Personalized surgical management of colorectal cancer in elderly population

Colorectal cancer(CRC)in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population.In this phase of the life cycle,treatment is frequently suboptimal.Despite the fact that,nowadays,older people tend to be healthier than in previous generations,surgical undertreatment is frequently encountered.On the other hand,surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability.Unfortunately,due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors(heterogeneity,frailty,etc.),there is a dearth of evidence-based clinical guidelines for the management of these patients.The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly.More than in any other patient group,both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC.Although cure and sphincter preservation are the primary goals,many other variables need to be taken into account,such as maintenance of cognitive status,independence,life expectancy and quality of life.

COVID-19 and the Vascular Elderly Subject: Illustration of Therapeutic Management with Corticosteroids in an Elderly Diabetic Patient with COVID-19

Introduction: The severity of Sars-Cov-2 infection is associated with the development of acute respiratory distress syndrome (ARDS). The progression to ARDS appears to be driven by a major inflammatory mechanism potentially sensitive to corticosteroids. Observation: This article describes the case of an elderly patient was admitted to emergency departments for intense asthenia, accompanied by motor diarrhoea, dyspnoea with desaturation in ambient air, in a context of strong suspicion of infection linked to COVID-19. The article also reviews the existing literature on the diagnosis and treatment of this severe form of the disease. Conclusion: Corticosteroids, and in particular dexamethasone, have been shown to be effective in the management of patients with COVID-19, an oxygen-releasing disease.

Personal Space of Small Mobile Robot Moving towards Standing or Sitting Elderly Individuals

Recently, Japan has experienced a low birthrate and an aging population. The development of communication robots, such as cleaning and a care-giver robot, has been progressing. Care-giver robots provide daily assistance, including contacting emergency services. This study is part of the ＂study on planning techniques of living space in harmony with robots＂, and focused on the elderly. Minimum distance was the subjects felt ＂I do not want any more approached＂. Subjects were 21 elderly persons （eight males and thirteen females）, aged 66-86 years. The experimental room was an assembly room in a public accommodation （14 m× 6.5 m）. The small mobile robot used in this experiment was external form dimensions of 120 mm （W）× 130 mm （D）× 70 mm （H）, In this experiment, considering the personal space as the small mobile robot is watching robot without support function for person. The robot moved toward standing or sitting subjects at constant velocities from a distance 5 m apart. Research factors are 5 angles （0°, 45°, 90°, 135° and 180°） and 2 speeds （0.08 m/s and 0.24 m/s）.

Epidemiological investigation of Helicobacter pylori infection in elderly people in Beijing

BACKGROUND The Helicobacter pylori(H.pylori)infection rate in China is approximately 50%.H.pylori is a pathogenic factor of peptic ulcer and chronic gastritis.In addition,H.pylori infection may also be associated with a variety of cardiovascular diseases in elderly people,such as arteriosclerosis,coronary heart disease,and cerebral infarction,having deleterious effect on their health.With the aging of the population,the disease characteristics of the elderly population have been increasingly valued by the whole society.We conducted an epidemiological survey of H.pylori infection among elderly people in Beijing to provide a basis for health management of H.pylori infection.AIM To understand the epidemiological characteristics of H.pylori infection in elderly people in Beijing.METHODS A total of 1090 elderly people aged more than 60 years from different parts of Beijing(urban and rural areas)were selected using the random cluster sampling method.Structured questionnaires were completed during home visits and the 13C-urea breath test was conducted for H.pylori detection.RESULTS The prevalence of H.pylori infection was 46.5%(507/1090).The infection rate in men was 51.8%,which was significantly higher than that in women(42.5%;P<0.05).The H.pylori infection rate in illiterate people was significantly higher than that in literate persons(53.5%vs 44.8%,P<0.05).The total infection rate of H.pylori gradually increased with age and the difference was statistically significant(P<0.01).The H.pylori infection rate in smokers was significantly higher than that in non-smokers and those who had quit smoking(P<0.05).CONCLUSION The prevalence of H.pylori infection among elderly people is 46.5%and the infection rate gradually increases with age.Sex,education level,age,and smoking were determined to be H.pylori infection risk factors.The relationship of H.pylori infection with region,occupation,drinking,and diet structure needs to be further studied.

