Patient and graft outcomes from deceased kidney donors age 70 years and older: an analysis of the Organ Procurement Transplant Network/United Network of Organ Sharing database

BACKGROUND: The organ shortage has resulted in more use of older deceased donor kidneys. Data are limited on the impact of donor aged 70 years and older on transplant outcomes. We examined patient and graft outcomes of renal transplant from expanded criteria donors (ECDs) aged 70 years and older, using the Organ Procurement Transplant Network/United Network of Organ Sharing database. METHODS: We identified 601 deceased donor transplants from donors older than 70 years from 2000 to 2005. The follow-up time was until May 2007. Allograft and patient survival were compared between recipients of transplants from older ECDs (age > or =70) and younger ECDs (age 50-69). The relative risk of graft loss and patient death were determined using multivariate models. RESULTS: The adjusted relative risks of overall graft loss (hazards ratio [HR] 1.37; 95% confidence interval [CI] 1.19-1.58), death-censored graft loss (HR 1.32; 95% CI 1.09-1.61), and patient death (HR 1.37; 95% CI 1.15-1.64) were greater among recipients of transplants from older ECD kidneys. The relative risk of patient death was lower when older ECD kidneys were transplanted into recipients older than 60 compared with recipients aged 41 to 60. In contrast, the relative risk of death-censored graft loss was not increased when older ECD kidneys were transplanted into recipients older than 60. CONCLUSIONS: Transplants from older ECD kidneys are associated with a higher risk of graft loss and patient death. The risk was highest when older ECD kidneys were transplanted into recipients younger than 60 years.     

Comparison of Clinician‐ and Self‐Assessments of Posttraumatic Stress Symptoms in Older Versus Younger Veterans

Assessment of posttraumatic stress disorder (PTSD) in older adults has received limited investigation. The purpose of this study was to compare the severity of PTSD symptoms in treatment‐seeking older and younger U.S. veterans with PTSD. Participants were 360 male and 284 female veterans enrolled in 2 separate clinical trials of psychotherapy for PTSD. About 4% of the participants were age 60 years or older. Symptoms were assessed before treatment using clinician‐rated and self‐report measures. For men, only numbing symptoms were lower in older veterans; this was so in clinician ratings, d = 0.76, and self‐reports, d = 0.65. For women, clinician‐rated hyperarousal symptoms were lower in older veterans, d = 0.57. Clinician‐rated and self‐reported symptoms were strongly related, Bs = 0.95 and 0.80 in the male and female samples, respectively. Among men, clinician‐rated and self‐reported reexperiencing and hyperarousal symptoms were associated only in younger veterans. Accurate assessment of PTSD symptoms in older adults is essential to identifying and implementing effective treatment. Our findings suggest that some symptoms may be lower in older men, and that some symptoms of PTSD may be underdetected in older women. Future research should assess the combined effect of gender and age on PTSD symptom presentation.     

Age- and gender-related differences in bone mineral status and biochemical markers of bone metabolism in Northern Chinese men and women

The aim of this study was to provide insight into the bone mineral status and biochemical markers of bone metabolism in a Chinese population from Shenyang, in the north of China, where hip fracture incidence is low. A total of 194 healthy men and women, aged 25-35 years and 65-75 years, were studied. Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured using dual-energy X-ray absorptiometry. Fasting blood and 24 h urine samples were collected for bone alkaline phosphatase (bAP), osteocalcin, calcium, phosphate, and free deoxypyridinoline (Dpd). Both older women and men had lower BMD compared with younger women and men by 27.2 +/- 3.0% (mean +/- SE) and 9.8 +/- 3.0% at the LS and 22.0 +/- 3.4% and 12.8 +/- 3.4% at the FN, respectively, after adjusting for bone and body size (p < 0.01). BMD at the two sites was lower in older women than in older men by 10.7 +/- 4.1% and 10.2 +/- 4.2%, respectively, after size correction (p < 0.05). Plasma bAP, osteocalcin, calcium, and phosphate concentrations were higher in older women than younger women by 69.3 +/- 9.7%, 77.2 +/- 11.1%, 7.5 +/- 2.3%, and 8.0 +/- 3.8%, respectively, and older men by 67.6 +/- 11.1%, 72.1 +/- 11.0%, 7.7 +/- 2.3%, and 23.8 +/- 3.8%, respectively (p < 0.01). However, plasma osteocalcin, calcium, and phosphate concentrations were lower in older men compared with their younger counterparts by 35.6 +/- 11.0%, 8.7 +/- 2.3%, and 14.1 +/- 3.8%, respectively (p < 0.05). Urinary calcium and phosphate output were lower in older men compared with younger men by 48.0 plus minus 10.3% and 27.6 +/- 6.9%, respectively (p < 0.01), whereas there were no differences between older and younger women. No differences in Dpd between older and younger groups were found. This study demonstrates that bone mineral status is lower in older people in Shenyang, as has been shown in populations elsewhere. The pronounced low bone mineral status in older women may be associated with increased bone turnover, which was not observed in older men.     

