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Purpose: Pre‐existing comorbidities play an important role in choice of cancer treatment. We retrospectively evaluated the relationship between pre‐existing comorbidities and receipt of local and systemic therapy in a cohort of Black women with Stage I–III breast cancer. Methods: The study population for analysis included 1169 women with Stage I–III disease enrolled in the Detroit Research on Cancer Survivors (ROCS) cohort. Information on comorbidities, socio‐demographic, and clinical variables were obtained from self‐reported questionnaires and the cancer registry. Comorbidities were analyzed individually, and comorbidity burden was categorized as low (0–1), moderate (2–3) or high (≥4). We used logistic regression analysis to evaluate factors associated with receipt of local treatment (surgery ± radiation; N = 1156), hormonal (N = 848), and chemotherapy (N = 680). Adjusted models included variables selected a priori that were significant predictors in univariate analysis. Results: Receipt of treatment was categorized into local (82.6%), hormonal (73.7%), and/or chemotherapy (79.9%). Prior history of arthritis and depression were both associated with a lower likelihood to receive local treatment, [odds ratio (OR), 95% confidence interval (CI), 0.66, 0.47–0.93, and 0.53, 0.36–0.78], respectively. Obesity was associated with higher likelihood of receiving hormonal therapy (OR: 1.64, 95% CI: 1.19, 2.26), and heart failure a lower likelihood (OR: 0.46, 95% CI: 0.23, 0.90). Older age (Ptrend <0.01) and increasing co‐morbidity burden (Ptrend = 0.02) were associated with lower likelihood of receiving chemotherapy. Conclusion: History of prior co‐morbidities has a potentially detrimental influence on receipt of recommended cancer‐directed treatment among women with Stage I–III breast cancer. [ABSTRACT FROM AUTHOR]

Background: Advanced age is associated with decreased likelihood of colorectal cancer treatment. Here, we investigated the extent to which comorbidities are accountable for this lesser treatment. Methods: Using population‐based datasets, the pattern of care among CRC cases in South Australia during 2004–2013 was investigated. Models were used to investigate associations of age with each treatment type, and differences in these associations were explored by comorbidity and cancer site. Results: The presence of comorbidity was associated with a significantly weaker relationship of age with surgery and chemotherapy. The association of age with surgery also varied for colon and rectal primary cancer sites. Individual comorbidity types varied in their associations with each treatment category. For example, dementia was associated with less chemotherapy provision, however, it was not significantly related to the likelihood of surgery. Conclusion: This study indicates that the association of age with surgical treatment differed significantly by the CRC subsite. Comorbidity moderated the negative association of age with chemotherapy, and less so, with extent of surgery. Results were novel in indicating associations of multiple individual comorbidity types with CRC treatment modalities. The data suggest that different individual comorbidity types may have different effects on treatment and should be studied separately. [ABSTRACT FROM AUTHOR]

The regulation of erythropoiesis via hemodynamic stimuli such as reduced central blood volume (CBV) remains uncertain in women and elderly individuals. This study assessed the acute effects of lower body negative pressure (LBNP) on key endocrine biomarkers regulating erythropoiesis, that is, erythropoietin (EPO) and copeptin, in young and older women and men (n = 87). Transthoracic echocardiography and hemodynamics were assessed throughout incremental LBNP levels for 1 hour, or until presyncope, with established methods. Venous blood samples were collected at baseline and immediately after termination of the orthostatic tolerance (OT) test for subsequent hormone analyses. The average age of young women and men (33.1 ± 6.0 vs. 29.5 ± 6.9 yr) and older women and men (63.8 ± 8.0 vs. 65.3 ± 8.9 yr) as well as their physical activity levels were matched within each age and sex group. CBV, as determined by right atrial volume, was reduced in all individuals at the end of the OT test (p < 0.001). The average OT time ranged from 50.1 to 58.1 min in all individuals. LBNP increased circulating EPO in young women (p = 0.023) but not in young men or older individuals. Copeptin was increased in all individuals with LBNP but was exclusively associated with EPO in men (r = 0.39, p = 0.013). The present study indicates that the acute hemodynamic regulation of EPO production is both sex‐ and age‐dependent. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Speech recognition with a cochlear implant (CI) tends to be better for younger adults than older adults. However, older adults may take longer to reach asymptotic performance than younger adults. The present study aimed to characterize speech recognition as a function of age at implantation and listening experience for adult CI users.Study Design: Retrospective review.Methods: A retrospective review identified 352 adult CI recipients (387 ears) with at least 5 years of device listening experience. Speech recognition, as measured with consonant-nucleus-consonant (CNC) words in quiet and AzBio sentences in a 10-talker noise masker (10 dB signal-to-noise ratio), was reviewed at 1, 5, and 10 years postactivation.Results: Speech recognition was better in younger listeners, and performance was stable or continued to improve through 10 years of CI listening experience. There was no indication of differences in acclimatization as a function of age at implantation. For the better performing CI recipients, an effect of age at implantation was more apparent for sentence recognition in noise than for word recognition in quiet.Conclusions: Adult CI recipients across the age range examined here experience speech recognition benefit with a CI. However, older adults perform more poorly than young adults for speech recognition in quiet and noise, with similar age effects through 5 to 10 years of listening experience.Level Of Evidence: 3 Laryngoscope, 131:2106-2111, 2021. [ABSTRACT FROM AUTHOR]

