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Terai, Hidetomi, Yusuke Hori, Shinji Takahashi, Koji Tamai, Masayoshi Iwamae, Masatoshi Hoshino, Shoichiro Ohyama, Akito Yabu, and Hiroaki Nakamura. "Impact of the COVID-19 pandemic on the development of locomotive syndrome." Journal of Orthopaedic Surgery 29, no. 3 (September 2021): 230949902110609. http://dx.doi.org/10.1177/23094990211060967.
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Background The coronavirus disease 2019 (COVID-19) pandemic has affected people in various ways, including restricting their mobility and depriving them of exercise opportunities. Such circumstances can trigger locomotor deterioration and impairment, which is known as locomotive syndrome. The purpose of this study was to investigate the incidence of locomotive syndrome in the pandemic and to identify its risk factors. Methods: This was a multicenter questionnaire survey performed between 1 November 2020 and 31 December 2020 in Japan. Patients who visited the orthopedics clinic were asked to answer a questionnaire about their symptoms, exercise habits, and locomotor function at two time points, namely, pre-pandemic and post-second wave (current). The incidence of locomotive syndrome in the COVID-19 pandemic was investigated. Additionally, multiple logistic regression analysis was used to identify the risk factors for developing locomotive syndrome during the pandemic. Results: A total of 2829 patients were enrolled in this study (average age: 61.1 ± 17.1 years; 1532 women). The prevalence of locomotive syndrome was 30% pre-pandemic, which increased significantly to 50% intra-pandemic. Among the patients with no symptoms of locomotive syndrome, 30% developed it in the wake of the pandemic. In the multinomial logistic regression analysis, older age, deteriorated or newly occurring symptoms of musculoskeletal disorders, complaints about the spine or hip/knee joints, and no or decreased exercise habits were independent risk factors for developing locomotive syndrome. Conclusions: The prevalence of locomotive syndrome in patients with musculoskeletal disorders has increased during the COVID-19 pandemic. In addition to age, locomotor symptoms, especially spine or hip/knee joint complaints, and exercise habits were associated with the development of locomotive syndrome. Although the control of infection is a priority, the treatment of musculoskeletal disorders and ensuring exercise habits are also essential issues to address during a pandemic such as COVID-19.
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Inagawa, Tetsuji. "Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan." Journal of Neurosurgery 102, no. 1 (January 2005): 60–67. http://dx.doi.org/10.3171/jns.2005.102.1.0060.
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Object. The annual incidence of aneurysmal subarachnoid hemorrhage (SAH) in Izumo City, Japan, appears to be the highest rate among those reported; therefore the author investigated the risk factors for SAH in patients in this city. Methods. A case-control study of 247 patients (108 men and 139 women with ages ranging from 28–96 years) with aneurysmal SAH was conducted in Izumo between 1980 and 1998. Hypertension, diabetes mellitus, heart disease, liver disease, cigarette smoking, alcohol consumption, and serum levels of total cholesterol, aspartate aminotransferase, alanine aminotransferase, and urea nitrogen were assessed as possible risk factors for SAH by using conditional logistic regression. After adjustment for other risk factors, results of multivariate analysis showed that hypertension was the most powerful risk factor, regardless of age and sex. The odds ratio for hypertension was higher in women than in men. The second greatest risk factors were cigarette smoking in those 59 years of age or younger and in men and hypercholesterolemia in those 60 years of age or older and in women. Among individuals 60 years of age or older and among women, diabetes mellitus and heart disease were inversely associated with the risk of SAH. When analyses were performed in 219 cases of confirmed ruptured cerebral aneurysm, very similar results were obtained. Conclusions. Among patients in Izumo, hypertension was the most notable risk factor for aneurysmal SAH, regardless of age and sex, followed by cigarette smoking in younger men and hypercholesterolemia in older women. In older women, diabetes mellitus and heart disease decreased the risk of SAH.
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Suzuki, Noriko, Masahiko Hashizume, and Hideyuki Shiotani. "Prevalence and Risk Factors of Postprandial Hypotension Among Japanese Older Adults in a Facility." Innovation in Aging 4, Supplement_1 (December 1, 2020): 222. http://dx.doi.org/10.1093/geroni/igaa057.716.
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Abstract Postprandial hypotension (PPH) is an unrecognized sudden drop of blood pressure (BP) after meals and a hidden problem among older people including those living in long-term care facilities (LTCFs). Though PPH causes dizziness, falls, and syncope, it has received little attention from¬¬¬ healthcare workers (HCW) including caregivers, nurses and physicians, and risk factors of PPH should be carefully assessed to improve quality of life. Therefore, we aimed to examine the prevalence and risk factors of PPH in a LTCF in Japan. Participants were 114 older adults living in a LTCF in Japan (mean age 85.9 years old; 85 female (74%)). To examine PPH, blood pressure (BP) was measured before and after lunch. BP after meal was measured four times every 30 minutes. PPH is defined as a BP drop of 20 mmHg or more and we also defined a BP drop within a range of 19 to 15 mmHg as potential-PPH. As risk factors, we compared systolic and diastolic BP at baseline, body mass index, pulse rate, disease and complications between groups with/without PPH. The prevalence of PPH was 41% (47/114) and 52% with potential-PPH; 11% (13/114) added. Among risk factors, systolic BP was significantly higher in those with PPH (142.6 vs 123.5 mmHg, p <0.001). This study revealed that PPH & potential-PPH occurred in half of the subjects in a LTCF in Japan. HCW need to focus on high systolic BP to predict PPH and future research is necessary to prevent and cope with PPH for older people.
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Jennett, Bryan. "High Technology Therapies and Older People." Ageing and Society 15, no. 2 (June 1995): 185–98. http://dx.doi.org/10.1017/s0144686x00002361.
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ABSTRACTTherapies to save or sustain the lives of elderly patients are sometimes used when they can bring little benefit, and sometimes denied because of age to patients who could benefit. Selection for treatment should depend on balancing probable benefits and burdens for the patient and on the patient's preferences. Burdens include those of the treatment itself, the risk of complications and of extending life of poor quality. Factors to consider when deciding are illustrated by reference to intensive care, surgery, dialysis, cardiopulmonary resuscitation and tube feeding.
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Xu, Gang, Norio Yamamoto, Katsuhiro Hayashi, Akihiko Takeuchi, Shinji Miwa, Kentaro Igarashi, Yuta Taniguchi, et al. "The accuracy of different FRAX tools in predicting fracture risk in Japan: A comparison study." Journal of Orthopaedic Surgery 28, no. 2 (January 1, 2020): 230949902091727. http://dx.doi.org/10.1177/2309499020917276.
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Introduction: The web version of Fracture Risk Assessment (FRAX) tool is widely used in many countries to predict the 10-year probability of major osteoporotic fracture (MF) and hip fracture (HF) rate. However, other FRAX tools, calculator older version (first generation), calculator new version (second generation), and application of mobile software had also been used in Japan. Purpose: The aim of this study is to investigate the consistency of results obtained from the four predicting tools for MF and HF rate in both male and female groups. Methods: The data were extracted from 2016 medical examination report of Japanese Ministry of Health of Labor and Welfare. The MF and HF rates were calculated from 40 to 90 years old under different risk factors using four FRAX tools while the consistency of predicting value was evaluated. Results: The predicted MF or HF rates were extremely similar among calculator new version, mobile software, and website version in each risk factors. On other hand, for calculator older version, the predicted MF or HF rates are a little higher than other versions. The significant difference is only present in patients aged 75 and above, and this exceeds the FRAX threshold older than 75 years old by Japanese Society for Bone and Mineral Research. Conclusions: The application of four FRAX tools generated consistent results in predicting the 10-year probability of major osteoporotic fracture and HF for clinical practice, which provides an effective evidence for clinical application.
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Inoue, Machiko, Shoko Matsumoto, Kazue Yamaoka, and Shinsuke Muto. "Risk of Social Isolation Among Great East Japan Earthquake Survivors Living in Tsunami-Affected Ishinomaki, Japan." Disaster Medicine and Public Health Preparedness 8, no. 4 (July 21, 2014): 333–40. http://dx.doi.org/10.1017/dmp.2014.59.
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ABSTRACTObjectiveThe Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.MethodsThe surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants’ risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.ResultsThe elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.ConclusionsOur findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention. (Disaster Med Public Health Preparedness. 2014;0:1-8)
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Ozaki, Etsuko, Daisuke Matsui, Nagato Kuriyama, Satomi Tomida, Yukiko Nukaya, and Teruhide Koyama. "Association between Sedentary Time and Falls among Middle-Aged Women in Japan." Healthcare 10, no. 12 (November 23, 2022): 2354. http://dx.doi.org/10.3390/healthcare10122354.
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There are many reports on the risk of falls in older adults but none regarding the risk among middle-aged people. We aimed to determine fall risk factors among middle-aged women. The participants comprised 1421 women aged 40 to 64 years; anthropometric and other measurements were obtained, and lifestyle factors were examined using a self-administered questionnaire. The participants were categorized into two groups (No-fall and Fall/Almost-fall) based on their questionnaire responses. The No-fall and Fall/Almost-fall groups comprised 1114 and 307 participants, respectively. Body mass index, abdominal circumference measurements, and prevalence of dyslipidemia were significantly higher in the Fall/Almost-fall group. Additionally, those in the Fall/Almost-fall group had a shorter two-step test, experienced difficulty performing the 40 cm single-leg sit-to-stand test, and had higher 25-question Geriatric Locomotive Function Scale (GLFS-25) scores than those in the No-fall group. The results of the adjusted logistic regression analysis indicated that physical activity, higher GLFS-25 scores, and sedentary time of more than seven hours were all risk factors for falling or almost falling. Longer sedentary time is a new risk factor for falls among middle-aged women. It is necessary for people to be concerned with their sedentary behavior, such as by reducing or interrupting continuous sedentary time.
