OBJECTIVE: To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians. METHODS: Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis. RESULTS: 326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%. CONCLUSIONS: Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.
- Publication type
- Journal Article MeSH
Přestože arteriální hypertenze patří mezi nejčastější onemocnění vyššího věku a je nepochybně odborná shoda o přínosu léčby v širokém věkovém rozmezí na snížení kardiovaskulárních příhod a celkové mortality, je léčba u starých pacientů spojena s řadou farmakologických rizik. Právě s ohledem na věk uvádějí současné guidelines pro management hypertenze Evropské společnosti pro hypertenzi dvě seniorská věková pásma (65–79 a více než 80 let), pro která jsou individuálně nastavena kritéria pro zahájení léčby i cílové hodnoty krevního tlaku. Bohužel pro seniory ve věku nad 80 a také nad 90 let není dost důkazů o efektivitě a bezpečnosti léčby antihypertenzivy. Při léčbě vycházíme z klinických studií provedených na populaci věkově mladší obvykle bez doprovodných komorbidit a funkčních omezení. V klinické praxi pro rozhodování o léčbě se řídíme nejen EBM doporučeními, ale u seniorů léčbu individualizujeme s ohledem komorbidity, fyzickou zdatnost a soběstačnost, kognitivní schopnosti, stupeň seniorské křehkosti a očekávanou dobu dožití. V článku shrnujeme poznatky o účinnosti a bezpečnosti antihypertenziv, měnícím se poměru přínos/riziko léčby, a také o možném využití kritérií potenciálně nevhodných antihypertenziv a lékových postupů i klinické doporučení pro vysazování (depreskripci) antihypertenziv avšak pouze u přísně indikovaných nemocných.
Arterial hypertension is one of the most common disorders in older people and there is undoubtedly professional agreement that antihypertensive treatment is beneficial in the wide range of older age for preventing cardiovascular events and reducing overall mortality. However, treatment in old age confers several pharmacological risks. The 2023 Guidelines on hypertension management of the European Society of Hypertension distinguish two age groups (65-79 and 80+years) for which separate criteria for treatment initiation and target blood pressure values are recommended. Unfortunately, there is a gap of evidence on effectiveness and safety of antihypertensives treatment in octogenarians and even less in nonagenarians. Therefore, treatment is based on clinical trials performed in younger populations usually without concomitant comorbidities and functional limitations. In clinical practice treatment decisions in old and very old patients are not exclusively based on EBM recommendations but also on other factors such as comorbidities, physical performance status and self-care, cognitive functioning and life expectancy which warrant individualized pharmacological treatment. The paper reviews current knowledge on changing benefit/risk ratio of antihypertensives in old and frail patients, suggests use of explicit criteria of potentially inappropriate antihypertensives in older persons and provides clinical recommendations for antihypertensives deprescribing but only in strictly eligible patients.
- MeSH
- Antihypertensive Agents administration & dosage MeSH
- Deprescriptions MeSH
- Hypertension * drug therapy MeSH
- Cardiovascular Diseases drug therapy MeSH
- Clinical Decision-Making MeSH
- Comorbidity MeSH
- Frail Elderly MeSH
- Humans MeSH
- Multimorbidity MeSH
- Risk MeSH
- Aged, 80 and over MeSH
- Aged * MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged * MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Gallstone ileus is an uncommon complication of cholelithiasis and occurs when a gallstone migrates through a cholecystoenteric fistula and impacts within the gastrointestinal tract. Surgical intervention remains the treatment of choice, which consists of a full-thickness incision of the visceral wall and removal of the impacted gallstone. In this paper we present the treatment approach of 6 cases of gallstone ileus in octogenarians. In our cohort, intestinal obstruction was resolved through an enterotomy or gastrotomy and lithotomy/stone extraction in every patient. No cholecystectomies were undertaken. Despite the fact that gallstone ileus is diagnosed in small percent of patients suffering from gallstone disease, it accounts for a large proportion of intestine obstruction in patients older than 65 years old. Since accurate diagnosis and timely intervention are vital, providers should be familiar with the diagnostic approach and the treatment of this clinical entity.
