Stakeholder collaboration in long-term care of older people in Lithuania

Demographic situation, changes in the role of women in society and growing demand for long-term care (LTC) of older people have challenged the ability to meet the growing LTC needs in most developed countries. In countries where responsibility for LTC is still largely laid on families, it is, however, even more critical and calls for improvements in formal LTC systems. More intensive stakeholder collaboration in LTC policy development, organising and delivery are of primary importance in improving LTC systems. Such collaboration, however, is not always successful; thus, it is critical to understand what makes it effective and efficient. In this paper, we specifically look into multistakeholder collaboration in LTC in Lithuania, one of the fastest ageing countries in the EU, with the demand for LTC services growing fast and exceeding the supply despite rising business and NGO engagement. To determine facilitators of such collaboration, we build on the data obtained through eight focus group discussions with all key stakeholder representatives (LTC policymakers, organisers and service providers [public, private and NGOs], 54 participants in total). Our findings indicate that in addition to national and organisational level facilitators studied in prior research, there are important individual level factors, such as meaningfulness at work, concern and care for others, possibility for personal growth and development, satisfaction with supervision, a sense of belonging and role clarity. On the other hand, our results show that collaboration is constrained by a shortage of human resources, increased workload caused by growing LTC demand, bureaucratic requirements, legal restrictions, lack of awareness of LTC service availability among elder persons, and prevailing social norms and attitudes to institutionalised care. Interestingly, a lack of financial resources is not perceived as a major constraint.     

Extending Screening in “Elderly” Patients: Should We Consider a Selective Approach?

BackgroundBreast cancer screening has been shown to reduce breast cancer-associated mortality. However, screening is limited to the targeted age group of 45 to 69 years in New Zealand despite the recognized increased risk with age. This study aims to compare the outcomes of women aged over 70 years with screen-detected and clinically detected cancers.Patients and MethodsA retrospective review was performed of prospectively collected data from June 2000 to May 2013 by the Auckland Breast Cancer Register. Demographic and tumor characteristics of women with invasive cancer and ductal carcinoma in situ diagnosis aged 70 years and over were compared between those screened and clinically detected. Five-year disease-free and overall survival outcomes were reviewed.ResultsA total of 2128 women aged 70 years and over were diagnosed with breast cancer (median, 77 years; interquartile range [IQR], 74-84 years). Of these, 416 (19.5%) were diagnosed through mammography screening, with a median age of 74 years (IQR, 71-77 years) compared with 79 years (IQR, 74-85 years) for those with clinical detected cancer diagnosis. Screen-detected cancers accounted for a significantly higher proportion of diagnoses in those aged 70 to 74 years compared with older patients (P < .001). Screen-detected cancers were of lower T and N stages. Disease-specific survival was significantly longer in screen-detected cancers versus other cancers (5-year survival, 93.7% vs. 81.9%; P < .001), as was overall survival (5-year survival, 84.7% vs. 57.4%; P < .001).ConclusionScreening in those aged 70 years and over continues to identify breast cancer at early stages and with improved survival. Although aware of the potential for lead-time bias and the healthy volunteer effect, there should still be consideration to extend breast cancer screening to patients aged to up 74 years after appropriate assessment of comorbidities and functional status.     

Treating pulmonary hypertension in the elderly

ABSTRACT

Introduction

Despite an increasingly older pulmonary hypertension (PH) population, data on PH treatments in these patients are limited because there exist no clinical studies dedicated to geriatric groups. Furthermore, elderly patients with comorbidities have been systematically excluded from clinical trials, limiting the evidence base for drugs approved for pulmonary arterial hypertension (PAH).     

Utilization of hypofractionated radiation therapy in older glioblastoma patients

Background

Though the optimal treatment regimen in older patients with glioblastoma multiforme (GBM) remains to be established, multiple randomized studies have supported the use of hypofractionated (1–3?weeks) versus traditional regimens (6?weeks). Here we examine hypofractionated regimen practice patterns among older patients with GBM.