Objective: To develop a clinical model for predicting postoperative acute kidney injury (AKI) in patients of advanced age undergoing cardiac surgery. Methods: A total of 848 patients (aged ≥ 60 years) undergoing cardiac surgery were consecutively enrolled. Among them, 597 were randomly selected for the development set and the remaining 251 for the validation set. AKI was the primary outcome. To develop a model for predicting AKI, visualized as a nomogram, we performed logistic regression with variables selected by Lasso regression analysis. The discrimination, calibration, and clinical usefulness of the new model were assessed and compared with those of Cleveland Clinic score and Simplified Renal Index (SRI) score in the validation set. Results: The incidence of AKI was 61.8% in the development set. The new model included seven variables including preoperative serum creatinine, hypertension, preoperative uric acid, New York Heart Association classification ≥ 3, cardiopulmonary bypass time > 120 min, intraoperative red blood cell transfusion, and postoperative prolonged mechanical ventilation. In the validation set, the areas under the receiver operating characteristic curves for assessing discrimination of the new model, Cleveland Clinic score, and SRI score were 0.801, 0.670, and 0.627, respectively. Compared with the other two scores, the new model presented excellent calibration according to the calibration curves. Decision curve analysis presented the new model was more clinically useful than the other two scores. Conclusions: We developed and validated a new model for predicting AKI after cardiac surgery in patients of advanced age, which may help clinicians assess patients' risk for AKI. [ABSTRACT FROM AUTHOR]

Doxorubicin is the most effective single agent in the treatment of non‐Hodgkin's lymphoma (NHL). Its use is limited because of the cardiac toxicity primarily in elderly patients (pts) and in pts with history of cardiac disease. Liposomal doxorubicin has been proven to reduce cardiotoxicity. The aim of this retrospective study was the use of nonpeghylated liposomal doxorubicin (NPLD) in term of efficacy, response rate and incidence of cardiac events. We retrospectively collected the experience of 33 Hematological Italian Centers in using NPLD. Nine hundred and forty‐six consecutive pts treated with R‐COMP (doxorubicin was substituted with NPLD, Myocet) were collected. Median age was 74 years, the reasons for use of NPLD were: age (466 pts), cardiac disease (298 pts), uncontrolled hypertension (126 pts), other reasons (56 pts). According to clinicians' evaluation, 49.9% of pts would not have used standard doxorubicin for different situations (age, cardiomyopathy, previous use of doxorubicin, and uncontrolled hypertension). Overall 687 pts (72.6%) obtained a complete remission (CR). About 5% (n = 51) of subjects developed major cardiotoxic events including heart failure (N = 31), ischemic heart disease (N = 16), acute heart attack (N = 3), and acute pulmonary oedema (N = 1). After a median follow‐up of 32 months, 651 pts were alive and the overall survival (OS) was 72%. After a median observation period of 23 months disease free survival (DFS) was 58%. Either in univariate or in multivariate analysis OS and DFS were not significantly affected by age or cardiac disease. Our findings strongly support that including R‐COMP is effective and safe when the population is at high risk of cardiac events and negatively selected. Moreover, the use of this NPLD permitted that about half of our population had the opportunity to receive the best available treatment. [ABSTRACT FROM AUTHOR]

