Elderly patient

We compared the efficacy and adverse effects of antihypertensive drug regimens in 690 men past age 60 with diastolic blood pressure 90-114 mm Hg and systolic blood pressure less than 240 mm Hg. They received either a low (25-50 mg) or high (50-100 mg) dose of hydrochlorothiazide daily. Of 644 patients who completed the hydrochlorothiazide titration, 375 (58.2%) were responders (diastolic blood pressure <90 and <5 mm Hg below baseline) and 92.8% of these completed a 6-month maintenance period. Blood pressure was reduced from 157.6/98.5 mm Hg by 18.3/9.5 mm Hg with low dose hydrochlorothiazide and by 20.4/9.6 mm Hg with high dose hydrochlorothiazide; more patients achieved goal blood pressure with the high dose. Whites and blacks responded equally. Serum potassium less than 3.5 mmol/1 occurred in 104 of 321 (32.3%) of the high dose versus 62 of 333 (18.6%) of the low dose hydrochlorothiazide patients. The 269 nonresponders to hydrochlorothiazide were randomly assigned in a doubl...

Background and HypothesisThe study aimed to compare the clinical picture and treatment differences in elderly patients (aged 75 years or older) and younger patients (aged below 75 years).The study aimed to compare the clinical picture and treatment differences in elderly patients (aged 75 years or older) and younger patients (aged below 75 years).MethodsThe study included 80 consecutive patients with myocardial infarction (MI) treated in the Cardiology Ward of the Specialist Hospital in Radom, Poland, in 2005. Analyses were performed retrospectively. The patients were separated into 2 groups according to age. The group I study group consisted of 40 patients aged 75 or over (aged 75–95; mean 81 years) and the group II control group consisted of 40 patients aged below 75 years (aged 42–67; mean 60 years).The study included 80 consecutive patients with myocardial infarction (MI) treated in the Cardiology Ward of the Specialist Hospital in Radom, Poland, in 2005. Analyses were performed retrospectively. The patients were separated into 2 groups according to age. The group I study group consisted of 40 patients aged 75 or over (aged 75–95; mean 81 years) and the group II control group consisted of 40 patients aged below 75 years (aged 42–67; mean 60 years).ResultsIn the elderly, as compared with younger subjects, dyspnea, fatigue, and other heart failure symptoms, were more frequently the first symptoms of MI than typical chest pain (p<0.05). ST-segment elevation myocardial infarction (STEMI) was also more common (p<0.05). Non-ST-segment elevation myocardial infarction (NSTEMI) was more frequently diagnosed in the elderly (p<0.05). In elderly patients there were more women (p<0.05), more patients with previously diagnosed ischemic heart disease (p<0.05), with hypertension (p<0.05), and with diabetes mellitus (p<0.05). Obesity was less frequently diagnosed in the elderly; however the difference was not statistically significant. Dyslipidemia and cigarette smoking were both significantly less common among elderly patients (p<0.05). The elderly were significantly less frequently revascularized (p<0.05). Both fibrinolysis and primary percutaneous coronary intervention (PCI) were less commonly applied to the elderly (p<0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (p<0.05). The MI complications and side effects of treatment seemed to be more frequent in the elderly, but only post-MI heart failure was observed more frequently in this group of patients (p<0.05).In the elderly, as compared with younger subjects, dyspnea, fatigue, and other heart failure symptoms, were more frequently the first symptoms of MI than typical chest pain (p<0.05). ST-segment elevation myocardial infarction (STEMI) was also more common (p<0.05). Non-ST-segment elevation myocardial infarction (NSTEMI) was more frequently diagnosed in the elderly (p<0.05). In elderly patients there were more women (p<0.05), more patients with previously diagnosed ischemic heart disease (p<0.05), with hypertension (p<0.05), and with diabetes mellitus (p<0.05). Obesity was less frequently diagnosed in the elderly; however the difference was not statistically significant. Dyslipidemia and cigarette smoking were both significantly less common among elderly patients (p<0.05). The elderly were significantly less frequently revascularized (p<0.05). Both fibrinolysis and primary percutaneous coronary intervention (PCI) were less commonly applied to the elderly (p<0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (p<0.05). The MI complications and side effects of treatment seemed to be more frequent in the elderly, but only post-MI heart failure was observed more frequently in this group of patients (p<0.05).ConclusionsOur observations confirm the differences in the clinical picture of MI in the elderly as described previously. All patients of advanced age should be considered as having the highest risk of death and complications occurrence. Copyright © 2009 Wiley Periodicals, Inc.Our observations confirm the differences in the clinical picture of MI in the elderly as described previously. All patients of advanced age should be considered as having the highest risk of death and complications occurrence. Copyright © 2009 Wiley Periodicals, Inc.