- MeSH
- Cholecystectomy adverse effects MeSH
- Ileus * diagnostic imaging etiology surgery MeSH
- Humans MeSH
- Octogenarians MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Intestinal Obstruction * complications surgery MeSH
- Gallstones * complications diagnostic imaging surgery MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
PURPOSE: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. METHODS: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. RESULTS: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). CONCLUSION: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
Se zvyšujícím se věkem se pozornost seniorů zaměřuje na jejich zdravotní stav a fyzickou zdatnost. Udržení fyzických schopností včetně bezpečné chůze a pohybu významně přispívá k pocitu zdraví ve stáří. V této souvislosti se stále více mezi odbornou veřejností diskutují termíny jako například vnitřní kapacita (intrinsic capacity), křehkost, sarkopenie, ale i pocit pohody, fitness a odolnost. Jedním z časných projevů ubývající zdatnosti či fitness je omezená mobilita staršího člověka. Omezení v mobilitě narůstají se zvyšujícím se věkem. Kolem 35 % sedmdesátiletých a většina osmdesátiletých osob udává omezení pohyblivosti v sociálním prostředí bytu a jeho blízkém okolí. Omezení, nebo dokonce ztráta mobility je komplexní multifaktoriálně podmíněný proces, který starého člověka činí náchylnějšího k pádům, úrazům, hospitalizacím, zhoršuje kvalitu života i celkovou mortalitu. V tomto přehledovém článku se pokusíme podat definici mobility, zaměříme se na věkově podmíněné změny a rizikové faktory včetně kognitivních poruch, neuromuskulární, psychologické a behaviorální faktory přispívající k omezení mobility. Stručně shrneme vyšetřovací nástroje ke zhodnocení mobility, k rozpoznání časných poruch a možné směry v prevenci. Tréninkové cvičební programy zahrnující aerobní cvičení (chůze), posilovací a rovnovážná cvičení mají největší účinnost pro zlepšování mobility a chůze, zvyšují svalovou hmotu i svalovou sílu, snižují výskyt pádů a zlepšují výkonnost v provádění běžných denních činností.
With advancing age older people shift their attention to health and physical fitness. Maintaining physical capacity including safe walking and mobility contribute significantly to overall health and wellbeing. In this context, professional community is using terms such as intrinsic capacity, frailty, sarcopenia but also wellbeing, fitness, and resilience. Limited mobility is an early sign of declining physical performance and fitness in older people. Mobility limitations increase with advancing age. About 35 % of persons in their 7th decade and majority of octogenarians report limited mobility in their own social environment – apartment and its nearby surroundings. Limited or even lost mobility is a complex multifactorial process that not only worsens quality of life but also increases risk of falling, fall-related injuries, hospitalization, and overall mortality. In this narrative review we provide the definition of mobility, describe age-related changes and risk factors including cognitive, neuromuscular, psychological, and behavioural factors contributing to mobility limitations. Also, we summarize mobility assessment tools, recognition of the early manifestation and potential approaches to prevent mobility disorders. Exercise training programs involve aerobic exercise (walking), strength and balance training that show the highest effectiveness in improving mobility and gait, increase muscle mass and strength, decrease falls rate, and improve performance in daily activities.
- Keywords
- mobilita, zdravé stárnutí,
- MeSH
- Walking MeSH
- Exercise MeSH
- Frail Elderly MeSH
- Motor Activity MeSH
- Movement Disorders MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Aging MeSH
- Physical Fitness * MeSH
- Check Tag
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Review MeSH
Se zvyšujícím se věkem se pozornost seniorů zaměřuje na jejich zdravotní stav a fyzickou zdatnost. Udržení fyzických schopností včetně bezpečné chůze a pohybu významně přispívá k pocitu zdraví ve stáří. V této souvislosti se stále více mezi odbornou veřejností diskutují termíny jako například vnitřní kapacita (intrinsic capacity), křehkost, sarkopenie, ale i pocit pohody, fitness a odolnost. Jedním z časných projevů ubývající zdatnosti či fitness je omezená mobilita staršího člověka. Omezení v mobilitě narůstají se zvyšujícím se věkem. Kolem 35 % sedmdesátiletých a většina osmdesátiletých osob udává omezení pohyblivosti v sociálním prostředí bytu a jeho blízkém okolí. Omezení, nebo dokonce ztráta mobility je komplexní multifaktoriálně podmíněný proces, který starého člověka činí náchylnějšího k pádům, úrazům, hospitalizacím, zhoršuje kvalitu života i celkovou mortalitu. V tomto přehledovém článku se pokusíme podat definici mobility, zaměříme se na věkově podmíněné změny a rizikové faktory včetně kognitivních poruch, neuromuskulární, psychologické a behaviorální faktory přispívající k omezení mobility. Stručně shrneme vyšetřovací nástroje ke zhodnocení mobility, k rozpoznání časných poruch a možné směry v prevenci. Tréninkové cvičební programy zahrnující aerobní cvičení (chůze), posilovací a rovnovážná cvičení mají největší účinnost pro zlepšování mobility a chůze, zvyšují svalovou hmotu i svalovou sílu, snižují výskyt pádů a zlepšují výkonnost v provádění běžných denních činností.
