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To investigate the clinical characteristics, risk factors, and outcomes of inpatients with peripheral arterial disease (PAD) including lower extremity PAD, abdominal aortic aneurysm (AAA), and carotid artery disease in a large cohort of critically ill patients aged ≥ 90 years. A retrospective analysis was conducted of all adult patients aged ≥ 90 years consecutively admitted to the intensive care unit at a tertiary care centre in Hamburg, Germany, between 1 January 2008 and 30 April 2019. Multivariable regression and Kaplan–Meier methods were used to determine the independent impact of PAD on short and long term mortality endpoints. The analyses were adjusted for confounding by several sociodemographic and clinical parameters including Charlson Comorbidity Index (CCI) and established clinical risk scores. A total of 1 108 eligible patients were identified (92.3 years, 33% men). Of these, 24% had PAD (9% lower extremity PAD, 2% AAA, 15% coronary artery disease) and 76% did not have any history of PAD and were used as a comparison group. When compared with the comparison group, patients with PAD had a higher CCI (2 vs. 1, p <.001), more often had chronic kidney disease (28% vs. 21%, p =.019), and renal replacement therapy (5% vs. 2%, p =.016). Furthermore, they needed vasopressors (48% vs. 40%, p =.027) and parenteral nutrition (10% vs. 6%, p =.041) more often. After adjusting for confounding, PAD was independently associated with increased in hospital (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.39 – 2.81, p <.001) and long term mortality rates (HR 1.32, 95% CI 1.05 – 1.66, p =.019). One of four critically ill nonagenarians and centenarians in an ICU in Germany had PAD. PAD was associated with both higher short and long term mortality rates while its impact outweighed higher age. Future studies should address this increasingly important population beyond 89 years of age. [ABSTRACT FROM AUTHOR]

Study Objective: There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old.Methods: Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements.Results: From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels.Conclusions: The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA. [ABSTRACT FROM AUTHOR]

Introduction: Elderly people, defined by age 65 years and older, made up 18.45% of the Swiss Population in 2018 and their number is projected to rise continuously. Data investigating specific characteristics of this patient subgroup, especially in the emergency setting, is scarce.Methods: Demographic data of admission records from all patients aged 65 years or older admitted to our emergency department (ED) between January 1st 2015 and December 31st 2018 were investigated. Retrospective chart reviews of patients admitted in 2018 were conducted. Comorbidity burden was assessed by Charlson Comorbidity Index. Risk factors for death, longer hospitalization and placement in a nursing facility were identified by multivariate regression.Results: The prevalence of elderly patients (≥65 years) admitted to the ED between 2015 and 2018 was rising from 33% in 2015 to 37.8% in 2018. In 2018 709 patients were 90 years and older (3.6%). Age above 90 years and high comorbidity burden were identified as independent risk factors for death. Polypharmacy, hyponatremia and high comorbidity burden were independent risk factors for longer hospitalizations. Advanced age and high comorbidity burden were independent risk factors for placement in a nursing facility.Conclusion: The number of elderly patients admitted to our ED is continuously rising. There was no difference in overall disease burden, number of medications and hospital length of stay between octogenarians and nonagenarians. We identified risk factors for mortality, long hospitalizations and need of placement in a nursing facility. [ABSTRACT FROM AUTHOR]

Background/purpose: Calcified coronary artery stenosis remains a challenge for Percutaneous Coronary Intervention (PCI). Calcium modification is facilitated by rotablation and is used in 1-3% of cases. Data on rotablation in patients ≥80 years is limited and perceived to be high risk. We compared PCI with rotablation and outcomes between patients ≥80 years and those <80 years.Methods/materials: Retrospective analysis was performed of consecutive patients who underwent rotablation and PCI from 3 United Kingdom (UK) PCI Centres (2014-2017). In-hospital outcomes (composite of stroke, myocardial infarction, death, emergency coronary artery bypass graft surgery, vascular damage, coronary perforation, advanced AV-block, bleeding and renal impairment) and 30 day mortality risk score was compared between groups.Results: 213 patients were included. 33.3% (n = 71) were ≥80 years. Baseline and angiographic characteristics were similar in the two groups. Older patients were more likely to present with acute coronary syndrome (ACS) (≥80 years 53.5% vs. 33.8% in <80 years, p = 0.006) and had increased hospital stay (≥80 years 2.8 days (±6.0) vs. 1.3 days (±1.9) <80 years, p = 0.009). Majority of PCI were performed through radial access (≥80 years 91.5% vs. 88.0% <80 years, p = 0.43). In-hospital composite outcomes were similar between the groups (≥80 years 5.6% vs. 4.9% <80 years, p = 1.0). The 30-day mortality risk score demonstrated a higher average risk of 2.5% in ≥80 years versus under 1% risk in <80 years (p < 0.001).Conclusion: This study demonstrates that outcomes after rotablation in the very elderly are similar to younger patients despite being high risk and presenting with ACS. [ABSTRACT FROM AUTHOR]

Background: Patients aged ≥80 years old often present to Emergency Departments (ED) with symptoms potentially due to an acute coronary syndrome (ACS). This study aimed to evaluate associations between baseline level(s) of high sensitivity troponin T (HsTnT), adjudicated diagnoses and outcomes.Methods: Consecutive patients aged ≥80 years were studied, who presented to the ED at Liverpool Hospital, NSW, Australia during the 4 months period March to June 2014 (inclusive) with symptoms suggestive of an ACS, and who had at least one HsTnT assay performed. Diagnoses were based on the fourth universal definition of MI (myocardial infarction) including type-1 MI, type-2 MI, acute myocardial injury, chronic myocardial injury; the rest were termed "other diagnoses". Patients were categorised by baseline HsTnT levels 1) ≤14 ng/L, 2) 15-29 ng/L, 3) 30-49 ng/L and 4) ≥50 ng/L.Results: Of 2,773 patients screened, 545 were aged ≥80 years (median age 85 [IQR 82-88]); median follow-up was 32 months (IQR 5-56). The respective rates of adjudicated diagnoses were type-I MI 3.1%, type-2 MI 13%, acute myocardial injury 9.5%, chronic myocardial injury 56% and 18.6% had other diagnoses. Mortality rates increased, irrespective of adjudicated diagnoses with increasing HsTnT levels (ng/L): 17% (16/96) for ≤14; 35% (67/194) for 15-29; 51% (65/127) for 30-49; and 64% (82/128) for ≥50 ng/L; log rank p≤0.001. On multi-variable analyses, after adjusting for potential confounding factors including age, hypertension, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), MI type was not associated with late mortality.Conclusions: Among patients aged ≥80 years higher HsTnT levels, irrespective of adjudicated diagnoses, were associated with increased mortality. Most very elderly patients presenting with symptoms suggestive of an ACS undergoing HsTnT testing in EDs had elevated levels most commonly due to chronic myocardial injury. Whether any interventions can modify outcomes require prospective evaluation. [ABSTRACT FROM AUTHOR]