Outcome of Silicone Ring Vertical Gastroplasty in Patients Aged 50 Years and Older

Background: The authors studied the results of silicone ring vertical gastroplasty (SRVG) in patients aged 50 years and older. Methods: The early and late postoperative results in 28 patients aged 50 years or older undergoing SRVG were reviewed retrospectively. The results were compared to those of 370 patients younger than 50 years operated during the same period. Results: There was no postoperative mortality among patients aged 50 years and older. There was a significantly higher incidence of pulmonary embolus and wound infection among patients aged 50 years and older (p < 0.05). The weight loss did not differ significantly between the two studied age groups. Conclusion: SRVG may be performed on patients aged 50 years or older with acceptable complication rate and favourable postoperative results.     

Comparing outcomes of third and fourth kidney transplantation in older and younger patients

Performing third or fourth kidney transplantation (3KT and 4KT) in older patients is rare due to surgical and immunologic challenges. We aimed to analyze and compare the outcomes of younger (18–64 years) and older (≥65 years) recipients of 3KT and 4KT. Between 1990 and 2016, we identified 5816 recipients of 3KTs (153 were older) and 886 recipients of 4KTs (18 were older). The incidences of delayed graft function (24.3% vs. 24.8%, p = .89), primary non-function (3.2% vs. 1.3%, p = .21), 1-year acute rejection (18.6% vs. 14.8%, p = .24), and 5-year death censored graft failure (DCGF) (24.8% vs. 17.9%, p = .06) were not different between younger and older recipients of 3KT. However, 5-year mortality was higher in older recipients (14.0% vs. 33.8%, p < .001) which remained significant after adjustment (aHR = 3.21, 95% CI: 2.59–3.99). Similar patterns were noted in the 4KT cohort. When compared with waitlisted patients, 3KT and 4KT are associated with a lower risk of mortality; aHR = 0.37, 95% CI: 0.33–0.41 and aHR = 0.31, 95% CI: 0.24–0.41, respectively. This survival benefit did not differ by recipient age (younger vs. older, p for interaction = 3KT: .49 and 4KT: .58). In the largest cohort described to date, we report that there is a survival benefit of 3KT and 4KT even among older patients. Although a highly selected cohort, our results support improving access to 3KT and 4KT.     

Study protocol: the effects of work-site exercise on the physical fitness and work-ability of older workers

Background  

Older workers have a higher rate and cost of injury than younger workers and with a rapidly ageing work force there is a need to identify strategies to address this problem. Older workers are less physically active and fit than younger workers and so have reduced work ability. The reduced work ability means they are more likely to be fatigued at work and so at greater risk of injury. Exercise could potentially assist this problem. Exercise training has been previously shown to improve fitness in older people however there has been no evaluation of workplace exercise program for older workers. We do not know if the programs are feasible and can improve the fitness and work ability of older workers. We have designed a randomised controlled trial to evaluate whether exercise improves fitness and perceived work-ability of older workers.     