A striking rise in the incidence and prevalence of congestive heart failure (CHF) in the Chinese population has been reported. While promoting the quality of life (QOL) of these patients is widely recognized as an important clinical priority, there is not a validated Chinese disease-specific QOL measure for CHF patients. The aim of this study was to validate the Chinese version of Chronic Heart Failure Questionnaire (CHQ-C) which measures the disease-specific QOL of patients with CHF. A sample of 110 CHF elderly patients and a comparison group of 64 healthy elderly people was recruited. Structured questionnaires were administered by a research nurse. Criterion and construct validity of CHQ-C was demonstrated by its significant correlation with the New York Heart Association classification (Spearman r = −0.52, p Hospital Anxiety and Depression scale (Pearson r = −0.74, p

Purpose: To present the application of custom-made 3D-printed subperiosteal implants for fixed prosthetic restoration of the atrophic posterior mandible of elderly patients. Methods: Between January 2017 and June 2018, all partially edentulous patients aged over 65 years, with two or more missing teeth in the posterior atrophic mandible, and who did not want to undergo bone regenerative procedures, were included in this study. These patients were rehabilitated with custom-made subperiosteal implants, designed from cone beam computed tomography (CBCT) and fabricated in titanium by means of direct metal laser sintering (DMLS). The outcome measures were fit and stability of the implants at placement, duration of the intervention, implant survival, and early and late complications. All patients were followed for 1 year after surgery. Results: Ten patients (four males, six females; mean age 69.6, SD ± 2.8, median 69, 95% CI 67.9-71.6) were included in the study. The fit of the implants was satisfactory, with a mean rating of 7 out of 10 (SD ± 1.6, median 7, 95% CI 6-8). Only two implants had insufficient fit, because of the presence of scattering in the CBCT; however, they were adapted to the sites during the interventions. The mean duration of the intervention was 44.3 min (SD ± 19.4, median 37, 95% CI 32.3-56.3). At the one-year follow-up, no implants were lost (survival rate 100%). One implant presented immediate postoperative complications with pain, discomfort and swelling, and two patients experienced late complications, having their provisional restorations fractured during the temporisation phase. All these complications were minor in nature, but the final complication rate amounted to 30% (three of ten patients). Conclusions: Although this study has limits (small patient sample and short follow-up), DMLS has proven to be an effective method for fabricating accurate subperiosteal implants, with high survival rates. This may represent an alternative treatment procedure in elderly patients with a severely atrophic posterior mandible, since it allows avoidance of regenerative bone therapies. Further studies are needed to confirm these outcomes.

The α1-adrenoceptor antagonist doxazosin has been compared with placebo in 40 elderly hypertensive patients (mean age 71.4 years). At the end of 10 weeks once daily treatment with doxazosin the mean 24-h post-dose changes in standing and supine blood pressure compared with placebo were −6.9/−5.6 mmHg (systolic/diastolic) and −6.2/−5.5 mmHg respectively. The reductions in standing and supine diastolic blood pressures were statistically significant compared with placebo. At the end of treatment steady-state pharmacokinetics were evaluated in 18 patients. The plasma elimination half-life during the dose interval in these patients was 16.1 h (range 10.1–27.1 h) and the median time to peak plasma concentration was 3 h (range 1–4 h). One patient was withdrawn because of adverse effects (headache, weakness, and sweating) during doxazosin treatment. Once daily doxazosin reduced diastolic blood pressure and was well tolerated in these elderly hypertensive patients.