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UEDA, TOMOHIRO, MASAHIRO TAMAKI, SUSUMU KAGEYAMA, NAOKI YOSHIMURA, and OSAMU YOSHIDA. "Urinary incontinence among community‐dwelling people aged 40 years or older in Japan: Prevalence, risk factors, knowledge and self‐perception." International Journal of Urology 7, no. 3 (March 2000): 95–103. http://dx.doi.org/10.1046/j.1442-2042.2000.00147.x.
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Kosugi, Motoko. "Determinants of Preventive Behaviors for COVID-19 in Japan." International Journal of Environmental Research and Public Health 18, no. 19 (September 23, 2021): 9979. http://dx.doi.org/10.3390/ijerph18199979.
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As of June 2021, there have been more than 13,000 deaths in Japan due to the COVID-19 pandemic. Data from the Ministry of Health, Labor, and Welfare show that the mortality rate of COVID-19 greatly varies by age. In this study, using data from a questionnaire survey, an investigation was carried out to find differences in anxiety and risk perception, attitudes toward risk, and the frequency of implementation of countermeasures to infection among age groups that are prone to a greater risk of mortality, as well as the main factors that determine the frequency of implementation. Older people, who form a high-risk group, have a stronger tendency for anxiety and cautious attitudes toward COVID-19, and they more frequently implement preventive behaviors. The results of multiple regression analysis showed that the frequency of implementation of behaviors is determined not only by anxiety, cautious attitude, risk of aggravation to oneself, and perceived effectiveness of behaviors but also by regret, altruism, and conformity. In addition, almost no age-based gap was found between the determinants, suggesting that the motivation to take infection preventive behaviors is the same regardless of age.
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Maeda, Hiromichi, Takehiro Okabayashi, Kengo Ichikawa, Jyunichi Miyazaki, Kazuhiro Hanazaki, and Michiya Kobayashi. "Colorectal Cancer Surgery in Patients Older than 80 Years of Age: Experience at One Nonteaching Hospital in Japan." American Surgeon 77, no. 11 (November 2011): 1454–59. http://dx.doi.org/10.1177/000313481107701132.
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The safety and efficacy of surgical treatment for colorectal cancer in patients older than 80 years of age are seldom assessed. The aim of the present study was to compare short- and long-term outcomes after surgery between younger and elderly patients at a single nonteaching hospital. In all, 342 consecutive patients who underwent surgical resection for invasive primary colorectal cancer between April 1999 and April 2007 were included in the study. Patients were divided into two groups according to their age at the time of surgery, those younger than 79 years of age (n = 283) and those older than 80 years of age (n = 59). A greater proportion of elderly patients had concurrent disease before surgery, right-sided colon cancer, and postoperative complications. Cox proportional hazards model (multivariate analysis) identified three independent risk factors for a poor outcome after surgery (excluding death by other causes): 1) the presence of preoperative symptoms; 2) noncurative resection for colorectal cancer; and 3) the presence of lymph node metastases. Age older than 80 years was not a risk factor for a poor postoperative prognosis. At our nonteaching hospital, surgical resection appears to be a safe and beneficial treatment option for elderly patients (older than 80 years of age) who have colorectal cancer.
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Su, Ya, Kengo Hirayama, Tian-fang Han, Miku Izutsu, and Michiko Yuki. "Sarcopenia Prevalence and Risk Factors among Japanese Community Dwelling Older Adults Living in a Snow-Covered City According to EWGSOP2." Journal of Clinical Medicine 8, no. 3 (February 28, 2019): 291. http://dx.doi.org/10.3390/jcm8030291.
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Sarcopenia is a common problem among the elderly worldwide. Muscle mass can decrease with aging and decreased physical activity may occur. However, the sarcopenia prevalence among community dwelling older adults living in snow-covered cities remains largely unknown. Therefore, we evaluated the prevalence of and risk factors for sarcopenia in this population aged 65 years or older according to the definitions and diagnoses of the European Working Group on Sarcopenia in Older People-2 from two welfare centers in Sapporo, Hokkaido, Japan. The demographic characteristics, nutrition, and depression status of 310 participants were assessed using a standardized questionnaire. All participants were assessed for grip strength. Skeletal muscle index, body mass index (BMI), and total body water (TBW) were measured using bioelectrical impedance analysis. The overall sarcopenia prevalence in the study population was 8.1%. Multivariate analysis revealed that diabetes and taking more than four drugs per day were independently associated with sarcopenia (adjusted odds ratio (OR) = 3.66, 95% confidence interval (CI) = 1.06–12.61; OR = 2.66, CI = 1.05–6.77, respectively). BMI and TBW were negatively associated with sarcopenia. Sarcopenia prevalence was low in community dwelling older adults living in the snow-covered city. It is indicated that welfare center exercise may be a good intervention for the prevention of sarcopenia. Moreover, the management of diabetes, medication, and nutrition is necessary for sarcopenia prevention in community dwelling older adults.
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Lee, Sang Hee, and Ki Uk Kim. "Risk Factors for Postoperative Pneumonia in the Elderly Following Hip Fracture Surgery: A Systematic Review and Meta-Analysis." Geriatric Orthopaedic Surgery & Rehabilitation 13 (January 2022): 215145932210838. http://dx.doi.org/10.1177/21514593221083825.
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Introduction: Pneumonia is a serious complication following hip fracture surgery in older people. However, the prevalence and risk factors of postoperative pneumonia (POP) are not well-established. This study identified pre- and peri-operative factors associated with the development of POP following hip fracture surgery. Methods: We searched the Cochrane library, PubMed, and Embase databases for relevant articles published up to June 2021. Studies involving older patients who underwent hip fracture surgery were considered if they detailed the demographic or surgical characteristics of the participants. For all analyses, the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results: A total of 24 studies (288819 participants) were included. The overall prevalence of POP following hip fracture surgery was 5.0%. There were 36 risk factors for POP, and the meta-analysis included the five most common: delayed surgery (OR: 1.84, 95% CI: 1.29-2.63), low serum albumin (OR: 2.34, 95% CI: .82-6.73), chronic respiratory diseases (OR: 2.42, 95% CI: 1.82-3.24), increased age (OR: 1.25, 95% CI:1.11-1.40), and male sex (OR: 2.22, 95% CI: 2.00-2.47). Conclusions: The prevalence of POP was 5.0% following hip fracture surgery in the elderly. Older age, male sex, chronic respiratory diseases, delayed surgery, and low serum albumin were significant risk factors. Clinicians treating hip fracture patients must remain be aware of these risk factors.
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Zhang, Xiao‐juan, Yan‐bin Zhu, Song Liu, Wei Chen, Bo Liu, Fei Zhang, Hong‐zhi Lv, Chen‐ni Ji, Xiao‐lin Zhang, and Ying‐ze Zhang. "Incidence of Low‐energy Upper Extremity Fractures and the Risk Factors in Chinese People 50 years or Older." Orthopaedic Surgery 11, no. 2 (April 2019): 304–10. http://dx.doi.org/10.1111/os.12448.
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Pappa, Maria D., Nikolaos V. Theodosiadis, Andreas Tsounis, and Pavlos Sarafis. "Risk Factors for the Development of Post-Operative Cognitive Dysfunction." Global Journal of Health Science 9, no. 1 (June 17, 2016): 303. http://dx.doi.org/10.5539/gjhs.v9n1p303.
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BACKGROUND: Many studies have shown that a large number of patients undergoing surgery show a measurable cognitive deterioration after surgery, while many of them still show cognitive deficits even three months later an operation. These specific cognitive deficits in which there is a temporal association between surgery and mental disorders are defined as postoperative impairment of cognitive function. Among cognitive disorders occurring during the postoperative period, the post-operative cognitive dysfunction (POCD) is less studied.AIM: Risk factors concerning POCD will be overviewed in order to be considered as a measure of prevention of POCD.METHOD: A literature search using combined keywords was undertaken on bibliographic databases including PubMed, Google Scholar and Scopus and through systematic selection 72 scientific articles were identified. Concerning the selection criteria, the material of this study consists of sources published mainly over the last fifteen years, while some articles that published before 2000 were selected because they were considered to be important.RESULTS: These disorders frequently occur in patients of advanced age. It is obvious that as the population of humanity ages, many older people are likely to develop health problems that require surgery and therefore a large number of people are likely to develop post-operative cognitive disorders. For the appearance of POCD, as for other mental disorders (e.g. delirium), several factors are implicated. According to the findings, except the advanced age, genetic polymorphism, idiosyncratic condition, the presence of metabolic syndrome and neurological diseases, the type of anaesthesia and surgical operation and sleep disturbance are among the most important risk factors.
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Kobayashi, Kazuyoshi, Shiro Imagama, Kei Ando, Naoki Ishiguro, Masaomi Yamashita, Yawara Eguchi, Morio Matsumoto, et al. "Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study." Global Spine Journal 7, no. 6 (April 11, 2017): 560–66. http://dx.doi.org/10.1177/2192568217700115.
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Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.
