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Geriatrics, Volume 2, Issue 3 (September 2017)

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Research

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Open AccessFeature PaperCommunication Risk Prediction Models for Post-Stroke Dementia
Geriatrics 2017, 2(3), 19; doi:10.3390/geriatrics2030019
Received: 7 April 2017 / Revised: 8 June 2017 / Accepted: 16 June 2017 / Published: 22 June 2017
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Abstract
A strong association exists between stroke and dementia with both diseases linked to ageing. Survival rates from stroke are improving which would equate to an ever-expanding population of patients at risk of future dementia. Early or timelier identification of dementia has become a
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A strong association exists between stroke and dementia with both diseases linked to ageing. Survival rates from stroke are improving which would equate to an ever-expanding population of patients at risk of future dementia. Early or timelier identification of dementia has become a priority in many countries, including the UK. Although screening for dementia is not advocated, targeting at risk populations could be used to reduce an individual’s risk via intervention (i.e., personalised medicine), where available. One approach to improving identification of high-risk dementia individuals is using risk prediction models. Such models could be applied to stroke survivors. Dementia risk prediction models specific to stroke survivors have recently been developed and will be discussed here. Full article
(This article belongs to the Special Issue Stroke in Ageing)
Open AccessArticle The Effects of Resistance Exercise on Muscle Damage, Position Sense, and Blood Redox Status in Young and Elderly Individuals
Geriatrics 2017, 2(3), 20; doi:10.3390/geriatrics2030020
Received: 10 May 2017 / Revised: 19 June 2017 / Accepted: 20 June 2017 / Published: 23 June 2017
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Abstract
Background: The purpose of the present investigation was to study the possible differences between young and elderly individuals regarding muscle damage, position sense, and oxidative stress biomarkers in response to resistance eccentric-biased exercise. Methods: Ten young and 10 elderly individuals performed a bout
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Background: The purpose of the present investigation was to study the possible differences between young and elderly individuals regarding muscle damage, position sense, and oxidative stress biomarkers in response to resistance eccentric-biased exercise. Methods: Ten young and 10 elderly individuals performed a bout of resistance exercise (i.e., squat exercise). Muscle damage indices (i.e., isometric peak torque, range of movement, delayed onset muscle soreness, and creatine kinase), position sense, and oxidative stress biomarkers (i.e., protein carbonyls and reduced glutathione) were assessed before and 48 h post exercise. Results: The main effect of time was significant for all measured parameters, indicating that resistance exercise that includes a large eccentric component causes muscle damage, disturbs position sense, and induces oxidative stress. However, no significant main effect of group or time × group interaction was found for all measured parameters (except isometric peak torque), indicating similar responses to resistance exercise for both young and the elderly individuals. Conclusion: There are no differences between young and elderly individuals regarding muscle damage, position sense, and oxidative stress after resistance exercise, while elderly individuals have lower muscle strength and seem to have a tendency for greater baseline oxidative stress compared to young individuals. Full article
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Open AccessArticle Cervical Fractures: Does Injury Level Impact the Incidence of Dysphagia in Elderly Patients?