Le risque de fractures ostéoporotiques augmente avec l'âge et le vieillissement de la population va s'accompagner d'une augmentation du nombre de fractures, notamment de fractures de l'extrémité supérieure du fémur. Paradoxalement, alors que ces fractures s'accompagnent d'une augmentation de la mortalité et d'une perte d'autonomie, l'ostéoporose est sous-diagnostiquée et rarement prise en charge chez les sujets très âgés. Il est nécessaire de développer des filières de soins pluridisciplinaires, telles que l'orthogériatrie et les filières fractures, permettant une prise en charge initiale optimale pour diminuer la mortalité précoce et une prise en charge exhaustive de l'ostéoporose. La prise en charge de l'ostéoporose repose sur un apport suffisant en vitamine D, calcium et protéines et un traitement anti-ostéoporotique spécifique dont l'efficacité densitométrique et anti-fracturaire a été démontrée dans cette population. Le poids des facteurs liés aux chutes, dans le déterminisme des fractures, est comparable à celui de la densité minérale osseuse. Il est ainsi primordial d'évaluer le risque de chute de ces patients et d'appliquer les mesures visant à diminuer ce risque : travail de l'équilibre, prise en charge des troubles visuels et musculo-squelettiques, diminution des médicaments inducteurs de chutes. The risk of osteoporotic fractures increases with age and the aging of the population will be accompanied by an increase in the number of fractures, particularly of hip fractures. Paradoxically, while these fractures are associated with increased mortality and loss of autonomy, osteoporosis is under-diagnosed and rarely managed in very elderly subjects. It is necessary to develop multidisciplinary care pathways, such as orthogeriatric comanagement and fracture liaison service, that provide optimal initial management to reduce early mortality and comprehensive management of osteoporosis. The management of osteoporosis is based on an adequate supply of vitamin D, calcium and protein and a specific anti-osteoporotic treatment whose densitometric and anti-fracture efficacy has been proved in this population. The weight of fall factors in fracture determinism is comparable to that of bone mineral density. It is therefore essential to assess the risk of falling and to apply measures to reduce this risk: improve balance, management of visual and musculoskeletal disorders, reduction of drugs that induce falls. [ABSTRACT FROM AUTHOR]

Background: The number of cardiac arrests (CA) in the group of very elderly patients (≥ 90 years) is expected to increase markedly due to the world`s rapidly ageing population. However, only little is known about long term outcome, CA- and intensive care unit (ICU) characteristics of patient's ≥ 90 years (nonagenarians) suffering from CA.Methods: This single-center retrospective study included all adult patients ≥ 90 years after CA and return of spontaneous circulation (ROSC) which were treated at our ICU between January 1st 2008 and September 15th 2016. Patients were followed at least 1-Year after ICU discharge for assessment of survival and neurological outcome. Aim of the study was to evaluate CA- and patients characteristics, as well as ICU- and neurological outcome after CA in patient's ≥ 90 years.Results: 657 patients ≥ 90 years were treated at our ICU during the study period, of these we could identify 48 patients with CA and successful resuscitation. 27 (56%) were female and the median age was 91.7 (90.7 - 92.6) years. 41 (85%) patient suffered from in-hospital CA. Cardiac events leading to CA were observed in 19 (40%) patients. Initial rhythm was shockable (VT/VF) in 12 (25%) patients and time to ROSC was median 4 (1.6 - 9.5) minutes. Patients after CA who survived the ICU stay had significantly lower SAPS II score (44 (36 - 55) vs. 58 (46.5 - 75.5), p < 0.05), lower maximum lactate (2.8 (1.9 - 4.3) mmol/l vs. 6.2 (4 - 9) mmol/l, p < 0.001) and higher pH (7.29 (7.26 - 7.38) vs. 7.23 (7.12 - 7.32), p < 0.05) on admission compared to patients with CA who did not survive the ICU stay. Overall, after CA, 39 (81%) patients needed mechanical ventilation, 44 (92%) received catecholamine support, 17 (35%) received red blood cell transfusion and 4 (8%) received renal replacement therapy. Mechanical ventilation and red blood cell transfusion was significantly more common in ICU non-survivors (both p < 0.05). 19 (46%) patients survived the ICU-stay, of these 86% had favourable neurological outcome (CPC I/II) at ICU discharge. One year survival rate was 23% (n = 11), of these 55% (n = 6) had favorable neurological outcome.Conclusions: 46% of successfully resuscitated nonagenarians survived the ICU stay, the majority with favourable neurological outcome at ICU discharge. Resuscitation and post-CA care, in the highly selected group of very elderly patients (≥ 90 years), seems to be justified. [ABSTRACT FROM AUTHOR]

