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Influence of fall related factors and bone strength on fracture risk in the frail elderly.

INTRODUCTION: When subjects are selected on the basis of fall risk alone, therapies for osteoporosis have not been effective. In a prospecti … rment and better balance as significant independent risk factors for fracture. CONCLUSIONS: In the frail elderly, both skeletal fragility and fall risk including the frequency of exposure to falls are important determinants of fracture risk.

Minimal preparation CT for the diagnosis of suspected colorectal cancer in the frail and elderly patient.

Colorectal cancer is a common malignancy with an increased incidence in the elderly population. Traditional methods of evaluating this disease have included double contrast barium enema and colonoscopy. Unfortunately, in the frail and elderly patient, these investigations can be difficult to perform and are often not tolerated. Minimal preparation computed tomography (MPCT) of the colon has been suggested as an alternative in this patient population. In this technique, no bowel preparation is used apart from the administration of oral contrast medium. The patient is imaged only in the supine p

The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.

Elderly participants experiencing difficulty in chair rising and with a maximum knee-extensor torque below 87.5 N . m were randomized to different versions of a strength-training program for the knee-extensors: to a high-guidance group (HG; two group sessions supervised by a physical therapist and one unsupervised home session per week, n = 17), a medium-guidance group (MG; one supervised group session and two unsupervised home sessions per week, n = 16), or a control group (C; no exercise, n = 16). Maximal isometric knee strength increased more in HG than in C (p = .03) and with increasing gu

Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population.

OBJECTIVES: To determine patterns of within-day orthostatic blood pressure (BP) changes and clinical factors correlated with them in frail, elderly nursing home residents. DESIGN: Prevalence study of orthostatic BP change. SETTING: Sample of 45 nursing homes. PARTICIPANTS: A total of 911 long-stay residents, aged 60 years or older, able to stand for at least 1 minute. MAIN OUTCOME MEASURES: Supine and 1-minute and 3-minute standing BP measurements and heart rates, taken by a random-zero sphygmomanometer before and after breakfast and before and after lunch, symptoms upon standing, medicati

Surgical management of benign prostatic hyperplasia in elderly and frail patients: a narrative review.

PURPOSE OF REVIEW: The aim of this review was to evaluate the outcomes of the various surgical techniques available today, focusing on their applicability to frail and/or elderly patients. RECENT FINDINGS: Transurethral resection of prostate (TURP) allowed a reduction of hemorrhagic complications compared to open simple prostatectomy. However, laser surgery show the best safety profile among the standards techniques. Importantly, most of studies demonstrate no difference in efficacy of LUTS management in frail or elderly population compared to younger patients. Recently, mini invasive surgica

Monoclonal gammopathy of renal significance presenting as cryoglobulinaemic vasculitis in a frail elderly patient.

We report the case of a woman in her late 70s with frailty and treatment-resistant hypertension who presented with marked albuminuria, purpuric rash and elevated serum free light chains. Renal biopsy confirmed monoclonal gammopathy of renal significance (MGRS) with Type I cryoglobulinaemia. She was treated with bortezomib and dexamethasone, resulting in clinical and biochemical remission. However, she experienced a relapse within months, requiring re-initiation of therapy with additional agents. Despite supportive measures, she later developed complications of infection and fluid overload, whi

Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients.

Multiple myeloma (MM) mostly affects elderly patients, which represent a highly heterogeneous population. Indeed, comorbidities, frailty status and functional reserve may vary considerably among patients with similar chronological age. For this reason, the choice of treatment goals and intensity is particularly challenging in elderly patients, and it requires a multidimensional evaluation of the patients and the disease. In recent years, different tools to detect patient frailty have been developed, and the International Myeloma Working Group frailty score currently represents the gold standar

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… This review provides an overview of available strategies to assess patient frailty and of treatment management options for intermediate-fit and frail elderly patients. 2. Frailty: Definition and Assessment in MM Patients 2.1. …

Fragility fractures of the ankle in the frail elderly patient: treatment with a long calcaneotalotibial nail.

Conventional methods of treating ankle fractures in the elderly are associated with high rates of complication. We describe the results of treating these injuries in 48 frail elderly patients with a long calcaneotalotibial nail. The mean age of the group was 82 years (61 to 96) and 41 (85%) were women. All were frail, with multiple medical comorbidities and their mean American Society of Anaesthesiologists score was 3 (3 to 4). None could walk independently before their operation. All the fractures were displaced and unstable; the majority (94%, 45 of 48) were low-energy injuries and 40% (19 o…

Factors associated with the utilization and costs of health and social services in frail elderly patients.

BACKGROUND: Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. METHODS: Hierarchical analysis was applied to estimate the effects of patient …

Percutaneous Treatment of Multivalvular Disease Including Refractory Tricuspid Regurgitation in a Frail Elderly Patient.

