ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.
Objective To explore the effect of early rehabilitation treatment on complications and prognosis of elderly patients with sever pneumonia undergoing mechanical ventilation. Methods The patients who meeting the inclusion criteria were randomly divided into an early rehabilitation group and a control group, with 35 cases in each group. On basis of same routine treatment, the early rehabilitation group was treated with early rehabilitation. The early rehabilitation methods included exercise therapy, electrical stimulation therapy, swallowing therapy, cough training and wheelchair-bed transfer training, etc. The patients received individual training methods according to their conditions. The difference of two groups were observed in the rates of ICU-acquired weakness (ICU-AW), ventilator-associate pneumonia (VAP), the incidence of delirium, the mechanical ventilation time, ICU-hospital time, total hospital time, 30-day hospital mortality, extubation fail rate and tracheotomy rate. Results Compare with the control group, the incidence of ICU-AW (14.28% vs. 37.14%), VAP (8.57% vs. 28.57%), and delirium (40.00% vs. 65.71%) in the early rehabilitation group were significantly reduced (all P<0.05). The duration of delirium [(3.50±1.31) dvs. (6.40±1.47) d], the ventilation time [(6.32±2.19) d vs. (9.40±4.43) d], ICU hospitalization time [(10.80±3.64) d vs. (15.31±3.85) d] and total hospitalization time [(22.52±7.56) d vs. (30.22±11.54) d] of the early rehabilitation group were significantly lower than the control group (all P<0.001). The tracheotomy rate and 30-day hospital mortality of the early rehabilitation group were significantly lower than the control group (25.71%vs. 51.42% and 28.57% vs. 54.28%, both P<0.05). There was no significant difference in extubation fail rate (5.71%vs. 11.42%, P>0.05). In the early rehabilitation group, there were no complications such as pipe prolapse, limb injury or serious arrhythmia. Conclusion Early rehabilitation can reduce the incidence of ICU-AW, VAP, delirium in elderly patients with severe pneumonia, help to shorten the mechanical ventilation time, ICU hospitalization time and total hospitalization time, reduce extubation failure rate and tracheotomy rate, so it is safe and effective, and worthy of being popularized and applied.
Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group. Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on all-cause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To investigate the impact of nutritional risk on unplanned readmissions in elderly patients with chronic obstructive pulmonary disease (COPD), to provide evidence for clinical nutrition support intervention. Methods Elderly patients with COPD meeting the inclusive criteria and admitted between June 2014 and May 2015 were recruited and investigated with nutritional risk screening 2002 (NRS 2002) and unplanned readmission scale. Meanwhile, the patients’ body height and body weight were measured for calculating body mass index (BMI). Results The average score of nutritional risk screening of the elderly COPD patients was 4.65±1.33. There were 456 (40.07%) patients who had no nutritional risk and 682 (59.93%) patients who had nutritional risk. There were 47 (4.13%) patients with unplanned readmissions within 15 days, 155 (13.62%) patients within 30 days, 265 (23.28%) patients within 60 days, 336 (29.53%) patients within 180 days, and 705 (61.95%) patients within one year. The patients with nutritional risk had significantly higher possibilities of unplanned readmissions within 60 days, 180 days and one year than the patients with no nutritional risk (all P<0.05). The nutritional risk, age and severity of disease influenced unplanned readmissions of the elderly patients with COPD (all P<0.05). Conclusions There is a close correlation between nutritional risk and unplanned readmissions in elderly patients with COPD. Doctors and nurses should take some measures to reduce the nutritional risk so as to decrease the unplanned readmissions to some degree.