Background and Aims: Laboratory studies on human adipose tissue and differentiated adipocytes indicate that natriuretic peptides (NPs) affect lipid metabolism and plasma cholesterol. Few previous clinical studies in non-elderly populations found associations between NPs in the physiological range and cholesterol.Aim: evaluate the association between NT-proBNP and lipid profile in very elderly hospitalized patients characterized by a wide range of NT-proBNP levels.Methods and Results: Cross-sectional study on 288 very elderly patients hospitalized for medical conditions, in which increased NT-proBNP levels are very common. NT-proBNP, total cholesterol (TC), HDL cholesterol (HDLc) and triglycerides were collected just few days before discharge. Patients taking lipid-lowering drugs and patients with an admission diagnosis of acute heart failure were excluded. Calculated LDL-cholesterol (LDLc) was used for the analyses. Mean age: 87.7 ± 6.2 years; female prevalence (57.3%). Median NT-proBNP: 2949 (1005-7335) pg/ml; mean TC: 145.1 ± 40.3 mg/dl; mean HDLc: 38.4 ± 18.6 mg/dl; median triglycerides: 100 (75-129) mg/dl; mean LDLc: 84.0 ± 29.5 mg/dl. We found negative correlations between NT-proBNP and both TC and LDLc (Rho = -0.157; p = 0.008 and Rho = -0.166; p = 0.005, respectively), while no correlations emerged between NT-proBNP and HDLc (Rho = -0.065; p = 0.275) or triglycerides (Rho = -0.009; p = 0.874). These associations were confirmed considering NT-proBNP tertiles. The inverse association between NT-proBNP and LDLc was maintained even after adjusting for confounding factors.Conclusion: Our real-life clinical study supports the hypothesis that NPs play a role on cholesterol metabolism, given the association found between LDLc and NT-proBNP even in very elderly patients where NT-proBNP values are often in the pathological range. [ABSTRACT FROM AUTHOR]

Objectives Cardiovascular diseases are mainly related to hypertension and dyslipidemia and increase with aging because of the larger time span for these risk factors to damage arterial blood vessels. The impact of cardiovascular drug therapy on outcomes in the very elderly hospitalized is still not well established. The aim of our study was to evaluate the associations between cardiovascular therapy and in-hospital mortality in very elderly hypertensives. Design Prospective observational study. Setting Hospital assessment. Participants 310 very elderly hypertensive patients admitted to our Internal Medicine and Geriatrics Department for medical conditions. Measurements Main comorbidities, laboratory parameters, and cardiovascular drug therapy taken before admission were considered for the analyses. Results The mean age was 88.1 ± 5.1 years, with female prevalence of 57.4%. Among cardiovascular drugs taken before admission, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and statins were those associated with lower in-hospital mortality, even after adjusting for covariates (age, hemoglobin, albumin, acute kidney injury, ADL Hierarchy Scale, NT-proBNP levels) [odds ratio (OR) = 0.46, P  = .045, and OR = 0.21, P  = .008, respectively]. No difference regarding in-hospital mortality was found between ACE inhibitors and angiotensin receptor blockers ( P  = .414). Conclusion ACE inhibitors/angiotensin receptor blockers and statins, through their beneficial effects on the cardiovascular system, have a positive impact on survival in very elderly hospitalized patients. Our data confirm the important role of such drugs even in this particular population with a mean age higher than 88 years, where scientific evidence is still scanty. [ABSTRACT FROM AUTHOR]

Aim To assess whether in individuals aged 80 years or older adherence to statins is accompanied by a reduced risk of all-cause mortality and major cardiovascular events. Methods A nested case–control study was carried out on a cohort of patients aged 80 years or older (very elderly individuals), who were under treatment with statins between 2008 and 2009, using the database available for all citizenship (about 10 million) of Lombardy (Italy). Cases were the cohort members who experienced death or hospitalization for stroke, myocardial infarction or heart failure from the initial prescription until 2012. Up to five controls were randomly selected for each case. Logistic regression was used to model the outcome risk associated with the adherence to therapy with statins. Two younger patient cohorts aged 60 to 69 years and 70 to 79 years were taken for comparison. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty. Results Among very elderly individuals, those who had high adherence to statins showed significant risk reductions of death (56%; 95% Confidence Interval, 54% to 59%), myocardial infarction (15%; 5% to 24%), stroke (13%; 0% to 24%) and heart failure (30%; 23% to 36%) with respect to those at very low adherence. Adherence-related risk reductions were only slightly better for younger cohort members. Conclusions Adherence to therapy with statins reduced the risk of both death and cardiovascular morbidity in patients aged 80 years or older. [ABSTRACT FROM AUTHOR]

Background Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥ 85 years with ST-Elevation Myocardial Infarction (STEMI). Methods and Results We analyzed 126 consecutive patients aged ≥ 85 years (age 88 ± 2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score > 8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. Conclusions PPCI in patients ≥ 85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events. [ABSTRACT FROM AUTHOR]

Background and aims Excess weight is a widespread condition related to increased risk of coronary heart disease (CHD). Sarcopenia is a catabolic pathway common of the aging process and also associated with CHD. In the elderly, both changes occur concurrently and it remains unclear the relative contribution on CHD risk. We aimed to investigate whether sarcopenia, excess weight, or both are associated with subclinical atherosclerosis and/or endothelial dysfunction in very elderly individuals. Methods We performed a cross-sectional study of cohort enrolled individuals, aged 80 years or older (n = 208), who had never manifested cardiovascular diseases. Blood tests, medical and nutritional evaluations, cardiac computed tomography, flow-mediated dilation (FMD) and physical performance tests were obtained at the study admission. Odds ratio (OR) was calculated by multivariate regression models using coronary calcium score (CCS) categories and FMD as dependent variables. Adjustment for potential confounders was done. Results Muscle mass, but not fatty mass, was inversely associated with CCS categories [OR:2.54(1.06–6.06); p = 0.018]. The lowering of gait speed was negatively related to CCS>100 [OR:2.36 (1.10–5.06); p = 0.028] and skeletal muscle index was directly associated with FMD [OR:5.44 (1.22–24.24); p = 0.026]. Total caloric intake was positively related to fatty mass [OR:2.71 (1.09–6.72); p = 0.031], but was not related to CCS. Conclusions This study reveals that sarcopenia - comprised by reduction of muscle mass and its strength - is associated with subclinical atherosclerosis and endothelial dysfunction. Surprisingly, the excess of fatty mass seems not to be related to atherosclerotic burden in very elderly individuals. [ABSTRACT FROM AUTHOR]

