. This review examines the relationships between moderate-vigorous physical activity and sedentary behaviour in relation to the fitness-frailty continuum. The association between increased physical activity and decreased adverse health outcomes is firmly established. A direct association between frailty and moderate-vigorous physical activity has been established to a lesser degree. What has some potential to undermine even these gains is the increasingly recognized relationship between sedentary behaviour and poor health. It now seems likely that sedentary behaviour can have a negative impact on an individual's health, over and above that of meeting the recommendations of moderate-vigorous physical activity. Individuals must consider both increasing their level of moderate-vigorous physical activity and minimizing their level of sedentary behaviour during all aspects of daily life.
{"title":"Frailty in relation to sedentary behaviours and moderate-vigorous intensity physical activity","authors":"J. Blodgett, O. Theou, S. Kirkland, P. Andreou, K. Rockwood","doi":"10.1017/S0959259814000124","DOIUrl":"https://doi.org/10.1017/S0959259814000124","url":null,"abstract":"As the mean life expectancy of the population continues to increase, the challenge for individuals is to remain healthy and fit throughout their life span. This review examines the relationships between moderate-vigorous physical activity and sedentary behaviour in relation to the fitness-frailty continuum. The association between increased physical activity and decreased adverse health outcomes is firmly established. A direct association between frailty and moderate-vigorous physical activity has been established to a lesser degree. What has some potential to undermine even these gains is the increasingly recognized relationship between sedentary behaviour and poor health. It now seems likely that sedentary behaviour can have a negative impact on an individual's health, over and above that of meeting the recommendations of moderate-vigorous physical activity. Individuals must consider both increasing their level of moderate-vigorous physical activity and minimizing their level of sedentary behaviour during all aspects of daily life.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"24 1","pages":"239-254"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259814000124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57030378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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