Problem To determine if maternal immune maladaptation associated with pre-eclampsia is reflected in the rubella immunity status. Method of study Incidence of pre-eclampsia was compared between rubella non-immune and immune gravidae carrying a singleton pregnancy beyond 24 weeks, taking into account maternal characteristics and reported risk factors for pre-eclampsia. Results The 9870 (10.4%) rubella non-immune gravidae among the 95 024 in the cohort exhibited no difference in incidence of underlying medical disorders, but they were slightly but significantly older, shorter, heavier, and had more pre-eclampsia ( OR 1.24, 95% CI 1.05-1.47) despite having fewer nulliparas. Regression analysis confirmed an overall association between rubella non-immunity with pre-eclampsia ( aOR 1.27, 95% CI 1.06-1.54), which was related to multiparas ( aOR 1.42, 95% CI 1.05-1.91) and carrying a male fetus ( aOR 1.37, 95% CI 1.06-1.78). Conclusion The association between rubella non-immunity and pre-eclampsia reflects immune maladaptation in multiparas and toward a male fetus. [ABSTRACT FROM AUTHOR]

Aim To investigate which risk factors contribute to a lower oocyte retrieval ratio in women who are receiving controlled ovarian hyperstimulation. Methods The authors retrospectively analyzed 329 in vitro fertilization (IVF) cycles under controlled ovarian hyperstimulation by using a gonadotropin-releasing hormone antagonist or agonist at Osaka Medical College, Japan. The patients were classified into five groups: advanced age, male infertility, severe endometriosis, tubal infertility, and unexplained infertility. The primary outcomes were the patients' age, oocyte retrieval ratio, serum basal follicle-stimulating hormone, total dose of gonadotropin, and the clinical outcome. A secondary outcome was the stepwise multivariate logistic regression analysis to assess the factors associated with the failure of oocyte retrieval. Results The oocyte retrieval ratio declined significantly with the patient's age. The ratio of endometriosis in unsuccessful cases was significantly higher than that in successful cycles. Advanced age and endometriosis were the factors that were significantly associated with a lowered oocyte retrieval rate. Conclusion Advanced age and endometriosis are high-risk factors that contribute to oocyte retrieval failure in infertile patients who are receiving IVF treatment. [ABSTRACT FROM AUTHOR]

Aim The purpose of the paper was to compare the prevalence of barriers to optimum postoperative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. Background It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. Methods A questionnaire-based study of 1602 nurses working at clinical, provincial and municipal hospitals. Results In the clinical hospitals barriers more often related to a poorly organised systems of care and obstacles in discussing pain management within the team. In provincial and municipal hospitals lack of uninform pain measurement was more evident. Conclusions Despite the availability of effective pain treatments in hospitals difficulties continue with communication, poorly organised care and limited access to clinical guidelines. Implications for nursing management Although there are possibilities of pain relief after surgery, they are still used insufficiently. Postoperative pain management in Poland needs considerable improvement. This study can contribute to the improvement of pain management quality by supporting and developing practical guidelines or management algorithms for nurses, facilitating the effective implementation of new pain management practices. [ABSTRACT FROM AUTHOR]

Background Microvascular reconstruction in head and neck surgery is increasing in the elderly because of prolonged life expectancy. The purpose of this study was to evaluate the impact of age on outcomes after microvascular reconstruction. Methods We retrospectively reviewed 453 microvascular reconstructions and stratified patients according to age (40.8% >65 years old). Medical and surgical complications and flap success rates were evaluated according to the American Society of Anesthesiologists (ASA) score for physical status and age. Results Overall flap success and perioperative mortality were 96.1% and 0.7%, respectively. Minor medical complications were higher in the elderly (28.1% vs 15.3%; p = .001). High ASA scores affected rates of major surgical (20% vs 9.2%; p = .001) and minor medical complications (27.2% vs 13.3%; p < .001). Conclusion Microvascular reconstruction is reliable in the elderly. Age should not be considered a contraindication by itself; comorbidities play a stronger role in predicting adverse events. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1488-E1492, 2016 [ABSTRACT FROM AUTHOR]

