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The assessment and management of pain in the demented and non-demented elderly patient
Andrade, D C;Faria, J W V;Caramelli, P;Alvarenga, L;Galhardoni, R;Siqueira, S R D;Yeng, L T;Teixeira, M J;
Arquivos de Neuro-Psiquiatria , 2011, DOI: 10.1590/S0004-282X2011000300023
Abstract: persistent pain is a frequent health problem in the elderly. its prevalence ranges from 45% to 80%. chronic diseases, such as depression, cardiovascular disease, cancer and osteoporosis have a higher prevalence in aged individuals and increase the risk of developing chronic pain. the presence of pain is known to be associated with sleep disorders in these patients, as well as functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs. alzheimer's disease patients seem to have a normal pain discriminative capacity and they may probably have weaker emotional and affective experience of pain when compared to other types of dementia. many patients have language deficits and thus cannot properly describe its characteristics. in more advanced cases, it becomes even difficult to determine whether pain is present or not. therefore, the evaluation of these patients should be performed in a systematic way. there are three ways to measure the presence of pain: by direct questioning (self-report), by direct behavioral observation and by interviews with caregivers or informants. in recent years, many pain scales and questionnaires have been published and validated specifically for the elderly population. some are specific to patients with cognitive decline, allowing pain evaluation to be conducted in a structured and reproducible way. the next step is to determine the type of painful syndrome and discuss the bases of the pharmacological management, the use of multiple medications and the presence of comorbidities demand the use of smaller doses and impose contra-indications against some drug classes. a multiprofessional approach is the rule in the management of these patients.
Is Cognition a Determinant of Health Related Quality of Life in Community Dwelling Non Demented Elderly?  [PDF]
Motassem S. Amer, Rania M. El Akkad, Heba S. Hassan
Advances in Aging Research (AAR) , 2014, DOI: 10.4236/aar.2014.35044
Abstract: Quality of life (QOL) is an important topic in social and medical sciences, it has a multidimensional nature and is influenced by many factors. Aim of the Work: In this study we want to assess the impact of cognitive impairment on the health related quality of life (HR-QOL) of community dwelling non demented elderly. Subject and Method: 115 non demented elderly, 60 years and older recruited from outpatient geriatric clinic at Al Mansoura General Hospital, Dakahlia, Egypt. Each participant underwent, comprehensive geriatric assessment, assessing cognitive function using the mini-mental state examination (MMSE) and montreal cognitive function test, assessing the health related quality of life (HR-QOL) by the RAND-36 health survey. Results: We found that the elderly with impaired cognition by both MMSE and Montreal test were significantly older; the ones with lower education, with more depressive symptoms, had more functional impairment and had lower HR-QOL scores than the elderly with normal cognitive function, after controlling for confounders still cognition was a determinant of HR-QOL. Also by linear correlation coefficient a significant correlation between HR-QOL and age, function, cognition and depression was found. Conclusion: Cognition affects significantly HR-QOL of the elderly, so we can say that interventions targeting cognition in the elderly can significantly improve their QOL.
Systemic Inflammation in Non-Demented Elderly Human Subjects: Brain Microstructure and Cognition  [PDF]
Konstantinos Arfanakis, Debra A. Fleischman, Giorgia Grisot, Christopher M. Barth, Anna Varentsova, Martha C. Morris, Lisa L. Barnes, David A. Bennett
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073107
Abstract: The purpose of this study was to test the hypothesis that higher levels of systemic inflammation in a community sample of non-demented subjects older than seventy years of age are associated with reduced diffusion anisotropy in brain white matter and lower cognition. Ninety-five older persons without dementia underwent detailed clinical and cognitive evaluation and magnetic resonance imaging, including diffusion tensor imaging. Systemic inflammation was assessed with a composite measure of commonly used circulating inflammatory markers (C-reactive protein and tumor necrosis factor-alpha). Tract-based spatial statistics analyses demonstrated that diffusion anisotropy in the body and isthmus of the corpus callosum was negatively correlated with the composite measure of systemic inflammation, controlling for demographic, clinical and radiologic factors. Visuospatial ability was negatively correlated with systemic inflammation, and diffusion anisotropy in the body and isthmus of the corpus callosum was shown to mediate this association. The findings of the present study suggest that higher levels of systemic inflammation may be associated with lower microstructural integrity in the corpus callosum of non-demented elderly individuals, and this may partially explain the finding of reduced higher-order visual cognition in aging.