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Abe, Y., N. Fujise, R. Fukunaga, Y. Nakagawa, and M. Ikeda. "Comparisons of the prevalence of and risk factors for elderly depression between urban and rural populations in Japan." International Psychogeriatrics 24, no. 8 (February 20, 2012): 1235–41. http://dx.doi.org/10.1017/s1041610212000099.
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ABSTRACTBackground: The aim of the present study was to investigate the differences in the prevalence of and risk factors for elderly depression between urban and rural areas in Japan and to further understanding of the features of elderly depression.Methods: A multistage, random sampling procedure and mailing method were used in urban and rural areas in Kumamoto Prefecture. A total of 2,152 participants aged 65 years and older were evaluated for depression using the Geriatric Depression Scale (GDS). Factors associated with depression were also examined. In order to assess the relationship between risk factors and subjective happiness, the Philadelphia Geriatric Center Morale Scale (PGC-MS) was used.Results: Depressive symptoms were associated with living alone, being unemployed, chronic illness, sleep disturbance, suicidal ideation, financial strain, and poor social support; the risk factors for elderly depression were almost the same in the two areas. Although three factors (financial strain, work status, and PGC-MS) were significantly associated with depression in both areas on logistic regression analysis, sleep disturbance was significant only for the urban area, and poor social support was significant only for the rural area.Conclusions: Although factors related to depression did not differ markedly between urban and rural elderly people, some risk factors differed between the two areas. Effective intervention programs for elderly depression should pay more attention to regional differences.
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Jiao, Wanzhen, Chengchao Zhou, Ting Wang, Shaoyuan Yang, Hongsheng Bi, Liping Liu, Yan Li, and Lihua Wang. "Prevalence and Risk Factors for Pterygium in Rural Older Adults in Shandong Province of China: A Cross-Sectional Study." BioMed Research International 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/658648.
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To investigate the prevalence and risk factors for pterygium in rural older adults in Shandong Province, eastern China, a population-based, cross-sectional study was performed from April to July 2008. By means of cluster random sampling methods, a total of 19,583 people aged 50 years or above were randomly selected from four rural counties. Out of 19,583 people, 1,767 residents were excluded mainly because they were migrant workers when this study was performed. Finally, 17,816 (90.98%) people were included as eligible subjects. They received a comprehensive eye examination and a structured questionnaire voluntarily. Patients with pterygium were defined as having pterygium at the time of survey or pterygium surgery had been performed. 1,876 people were diagnosed as pterygium, either unilateral (1,083) or bilateral (793), which is equivalent to a prevalence of 10.53% (95% CI, 10.08–10.98). The multivariate logistic regression analysis showed that pterygium was independently associated with older age, areas, outdoor time, educational level, and use of hat and/or sunglasses. The prevalence of pterygium increased with age and hours spent under sunshine per day. Meanwhile, the higher the educational level and the more use of hat and/or sunglasses, the lower the pterygium prevalence.
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Khan, Mostafa Saidur Rahim, Pattaphol Yuktadatta, and Yoshihiko Kadoya. "Who Became Lonely during the COVID-19 Pandemic? An Investigation of the Socioeconomic Aspects of Loneliness in Japan." International Journal of Environmental Research and Public Health 19, no. 10 (May 20, 2022): 6242. http://dx.doi.org/10.3390/ijerph19106242.
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The COVID-19 pandemic has impacted social and economic aspects of people’s lives in different ways, causing them to experience different levels of loneliness. This study examines the extent of loneliness among men and women of various ages in Japan during the pandemic and attempts to determine the underlying causes. We used data from Hiroshima University’s nationwide survey conducted before and during the pandemic in Japan. The sample consists of 3755 participants, of which 67% are men and 33% are women with an average age of 51 years (SD = 13.64). Using mean comparison tests and probit regression models, we show that loneliness is a common occurrence among the Japanese population and that a significant number of people became lonely for the first time during the pandemic. In general, loneliness was greater among younger respondents, but older people became lonelier during the pandemic. Simultaneously, we observed significant differences in loneliness across age and gender subsamples. Although depression and subjective health status contributed to loneliness, we found no single explanation for the loneliness experienced by people during the pandemic; rather, subsample analysis revealed that the causes of loneliness for each group differed. Nevertheless, we discovered that older people are at a higher risk of developing loneliness during the pandemic due to a variety of socioeconomic and behavioral factors. The findings of this study suggest that health authorities should not generalize cases of loneliness, but rather intervene individually in each group to avoid further complications.
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Yanik, Elizabeth L., Graham A. Colditz, Rick W. Wright, Nancy L. Saccone, Bradley A. Evanoff, Nitin B. Jain, Ann Marie Dale, and Jay D. Keener. "Risk factors for surgery due to rotator cuff disease in a population-based cohort." Bone & Joint Journal 102-B, no. 3 (March 2020): 352–59. http://dx.doi.org/10.1302/0301-620x.102b3.bjj-2019-0875.r1.
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Aims Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort. Methods A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking. Results Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for ‘always’, ‘usually’, and ‘sometimes’ doing heavy manual labour vs ‘never’, all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking. Conclusion Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: Bone Joint J 2020;102-B(3):352–359
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Cummings, Amanda, Rebecca Foster, Lynn Calman, Natalia V. Permyakova, Jackie Bridges, Theresa Wiseman, Teresa Corbett, Peter W. F. Smith, and Claire Foster. "Quality of life and health status in older adults (≥65 years) up to five years following colorectal cancer treatment: Findings from the ColoREctal Wellbeing (CREW) cohort study." PLOS ONE 17, no. 7 (July 14, 2022): e0270033. http://dx.doi.org/10.1371/journal.pone.0270033.
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Objective Colorectal cancer (CRC) is common in older adults, with more than 70% of diagnoses in people aged ≥65 years. Despite this, there is a knowledge gap regarding longer-term outcomes in this population. Here, we identify those older people most at risk of poor quality of life (QoL) and health status in the five years following CRC treatment. Materials and methods CREW is a UK longitudinal cohort study investigating factors associated with health and wellbeing recovery following curative-intent CRC surgery. Participants completed self-report questionnaires pre-surgery, then at least annually up to five years. Longitudinal analyses explored the prevalence and pre-surgery risk factors of poor QoL (QLACS-GSS) and health status (EQ-5D: presence/absence of problems in five domains) in older (≥65 years) participants over five years. Results 501 participants aged ≥65years completed questionnaires pre-surgery; 45% completed questionnaires five years later. Oldest-old participants (≥80 years) reported poorer QoL (18% higher QLACS-GSS) and 2–4 times higher odds of having problems with mobility or usual activities, compared with the youngest-old (65–69 years) over follow-up. Baseline higher self-efficacy was significantly associated with better QoL (10–30% lower QLACS-GSS scores compared to those with low self-efficacy) and lower odds of problems in all EQ-5D domains. Adequate social support was significantly associated with better QoL (8% lower QLACS-GSS) and lower odds of problems with usual activities (OR = 0.62) and anxiety/depression (OR = 0.56). Conclusion There are important differences in QoL and health status outcomes for the oldest-old during CRC recovery. CREW reveals pre-surgery risk factors that are amenable to intervention including self-efficacy and social support.
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Utsumi, Momoe, Terumasa Yamada, Kazuo Yamabe, Yoshiteru Katsura, Nariaki Fukuchi, Hiroki Fukunaga, Masahiro Tanemura, et al. "Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery." PLOS ONE 17, no. 9 (September 19, 2022): e0274887. http://dx.doi.org/10.1371/journal.pone.0274887.
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Extensive gastrointestinal surgery surveillance data in Japan were analyzed to examine the differences in the risk factors for surgical site infection (SSI) between laparotomy and laparoscopic abdominal procedures. Surgical procedures investigated in the study were gastrectomy, cholecystectomy, colectomy, rectal resection, and appendectomy. A total of 32,629 patients were included in the study. The study participants were divided into two groups according to the year of surgery, 2003–2009 (first study period) and 2010–2015 (second study period), due to the increase in the number of laparoscopic surgeries in the second study period. The incidence of SSI was stratified by three SSI classifications (superficial incisional, deep incisional, and organ/space SSI). Multiple logistic regression analysis was performed to predict the risk factors for SSI. The percentage of laparoscopic surgeries performed has increased linearly since 2010. Patients in the second study period were significantly older and had a higher prevalence of SSI risk factors compared with those in the first study period. In addition, the predictive factors changed substantially in most surgical procedures between the two study periods. Wound class ≥ 3 was a ubiquitous risk factor for superficial incisional SSI (SI-SSI) and organ/space SSI (OS-SSI) in both open (laparotomy) and laparoscopic procedures in the first study period. Meanwhile, in the second study period, operative duration was a ubiquitous risk factor in both procedures. The risk factors for SI-SSI differed from those for OS-SSI in the five abdominal surgeries investigated in the study. Periodic examination of risk factors for SSI is recommended in an aging society.
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Adomi, Motohiko, Masao Iwagami, Takashi Kawahara, Shota Hamada, Katsuya Iijima, Satoru Yoshie, Tatsuro Ishizaki, and Nanako Tamiya. "Factors associated with long-term urinary catheterisation and its impact on urinary tract infection among older people in the community: a population-based observational study in a city in Japan." BMJ Open 9, no. 6 (June 2019): e028371. http://dx.doi.org/10.1136/bmjopen-2018-028371.
