Safety and outcomes of cochlear implantation in the elderly:A review of recent literature

Global demographic changes related to longevity are leading to increasing numbers of the elderly, for whom hearing loss is a significant cause of morbidity and disability. Once met with reticence, severely hearing impaired older adults are increasingly being considered for cochlear implantation (CI). Significant data indicate that CI in the elderly population is safe, well-tolerated, and effective. Risks from CI surgery and anesthesia are low and generally comparable to rates in other age groups. Outcomes studies regarding CI in older adults have shown excellent improvements to speech perception, quality of life, and even cognition. Overall, currently available data suggests that advanced age should not, in itself, be considered a barrier to implantation. This review paper will highlight selected articles from recent medical literature regarding the safety and efficacy of CI in the elderly population. Copyright ? 2016, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？

Objective To evaluate whether cardiac resynchronisation therapy （CRT） implantation was feasible and safe in octogenarians and the asso- ciation with symptoms. Methods Consecutive patients undergoing CRT implantation were recruited from two UK centers. Patients grouped according to age： 〈 80 ＆ ≥ 80 years. Baseline demographics, complications and outcomes were compared between those groups. Results A total of 439 patients were included in this study, of whom 26% were aged ≥ 80 years. Octogenarians more often received cardiac resynchronization therapy pacemaker in comparison to cardiac resynchronisation therapy-defibrillator. Upgrade from pacemaker was common in both groups （16% 〈 80 years vs. 22% ≥ 80 years, P = NS）. Co-morbidities were similarly common in both groups （overall diabetes： 25%, atrial fibrillation： 23%, hypertension： 45%）. More patient age ≥ 80 years had significant chronic kidney disease （CKD, estimated glomerular filtration rate 〈 45 mL/min per 1.73 m^2, 44% vs. 22%, P 〈 0.01 ）. Overall complication rates （any） were similar in both groups （16% vs. 17%, P = NS）. Both groups demonstrated symptomatic benefit. One-year mortality rates were almost four fold greater in octogenarians as compared with the younger cohort （13.9% vs. 3.7%, P 〈 0.01）. Conclusions CRT appears to be safe in the very elderly despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement appears to be meaningful. Strategies to increase the appropriate identification of elderly patients with CHF who are potential candidates for CRT are required.

Effectiveness, safety, and drug sustainability of biologics in elderly patients with inflammatory bowel disease: A retrospective study

BACKGROUND Biologic therapy resulted in a significant positive impact on the management of inflammatory bowel disease(IBD) however data on the efficacy and side effects of these therapies in the elderly is scant.AIM To evaluate retrospectively the drug sustainability, effectiveness, and safety of the biologic therapies in the elderly IBD population.METHODS Consecutive elderly(≥ 60 years old) IBD patients, treated with biologics [infliximab(IFX), adalimumab(ADAL), vedolizumab(VDZ), ustekinumab(UST)] followed at the McGill University Inflammatory Bowel Diseases Center were included between January 2000 and 2020.Efficacy was measured by clinical scores at 3, 6-9 and 12-18 mo after initiation of the biologic therapy. Patients completing induction therapy were included. Adverse events(AEs) or serious AE were collected during and within three months of stopping of the biologic therapy.RESULTS We identified a total of 147 elderly patients with IBD treated with biologicals during the study period, including 109 with Crohn’s disease and 38 with ulcerative colitis. Patients received the following biologicals: IFX(28.5%), ADAL(38.7%), VDZ(15.6%), UST(17%). The mean duration of biologic treatment was 157.5(SD = 148) wk. Parallel steroid therapy was given in 34% at baseline,19% at 3 mo, 16.3% at 6-9 mo and 6.5% at 12-18 mo. The remission rates at 3, 6-9 and 12-18 mo were not significantly different among biological therapies. Kaplan-Meyer analysis did not show statistical difference for drug sustainability(P = 0.195), time to adverse event(P = 0.158) or infection rates(P = 0.973) between the four biologics studied. The most common AEs that led to drug discontinuation were loss of response, infusion/injection reaction and infection.CONCLUSION Current biologics were not different regarding drug sustainability, effectiveness, and safety in the elderly IBD population. Therefore, we are not able to suggest a preferred sequencing order among biologicals.