Cardiovascular surgery in the elderly: an update
Song WAN,Ahmed A ARIFI,Calvin S H NG,Anthony P C YIM,
Song WAN
,Ahmed A. ARIFI,Calvin S. H. NG,Anthony P. C. YIM

老年心脏病学杂志(英文版) , 2005,
Abstract: The aging of the population and improvements in outcomes after cardiovascular surgery have resulted in a worldwide growing demand of complex surgical intervention for elderly patients. We briefly review the up-to-date English-language literature with particular focus on cardiovascular surgery in elderly patients. With earlier referral, careful preoperative evaluation, strategic planning, and the continuing efforts in optimizing surgical techniques, operative mortality and morbidity following primary or reoperative coronary artery bypass grafting and valvular interventions are expected to fall in this high-risk patient subset. Importantly, accumulating evidence indicates that elderly patients may benefit from improved functional status and quality of life after cardiovascular surgical therapy(J Geriatr Cardiol 2005,2(2): 123-128).
Family caregivers of demented elderly people and access to medical care: Who gets worn out, why and what for?  [PDF]
Cyril Hazif-Thomas, Marie-Hélène Tritschler-LeMa?tre, Philippe Thomas
Open Journal of Psychiatry (OJPsych) , 2013, DOI: 10.4236/ojpsych.2013.32023
Abstract:

Demented persons in the process of slowly becoming dependent have to rely on the assistance of others. These others are health professionals (formal care), on the one hand and family carers (informal care) on the other hand. The latter, whether or not they have chosen to play a role which is hardly defined officially, have to face many difficult situations such as complicated access to care due to lack of equal opportunities under the health system, unable to support them efficiently. Taking care of a demented patient is a life challenge often leading to burn out, having impact on physical and mental health. Caregivers may thus even have no time or opportunity to take care of their own health. So, is it not high time for the decision-makers to think it over and take care of the carers by setting up programs and giving them the opportunity to learn, to work as a team with the professionals so as to protect themselves and their dignity as well as that of their patients. The difficulties/problems carers of demented patients may encounter should be a major issue for public health care because their role is a vital one and because the consequences which may have on their own health can be negative.

Longitudinal Changes in the Government-Certified Index Stage and Requisite Costs for Long-Term Care Insurance System among the Community-Dwelling Demented Elderly in Japan  [PDF]
Shunichiro Shinagawa,Shiori Nakamura,Makoto Iwamoto,Norifumi Tsuno,Masahiro Shigeta,Kazuhiko Nakayama
International Journal of Alzheimer's Disease , 2013, DOI: 10.1155/2013/164919
Abstract: Background. A new public long-term care (LTC) insurance was launched in 2000 in Japan. However, there have been few studies involving factors that increase LTC costs of demented subjects; no follow-up studies involving the Government-Certified Index (GCI) and requisite costs related to the causes of dementia. Method. An epidemiological survey was conducted in a rural area in Japan in 1999, and 271 subjects were diagnosed as dementia patients. Age, sex, mini-mental state examination, clinical dementia rating, activity of daily living, causes of dementia, and coexisting physical disease were confirmed. After the LTC insurance has been launched, we tracked the GCI stages and payment amounts every month for 8 years. Result. 209 subjects were certified to be eligible for LTC insurance; however, 13 did not receive any payment. Only 49 out of 209 were alive after the follow-up period. The most common cause of dementia was Alzheimer’s disease (AD), followed by vascular dementia (VaD). There was no significant difference between the mortality rates of the two groups. VaD subjects required higher costs than AD subjects in the total certified period and in GCI stage 5. Conclusion. Our results indicate that causes of dementia can have an impact on the requisite costs for the LTC insurance. 1. Introduction A growth of the elderly population consequently increases the number of demented subjects, and dementia is one of the major challenges of health care systems in most countries, especially in aging societies such as Japan. The presence of dementia is strongly related to a decline in the level of daily functioning [1], and the severity of dementia is one of the predictors of higher levels of care [2]. Furthermore, the presence of dementia has an impact on patients’ physical condition, increase the burden on caregivers [3], and can even diminish the life expectancy of elderly people [4, 5]. In Japan, the public long-term care (LTC) insurance system was launched in 2000 to deal with an increasing number of impaired elderly and was revised in 2006. The aims of the LTC insurance system are to allocate limited resources to impaired elderly in a way that adequately reflects need and to reduce the burden on caregivers [6]. Services are allocated based on the Government-Certified Index (GCI), which indicates the amount that can be spent on services for a particular patient with a given GCI stage, basically ranging from 0 (need only support) to 5. Once this procedure has been completed, a care management agency steps are taken to provide the level of services indicated by