Geriatrics 2017, 2(3), 21; doi:10.3390/geriatrics2030021
Received: 31 May 2017 / Revised: 27 June 2017 / Accepted: 6 July 2017 / Published: 12 July 2017
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Abstract
Dysphagia is common in the elderly with significant consequences such as aspiration and malnutrition. This study seeks to investigate oropharyngeal dysphagia in elderly patients with cervical fractures and determine whether the level of cervical fracture impacts the incidence of swallowing dysfunction. Records of
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Dysphagia is common in the elderly with significant consequences such as aspiration and malnutrition. This study seeks to investigate oropharyngeal dysphagia in elderly patients with cervical fractures and determine whether the level of cervical fracture impacts the incidence of swallowing dysfunction. Records of trauma patients ≥65 admitted with cervical fractures over a 76-month period to a level 1 trauma center were reviewed. History of dysphagia, stroke, tracheostomy or spinal cord injury were excluded criteria, leaving 161 patients for analysis. Evaluation of swallowing function was performed to identify dysphagia and variables were analyzed. A total of 161 patients met inclusion criteria and 42 (26.1%) had dysphagia. Patients with dysphagia were older (84.1 ± 8.93 vs. 79.9 ± 8.48, p = 0.006), had higher hospital length of stay (9.0 ± 4.48 vs 4.6 ± 3.30, p = <0.0001), and were more likely to have intensive care unit days (52.4% vs 21.8%, p = 0.0002). Non-operatively-managed patients with C1 fractures were more likely to have dysphagia than patients without C1 fractures (29.2% vs 7.1%, p = 0.0008). After regression analysis, C1 fracture increased the likelihood of dysphagia by four times (OR = 4.0; 95% CI 1.2–13.0). Oropharyngeal dysphagia is common in elderly patients with cervical fracture. Non-operatively-managed patients with C1 fractures are at increased risk and may benefit from more vigorous surveillance. Full article
Open AccessArticle Health-Related Characteristics of Older Adults Who Attend Congregate Meal Sites in the United States
Geriatrics 2017, 2(3), 22; doi:10.3390/geriatrics2030022
Received: 26 June 2017 / Revised: 7 July 2017 / Accepted: 12 July 2017 / Published: 14 July 2017
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Abstract
The purpose of this study was to determine health-related characteristics of a representative sample of older adults who attend congregate meal sites in the United States, and compare races/ethnicities and sexes. Participants were adults, aged 60 years and older, (N = 901)
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The purpose of this study was to determine health-related characteristics of a representative sample of older adults who attend congregate meal sites in the United States, and compare races/ethnicities and sexes. Participants were adults, aged 60 years and older, (N = 901) of the 2015 Tenth Annual National Survey of Older American Act Participants (NSOAAP). Difficulties with mobility and Activities of Daily Living were common among older adults who attended congregate meals. Health-related characteristics differed by race/ethnicity and sex. Higher percentages of men reported eating more than half their calories from the site: 61.0% (53, 68), compared to women: 41.2% (33,50); while twice the number of women reported exercising at the site: 42.7% (36, 50), compared to 21.8% (16, 29) for men. Hispanics reported poor/fair health, food insecurity, diabetes, and poverty more often than White non-Hispanics. The odds of reporting that meals helped maintain independence were higher for persons with food insecurity: OR = 2.67 (1.05, 6.80) and those who reported eating half or more of their calories from the site: OR = 5.78 (2.36, 14.30). Strategies that consider preferences by sex and race/ethnicity are required at congregate meal sites to encourage mobility and healthy eating. Full article
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Open AccessArticle Feasibility of Using Accelerometer Measurements to Assess Habitual Physical Activity in Rural Heart Failure Patients
Geriatrics 2017, 2(3), 23; doi:10.3390/geriatrics2030023
Received: 17 May 2017 / Revised: 5 July 2017 / Accepted: 12 July 2017 / Published: 14 July 2017
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Abstract
(1) Background: Physical inactivity is prevalent in rural heart failure (HF) patients. To evaluate the effectiveness of interventions aimed at improving physical activity (PA), we need an accurate, reliable PA assessment tool that is feasible and acceptable to HF patients. The purpose of
