ObjectiveTo systematically review the correlation between sleep quality and social support of the elderly.MethodsDatabases including PubMed, MEDLINE, The Cochrane Library, Springerlink, ProQuest, CMB, CNKI, VIP, and WanFang Data were searched to collect studies on the correlation between sleep quality and social support of the elderly from January 1996 to January 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 9 studies involving 2 427 elderly people were included. The meta-analysis showed that the combined correlation coefficient between sleep quality and social support was -0.40 (95%CI ?0.54 to ?0.26). The correlation between sleep quality and social support of the elderly varied with the year of publication and sample size, however without regular change. The correlation coefficient of the elderly from institutions (hospital or pension institutions) was higher than that of the community (?0.33 vs. ?0.26); the correlation coefficient of the elderly with health problems was higher than those without health problems (?0.32 vs. ?0.25); the results measured by non-random sampling method were higher than those measured by random sampling (?0.37 vs. ?0.23); and the results measured by Pittsburgh sleep quality index (PSQI) and social support rating scale (SSRS) were higher than those measured by PSQI and perceived social support scale (PSSS) (?0.30 vs. ?0.13).ConclusionsThe higher the level of social support of the elderly in China, the lower the score of PSQI, and the better the sleep quality, in which there are differences in different sample sources and physical conditions.
Frailty is a syndrome characterized by vulnerability to stressors due to loss of physiological reserve. In recent years, many researches have confirmed that frailty is a risk factor for postoperative complications of cardiac surgery, such as readmission, adverse cardiovascular events, and death in elderly patients. This paper reviews the concept of frailty, the relationship between frailty and cardiac surgery, the frailty assessment and intervention strategy in perioperative period, aimed at providing decision making basis for the risk stratification and perioperative management of cardiac surgery in elderly patients.
Objective To summarize the tumor characteristics and the research progress in diagnosis and treatment of elderly patients with breast cancer. Methods To combine the literature review and clinical guidelines, to introduce tumor characteristics, the advance of diagnosis and therapy and expert consensus in elderly breast cancer. Results Compared to the patients in other age group, the elderly patients with breast cancer have special physiological and psychoical characteristics, meanwhile aged patients frequently together with basic disease, the strategy of clinical diagnosis and treatment and prognosis are very different from young and middle-aged patients. Conclusion For the elderly patients with breast cancer, we should formulate the corresponding treatment plan on the premise of the comprehensive evaluation of patients’ life expectancy, with the disease, the degree of benefit, treatment tolerance and other factors.
ObjectiveTo evaluate the conditions of activity of daily living (ADL) and influence factors of ADL of hospitalized elderly (≥60 years old) patients. MethodsA cross-sectional study was conducted to investigate the health and ADL conditions of hospitalized elderly patients in the geriatric department of a tertiary hospital in Chongqing by ADL scale. The influence factors of ADL were analysed by using logistic regression analysis. ResultsA total of 375 hospitalized elderly patients were included. The ADL impairment rate of female was 59.60% (93/156), the one of male was 75.90% (166/219), and there was significant difference between different sex (χ2=11.169, P=0.001). The impairment rate by age were 95.40% at 60 to 69 years old, 91.40% at 70 to 79 years old, 87.20% at 80 to 89 years old, and 98.55% at above 90 years old, respectively; there was significant difference among different age groups (χ2=8.575, P=0.036). The result of logistic regression analysis showed that age was the individual risk factor of ADL (OR=0.188, 95%CI 0.085 to 0.416, P=0.000). The difficulty of walking up and down stairs occupied the highest proportion (68.80%) in 10 items of ADL scale. ConclusionHospitalized elderly patients should be equipped with specialized paramedics to minimize the difficulties of ADL, in order to improve their quality of life.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
ObjectivesTo investigate and analyze the activities of daily living status and influencing factors for the elderly of long-term care in Shangrao City of Jiangxi Province, and provide a basis for Shangrao City to carry out long-term care insurance for the elderly. MethodsCluster sampling was used to investigate the elderly aged 60 and over in 12 counties (cities, districts)of Shangrao, including the elderly general demographic characteristics and activity of daily living survey. ResultsA total of 1 087 elderly people were surveyed, with an average age of 77.75±8.12 and a total 70.6±21.4 score of activity of daily living. Comparing different age groups, the elder age group had a worse activity of daily living (P<0.001). Those with a higher education level had relatively poor activity of daily living (P<0.001), and those with spouse also had poor activity of daily living (P<0.05). Multiple linear regression analysis showed that age (P<0.001), education level (P<0.001), marital status (P<0.05) and income level (P<0.05) were important factors affecting the scores of activity of daily living of the elderly. ConclusionsAge, education level, marital status, low-income situation, chronic disease, and household registration are the main risk factors affecting the score of the long-term care of the elderly in daily life. The establishment of a long-term care insurance system should be based on chronic diseases, age, marital status and other factors to determine the corresponding long-term care standard scoring system and compensation standards.
Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantlyimproved (2.5±1.8 cm2 vs. 5.6±1.0 cm2, P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P＜0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.
Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
Senile sarcopenia has become a prominent problem affecting the normal life and self-care ability of the elderly. More attention to the research on senile sarcopenia is conducive to its prevention and treatment. This article states information details about the epidemiology, influencing factors and mechanism, clinical manifestations and diagnostic criteria, evaluation methods and rehabilitation therapy, so as to provide reference for research on elderly sarcopenia.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.