高龄产妇妊娠分娩结局的临床现状研究

介绍高龄产妇妊娠分娩结局的临床现状研究，探讨其可研究的方向。本文通过横向比较多篇研究高龄产妇妊娠分娩结局的文献进行综述。近年来，高龄产妇数量不断增加，并已成为全球的趋势。高龄产妇不良妊娠分娩结局较多，包括妊娠高血压、妊娠糖尿病、胎盘早剥、围产期死亡、早产、胎儿巨体症和胎儿生长受限等；与产妇高龄无关的妊娠分娩结局有冠心病、子女的长期发病率等；医学界普遍鼓励妇女早育。     

反复粪便培养金黄色葡萄球菌阳性老年患者口服万古霉素效果评价

目的 通过探讨肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者口服万古霉素的效果，为此类患者提供一种潜在的治疗方案。方法 前瞻性分析吉林大学第一医院干部病房2015 年9 月～2018 年12 月收治的186 例肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者。根据是否口服万古霉素治疗分为万古组和对照组。收集两组患者的一般临床资料，比较两组患者试验前后万古霉素血药浓度、血常规、降钙素原（PCT）、C 反应蛋白（CRP），试验期间粪便培养结果、体温、抗生素使用情况。结果 试验治疗期间，万古组便培养转阴率高于对照组，差异有统计学意义（P＜0.05）；万古组发热率（29.75%）低于对照组的34.77%，差异有高度统计学意义（P＜0.01）；万古组抗生素使用率（4.49%）低于对照组的19.23%，差异有高度统计学意义（P＜0.01）。试验前两组白细胞、中性粒细胞计数、中性粒细胞比例、PCT、CRP 比较，差异无统计学意义（P＞0.05）；试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP 低于对照组，差异有高度统计学意义（P＜0.01）。试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP 低于试验前，差异有高度统计学意义（P＜0.01）。结论 口服万古霉素可能提高肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者粪便转阴率，减少发热及抗生素的应用，降低炎症细胞水平，可能是此类患者一种潜在的临床治疗方案。     

高龄直肠癌患者腹会阴联合切除术后会阴切口并发症发生的相关危险因素

探讨高龄直肠癌患者腹会阴联合切除术(APR)后会阴切口并发症发生的相关危险因素。方法采用回顾性病例对照研究的方法,分析中国医学科学院肿瘤医院结直肠外科2007年1月至2018年9月行APR的72例高龄(≥80岁)直肠癌患者的临床病理资料。采用单因素和多因素分析确定影响高龄直肠癌患者APR后会阴切口并发症发生的危险因素。结果72例患者中,男47例,女25例,年龄为(81.8±1.8)岁。术后会阴切口并发症发生率为23.6%(17/72),其中切口感染5例,切口脂肪液化4例,切口延迟愈合8例。所有患者均顺利出院,无围手术期死亡病例。单因素分析显示,术前血清白蛋白<35 g/L、术中置入氟尿嘧啶缓释剂/洛铂冲洗液、盆底修复、糖尿病和冠心病与高龄患者APR术后会阴切口并发症的发生均有关(均P<0.05)。多因素分析显示,未行盆底修复(OR=0.17,95%CI为0.04~0.82;P=0.027)和糖尿病(OR=4.32,95%CI为1.05~17.81;P=0.043)为高龄直肠癌患者APR后会阴切口发生的独立危险因素。结论行APR的高龄直肠癌患者应尽可能保留盆底腹膜,并予以关闭。围手术期血糖监测也是预防会阴切口并发症发生的有力保障。     

Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution

Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.     

Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.

Quality of life and subjective health status according to handgrip strength in the elderly: a cross-sectional study

Objectives: The purpose of this cross-sectional study was to examine potential associations between handgrip strength and health-related quality of life, or subjective health status, in the elderly.

Method: We performed secondary data analysis on 2377 elderly individuals aged >65 years. Raw data from the Korea National Health and Nutrition Examination Survey VI (2014–2015), were drawn from a representative national sample.

Results: Of those aged ≥65 years or older, 25.4% had low handgrip strength. After adjusting for confounding variables, the odds ratios of elderly individuals with low handgrip strength were 1.30 (95% confidence interval [CI]: 1.00–1.69) for mobility, 2.18 (95% CI: 1.47–3.22) for self-care, 1.70 (95% CI: 1.30–2.23) for usual activities, 1.30 (95% CI: 1.01–1.67) for pain/discomfort, 1.03 (95% CI: 0.74–1.44) for anxiety/depression, 1.44 (95% CI: 1.10–1.87) for the EQ-5D index, and 1.37 (95% CI: 1.08–1.73) for subjective health status.

Conclusion: Health-related quality of life and subjective health status differ according to handgrip strength. Therefore, handgrip strength should be addressed to improve quality of life in elderly individuals. Elderly individuals require exercise education and adequate nutritional intake to increase handgrip strength.