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ObjectivesThis study aimed to identify factors associated with long-term urinary catheterisation (LTUC) in community-dwelling older adults and to evaluate the risk of urinary tract infection (UTI) among people with LTUC.DesignPopulation-based observational study.SettingMedical and long-term care insurance claims data from one municipality in Japan.ParticipantsPeople aged ≥75 years living at home who used medical services between October 2012 and September 2013 (n=32 617).Outcome measures(1) Use of LTUC, defined as urinary catheterisation for at least two consecutive months, to identify factors associated with LTUC and (2) the incidence of UTI, defined as a recorded diagnosis of UTI and prescription of antibiotics, in people with and without LTUC.ResultsThe 1-year prevalence of LTUC was 0.44% (143/32 617). Multivariable logistic regression analysis showed that the male sex, older age, higher comorbidity score, previous history of hospitalisation with in-hospital use of urinary catheters and high long-term care need level were independently associated with LTUC. The incidence rate of UTI was 33.8 and 4.7 per 100 person-years in people with and without LTUC, respectively. According to multivariable Poisson regression analysis, LTUC was independently associated with UTI (adjusted rate ratio 2.58, 95% CI 1.68 to 3.96). Propensity score-matched analysis yielded a similar result (rate ratio 2.41, 95% CI 1.45 to 4.00).ConclusionsWe identified several factors associated with LTUC in the community, and LTUC was independently associated with the incidence of UTI.
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Suzuki, Ai, Xueying Jin, Tomoko Ito, Satoru Yoshie, Tatsuro Ishizaki, Katsuya Iijima, and Nanako Tamiya. "Factors Affecting Care-Level Deterioration among Older Adults with Mild and Moderate Disabilities in Japan: Evidence from the Nationally Standardized Survey for Care-Needs Certification." International Journal of Environmental Research and Public Health 19, no. 5 (March 5, 2022): 3065. http://dx.doi.org/10.3390/ijerph19053065.
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This study aims to investigate the factors of care-level deterioration in older adults with mild and moderate disabilities using nationally standardized survey data for care-needs certification. We enrolled people aged 68 years or older, certified as support levels 1–2 (mild disability) or care levels 1–2 (moderate disability) with no cancer. The outcome was care-level deterioration after two years. The possible factors were physical and mental functions which were categorized as the following five dimensions according to the survey for care-needs certification: body function, daily life function, instrumental activities of daily living (IADL) function, cognitive function, and behavioral problems. A multivariate logistic regression analysis was conducted after stratifying the care level at baseline. A total of 2844 participants were included in our analysis. A low IADL function was significantly associated with a risk of care-level deterioration in all participants. In addition, low cognitive function was linked to care-level deterioration, except for those with support level 1 at baseline. Participants with more behavioral problems were more likely to experience care-level deterioration, except for those with care level 2 at baseline. Our study showed the potential utility of the care-needs certification survey for screening high-risk individuals with care-level deterioration.
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Bui, My Hanh, Duong Duc Hung, Pham Quang Vinh, Nguyen Hoang Hiep, Le Lan Anh, and Toi Chu Dinh. "Frequency and Risk Factor of Lower-limb Deep Vein Thrombosis after Major Orthopedic Surgery in Vietnamese Patients." Open Access Macedonian Journal of Medical Sciences 7, no. 24 (December 20, 2019): 4250–54. http://dx.doi.org/10.3889/oamjms.2019.369.
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BACKGROUND: Deep venous thrombosis (DVT) is a prevalent complication of orthopedic surgery. According in many studies. The incidence of DVT may be up to 50% if thromboprophylaxis is not available.
AIM: The objective of this study was to check the degree of disease, clinical characteristics and analyzed factors in vulnerabilities with lower-limp DVT after orthopedic surgery in a Vietnam teaching hospital.
METHODS: Orthopedic patients who met criteria were recruited at our hospital between August 2017 and June 2018. Ultrasound was used to discovering lower-limp DVT in pre-surgery and 7 days after surgery in all patients.
RESULTS: The incidence of DVT after orthopedic surgery was 7.2%. Patients with older age (> 60) have a risk of 2 times higher of DVT after surgery than normal people (p < 0.05). The incidence of postoperative DVT was higher in immobile individuals > 72 hours (p < 0.05). Patients with prolonged surgical time (>120 minutes) had a higher risk of postoperative DVT than non-surgical patients’ surgery (p < 0.05).
CONCLUSIONS: DVT remains a common complication following orthopedic surgery. Older age, immobility status, and surgical time have been found to be risky factors for the development of postoperative lower-limp DVT in orthopedic patients.
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Chen, Tuo-Yu, Angelique Chan, Karen Andersen-Ranberg, Marie Herr, Stefan Fors, Bernard Jeune, François R. Herrmann, Jean-Marie Robine, Yasuyuki Gondo, and Yasuhiko Saito. "Prevalence and Correlates of Falls Among Centenarians: Results from the Five-Country Oldest Old Project (5-COOP)." Journals of Gerontology: Series A 75, no. 5 (May 4, 2019): 974–79. http://dx.doi.org/10.1093/gerona/glz116.
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Abstract Background Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians. Methods Data collection was carried out in 2011–2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis. Results The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different. Conclusions The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.
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Kimura, Atsushi, Yoshihiro Matsumoto, Yoshifumi Wakata, Akiko Oyamada, Masanobu Ohishi, Toshifumi Fujiwara, Ko Ikuta, et al. "Predictive factors of mortality of patients with fragility hip fractures at 1 year after discharge: A multicenter, retrospective study in the northern Kyushu district of Japan." Journal of Orthopaedic Surgery 27, no. 3 (August 29, 2019): 230949901986696. http://dx.doi.org/10.1177/2309499019866965.
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Purpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8–12.0%, n = 45). Log-rank test revealed that previous fractures ( p = 0.003), Barthel index (BI) at discharge ( p = 0.011), and place-to-discharge ( p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking ( p = 0.007), length of hospital stay (LOS; p = 0.009), and BI ( p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. Conclusions: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.
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Cadar, Dorina, and Kokoro Shirai. "DETERMINANTS OF NEUROCOGNITIVE IMPAIRMENT AND DEMENTIA IN ENGLAND AND JAPAN." Innovation in Aging 3, Supplement_1 (November 2019): S190. http://dx.doi.org/10.1093/geroni/igz038.682.
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Abstract Dementia is one of the major contributors to disability and dependency amongst the elderly populations and a significant public health concern. Even though the prevalence of dementia in the UK is rising due to higher numbers of people surviving into older ages, recent evidence suggests that the UK is experiencing a decline in dementia incidence. By contrast, Japan has witnessed a different trend, with increases in both incidence and prevalence. This difference could be related to diagnostic practices within each country, or to the cultural variability in the risk and protective factors driving these emerging forecasts that remain fundamentally different between the UK and Japan. Research in this field has been dominated by clinical studies of dementia mostly conducted in the UK and US, and the current evidence lacks reliable national data on dementia incidence. Socioeconomic inequalities and social determinants of neurocognitive health and dementia risk in two longitudinal studies of ageing: the English Longitudinal Study of Ageing (ELSA) from the UK and Japan Gerontological Evaluation Study of Aging (JAGES). These studies are ideally placed for addressing pivotal research questions in gerontology: 1. What are the biopsychosocial determinants of cognitive impairment and dementia in England and Japan? 2. What are the potential exploratory mechanisms related to the divergent trends in dementia incidence observed in England and Japan? 3. What are the critical differences between the social determinants of dementia in England and Japan?
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Honda, Kazuki, Tomohisa Ishikawa, Ryuji Fukuhara, Seiji Yuki, Yusuke Miyagawa, Asuka Koyama, Yosuke Hidaka, Shuken Boku, and Minoru Takebayashi. "447 - Risk factors associated with sleep disturbance in a general elderly Japanese population: The Arao Cohort Study." International Psychogeriatrics 32, S1 (October 2020): 167. http://dx.doi.org/10.1017/s1041610220002999.
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[Background]Sleep disturbance is a common symptom in elderly people. However, the associated risk factors have not been completely clarified. We examined possible risk factors associated with sleep disturbance in a community-based Japanese cohort study.[Methods]1521 community-dwelling individuals aged 65 years or older were selected from a consecutive series at a cohort study from 2016 to 2018 in Arao city, where located at south part of Japan. In this survey, the clinical valuables were collected as follows: age, sex, occupational status, education, lifestyle information, medical history, EuroQoL(EQ)-5D (a score of health-related quality of life [QOL]), Barthel index (a score of performance in activities of daily living), a score of Geriatric Depression Scale (GDS) and a score of Mini-Mental State Examination (MMSE). Sleep disturbance was assessed by the Pittsburgh Sleep Quality Index (when the global score was 6 or over, sleep disturbance was determined to be present). Multiple logistic regression analysis was used to examine the association between clinical valuables and sleep disturbance. This research was supported by AMED (Japan Agency for Medical Research and Development) under Grant Number JP18dk0207025h0003 and has been approved by the research ethics committee of Kumamoto University. Informed consent was obtained from all participants and their family members.[Results]Multiple logistic regression analysis revealed that Parkinson disease (Odds ratio[OR]=5.59), living alone (OR=1.93), liver disease (OR=1.89), hyperlipidemia (OR=1.36), higher score of GDS (OR=1.14), lower scores of both EQ-5D index (OR=1.11) and Barthel index (OR=1.03) were significantly associated as risk factors with sleep disturbance. Unexpectedly, lower score of MMSE was not a significant risk factor.[Conclusion]These results suggest that several physical illnesses, solitude, depressive symptoms and lower QOL, but not cognitive impairment, might be crucial risk factors associated with sleep disturbance in elderly population.