Update on the management of constipation in the elderly: new treatment options
Satish SC Rao, Jorge T Go
Clinical Interventions in Aging , 2010, DOI: http://dx.doi.org/10.2147/CIA.S8100
Abstract: ate on the management of constipation in the elderly: new treatment options Review (9916) Total Article Views Authors: Satish SC Rao, Jorge T Go Published Date June 2010 Volume 2010:5 Pages 163 - 171 DOI: http://dx.doi.org/10.2147/CIA.S8100 Satish SC Rao, Jorge T Go Section of Neurogastroenterology, Division of Gastroenterology-Hepatology, Department of Internal Medicine, Iowa City, University of Iowa Carver College of Medicine, Iowa City, Iowa Abstract: Constipation disproportionately affects older adults, with a prevalences of 50% in community-dwelling elderly and 74% in nursing-home residents. Loss of mobility, medications, underlying diseases, impaired anorectal sensation, and ignoring calls to defecate are as important as dyssynergic defecation or irritable bowel syndrome in causing constipation. Detailed medical history on medications and co-morbid problems, and meticulous digital rectal examination may help identify causes of constipation. Likewise, blood tests and colonoscopy may identify organic causes such as colon cancer. Physiological tests such as colonic transit study with radio-opaque markers or wireless motility capsule, anorectal manometry, and balloon expulsion tests can identify disorders of colonic and anorectal function. However, in the elderly, there is usually more than one mechanism, requiring an individualized but multifactorial treatment approach. The management of constipation continues to evolve. Although osmotic laxatives such as polyethylene glycol remain mainstay, several new agents that target different mechanisms appear promising such as chloride-channel activator (lubiprostone), guanylate cyclase agonist (linaclotide), 5HT4 agonist (prucalopride), and peripherally acting μ-opioid receptor antagonists (alvimopan and methylnaltrexone) for opioid-induced constipation. Biofeedback therapy is efficacious for treating dyssynergic defecation and fecal impaction with soiling. However, data on efficacy and safety of drugs in elderly are limited and urgently needed.
Update on the management of constipation in the elderly: new treatment options  [cached]
Satish SC Rao,Jorge T Go
Clinical Interventions in Aging , 2010,
Abstract: Satish SC Rao, Jorge T GoSection of Neurogastroenterology, Division of Gastroenterology-Hepatology, Department of Internal Medicine, Iowa City, University of Iowa Carver College of Medicine, Iowa City, IowaAbstract: Constipation disproportionately affects older adults, with a prevalences of 50% in community-dwelling elderly and 74% in nursing-home residents. Loss of mobility, medications, underlying diseases, impaired anorectal sensation, and ignoring calls to defecate are as important as dyssynergic defecation or irritable bowel syndrome in causing constipation. Detailed medical history on medications and co-morbid problems, and meticulous digital rectal examination may help identify causes of constipation. Likewise, blood tests and colonoscopy may identify organic causes such as colon cancer. Physiological tests such as colonic transit study with radio-opaque markers or wireless motility capsule, anorectal manometry, and balloon expulsion tests can identify disorders of colonic and anorectal function. However, in the elderly, there is usually more than one mechanism, requiring an individualized but multifactorial treatment approach. The management of constipation continues to evolve. Although osmotic laxatives such as polyethylene glycol remain mainstay, several new agents that target different mechanisms appear promising such as chloride-channel activator (lubiprostone), guanylate cyclase agonist (linaclotide), 5HT4 agonist (prucalopride), and peripherally acting μ-opioid receptor antagonists (alvimopan and methylnaltrexone) for opioid-induced constipation. Biofeedback therapy is efficacious for treating dyssynergic defecation and fecal impaction with soiling. However, data on efficacy and safety of drugs in elderly are limited and urgently needed.Keywords: constipation, elderly, treatment