社区老人智力活动与认知功能状况研究

目的探讨老年人智力活动与认知功能的关系。方法采用蒙特利尔认知评估量表、一般人口学资料调查问卷和智力活动调查表对杭州市528位社区老年人进行认知功能和智力活动调查。结果 528名老年人认知功能得分25.65±2.59;智力活动参与得分2.00(1.00,2.00);是否参与玩棋牌纸牌麻将游戏和是否演奏乐器对老年人认知功能有显著影响(均P0.01);各认知域受损程度最高的是延迟回忆与视空间与执行功能。结论护理人员要重视老年人的认知功能下降并给予合理帮助,让老年人认识智力活动的重要性,提高积极性,科学参与,丰富晚年生活质量,改善认知功能。     

Comparison of In Vivo Three-Dimensional Glenohumeral Positions and Scapular Kinematics between Young and Older Male Groups

BackgroundMany researchers have questioned whether shoulder kinematics such as the glenohumeral position and scapular kinematics would be different in different age groups. However, studies comparing shoulder kinematics between different age groups have been rare. The aim of this study was to analyze and compare the three-dimensional (3D) glenohumeral position, scapular kinematics, and scapulohumeral rhythm (SHR) during scapular plane arm abduction between a normal young male group and a normal older male group.MethodsTwenty normal men (10 young and 10 older) were enrolled in this controlled laboratory study. Fluoroscopic images were obtained using a single plane X-ray system. Bilateral computed tomography scans were taken to create a 3D model. A 3D-2D registration technique was used to determine the 3D position and orientation of the bones of the shoulder.ResultsDuring scapular plane arm abduction, there were significant differences in scapular kinematics between the groups. The older male group showed more upward rotation, posterior tilt, and external rotation than the young male group. On the other hand, the glenohumeral position such as superior inferior translation, anterior posterior translation, and external rotation of the humeral head did not show significant difference between the groups. The mean value of SHR for the overall arm elevation range from start to maximum elevation angle for the older group and young group was 2.298 ± 0.964 and 2.622 ± 0.931, respectively, showing a significant difference between the two groups (p = 0.035).ConclusionsScapular kinematics and SHR were significantly different between the older male group and the young male group. Our study could provide reference values of shoulder kinematics for older men aged 55–65 years.     

Low-dose thymoglobulin use in elderly renal transplant recipients is safe and effective induction therapy

Current immunosuppressive therapies and protocols have led to significant improvements in early patient and graft survival rates following kidney transplantation. Whether induction therapies such as rabbit anti-thymocyte globulin (rATG) contribute to these improved results remains controversial. Full-dose rATG induction therapy (7-10 mg/kg) has been associated with increased morbidity, which may be especially true in a high-risk population such as the elderly. Therefore, we studied the efficacy and tolerability of a low-dose rATG induction strategy in 45 older recipients (>65 years) compared to 45 concurrently transplanted younger patients (<65 years). Both groups received a similar low-dose of rATG induction therapy (older: 2.96 ± 1.29 vs younger: 3.2 ± 2.11 mg/kg). All patients were maintained on a calcineurin inhibitor, mycophenolic acid, and low-dose prednisone (5 mg/d). To date, none of the older patients experienced acute rejection, whereas one younger patient had an acute rejection episode. Initial hospital stays were equal (older: 7.8 ± 3.2 vs younger: 7.5 ± 4.4 days, P = .35). Within the first 6 months, nine older patients required rehospitalization compared to 15 younger patients (P = .15). Bacterial infections in older and younger recipients were equal including wound (4 vs 0), urine (20 vs 15), lung (1 vs 1), and skin (0 vs 2), respectively. There were two BK viral infections in older patients, whereas there were three viral infections, two cytomegalovirus cases, and one Herpes zoster case in younger patients. Calculated 6-month glomerular filtration rate was equal in both groups (older: 55.7 ± 18.5 vs younger: 52.7 ± 18.5 mL/min). Three-year patient and graft survival rates were equivalent for older and younger patients (86.6% vs 97.6%, respectively). In conclusion, low-dose rATG induction therapy is safe and effective in patients older than 65. When compared to younger patients, low-dose rATG leads to equivalent graft survival and function without incurring excess morbidity in the older population.     

The impact of donor age and recipient age on clinical course and immune response after organ transplantation

Organ shortage and increasing numbers of older patients on the waiting list represent major challenges in organ transplantation. As a consequence, older donor organs are increasingly used and preferentially allocated to elderly recipients. However, knowledge on donor age– and recipient age–dependent immune responses is limited. We reviewed the impact of donor age and recipient age on clinical outcomes. An increased immunogenicity of older grafts and an altered immune response of elderly recipients may require age-specific immunosuppression. Age-related immune responses may also impact current preclinical tolerance protocols.     

Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients

Porous tantalum (Ta) implants have been successful in various orthopedic procedures for patients with compromised bone‐forming abilities. Previous studies demonstrated that human osteoblast (HOB) cultures from older female patients produced less bone on implant materials in vitro compared to HOBs from age‐matched male and younger female patients. In this study, the responses of HOBs from younger (<45) and older (>60 years old) female patients were compared on Ta, titanium fiber mesh (TFM) and tissue culture plastic. Adhesion, proliferation, and mineralization were greater in cells from younger patients than from older patients. Cell adhesion was slightly higher on Ta than TFM or plastic. However, Ta highly stimulated cell proliferation with a 4‐ and 6‐fold increase compared to TFM for cells from younger and older patients, respectively, and 12‐ and 16‐fold increase in proliferation compared to cells on plastic (p ≤ 0.001). At 3 weeks, mineralization was significantly higher on Ta compared to TFM for HOBs from older patients (p ≤ 0.05). Expression levels of bone matrix markers demonstrated differences dependent on age and substrate. Scanning electron micrographs revealed HOBs covering the surfaces and entering the pores of both Ta and TFM. In conclusion, tantalum greatly stimulates cell proliferation, and improves the ability of HOBs from older patients to form bone. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:609–616, 2011     

Safety and efficacy of isolated limb perfusion in elderly melanoma patients

Background Older patients are assumed to have a higher risk of complications from isolated limb perfusion (ILP). A study was performed evaluating the safety and efficacy of ILP in patients older than 75 years with advanced melanoma of the limbs. Methods A total of 218 therapeutic ILPs with melphalan with or without tumor necrosis factor α were performed in 202 patients with advanced measurable melanoma and were analyzed retrospectively. Fifty-three patients (28%) were 75 years or older. Results Complete response rates were 56% for those older than 75 years and 58% for the younger group (P=.79). Locoregional relapse occurred in 56% of the older group versus 51% in the younger group (P=.61). Limb toxicity, systemic toxicity, local complications, and long-term morbidity were similar in both age groups. Perioperative mortality was low, with one procedure-related death in the older group. Older patients stayed in the hospital for a median of 23 days (younger patients, 19 days;P<.01). Conclusions ILP results in similar response rates in the elderly with recurrent melanoma, without increased toxicity, complications, or long-term morbidity compared with younger patients. Older age in itself is not a contraindication for ILP.     

Severe and multiple trauma in older patients; incidence and mortality

Objective

To examine the differences between severely injured older patients (aged over 65 years) compared with similarly injured younger adults in terms of incidence, inpatient mortality and factors predicting outcome.

Methods

Data prospectively entered into the Trauma Audit and Research Network (TARN) database from our level I trauma unit over a 5-year period were retrospectively examined, with 3172 patients included in the final analysis.

Results

Older patients accounted for 13.8% of those with severe injuries (Injury Severity Score 16 or more) and almost 2% of our trauma admissions overall. High energy injuries were responsible for the majority of these injuries though relatively minor trauma became increasingly important in older patients. Mortality rates in the older patients were more than twice those seen in the adult population (19% in the under 40's to almost 50% in the over 75's). Age, Injury Severity Score and Glasgow Coma Score continued to be predictive of mortality in older patients but other factors relevant in younger adults were not.

Conclusions

Patients in the older group without physiological derangement on admission were still at a relatively high risk of inpatient mortality. This was in contrast to the younger patients, suggesting that it might be more difficult to predict which older patients might benefit from more aggressive monitoring or treatment. Despite increased mortality in older patients, significant survival rates were achieved even in the oldest. Active treatment should not be withdrawn on the basis of age alone.     