Objective To explore the efficacy of multidisciplinary nutritional support model in the perioperative management of elderly patients with nutritional risks undergoing joint replacement. Methods Between March 1, 2014 and May 31, 2015, 342 elderly patients who underwent joint replacement due to osteoarthritis were screened with nutritional risk screening 2002 (NRS2002). For patients who got a NRS2002 score of equal to 3 points or higher, nutritional treatment and intervention was carried out by doctor-nurse-rehabilitation therapist-dietitian collaboration and hospital departments related to patients’ complications. Results Among all the 342 patients, 225 (65.79%) had a NRS2002 score of equal to 3 points or higher on the admission day, in which 117 (52.00%) were male and 108 (48.00%) were female, 168 (74.67%) were at the age between 60 and 70 years old and 57 (25.33%) were at the age between 71 and 87. One day before surgery, the number of patients with a NRS2002 score equal to 3 points or higher decreased to 10 (2.92%), and the number became 68 (19.88%) after surgery. The difference was statistically significant (P<0.05). In those 68 elderly patients, 10 had a preoperative NRS2002 score equal to 3 points or higher, and 58 had newly developed nutritional risks after surgery; there were 23 patients with an age over 75, and 7 over 80. The NRS2002 score of all the 342 patients was below 3 points before discharge. For patients with nutritional risks at different periods before and after surgery, their serum albumin and hemoglobin levels were both improved after the treatment of nutritional support (P<0.05). Conclusion Multidis- ciplinary nutritional support for elderly perioperative patients undergoing joint replacement can reduce the incidence of postoperative complications, providing favorable conditions for the patients to undergo joint replacement surgery.
At present, China has entered an aging society facing the dual challenges of “growing old before becoming affluent” and “aging without adequate preparation”, leading to significant eldercare pressures. With the rapid development of smart healthcare, the elderly population’s diverse, differentiated, and personalized medical demands have become increasingly prominent, presenting new challenges for geriatric healthcare services. This article elaborates and analyzes the elderly healthcare policies and the healthcare challenges faced by the elderly under China’s national strategy for actively addressing population aging. It also introduces the practical experience of intelligent elderly medical assistance in West China Hospital of Sichuan University from the aspects of enhanced appointment coordination mechanisms, refined treatment workflow optimization, and upgraded patient-centered service provisions. The research ultimately proposes actionable management strategies to achieve intelligent continuity in geriatric care delivery.
Objective To evaluate the efficacy of normalization management on prognosis in elderly patients with coronary artery disease, in aspects of drug compliance, readmission rate and quality of life. Methods A total of 110 patients above 65 years old with coronary artery disease visiting West China Hospital from August 2010 to February 2011 were investigated. The patients were divided into two groups: the intensive management group (n=55) and the general management group (n=55). The measures such as regular follow-up, regular examination and medical education were conducted in the intensive management group, and the two groups were observed in aspects of drug compliance, readmission rate and quality of life. Results After 1-year follow-up, the percentages of patients taking aspirin/clopidogrel (98.18% vs. 67.27%, Plt;0.05), nitrate (85.45% vs. 40.00%, Plt;0.05), ACEI/ARB (56.36% vs. 18.18%, Plt;0.05), β receptor blocker (58.18% vs. 29.09%, Plt;0.05) and statin (94.55% vs. 32.73%, Plt;0.05) were higher in the intensive management group than those in the general management group. Also, the readmission rate was lower (12.73% vs. 41.42%, Plt;0.05) and the score of quality of life was higher in the intensive management group than that in the general management group. Conclusion The normalization management guided by evidence-based medicine for the elderly patients with coronary artery disease is helpful to improve the drug compliance, reduce the readmission rate, and improve the quality of life.
Objective To explore the expression levels and clinical significance of serum long noncoding RNA myocardial infarction associated transcript (lncRNA MIAT) and microRNA-515-5p (miR-515-5p) in elderly patients with chronic obstructive pulmonary disease (COPD) at different periods. Methods From April 2021 to June 2023, 90 elderly patients with acute exacerbation of COPD treated in Huaibei People’s Hospital were selected as a COPD acute exacerbation group, 88 elderly patients with stable COPD as a COPD stable group, and 90 healthy elderly individuals undergoing physical examination as a control group. The white blood cell count (WBC) and serum lncRNA MIAT and miR-515-5p expression levels were detected in all subjects, blood gas analysis and pulmonary function indexes [oxygenation index (PaO2/FiO2), arterial blood carbon dioxide partial pressure (PaCO2), ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), and FEV1 as a percentage