Binocular Vision Positioning Method for Safety Monitoring of Solitary Elderly

In nowadays society,the safety of the elderly population is becoming a pressing concern,especially for those who live alone.There might be daily risks such as accidental falling or treatment attack on them.Aiming at these problems,indoor positioning could be a critical way to monitor their states.With the rapidly development of the imaging techniques,wearable and portable cameras are very popular,which could be set on human individual.And in view of the advantages of the visual positioning,the authors propose a binocular visual positioning algorithm to real-timely locate the elderly indoor.In this paper,the imaging model has been established with the corrected image data from the binocular camera;then feature extraction has been completed to provide reference to adjacent image matching based on the binary robust independent elementary feature(BRIEF)descriptor,finally the camera movement and the states of the elderly have been estimated to distinguish their falling risk.In the experiments,the real-sense D435i sensors were adopted as the binocular cameras to obtain indoor images,and three experimental scenarios have been carried out to test the proposed method.The results show that the proposed algorithm can effectively locate the elderly indoor and improve the real-time monitoring capability.

Effectiveness and safety of antithrombotic strategies in elderly patients with acute myocardial infarction

BACKGROUND Elderly patients represent a rapidly growing part of the population more susceptible to acute coronary syndromes and their complications.However,literature evidence is lacking in this clinical setting.AIM To describe the clinical features,in-hospital management and outcomes of“elderly”patients with myocardial infarction treated with antiplatelet and/or anticoagulation therapy.METHODS This study was a retrospective analysis of all consecutive patients older than 80 years admitted to the Division of Cardiology of St.Andrea Hospital of Vercelli from January 2018 to December 2018 due to ST-elevation myocardial infarction(STEMI)or non-ST elevation myocardial infarction(NSTEMI).Clinical and laboratory data were collected for each patient,as well as the prevalence of previous or in-hospital atrial fibrillation(AF).In-hospital management,consisting of an invasive or conservative strategy,and the anti-thrombotic therapy used are described.Outcomes evaluated at 1 year follow-up included an efficacy ischemic endpoint and a safety bleeding endpoint.RESULTS Of the 105 patients enrolled(mean age 83.9±3.6 years,52.3%males),68(64.8%)were admitted due to NSTEMI and 37(35.2%)due to STEMI.Among the STEMI patients,34(91.9%)underwent coronary angiography and all of them were treated with percutaneous coronary intervention(PCI);among the NSTEMI patients,42(61.8%)were assigned to an invasive strategy and 16(38.1%)of them underwent a PCI.No significant difference between the groups was found concerning the prevalence of previous or in-hospital de-novo AF.10.5%of the whole population received triple antithrombotic therapy and 9.5%single antiplatelet therapy plus oral anticoagulation(OAC),with no significant difference between the subgroups,although a higher number of STEMI patients received dual antiplatelet therapy without OAC as compared with NSTEMI patients.A low rate of in-hospital death(5.7%)and 1-year cardiovascular death(3.3%)was registered.Seven(7.8%)patients experienced major adverse cardiovascular events,while the rate of minor and major bleeding at 1-year follow-up was 10%and 2.2%,respectively,with no difference between NSTEMI and STEMI patients.CONCLUSION In this real-world study,a tailored evaluation of an invasive strategy and antithrombotic therapy resulted in a low rate of adverse events in elderly patients hospitalized with acute myocardial infarction.

Addressing Nursing Safety Hazards and Mitigation Strategies for Elderly Endocrinology Patients in Hospital Care

Objective:To investigate the safety hazards in nursing and explore mitigation strategies for elderly patients in the endocrinology department.Methods:A total of 240 bedridden elderly patients from February 2021 to January 2023 were recruited and divided into two groups using the random number table method.The control group(n=120)received conventional nursing care,and the observation group(n=120)received personalized nursing care.Patients’quality of life,the incidence rate of pressure sores,and patient satisfaction with nursing care were observed and analyzed.Results:The incidence of pressure ulcers in the observation group was significantly lower at 17.50%compared to 30.00%in the control group(P<0.05).Quality of life in the observation group was significantly higher than that in the control group(P<0.05).The satisfaction rate in the observation group was significantly higher at 93.33%compared to 84.17%in the control group(P<0.05).Conclusion:These findings emphasize that only through the implementation of scientific and rational nursing measures can effectively reduce nursing risks,enhance therapeutic outcomes,and improve the quality of life for elderly patients.

Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians lO-year experience of a one high-volume center

Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.Methods From our database, we extracted procedural and follow-up data for patients 〉 80 years with symptomatic AF undergoing RFCAand compared this population to RFCA patients 〈 50 years. All patients underwent pulmonary vein isolation （PVI） supplemented by linearlesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patientscompleted their 12 months follow-up. Results Fifty patients aged ≥80 years （80.5 ± 1.6 years） were compared to 259 patients aged 〈 50years （43.5±5.5 years）. The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seenafter being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of anyarrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower（58.6% octogenarians vs. 81.2% younger patients, P = 0.023）. If AAs were used, arrhythmia-free survival for paroxysmal AF increased to90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation inoctogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still rea-sonable clinical effectiveness.

Percutaneous interventions in elderly patients with atrial fibrillation： leftatrial ablation and left atrial appendage occlusion

Heart rhythm disturbances become of special importancewhen patients reach a senior age. Atrial fibrillation （AF） isthe most prevalent arrhythmia among the old age groups,and its impact on morbidity and mortality becomes of para-mount significance. In this population, AF is responsible forsignificant amount of thromboembolic cerebrovascularevents, especially for disabling and fatal strokes, Follow-ing announcement of the special issue of the Journal of Geri-atric Cardiology devoted to heart rhythm disorders in theelderly, a number of submissions have been received withAF as the major topic of authors＇ researches.

The status quo and prospect of transfer and shift in patients receiving hemodialysis in China

Hemodialysis is the main alternative therapy for patients with end-stage renal disease;most of the hemodialysis centers in China are not designed together with the inpatient ward.During the hospitalization period,hemodialysis patients often move back and forth between wards and hemodialysis rooms because of the treatment needed.Hemodialysis patients are a special group of hospitalized patients,most of them are elderly patients.The overall basic diseases of the patients vary very much,and the cause of the disease is complex.Moreover,the chronic inflammation progresses slowly,and immune function declines.Some of the patient are seriously ill or even hav organ failure.All these factors affect the patients in general.Therefore,the transfer safety of patients during hospitalization is facing great challenges.The researchers reviewed the status of transshipment research in Chinese hemodialysis patients and laid the foundation for the research and development of related handover tools and perfect handover mode in the future.

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases

BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

Consideration of Safety Management When Using Pepper, a Humanoid Robot for Care of Older Adults

Pepper, a humanoid robot, is 1.2 m in height and is designed to move its limbs. There are risks of the older adults experiencing falling and collision accidents when they interact with Pepper. When physical interaction happens between a humanoid robot and human beings, potential harmful physical contact might occur. The aim of this report was to examine the safety management aspects when using Pepper, a humanoid robot for the care of older adults. The older adults’ reactions to Pepper’s functions cannot be predicted. Hence, it is necessary to clarify methods to guarantee its safety in advance and to increase the safety and properties of the robots. The benefits of introducing support robots such as Pepper for aging medical and nursing care settings are obvious. Therefore, engagement in robot development while considering both the risks and benefits is critical. Our academic initiatives have just begun. Through information exchange among researchers, users, engineers, and law specialists, we need to identify latent and prominent risks in situations where Pepper and the older adults interact and deepen our examination of measures against such risks.