Tensile and viscoelastic properties of human patellar tendon

The tensile and viscoelastic properties of fresh-frozen, nonirradiated human patellar tendon were investigated in two groups of 15 specimens: one group was from individuals 29–50 years old and the other group was from individuals 64–93 years old. The central portion of each patella-patellar tendon-tibia complex was subjected to cyclic preconditioning, stress-relaxation, cyclic stress-relaxation, and load to failure tests. For each age group, stress-relaxation and stress-strain curves were obtained, from which percentage relaxation, ultimate tensile strength, strain at failure, modulus, and strain energy density were determined. Viscoelastic behavior was described with use of quasilinear viscoelasticity. The younger group showed a 46 ± 9% (mean ± SD) decrease in stress after 15 minutes, whereas the older group exhibited a 50 ± 6% decrease. The values for ultimate tensile strength and strain at failure, respectively, were 64.7 ± 15.0 MPa and 14 ± 6% for the younger group and 53.6 ± 10.0 MPa and 15 ± 5% for the older group. Modulus values were 660 ± 266 MPa for the younger group and 504 ± 222 MPa for the older group. Except for ultimate tensile strength, which was 17% less for the older group than for the younger one, no statistically significant differences were found in tensile or viscoelastic properties. This study indicated that there were minimal differences in biomechanical properties of the substance of the patellar tendon between younger and older age groups.     

Evaluation of the older cadaveric kidney donor: the impact of donor hypertension and creatinine clearance on graft performance and survival

BACKGROUND: The use of older donors for cadaveric renal transplantation (CRT) remains controversial because older donors are associated with decreased graft survival, yet offer the opportunity for donor pool expansion. We investigated the impact of two age-related donor factors, hypertension and calculated creatinine clearance (C(Cr)), as predictors of graft outcome in recipients of CRTs from donors > or =55 years of age. METHODS: We reviewed 33,595 recipients of CRTs reported to UNOS since 4/1/94, of which 4,732 were from donors aged > or =55 years. Outcome measures were graft survival, serum creatinine, and incidence of delayed graft function with 3 years of follow-up. We first analyzed the effect of hypertension on outcome from donors > or =55 years: 2679 donors had no hypertension, 1058 had hypertension < or =10 years, and 557 had hypertension > 10 years. Next, the effect of donor C(Cr) as a risk predictor was investigated. Based on this analysis, recipients of older donors were grouped into two cohorts for comparison: 2570 donors with C(Cr)<80 ml/min and 2162 donors with C(Cr) > or =80 ml/min. RESULTS: Actuarial graft survival from donors aged <55 years was 88.0, 83.4, and 78.5% at 1, 2, and 3 years, vs. 80.6, 73.5, and 65.3% from donors > or =55 years (P<0.0001). When stratified by hypertension, older donors hypertensive > 10 years had survivals of 77, 66, and 57% vs. 81, 73, and 65% from donors without hypertension (P<0.017) and 80, 74, and 66% from donors hypertensive <10 years (P<0.017). When stratified by C(Cr), older donors with C(Cr) <80 ml/min had survivals of 77, 69, and 62% vs. 83, 76, and 66% from donors with C(Cr) > or =80 (P<0.0001). Finally, older donors with both hypertension > 10 years and C(Cr) <80 ml/min had survivals of 77, 61, and 53%. CONCLUSIONS: Long-standing hypertension and low calculated creatinine clearance are risk factors for decreased graft survival of CRTs from older donors. When both factors are present, graft survival is significantly decreased.     

基于CLHLS的老年人社区养老服务需求及影响因素研究

目的 分析社区现有养老服务内容以及老年人对社区养老服务的护理需求,为政府合理分配社区养老服务资源,提高老年人生活质量提供参考.方法 基于2017?2018年中国老年人健康长寿影响因素追踪调查数据(CLHLS),采集有关老年人期望社区提供的养老服务需求与社区供给情况,以及老年人人口学、社会经济状况、健康状况相关数据,运用...     

Older donors and kidney transplantation

Reluctance to use kidneys from older donors (>50 years of age) is based on reports of inferior results. We reviewed our experience with 45 kidneys transplanted from older donors. Primary nonfunction, immediate graft function, and 1-, 2- and 3-year graft survival rates were similar to those obtained with kidneys transplanted from donors aged between 20 and 40 years. Renal function at 1 year (as measured by serum creatinine) was poorer in kidneys from older donors. No beneficial effect with respect to graft survival was noted with cyclosporin therapy compared to conventional immunosuppression; however, the numbers are small. We conclude that kidneys from older donors are a valuable source for transplantation.     

