ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
ObjectiveTo systematically review the purchase willingness rate and influencing factors of long-term care insurance in Chinese population.MethodsCNKI, VIP, WanFang Data, EMbase and PubMed databases were electronically searched to collect cross-sectional studies on the purchase willingness rate of long-term care insurance in China from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software.ResultsA total of 66 cross-sectional studies involving 151 231 subjects were included. The results of the meta-analysis showed that the purchase willingness rate of long-term care insurance in China was 52.4% (95%CI 48.1% to 56.8%). Subgroup analysis showed that: among the sample characteristic factors, residents who were from the central region of China (56.4%), being studied after 2016 (53.3%), and residing in pilot regions (53.1%) had a higher willingness rate to purchase long-term care insurance. Among demographic factors, the research considered factors of residence and family size (56.2%) contributed to a higher willingness to purchase long-term care insurance, and residents with monthly income from 1 000 yuan to 5 000 yuan (55.4%) and who were unmarried (55.3%) had a higher willingness to purchase long-term care insurance. Among health and concept factors, the research considered factors of insurance and government trust (57.3%), factor of number of chronic diseases (55.0%), and factor of health risk cognition (52.4%) contributed to a higher willingness to purchase long-term care insurance. Among the factors of long-term care insurance system, factor of the government subsidy (60.6%), factor of long-term care insurance price (58.0%) and factor of payment methods (56.2%) contributed a higher willingness to purchase long-term care insurance.ConclusionsCurrent evidence shows that over half of residents are willing to purchase long-term care insurance. However, different factors still affect their purchase willingness. The influencing factors reflect numerous difficulties in the current long-term care insurance system, which requires attention and continuous improvement of policy formulators and related researchers.
Objective To evaluate the cardiovascular risk for non-cardiac thoracic surgery （NCTS） in elderly patients with dobutamine stress echocardiography and to decrease surgical risk for NCTS in the geriatrics. Methods Dobutamine stress echocardiography was used for cardiovascular evaluation in 32 NCTS candidates aged over 65 years. Patients with positive echocardiography underwent coronary angiography. Postoperative course and all complications were carefully recorded for the study. Results No serious cardiovascular events occurred during the test except for atrial or ventricular premature contracts in 5 cases. In 2 patients （6.7%,2/30） dobutamine test was positive and coronary artery occlusion was proved by further angiography. Thoracotomy was performed in 28 cases, including 2 cases with dubious result at dobutamine test. Cardiopulmonary complications occurred in 13 patients （46.4%,13/28） after surgery. Supraventricular tachyarrhythmia was the most common complication, occurred in 8 patients （28.6%,8/28）. One of the 2 patients with dubious result at dobutamine test developed definitive angina in the 5th postoperative day. The negative predictive value of dobutamine test was 100%. Conclusion Dobutamine stress echocardiography is a safe and effective method to evaluate major cardiovascular risk of NCTS in the geriatrics. But it is not predictive of tachyarrhythmia after surgery.
Objective To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP). Methods From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparingtechnique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures includedpain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. Results Theaverage length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with anaverage of about 4 months. At 1 year follow-up, 83% (n=20) of patients felt no pain and 17% (n=4) of patients had mildpain; 83% of patient can gain a flexion range of more than 100°; according to Mayo elbow performance score, the meanscores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of typeA fracture was significantly better than that of type B and C (P=0.034). Four patients had postoperative compl ications.Conclusion Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functionalresult and bony union despite of age.