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Sugai, Keiko, Takehiro Michikawa, Toru Takebayashi, and Yuji Nishiwaki. "Knee pain and future decline in higher-level functional competence in community-dwelling older Japanese: the Kurabuchi cohort study." Age and Ageing 49, no. 4 (March 3, 2020): 592–98. http://dx.doi.org/10.1093/ageing/afaa024.
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Abstract Background The effect of knee osteoarthritis, which causes knee pain, on higher-level functional competence (HLFC) is not clear. Objective To clarify the effect of knee pain on HLFC in older people. Design Community-based prospective cohort study. Setting Kurabuchi town, Gumma prefecture, Japan. Subjects Community-dwelling individuals aged 65 and older. Methods A total of 808 residents participated to the baseline examinations. The frequency of knee pain, degree of pain and functional impairment resulting from the pain were asked at baseline (2005–2006) via a self-administered questionnaire in Japanese based on an English version of the Western Ontario and McMaster Universities Osteoarthritis Index. Information on HLFC at baseline and during home visits were collected annually until 2014 with the Tokyo Metropolitan Institute of Gerontology Index of Competence. The association between baseline knee pain and HLFC decline was assessed with a Cox proportional hazards model. Results Two factors, persistent knee pain and severe functional impairment caused by the pain, were significantly associated with future declines in total HLFC, with adjusted hazard ratios (95% confidence intervals) of 1.51 (1.08–2.11) and 1.49 (1.10–2.00). In analysis by subcategory, persistent knee pain had a significant adverse effect on participants’ intellectual and social activities, and that severe physical functional impairment also had a significant impact on social activities. Conclusions The clear association of the frequency of knee pain and resultant functional impairment with future HLFC decline indicates that collecting information about these factors may be useful in identifying older people at high risk of future HLFC decline.
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Nakamura, Keiji, Kayoko Hayakawa, Shinya Tsuzuki, Satoshi Ide, Hidetoshi Nomoto, Takato Nakamoto, Gen Yamada, Kei Yamamoto, and Norio Ohmagari. "7. Clinical outcomes and epidemiological characteristics of bacteremia in the older population of Japan." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S6. http://dx.doi.org/10.1093/ofid/ofab466.007.
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Abstract Background Japan is one of the most aging societies worldwide. Because older people are highly susceptible to infectious diseases, the characteristics and clinical consequences of bacteremia in this population need clarification. Methods Patients aged ≥ 65 years with positive blood cultures were included in this study conducted between April 1, 2015 and March 31, 2018, and divided into three groups: pre-old (65–74 years), old (75–89 years), and super-old (≥90 years) according to the criteria of the Japanese Society of Geriatrics. They were also classified based on medical exposure: community-acquired (CA), healthcare-associated (HCA), and hospital-onset (HO). Parameters retrieved from medical records were used to compare each group using the chi-square test or Fisher’s exact test; factors related to mortality were identified using multivariate logistic regression analysis after controlling for the confounding effect of baseline characteristics and underlying diseases. The Bonferroni corrected P < 0.05 was deemed to be statistically significant. Results Overall, 1716 cases of bacteremia were identified in 1415 patients. Of these, 505 cases (29.4%) were found to be due to contamination. Of the 1211 cases without contamination, 397 (32.8%) included pre-old, 658 (54.3%) included old, and 156 (12.9%) included super-old patients. HCA bacteremia increased with age, while HO bacteremia was most common in pre-old patients. Escherichia coli bacteremia was most common in super-old patients. While a central line-associated bloodstream infection was more common in pre-old patients, a urinary tract infection was more common in old and super-old patients. The 7-day mortality was 7.4%, 5.8%, and 14.2% in the pre-old, old, and super-old groups, respectively (P = 0.002). The 7-day mortality for CA, HCA, and HO bacteremia was 5.4%, 6.6%, and 9.5%, respectively (P > 0.05). Multivariate logistic regression showed that HO bacteremia (aOR: 1.76 [1.05–2.94], P = 0.028) and increasing age (aOR: 1.03 [1–1.06], P=0.038) are independent risk factors for 7-day mortality. Table Comparison of characteristics of bacteremia among the pre-old, old, super-old groups, n (%) Conclusion The epidemiology of bacteremia differs among different older age groups; thus, these populations should not be treated as a single entity. A careful approach is needed for the optimal management of bacteremia in them. Disclosures All Authors: No reported disclosures
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Agodi, Antonella, Annalisa Quattrocchi, Martina Barchitta, Veronica Adornetto, Aldo Cocuzza, Rosalia Latino, Giovanni Li Destri, and Antonio Di Cataldo. "Risk of Surgical Site Infection in Older Patients in a Cohort Survey: Targets for Quality Improvement in Antibiotic Prophylaxis." International Surgery 100, no. 3 (March 1, 2015): 473–79. http://dx.doi.org/10.9738/intsurg-d-14-00042.1.
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The aims of the present study were to: (1) assess surgical site infection (SSI) incidence in a cohort of surgical patients and (2) estimate the compliance with national guidelines for perioperative antibiotic prophylaxis (PAP). SSIs, among the most common health care–associated infections, are an important target for surveillance and an official priority in several European countries. SSI commonly complicates surgical procedures in older people and is associated with substantial attributable mortality and costs. The implementation of PAP guidelines is difficult among surgeons, and failure to comply with the standard of care has been widely reported. A 12-month prospective survey was performed in accordance with the methods, protocols, and definitions of the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. The compliance of the current PAP practices with the published national guidelines was assessed. A total of 249 patients were enrolled. The cumulative SSI incidence was 3.2 per 100 operative procedures. Cumulative compliance for PAP was 12.4%. Overall, only infection risk index ≥1 was confirmed as a significant risk factor for SSI (odds ratio, 6.65; 95% confidence interval, 1.04–42.59; P = 0.045). When only older patients (age >65 years) were considered, no significant risk factors for SSI were identified. Our study indicates an overall inadequate compliance with PAP recommendations, thus highlighting the need to develop multimodal and targeted intervention programs to improve compliance with PAP guidelines.
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Liao, Chun-De, Shih-Wei Huang, Yu-Yun Huang, and Che-Li Lin. "Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study." Nutrients 13, no. 11 (October 27, 2021): 3817. http://dx.doi.org/10.3390/nu13113817.
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Sarcopenic obesity is closely associated with knee osteoarthritis (KOA) and has high risk of total knee replacement (TKR). In addition, poor nutrition status may lead to sarcopenia and physical frailty in KOA and is negatively associated with surgery outcome after TKR. This study investigated the effects of sarcopenic obesity and its confounding factors on recovery in range of motion (ROM) after total knee replacement (TKR) in older adults with KOA. A total of 587 older adults, aged ≥60 years, who had a diagnosis of KOA and underwent TKR, were enrolled in this retrospective cohort study. Sarcopenia and obesity were defined based on cutoff values of appendicular mass index and body mass index for Asian people. Based on the sarcopenia and obesity definitions, patients were classified into three body-composition groups before TKR: sarcopenic-obese, obese, and non-obese. All patients were asked to attend postoperative outpatient follow-up admissions. Knee flexion ROM was measured before and after surgery. A ROM cutoff of 125 degrees was used to identify poor recovery post-surgery. Kaplan-Meier curve analysis was performed to measure the probability of poor ROM recovery among study groups. Cox multivariate regression models were established to calculate the hazard ratios (HRs) of postoperative poor ROM recovery, using potential confounding factors including age, sex, comorbidity, risk of malnutrition, preoperative ROM, and outpatient follow-up duration as covariates. Analyses results showed that patients in the obese and sarcopenic-obese groups had a higher probability of poor ROM recovery compared to the non-obese group (all p < 0.001). Among all body-composition groups, the sarcopenic-obese group yielded the highest risk of postoperative physical difficulty (adjusted HR = 1.63, p = 0.03), independent to the potential confounding factors. Sarcopenic obesity is likely at the high risk of poor ROM outcome following TKR in older individuals with KOA.
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Okazaki, Kanako, Tetsuya Ohira, Akira Sakai, Michio Shimabukuro, Junichiro J. Kazama, Atsushi Takahashi, Hironori Nakano, et al. "Lifestyle Factors Associated with Undernutrition in Older People after the Great East Japan Earthquake: A Prospective Study in the Fukushima Health Management Survey." International Journal of Environmental Research and Public Health 19, no. 6 (March 14, 2022): 3399. http://dx.doi.org/10.3390/ijerph19063399.
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We conducted a longitudinal examination to assess the relationship between lifestyle habits, including exercise habits, and the incidence of undernutrition after the Great East Japan Earthquake in March 2011. Of the 31,411 participants aged ≥60 years who lived in the municipalities’ evacuation areas before the disaster and had undergone health examinations, 17,622 persons with a body mass index of 20–25 kg/m2 were followed up through the FY 2017 (a mean follow-up of 6.9 years). The analysis involved 13,378 individuals who could be followed. The associations between undernutrition after the disaster and lifestyle factors were estimated via multivariable-adjusted analysis using the Cox proportional hazard regression model. The dependent variable was the proportion of undernutrition after the disaster, whereas independent variables included evacuation, exercise habits/physical activity, alcohol consumption, smoking, meals before bedtime, gastrointestinal surgery history, history of lifestyle-related diseases, and two or more subjective symptoms. In total, 1712 of the 13,378 participants were newly undernourished after the disaster. The statistically significant variables influencing the occurrence of undernutrition were non-evacuation (hazard ratio (HR), 1.31; 95% confidence index (CI) 1.17–1.47), poor exercise habits (HR, 1.14; 95% CI 1.03–1.50), and poor physical activity (HR, 1.12; 95% CI 1.01–1.25). Other significant related variables were drinking habits, surgical history, lifestyle-related diseases, and two or more subjective symptoms. These results suggest that regular exercise and/or physical activity might be important in preventing undernutrition following a disaster, regardless of sex, other lifestyle habits, or past medical history.