Background: In cases of femoral neck fracture, it is often not possible to accurately determine the original position of the head center to assess appropriate restoration of leg length. The aim of this study was to determine the accuracy of predicting the position of the femoral head center based on new and established correlations between the femoral head diameter (FHD) and the distance between the lesser trochanter and the femoral head center (LT-FHC) in the very elderly (aged ≥80 years) as the mainly affected but yet underinvestigated group.Methods: The FHD and the LT-FHC distance were determined in 148 subjects (104 males, 44 females); 90 aged ≥80 years and 58 aged <80 years. For each age and gender subgroup one specific (LT-FHC)/FHD ratio was determined. The accuracy of the new determined ratios and the established ratios by others were compared by recalculating the LT-FHC distance of each individual subject.Results: The FHD and the LT-FHC were significantly correlated, most strongly in elderly females (R = 0.554, P < .001). Using the new age- and gender-specific ratios, the LT-FHC distance could be predicted within 10 mm of the true value in 95% of the cases and in only 77% using previously reported formulas.Conclusion: Age- and gender-specific formulas yield higher accuracy than generic formulas. The formulas presented in this study can offer a practical, easy to use instrument for orthopedic surgeons performing hip arthroplasty in very elderly patients in addition to classic techniques to prevent significant leg-length discrepancy. [ABSTRACT FROM AUTHOR]

Background: Accurate reconstruction of hip joint biomechanics is the key stone in total hip arthroplasty. Although proximal femur morphology is known to vary with both age and gender, few studies investigated this in the very elderly (ie, ≥80 years). The purpose of this study was to compare basic morphological parameters describing the position of the femoral head between very elderly and middle-aged subjects.Methods: Computed tomographic scans of the femur of 90 very elderly (mean 84 years, range 80-105 years) and 58 middle-aged subjects (mean 52 years, range 20-79 years) were made. After 3-dimensional reconstruction, the neck-shaft angle, femoral neck anteversion angle, femoral head height, femoral neck length, and mediolateral offset (ML-offset) were determined.Results: The neck-shaft angle was on average 3.6° less in elderly males (125.9° ± 5.0°) than in middle-aged males (129.5° ± 5.1°) (P < .001). The femoral neck anteversion angle was not significantly different between both age and gender groups. The femoral head height was -12.3 mm in elderly females compared to -10.5 mm (Δ 17%) in elderly males (P = .284) and even -8.0 mm (Δ 54%) in middle-aged males. The ML-offset was 10% (4.1 mm) larger in elderly compared to middle-aged males (P < .001).Conclusion: These findings suggest that the femoral neck and head shift in a relative varus position during aging. Femoral prostheses with increased ML-offset and a lower caput-collum-diaphyseal angle are needed to accommodate the morphology of the femur in the very elderly. Care must be taken not to lengthen the operated leg, particularly in very elderly females. [ABSTRACT FROM AUTHOR]

Background Traumatic odontoid fractures (tOFs) in the very elderly are associated with high morbidity and mortality. The best treatment strategy (conservative vs. surgery) is still unclear. Methods Between April 2008 and April 2014, fifty (17 male, 33 female) patients (mean age 87.2 ± 4.4 years; range: 80−99) were included in this retrospective cohort study. All patients underwent posterior fusion surgery for tOF. Early outcome, morbidity and mortality, length of hospital and intensive care unit (ICU) stay, comorbidities, and perioperative complications were assessed. Results The mean age-adjusted Charlson Comorbidity Index (CCI) was 5.8 ± 3.9 (range: 0−13), and the mean American Society of Anesthesiologists score was 3 ± 0.5 (range: 2−4). Surgery was delayed in 48% of patients. Thirty percent of patients had preoperative complications (72.4% severe), of which a leading cause was dysphagia with subsequent pneumonia, and 18% required preoperative assessment or improvement of health status. Surgery-related complications were experienced in 14% with no neurovascular lesion. Postoperative medical complications occurred in 52% of patients (67.3% severe). Major complications were mostly respiratory/pulmonary (66.7%), of which postoperative pneumonia (36.4%) was leading. Twenty-four percent of patients were ICU monitored. Mean length of ICU stay was 9 ± 6.6 days (1−20). Mean length of hospital stay was 15 ± 8.6 days (4−56). There was no in-hospital mortality, and 30-day mortality was 6%. Conclusions Posterior fusion for tOF in patients 80 years or older seems to be a feasible treatment option in these high-risk patients. Despite a high incidence of severe comorbidities and perioperative complications, outcome was satisfactory. Level of Evidence Our research was a retrospective cohort study, Level III. [ABSTRACT FROM AUTHOR]

A shape mismatch between cementless stems and the femoral canal of very elderly patients could partly explain the inferior performance of cementless compared to cemented stems in this age group. Influences of age and gender on canal morphology were investigated by measuring coronal/sagittal dimensions on CT-scans of subjects ≥80 years old (n = 117) and subjects < 80 years old (n = 51). Absolute canal dimensions like width were larger in octogenarians than in younger subjects. These differences were larger in the sagittal plane than in the coronal plane (P < 0.001). Canal flaring changed asymmetrically with increased medial and less lateral flaring in octogenarians. Age-related changes were mainly observed in females and should be taken into consideration for implant design, selection and implantation in octogenarians. [ABSTRACT FROM AUTHOR]

Several reports have recently been published regarding dysphagia in very elderly patients, and centenarian dysphagia patients have become more common in Japan. The aim of this study was to assess the prognosis of dysphagia in very elderly patients. Participants were 24 centenarian dysphagia patients. For each patient, we collected information on age, care level, past medical history, and changes in oral intake according to the Functional Oral Intake Scale (FOIS). Patients were divided into two groups based on the mode of food intake at the time of transfer or discharge: the per oral-only group (the PO-only group, i.e., oral intake alone) and the tube feeding-dependent group (the TF-dependent group, i.e., combination of oral intake and tube feeding, or tube feeding alone). In both groups, the FOIS score decreased significantly from pre-hospitalization to the time of transfer or discharge (p = 0.006 for both). The FOIS score at initial assessment was higher in the PO-only group with the TF-dependent group (p = 0.0004). Furthermore, the frequency of a FOIS score of 4 at initial assessment was significantly higher in the PO-only group, and the frequency of a FOIS score of 1 was significantly higher in the TF-dependent group (p = 0.0006). These findings collectively suggest that oral intake can be recovered if the FOIS score is ≥4 at initial assessment, is difficult if the score is 1, and may be possible with a FOIS score of 2. [ABSTRACT FROM AUTHOR]