Endoscopic submucosal dissection in early gastric cancer in elderly patients and comorbid conditions

The prognosis of early gastric cancer(EGC) is good if there is no concomitant lymph node metastasis. Therefore, the early detection of EGC is important to improve the prognosis of patients with gastric cancer. In Japan, 40% to 50% of all gastric cancers are EGC, and endoscopic submucosal dissection(ESD) is widely accepted as a local treatment for these lesions, particularly for large lesions that at one time were an indication for gastrectomy because of the difficulty of en-bloc resection. Consequently, this procedure can preserve the entire stomach and the patient's postoperative quality of life. ESD has become a general technique with improved procedures and devices, and has become the preferred treatment for EGC rather than gastrectomy. Therefore, ESD may demonstrate many advantages in patients who have several comorbidities, particularly elderly population, patients taking antithrombotic agents, or patients with chronic kidney disease, or liver cirrhosis. However, it is not yet clear whether patients with both EGC and comorbidities are feasible candidates for ESD and whether they would consequently be able to achieve a survival benefit after ESD. In this review, we discuss the clinical problems of ESD in patients with EGC and those comorbid conditions.

Exploration on China's Institution-oriented Elderly Care Service System Based on Human Factors Engineering

Objective Aging process in China has brought more and more challenges to traditional home-based care for the aged and more attentions to the mode of institution-oriented elderly care.This work,by analyzing the problems and defects of institution engaging in elderly care based on the human factors engineering theory,discusses the people-centered institution-oriented elderly care service system,in terms of the problems that the pattern of institution-oriented elderly care focuses more on the facilities and environment construction than the principal role of people in the elderly care service system.Methods Sampled the institutions engaging in elderly care in Hefei City,Anhui Province,P.R.China(a medium-sized city in China);surveyed 45 institutions engaging in elderly care and 828 registered elders in Hefei City by hierarchical and systematic sampling method.Results(1)institutions engaging in elderly care shared the occupancy rate of 49.6%and low total service efficiency;(2)institutions engaging in elderly care offered 100%life-oriented service items,but only 6.1%personalized service items provided;(3)100%simple housing facilities in elderly care institutions,but extremely less personalized service facility(3.2%),with poorer quality and less satisfaction;(4)insufficient professional service staff could be available;48.1%institutions have 5 or less professional service staffs.Conclusion A countermeasure to improve the elderly care service system was raised here by aiming at improving the institution-oriented elderly care service:(1)to transfer service toward the people-oriented concept,formulating preferential policy for endowment insurance;(2)to pay attention to personalized design of service facility,offer personalized and featured service items,and improve service management level;(3)to build professional team for elderly care.

Prevaccination Antibody Confers Additional Immune Responses to Repeated Yearly Influenza Vaccination in an Elderly Population

Annual vaccination is necessary to maintain humoral immunity in the elderly population. However, the factors influencing the response to influenza vaccination have not been completely identified. The aim of this study was to explore the factors that influenced antibody responses to repeated vaccination using measures that were both objective and quantitative. A total of 111 volunteers aged > 61 years were vaccinated subcutaneously with one dose of influenza vaccine from the 2005-2006 season through the 2009-2010 season. The factors that influenced antibody responses after vaccination were evaluated. The seroprotection rates (PRs) were significantly higher in responders (subjects with a higher antibody titer in the 2005-2006 season) than in nonresponders only in the 2006-2007 and 2007-2008 seasons. PRs after vaccination were significantly higher in seropositive individuals (subjects with a higher prevaccination antibody titer in the 2006-2007 season) than in seronegative individuals for all three virus strains in almost all of the 5 years. Age, gender, and vaccination in the 2004-2005 season did not influence the response. These results suggest that an immune response at a certain time point would predict immune responses only in the near future. However, prevaccination antibody titer in the following season is the ideal predictor for future responses that last over several influenza seasons.

Appropriate prescribing in the elderly: Current perspectives

Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.