With advancing age older people shift their attention to health and physical fitness. Maintaining physical capacity including safe walking and mobility contribute significantly to overall health and wellbeing. In this context, professional community is using terms such as intrinsic capacity, frailty, sarcopenia but also wellbeing, fitness, and resilience. Limited mobility is an early sign of declining physical performance and fitness in older people. Mobility limitations increase with advancing age. About 35 % of persons in their 7th decade and majority of octogenarians report limited mobility in their own social environment – apartment and its nearby surroundings. Limited or even lost mobility is a complex multifactorial process that not only worsens quality of life but also increases risk of falling, fall-related injuries, hospitalization, and overall mortality. In this narrative review we provide the definition of mobility, describe age-related changes and risk factors including cognitive, neuromuscular, psychological, and behavioural factors contributing to mobility limitations. Also, we summarize mobility assessment tools, recognition of the early manifestation and potential approaches to prevent mobility disorders. Exercise training programs involve aerobic exercise (walking), strength and balance training that show the highest effectiveness in improving mobility and gait, increase muscle mass and strength, decrease falls rate, and improve performance in daily activities.
- Keywords
- mobilita,
- MeSH
- Frail Elderly MeSH
- Humans MeSH
- Motor Activity MeSH
- Movement Disorders MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Aging MeSH
- Physical Fitness * MeSH
- Healthy Aging MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Review MeSH
- MeSH
- Frailty diagnosis epidemiology MeSH
- Humans MeSH
- Multiple Myeloma diagnosis epidemiology MeSH
- Octogenarians MeSH
- Proportional Hazards Models MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Letter MeSH
Background: Remote monitoring (RM) is increasingly employed for all types of cardiac implantable devices (CIED). However, there are only limited data on the acceptance of RM by the elderly. The aim of our study was to ascertain how octogenarians assess RM technologies compared to younger, presumably technically more literate patients, and what concerns or technical problems the system presents to both groups of patients. Methods: The trial was designed as a descriptive, register-based single-center study. The study population consisted of all consecutive patients ≥ 80 years of age (group A, n = 94) and all consecutive patients aged ≤ 40 years (group B, n = 71), who had undergone implantation of an implantable cardioverter-defibrillator (ICD) between the years of 2009 and 2018 and were using a Home MonitoringTM (HM, Biotronik, Berlin, Germany) system. All patients fulfilling entry criteria were approached with a request to participate in the survey. Results: A total of 85 (90.4%) and 65 (91.5%) valid surveys were obtained for groups A and B, respectively. Ninety-two percent of patients in both groups (P = 0.903) were satisfied with the limited number of planned ambulatory follow-ups (i.e., once a year). All patients in both groups (100%) reported that they were satisfied with the HM system, and 97% and 94% of patients in Groups A and B, respectively, ranked it highly beneficial (P = 0.68). A significant proportion of patients in both groups were completely unaware of any health-related benefits associated with the use of the HM system (42% in Group A vs. 49% in Group B, P = 0.4). Among the most frequently reported personal benefits of HM were a sense of safety and security and savings on travel expenses and time. 5% and 9% of patients in Groups A and B, respectively, reported that usage of HM caused them some degree of psychological stress (P = 0.27). Nearly all patients in both groups reported receiving information on HM from their doctor after ICD implantation. None of Group A reported receiving information from a nurse either before or after ICD implantation, while 14% of Group B patients reported receiving information from a nurse after, but not before ICD implantation. Seven and 51% (P < 0.0001) of patients in Group A and B, respectively, sought additional information about HM post-discharge. Conclusions: The HM system received good marks and was much appreciated, even in patients over 80 years of age. The level of acceptance and potential psychological stress resulting from RM technology appears to be about the same in older patients as in younger patients. The majority of octogenarians either did not fully understand the clinical benefits of the system or mistakenly thought that the HM system was a substitute for emergency 24-h surveillance. These results highlight the need for better patient education relative to RM technology, with one option being to delegate more of this educational process to specially trained nurses.
- Publication type
- Journal Article MeSH