氨氯地平联合依那普利治疗老年高血压疗效观察

目的:观察苯磺酸氨氯地平片和马来酸依那普利片联合使用对老年高血压患者的治疗效果。方法:选取2019年2月—2022年1月上海市浦东新区陆家嘴社区卫生服务中心诊治的150例老年高血压病患者,依据随机数字表法,将患者分为对照组(n=75)和观察组(n=75)。给予观察组患者苯磺酸氨氯地平片和马来酸依那普利片联合治疗,给予对照组患者单纯苯磺酸氨氯地平片进行治疗,治疗8周后,观察两组患者的药物疗效及安全性。结果:治疗后,观察组血压达标率89.33%,高于对照组的72.00%,差异有统计学意义(χ^(2)=7.224,P<0.05);观察组患者收缩压、舒张压及平均动脉压水平均明显低于对照组,差异均有统计学意义(t值分别为9.029、8.229、7.719,P值均<0.05);观察组一氧化氮水平为(39.54±4.30)μmol/L,明显高于对照组的(33.84±4.17)μmol/L,差异有统计学意义(t=8.241,P<0.05);观察组血管紧张素Ⅱ、内皮素水平分别为(50.19±7.13)ng/dl、(63.12±7.94)ng/L,明显低于对照组的(57.34±6.22)ng/dl、(74.85±8.83)ng/L,差异均有统计学意义(t值分别为6.544、8.555,P值均<0.05)。对照组不良反应发生率为13.33%,明显高于观察组的4.00%,差异有统计学意义(χ^(2)=4.127,P<0.05)。结论:苯磺酸氨氯地平片和马来酸依那普利片联合治疗老年高血压患者能够实现协同降压效果,可以显著改善患者血管活性物质,提高血压控制达标率,且其药物不良反应发生率、有效性及安全性明显优于单独使用氨氯地平。

上海市老年人交通安全意识的调查研究

[目的 ]通过调查分析 ,了解不同性别、年龄老年人对交通意识伤害的知、信、行的掌握程度 ,为下一步有针对性地开展交通伤害预防和控制的健康促进工作提供依据。 [方法 ]采取整群抽样的方法 ,同时采用统一编制的“上海市老年人交通安全知识认知调查表”进行调查。 [结果 ] 62 7%以上的老年人对交通安全知识有一定了解 ,但其程度却不尽人如意 ,能较好掌握步行和骑车规则的只占 5 0 %左右。尽管在认知与其相应的信念及态度表现出了一致性 ,但认知与其相应的行为却不相一致。认知情况和其程度随年龄的增长而逐渐下降 ,以“60岁～”组最好 ;而不安全行为也是“60岁～”组最高。知、信、行间相关性分析显示“60岁～”和“70岁～”年龄组中知、信、行间都有显著相关性 ;“60岁～”组中认知与态度、行为与态度之间的相关程度具有显著性意义 ,其中“65岁～”组的认知与态度的相关程度最高。 [结论 ]预防和控制老年人的交通意外伤害是一项系统工程 ,必须得到全社会的关注 ,加强对老年人的安全教育和健康促进不但要重视“知” ,还必须在“行”和“信念及态度”多下功夫。特别要值得注意的是 ,在教育计划中 ,应结合老年人的心理、生理特点有针对性地开展观念 行为的教育 ,提高防范意识 ;特别对

老年人髋关节置换围手术期并发症及伴发症分析

目的:探讨髋关节置换术对老年人内科伴发症的影响。方法:回顾分析本院1994年1月～2002年7月行髋关节置换术498例病人,分析围手术期65岁以上及65岁以下2组患者内科伴发症变化。结果:术后贫血、肺感染、呼吸衰竭及心力衰竭高龄组发生高于低龄组,高龄组有2例死亡。结论:高龄患者围术期心肺并发症发生率高于低龄组,但绝大多数患者可以安全的接受髋关节置换术。

社区照顾者对老年常见安全风险的知信行现状及影响因素研究

目的 :了解社区照顾者对老年常见安全风险知信行的现状水平及影响因素,为社区护士进行健康教育提供基础。方法 :采用自行设计的调查问卷,对重庆市4个社区280名老年人的照顾者就老年常见安全风险知信行水平进行现状调查并分析影响因素。结果 :知信行总分(61.72±6.99)分。照顾者文化程度、职业、知识维度得分以及老年人年龄、居住地、患病情况和是否发生过安全风险是照顾者对老年常见安全风险行为水平的影响因素。结论 :社区照顾者对老年常见安全风险的知信行水平现状有待提高,社区护士应在家庭访视中加强开展全面、针对性的健康教育。

北京市16所养老机构老年人对护理安全问题认知状况的调查分析及对策

目的:了解目前北京市各级养老机构老年人对护理安全问题的认知状况及相关影响因素,为强化安全管理,改进管理措施提供参考。方法:采用问卷调查法,对北京市16所不同级别的养老机构的1025位老年人进行了抽样调查。结果:有98.5%的老年人认为安全问题非常重要;认为入住养老机构后容易发生如跌倒(占21.1%)、皮肤压伤、走失等不安全问题;认为影响护理安全的相关因素主要与预防安全知识的宣传和护理安全防护措施的落实有关;同时调查还了解到只有26.4%的老年人或照顾者了解如何预防护理安全问题的知识;有38.1%的被调查者否认获得过预防安全知识的宣传指导。结论:各级养老机构应从老年人及其家属对安全方面的认知特点入手,充分了解影响医疗护理安全的相关因素,采取相应对策,满足老年人对预防安全问题的服务需求,从而保障老年人的生命健康和生活质量。