Summary Objectives The proportion of very elderly people in the population is increasing, and infectious diseases in this patient group may present with specific characteristics. The objective of this study was to investigate the outcome predictors of bacteremia among the very elderly. Methods This was a multicenter prospective cohort study of bloodstream infections (BSI) in patients ≥80 years old in 15 hospitals in Spain. The outcome variables were 14-day and 30-day mortality. Multivariate analysis was performed. Results One hundred and twenty episodes were included. Mortality was 22% ( n = 26) on day 14 and 28% ( n = 34) on day 30. In the univariate analysis, the variables associated with mortality were neutropenia, recent surgery, Pitt score ≥2, intensive care unit (ICU) admission, severe sepsis or shock, and abdominal, unknown, and respiratory tract sources. In the multivariate analysis, variables associated with mortality on day 14 were high-risk source (abdominal, unknown, and respiratory tract sources; odds ratio (OR) 7.9, 95% confidence interval (CI) 1.8–33.9), Pitt score ≥2 (OR 5.6, 95% CI 1.3–23.3), inadequate empirical treatment (OR 11.24, 95% CI 1.6–80.2), and severe sepsis or shock at presentation (OR 5.3, 95% CI 1.4–20.7); the interaction between empiric treatment and high-risk source was significant. On day 30, mortality was independently related to a high-risk source (OR 2.92, 95% CI 1.1–7.5) and presentation with severe sepsis or shock (OR 3.81, 95% CI 1.2–12.4). Conclusions Presentation with severe sepsis or shock and a high-risk source of BSI were independent predictors of 14-day and 30-day mortality. Inadequate empirical treatment was also a predictor of early mortality in patients with a high-risk source. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine the characteristics and prognostic factors of early death in the very elderly with acute heart failure (AHF). Patients and methods: We performed a prospective, observational study of AHF patients attended in Emergency Departments (ED), analyzing 45 variables collected in ED and studying troponin, natriuretic peptides and echocardiographies, not always available in the ED. The patients were divided into 2 groups: nonagenarian (age ≥90years) and controls (age <90years). The study variables were mortality and death or reconsultation to the ED for AHF within 30days after inclusion. Results: We included 4700 patients (nonagenarians: 520, 11.1%). The 30-day mortality was 21.5% and 8.7% (p<0.01), respectively with a combined event of 33.3% and 26.7% (p=0.001). Age ≥90years was maintained in all the models associated with death (OR: 1.94, CI 95%: 1.40–2.70). In nonagenarians, chronic kidney insufficiency (OR: 2.07, CI95%: 1.16–3.69), severe functional dependence (OR: 2.18, CI95%; 1.30–3.64) and basal oxygen saturation <90% (OR: 1.97, CI95%: 1.17–3.32) and hyponatremia <135mEq/L (OR: 1.89, CI95%: 1.05–3.42) were predictive variables of mortality. We observed an association between elevated troponin levels and natriuretic peptide values >5180pg/mL and mortality (OR: 4.26, CI95%: 1.83–9.89; and OR: 3.51, CI95%: 1.45–8.48; respectively). Conclusions: The profile of nonagenarians with AHF differs from that of younger patients. Although very advanced age is an independent prognostic factor of mortality, these patients have fewer predictive factors of mortality, being only functional deterioration, basal kidney disease, hyponatremia and respiratory insufficiency on arrival at the ED and probably troponin values and elevated natriuretic peptides. [Copyright &y& Elsevier]

Abstract: Introduction: D-dimer is commonly used in the workup of suspected Pulmonary Embolism (PE), but its specificity decreases with age. We evaluated whether using a higher cutoff value for D-dimer could increase the test specificity without reducing its sensitivity for ruling-out PE in elderly and very elderly patients presenting to the Emergency Department (ED). Material and Methods: All patients with D-dimer and pulmonary Computed Tomography Angiography (CTA) performed in the ED of Vimercate Hospital, from 2010 through 2012 for clinical suspicion of PE were included in this retrospective cohort study. Results: Study population 481 patients (63.4% women, mean age 73.0±16.1years, confirmed PE 22.5%). In very elderly patients (aged 80 or more years, n=191), compared with standard 490ng/mL D-dimer threshold, both higher fixed (1000ng/mL) and age-adjusted cutoffs increase the specificity of D-dimer for the exclusion of PE maintaining a Negative Predictive Value of 100%. Potentially avoided CTAs were 12(6.3%) using 1000ng/mL cutoff and 10(5.2%) age-adjusted. In very elderly patients the Number Needed to Test was incalculable for the standard cutoff (0 cases), 16 for 1000ng/mL and 19 for age-adjusted. In patients with PE, index episode mortality was 6.5%, and death occurred only in subjects with D-dimer values above 1000ng/mL and age-adjusted thresholds. Conclusion: For very elderly patients with suspected PE in ED, both higher fixed D-dimer (1000ng/mL) and age-adjusted thresholds increase test specificity for excluding PE without reducing its sensitivity, leading to a safe reduction in the number of CTAs. [Copyright &y& Elsevier]