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Shimo, Satoshi, Yuta Sakamoto, Takashi Amari, Masaaki Chino, Rie Sakamoto, and Masanori Nagai. "Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan." Healthcare 9, no. 6 (May 25, 2021): 630. http://dx.doi.org/10.3390/healthcare9060630.
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Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.
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Kelly, Emma, and Peter Stephens. "Cancer in the older person." Reviews in Clinical Gerontology 25, no. 3 (August 2015): 172–80. http://dx.doi.org/10.1017/s0959259815000131.
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SummaryThe challenges of treating malignant disease in the elderly population have gained greater prominence over the last 5–10 years. Developed nations all have ageing populations, and cancer in older people is an increasing physical and financial burden on both healthcare systems and populations.When assessing oncology patients, oncologists have traditionally used the Eastern Cooperative Oncology Group or Karnofsky performance status. However, it has been shown that sometimes this does not detect potential problems in older patients, and that a comprehensive geriatric assessment may be a better tool. However good surgeons and oncologists are at adapting their services for older patients, there is little value if they are inappropriately referred or filtered out by either primary or secondary care.Surgery forms the basis of most curative treatment options. The elderly have more peri-operative risk factors including multiple co-morbidities, poly-pharmacy, malnutrition, frailty, cognitive dysfunction and an increased anaesthetic risk, which can create obstacles.Treating older patients with systemic cytotoxic therapy often relies on extrapolating evidence from younger patients. In previous decades, the majority of trials had upper age limits of 65 or 70 years. More recent trials normally include patients of all ages, and entry is based on performance status. Radiotherapy may be chosen as a potentially curative option in patients with an operable tumour, who are unfit. However, oncologists should not underestimate the burden that multiple frequent visits to hospital for treatment may have on an elderly patient population.This article looks at the assessment of elderly oncology patients, referral patterns, surgery, systemic therapies, radiotherapy, supportive therapies and long-term side-effects from treatment.
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Teipel, Stefan J., Thomas Fritze, Martin Ellenrieder, Britta Haenisch, Wolfram Mittelmeier, and Gabriele Doblhammer. "Association of joint replacement surgery with incident dementia diagnosis in German claims data." International Psychogeriatrics 30, no. 9 (March 21, 2018): 1375–83. http://dx.doi.org/10.1017/s1041610217002976.
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ABSTRACTBackground:Cognitive decline is an important complication of joint replacement surgeries in senior people.Methods:We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD).Results:The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001).Conclusion:In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.
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McIsaac, Daniel I., Coralie A. Wong, Gregory L. Bryson, and Carl van Walraven. "Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery." Anesthesiology 128, no. 6 (June 1, 2018): 1140–50. http://dx.doi.org/10.1097/aln.0000000000002124.
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Abstract Background Polypharmacy is increasingly prevalent in older patients and is associated with adverse events among medical patients. The impact of polypharmacy on outcomes after elective surgery is poorly described. The authors’ objective was to measure the association of polypharmacy with survival, complications, and resource use among older patients undergoing elective surgery. Methods After registration (NCT03133182), the authors identified all individuals older than 65 yr old having their first elective noncardiac surgery in Ontario, Canada, between 2002 and 2014. Using linked administrative data, the authors identified all prescriptions dispensed in the 90 days before surgery and classified people receiving five or more unique medications with polypharmacy. The associations of polypharmacy with 90-day survival (primary outcome), complications, length of stay, costs, discharge location, and readmissions were estimated after multilevel, multivariable adjustment for demographics, comorbidities, previous healthcare use, and surgical factors. Prespecified and post hoc sensitivity analyses were also performed. Results Of 266,499 patients identified, 146,026 (54.8%) had polypharmacy. Death within 90 days occurred in 4,356 (3.0%) patients with polypharmacy and 1,919 (1.6%) without (adjusted hazard ratio = 1.21; 95% CI, 1.14 to 1.27). Sensitivity analyses demonstrated no increase in effect when only high-risk medications were considered and attenuation of the effect when only prescriptions filled in the 30 preoperative days were considered (hazard ratio = 1.07). Associations were attenuated or not significant in patients with frailty and higher comorbidity scores. Conclusions Older patients with polypharmacy represent a high-risk stratum of the perioperative population. However, the authors’ findings call into question the causality and generalizability of the polypharmacy-adverse outcome association that is well documented in nonsurgical patients.
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Lachmann, Gunnar, Insa Feinkohl, Friedrich Borchers, Thomas H. Ottens, Hendrik M. Nathoe, Anne-Mette Sauer, Jan M. Dieleman, et al. "Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction." Dementia and Geriatric Cognitive Disorders 46, no. 3-4 (2018): 193–206. http://dx.doi.org/10.1159/000492962.
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Background/Aims: Older people undergoing surgery are at risk of developing postoperative cognitive dysfunction (POCD), but little is known of risk factors predisposing patients to POCD. Our objective was to estimate the risk of POCD associated with exposure to preoperative diabetes, hypertension, and obesity. Methods: Original data from 3 randomised controlled trials (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis on diabetes, hypertension, baseline blood pressure, obesity (BMI ≥30 kg/m2), and BMI as risk factors for POCD in multiple logistic regression models. Risk estimates were pooled across the 3 studies. Results: Analyses totalled 1,034 patients. POCD occurred in 5.2% of patients in DECS, in 9.4% in SuDoCo, and in 32.1% of patients in OCTOPUS. After adjustment for age, sex, surgery type, randomisation, obesity, and hypertension, diabetes was associated with a 1.84-fold increased risk of POCD (OR 1.84; 95% CI 1.14, 2.97; p = 0.01). Obesity, BMI, hypertension, and baseline blood pressure were each not associated with POCD in fully adjusted models (all p > 0.05). Conclusion: Diabetes, but not obesity or hypertension, is associated with increased POCD risk. Consideration of diabetes status may be helpful for risk assessment of surgical patients.
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Hiramoto, Shiori, Hajime Asano, Tomoyoshi Miyamoto, Manabu Takegami, and Atsufumi Kawabata. "Risk factors and pharmacotherapy for chemotherapy-induced peripheral neuropathy in paclitaxel-treated female cancer survivors: A retrospective study in Japan." PLOS ONE 16, no. 12 (December 31, 2021): e0261473. http://dx.doi.org/10.1371/journal.pone.0261473.
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Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse reaction in cancer patients treated with several cytotoxic anticancer agents including paclitaxel. Duloxetine, an antidepressant known as a serotonin-noradrenalin reuptake inhibitor, is the only agent that has moderate evidence for the use to treat painful CIPN. The present retrospective cohort study aimed to analyze risk factors for paclitaxel-induced peripheral neuropathy (PIPN), and investigate ongoing prescription drug use for PIPN in Japan. Female breast and gynecologic cancer patients who underwent paclitaxel-based chemotherapy at a single center in Japan between January 2016 and December 2019 were enrolled in this study. Patients’ information obtained from electronic medical records were statistically analyzed to test possible risk factors on PIPN diagnosis. Patients’ age, total paclitaxel dose, the history of female hormone-related diseases, hypertension and body mass index (BMI), but not additional platinum agents, were significantly associated with increased PIPN diagnosis. Drugs prescribed for PIPN included duloxetine, pregabalin, mecobalamin and Goshajinkigan, a polyherbal medicine, regardless of poor evidence for their effectiveness against CIPN, and were greatly different between breast and gynecologic cancer patients diagnosed with PIPN at the departments of Surgery and Gynecology, respectively. Thus, older age, greater total paclitaxel dose, the history of estrogen-related diseases, hypertension and BMI are considered risk factors for PIPN in paclitaxel-based chemotherapy of female cancer patients. It appears an urgent need to establish a guideline of evidence-based pharmacotherapy for PIPN.
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Laubscher, Cornelius V., Marilize C. Burger, Maria M. Conradie, Magda Conradie, and Jacobus D. Jordaan. "Prevalence of Sarcopenia in Older South African Patients Following Surgery for Fragility Fractures of the Hip." Geriatric Orthopaedic Surgery & Rehabilitation 11 (January 1, 2020): 215145932097156. http://dx.doi.org/10.1177/2151459320971560.
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Introduction: Geriatric patients with a fragility fracture of the hip (FFH) are especially prone to sarcopenia with poor functional outcomes and quality of life. We assessed the prevalence of sarcopenia in older South African patients with FFH. Risk factors for sarcopenia were also investigated. Materials and Methods: From August 1 to November 30, 2018, all older patients with FFH were invited to participate. Sarcopenia was diagnosed based on the revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Handgrip strength (HGS) and muscle strength were assessed. Muscle quantity was determined by dual-energy X-ray absorptiometry. Demographic information was collected, and 25-hydroxyvitamin D (25[OH]D) status was determined. Results: Of the 100 hip fracture cases, 65 were enrolled, and 52% (34/65) were sarcopenic (women: 62%; men: 38%). HGS accurately identified sarcopenia (sensitivity and specificity: 100%). Patients >80 years of age had a prevalence of sarcopenia twice (18/21 [83%]) that of younger patients (18/44 [36%]). Women with sarcopenia were smaller than those without (weight: p < 0.001; height: p < 0.001; body mass index: p = 0.018). Low 25(OH)D was almost universally present, with median 25(OH)D levels significantly lower in the patients with sarcopenia (27 nmol/L [interquartile range {IQR}: 20–39] vs. 40 nmol/L [IQR: 29–53]). Several risk factors, including advanced age; female sex; a smaller body size, especially among women; limited physical activity; and low 25(OH)D levels, were identified. Discussion: The accuracy of HGS testing in this cohort underscores EWGSOP2’s recommendation that muscle strength is key to sarcopenia. Further study and follow-up are required to determine the clinical relevance of sarcopenia among FFH patients. Conclusion: The prevalence of sarcopenia in our FFH population is high. Sarcopenia is associated with poor patient outcomes following surgical intervention. Orthopaedic surgeons should therefore be cognizant of the presentation and associated risk of sarcopenia as our patient populations age.