老年供肾亲属肾移植疗效和安全性分析

目的:探讨老年供肾亲属肾移植的疗效和安全性。方法:对我院66例行活体肾移植的供受者资料进行回顾性分析。供者50岁以上24例,其中8例次供者术前检查存在轻度医学异常(包括镜下血尿4例,高血压2例,肥胖1例,结石1例),比较老年供者和非老年供者术前总肾小球滤过率(GFR),手术前后血清肌酐(SCr),留存肾GFR以及并发症等情况。同时对二组受者的手术前后SCr,内生肌酐清除率(Ccr)、并发症、人肾存活率进行比较。结果:两组供者术后总体肾功能恢复良好,无显著性差异。但50岁以上组术后3月以上留存肾GFR显著低于50岁以下组(P<0.05)。两组受者在术后1年内SCr、Ccr、DGF、急性排斥和并发症均无显著性差异。结论:老年供者选择需十分谨慎。术前全面而彻底评估,严格控制纳入标准,其安全性和疗效良好。

安罗替尼治疗老年肺癌患者疗效及安全性分析

目的:探讨安罗替尼对老年肺癌患者疗效及安全性分析。方法:回顾性收集2018年12月1日至2020年5月1日首都医科大学附属北京友谊医院收治的晚期肺癌老年患者73例,均使用安罗替尼治疗,观察患者无进展生存期(progression-free survival,PFS)、总生存期(overall survival,OS)以及药物不良反应情况。结果:安罗替尼的客观有效率(objective response rate,ORR)和疾病控制率(disease control rate,DCR)分别为8.22%、56.16%,PFS为5.2个月,OS为11.2个月。Cox比例风险模型单因素分析显示年龄、病理类型、治疗线数、安罗替尼的使用剂量是影响老年肺癌患者PFS的因素(P<0.05),性别、病理类型、治疗线数、用药剂量是影响OS的因素,差异均有统计学意义(P<0.05)。多因素分析显示肿瘤分期是影响老年患者中位PFS、OS的因素。安罗替尼的不良反应主要为乏力(27/73,36.90%)、胃肠道反应(24/73,28.70%)、出血(8/73,11%)、高血压(6/73,8.2%)、蛋白尿(5/73,6.8%)等。结论:安罗替尼对老年晚期肺癌患者的疗效好,可改善患者预后,延长生存期,不良反应可控,使用方便,值得临床推广。

影响养老机构安全因素及对策

目的 了解养老机构入住老年人存在的安全问题,探究有效的解决办法。方法 对江汉油田养老机构入住的928名老年人进行问卷调查和查阅病历资料。结果 入住老人存在一些不安全因素;老年人慢性病患病率高;硬件设施不能达到安全标准;老年人安全认知率较低。结论 加强对养老机构环境、设施的适老工程改造;规范老年人慢性病的管理;加强对入住老人的安全知识教育,提高安全意识。

硫酸依替米星在老年感染性疾病中应用的安全性观察

观察硫酸依替米星在老年感染性疾病中应用的安全性。择 6 2例年龄大于 6 0岁的老年感染性疾病病例 ,随机分成两组。硫酸依替米星组 ,单一用药 15例 ,联合用药 16例 ;阿米卡星组 ,单一用药 12例 ,联合用药 19例。记录用药前后血 GPT、BUN、Cr的变化及用药过程中的临床不良反应。结果 ,硫酸依替米星组与阿米卡星组的血 GPT、BUN、Cr在治疗前后无明显差异 (P>0 .0 5 ) ,而临床不良反应的发生率 ,硫酸依替米星组明显低于阿米卡星组 ,分别为 3.2 3%和 16 .13%。结论 :硫酸依替米星是一个毒性较低 ,安全有效的氨基糖苷类抗生素 ,可用于老年感染性疾病。