A Comparison of Outcomes for Younger and Older Adult Patients Undergoing Surgery for Primary Hyperparathyroidism

Background

In adolescents and young adults, primary hyperparathyroidism (PHPT) is an uncommon diagnosis. We compared the clinical characteristics of these patients to those of older adult patients with PHPT. We hypothesized that PHPT in adolescents and young adults is more often caused by single-gland disease and is amenable to minimally invasive parathyroidectomy (MIP).

Methods

We retrospectively reviewed the medical records of 452 consecutive patients who had surgery for PHPT. Patients ranged in age from 13 to 94?years and were dichotomized into younger (age <30?years, n?=?17, 3.8%) and older (age ??30?years, n?=?435, 96.2%) patients. Continuous baseline and intraoperative and postoperative measures were not normally distributed and were summarized with medians and interquartile ranges (IQRs). Groups were compared using Wilcoxon rank sum test or Fisher exact test, and significance was set at P?Results Median [IQR] age was 24 [23?C27] years for the younger group and 58 [51?C66] years for the older group. Though not statistically significant, a smaller proportion of the younger patients compared with the older patients had a positive ^99mTc-sestamibi scan (71%; 95% confidence interval [95% CI]?=?44?C90% vs. 83%; 95% CI?=?79?C86%) and showed a suspected parathyroid adenoma on ultrasound (65%; 95% CI?=?38?C86% vs. 80%; 95% CI?=?76?C83%). The younger and older age groups did not significantly differ on preoperative serum PTH levels (median [IQR]: 111 [76?C145] pg/ml vs 110 [84?C152] pg/ml; P?=?.73 respectively). The younger group had higher serum calcium levels (11.6 [11.1?C12.2] mg/dl) compared with the older group (11.1 [10.7?C11.5] mg/dl; P?=?.01). MIP was performed less frequently on the younger patients (70.6%) compared with older patients (88.7%; P?=?0.04). Though the incidence of a single adenoma was somewhat more frequent in older patients (90%; 95% CI?=?87?C93%) than in younger patients (82%; 95% CI?=?57?C96%) it was the most frequent cause of PHPT in the younger patients. The younger and older groups did not significantly differ on percent drop from baseline for intraoperative PTH monitoring (81.7 vs 79.3%; P?=?.46), respectively.

Conclusions

Younger patients with PHPT present with significantly higher serum calcium levels than older patients. However, younger patients are less likely to localize abnormal parathyroid glands on sestamibi or ultrasound. Though younger patients appear to have a higher incidence of hyperplasia compared with older patients, single gland disease is still the overall most frequent cause. Our data suggest that MIP should be more frequently considered in younger patients because of the high incidence of single gland disease.     

Comparison of somatic development and status of conduit after extracardiac Fontan operation in young and older children

Objective: We set out to examine whether the extracardiac Fontan operation (ECFO) in young children is beneficial for the early postoperative course and whether it has a negative impact on the mid-term hemodynamics and growth of the children due to absent growth potential of the prosthetic conduit. Therefore we compared our medium-term experience with ECFO in children under 4 years of age to that in older children regarding the incidence of postoperative complications, somatomotoric development and conduit status. Methods and results: Between 11/95 and 12/02 ECFO was performed in 30 children under 4 years of age and 21 older children aged 4–13 years. There were no deaths in children under 4 years of age and two older children died. No prolonged support (>72 h) of suprarenin was required in small children compared to 4 older children. In twenty-seven children, who underwent postoperative heart catheterization no pulmonary artery or systemic vein distortion occurred. One re-operation and one transcatheter intervention were performed because of the partial conduit stenosis. During the median follow-up of 4.8 years a manifestly accelerated postoperative weight gain was observed in children operated on under 4 years of age, compared to that in older children (up to the 50 vs. 10th percentile, P<0.05). Conclusions: The ECFO could be performed in young children with low morbidity and mortality rates. In the majority of patients, implanted prosthetic grafts maintain stable form without the development of stenosis. Accelerated somatic development, especially in small children, is to be observed after completion of the Fontan circulation.