The purple urine bag syndrome is an underrecognized but quite common condition, resulting in marked discoloration of the urine bag system due to bacterial metabolism. This syndrome is associated with advanced age and bedridden persons. [ABSTRACT FROM AUTHOR]

Objectives To better understand how centenarians use the healthcare system as an important step toward improving their service delivery. Design Population-based retrospective cohort study using linked health administrative data. Setting Ontario-Canada's largest province. Participants All individuals living in Ontario aged 65 and older on April 1 of each year between 1995 and 2010 were identified and divided into three age groups (65-84, 85-99, ≥100). A detailed description was obtained on 1,842 centenarians who were alive on April 1, 2010. Measurements Sociodemographic characteristics and use of health services. Results The number of centenarians increased from 1,069 in 1995 to 1,842 in 2010 (72.3%); 6.7% were aged 105 and older. Over the same period, the number of individuals aged 85 to 99 grew from 119,955 to 227,703 (89.8%). Women represented 85.3% of all centenarians and 89.4% of those aged 105 and older. Almost half of centenarians lived in the community (20.0% independently, 25.3% with publicly funded home care). Preventive drug therapies (bisphosphonates and statins) were frequently dispensed. In the preceding year, 18.2% were hospitalized and 26.6% were seen in an emergency department. More than 95% saw a primary care provider, and 5.3% saw a geriatrician. Conclusion The number of centenarians in Ontario increased by more than 70% over the last 15 years, with even greater growth among older people who could soon become centenarians. Almost half of centenarians live in the community, most are women, and almost all receive care from a primary care physician. [ABSTRACT FROM AUTHOR]

Objective. To present cycle characteristics and results of in vitro fertilization in 27 patients with hypogonadotropic hypogonadism. Further, to demonstrate the consequences of advanced age (&nvge;35 years). Methods. Data from 27 hypogonadotropic hypogonadism patients treated with in vitro fertilization in the period from 2000 to 2004 were analyzed and compared with treatment results from 39 patients with unexplained infertility. Moreover, data from hypogonadotropic hypogonadism patients were analyzed according to the age factor. Mann–Whitney U, Chi-square, and Student's t-tests were used for statistical analysis. p<0.05 was considered significant. Results. Higher gonadotropin consumption and a longer stimulation period were observed in the hypogonadotropic hypogonadism group. Peak E2 levels, and the total number of oocytes and metaphase II oocytes were higher in the unexplained infertility group. Although a higher number of grade I embryos were transferred in the unexplained infertility group, the implantation rate was found to be better in the hypogonadotropic hypogonadism group (36.5% versus 13%; p<0.0001). Pregnancy rates were similar. When hypogonadotropic hypogonadism patients were evaluated according to the age factor, no significant difference was found with regard to cycle and outcome parameters, except higher gonadotropin consumption in aged patients. In aged hypogonadotropic hypogonadism patients, a pregnancy rate of 50% was achieved. Conclusion. Hypogonadotropic hypogonadism women undergoing in vitro fertilization were found to be good responders. In the presence of advanced age, management of these patients becomes challenging. However, even these patients still have a good chance of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of edentulousness with systemic factors: age, gender, tobacco-smoking, alcohol intake, body mass index, functioning in daily living, cortical thickness at the mandibular angle, and systemic diseases: bone-fracture (an indicator for osteoporosis), diabetes, thyroid disease, hyperparathyroidism, asthma, head failure, hypertension. Methods: The study population comprised 293 elderly subjects, 124 (42%) edentulous and 169 (58%) dentate. The data from clinical and radiographic examinations and structured interviews were analyzed by multiple logistic regression. Results: When edentulousness in both the mandible and the maxilla was considered, history of bone fracture and tobacco-smoking were significantly related to complete edentulousness with odds ratios (OR) of 2.51 (95% CI: 1.47-4.28) and 2.42 (95% CI 1.32-4 43) respectively, associations independent of age and gender. A similar association was found for the edentulous mandible. In the elderly subjects with an edentulous maxilla, besides the significant factor of history of bone fracture and tobacco-smoking, asthma was also associated with edentulousness at an odds ratio of 10.81 (95% CI: 1.38-84.66), oldest subjects most often being edentulous (OR: 2.23, 95% CI: 1.13-4.39). Diabetes was not related to edentulousness either in the mandible or in the maxilla. Conclusions: The finding of associations of history of bone fracture, tobacco-smoking and asthma with edentulousness emphasizes the association of systemic conditions with edentulousness. Advanced age was related to an edentulous maxilla. The relationship between asthma and total tooth loss in the maxilla might suggest a local oral effect of medications used by asthmatic patients. [ABSTRACT FROM AUTHOR]

