Aging clinical and experimental research
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Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.
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Inaccurate reporting of data hampers the generalizability and the correct interpretation of results of scientific medical papers. The Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiatives, both included in the Enhancing the Quality and Transparency of Health Research (EQUATOR) international network, have elaborated appropriate guidelines in order to improve the transparence, clearness and completeness of scientific literature. ⋯ The STROBE is a checklist of 22 items which should be addressed when observational studies (case-control, cohort and cross-sectional) are made up. Many editorial committees and prestigious international journals have now embraced these guidelines to improve the quality and methodology of their scientific reports.
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Review
Chronic pain in the elderly with advanced dementia. Are we doing our best for their suffering?
Elderly subjects with advanced dementia are exposed, like all aging individuals, to a wide range of chronic degenerative and progressive medical conditions which can cause pain and discomfort, both physical and psychological. Pain is defined as an unpleasant subjective experience, generally assessed with verbal self-reporting methods. The inability to report pain verbally - a common occurrence in advanced stages of dementia - is widely recognized as the main confounding factor in identifying these patients' pain. ⋯ Although some currently available tools for pain assessment in non-verbal older adults seem promising, no single tool has yet been sufficiently validated as reliable for widespread adoption in clinical practice. Prior research has documented a significantly lower prescription of analgesic medications in demented patients than in cognitively intact peers: as untreated or under-treated pain can have adverse physical and psychological consequences, there is an urgent need for appropriate pain assessment methods in elderly patients with advanced dementia, since too many of them continue to suffer needlessly. The purpose of this review is to discuss the main tools developed in the last decade for pain assessment in non-communicative older individuals, highlighting the strengths and weaknesses of each, and providing a guide for their use in clinical practice, particularly in geriatric settings.
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Comprehensive geriatric assessment (CGA) may benefit frail or chronically ill patients in the emergency department (ED), but take too much time to be performed routinely in ED. An alternative approach is to use first a screening tool to detect high-risk patients and then perform CGA in these patients only. This systematic review focuses on the use and value of CGA in ED for evaluation of older patients and its influence on adverse outcomes. This approach is compared with an alternative one using existing screening tools, validated in ED, to detect high-risk patients needing subsequent CGA. This review ends by suggesting a short assessment of CGA to be used in ED and ways to improve home discharge management from ED. ⋯ The selected studies demonstrated that screening of high-risk patients is more efficient than age-based screening, and that CGA performed in ED, followed by appropriate interventions, improves outcomes.
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Herpes zoster (HZ) results from reactivation of varicella zoster virus which has been persistent but clinically latent in dorsal root and cranial nerve ganglia since primary infection, usually as a child, with varicella (chicken pox). HZ affects 20-30% of individuals during their lifetime and up to 50% of those > or =80 years old. Although serious life- or sight-threatening complications occur rarely, postherpetic neuralgia (PHN) is the most common complication. ⋯ The safety profile of the vaccine is good, local soreness at the injection site being the only common adverse event. Health economics studies suggest that vaccination of adults about 60 years of age would be cost effective. Duration of protection following vaccination is the subject of ongoing surveillance, as is the potential benefit of vaccinating younger and sicker members of the population.