Relationship between Walking Speed and Exercise Habits of Elderly People

Japan becomes the super aged society. For Japan, the proportion of elderly people aged 65 and over is 27.3%. The Ministry of Health, Labor and Welfare estimates that in 2060, the proportion of the elderly people aged 75 or older to the total population will exceed 26.9%. Japan has nursing problems in a rapidly aging society. Therefore, the long-term care insurance system is being reviewed. The state, prefectures, and local governments are carrying out various campaigns from the perspective of long-term care prevention. One of them is fall prevention. Falling of the elderly often causes bedridden and death. Therefore, in this study, in order to examine the influence of exercise habits of the elderly on gait, the results of questionnaire survey and actual 10 m walking speed were obtained for elderly people who participated in the health class. As a result, walking speed was fast for people with exercise habits. As for exercise, walking speed was faster for those who continued with exercise such as walking than for those who did muscle training. By continuing the light exercise like walking, it might be possible to maintain the muscles of the lower limbs and cultivate a sense of balance or lead to the fall prevention of the elderly.

Multiple Vulnerabilities of the Elderly People in Indonesia： Ethical Considerations

A closer look to the state of affairs of the elderly in Indonesia has disclosed the fact that the Indonesian elderly facing what this paper is coined as ＂multiple vulnerabilities.＂ On the one hand, Indonesian demographic is showing that the Indonesian people are getting old. The fertility rate has significantly decreased since 1970 when the total fertility rate decreases from 5.0 to 2.1 in 2025. This alone gives rise to various problems of the elderly, among whom are the dependency ratio, aging index, potential support ratio, and the feminization of aging. These problems show the level of vulnerability of the Indonesian elderly. From the perspective of the dependency ratio, for example, the number of people under the age of 15 and above 65 who depend on the labor force （15-64 years） has increased since 1970, from 7.0 to 29.0 in 2050. Again, this shows the high level of vulnerability of Indonesian elderly given that the dependency ratio itself has influenced on health care, living arrangements and family support, and so on. Aside from that, the economic burden will be very visible in the workforce. On the other hand, the policies on the elderly are still far from maximum realization. Law on the Welfare of the Elderly （13/1998） has recommended that every hospital must have geriatrics and gerontology section, yet only 8 hospitals fulfill the requirement. The situation is worsened due to the lack of adequate medical staff at the health center, which can serve elderly patients in a professional and humane way. Again, this brings forth the other side of the state of the elderly in Indonesia, which indicates the high level of their vulnerability. In this paper I will analyze the state of vulnerability of the elderly people in Indonesia from the perspective of ethics of vulnerability and personalism. I consider these two approaches as representing all ethical discussion about the ethical treatment of the elderly due to their characters of valuing the elderly as persons with dignity. Thus, this paper will show that the elderly in Indonesia is in danger of not being treated humanely.

“Care That Respects Individuality” Provided to Elderly People with Dementia as Perceived by Japanese Dementia Carers Qualified

The objective of this study was to clarify the contents of “care that respects individuality” provided to elderly people with dementia living in group homes as perceived by dementia carers qualified. We interviewed 21 dementia carers qualified working at group homes in Prefecture A about the practical contents of and their thoughts on “care that respects individuality”. The data obtained from the interviews were analyzed using the modified grounded theory approach (M-GTA). As a result, 14 concepts regarding the contents of “care that respects individuality” provided to elderly people with dementia living in group homes as perceived by dementia carers qualified were generated in the following 4 categories: “placing emphasis on the individual”, “respecting feelings”, “eliciting strengths”, and “close mutual relationship”.

Changes in the Amount of Ingestion Nutrients in Meals before and after Ingesting High Caloric-Tofu—For Elderly People

As Katayama et al. reported in the past, it has been shown with a 50-70% probability that increases in skeletal muscle rate and decreases in body fat rate will occur in elderly people by taking high caloric-tofu for two months. Participants measured body composition before and after the experiment, and the results were statistically processed to confirm significant differences. Therefore, we decided to clarify how the amount of nutrient intake changed before and after taking high caloric-tofu for two months. The participants self-reported a 3-day meal record before entering the experiment. Similarly, participants performed a self-administered meal intake record for 3 days before the end of the high caloric-tofu intake two months. Food intake recording was performed using nutrition calculation software, and the results were recorded. The nutrition calculation software used the Excel eiyou-kun version 8 manufactured by Kenpaku. The calculated nutrients were 13 items: energy, protein, lipid, carbohydrate, dietary-fiber, calcium, iron, equivalent of retinol, vitamin D, vitamin B1, vitamin B2, vitamin C, equivalent of salt. As a result of statistically processing the nutrition of the participants, in both groups (effective group and not effective group) lipid intake increased with statistical significance. However, protein intake did not differ statistically. In the future, it will be necessary to conduct more detailed interviews with many participants.