Background: Elderly patients undergoing surgical revascularisation may disproportionately benefit from avoiding manipulation of the ascending aorta and cardiopulmonary bypass. In this multi-centre observational study, we sought to determine the 30-day outcomes of anaortic off-pump coronary artery bypass (OPCAB) in an elderly and very-elderly population. Methods: Data were prospectively collected for all patients aged >70 years old (y) undergoing anaortic OPCAB at three hospitals between January 2002 and October 2011. Analysis was carried out on two age sub-groups (70–79y vs. ≥80y). Multiple logistic regression was used to identify predictors of post-operative 30-day mortality. Results: In total, 1135 patients >70 years underwent anaortic OPCAB – 817 (72%) patients were aged 70–79y while 318 (28%) were aged ≥80y. The rate of mortality and morbidity for both groups was low: 30-day mortality (70–79y: 1.8%; ≥80y: 2.8%) or permanent stroke (70–79y: 0.2%; ≥80y: 0.9%). Chronic lung disease, a history of previous myocardial infarction and left main disease were independent predictors of 30-day mortality. Conclusions: OPCAB is associated with low rates of 30-day mortality and peri-operative stroke in this elderly and very elderly patient cohort. Anaortic OPCAB can provide excellent short-term post-operative outcomes and may give the elderly and very elderly population the opportunity to benefit from surgical coronary revascularisation. [Copyright &y& Elsevier]

Abstract: Summary: To describe the characteristics of nonagenarians admitted to the surgical and medical divisions at a tertiary hospital and compare them with nonagenarians admitted to other hospital care services. Methods: A retrospective study of all hospital discharge episodes via the registry of the Basic Minimum Data Set at the Hospital General Universitario de Alicante from January 2007 until December 2011. Results: Of the 165,870 hospitalizations, 2461 (1.5%) were nonagenarians. The highest number of admitted nonagenarians was in the Division of General Internal Medicine (DGIM) (n=751), followed by the short stay unit (SSU) (n=633). The rate of nonagenarians per 100 admissions to the DGIM was 10.2, significantly higher than that of those admitted to the SSU (6.2) (p<0.001), the service of orthopedic and trauma surgery (2.2) (p<0.001), and other specialties. Females comprised 64.8% of the nonagenarians. Mortality was 17% for the nonagenarians admitted, while for those admitted to the DGIM it was 27.7%. Those hospitalized in the SSU had a lower risk of death during hospitalization (8.1%) (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.16–0.32) and a greater risk of being admitted for diseases and disorders of the circulatory system (OR: 1.58, 95% CI: 1.22–2.05), particularly for heart failure and shock (OR: 1.82, 95% CI: 1.30–2.53), and being discharged with home hospitalization (OR: 8.05, 95% CI: 5.5–11.8). Conclusions: Nonagenarian patients represent a tenth of those admitted to the DGIM. The profile of nonagenarians admitted to the DGIM is different from other hospital services. Hospital mortality for nonagenarians admitted to the DGIM is high and superior to other hospital services. [Copyright &y& Elsevier]

Abstract: Background: Heart failure (HF) is frequent in elderly patients, but few studies have focused on patients older than 84years. The aim of this study was to evaluate major comorbidities and 1-year survival in HF patients aged ≥85years compared with younger age groups. Methods: Patients included in a prospective national registry of HF (RICA) were evaluated. Sociodemographic data, Charlson comorbidity index, cognitive status, basal functional status, body mass index, NYHA functional class, and left ventricle ejection fraction (LVEF) were recorded. Patients aged ≥85years were compared with the rest using the Cox regression model to detect independent predictive factors of 1-year survival. Results: Of the 1172 patients included, 224 (19%) were aged over 84years-old, mostly women, with hypertensive heart disease (46%, p<0.001) and preserved LVEF (68.7%; p<0.001). Diabetes (p<0.001), dyslipidemia (p=0.03) and obesity (p<0.001) were less prevalent in this group of patients. One-year mortality in the oldest old patients was 26.3%, which was higher than the rest (p<0.001). By multivariable analysis, a higher NYHA functional class (p=0.038), anemia (p=0.037), absence of obesity (p=0.002), and a worse functional status (p=0.049) were related to a worse 1-year survival in the oldest HF patients. Conclusions: The oldest old HF patients have differential characteristics with lower prevalence of diabetes, dyslipidemia and obesity and a lower 1-year survival. Independent factors related to a worse 1-year survival in the oldest age group were a higher NYHA class, a worse functional status, presence of anemia and absence of obesity. [Copyright &y& Elsevier]

Background: There are very few data about percutaneous coronary intervention (PCI) in very elderly patients. This study was aimed at assessing the demographic, clinical and angiographic features, procedural characteristics and in-hospital results of very elderly patients (VEP), aged ≥85 years undergoing PCI and comparing their results with those of a control group (CG) of patients younger than 85 years undergoing PCI throughout the same period of time. Methods and Results: Between November 2004 and January 2007, 1699 consecutive PCI procedures were evaluated, 102 (6%) PCI procedures were performed in VEP and 1597 (94%) in patients <85 years. The mean age in the VEP group was 87.4±2.4 years vs. 66.7±11.2 years in the CG (p <0.0001). There were more females in the VEP group 49% vs. 22% than in the CG p <0.0001. Acute coronary syndromes (ACS) were a more frequent indication for PCI in VEP than in the CG: ST segment elevation myocardial infarction (STEMI) 14.7% vs. 8.3%, p =0.025 and non-ST segment elevation acute coronary syndromes 54.9% vs. 43.5%, p =0.024. The proportion of drug-eluting stents used, although high in both groups, was lower in VEP than in the CG (86.5% vs. 92.9%, p =0.005). Angiographic lesion success rates were similar in both groups (95.9%). Global unadjusted in-hospital mortality was higher in the VEP group in comparison with the CG 3.9% vs. 0.68%, p =0.01. The difference in mortality was due only to PCI in patients presenting with STEMI (26.6% in VEP group vs. 3.7% in the CG p =0.007). There were no in-hospital deaths in VEP presenting with stable coronary syndromes or other ACS. There were no differences in unadjusted in-hospital myocardial infarction, new revascularisation or stroke between both groups. Conclusions: In patients ≥85 years old, PCI seems effective and carries an acceptable in-hospital mortality rate. The presence of STEMI substantially increases the risk of in-hospital death. [Copyright &y& Elsevier]