The therapeutic efficacy of thiothixene in the treatment of behaviorally agitated dementia nursing home patients was studied in a double-blind, randomized, placebo-controlled clinical trial. Thirty-three subjects were randomized for thiothixene (dose range: 0.25–18 mg) or placebo treatment over an 11-week period, followed by a 6-week crossover period to assess for return of symptoms in the group crossed over to placebo and further improvement in the group crossed over to thiothixene. Thiothixene was significantly more effective than placebo in the reduction of agitation at the end of 11 weeks of treatment. Symptoms tended to return after discontinuation. There were no significant changes in the Mini-Mental State Examination (MMSE) or Activities of Daily Living (ADLs) and no significant differences in side-effects. Two placebo-treated patients died, and two patients died after being crossed over from thiothixene to placebo. The results suggest the efficacy of low doses of thiothixene for well-defined agitation in specifically selected demented nursing home patients. [ABSTRACT FROM AUTHOR]

We investigated the common carotid arterial blood blow in 70 patients of advanced age (80 and older) in a nursing home using an ultrasonic quantitative blood flow measurement system. Systolic and end-diastolic velocities were obtained from the waveform, and using these two velocities, subjects were classified into three groups according to increasing severity. We then determined mortality rates and changes in the modified Stockton Geriatric Rating Scale (SGRS) over a 1-year period. The mortality of group 1 was significantly lower than that of group 3. the groups with more severely impaired carotid blood flow also demonstrated as groups change in the sequence 1→2→3 a worsening on some subscales of the modified SGRS over the year. These results suggest that carotid arterial blood flow velocity waveform can serve to predict some aspects of clinical outcome in very old age. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Waldenström U, Gottvall K, Rasmussen S. Caesarean section in nulliparous women of advanced maternal age has been reduced in Sweden and Norway since the 1970s: a register-based study. BJOG 2012;119:1591-1596. Objective To investigate rates of caesarean delivery in Sweden and Norway from 1973 to 2008 in relation to advanced and very advanced maternal age. Design Register study. Setting Sweden and Norway. Sample All nulliparous women aged over 30 years with a singleton pregnancy, with the fetus in a cephalic presentation, and delivering at term between 1973 and 2008 were evaluated. The study population comprised 329 824 women in Sweden and 127 810 women in Norway. Methods Data from the national Medical Birth Registers were used to describe caesarean section rates in three age groups: 30-34 years (reference group); 35-39 years (advanced age group); and ≥40 years (very advanced age group). Logistic regression analyses estimated the risk in each age group over four decades, in each of the two national samples. Results Caesarean delivery decreased from 1973-1979 to 2000-2008 in the two oldest age groups in Sweden (35-39 years, OR = 0.53, 95% CI = 0.50-0.58; ≥40 years, OR = 0.36, 95% CI = 0.30-0.43) and Norway (35-39 years, OR = 0.61, 95% CI = 0.54-0.68; ≥40 years, OR = 0.45, 95% CI = 0.34-0.58), but increased in women aged 30-34 years. The caesarean delivery rate in the two oldest groups peaked in the second half of the 1970s. Regardless of time point, the caesarean delivery rate was always highest in women aged ≥40 years, followed by women aged 35-39 years and lowest in women aged 30-34 years. Conclusions Caesarean delivery in nulliparous women of advanced and very advanced age peaked by end of the 1970s in Sweden and Norway. The subsequent reduction was contemporaneous with the introduction of electronic fetal monitoring and a more consistent use of the partogram, suggesting that more effective surveillance of labour increased the chance of a vaginal birth in these high-risk women. [ABSTRACT FROM AUTHOR]