Estado nutricional y factores asociados en pacientes ancianos ambulatorios

ObjectiveTo analyze the nutritional status (NS) of patients older than 65 years and establish their relationship with sociodemographic and health variables.DesignCross-sectional observational study in patients older than 65 years.Location3 health centers.Participants255 patients: ambulatory (AP), in domiciliary care (DP) or institutionalized (IP). They completed the study 243 (response rate 95.3%).Main measurementsThe Chang method was applied to determine the NS. Sociodemographic, anthropometric variables, dependence, mood, cognitive and analytical parameters were collected. Associations were analyzed applying chi-square and analysis of variance. The prevalence ratio (PR) for malnutrition was calculated. A multivariate model was applied (binary logistic regression). Significance was considered for p<0.05.ResultsThe average age was 81.3 years (SD = 7.4) and 72.0% were women. 48.9% were AP, 26.8% DP and 24.2% IP. 29.6% (95% CI: 23.9-35.8) presented malnutrition. Greater malnutrition was established in relation to living in a residence or requiring home help (PR = 5.3), age over 85 (PR = 4.9), presenting a moderate or higher dependency for basic activities of daily living (PR = 3.9) and instrumental (PR = 3.3), need help for mobility (PR = 2.9) and present moderate/severe cognitive impairment (PR = 2.1). The determinants of malnutrition in the multivariate model were older than 85 years old and being IP or DP.ConclusionsEmphasis should be placed on evaluating NS in patients older than 85 years of age who live in a residence or require home care, since they are the groups at greatest risk of malnutrition.     

Osteoporotic ankle fractures: A narrative review of management options

The management of Osteoporotic ankle fractures is still considered to be a challenge by many surgeons. One of the issues seems to be a lack of data focused on this special subgroup, with very little evidence of good quality. We did a narrative review of the literature in an attempt to identify the magnitude of the problem and to evaluate the evidence in support of management options.The current review of the literature has brought to light some interesting facts. Despite limited data there seems to be an in increase in the incidence of these fractures. Although we could not demonstrate any clear distinction between geriatric and osteoporotic ankle fractures from the available literature; it is clear that all geriatric fractures are not necessarily osteoporotic and neither is the reverse true. The evidence to associate osteoporotic ankle fractures with poor outcomes is weak, and factors other than osteoporosis may have a stronger influence. From this analysis, we could not establish a higher incidence of implant failure for this specific fracture group, although many modifications in technique have been proposed due to the fear of fixation failure. Hook plating and Tibia-pro fibula fixation have weak evidence in support, but posterior fibular plating is preferred due to soft tissue protection. There is weak evidence in support of Locking plates for these fractures, as publications focused on this are limited; nevertheless some advantages have been documented. Augmentation by calcium based bone graft substitutes has been reported to improve pull out strengths of screws, but again the evidence of its role in Osteoportic fractures is limited. Fibular nailing has been proposed with specific advantages in osteoporotic fibular fractures, but the concept is new and it is indicated only in a select a subgroup of cases. Some evidence exists for the use of trans-articular nails in geriatric subgroups with limited pre-injury mobility, but the technique has to be used with caution to prevent other complications.InferenceMore data needs to be accumulated before clear guidelines for management of osteoporotic ankle factures are defined; however the current literature supports the need for modifications in standard ankle facture fixation methods to improve outcomes.     

The relation between teeth loss and cognitive decline among Saudi population in the city of Riyadh: A pilot study

BackgroundTeeth are necessary for sensory input to the brain during the chewing process, but how the decrease in this sensory input, due to loss of teeth, may cause weak memory and lead to cognitive decline is not well understood. This pilot public survey aiming to assess the correlation between the number of missing teeth, periodontal disease, and cognitive skill in the city of Riyadh.Material& MethodsA multicenter cross-sectional survey, targeting geriatric population aged ≥60 years, was performed in Riyadh City, Saudi Arabia. The Montreal Cognitive Assessment (MoCA) was conducted to all participants to assess their cognitive function. Assessment of oral health status was carried out, including the number of present dentation and their periodontal status. Community periodontal-index (CPI) was used to assess the periodontal condition. The primary variables were number of missing teeth, periodontal disease and MoCA test scores. Chi-square test and Pearson’s correlation coefficients were computed and the significant P- value was set at <0.05.ResultsOf 95 participants, overall, 57 (60%) and 38 (40%) were male and female, respectively, with a mean age of 65.67 ± 6.32 years. Females showed more significant cognitive decline than males (P < 0.001). Cognitive decline was significantly high in participants with low educational level 19 (95%), unemployment 41 (79%), and lower income people 26 (79%), while being cognitive intact was significantly higher in highly educated 13 (87%), retired 21 (62%), and higher income people 28 (74%) at (P < 0.001). An advanced age and greater number of missing teeth are associated with lower MoCA test scores. No statistical significant correlation with regard to periodontal disease and MoCA test scores.ConclusionBased on the preliminary data, positive correlation was confirmed when the number of missing teeth and cognitive skill were assessed. Therefore, larger, multi-center regional surveys are needed to investigate further this relationship.     

Adjuvant chemotherapy in patients with colorectal cancer. Is there a role in the older adult?

As global life expectancy has increased in most countries, there is a rising percentage of patients over 65 years old being diagnosed with colorectal cancer. Despite an increase in the incidence and prevalence of colorectal cancer in older adults, this cohort receives adjuvant therapy at a decreased rate due to anticipated intolerance. The presumed limitations seem to be based on chronologic age, competing life limiting diagnoses, and the paucity of data studying this population in major clinical trials. This review explores the data regarding disparities in the treatment of older patients with colorectal cancer, safety and efficacy of adjuvant therapy, and newer tools to make decisions based on the biologic age, rather than chronologic age, of the patient.     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.