BACKGROUND: This clinical vignette highlights the feasibility of a comprehensive transcatheter strategy for managing advanced multivalvular heart disease in a frail elderly patient. CASE SUMMARY: A 79-year-old woman with prior surgical aortic valve replacement, chronic atrial fibrillation, and multiple comorbidities presented with worsening heart failure. Physical examination demonstrated anasarca with signs of left and right heart failure. An echocardiogram demonstrated severe stenosis of a prior bioprosthetic aortic valve, with a valve area of 0.64 cm2, functional mitral regurgitation, and …

Up-Front Treatment of Elderly (Age ≥75 Years) and Frail Patients With Multiple Myeloma.

Older patients with multiple myeloma (MM) exhibit wide heterogeneity in their baseline physiologic and functional status, which demands an individualized treatment approach based on biological rather than chronological age. Various frailty scores have been developed for older patients with MM, but they are underutilized in clinical trials and in practice. Older patients with MM are underrepresented in therapeutic clinical trials, and treatment recommendations are currently derived from clinical trials of transplant-ineligible patients. This article provides a summary of phase II and III clinic

[Frail elderly women following traffic accident: a specific approach to the trauma care chain].

Three octogenarian women suffered severe blunt trauma because of a car crash. The first patient was 81 years old. She had an instable dens fracture, multiple rib fractures, a haematopneumothorax and multiple extremity fractures. The second patient was 82 years old and was diagnosed with a flail chest because of multiple rib fractures, pelvic fractures, and thoracic spine fractures. Before the crash, she already needed help for her daily functioning. The third patient, 84 years old, developed a bradycardia at the site of the crash. In the hospital she was diagnosed with multiple rib fractures,

Comparison of maximum bite force and dentate status between healthy and frail elderly persons.

The purpose of the present study was to (1) determine the standard value of maximum bite force and to (2) compare the maximum bite force of the elderly between healthy and frail subjects. Subjects included 349 healthy elderly individuals (149 males, 200 females) and 24 frail elderly individuals (seven males, 17 females) ranging from 65 to 74 years of age. Maximum bite force was evaluated using a Dental Prescale system. The maximum bite force of the healthy subjects was significantly higher than that of the frail subjects in both males (P=0.020) and females (P=0.015). However, no significant di…

Total extra-peritoneal approach to radical cystectomy with ureterostomy: A novel technique for the elderly and frail.

OBJECTIVES: Radical cystectomy with urinary diversion is the gold standard treatment for bladder cancer (high-risk/muscle invasive). The transperitoneal approach is associated with significant gastrointestinal complications like ileus. In the elderly and frail with a single functional kidney, we describe an extraperitoneal technique of radical cystectomy, with a ureterostomy, to be performed without general anesthesia. MATERIALS AND METHODS: The elderly, frail, and high-risk candidates for general anesthesia, with a prior history of nephroureterectomy with a second primary muscle-invasive bla

Feeding Support Team for Frail, Disabled, or Elderly People during the Early Phase of a Disaster.

Japan was struck by two catastrophic disasters on March 11, 2011 and on April 16, 2016. The former was the Great East Japan Earthquake (M9.0) and the latter was the Kumamoto Earthquake (M7.0). Most inhabitants in the affected areas of both disasters were forced to live in evacuation centers right after the earthquake. Poor oral hygiene, inactivity, malnourishment, appetite loss, eating problems, and swallowing problems due to lack of support for frail, disabled, or elderly evacuees occur during the early phases after a disaster. Disaster-related sequelae, such as pneumonia and disuse syndrome,

The association between subjectively impaired sleep and symptoms of depression and anxiety in a frail elderly population.

BACKGROUND: Most previous studies showed an association between sleep impairment in the elderly and symptoms of depression and anxiety. Majority of these studies were conducted in "strong", community-dwelling elderly. AIM: To assess the association between subjective sleep impairment and its affective disturbances among frail elderly patients. METHODS: The retrospective study included patients 65 years old and above. Data included socio-demographic characteristics, the mini-mental state examination, the short anxiety screening test, the 15-item Geriatric Depression Scale, and the Patient Hea…

New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review.

INTRODUCTION: Life expectancy is constantly increasing and as a consequence older men, frequently with multiple comorbidities, are seeking treatment for benign prostatic hyperplasia. Given their frail health, these men need extreme attention in their management, as efficacious and safe treatment strategies in the general population may not be adequate for them. EVIDENCE ACQUISITION: The National Library of Medicine Database was searched for relevant articles published between 2006 and 2015. Each article's title, abstract and text were reviewed for their appropriateness and their relevance. 57

Intermittent oroesophageal vs. nasogastric tube feeding in frail elderly with dysphagia: a retrospective comparative study.

BACKGROUND: Dysphagia affects 15%-20% of community elderly, 50%-75 % of nursing-home and >80 % of hospitalized patients; 60 % cases stem from neurologic disease. We compared intermittent oro-esophageal (IOE) vs. nasogastric tube (NGT) feeding in 120 frail dysphagic elders (Jun-Dec 2024). METHODS: The sample size was calculated based on the expected prevalence of aspiration pneumonia (25 vs. 8%), with 60 participants enrolled per group. Frail elderly patients with dysphagia were randomly allocated to the intermittent oro-esophageal or nasogastric tube group using a random number table. Statist…