of predicted value (FEV1%pred)] were detected in the patients with COPD. The correlation between serum lncRNA MIAT, miR-515-5p and smoking, WBC, blood gas analysis and pulmonary function indexes were analyzed in the elderly patients with acute exacerbation of COPD. The influencing factors of acute exacerbation of COPD, and the value of serum lncRNA MIAT, miR-515-5p in predicting the occurrence of acute exacerbation of COPD were also analyzed. Results The smoking proportion, WBC, serum lncRNA MIAT expression levels of the control group, the COPD stable group and the COPD acute exacerbation group were increased in turn, serum miR-515-5p expression levels were decreased in turn (P<0.05). Compared with the COPD stable group, PaCO2 was significantly increased in the COPD acute exacerbation group, while PaO2/FiO2, FEV1/FVC and FEV1%pred were significantly decreased (P<0.05); serum lncRNA MIAT in the elderly patients with acute exacerbation of COPD was positively correlated with smoking, WBC, PaCO2 (P<0.05), and negatively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p (P<0.05); serum miR-515-5p was negatively correlated with smoking, WBC, PaCO2 (P<0.05), and positively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred (P<0.05). Smoking, WBC, PaCO2, and lncRNA MIAT were risk factors affecting the acute exacerbation of COPD patients, PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p were protective factors affecting the acute exacerbation of elderly COPD patients (P<0.05). The area under the ROC curve (AUC) of serum lncRNA MIAT, miR-515-5p and their combination in predicting acute exacerbation in elderly COPD patients were 0.823, 0.862 and 0.919, respectively, higher than the AUC predicted by serum lncRNA MIAT and miR-515-5p separately (P<0.05). Conclusions Serum lncRNA MIAT expression was high in elderly patients with COPD, and serum miR-515-5p expression was low, and the changes of both were more obvious in patients with acute exacerbation. Both were correlated with blood gas analysis and pulmonary function indexes in patients with acute exacerbation, and have high value in predicting the occurrence of acute exacerbation in elderly patients with COPD.
Objective To investigate the effective dose of remimazolam benzenesulfonate to suppress cardiovascular responses to laryngeal mask placement in elderly patients. Methods Elderly patients undergoing laryngeal mask anesthesia between March and June 2023 were selected. Combined with sulfentanil 0.2 μg/kg, remimazolam was used as induction hypnotic. The first patient was given remizolam benzenesulfonate 0.16 mg/kg infused by pump for 1 min. The dose of remimazolam for the next patient was determined by the biased coin up-and-down method based on the patient’s response to the laryngeal mask placement. The score of Modified Observer’s Assessment of Alert/Sedation, vital signs and anesthesia depth index (AI) were recorded during induction. Probit analysis was used to calculate the half effective dose (ED50), 95% effective dose (ED95) and half effective AI (AI50). According to the statistical requirements, at least 45 negative patients were required. Results A total of 53 elderly patients were enrolled in the study until the end of the trial. The ED50 and ED95 of remimazolam benzenesulfonate for inhibiting cardiovascular responses to laryngeal mask insertion were 0.154 mg/kg [95% confidence interval (CI) (0.034, 0.170) mg/kg] and 0.207 mg/kg [95%CI (0.190, 0.614) mg/kg], respectively. AI decreased during induction, with an AI50 of 64.119 [95%CI (60.609, 69.984)]. Conclusion When combined with 0.2 μg/kg sufentanil, infusing 0.2 mg/kg remimazolam benzenesulfonate for 1 min is effective and safe for laryngeal mask anesthesia induction in elderly patients.
ObjectiveVideo electroencephalography (VEEG) monitoring for health education of elderly patients based on a process-based communication model, and explore the impact of this model on the success rate, negative emotions, nursing satisfaction, and active cooperation rate of such patients.MethodsFrom September 2017 to September 2019, 118 patients with suspected epilepsy, encephalitis and other diseases who required VEEG monitoring in Suining Central Hospital were selected for this study (patients aged 61 to 73 years; 54 males and 64 females). Patients were divided into 2 groups using a random number table method, 59 patients in each group.A group received routine nursing, and B group received health education based on the process communication model. The monitoring success rate, negative emotion, active cooperation rate, and nursing satisfaction were compared between the two groups.ResultsThe total effective rate in the B group was 86.44%, which was significantly higher than 76.27% in the A group (P<0.05). After nursing intervention, the scores of anxiety and depression in the two groups were significantly decreased, but the decline was greater in the B group (P<0.05). The active cooperation rate and nursing satisfaction of the B group were significantly higher than those of the A group (P<0.05).ConclusionCompared with conventional nursing, health education based on process communication mode can significantly improve the success rate of VEEG monitoring in elderly patients, alleviate the negative emotions of patients, improve the active cooperation rate and nursing satisfaction.