Comparison of Body Composition Two Months after High Caloric-Tofu Intake and Body Composition Six Months after the Experiment—In the Case of Elderly People

Japan becomes the super aged society. It is expected from now on that the population of the elderly person increases more and more. Therefore, disease prevention such as sarcopenia and frailty in the elderly person is required. This study tried the improvement of meal contents by taking in soy protein using caloric-tofu in daily life. The ten elderly people (one man, 9 women: from age 55 years old to 83 years old) who submitted the written consent of the subject participated in this study. We performed the gene analysis (β3AR, UCP1,β2AR) of the subject. The subject lived a normal life every day. The subject had eaten two high caloric-tofu a day. A caloric-tofu has 100 kcal. The subject participated in a study for two months. As for the subject, body composition was measured on the first day and two months after the start of the experiment, and six months after the end of the experiment. As a result, skeletal muscle rates of five people increased slightly, and body fat rate decreased slightly. However, five people changed into neither the skeletal muscle rate nor the body fat rate. Six months after the end of the experiment, the pair composition results were kept almost the same as at the end of the experiment. It can be highly appreciated that in the effective group, the pair composition could be maintained in a better condition than at the beginning of the experiment. For elderly people, the effective group, it is significant that intake of high caloric-tofu is effective in increasing the rate of skeletal muscle, and the effect is maintained even after half a year.

Factors associated with activities of daily living among the disabled elders with stroke

Objective:To determine the factors associated with activities of daily living(ADL)among the disabled elders post-stroke.Methods:A total of 158 patients were chosen from community health service stations in eighteen regions of Tianjin city by convenience sampling from March to November in 2013.The Barthel Index(BI)and the short-formmini-nutritional assessment(MNA-SF)were used to evaluate the ADL,the nutritional status respectively.Statistical analysis was performed using independent sample t-test,one-way ANOVA,Pearson correlation and multiple linear regression analysis.Barthel ADL index was the main outcome.Results:The mean score of ADL was 50.50±27.125.The multiple linear regression showed that the factors which had significant impact on ADL were stroke frequency,types of stroke,nutritional status,financial status,and age.Conclusions:Disabled elders with recurrent strokes,hemorrhagic stroke,dependent financial resources,older age,worse nutritional status and living with family had poorer strokerelated outcome.Healthcare providers can discover the high-risk groups of disability and implement individualized preventive interventions in accordance with the related factors.

不同心理类型中老年婚恋特点的个案研究

使用荣格心理类型和自性化理论,对极端思维型、典型感觉型中老年婚恋心理和行为进行个案分析,对四种心理类型个体的婚恋行为和情感特征进行童年情结的根源探索,指出实现中老年婚恋和心理健康的道路是发展其他心理机能尤其是对立面心理机能的情绪和行为,通过走出个人情结、避免偏激、发展复合型人格,最终实现自性化圆满和身心健康。

个性化健康教育干预对原发性闭角型青光眼患者睡眠质量的影响

目的:分析个性化健康教育干预的价值,与该护理模式在改善原发性闭角型青光眼患者睡眠质量中的优势。方法:选取2022年1月至2023年12月山东大学齐鲁医院收治的原发性闭角型青光眼患者80例作为研究对象,按照随机数字表法分为对照组和观察组,每组40例。对照组仅实施常规护理,观察组实施常规护理配合个性化健康教育干预。评价患者疾病认知情况、患者睡眠质量水平。结果:干预后,与对照组相较,观察组患者自拟原发性闭角型青光眼的基本知识了解程度调查量表评分更高,差异有统计学意义(P<0.05),且患者匹兹堡睡眠指数量表(PSQI)评分更低,差异有统计学意义(P<0.05)。结论:个性化健康教育干预利于促进原发性闭角型青光眼患者对于疾病知识的理解,并协助患者获得理想的睡眠质量改善水平。