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(1) Background: Physical inactivity is prevalent in rural heart failure (HF) patients. To evaluate the effectiveness of interventions aimed at improving physical activity (PA), we need an accurate, reliable PA assessment tool that is feasible and acceptable to HF patients. The purpose of this study was to examine the feasibility and reliability of using an accelerometer to assess HF patients’ PA. (2) Method: A total of 100 HF patients discharged from a rural hospital participated in the study and wore an accelerometer at baseline, 3, and 6 months following discharge. (3) Result: The daily average wear time across all three time points was 15.7 (±3.3) h for weekdays, and 15.8 (±3.7) h for weekends. Approximately 50% of the participants adhered to the device wear protocol at baseline, 3, and 6 months. Factors related to wear time were also examined. Acceptable reliability assessed by intra-class correlation (ICC > 0.879) was found for daily activity calories, activity counts per minutes, and time spent on moderate or greater PA. (4) Conclusion: The present findings suggest that an accelerometer is a feasible and reliable measure of habitual PA in rural HF patients over time. Full article
Open AccessFeature PaperArticle Determinants of Length of Stay Following Total Anterior Circulatory Stroke
Geriatrics 2017, 2(3), 26; doi:10.3390/geriatrics2030026
Received: 10 June 2017 / Revised: 25 July 2017 / Accepted: 29 July 2017 / Published: 4 August 2017
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Abstract
Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The
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Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The study sample population was drawn from the Norfolk and Norwich Stroke and Transient Ischemic Attack (TIA) Register (1996–2012), a prospective registry. 2965 patients admitted with TACS verified by a stroke specialist team were included. Primary analysis identified predictors of length of stay (LOS) in either haemorrhagic or ischaemic TACS. Secondary analyses identified predictors of LOS in patients who were discharged alive or who died during admission separately. Moderate (p = 0.014) to severe disability (p = 0.015) and history of congestive heart failure (p = 0.027) in the primary analysis and pre-stroke residence in a care facility among patients who survived to discharge (p = 0.013) were associated with a shorter length of stay. Factors associated with increased length of stay included presence of neurological lateralisation in the primary analysis (p = 0.004) and amongst patients who died (p = 0.003 and p = 0.014 for ischaemic and haemorrhagic stroke, respectively). Patients with advanced age (≥85 years) with haemorrhagic stroke had longer LOS regardless of mortality outcome. Patients with low pre-morbid disability (modified Rankin score ≤2 who died following haemorrhagic TACS also had longer LOS. Our study found predictors of LOS following TACS include neurological lateralisation, pre-stroke disability status, congestive heart failure, pre-morbid residence and age. The identification of such factors would assist in resource allocation and discharge planning. Full article
(This article belongs to the Special Issue Stroke in Ageing)
Open AccessFeature PaperArticle Management of Acute Stroke in the Older Person
Geriatrics 2017, 2(3), 27; doi:10.3390/geriatrics2030027
Received: 3 July 2017 / Revised: 21 July 2017 / Accepted: 31 July 2017 / Published: 15 August 2017
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Abstract
The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However,
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The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However, acute, interventional and preventative treatments have mostly been trialled in younger age groups. In this article we will provide an overview of the evidence for acute stroke treatments in relation to age, discuss special considerations in the older person, and contemplate patient choice, quality of life, and end-of-life-decisions. Full article
(This article belongs to the Special Issue Stroke in Ageing)
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Open AccessFeature PaperArticle Association between Oral Conditions and Returning Home after Discharge in Elderly Patients
Geriatrics 2017, 2(3), 28; doi:10.3390/geriatrics2030028
Received: 14 August 2017 / Revised: 24 August 2017 / Accepted: 24 August 2017 / Published: 25 August 2017
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Abstract
For elderly inpatients, it may be preferable to return back to their homes after discharge. Therefore, it is important to predict whether elderly patients are able to return home after discharge. Our purpose is to examine the association between geriatric factors including oral
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For elderly inpatients, it may be preferable to return back to their homes after discharge. Therefore, it is important to predict whether elderly patients are able to return home after discharge. Our purpose is to examine the association between geriatric factors including oral conditions and returning home after discharge in elderly patients. A total of 257 elderly patients were enrolled (returned home: N = 116; changed to hospital/nursing home: N = 141). Oral conditions were evaluated by trained dentists. Cognitive impairment was evaluated using the clinical dementia rating scale. Odds ratios (OR) and 95% confidence intervals (CI) to predict the destination after discharge were obtained by unconditional logistic regression analysis. Impaired tongue movement and edentulous were significant oral factors that elderly patients cannot return home (Impaired tongue movement, OR: 2.72; Edentulous, OR, 1.89), whereas presence of loss of posterior occlusion and mobile teeth were not associated statistically. Cognitive impairment, but not aftereffect of cerebrovascular disease, was a significant problem to predict the destination after discharge in elderly patients (Cognitive impairment, OR: 3.58; Cerebrovascular disease, OR: 1.27). Simple, reliable and inexpensive evaluation including oral examination may better predict whether elderly patients can return home after discharge. Full article

