Gerontology
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Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. ⋯ Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches.
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Functional status in older people is a dynamic situation, which makes it necessary to evaluate functional capacity at different times to determinate their prognostic value. ⋯ The main functional gain obtained after treatment in a multidisciplinary post-acute geriatric unit is independently associated with a reduction in long-term mortality. In addition to baseline functional status and after acute illness, the subsequent potential recovery is very important to predict poor long-term outcomes.
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About half of the persons who die in developed countries are very old (aged 80 years or older) and this proportion is still rising. In general, there is little information available concerning the circumstances and quality of the end of life of this group. ⋯ ELDs are less common for very old than for younger patients. Physicians seem to have a more reluctant attitude towards the use of lethal drugs, terminal sedation and participation in decision-making when dealing with very old patients. Advance care planning should increase the involvement of very old competent and noncompetent patients in end-of-life decision-making.
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Chronic headache is common in the elderly, but there is little specific research on the impact on quality of life of headache and beliefs about pain in this age group. This study investigated the influence of headache type as well as headache frequency (> or =15 headache days/month vs. <15 headache days/month) on quality of life and determined the relationships between elder's well-being, pain beliefs and related headache features including commonly reported neck pain. 118 headache subjects and 44 non-headache controls, aged 60-75 years, were recruited from the community. Subjects completed a headache questionnaire for classification purposes, the SF-36, the Geriatric Depression Scale-short form (GDS-S), the Survey of Pain Attitudes (SOPA-35) and the Neck Disability Index (NDI). ⋯ The NDI score had the greatest influence on physical well-being and GDS-S score on mental well-being (p < 0.001). The results suggest that frequency of headache has an impact on health-related quality of life in elders. Notably, the level of neck pain and disability is an important factor influencing well-being and may warrant attention in the management of elders with chronic headache.
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The perioperative assessment and management of elderly patients with hip fracture and significant aortic stenosis (AS) is an increasingly common clinical problem with little data available to guide perioperative management. ⋯ Our results demonstrate that elderly patients with severe AS can safely undergo repair of hip fractures with a mortality and morbidity comparable with a control population. These patients should not be denied surgery on the basis of their aortic valve disease.