24周太极拳锻炼对中老年人静态平衡功能的影响

目的:探讨24周太极拳锻炼对中老年人静态平衡机能的影响。方法:24周简化太极拳和42式太极拳锻炼(每周锻炼4次,每次60分钟)前后,55～65岁中老年人70名分别在双足睁眼、闭眼,单足睁眼、闭眼状态下,采用WIN-POD平衡功能检测系统测试重心动摇总轨迹长(TL)、外周面积(Area)、前后方向和左右方向的动摇指数,其中,双足状态下测试时间为30s,单足状态下测试时间为10 s。结果:24周太极拳锻炼后,(1)双足测试状态下,男性受试者睁眼TL、Area、X轴动摇速度(X speed)、X轴平均摆幅(X dev.)、Y轴平均摆幅(Y dev.)较实验前显著降低(P<0.05);闭眼TL、Area、重心平均动摇速度(Avg.v)显著低于实验前(P<0.05)。女性睁眼Y轴动摇速度(Y speed)显著低于实验前(P<0.05);(2)单足测试条件下,男性受试者睁眼TL、Avg.v、X speed显著低于实验前(P<0.05,P<0.01)。女性受试者睁眼Area、X dev.、Y dev.显著降低(P<0.05,P<0.01);闭眼单位面积轨迹长(L/A)显著高于实验前(P<0.05)、Y dev.显著低于实验前(P<0.05)。结论:24周太极拳锻炼对中老年人静态平衡机能有积极影响。

某社区老年人冬季PM2.5和CO及O_3暴露水平评价

目的评价北京市某社区老年人冬季 PM2.5、CO 和 O_3三种污染物的暴露水平。方法于2007年11月28日-2008年1月17日,采用 PM2.5、CO 和 O_3个体采样器,对北京某社区老年人的10处主要活动场所(室内地点:居室、厨房、医院、菜市场、超市;室外地点:社区内室外、社区小花园、社区操场、交通要道旁、街边公园)进行污染物浓度监测,并采用活动日志收集该社区30名老年人的24 h 活动模式,对老年人 PM2.5、CO 和 O_3的24 h 个体平均暴露浓度进行计算和评价。结果老年人 PM2.5、CO 和 O_3的24 h 个体平均暴露浓度分别为(146.54±6.60)μg/m^3,(2.67±0.18)mg/m^3和(32.30±2.79)μg/m^3;不同性别老年人 CO 24 h 个体平均暴露浓度差异有统计学意义(P<0.05),而 PM2.5和 O_3 24 h 个体平均暴露浓度差异无统计学意义(P>0.05)。结论该社区老年人冬季 PM2.5的24 h 个体平均暴露浓度较高,而 CO 和 O_3的24 h个体平均暴露浓度较低,提示大气 PM2.5可能是冬季影响该社区老年人健康的主要污染物。

健身气功五禽戏对中老年人心血管功能的影响效果研究

【目的】通过对中老年人进行较长时间健身气功五禽戏锻炼的前后心血管机能的测试并评定其影响效果,为健身气功五禽戏运用于提高中老年人的心血管功能提供有益的参考。【方法】将84例中老年人随机分成实验组(进行五禽戏功法练习)和对照组(不进行五禽戏功法练习,保持平时生活习惯)各42例。采用XXG-D型心血管功能测试仪对2组中老年人进行定量负荷的五禽戏练习前后心血管功能指标的检测。【结果】实验组通过五禽戏练习能使中老年人心泵力代偿性增高,心肌收缩力增强,搏血量增多;能有效地改善血管的弹性状况,增加血容量,改善血液的浓度和流动速度(与练习前比,均P<0.05)。而对照组练习后各项心血管功能、血液状态和微循环机能指标均无显著变化,差异均无统计学意义(与练习前比,均P>0.05)。练习后2组比较多数指标差异有统计学意义(P<0.05)。【结论】五禽戏对于改善中老年人的心血管功能有着积极意义。

老年人心理健康与人格因素的相关性研究

目的 探讨老年人心理健康与其人格特质的相关性。方法 以 110名老年大学老人为研究对象 ,用症状自评量表(SCL 90 )、艾森克人格问卷、特质应对方式问卷为研究工具进行测验调查。结果 老年大学老人SCL 90的总分、总均分、阳性数目、阳性均分、躯体化、强迫、人际关系敏感、抑郁、焦虑、恐怖、敌对、偏执、精神病性等各项得分均与艾森克人格问卷的N分 (神经质维度 )显著相关 ;回归分析表明N分是影响SCL 90分数的主要人格因素。消极应对 (NC)与SCL 90总分、总均分、阳性数目及因子分敏感、抑郁、偏执、其他显著相关。结论 老年人的心理健康水平与人格的情绪稳定性维度、消极应对方式显著相关。