Review

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Open AccessReview Systematic Review of Cholinesterase Inhibitors on Cognition and Behavioral Symptoms in Patients of Chinese Descent with Alzheimer’s Disease, Vascular Dementia, or Mixed Dementia
Geriatrics 2017, 2(3), 29; doi:10.3390/geriatrics2030029
Received: 24 July 2017 / Revised: 24 August 2017 / Accepted: 25 August 2017 / Published: 27 August 2017
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Abstract
Cholinesterase inhibitors (ChEIs) are the primary pharmacologic treatment for dementia. Their efficacy in patients of Chinese descent is not well described. We reviewed how ChEIs could affect cognition and behavioral and psychological symptoms (BPSD) in Chinese patients with Alzheimer’s disease (AD), vascular dementia
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Cholinesterase inhibitors (ChEIs) are the primary pharmacologic treatment for dementia. Their efficacy in patients of Chinese descent is not well described. We reviewed how ChEIs could affect cognition and behavioral and psychological symptoms (BPSD) in Chinese patients with Alzheimer’s disease (AD), vascular dementia (VaD), or mixed (AD with vascular component) dementia. MEDLINE, PsycINFO, EMBASE and CINAHL were systematically searched for controlled trials of ChEIs, including donepezil, galantamine, and rivastigmine, for Chinese patients with AD, VaD, or mixed dementia. Outcomes for cognition and BPSD were extracted for discussion. Fifty-four studies were identified. While one larger study found that dementia patients of Chinese descent treated with ChEIs had significantly higher mean Mini-Mental State Examination (MMSE) score, other studies showed no significant difference. Evidence on BPSD after use of ChEIs was also conflicting. ChEIs may be effective in improving cognition among patients of Chinese descent with dementia. Further studies are needed to examine the possible effects of ChEIs on BPSD in Chinese patients with dementia in view of the small number of studies and limitations in their methodologies. Full article
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Other

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Open AccessFeature PaperCommentary Stroke in Frail Older People
Geriatrics 2017, 2(3), 24; doi:10.3390/geriatrics2030024
Received: 3 April 2017 / Revised: 20 June 2017 / Accepted: 22 June 2017 / Published: 15 July 2017
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Abstract
The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but
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The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but at the same time they suffer increased mortality. Their outcome following stroke and intervention is more often predicted by the presence of frailty rather than age alone. Intervention both in primary prevention and hyperacute stroke management needs to allow for preexisting morbidity and frailty in deciding what is and what is not appropriate, rather than an arbitrary decision on age. Frail older people are more likely to develop delirium and dysphagia combined with poor mouthcare and die, yet all of these issues are managed badly. An increased awareness of these complications of stroke in the frail older person is necessary. Full article
(This article belongs to the Special Issue Stroke in Ageing)
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Open AccessCase Report Never Too Late: A Case Report on Transcatheter Aortic Valve Implantation in a 97-Year-Old Patient
Geriatrics 2017, 2(3), 25; doi:10.3390/geriatrics2030025
Received: 7 May 2017 / Revised: 29 June 2017 / Accepted: 12 July 2017 / Published: 17 July 2017
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Abstract
Aortic valve stenosis is a well-recognized valvular problem in the aging population. Transcatheter aortic valve implantation (TAVI) is becoming an increasingly popular treatment alternative to surgical aortic valve replacement for frail elderly individuals with symptomatic severe aortic valve stenosis. There are multiple research
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Aortic valve stenosis is a well-recognized valvular problem in the aging population. Transcatheter aortic valve implantation (TAVI) is becoming an increasingly popular treatment alternative to surgical aortic valve replacement for frail elderly individuals with symptomatic severe aortic valve stenosis. There are multiple research reports documenting the effectiveness of TAVI in octogenarians; however, few authors discuss the success of this procedure in nonagenarians. This case report depicts the successful transfemoral implantation of a prosthetic aortic valve in a 97-year-old man. Moreover, the current literature on TAVI outcomes in nonagenarians is reviewed. Full article
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