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Maasakkers, Carlijn M., Jurgen A. H. R. Claassen, Paul A. Gardiner, Marcel G. M. Olde Rikkert, Darren M. Lipnicki, Nikolaos Scarmeas, Efthimios Dardiotis, et al. "The Association of Sedentary Behaviour and Cognitive Function in People Without Dementia: A Coordinated Analysis Across Five Cohort Studies from COSMIC." Sports Medicine 50, no. 2 (September 16, 2019): 403–13. http://dx.doi.org/10.1007/s40279-019-01186-7.
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Abstract Background Besides physical activity as a target for dementia prevention, sedentary behaviour is hypothesized to be a potential target in its own right. The rising number of persons with dementia and lack of any effective treatment highlight the urgency to better understand these modifiable risk factors. Therefore, we aimed to investigate whether higher levels of sedentary behaviour are associated with reduced global cognitive functioning and slower cognitive decline in older persons without dementia. Methods We used five population cohorts from Greece, Australia, USA, Japan, and Singapore (HELIAD, PATH, SALSA, SGS, and SLAS2) from the Cohort Studies of Memory in an International Consortium. In a coordinated analysis, we assessed the relationship between sedentary behaviour and global cognitive function with the use of linear mixed growth model analysis (mean follow-up range of 2.0–8.1 years). Results Baseline datasets combined 10,450 older adults without dementia with a mean age range between cohorts of 66.7–75.1 years. After adjusting for multiple covariates, no cross-sectional association between sedentary behaviour and cognition was found in four studies. One association was detected where more sedentary behaviour was cross-sectionally linked to higher cognition levels (SLAS2, B = 0.118 (0.075; 0.160), P < 0.001). Longitudinally, there were no associations between baseline sedentary behaviour and cognitive decline (P > 0.05). Conclusions Overall, these results do not suggest an association between total sedentary time and lower global cognition in older persons without dementia at baseline or over time. We hypothesize that specific types of sedentary behaviour may differentially influence cognition which should be investigated further. For now, it is, however, too early to establish undifferentiated sedentary time as a potential effective target for minimizing cognitive decline in older adults without dementia.
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Sugai, Keiko, Haruhiko Imamura, Takehiro Michikawa, Keiko Asakura, and Yuji Nishiwaki. "Awareness of Locomotive Syndrome and Factors Associated with Awareness: A Community-Based Cross-Sectional Study." International Journal of Environmental Research and Public Health 17, no. 19 (October 5, 2020): 7272. http://dx.doi.org/10.3390/ijerph17197272.
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Locomotive syndrome is a condition of reduced mobility, and patients have a high risk of requiring nursing care. In order to investigate the level of awareness of the term “locomotive syndrome” and the factors relating to awareness in a community, awareness of locomotive syndrome was included in a questionnaire survey on health and daily life conducted in Koumi Town (Japan), which was distributed to 3181 eligible residents aged 40 years or older. Information on age, sex, marital status, educational attainment, lifestyle, and social environment was also collected, and the association of awareness with various factors was analyzed with two multivariable Poisson regression models. As a result, awareness among respondents was 44.6%. Awareness was significantly higher among women, those who were 60–79 years old, married, and had received higher education. Additionally, awareness was significantly associated with social factors, especially attendance at regional events within the last one year, in both women and men: the adjusted prevalence ratios (95% confidence intervals) were 1.26 (1.10–1.43) and 1.48 (1.19–1.83), respectively. In conclusion, in addition to strengthen awareness rising campaigns targeting men and for younger people, providing health education at social settings such as regional events may help improve future musculoskeletal health in the elderly.
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Inagawa, Tetsuji. "Diurnal and seasonal variations in the onset of primary intracerebral hemorrhage in individuals living in Izumo City, Japan." Journal of Neurosurgery 98, no. 2 (February 2003): 326–36. http://dx.doi.org/10.3171/jns.2003.98.2.0326.
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Object. Little is known about the temporal patterns of primary intracerebral hemorrhage (ICH) among the general population. The aim of this study was to examine diurnal and seasonal variations in the onset of ICH in a community-based series. Methods. The study population consisted of 350 patients who presented with primary ICH for the first time and were treated between 1991 and 1998 in Izumo City, Japan. Among the entire patient population, the onset of hemorrhage was rarely observed during the night and a peak was observed in the late afternoon. In men 69 years of age or younger, the onset of ICH exhibited a bimodal distribution, with an initial high peak between 8:00 and 10:00 a.m. and a second, lower peak between 6:00 and 8:00 p.m. In contrast, in men 70 years of age or older and in women regardless of age, only a single evening peak, between approximately 6:00 and 10:00 p.m., was found, and no morning peak was observed. For the entire patient population (for both sexes), and for men alone, seasonal variations—a peak in winter and a trough in summer—were significant for all age groups combined. This factor was significant for patients 69 years of age or younger, during the daytime hours (8:00 a.m.–8:00 p.m.), and for patients with untreated hypertension; however, it was not significant for patients 70 years of age or older, during nighttime hours (10:00 p.m.–8:00 a.m.), or for treated hypertensive and normotensive patients. In women, no significant seasonal patterns were found, regardless of patient age, time of day at onset of ICH, or the presence of risk factors. Seasonal variations were statistically significant for patients with hematomas larger than 5 ml, but not for those with hematomas 5 ml or smaller. Conclusions. Temporal distributions in the onset of ICH seem to be influenced by patient sex and age. The seasonal patterns of ICH occurrence may result mainly from changes that occur during the daytime, and may also be modified by the presence of untreated hypertension and by the volume of the hematoma.
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Imamura, Kotaro, Akizumi Tsutsumi, Yumi Asai, Hideaki Arima, Emiko Ando, Akiomi Inoue, Reiko Inoue, et al. "Association between psychosocial factors at work and health outcomes after retirement: a protocol for a systematic review and meta-analysis." BMJ Open 9, no. 8 (August 2019): e030773. http://dx.doi.org/10.1136/bmjopen-2019-030773.
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IntroductionThe world’s population is rapidly ageing, and health among older people is thus an important issue. Several previous studies have reported an association between adverse psychosocial factors at work before retirement and postretirement health. The objective of this systematic review and meta-analysis is to examine the association between psychosocial factors at work and health outcomes after retirement, based on a synthesis of well-designed prospective studies.Methods and analysisThe participants, exposures, comparisons and outcomes of the studies in this systematic review and meta-analysis are defined as follows: (P) people who have retired from their job, (E) presence of adverse psychosocial factors at work before retirement, (C) absence of adverse psychosocial factors at work before retirement and (O) any physical and mental health outcomes after retirement. Published studies were searched using the following electronic databases: MEDLINE, EMBASE, PsycINFO, PsycARTICLES and Japan Medical Abstracts Society. The included studies will be statistically synthesised in a meta-analysis to estimate pooled coefficients and 95% CIs. The quality of each included study will be assessed using the Risk Of Bias In Non-randomised Studies-of Interventions. For the assessment of meta-bias, publication bias will be assessed by using Egger’s test, as well as visually on a funnel plot. Heterogeneity will be assessed using the χ² test with Cochran’s Q statistic and I2.Ethics and disseminationResults and findings will be submitted and published in a scientific peer-reviewed journal and will be disseminated broadly to researchers and policy-makers interested in the translatability of scientific evidence into good practices.PROSPERO registration numberCRD42018099043.
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McIlroy, Suzanne, Edward Walsh, Christina Sothinathan, Elizabeth Stovold, Daniel Norwitz, Sam Norton, John Weinman, and Lindsay Bearne. "Pre-operative prognostic factors for walking capacity after surgery for lumbar spinal stenosis: a systematic review." Age and Ageing 50, no. 5 (July 24, 2021): 1529–45. http://dx.doi.org/10.1093/ageing/afab150.
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Abstract Background Lumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes. Objective To synthesise the evidence for pre-operative mutable and immutable prognostic factors for post-operative walking in adults with LSS. Design Systematic review with narrative synthesis. Methods Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, OpenGrey) were searched for observational studies, evaluating factors associated with walking after surgery in adults receiving surgery for LSS from database inception to January 2020. Two reviewers independently evaluated studies for eligibility, extracted data and assessed risk of bias (Quality in Prognosis Studies). The Grading of Recommendations Assessment, Development and Evaluation method was used to determine level of evidence for each factor. Results 5526 studies were screened for eligibility. Thirty-four studies (20 cohorts, 9,973 participants, 26 high, 2 moderate, 6 low risk of bias) were included. Forty variables (12 mutable) were identified. There was moderate quality of evidence that pre-operative walking capacity was positively associated with post-operative walking capacity. The presence of spondylolisthesis and the severity of stenosis were not associated with post-operative walking capacity. All other factors investigated had low/very low level of evidence. Conclusion Greater pre-operative walking is associated with greater post-operative walking capacity but not spondylolisthesis or severity of stenosis. Few studies have investigated mutable prognostic factors that could be potentially targeted to optimise surgical outcomes.