To evaluate the efficacy and safety of comprehensive prophylaxis for deep venous thrombosis(DVT) after proximal femur fractures in geriatric patients. Methods From July 2003 to May 2006, 157 geriatric patients with proximal femur fractures treated with operation were divided into prophylaxis group and control group randomly. There were 82 patients (34 males, 48 females, aged 65-97 years) in prophylaxis group, 30 with femoral neck fracture and 52 with intertrochanteric fracture of femur. There were 75 patients (33 males, 42 females, aged 65-94 years) in control group, 28 with femoral neck fracture and 47 with intertrochanteric fracture of femur. In the prophylaxis group, comprehensive prophylaxis for DVT which included Aspirin, fibrinolytic enzyme, passive and active circumduction of the foot and ankle, CPM management wasappl ied. In the control group, no thromboproxylaxis was taken. All patients in the both groups received color doppler flow imaging (CDFI) examination before operation and on the 7th and 14th days after operation. Results CDFI found 2 cases of DVT in the prophylaxis group 7 and 14 days after operation respectively, while 21 and 15 cases of DVT in the control group respectively. The incidence of DVT was 48.0% in the control group compared with 4.9% in the prophylaxis group and the reduction was significant (P lt; 0.01). One patient gave up the intervention due to Melena 3 days after operation in the prophylaxis group. In the control group, 1 patient died 8 days after operation and another died 11 days after operation. Both died of acute pulmonary embol ism confirmed by autopsy. Conclusion The comprehensive prophylaxis can significantly decrease the incidence of DVT in geriatric patients after proximal femur fractures. There is no significant adverse effect during the intervention.
Objective To assess the risk factors associated with postoperative infection after elective abdominal operation for elderly in department of general surgery. Methods One hundred and fifty-nine consecutive elderly patients admitted to the department of general surgery in our hospital for elective abdominal operation between May 2010 and February 2012 were considered for inclusion and retrospectively analyzed. Thirty-eight patients （23.90%）with postoperative infection were taken as the infection group and 121 patients without postoperative infection as noninfection group. The differences in the objective physiological indicators， subjective health status indicators， operation status， the incidence of postoperative infective complications， and mortality were compared between the two groups. Results Of enrolled 159 patients in this study， the incidence of postoperative infective complications was 23.90% （38/159）； 2 patients died， and the postoperative mortality rate was 1.26%. Single factor and multivariate logistic regression analysis showed that preoperative malnutrition risk， history of diabetes， and chronic respiratory system disease were the independent risk factors of postoperative infection complications in elective abdominal surgery for elderly patients. Conclusion Improving preoperative respiratory function， diabetes mellitus， and nutritional status would help to reduce incidence of postoperative infection for elderly patients with elective abdominal operation.
ObjectiveTo summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures.MethodsThe literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail.ResultsClinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality.ConclusionThe application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.
With the acceleration of population aging, the health problems and care service needs of the elderly are increasing, while the capacity for family-based care is declining. To address these challenges, China has proposed the "integrated medical and nursing care" service model, which integrates medical and health services with elderly care. Geriatric medicine is one of the key technical components of this integrated service model. This study aims to construct a technical standard system for geriatric medicine within the integrated medical and elderly care services. It mainly includes the basic principles, overall framework, structure, and explanations of the geriatric medicine technical standard system, providing a technical and directional framework for the geriatric medicine technical standard system in the context of integrated medical and elderly care services.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
Objective To investigate epidemiological characteristics of geriatric hip fractures between 2010 and 2011 in Hebei province. Methods The digital radiography image data and basic information of patients above 60 years old with hip fractures (femoral neck fracture, femoral intertrochanteric fracture, and femoral head fracture) in 5 hospitals of Hebei province between January 2010 and December 2011 were analyzed retrospectively. All the data including patients’ gender, age, and AO types were abstracted and analyzed to investigate the epidemiologic characteristics of geriatric hip fractures in Hebei province. Results A total of 4 207 hip fracture patients above 60 years old were included, accounting for 59.61% of all patients with hip fractures and 26.24% of all fractures patients over 60 years old in the same period. There were 1 703 (40.48%) males and 2 504 (59.52%) females (M∶F=1∶1.47). The patients ranged in age from 61 to 99 years, with an average of 75.4 years; the majority of patients aged 70-79 years (43.97%) and the minority of the patients aged 90-99 years (2.02%); women of all ages were more than men, but the difference was not significant (P>0.05). According to AO classification, there were 2 118 cases (50.34%) of type 31-A, 2 004 case (47.63%) of type 31-B, and 85 cases (2.02%) of type 31-C. Except for the type 31-A1, 31-A3, and 31-C1 of 60-69 age group, and the type 31-A3 of 80-89 age groups, women were significantly more than men. Conclusion There are more women than men in hip fractures in Hebei province, and 70-79 age group is the high-risk age group of geriatric hip fractures. Among them, intertrochanteric comminuted fractures are common types.