Abstract: Objective: To verify the existence of association between plasma levels of pro- or anti-inflammatory mediators and atherosclerotic burden at coronary and carotid arteries in individuals aged of 80 or more years old. Methods: Healthy individuals aged between 80 and 102 years old (n =178) underwent evaluation of plasma cytokines and acute phase proteins, intima-media thickness (IMT) and presence of plaques in carotid arteries by ultrasound and coronary artery calcification (CAC) by cardiac computed tomography. Results: There was no association between CAC and carotid plaques (p =0.8), maximum (p =0.06) or mean IMT (p =0.2). No association was found between the presence of carotid plaques and CRP (p =0.4), TNF-α (p =0.8) or IL-10 (p =0.2). Likewise, individuals in the first three quartiles for CRP, TNF-α or IL-10 had similar values of CAC, mean and maximum IMT. In contrast, individuals above the 75th percentile for CRP or for TNF-α had enhanced maximum IMT (p =0.017 and p <0.0001) and CAC (p =0.026 and p =0.01) and subjects with IL-10 levels above the 75th percentile had lower maximum IMT (p =0.027) and CAC (p =0.006) as compared with those below this percentile. There was no difference in mean IMT for individuals above or below the 75th percentile for CRP, TNF-α or IL-10. Conclusion: In very old individuals, CAC and maximum IMT were positively associated with systemic inflammatory activity only in those above the 75th percentile. The markers of atherosclerotic burden at coronary and carotid arteries were not related to each other and were distinctly associated with pro- and anti-inflammatory mediators, suggesting that atherosclerosis development is different in these vascular beds. [Copyright &y& Elsevier]

Abstract: Summary: Patients over 90years of age (the “very elderly”) account for an increasing number of admissions to departments of internal medicine (IM). The aim of this study was to analyse the demographic data, hospitalization characteristics, medical complications, and predictors of mortality in patients over 90 admitted to IM departments. Material and methods: All patients admitted to IM departments in Spain between the years 2005 and 2007 were analysed. Clinical and demographic data were compared with records from “younger elderly” patients (65–90). Results: During the study period, there were 1,567,659 patient admissions to IM departments in Spain, and 90,679 (5.8%) were older than 90. Hospital mortality occurred in 22.3% of very elderly patients. The main predictors for hospital death were pressure ulcer (Odds Ratio [OR] 1.55, CI95% 1.45–1.66), thromboembolic disease (OR 1.83, CI95% 1.61–2.09), nosocomial pneumonia (OR 2.53, CI95% 2.39–2.69), hip fracture (OR 2.20, CI95% 1.53–3.18), male gender (OR 1.06, CI95% 1.03–1.10), age (OR 1.05, CI95% 1.04–1.06), dementia (OR 1.13, CI95% 1.08–1.18), cancer (OR 1.60, CI95% 1.51–1.71), acute respiratory failure (OR 1.83, CI95% 1.76–1.89), acute infectious disease (OR 2.30, IC95% 2.11–2.52), and Charlson comorbidity index (OR 1.21, CI95% 1.16–1.26). Conclusions: Very elderly patients represent a large and growing fraction of the total admissions to IM departments in Spain. They are at higher risk for complications during their hospital stay and mortality rate is double that of the younger elderly. [ABSTRACT FROM AUTHOR]

• Very elderly patients are more vulnerable to toxic effects of prescribed medications. • Safe doses of continuous infusion (CI) piperacillin/tazobactam should be considered. • Doses of CI piperacillin/tazobactam should not exceed 13.5g daily in very elderly patients. These doses ensure optimal cumulative fractions of response against Escherichia coli and Proteus mirabilis alone. Continuous infusion (CI) piperacillin/tazobactam is frequently used to treat infections in very elderly patients. This study aimed to conduct a population pharmacokinetic analysis of CI piperacillin/tazobactam, and to identify optimal dosages for safe and effective probability of target attainment (PTA) against Enterobacterales and Pseudomonas aeruginosa. Non-linear mixed-effects modelling was performed with Pmetrics. Monte Carlo simulations assessed the steady-state concentration (Css) of increasing piperacillin/tazobactam regimens (from 2.25 to 18 g daily by continuous infusion). Permissible doses were defined as those associated with <10% probability of Css >157.2 mg/L. PTA at the pharmacodynamic targets of free plasma steady-state concentration (f Css)/minimum inhibitory concentration (MIC) ≥1 and ≥4 and cumulative fraction of response (CFR) against EUCAST MIC distribution were also calculated. A total of 141 patients (median age 85 years) provided 217 plasma piperacillin Css. Most patients (55.2%) had hospital-acquired pneumonia and intra-abdominal infections. A one-compartment pharmacokinetic model with parallel linear and Michaelis–Menten elimination best described piperacillin data. Creatinine clearance (CL CR) was the covariate retained by the model. Pharmacokinetic estimates were 6.05 L/h for clearance and 3.39 mg/L for the Michaelis–Menten constant. Permissible doses were up to 4.5, 9, 11.25 and 13.5 g daily by continuous infusion for patients with CL CR of 0–19, 20–39, 40–59 and 60–79 mL/min/1.73 m2, respectively. At the clinical breakpoint of 8 mg/L, the permissible doses only achieved optimal PTA for f Css/MIC ≥1 in patients with CL CR 20–79 mL/min/1.73 m2. Optimal CFRs with the permissible doses were only attained against Escherichia coli and Proteus mirabilis. Permissible dosages and CL CR should be considered for prescribing CI piperacillin/tazobactam in very elderly patients. [ABSTRACT FROM AUTHOR]

Abstract: Sézary Syndrome (SS) is an aggressive T-cell malignancy often presenting in advanced age and associated with poor prognosis. There is no standard therapy and because of co-morbidities, elderly patients are particularly challenging to treat. Alemtuzumab is an anti-CD52 monoclonal antibody that has activity in SS but is profoundly immunosuppressive, leading to great hesitation about its use in older patients. We treated five octogenarian patients with SS with subcutaneous (SQ) alemtuzumab, at relapse or as initial therapy, for 5–9 weeks. With the exception of transient grade 1–2 hematological toxicity and asymptomatic cytomegalovirus (CMV) (two patients) and Epstein-Barr virus (EBV) (one patient) reactivation, no other toxicities were observed. The clinical and hematological complete response (CR) rate was 100%. Three patients achieved durable responses (8+ to 17+ months). Alemtuzumab was safely administered and showed significant activity in very elderly SS patients. [Copyright &y& Elsevier]