Interpersonal psychotherapy (IPT) is recommended in most depression treatment guidelines, but little is known about its effectiveness in real-life practice. This study investigates whether IPT, delivered by mental health workers to elderly patients with major depressive disorder, is more effective than usual general practitioners&#39; care (CAU). A pragmatic randomized, controlled trial was conducted in which 143 patients were allocated to IPT (10 sessions) or to CAU. PRIMary care Evaluation of Mental Disorders (PRIME-MD) and Montgomery Asberg Depression Rating Scale (MADRS) assessments were used as primary outcomes. IPT was significantly more effective in reducing the percentage of patients with a diagnosis of depression (PRIME-MD), but not in inducing remission (MADRS &lt;10). Among treatment completers, IPT was superior in improving social and overall mental functioning. A post hoc analysis revealed that IPT was superior to CAU in moderately to severely depressed patients, but no...

2 DEA U.O. Pronto Soccorso - Presidio Ospedaliero, Praia a Mare (CS) Objective. Strain and strain rate imaging have emerged as modern echocardio- graphic technique to estimate myocardial deformation and rate of deformation. Evidences about changes in strain and strain rate occurring with senescence are poor. Aim of our study was to verify the existence of age-related modifications of systolic

Osteonecrosis of the knee should be differentiated into two main categories: (1) primary, spontaneous, or idiopathic osteonecrosis and (2) secondary osteonecrosis (e.g., secondary to factors such as steroid therapy, systemic lupus erythematosus, alcoholism, Caisson decompression sickness, Gaucher’s disease, hemoglobinopathies, etc.). Spontaneous or primary osteonecrosis of the knee presents with an acute knee pain in elderly patients. It is three times more common in women than in men. Traumatic and vascular theories have been proposed as a causative factor of osteonecrosis of the knee, but the precise etiology still remains speculative. High index of clinical awareness and a good history and physical examination are essential to make an early, accurate diagnosis. Plain radiographs are often normal during the early course of the disease and, in such instances, radioisotope bone scan and magnetic resonance imaging may be helpful. In the early stage of the disease, non-operative treatment is indicated and many patients, if diagnosed early, have a benign course with a satisfactory pain relief and a good knee function. In patients with advanced stage of the disease, treatment options include arthroscopic debridement, curettage or drilling of the lesion, bone grafting, high tibial osteotomy, use of osteochondral allograft, and unicompartmental or total knee arthroplasty. The choice of treatment should be based on factors such as age of the patient, severity of symptoms, activity level and functional demands on the knee, site and stage of the lesion, and extent of deformity and secondary osteoarthritis. The clinical features and treatment of steroid-induced osteonecrosis of the knee are briefly discussed. In recent years, “postmeniscectomy” osteonecrosis has been reported, but at present its prevalence and pathophysiology remain unknown. It is possible that this may be a preexisting condition that was not recognized at the time of initial consultation or osteonecrosis may develop after meniscectomy in occasional cases.

Background and Purpose. An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient&#39;s goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if

CONTEXT: Interpersonal difficulties, affective instability, distortions of the clinician-patient relationship, and unpredictable responses to clinical interventions, are characteristics found in older adults as well as in younger patients with personality disorders. CASE REPORT: We report the case of a 68 years old patient with histrionic personality disorder and other psychiatric comorbidities. CONCLUSION: Personality disorders are frequently overlooked in the diagnostic workout of complex psychogeriatric syndromes, and require a comprehensive assessment of personality traits. The correct identification of personality disorders and their subtypes is critical for planning the therapeutic approach, including pharmacotherapy and psychological management.

Treatment with the neuroprotective drug riluzole has previously been shown to increase the probability of survival in patients with amyotrophic lateral sclerosis. This report describes a placebo-controlled, double-blind randomised clinical trial of riluzole carried out in ALS patients with advanced stage disease or aged over 75 years. The primary objective was to enable access to treatment to patients excluded from the pivotal trial which was run in parallel. Another goal was to assess the safety of riluzole in patients with advanced-stage disease. One hundred and sixty-eight patients were included, randomised to either riluzole 50 mg b. i. d. or to placebo, and treated for eighteen months. Riluzole was well-tolerated in this patient population, and the adverse events observed were similar in nature and frequency to those observed in previously published clinical trials in patients included in pivotal trials. The study could not include enough patients to reach adequate power to detect differences in survival between the two treatment groups, and no such difference was in fact observed. In conclusion, riluzole is well-tolerated in ALS patients with advanced stage disease.