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Kajikawa, Natsuki, Shoji Yokoya, and Tetsuhiro Maeno. "COVID-19 Vaccination Willingness and Associated Factors in Japanese Primary Care Patients: A Cross-Sectional Study." Journal of Primary Care & Community Health 13 (January 2022): 215013192210972. http://dx.doi.org/10.1177/21501319221097282.
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Introduction/Objectives: COVID-19 vaccination is important to stop the pandemic. It has been reported that willingness to be vaccinated is associated with system factors as well as individual attitudes and beliefs. Primary care patients include individuals at increased risk of poor outcomes after COVID-19 infection, such as elderly people and those with comorbidities. This study investigated attitudes in this population toward COVID-19 and COVID-19 vaccination, including willingness to be vaccinated and associated factors. This study was conducted in Japan, where the population has low vaccine confidence, during the initial phase of COVID-19 vaccination. Methods: Patients from 1 primary care clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study from March to April 2021. They were administered a self-reported questionnaire exploring factors such as willingness to undergo COVID-19 vaccination, perceived susceptibility, and perceived vaccine efficacy. Multivariable logistic regression analysis was conducted to identify factors associated with vaccination. Results: Of the 717 patients (response rate, 88.3%), 512 (70.0%) reported they were willing to be vaccinated for COVID-19. Multivariate analysis revealed that vaccination willingness was associated with older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), male gender (OR 1.95, 95% CI 1.15-3.30), influenza vaccination in in the 2020/2021 season (OR 2.54, 95% CI 1.49-4.32), recommendation from others (OR 3.11, 95% CI 1.58-6.18), high perceived susceptibility (OR 2.51, 95% CI 1.45-4.33), belief in vaccine efficacy (OR 3.83, 95% CI 1.54-9.56), high perceived susceptibility to vaccine-related adverse events (OR 0.37, 95% CI 0.22-0.64), and high espousal of social norms (OR 8.00, 95% CI 2.78-23.0). Conclusions: COVID-19 vaccination was widely acceptable to Japanese primary care patients. In addition to factors such as vaccine efficacy, and past influenza vaccination, social norms may be important in determining COVID-19 vaccination willingness.
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Arani, Monireh Dehghani, Alireza Abadi, Aarvin Yavari, Yousef Bashiri, Liley Mahmudi, and Chris Bajdik. "Evaluation of risk factors in patients with breast cancer in stages III and IV: comparison of Cox and Fine-Grey competing risk regression models." Biomedical Research and Therapy 5, no. 02 (February 28, 2018): 2022–33. http://dx.doi.org/10.15419/bmrat.v5i02.417.
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Introduction: The aim of this study is to fit Fine-Grey competing risk model and compare its results with stratified Cox model and to examine its application in breast cancer data.
Methods: The study was conducted on 15830 women diagnosed with breast cancer in British Columbia, Canada. They were divided into four groups according to patients' stage of disease then for patients with stage III and IV breast cancer was fitted Cox's model and Fine-Grey competing risk flexible models to each group.
Results: The data show that Out of 1888 patients, 578 lied in the age group of below 50 years old, while 1310 were above 50 years of age. The results obtained from fitting stratified Cox regression model indicate that the variables of age and surgery are significant. The patients in the age group of below 50 years old have 70% less hazard in comparison with people older than 50 years of age (HR=0.83). Further, the patients receiving surgery have 38% less hazard in comparison with the patients not receiving surgery (HR=0.62). Then we fit Fine-Grey competing risk models. the variable of chemotherapy is significant in both parametric and semi-parametric competing risk models, and its hazard ratio is HR=1.15 and HR=1.14 in the two models, respectively. On the other hand, the variable of age has not become significant in any of the models, and its hazard ratio is HR=0.92 and HR=0.93, respectively. The variable of surgery in the competing risk parametric model is significant with an HR of 0.67. In Cox model, the variable of surgery is also significant with HR=0.62. Moreover, the variable of age in the competing risk parametric model has not become significant (HR=0.92), and in contrast the variable of age in the Cox model is significant (HR=0.83).
Conclusion: The results of this study show that Considering the comparison of the two models, it is observed that regardless of the properties of competing risk data, estimations of hazard ratio and the extent of significance resulting from Cox models are different from those of competing risk models.
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NASSIF, Paulo Afonso Nunes, Osvaldo MALAFAIA, Jurandir Marcondes RIBAS-FILHO, Nicolau Gregori CZECZKO, Rodrigo Ferreira GARCIA, and Bruno Luiz ARIEDE. "WHEN AND WHY OPERATE ELDERLY OBESE." ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 28, suppl 1 (2015): 84–85. http://dx.doi.org/10.1590/s0102-6720201500s100022.
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Introduction : Concurrently with the pandemic obesity is observed global aging phenomenon, with a significant increase of obesity in the elderly population. Aim : To review the indications for bariatric surgery for the elderly, mainly focusing on the morbidity and mortality of procedures. Method : Review of the literature in PubMed/Medline and Scielo focusing on the relationship of risk factors with different techniques of bariatric surgery in the elderly. The following descriptors were crossed in the form of AND/OR: Obesity; Bariatric surgery; Complications; Elderly. Conclusion : In people older than 60 years bariatric procedures represent acceptable and effective treatment option. The elderly should be treated in specialized centers with experience in major surgical procedures and low morbimortality. Going in this way, they experience the benefits of bariatric surgery with acceptable morbidity and mortality. However, age alone should not be considered as an absolute impediment for surgical indication.
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Powell, Alice, Paul Finucane, Martin Jude, Jenna Mewburn, Katherine Mohr, and Stephen Kerr. "007 The impact of demographic changes on the presentation and outcome of stroke: experiences of the oldest old in the murrumbidgee region." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A4.2—A4. http://dx.doi.org/10.1136/jnnp-2018-anzan.7.
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IntroductionDemographic changes are leading to an ageing population with a disproportionate increase in the oldest old. Stroke is a leading cause of death and disability in Australia and is particularly prevalent in the elderly. The Murrumbidgee region has a population profile that is 14 years ahead of national Australia and therefore data from this population portends how stroke may present nationally in the future. Existing research suggests that stroke risk factors, subtype, treatment provided and outcomes differ between younger and older demographic groups. This study seeks to build a profile of the experiences of stroke in the oldest old and compare variables with two younger cohorts to test a number of hypotheses about background, treatment and outcomes.MethodsData was collected retrospectively from the electronic medical records of 100 stroke patients consecutively admitted to the Wagga Wagga Rural Referral Hospital Acute Stroke Unit. They were split into three demographic groups; young old, 65–74 old (75 to 84) and oldest old (85 and older) and comparisons were made of baseline functional status and risk factor profile, stroke type, stroke treatment and outcomes.ResultsOlder people admitted with stroke were more likely to be female with poorer premorbid functional status and higher numbers living in residential care. Atrial fibrillation (p=0.008) and hypertension (p=0.01) were significantly more common with advancing age while rates of smoking (p=0.006) were higher in younger patients. Stroke mechanism was predominantly cardioembolic in older patients and embolic stroke of undetermined source (ESUS) in the youngest group. Stroke severity and stroke treatment did not vary according to age. However, outcomes were poorer with rates of dependency (p=0.03) and residential aged care facility placement (p=0.06) increased among older patients post stroke.ConclusionThese data provide an indication of how stroke may manifest in our ageing population in the future.
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Nakase, Hiroshi, Yuki Hayashi, Daisuke Hirayama, Takayuki Matsumoto, Minoru Matsuura, Hideki Iijima, Katsuyoshi Matsuoka, et al. "Interim analysis of a multicenter registry study of COVID-19 patients with inflammatory bowel disease in Japan (J-COSMOS)." Journal of Gastroenterology 57, no. 3 (January 28, 2022): 174–84. http://dx.doi.org/10.1007/s00535-022-01851-1.
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Abstract Background The spread of coronavirus disease 2019 (COVID-19) had a major impact on the health of people worldwide. The clinical background and clinical course of inflammatory bowel disease (IBD) among Japanese patients with COVID-19 remains unclear. Methods This study is an observational cohort of Japanese IBD patients diagnosed with COVID-19. Data on age, sex, IBD (classification, treatment, and activity), COVID-19 symptoms and severity, and treatment of COVID-19 were analyzed. Results From 72 participating facilities in Japan, 187 patients were registered from June 2020 to October 2021. The estimated incidence of COVID19 in Japanese IBD patients was 0.61%. The majority of IBD patients with COVID-19 (73%) were in clinical remission. According to the WHO classification regarding COVID-19 severity, 93% (172/184) of IBD patients had non-severe episodes, while 7% (12/184) were severe cases including serious conditions. 90.9% (165/187) of IBD patients with COVID-19 had no change in IBD disease activity. A logistic regression analysis stepwise method revealed that older age, higher body mass index (BMI), and steroid use were independent risk factors for COVID-19 severity. Six of nine patients who had COVID-19 after vaccination were receiving anti-tumor necrosis factor (TNF)-α antibodies. Conclusion Age, BMI and steroid use were associated with COVID-19 severity in Japanese IBD patients.