Objective: The goal of this study is to understand how very elderly patients (VEP) after ischemic stroke are currently treated in a Stroke Unit (SU) Hub in Italy. We designed a retrospective monocentric study on patients admitted in the SU of "AO San Camillo Forlanini" over an 8-year period.Material and Methods: Data were collected among patients with acute ischemic stroke admitted to SU between January 2012 and December 2019. Patients were divided into three sub-groups: Adults (18-65 years); Elderly (66-85 years); and VEP (>85 years). Vascular risk factors and clinical variables as predictors of short-term clinical outcome were compared among age groups.Results: A total of 1979 patients were enrolled, 254 were VEP (12.8%). The proportion of VEP showed no significant modifications during the 8-year period (11.9% in 2012-2015 and 13.7% in 2016-2019; p=0.93). The proportion of women, hypertension and atrial fibrillation was significantly higher in VEP compared to other age groups (p<0.001). The rate of VEP being treated with rt-PA increased from 2012-2015 to 2016-2019 (from 12.8% to 25.5%, p<0.001). Endovascular thrombectomy was rarely performed in VEP (1.5% of VEP). Rt-PA treatment was associated with favorable outcome for all three age groups (p<0.05).Conclusions: We showed that VEP present different vascular risk factor profiles, clinical features, and prognostic elements for short-term stroke outcome. Future studies will reveal whether we will observe an increasing trend in the use of rt-PA and endovascular thrombectomy and whether it will result in improved functional outcome for VEP. [ABSTRACT FROM AUTHOR]

[Display omitted] • Treatment of elderly DLBCL patients represents a particular challenge. • Most clinical trials exclude the octogenarian patients with DLBCL. • Evidence favours R-miniCHOP treatment for very elderly fit patients. • Less intensive regimens should be considered for very elderly unfit. • Geriatric assessment is an important tool for selecting the best candidates to receive curative therapy. Diffuse large B cell Lymphoma (DLBCL) is a potentially curative lymphoma with increasing incidence with ageing. Treatment of elderly DLBCL patients represents a particular challenge due to their comorbidities and performance status. A search for original articles focused on the treatment of elderly DLBCL patients was performed in PubMed database and 633 were found and reviewed. Thirty-eight studies meeting our inclusion criteria were published since 2007. Thirteen studies were retrospective and 25 phase II/III clinical trials. Most of them investigated the efficacy of dose-adjusted R−CHOP regimen. Alternative therapeutic drugs together with geriatric assessment were also evaluated. For fit patients aged 80 and over, the strongest evidence favours R-miniCHOP regimen. A dose-adjusted R−CHOP may be the recommended treatment in elderly DLBCL patients. New tools such as the Comprehensive Geriatric Assessment provide useful guidance for treatment choice, based on comorbidities and frailty index of this group. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of outcomes data in patients over 80 years presenting with intracerebral hemorrhage (ICH). The primary aim of our study is to describe outcomes in this patient population.Method: Retrospective study of patients admitted with primary ICH from January 2012 to July 2018. Data were obtained from the Rush University Get With The Guidelines database; only patients 80 or above were included.Results: A total of 1713 patients were screened and 220 patients met inclusion criteria. About 68.2% were female and mean age was 85.6 years old. Median ICH score on admission was 2 (IQR 1-3). Location of ICH included: deep (48.2%), lobar (40%), and cerebellum (9.5%). ICH etiologies included hypertensive (51.8%), cerebral amyloid angiopathy (26.8%), coagulopathy (5.9%), and the remaining were undetermined. CT angiograms were performed in 34.5% (n = 76) of patients; of these patients one arteriovenous malformation was identified. Patients underwent the following procedures: external ventricular drains (8.6%), decompression (3.6%), and ventriculoperitoneal shunts (1.8%). Tracheostomy and percutaneous gastrostomy placement were performed in 8.2%. About 4.5% had seizures and 1.5% were treated for status epilepticus. Disposition at hospital discharge included: subacute nursing facility ([SNF] 24.1%), acute rehabilitation (23.2%), hospice (18.2%), death (18.2%), home (11.8%), long-term acute care facility ([LTAC] 3.6%), and unknown (1%). Patients with an ICH score ≥2 on admission had a roughly 6 times higher chance of experiencing an unfavorable outcome (LTAC, SNF, or death), when compared to patients with lower ICH score.Conclusions: This study shows that a significant proportion (35%) of ICH patients ≥80 years old have a good outcome, with discharge to home or to rehabilitation. Our data suggest that older patients with ICH presenting with supratentorial hemorrhages (volume < 30 cc) without intraventricular extension can have good outcomes despite their age. [ABSTRACT FROM AUTHOR]

The epidemiologic distribution of hypertension among very elderly Chinese is still not clear. This study aimed to investigate the prevalence, awareness, treatment, and control rate of hypertension among very elderly in Chengdu. From May 2013 to May 2015, a total of 1056 participants from 20 residential communities were sampled. Standard face-to-face interviews, physical examinations, and biochemical analysis were undertaken. Participants had a mean age of 83.6 ± 3.4 years (range: 80–100), and 49.8% were men. Mean systolic blood pressure (BP) and diastolic BP were 146.4 ± 20.6 and 74.1 ± 11.9 mm Hg, respectively, and both of the highest BP levels were among participants aged 80–84 years. Mean pulse pressure was 72.5 ± 17.1 mm Hg, and the highest pulse pressure level was among participants aged 90 years and older. The overall estimated hypertension prevalence was 75.3% (95% confidence interval: 72.6%–77.9%), and among overall participants, 51.9% were aware of their hypertensive condition and 45.5% were treated. However, only 18.1% of hypertensive participants were controlled (BP < 140/90 mm Hg). Among very elderly Chinese in Chengdu, the prevalence of hypertension is predominantly high, whereas awareness, treatment, and control rates are considerably low. Effective primary and secondary prevention strategies are needed. [ABSTRACT FROM AUTHOR]