Safety of phosphatidylserine containing omega-3 fatty acids in non-demented elderly: a double-blind placebo-controlled trial followed by an open-label extension
Veronika Vakhapova, Yael Richter, Tzafra Cohen, Yael Herzog, Amos D Korczyn
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-79
Abstract: 157 non-demented elderly participants with memory complaints were randomized to receive either PS-DHA (300 mg PS/day) or placebo for 15 weeks. Standard biochemical and hematological safety parameters, blood pressure and heart rate were evaluated at baseline and endpoint. 122 participants continued into an open-label extension for additional 15 weeks, in which they all consumed PS-DHA (100 mg PS/day) and were evaluated for their blood pressure, heart rate and weight at endpoint. Adverse events were monitored throughout the double-blind and open-label phases.131 participants completed the double-blind phase. No significant differences were found in any of the tested safety parameters between the study groups, or within each group. 121 participants completed the open-label phase. At the end of this phase, there was a reduction in resting diastolic blood pressure and a slight weight gain among participants who consumed PS-DHA for 30 weeks.The results of this study indicate that consumption of PS-DHA at a dosage of 300 mg PS/day for 15 weeks, or 100 mg PS/day for 30 weeks, is safe, well tolerated, and does not produce any negative effects in the tested parameters.clinicaltrials. gov, identifier: NCT00437983Phosphatidylserine (PS) is a naturally occurring phospholipid present in the inner leaflet of mammalian plasma membranes. In humans, PS is most concentrated in the brain where it comprises 15% of the total phospholipid pool. PS has been shown to play a key role in the functioning of neuron membranes, such as signal transduction, secretory vesicle release and cell-to-cell communication [1].The administration of PS extracted from bovine cortex (BC-PS) has positive effects on brain function. BC-PS was shown to improve learning and memory in age-associated memory impaired subjects [2], to enhance behavioral and cognitive parameters in geriatric patients [3], and to improve cognitive performance of Alzheimer's disease (AD) patients [4,5]. Although the primary objective of c
Comment: update on the management of constipation in the elderly: new treatment options
Lee Techner
Clinical Interventions in Aging , 2010, DOI: http://dx.doi.org/10.2147/CIA.S14548
Abstract: Comment: update on the management of constipation in the elderly: new treatment options Letter (3737) Total Article Views Authors: Lee Techner Published Date December 2010 Volume 2010:5 Pages 417 - 418 DOI: http://dx.doi.org/10.2147/CIA.S14548 Lee Techner Adolor Corporation, Exton, PA, USA To the editor, I read with great interest the recent article by Rao and Go regarding new treatment options for the management of constipation in the elderly.1 In this article, alvimopan was described as having been “recently…introduced for the treatment of opioid-induced constipation”. Furthermore, alvimopan was included in a treatment algorithm for management of opioid-induced chronic constipation in the elderly (see Figure 1 in Rao and Go).1 Additionally, other “potential uses” for peripherally acting mu-opioid receptor antagonists (including alvimopan) were identified by the authors and included treatment of “opioid-related nausea and vomiting, urinary retention, pruritus or post-operative ileus”. This characterization of alvimopan requires further clarification. Post to: Cannotea Citeulike Del.icio.us Facebook LinkedIn Twitter Readers of this article also read: Viral vectors for cystic fibrosis gene therapy: What does the future hold? Novel free paclitaxel-loaded poly(L-γ-glutamylglutamine)–paclitaxel nanoparticles Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey Everolimus-eluting stents: update on current clinical studies Rasch analysis of the Dutch version of the Oxford elbow score Successful mobilization of peripheral blood stem cells in children with cancer using plerixafor (Mozobil ) and granulocyte-colony stimulating factor Physicochemical properties and biocompatibility of a polymer-paclitaxel conjugate for cancer treatment Ambulatory blood pressure response to triple therapy with an angiotensin-receptor blocker (ARB), calcium-channel blocker (CCB), and HCTZ versus dual therapy with an ARB and HCTZ Significant neutralizing activities against H2N2 influenza A viruses in human intravenous immunoglobulin lots manufactured from 1993 to 2010 Predictors of refusal of provider initiated HIV testing among clients visiting adult outpatient departments in Jimma town, Oromia Region, Ethiopia: unmatched case control study
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